Introduction: The debate regarding the description on classification and nomenclature of the injury which includes olecranon fracture associated with radial neck fractures in children is ongoing. We report two pediatric cases that could not be classified in a Monteggia-equivalents system and were treated with open reduction and k-wire fixation. The aim of this study was to perform a systematic review regarding pediatric radial neck fractures associated with olecranon fractures and presentation of two pediatric cases of olecranon fractures associated with radial neck fractures with radiocapitellar dislocation.Case Presentation: Two boys, aged 7 and 12, came to two separate clinics on the same day after initial injury. On physical examination, the patients’ elbow range of motion was limited and painful. Their upper extremities were intact. Radiographs revealed the radial neck fracture with prominent ANTEROLATERAL radiocapitellar dislocation of radial head-associated with non-displaced olecranon fracture. Radial neck fracture was reduced easily by pushing posteromedially manually with the finger and secured with two K-wires. The olecranon fracture was visualized and confirmed that it was non-displaced and secured with two k-wires in the first case and one k-wire in the second case. After 2 months of follow-up, both patients had no pain in their elbow and a full functionality with a full range of motion of the elbow. The posterior intraosseous nerve functions were normal.Conclusions: The fracture of olecranon if it does not extend into the metaphyseal region; it could not fascilitate diastasis of the proximal radioulnar joint and radial head dislocation. So this type of fracture must not be addressed as a Monteggia-fracture dislocation.The description of radioulnar diastasis must be included when this type of injury is to be classified.

Introduction & Background: Only 12 years ago the first report on pachymeningeal gadolinium enhance-men in low-pressure headaches appeared in the lit-erasure. Intracranial hypotension is a result of low CSF volume caused by either spontaneous or postoperative leakage. The syndrome has been reported to occur after head trauma, a tear in a spinal nerve root sheath, per neural cyst, or spinal arachnoids diverticulum. Iatrogenic causes include lumbar puncture or overtraining ventricular or spinal shunts. Spontaneous intracranial hypotension is thought to result from rupture of a spinal arachnoids membrane that allows CSF passage into the subdural or epidural space. It is typically not attributable to a major traumatic event or prior diagnostic or therapeutic intervention; however, intracranial hypotension may be associated with a history of minor trauma such as sports activities or severe coughing. Diffuse pachymeningeal enhancement is thought to reflect the Monroe-Kellie rule, which describes the inverse relationship of CSF volume and intracranial blood volume within the rigid confines of the skull. This reflex mechanism protects nervous tissue by maintaining a constant buffer (i.e., blood or CSF) subjacent to its bony covering. Though this principle was described for intracranial processes and helps to explain the reason for intracranial pachymeningeal enhancement, it can also be applied to the bony spinal canal. Explaining pachymeningeal enhancement in the spine becomes more difficult because the hyper vascular outer dural layer covering the brain does not extend to cover the spine, and the single layer of durra that does cover the spine is relatively vascular. Perhaps reports of pachymeningeal enhancement along the spinal canal in intracranial hypotension more accurately reflect prominent epidural venous engorgement. In all cases of intracranial hypotension reported in the literature, patients presented with headaches. These headaches are typically generalized and pulsating, and often resolve with recumbence. Other clinical features may include nausea or emesis, diploid, neck pain, disturbance in hearing, vertigo, photophobia, and visual deficits. CSF pressures have reportedly been low, normal, or even high. CSF examination may be normal, or may reveal xanthocromia, lymphocytic pleocytosis, or increased protein possibly secondary to dural venous engorgement. With few exceptions, intracranial MR imaging of intracranial hypotension reveals diffuse pachymeningeal enhancement. Subdural fluid collections and brain descent, as measured by inferior displacement of the tier relative to the incisures line, may also be seen. Pachymeningeal enhancement is characteristically thick, smooth, and uninterrupted. The enhancement is thought to result from accumulation of gadolinium-based contrast material in engorged Dural veins and in the interstitial of the durra. More et al reported subdural fluid collections that were mostly bilateral and without mass effect in 69% of patients with intracranial hypotension. The authors also described imaging evidence of brain or brain-stem descent in 62% of patients in their series. Ventricular size in subjects with intracranial hypotension is usually small (1), but can reverse after treatment of the CSF leakage. In the relatively few reports in the literature of spinal imaging findings of intracranial hypotension, MR images showed extramural fluid collections and pachymeningeal enhancement (1, 4 “6). MR images may also depict the site of CSF leakage in the spine (1). Herein, we described a case of intracranial hypotension with symmetric bulky epidural enhancement seen along the ANTEROLATERAL borders of the cervical spine. This enhancement was compatible with engorged epidural venous structures based on their characteristic location in the ANTEROLATERAL spinal canal and sparing of the midline. Renowned et al (6) described a single case of intracranial hypotension with epidural venous engorgement in the region of the caudal equine, and Rabin et al (4) described another case of intracranial hypotension with prominent flow voids within the ventral epidural space near the midline of the upper thoracic spine adjacent to a ventral extramural fluid collection. Treatment of intracranial hypotension varies, depending on its origin and type. If intracranial hypotension is the result of a shunt procedure or surgery, then treatment is usually surgical. Spontaneous intracranial hypotension is often treated first with conservative management, and if this is not effective, an epidural blood patch is used. Surgical correction may be required when all other measures have failed, especially if a Dural tear or other meningeal defect has been demonstrated. In addition to the correction of meningeal defects, surgical drainage of subdural hematomas, a frequent complication of ICH, also may be necessary. 

Background and Aim: The aim of this study was to compare knee functional ability and static and dynamic postural control in healthy female handball players and female handball players with patellofemoral pain.Materials and Methods: This non-experimental and case-control study included 25 female handball players with PFP syndrome and 25 healthy female handball players. WOMAC scale and universal goniometer were used for assessment of knee function and range of motion of the knee joint. We used Sharpend Romberg and SEBT tests for measurement of static and dynamic postural control. Using SPSS version 21, data were analyzed by kolmogorov-Smirnov and independent t –tests. p£0.05 was considered significant.Results: Knee function was significantly weaker in the patients with PFP than the healthy control group (P=0.001). In PFP group, flexion range of motion was significantly more (P=0.002) and extension range of motion (P=0.005), static postural control (P=0.001) and dynamic postural control in posterior (P=0.002), posterolateral (P=0.001), lateral (P=0.001) and ANTEROLATERAL (P=0.006) directions were significantly less than those in the healthy subjects. But, there were no significant differences between the two groups in relation to dynamic postural control in anterior, anteromedial, medial and posteromedial directions (P>0.05).Conclusion: Negative changes in knee functional ability and static postural control and dynamic postural control in lateral and posterior directions in the women with PFP, can be attributed to weakness and atrophy of the knee anteromedial muscles or stiffness of the knee poster olateral muscles. Hence, in rehabilitation of PFP patients, the strengthening of the anteromedial muscles and stretching of the posterolateral muscles of the knee should be considered essential.

Introduction: The Valvular mechanism and associated intra-articular lesions has shifted therapeutic approach for Baker's cyst towards arthroscopic technique.Objectives: The aims of this study include determining the frequency of accompanying intra-articular lesions as well as comparing the outcomes of treating popliteal cyst with arthroscopy and open surgery.Materials and Methods: This is a prospective study on 45 patients referred with symptoms of pain, swelling, and limited range of motion in knees and underwent arthroscopy with a diagnosis of Baker's cyst confirmed by clinical examination and sonography. The accompanying intra-articular lesions were documented and treated and, whenever possible, the cyst's valve was removed ( 26 cases). Otherwise, the cyst would be excised by open surgery (19 cases). On arthroscopy, we used the ANTEROLATERAL and anteromedial portals to treat accompanying lesions, and the additional posteromedial portal for removing cyst's valve. We recorded and analyzed the patients' demographic characteristics, associated lesions and rate of reduction of symptoms (using Rauschning and Lindgren scale) before and three months after surgery. One year after surgery, recurrence was studied through sonography.Results: The arthroscopic group consisted of 11 women and 15 men (mean age: 48.27±8.27years) and 8 women and 11 men (mean age: 48.63±9.15 years) were in open surgery group. They all had at least one intra-articular lesion. The most frequent associated lesion wa s medial meniscus tear (75.6%), followed by sinovitis and chondral lesions. In both groups, the patients recovered considerably after three months (p<0.0001), in both modes of therapy symptoms were reduced almost equally (P=0.74) and no case of recurrence after one year was found.Conclusion: The results suggest that arthroscopic treatment of intra-articular pathologies may result in lower rate of recurrence for popliteal cyst. In case the valve is found and removed and the cyst is extracted through its entry into the knee, it is then not necessary to excise the cyst by open surgery.

Introduction: Patellofemoral pain syndrome (PFPS) is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome.Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT (Star Excursion Balance Test) before and after application of patellar taping. The severity of pain was measured by VAS (Visual Analog Scale).Results: The results of variance analysis by VAS (p<0.008) in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and ANTEROLATERAL directions (p<0.05).Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance) of female athletes with patellofemoral pain syndrome after patellar taping.

Background and Aim: Anterior cruciate ligament injury is a common knee problem that could affect balance. The purpose of this study was to investigate whether the additional sensory information could improve dynamic balance in individuals with anterior cruciate ligament (ACL) injury in comparison with healthy adults.Materials and Methods: 15 young patients with unilateral anterior cruciate ligament injury (mean age 28.9±4.7, male) and 15 healthy volunteers (mean age 26.1±3.8, male) participated in this study. Participants were completed the star excursion balance test under two sensory conditions: with and without using light touch. The force sensor that was placed on the light touch device transferred the sensory informations from index finger to the microprocessor and proper feedback was produced.Results: The results showed significant differences after using light touch in anterior cruciate ligament deficiency patients in compared with control group in these directions : medial, posterior, lateral, ANTEROLATERAL, Poster olateral and posteromedial (P=0.001).There was also significant differences between the patients and healthy controls in posterior (P=0.005),lateral(P=0.004) and medial(P=0.003) directions.Conclusion: Based on these results, we suggest that the reduction in dynamic test in patients with anterior cruciate ligament deficiency would be due to the reduction of sensory information provided by this ligament, but when sensory information is enhanced, dynamic performance improves. The results have implications for a new method to improve stability in these patients.

Introduction: In cases with lacrimal gland mixed tumor preoperative delicate clinical and radiological diagnosis lead to proper surgical approach. Incomplete resection of lacrimal gland mixed tumor may be complicated by severe tumor recurrence with the risk of malignant transformation. In this case report, we present 39 years old man with history of transcranial excision of lacrimal gland tumor. Six months before admission progressive proptosis and inferomedial displacement of right globe (approximately 3 cm) has been developed. Soft tissue hypertrophy of eyelids and corneal leukoma developed due to the chronic progressive course of proptosis with chronic corneal exposure. The other case also was a 38-year-old man with significant proptosis and history of two time lacrimal gland tumor excision, one from transcranial approach. The surgical procedure was performed in both cases through ANTEROLATERAL orbitotomy without bone removal and the whole lesions were removed with pseudo capsule. The vision of the first patient improved from hand motion preoperatively to one meter finger count after surgery, and there was no recurrence in both cases 6 months postoperatively. In general, regarding risk of malignant degeneration and recurrence after incomplete excision or incisional biopsy of lacrimal gland mixed tumor, it is strongly recommended to perform complete excision with psudocapsule in the first surgery.

Objective: Fetal cells enter the maternal circulation during all pregnancies. They may persist in maternal blood and tissues for decades, creating a state of physiologic microchimerism. We hypothesize that fetal stem cells may be associated with a maternal response to cardiac injury. This may even represent a mechanism that contributes to cardiac recovery in Peripartum Cardiomyopathy.Materials and Methods: In order to examine whether fetal stem cells cross the placenta and participate in cardiac repair in the maternal heart, we created a mouse model of cardiac injury during pregnancy. We crossed wild-type B6CBA female mice (age 3-6 months) with male GFP transgenic mice. The female mice then underwent ligation of the left-anterior descending (LAD) artery in order to induce an ANTEROLATERAL myocardial infarction (MI) at gestation day 12. Approximately 50% of the embryos were GFP-positive. 13 experimental females underwent infarction; 9 female pregnant controls did not undergo surgery. Post-partum females were sacrificed at 1 week post-MI (8 experimental, 4 control) or 2 weeks post-MI (5 experimental, 5 control). Genomic DNA was extracted from each total heart. Using primers designed to amplify GFP and an internal control gene, ApoB, real time PCR was done in triplicate. The DDCt method was used to calculate the relative quantity of GFP in experimental hearts compared to controls. Unpaired t-test was used to evaluate the DCt values generated from the PCR reactions.Results: Experimental hearts harvested at 1 week post-MI contained 4.1 times more GFP than controls (p=0.0477). Experimental hearts harvested 2 weeks post-MI contained 3.9 times more GFP than controls (p=0.0312). In a separate group of experimental and control mice, immunofluorescence analysis with confocal microscopy was utilized to detect GFPpositive cells in ventricular tissue sections of maternal hearts. GFP-positive cells were noted only in infarct zones of experimental maternal hearts at 1, 2, and 3 weeks post-MI. Further analysis of ventricular sections at 2 weeks and 3 weeks post-MI indicate co-expression of GFP and the cardiac markers alphasarcomeric actin and troponin, the vascular markers alpha smooth muscle actin and alpha smooth muscle MHC, and the endothelial marker PECAM. GFP positive fetal cells were isolated from the injured maternal hearts at various time points post-injury. When plated on mesenchymal feeder layers, the GFP positive cells form vascular structures and the expression of PECAM and Smooth muscle cell actin can be detected. Isolated GFP positive fetal cells differentiate into beating cardiomyocytes when cocultured with neonatal murine cardiomyocytes and express the cardiac markers alpha-sarcomeric actin and troponin.Conclusion: These data indicate that fetal cells home to the injured maternal heart and differentiate into cardiomyocytes, smooth muscle cells and endothelial cells. Furthermore, these differentiation pathways are recapitulated in vitro thus implicating fetal maternal stem cell transfer as an important mechanism in the maternal response to myocardial injury.

Objective(s): Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer.Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion.Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and ANTEROLATERAL (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction.Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome.