Hacettepe University Medical School is a medical school located at Hacettepe University Medical Center in Ankara, Turkey.
Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder in which bone is the commonly affected organ system. While treatment for its symptomatic bone lesions varies, modern minimally invasive techniques show significant advantages over traditional approaches. Conventional therapies present notable limitations. Curettage, while frequently used, is associated with local recurrence. The efficacy of intralesional corticosteroid injections remains uncertain, especially for lesions in the extremities or pelvis. Although effective, low-dose radiation therapy carries long-term risks and is reserved for specific cases. Systemic chemotherapy, the standard for multifocal disease, is associated with toxicity and high relapse rates. Radiofrequency ablation (RFA) has emerged as a superior alternative that fills this therapeutic gap. RFA is a minimally invasive procedure that uses targeted heat (60–100°C) to destroy tumor cells with curative intent. Validating prior case reports, our recent study of ten patients confirmed that RFA provides complete pain relief with no residual disease or recurrence on follow-up MRI. Importantly, no significant complications were observed in our cohort or have been reported in the literature for LCH patients treated with RFA. In conclusion, RFA offers a safe, rapid, and durable solution for painful LCH lesions. It should be considered a primary curative treatment for symptomatic LCH of the bone, avoiding the risks of more invasive procedures and systemic therapies.
BACKGROUND:Existing literature on slap fighting is restricted to frequency and the distribution of visible signs of possible concussion. This study examines possible concussions and their assessments in male slap fighting. METHODS:All male slap fights conducted between January 2023 and August 2025 were reviewed using video analysis and coded independently by two investigators with a focus on visible signs of possible concussion, referee and ringside physician assessments. RESULTS:A total of 231 possible concussions were identified across 164 fights and 766 slaps (a mean of 1.4/fight and 0.3/slap). Overall, 558 visible signs were observed i.e. most commonly being motor incoordination (n = 224, 40.1%). Of the 231 possible concussions, 223 were assessed by the referee; 124 (55.6%) resulted in continuation of the fight, of which 113 (91.1%) presented with one or two visible signs. Eleven possible concussions were assessed by the ringside physician and 45.5% resulted in the fight's continuation. Both referee and ringside physician assessments were brief (16.9 ± 11.1 and 15.8 ± 11.2 seconds, respectively). CONCLUSION:Findings underscore the need for referees and ringside physicians to receive structured training in identifying visible concussion signs-particularly motor incoordination-and to ensure that all suspected cases are referred for medical assessment and withheld from continuing competition.
Intra-articular corticosteroid injection is a standard treatment for adhesive capsulitis and is commonly performed via the rotator interval or posterior glenohumeral approaches, with prior evidence favoring the former. Injectate distribution varies by technique. Additionally, a dual-target approach combining rotator interval and subdeltoid bursal injections has been proposed for subacromial impingement. This study compared dye distribution among rotator interval, dual-target, and posterior glenohumeral injection techniques. This cadaveric study evaluated dye spread in 18 shoulders from nine embalmed cadavers. Three ultrasound-guided techniques were assessed: rotator interval injection (15 mL), dual-target injection (10 mL rotator interval + 5 mL subdeltoid bursa), and posterior glenohumeral injection (15 mL). Following the injection, systematic dissection was performed. Staining of the subdeltoid bursa, long head of the biceps tendon sheath, anterior glenohumeral capsule, and posterior glenohumeral capsule was graded as absent, partial, or extensive. Extensive staining of the biceps tendon sheath and anterior glenohumeral capsule was observed in all shoulders receiving rotator interval or dual-target injections, whereas posterior glenohumeral injections showed inconsistent coverage of these structures. Reliable subdeltoid bursal infiltration occurred only in the dual-target group (5/6 shoulders). The posterior glenohumeral capsule was most consistently and extensively stained following posterior glenohumeral injection (6/6), with moderate coverage in the rotator interval and dual-target groups. Infraspinatus infiltration was uncommon and observed only after posterior glenohumeral injection. The injection technique markedly influences shoulder injectate distribution. Rotator interval and dual-target approaches preferentially address anterior structures, the dual-target technique ensures subdeltoid bursal coverage, and the posterior approach most consistently infiltrates the posterior glenohumeral capsule. Technique selection should be guided by the predominant pathological target in adhesive capsulitis and related disorders. Dual-target and rotator interval approaches reliably infiltrate the anterior capsule, making them suitable for adhesive capsulitis with biceps long head pathology, whereas the posterior glenohumeral approach primarily covers the posterior capsule and is less suitable for concomitant anterior shoulder disorders.
