PURPOSE:To evaluate whether genicular artery embolization (GAE) performed with imipenem/cilastatin (IPM/CS) followed by Lipiodol (IPM/CS+L) is associated with higher clinical success without increased adverse events compared with IPM/CS alone in patients with symptomatic knee osteoarthritis (OA). MATERIALS AND METHODS:This retrospective cohort study included 77 patients (IPM/CS: n=47; IPM/CS+L: n=30) treated between May 2024 and February 2025. Eligible patients had symptomatic OA (Kellgren-Lawrence grades 1-4) and persistent pain (VAS >50 mm). Primary endpoints were longitudinal changes in VAS and WOMAC scores over a 6-month follow-up; secondary endpoints included adverse events and technical/clinical success. Data were analyzed using generalized estimating equations (GEE) adjusted for baseline characteristics. RESULTS:Both groups achieved significant improvements in pain and physical function at 6 months (p < 0.05), with no significant between-group differences in overall clinical success. A significant agent-by-time interaction was observed at 1 month (p = 0.024), indicating a greater early reduction in VAS scores in the IPM/CS+L group; this effect was not sustained at 3 or 6 months. The median number of embolized arteries was lower in the IPM/CS+L group (2 vs. 3, p = 0.040). No severe adverse events occurred, and mild adverse events, including transient skin discoloration, were comparable between groups. CONCLUSION:GAE performed with either IPM/CS alone or a combined IPM/CS+L regimen is safe and provides significant symptomatic relief for knee OA. While Lipiodol offers technical advantages, it does not confer superior long-term clinical efficacy compared to IPM/CS alone.

Purpose: To evaluate the feasibility, technical success, and safety of ultrasound (US)-guided direct thrombolytic injection in patients with acute and early-subacute extremity arterial occlusions. Materials and Methods: This retrospective, single-center study included 24 patients treated between July 2023 and January 2025 for acute (≤14 days) or early-subacute (14-21 days) arterial occlusions (Rutherford I-IIb). Under real-time US guidance, alteplase (2-10 mg total) was injected into the thrombus at 2 to 3 cm intervals using a 27-gauge (40-mm) or, for deeper targets, a 22-gauge (90-mm) needle. Doppler US was performed at 2, 4, and 6 hours to assess recanalization. The primary endpoint was Doppler US-based recanalization category at 6 hours (complete/partial/none) prior to any adjunct endovascular revascularization. Secondary endpoints included adjunct angiography/endovascular procedures, complications, and follow-up primary-assisted and secondary patency at 1, 3, and 6 months. Results: At 6 hours, complete recanalization was observed in 12/24 (50.0%), partial in 4/24 (16.7%), and no recanalization in 8/24 (33.3%). The median alteplase dose was 6 mg (range, 2-10 mg). Diagnostic angiography was performed in 15/24 (62.5%), and adjunct endovascular procedures were performed as indicated. Minor complications occurred in 10/24 (41.7%); no major bleeding or procedure-related mortality occurred. Two patients with Rutherford IIb ischemia and symptom duration >14 days ultimately underwent major amputation after refusing further revascularization. Primary-assisted patency rates were 66.7%, 58.3%, and 41.7%, and secondary patency rates were 87.5%, 79.2%, and 75.0% at 1, 3, and 6 months, respectively. In multivariable ordinal regression, shorter time to alteplase administration was independently associated with a more favorable 6-hour Doppler recanalization category (OR 15.67; 95% CI, 1.88-130.59; p=0.011), with wide confidence intervals indicating limited precision. Conclusions: US-guided direct intrathrombus alteplase injection appears feasible with an acceptable safety profile and provides an early Doppler-defined response in selected patients. Prospective comparative studies are needed to define its role and refine patient selection. Clinical Impact Ultrasound-guided direct intrathrombus alteplase injection is a feasible, minimally invasive option for selected patients with acute and early-subacute arterial occlusions. The innovation is localized, real-time US-targeted delivery of low-dose tPA without catheter placement or prolonged infusion, combined with serial Doppler assessment to guide repeat dosing and timely escalation to angiography and adjunct endovascular therapy when indicated. For clinicians, this provides a practical workflow with close non-ICU monitoring, enabling early identification of residual thrombus, distal embolization, or underlying stenosis. The study also reinforces that shorter symptom duration strongly influences early recanalization.

Diz yaralanmaları, özellikle ön çapraz bağ yırtıkları, menisküs lezyonları ve patellofemoral problemler sporcularda sık görülmekte ve spora dönüş sürecini zorlaştırmaktadır. Güncel yaklaşımlar, yalnızca zaman tabanlı protokollerin yetersiz olduğunu; bunun yerine fiziksel yeterlilik, fonksiyonel kapasite, biyomekanik uyum ve psikolojik hazırlığı içeren kriter bazlı aşamalı modellerin daha güvenli ve etkili olduğunu ortaya koymaktadır. Bu bağlamda, sporcunun performansını en üst düzeye çıkarmak ve yeniden yaralanma riskini azaltmak için biyolojik iyileşme süreci de dikkate alınarak çok boyutlu bir değerlendirme yapılmalıdır.

BACKGROUND:Insertional Achilles tendinopathy may require surgery when nonoperative treatment fails. Flexor hallucis longus (FHL) tendon transfer is used as an adjunct in advanced insertional degeneration. PURPOSE:To compare 1-year outcomes, minimal clinically important difference (MCID) achievement, and complications between FHL transfer with debridement/retrocalcaneal ostectomy and debridement/ostectomy alone. STUDY DESIGN:Retrospective comparative cohort study (indication-based group allocation). METHODS:Thirty consecutive patients treated surgically between 2017 and 2023 were reviewed retrospectively. Preoperative magnetic resonance imaging (MRI) planimetry guided selection: patients with >50% degeneration underwent FHL transfer plus debridement and retrocalcaneal ostectomy (n = 15), whereas patients with ≤50% degeneration underwent debridement and ostectomy alone (n = 15). Outcomes were assessed preoperatively and at 1 year using the Victorian Institute of Sport Assessment-Achilles (VISA-A), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH), Foot and Ankle Ability Measure (FAAM), Foot and Ankle Disability Index (FADI), and visual analog scale (VAS) pain. MCID was calculated using a distribution-based method. RESULTS:Both groups improved significantly at 1 year (all p < 0.05). No between-group differences were observed for VAS, AOFAS-AH, FAAM, or FADI (all p > 0.05). The FHL group had higher postoperative VISA-A scores (65.9 ± 15.3 vs 49.9 ± 19.7; p = 0.031) and higher VISA-A MCID achievement (93.3% vs 66.6%; p = 0.046). Minor wound complications occurred in 4 patients (2/15 in each group). CONCLUSIONS:Both surgical approaches improved pain and function at 1 year. In this indication-based cohort, adding FHL transfer for >50% MRI-defined degeneration was associated with higher Achilles-specific function (VISA-A) without increased wound complications.

Objective: To evaluate the effect of patient positioning on duplex ultrasound (DUS) findings in lower-extremity varicose veins, with particular emphasis on changes in saphenous vein diameter and reflux detection between the supine and standing positions.Methods: This retrospective study included 72 patients involving 126 extremities who underwent DUS for suspected venous insufficiency between January and May 2019. Adult patients with primary varicose veins and no history of venous surgery were included, whereas those with a history of deep vein thrombosis, pregnancy, active skin infection, or significant peripheral arterial disease were excluded. All examinations were performed using a Toshiba Aplio 500 ultrasound system equipped with a 14–7.2 MHz linear-array transducer. DUS examinations were performed by two radiologists, each with more than five years of experience in vascular ultrasonography. Great saphenous vein (GSV) diameters were measured at the saphenofemoral junction and distal thigh, and small saphenous vein (SSV) diameter was measured at the saphenopopliteal junction. Reflux times were assessed in the GSV at the saphenofemoral junction and distal thigh in both positions. Pathological reflux was defined as retrograde flow lasting ≥0.5 s. Statistical analyses were performed using Student’s t-test, the Mann–Whitney U test, and the chi-square or Fisher’s exact test, as appropriate. A p value

Anterior cruciate ligament (ACL) reconstruction improves knee stability but does not fully prevent the development of postoperative osteoarthritis (OA). Most long-term OA outcomes reported in the literature are derived from traditional transtibial reconstruction techniques, which may not adequately reflect the results of contemporary anatomical reconstruction. Therefore, the aim of this study was to compare the long-term development of knee OA following isolated anatomical single bundle and transtibial ACL reconstruction while accounting for potential confounding factors. This study included 48 patients who underwent isolated ACL reconstruction without concomitant meniscal, cartilaginous or additional ligamentous injuries. Participants were classified into anatomical (n = 35) or transtibial (n = 13) reconstruction groups. Radiographic OA was assessed using the Kellgren-Lawrence grading system. Knee muscle torque was evaluated with an isokinetic dynamometer, functional outcomes with the Knee Society Score (KSS), and activity level with the Tegner Activity Score (TAS). Comparisons were performed before and after stratification for age and postoperative duration. Radiographic OA was identified in 29

The objective of this case report is to present a rare case of patellar tendon avulsion at the tibial tubercle in a 12-year-old male patient and describe the surgical treatment and rehabilitation process. A 12-year-old male patient with an otherwise healthy status presented with a rupture of the patellar tendon without bony involvement after sustaining a knee injury during a soccer game. Treatment involved a combination of end-to-end suture, support with anchors, and patellar reinforcement using a cerclage wire, a unique approach not previously documented for the pediatric population. Early range of motion exercises were initiated with the use of a functional knee brace. The patient’s progress was assessed through Lysholm and Kujala Scores, as well as a visual analog scale (VAS) for pain. At the final follow-up, conducted 6 months after the surgery, the patient showed satisfactory knee function, with Lysholm and Kujala scores of 85 and a VAS pain score of 0. Radiographic examinations confirmed the successful healing of the patellar tendon with full range of motion in the knee joint. Patellar tendon avulsion at the tibial tubercle is a rare injury in the pediatric population, requiring early diagnosis and prompt surgical treatment to preserve the extensor mechanism and prevent functional loss. The presented combination of end-to-end suture, cerclage wire reinforcement, and anchor support proved effective in this case. This report contributes valuable insights into the treatment of distal patellar tendon avulsion in pediatric patients and emphasizes the importance of appropriate management of such injuries to ensure optimal recovery and knee function. Further research and prospective studies are warranted to validate the efficacy of this surgical approach in larger cohorts.

Aim: We aimed to assess the quality and reliability of YouTube videos on percutaneous ablation of thyroid nodules (PATN) to evaluate their utility as educational tools for patients and healthcare professionals. Materials and Methods: This cross-sectional study analyzed 76 YouTube videos identified through keyword searches ("percutaneous ablation of thyroid nodules", "thyroid radiofrequency ablation", and "thyroid microwave ablation") on November 10, 2024. Videos were categorized by type (informative, technical, personal experience, and news), duration (≤4 minutes, >4 minutes), upload source (professional healthcare providers, non-professionals, or independent users), and target audience (patients or healthcare professionals). Quality and reliability were assessed using the Journal of the American Medical Association (JAMA) criteria, the Global Quality Score (GQS), and the modified DISCERN (mDISCERN). Statistical analyses, including the Kruskal-Wallis and Spearman correlation tests, were conducted. Results: A total of 76 videos were evaluated. Informative videos scored significantly higher on quality metrics (GQS, 2.85 ± 0.15, p= 0.002; mDISCERN, 2.13 ± 0.16, p= 0.008). Videos >4 minutes demonstrated higher quality scores (p= 0.001). No statistically significant differences in popularity metrics (likes, comments, view rates) were observed across groups (p> 0.05). No significant correlations were found between quality scores (JAMA, GQS, mDISCERN) and popularity metrics (R² = -0.019 to 0.147). Conclusion: While informative and longer videos exhibited higher quality, popularity metrics were not reliable indicators of video quality. These findings highlight the need for healthcare professionals to produce engaging and accurate content for platforms like YouTube to improve public education about PATN.

Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) surgeries are often preferred in individuals with medial knee osteoarthritis (OA). The aim of the study was to compare the functional outcomes of patients with UKA and HTO. Seventy-seven individuals were included in the study, of which 39 individuals had undergone HTO surgery (median age = 58.38 ± 7.99, median body mass index [BMI] = 30.93 ± 3.33 kg/m2) and 38 individuals had undergone UKA surgery (median age = 62.95 ± 7.74 years, median BMI = 30.48 ± 3.57 kg/m2). Pain was evaluated before and after surgery. Pain severity, 6-Minute Walk Test (6MWT), 10-Repetition Sitto-Stand Test (10 × STS), stairs test, Timed Up and Go (TUG), and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were used for functional evaluation. There were no differences in demographic characteristics between groups (p > 0.05). The HTO group had lower postoperative pain (p = 0.043) and KOOS pain subscale scores (p = 0.043), better stairs test (p = 0.041), and 10 × STS results (p = 0.007). There were no significant differences between the groups in terms of the 6MWT, TUG, and KOOS total scores (p > 0.05). The results showed that individuals who underwent HTO surgery experienced less postoperative pain and had better functional levels compared with those who underwent UKA surgery. It shows that good functional performance can be achieved with HTO surgery in early medial compartment OA.

Simple renal cysts are not commonly found in children. They occur in a small percentage of cases, with an incidence of 0.2%-0.5%. These cysts are typically solitary and develop in the renal cortex. Pain, infection, hematuria, hypertension, or obstruction of the collecting system are indications for treatment. When intervention is necessary, there are several ways to reduce cyst volume. In this report, we discuss the pediatric case of a solitary giant renal cyst and its therapeutic approach. We present a symptomatic pediatric renal cyst patient treated with a sclerosing agent. A simple renal cyst is a rare condition in children, and its treatment includes conservative management, percutaneous sclerosing agent injection, and surgical approach. Choosing the appropriate treatment according to the patient's condition and clinical symptoms is essential. We think that sclerotherapy should be the first-line therapy before surgery in symptomatic simple renal cysts.

Aims: Peripheral arterial disease is a significant health problem affecting approximately 50 million people in the United States and Europe, which can lead to disability, limb loss, and poor quality of life. The incidence of cardiovascular disease is 2–3 times higher in patients with peripheral arterial disease. This is the main cause of significant morbidity and mortality. In this study, we aimed to share our early Doppler findings and technical success in patients who underwent endovascular procedures in our clinic. Methods: The radiological findings of patients who applied to our clinic for treatment in the last 6 months were evaluated retrospectively and the results were analyzed with descriptive statistical methods. Results: Patients with peripheral arterial occlusion or sever stenosis treated with endovascular treatment showed significant increase in lower extremity arterial flow evaluated by color Doppler ultrasound regardless of endovascular technique. Conclusion: Endovascular interventional methods for the treatment of lower extremity peripheral arterial disease are a method that provides an increase in lower extremity arterial flow demonstrated by Doppler ultrasonography.

Objectives: This study aimed to compare the functional outcomes of patients undergoing fixed -bearing medial unicompartmental knee arthroplasty (UKA) classified as either varus or neutral based on their postoperative femorotibial angle (FTA), with the goal of evaluating the impact of FTA on functional results. Patients and methods: A total of 38 knees of 35 patients (27 females, 8 males; mean age: 63.6 +/- 7.1 years; range, 52 to 75 years) were included in this retrospective study. The data was collected between December 15, 2020, and January 15, 2021. Patients were categorized into two groups based on their postoperative FTA. The neutral group consisted of patients with an FTA range of 5.1 degrees to 7.4 degrees, while the varus group included patients with an FTA range of 0.1 degrees to 4.8 degrees. Knee Outcome Osteoarthritis Score (KOOS), Visual Analog Scale (VAS) scores, sit to stand test results, and six minute walk test data were analyzed. Results: The mean follow-up was 42.0 +/- 19.3 months. The postoperative VAS score for the varus group was 0.95 +/- 0.99, whereas the neutral group had a VAS score of 2.19 +/- 1.83 (p=0.021). The mean KOOS for the varus group was 88.01 +/- 7.88, whereas the neutral group had a mean KOOS score of 78.46 +/- 13.69 (p=0.006). Conclusion: In patients undergoing UKA, mild varus alignment could yield superior early and midterm functional outcomes compared to a neutral femorotibial angle.

Objective: The aim of this study was to evaluate the diagnosis of sarcopenia by abdominal tomography, prevelance and prognosis in critical patient admitted to intensive care unit(ICU). Methods: It was planned as a retrospective observational study. Patients older than 40 years of age with abdominal tomography who needed to be in the ICU were included. Muscle mass was measured by abdominal tomography. All patients were divided into two groups as sarcopenic and non-sarcopenic according to the measurement results. We compared the prognosis and clinical features of patients with and without sarcopenia. Results: Fifty five(59%) of all patients were found as sarcopenic and 70.8% over 70 years of age. The length of stay in ICU and in hospital were 27.8 ± 29.7 and 33.0 ± 31.2 days in sarcopenic patients, 15.1±17 and 23.8±21.3 days in nonsarcopenic patients respectively(p <0.05). Thirty day mortality was found 49.1% in patients sarcopenic(<0.05). SMI was found lower over aged 70 years(p <0.05). Conclusions: Sarcopenia was associated with the increasing of 30 day mortality, a prolongation in the lenght of stay in ICU and hospital. Therefore, we believe that awareness about sarcopenia will be important in order to shorten the mortality and lenght of stay in ICU.

OBJECTIVES:This study aimed to explore the use of Gerdy's tubercle (GT) as an innovative and dependable anatomical landmark for the proximal tibial cut in total knee arthroplasty (TKA) in cases with extensive knee degeneration.MATERIALS AND METHODS:One hundred dry tibia bones and 10 formalin-fixed cadaveric knee specimens of both sexes were examined. A Zimmer NexGen tibial cutting guide and a Mitutoyo digital caliper were utilized to align the guide with the tibia's mechanical axis. The procedure was replicated on cadaver knees using a standardized medial parapatellar arthrotomy approach. Measurements included the distance from GT superior border to the resection line and the length of the tibia. A radiological study involving magnetic resonance imaging examinations of 48 patients, which were evaluated focusing on the upper border of GT and the least degenerated segment of the posterolateral part of the lateral tibial condyle, was conducted.RESULTS:Anatomical measurements of GT and proximal tibial areas in 110 specimens showed slight but consistent variations with cadaver measurements. Magnetic resonance imaging analysis of 48 patients revealed notable sex differences in the distance between the superior border of GT and the tibia's posterolateral surface. There was also a significant negative correlation between the distance from GT to the posterolateral corner and cartilage thickness.CONCLUSION:Proper alignment in TKA is crucial for success, but identifying an extra-articular landmark for horizontal tibial resection remains challenging, particularly in severely arthritic knees. This study introduces GT as a novel anatomical landmark for TKA, offering a more reliable reference for achieving desired joint levels in knees with significant degenerative changes.

N-butyl cyanoacrylate (NBCA) is commonly used in interventional radiology procedures for its efficacy in vessel occlusion, yet it poses risks of embolic material migration. We present a unique case of NBCA cast migration during deep circumflex iliac artery (DCIA) embolization, leading to occlusion of the dorsalis pedis and posterior tibial arteries, subsequently retrieved using a stent retriever device. A 68-year-old woman with a history of heart valve replacement presented with a large intramuscular hematoma. N-butyl cyanoacrylate embolization of DCIA resulted in cast migration, occluding distal arteries. Retrieval was attempted using a stent retriever device, successfully restoring arterial flow. N-butyl cyanoacrylate use necessitates attention to vascular anatomy and test injections to mitigate complications. Stent retriever devices, originally designed for acute stroke thrombectomy, offer a viable solution for embolic material retrieval in vascular interventions. This case highlights successful NBCA cast retrieval in lower extremity arterial occlusion using a stent retriever device. Prompt recognition and intervention are crucial in mitigating complications associated with NBCA use. Stent retriever devices present a valuable tool for NBCA cast retrieval, preserving arterial perfusion in affected areas. Clinical Impact This case highlights the innovative application of stent retriever devices for retrieving migrated NBCA casts, traditionally used for stroke management in peripheral arterial occlusions. This adaptation offers clinicians a new, effective tool for managing embolization complications, such as unintended material migration that can cause severe ischemia. Implementing this technique could change clinical practice by providing a reliable method to swiftly address and resolve potentially limb-threatening situations, thereby improving patient outcomes and procedural safety. This advancement in interventional radiology enhances clinicians’ ability to handle complex embolic events with greater confidence and efficacy.

Objectives: This study aimed to investigate the relationship between the ratio of stem size to intramedullary canal diameter, stem length, and functional outcome in revision total knee arthroplasty (RTKA) procedures, which remains largely unexplored in the current literature.Patients and methods: A single surgeon series of RTKA procedures performed between October 2014 and November 2022 were included in this case series, and data were analyzed retrospectively. A total of 32 patients (27 females, 5 males; mean age: 73.2 +/- 8.1 years; range, 52 to 88 years) were identified, with a minimum follow-up period of five months and a maximum of eight years. Filtering the patients based on >24 month follow-up, we were left with 13 patients aged between 65 and 88 (mean 74.85 +/- 6,854) years. The latest X-rays of patients were analyzed, and the ratio of intramedullary canal diameter to stem width was calculated for both femur and tibia in both anteroposterior and lateral planes. Household income, preoperative C-reactive protein, erythrocyte sedimentation rate, comorbidities, body mass index, and implant dimensions were also recorded. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF-12) scores, and range of motion (ROM) measurements were used to evaluate functional outcome.Results: A moderate negative relationship between the tibial canal fill ratio (CFR) in anteroposterior views and ROM of the patients was noted. Additionally, a significant positive correlation was found between SF-12 physical score and CFR in lateral view. A moderate level of correlation between femoral CFR in anteroposterior views was also established. Due to insufficient data, joint ROM data did not show normal distribution. Therefore, a cutoff value indicating the relationship between the stem size and knee ROM could not be calculated using receiver operating characteristic analysis. Multiple regression analysis did not yield significant results, suggesting that hypothesized predictor variables were not sufficient to predict the variation in functional scores. Otherwise, no clear statistical importance or correlation between functional scores, such as WOMAC or SF-12, and CFR was found.Conclusion: In conclusion, the findings suggest that other factors, such as other patient characteristics, surgical techniques, or implant designs, may have a more substantial impact on the functional outcomes in RTKA patients.

BACKGROUND:Ultrasonography is widely used in neonatological practice and studies investigating the hemodynamic effects of various treatment protocols or clinical situations. On the other hand, pain causes changes in the cardiovascular system; so, in the case of ultrasonography leading to pain in neonates, it may cause hemodynamic alterations. In this prospective study, we evaluate whether ultrasonographic application causes pain and changes in the hemodynamic system. METHODS:Newborns undergoing ultrasonographic examination were enrolled in the study. Vital signs, cerebral and mesenteric tissue oxygenation (StO2) levels, and middle cerebral artery (MCA) Doppler measurements were recorded, and NPASS scores were calculated before and after ultrasonography. RESULTS:We enrolled 39 patients in the study. After ultrasonography, Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores were significantly higher (p < 0.01), and all vital signs (heart rate, respiratory rate, SpO2, diastolic and systolic blood pressure; p = 0.03; p < 0.01, p < 0.01, p < 0.01, p = 0.02, p = 0.03, respectively) were altered. Cerebral (p = 0.008) and mesenteric (p = 0.039) StO2 levels were significantly lower in the whole study group, MCA end-diastolic velocity decreased (p = 0.02), and the resistive index (p = 0.03) increased in patients whose NPASS score was >7 after ultrasonography. CONCLUSIONS:This study is the first to show that ultrasonography may cause pain in newborn patients, and alters vital signs and hemodynamic parameters. Therefore, precautions should be taken to protect newborn babies from pain during ultrasound applications, as they are already exposed to many noxious stimuli. Furthermore, pain scores should be considered in studies using ultrasonography and evaluating hemodynamic parameters to increase the reliability of the studies.

Wear of metallic surfaces after total knee arthroplasty is uncommon. In this case, we report a catastrophic failure of the knee prosthesis in a 60-year-old male patient who had undergone total knee prosthesis 7 years prior to his admission to our clinic. Genu recurvatum was observed in the affected knee. Surgical exploration of the knee showed wear of the polyethylene insert accompanied by metallic tibial component abrasion of the posterior-cruciate-retaining total knee prosthesis (Maxim, Biomet, Warsaw, IN, USA). Single-stage revision was performed, and a new total knee prosthesis was implanted (Legion, Smith & Nephew, Memphis, TN, USA). Postoperative examination showed improved stability and correction of recurvatum of the affected knee and follow-up examination showed improved weight bearing ability and better overall functional outcome.

BackgroundKnee osteoarthritis (OA) is the most common chronic joint disease and is the main cause of disability and pain. It is important to better understand potentially modifiable risk factors that may reduce disability and pain in advanced knee osteoarthritis.ObjectivesThe aim of this study was to investigate the relationship between knee muscle strength with disability and pain in patients with advanced OA.MethodsTwenty-one patients (66.05 ± 8.02 years, 32.77 ± 5.37 kg/m2) with Kellgren-Lawrence grade III-IV OA were included in this pilot study. Knee flexion and extension muscle strength were measured with Easy Force® isometric pull dynamometer in accordance with the make test procedure. Disability was measured with Knee Injury and Osteoarthritis Outcome Score (KOOS), and pain intensity was measured with VAS and Pain Catastrophizing Scale (PCS).ResultsThe knee flexion strength of the patients was 75.52 ± 29.58 N, and the knee extension strength was 155.42 ± 49.84 N. Knee flexion strength was 17.85 ± 32.06 % and extension strength was 22.60 ± 21.10 % less than the other extremity. The total KOOS scores of the patients were 48.90 ± 24.78 %, PCS scores were 27.58 ± 15.82 and VAS were 8.42 ± 1.69. Flexion muscle strength of patients were moderately correlated with KOOS (r=0.44, p<0.05), but not with PCS and VAS scores. Extension muscle strength of patients was highly correlated with KOOS (r=0.70, p< 0.001), but not with PCS and VAS scores.ConclusionIn advanced knee osteoarthritis, knee extension strength deteriorated more than knee flexion strength. Exercise interventions for knee extension strength training can provide superior outcomes in knee extensor strength and function but not in pain.References[1]Nishigami, T., Tanaka, S., Mibu, A. et al. Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. Sci Rep11, 5835 (2021). [2]Pietrosimone B, Thomas AC, Saliba SA, Ingersoll CD. Association between quadriceps strength and self-reported physical activity in people with knee osteoarthritis. Int J Sports Phys Ther. 2014 May;9(3):320-8.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

A 23-year-old male patient had tetraplegia owing to a spinal cord injury after a traffic accident. In the intensive care unit, a tracheostomy was performed on the patient, who developed massive hemoptysis during follow-up. The patient was taken for urgent bronchoscopic evaluation by the thoracic surgeon, but no intervention could be carried out due to massive bleeding. A computed tomography angiography (CTA) was performed to determine the etiology of the bleeding. The chest CTA revealed that the heart’s four chambers and the arterial and venous vascular systems, including the portal venous system, were completely filled with air (Figures 1a, 1b, and 1c). Additionally, cavitary lesions, consolidation areas, and tree-in-bud appearance were observed in both lung parenchymas, and pneumothorax was detected on the right side. A clotted appearance was observed in the right superior lobar and right main bronchus (Movie). The CTA findings were thought to have developed secondary to a bronchovascular fistula following the rupture of the right apex cavitary lesion and rapid blood-gas exchange with the check valve mechanism of the tracheostomy. The bronchovascular fistula is believed to be related to both the pulmonary artery and venous system due to rapid air embolism and bleeding. Hemoptysis is believed to have originated from the pulmonary arterial system, subsequently leading to air embolism through the pulmonary venous system. Previous literature has documented cases of air embolisms resulting from bronchovascular fistulas and hemoptysis resulting from bronchoarterial fistulas. 1,2 Additionally, there have been reports of air embolisms arising from cavitary lesions of the lungs. 3 Massive