Tülay Tiftik

Although minor apical extrusion of calcium silicate-based sealers is relatively common, massive extrusion into the maxillary sinus is rare and may lead to severe complications when vital anatomical structures are involved. This case is notable for presenting palatal bone necrosis associated with calcium silicate-based sealer extrusion into the maxillary sinus in an adolescent, requiring staged surgical management. A 14-year-old female was referred one week after root canal treatment with severe spontaneous pain, palatal bone exposure, swelling, and purulent discharge. Radiographic and cone-beam computed tomography examinations revealed extensive extrusion of calcium silicate-based sealer into the maxillary sinus. Initial medical management included antibiotics, chlorhexidine mouthwash, saline irrigation, and analgesics. After symptomatic improvement, necrotic palatal bone was removed via local debridement. A lateral window sinus surgery was subsequently performed to eliminate the extruded material and associated granulation tissue while preserving the Schneiderian membrane. Two months later, nonsurgical endodontic retreatment was completed. Follow-up imaging demonstrated gradual resorption of the residual sealer and complete symptom resolution. Within the limitations of this case report, it can be concluded that massive extrusion of calcium silicate-based sealers-despite their recognized biocompatibility-may cause destructive complications when displaced into the maxillary sinus. Early diagnosis, appropriate surgical intervention, and careful endodontic retreatment are essential for successful outcomes. Preventive measures, including accurate working-length determination and controlled obturation pressure, remain critical to avoiding such adverse events.

Summary As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times. Introduction As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women. Methods Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed. Results Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP. Conclusion Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Objective: To compare isokinetic muscle performances of a proximal (hip) and a distal (ankle) muscle of fibromyalgia syndrome (FMS) patients with those of age‐ and body mass index (BMI)‐matched healthy subjects.Methods: Thirty female patients with FMS (mean age: 41.5 ± 6.7 years [range, 27–54]) and 30 age‐ (mean age: 40.6 ± 6.0 years [range, 27–54]) and BMI‐matched female healthy controls were consecutively enrolled. Demographic and clinical characteristics of the subjects were recorded. Isokinetic measurements of hip and ankle flexion and extension at angular velocities of 60°/s and 180°/s, peak torques, flexor‐extensor torque ratios, muscle fatigue resistance values and average power were obtained.Results: Mean disease duration of FMS patients was 2.4 ± 1.9 years. Mean weight, height and BMI values were 70.4 ± 12.5 kg, 159.5 ± 6.0 cm and 27.7 ± 4.7 kg/m² (FMS patients) and 69.3 ± 10.1 kg, 161.7 ± 6.2 cm and 26.6 ± 4.3 kg/m² (control subjects), respectively (all P > 0.05). All isokinetic values were statistically decreased in the FMS group when compared with the control group, except for the peak torques at angular velocity of 180°/s on flexion of the hip and extension of the ankle and the total work and average power on extension of the ankle. We did not find any correlation between isokinetic values and disease related parameters of FMS patients.Conclusions: In the light of our results, we may conclude that muscle strength and muscle fatigue seem to decrease in FMS patients' both proximal and distal lower extremity muscles.

A 60-yr-old woman reported severe pain in the proximal part of her left forearm. The pain was also radiating toward the median nerve-innervated areas of the arm, especially during elbow flexion. Ultrasonographic imaging showed a well defined ganglion cyst around the distal biceps tendon close to the median nerve. Under ultrasound guidance, the cyst was aspirated and corticosteroid injection was performed. The patient's complaint improved 1 wk after the injection, and she started to flex her elbow without any pain. This case highlights the role of ultrasonography as a useful adjunctive tool not only to morphologically confirm a peripheral nerve entrapment but also to uncover the possible underlying etiology and to guide precisely during an intervention.

Objective: To evaluate the possible risk factors of heterotopic ossification (HO) in traumatic brain injury (TBI) patients. Methods: A total of 151 patients with TBI were included. Demographical variables, laboratory investigations and risk factors for HO including spasticity, walking ability (using Functional Ambulation Category (FAC)), pressure ulcer, neurogenic bladder and systemic infection were recorded. Results: Fifty-six patients (37.1%) had HO. Time since injury and serum ALP and ESR levels were significantly higher in HO patients than in non-HO patients. Hip (73.2%) and knee (44.6%) were the most commonly involved joints. This study has detected significant associations between FAC scores (FAC 0-1-2 vs. FAC 3-4-5, p < 0.001), degree of spasticity (p = 0.01), pressure ulcer (Absent/Grade 1 vs. Grade 2, 3 and 4, p = 0.001), presence of neurogenic bladder (p < 0.001) and systemic infection (p = 0.002) with the development of HO. According to the final logistical regression analysis, only lower FAC score was independently associated with HO development (p = 0.006). Conclusion: As lower scores of FAC is an independent risk factor for HO formation and is related to the severity and consequences of injury, ambulation and regular/cautious mobilization of the joints are of paramount importance in the early period of the rehabilitation in TBI patients.

Design: A cross-sectional study. Objective: To assess the effects of pain on quality of life (QoL), functional independence and depression in patients with spinal cord injury (SCI). Setting: An inpatient rehabilitation center. Methods: A total of 140 patients (104 M, 36 F) with SCI who underwent inpatient rehabilitation treatment were examined. A questionnaire including clinical variables was applied. Motor score of Functional Independence Measure was used to assess daily-life activities, the 36-Item Medical Outcomes Short-Form Health (SF-36) for QoL and Beck Depression Inventory (BDI) for depression. Patients were then divided into those having chronic pain (Group I) and those without any pain (Group II), and groups were compared according to demographic and clinical variables. Results: The most common causes of SCI were falls (35.0%) and motor vehicle accidents (34.2%). Chronic pain was present in 78% of patients. Patients employed before injury and patients who had complete injury had lower Numerical Rating Scale scores (PPP<0.05) when compared with Group II. Conclusion: As mood and QoL are negatively affected with pain in SCI patients, we suggest that chronic pain should always be treated in a multidisciplinary setting where pharmacological, physical and psychological therapies are combined.