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This article discusses a case report of a successful heart transplant in a child with Titin-related cardiomyopathy and skeletal myopathy. The authors emphasize the importance of considering patients with neuromuscular disorders for cardiac transplantation. The case report demonstrates excellent outcomes in the patient's cardiac function and motor performance after an 8-year follow-up. The article highlights the need for a correct diagnosis to guide transplant teams in understanding the risks and benefits of transplantation for patients with both skeletal and cardiac muscle disease. The prevalence of TTN mutations and their significance in cardiomyopathy and skeletal myopathy is increasing, and this case serves as an example of the success that cardiac transplantation can provide for such patients. [Extracted from the article]

Objective To systematically analyze the literature on the use of platelet-rich plasma (PRP) for intra-articular injections of the knee and its efficacy in the treatment of knee osteoarthritis (OA). Design Systematic literature reviews were conducted in PubMed, Embase, and CINAHL (ie, Cumulative Index to Nursing and Allied Health Literature) on October 30, 2013, using the keywords “platelet-rich plasma” and “knee” and “osteoarthritis.” Inclusion criteria included (1) studies with human subjects, (2) prospective clinical studies (including either clinical trials or observational studies), and (3) full-text articles published in English. Exclusion criteria were: (1) animal studies; (2) retrospective studies; (3) patients with previous surgical intervention with total knee arthroplasty or reconstruction of the anterior cruciate ligaments; and (4) articles not published in English Results A total of 319 abstracts and titles were reviewed (60 from PubMed, 250 from Embase, and 9 from CINAHL). A total of 8 relevant journal articles were identified, all of which were published between 2010 and 2013. One-half of the studies were prospective observational studies that included only PRP treatment; the rest were prospective comparative studies including both PRP and controls—2 were randomized controlled trials. Of the 4 comparative studies, 3 compared PRP with hyaluronic acid, which was considered as a commonly used effective treatment for knee OA; the other one used saline injection (ie, placebo) as the control. Although most of the analyses suffered from small sample size and was thus inconclusive, the findings consistently indicated that PRP might have better outcomes in patients with a lesser degree of degeneration and in younger patients. Conclusion PRP intra-articular injections of the knee may be an effective alternative treatment for knee OA. However, current studies are at best inconclusive regarding the efficacy of the PRP treatment. A large, multicenter randomized trial study is needed to further assess the efficacy of PRP treatment for patients with knee OA. [ABSTRACT FROM AUTHOR]

Pareidolia is the human tendency to "see", imagine, or perceive an alternative image that resembles the image that is actually displayed.1 Examples include "seeing" faces and other familiar images when looking at clouds or other stimuli. The appearance of a collar or break in the neck of the Scotty Dog helps us to diagnose a par interarticularis fracture in the human patient.1 Now we present a new example of pareidolia/patternicity in medical imaging, which is the face-like appearance seen in magnetic resonance imaging (MRI) and computed tomography (CT) scans of the sacrum on axial views. [Extracted from the article]

A new technique for performing nerve blocks of the ganglion impar (ganglion Walther) is presented. These injections have been reported to relieve coccydynia (tailbone pain), as well as other malignant and nonmalignant pelvic pain syndromes. A variety of techniques have been previously described for blocking this sympathetic nerve ganglion, which is located in the retrorectal space just anterior to the upper coccygeal segments. Prior techniques have included approaches through the anococcygeal ligament, through the sacrococcygeal joint, and through intracoccygeal joint spaces. This article presents a new, paracoccygeal approach whereby the needle is inserted alongside the coccyx and the needle is guided through three discrete steps with a rotating or corkscrew trajectory. Compared with some of the previously published techniques, this paracoccygeal corkscrew approach has multiple potential benefits, including ease of fluoroscopic guidance using the lateral view, ability to easily use a stylet for the spinal needle, and use of a shorter, thinner needle. While no single technique works best for all patients and each technique has potential advantages and disadvantages, this new technique adds to the available options. [ABSTRACT FROM AUTHOR]

Piriformis syndrome (PS) is an uncommon cause of sciatica that involves buttock pain referred to the leg. Diagnosis is often difficult, and it is one of exclusion due to few validated and standardized diagnostic tests. Treatment for PS has historically focused on stretching and physical therapy modalities, with refractory patients also receiving anesthetic and corticosteroid injections into the piriformis muscle origin, belly, muscle sheath, or sciatic nerve sheath. Recently, the use of botulinum toxin (BTX) to treat PS has gained popularity. Its use is aimed at relieving sciatic nerve compression and inherent muscle pain from a tight piriformis. BTX is being used increasingly for myofascial pain syndromes, and some studies have demonstrated superior efficacy to corticosteroid injection. The success of BTX in treating PS supports the prevailing pathoanatomic etiology of the condition and suggests a promising future for BTX in the treatment of other myofascial pain syndromes. Muscle Nerve, 2009 [ABSTRACT FROM AUTHOR]

Background Medical educators use a variety of strategies to help medical students and resident doctors understand and remember complex topics. Methods One teaching tool is matching up radiographic appearances with unrelated, common, non-medical images, in order to help students easily recognise clinical patterns. Discussion However, even among medical educators who use this approach, many are not aware of the neuropsychiatric phenomenon they are using, known as pareidolia. We will describe pareidolia (a form of patternicity) and give two examples of its use in the clinical teaching of musculoskeletal imaging abnormalities: the winking owl and the Scottie dog. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Long-term Survivor with X-Linked Myotubular Myopathy," by B. Sustersic and D. Neubauer in the 2005 issue of the journal.