Comparison of physical examination findings and evaluation of pain between two groups of chronic low back pain patients with and without psychiatric disorders

Bu çalışmada kronik bel ağrısı nedeniyle bel okuluna alınan ve istanbul Tıp Fakültesi Liyezon Psikiyatri Birimi tarafından da değerlendirilen hastalardan psikiyatrik tanı alanlar ile psikiyatrik tanı almayanlarda fizik muayene bulguları, ağrı ve ağrı şiddeti değerleri karşılaştırmıştır ve psikiyatrik tanıların dağılımı belirlenmiştir. Çalışmaya mekanik kaynaklı kronik bel ağrısı olan 68 hasta alınmıştır. Hastalar Bel Okulu uygulama grubu tarafından ağrı (yok, hafif, orta, şiddetli, dayanılmaz), ağrı şiddeti (VAS), lomber schober (cm), düz bacak kaldırma testi (DBKT), el-yer mesafesi (cm) yönünden, Liyezon-Psikiyatri Birimi tarafından da psikiyatri muayeneleri (DSM Ill-Rtanı ölçütleri) yapılarak değerlendirilmişlerdir. Hastaların % 80.9'unun psikiyatrik tanı aldığı, % 19.1'inin ise psikiyatrik tanı almadığı belirlenmiştir. Psikiyatrik tanı alanların % 27.3'ünde fiziksel hastalığa eşlik eden anksiyeteli uyum güçlüğü, % 18.2'sinde distimik bozukluğu, % 14.5'inde yaygınlaşmış anksiyete bozukluk görülmüştür. Psikiyatrik tanı alan hastalar ile tanı almayan hastalar arasında fizik muayene bulguları açısından anlamlı bir fark olmamasına rağmen, psikiyatrik tanı alan hastalarda tanı almayanlara göre ağrı ve ağrı şiddetinin anlamlı şekilde daha fazla olduğu saptanmıştır(p<0.001). Anksiyete ve depresyona ait semptomlar sıklıkla ağrı şeklinde algılanabilirler ve genellikle kronik ağrılı tablonun major komponentleridirler. Çalışmamızda da anksiyetesi ve depresyonu olan hastalarda ağrı yakınmasının daha fazla olduğu görülmüştür, Bu nedenle kronik bel ağrılı hastaların tedavisi için Liyezon-Psikiyatri birimi ile iş birliği yapılmasının yararlı olduğu kanısındayız.COMPARISON OF PHYSICAL EXAMINATION FINDINGS AND EVALUATION OF PAIN BETWEEN TWO GROUPS OF CHRONIC LOW BACK PAIN PATIENTS WITH AND WITHOUT PSYCHIATRIC DISORDERS. This is a comperative study in chronic low back pain patients (CLBP) who had Back School training and evaluates physical findings, pain and pain intensity between two groups with and without additive psychiatric disorder diagnosed in the Department of Liason Psychiatry of Istanbul Medical Faculty. 68 patients with CLBP of mechanical origin were enrolled in the study and evaluated for pain by verbal reports of none, mild, moderate, intense and unbearable pain. Pain intensity was evaluated by VAS, lumbar flexibility by Schober, straight leg rasising test (SLRT), and finger tip to floor distance. All patients were also examined by the Liaison Psychiatry Department and evaluated by the DSM Ill-R diagnostic criteria. 80.9 % of our patients were diagnosed as having a psychiatric disorder while 19.1 % had no psychiatric disorder while 19.1 % had no psychiatric disorder. Compliance difficulty with anxiety was diagnosed in 27.3 % dysthymic disorder in 18,2 % and generalized anxiety disorder in 14.5 %. No significant difference in physical findings was found between two groups while there was significant difference in verbal pain report and pain intensity between those with and without psychiatric diagnosis (p&lt;0.001). It is well known that symptoms of anxiety and depression can often be perceived as pain so that depression and anxiety are usually major components of the clinical picture of chronic pain. This study shows a higher pain intensity and verbal reporting of pain in patients with anxiety and depression. We believe a mutual approach of Liaison Psychiatry and Physical Medicine and Rehabilitation teams in the rehabilitation of CLBP patients can be very beneficial

Mycobacterial flora of the skin in leprosy

Attempts were made to investigate mycobacteria other than Mycobacterium tuberculosis on the hands and in biopsy specimens of fifty leprosy patients receiving treatment at the center for Leprosy at &Uuml;stanbul Medical School, who were under control for reaction, who were maintained for their lesions or who were hospitalized for non-leprosy reasons. The same investigation was also performed on the hands of fifty healthy subjects who were selected randomly as control group. On the hands of one male subject wtih lepromatous leprosy (2%) mycobacteria other than Mycobacterium tuberculosis was cultivated, whereas these bacteria were not recovered in the control group. Results were not considered to be statistically significant

Decompression, spinal distraction and fusion in nerve root compression due to Paget's disease

Ağrı ve kas zaafına yol açan kök basısı bulunan Paget hastalıklı bir olgu sunularak manyetik rezonans görüntüleri ve tedavi yöntemleri üzerinde durulmuştur. Paget hastalığındaki kontrolsüz ve fazla kemikleşme, manyetik rezonans görüntülemede kortikal bölgede kalınlaşma olarak görülür. Omur cismi yayvanlaşmıştır. İlik dokusu azalmış ve bağ dokusuyla bölünmüştür. Muhtemelen artmış dolaşım ve venöz göllenmeye bağlı olarak kontrast madde tutar. Paget hastalıklı omur nöral dokuya bası yaparsa cerrahi serbestleştirme yapılabilir. Hastamızda hem tanıyı doğrulamak hem de kökü serbestleştirmek için hemilaminektomi ve foraminotomi yapıldı. Ayrıca pedikül vidası yardımıyla omurga gerilerek köklerin daha da rahatlaması sağlandı ve füzyon uygulandı. Omurganın gerilmesinin kanalı genişlettiği bilinmektedir. İç sabitleyiciyle germe ve arka elemanlara füzyon işlemi hastalıklı ön ve orta kolonlara binecek yükü azaltarak çökme ve yayvanlaşmanın önüne geçecektir. Paget hastalığında artmış osteoblastik aktiviteyle hiperostoz ile blok omurgaya eğilim vardır ve bu sayede füzyon oluşması da kolaydır. Bu girişimlerden yararlanan hastanın tedavisi kalsitonin ile sürdürüldü ve takip edildiği sürede yakınması olmadı.A case of Paget's disease causing radicular pain and reduced muscle power is presented. MR imaging and therapeutic features are discussed. Excessive and uncontrolled bone reformation is imaged as decreased signal intensity in enlarged cortical areas on MR. The vertebra is flattened. The marrow is reduced and divided by connective tissue and is enhanced probably because of increased circulation and venous pooling. Surgical decompression is considered if Paget's disease of the vertebral column causes neural compression. We performed hemilaminectomy and foraminotomy to decompress the nerve root and for histological confirmation. Further root decompression is obtained by vertebral distraction by pedicle screw system, and osseous fusion is added. It is known that distraction improves the stenotic canal and foramen; besides internal fixation and fusion of the posterior elements reduce the pressure on the affected anterior and medial columns. Diffuse idiopathic skeletal hyperostosis has been reported in Pagetic patients and this may facilitate vertebral fusion. The patient benefited from the surgical procedure and remained asymptomatic during the follow-up under calcitonin treatment

Bası yarası karsinomu: Bir olgu bildirisi

Observation.- Pressure sore carcinomas are ra&not;rely seen. They have a high recurrence rate with poor prognosis. Generally they require radical sur&not;gical excision and elective lymph node dissection. A male patient suffering from paraplegia secon&not;dary to a spinal cord injury, for 20 years is repor&not;ted, The histopathological examination of the sac&not;ral pressure sore which developed 15 years later revealed a well- differentiated squamous cell car&not;cinoma. Here we present a review of the literature and the details of the surgical therapy instituted

Effect of epidermal growth factor receptor status on the outcomes of patients with metastatic gastric cancer: A pilot study

İstanbul Bilim Üniversitesi, Tıp Fakültesi.The expression of epidermal growth factor receptor (EGFR) has been linked to clinical outcome in several solid tumors. However, the clinical significance of EGFR (c-erbB1) in gastric cancer remains unclear. The present study was designed to detect the clinical implications of EGFR in the Turkish population. Paraffin-embedded tissue microarrays containing gastric cancer tissue were obtained from 30 patients. EGFR expression was detected using immunohistochemistry. The correlation of this biomarker to the clinicopathological features and survival of patients with gastriccancer was studied. The overall positivity rate of EGFR was 63.3%. EGFR expression was significantly correlated with an improved progression-free survival (PFS) and overall survival (OS) rate (P=0.039 and 0.01, respectively). EGFR expression is a good prognostic marker for patients withgastric cancer