Neonatal brachial plexus palsy

Obstetrik brakial pleksus palsisi doğum sırasında brakial pleksusun hasarlanmasıyla kolda görülen flask bir paralizidir ve önemli bir neonatal morbidite nedenidir. Hastada ilk iki haftada iyileşme görülmesi iyi prognoza işarettir, ancak iki haftadan sonra başlayan iyileşmede tam bir düzelme elde etmek zordur. Obstetrik brakial pleksus palsisinin değerlendirilmesi ve tanısında yüksek rezolüsyonlu manyetik rezonans görüntüleme en iyi araçtır. Elektrodiagnostik inceleme ise yaralanma zamanı, derecesi, prognozu ve lokalizasyonu konusunda bilgi vermektedir. Temel tedavi yöntemleri düzenli ev programlarıyla beraber olan fizik tedavi ve/veya iş-uğraşı terapisidir. Bazı brakial palsili çocuklarda elektriksel stimulasyon ve botulinum toksin injeksiyonu gibi cerrahi dışı girişimler iyileşmeye yardım etmektedir. Az sayıda hasta erken dönemde cerrahi girişimden yararlanabilmektedir. Temel olarak tedavide önemli nokta multidisipliner yaklaşım ve sonuçların dikkatli değerlendirilmesidir.Obstetrical brachial plexus palsy is defined a flaccid paresis of an arm at birth with an injury to the brachial plexus and a serious form of neonatal morbidity. Rate of recovery in the first two weeks is a good indicator of final outcome whereas complete recovery is unlikely if no improvement is noted in the first 2 weeks of life. High-resolution magnetic resonance imaging is the best procedure for evaluating and diagnosis of obstetrical brachial plexus palsy. Electrodiagnostic studies can provide data for timing, degree, prognosis and localization. The mainstay of treatment is physical and/or occupational therapy together with a regular home exercise program. Non-surgical procedures like electrical stimulation and botulinum toxin injections may prove effective in some brachial palsy children. A few patients may benefit from surgery in the early stages. The most important factor in treatment is a multidisciplinary approach with careful evaluation of outcome

Evaluation of functional status in cases with polio sequele and postpolio syndrome

Çalışmamızın amacı; sağlıklı kişilerle, polio sekeli ve postpolio sendromu olan olguları fiziksel fonksiyonlar, psikolojik ve sosyal yönden değerlendirerek karşılaştırmaktı. Polio sekeli olan 20, postpolio sendromu olduğu düşünülen 15 ve kontrol grubu olarak seçilen sağlıklı 20 kişi kısa, standardize edilmiş ve hastaların kendileri tarafından doldurulabilen Jette Fonksiyonel Durum Anketi (FD A) kullanılarak fiziksel fonksiyonla, psikolojik durum, ve sosyal fonksiyonlar yönünden sorgulandı. İstatistik analizler SPSS (Statistical Package for Social Sciences) paket programıyla yapıldı. Sonuç olarak; kontrol, polio sekeli ve postpolio sendromu olan gruplar arasında FDH ile yapılan değerlendirmede, fiziksel fonksiyonlar ve sosyal aktivite yönünden postpolio sendromu olan vakalarla, kontrol ve polio sekeli olan vakalar arasında anlamlı bir fark olduğu (p<0.05), psikolojik fonksiyonlar, çalışma performansı ve insan ilişkileri kalitesi yönünden ise üç grup arasında anlamlı bir fark olmadığı görüldü.The aim of this study was to assess and compare cases who have polio sequele and postpolio syndrome with healthy cases on the basis of psychological, physical and social functions. 20 cases with polio sequele, 15 cases with postpolio syndrome and 20 healthy cases as control group were included in the study. They were given brief, standartized Jette Functional Status Questionnaire (FSQ). They answered the questionnaire by themselves. The cases were asked questions about psychological condition, physical and social functions with FSQ. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) package program. As a result, there was statistically significant difference between postpolio syndrome group and other groups on the basis of physical functions and social activity (p&lt;0.05). There were no significant differences between three groups on the basis of psychological functions, work performance and human relation qualities

Relation of Vitamin B12 Levels to Bone Mineral Density of Postmenopausal Women - Original Investigation

Aim: Although vitamin B12 (vit-B12) is known to influence the hemopoeitic and nervous systems, little is known about the skeletal effects of vit-B12. Researchs that demonstrated an association between serum vitamin B-12 concentration and osteoblastic function and its’ role in DNA synthesis, which suggesting a relationship between osteoporosis, this randomized controlled trial were planned. Material and Methods: Vit-B12 levels of 740 patients aged between 50-65 years, who were applied to our outpatient clinic because of chronic low back pain were examined and divided with vitamin B-12 levels over or below 400 pg/ml. 26 participant who met all inclusion criteria with vit-B12 level below 400pg/ml were assigned to case group. Among the patients that vit-B12 levels were over 400pg/ml, 20 participants were randomly selected to control group. Bone mineral density (BMD), biochemical measurements, causes of osteoporosis and vit-B12 defiencies were investigated. A computer program was used for statistic evaluation. Results: There was not statistically significant difference between BMD’s of case and control groups (p>0.05). When the vit-B12 levels were grouped with over 400 pg/ml, below 200 pg/ml and between 200-400 pg/ml, osteodensimetric examinations of femur neck BMD (p<0.05) were achieved statistically significant difference. Conclusion: The results of this trial highlight an association of vitamin B-12 status with osteoporosis. Vit-B12 defiency is an easy and cheap treatable condition so that reason we suggest that levels of vit-B12 should be investigated. (From the World of Osteoporosis 2009;15:1-6

Importance of tinel and phalen test in the carpal tunnel syndrome

Çalışmamızın amacı karpal tünel sendromu'nun (KTS) klinik teşhisinde sıklıkla kullanılan Tinel ve Phalen testinin duyarlılık ve özgüllüğünü değerlendirmekti. KTS lokal sıkışma sendroniları arasında en sık görülenidir. Teşhiste klinik muayene ve şikayetler temel alınırken, elektrodiagnostik çalışmalar bu teşhisin doğrulanmasında faydalı olabilmektedir. Phalen ve Tinel testi teşhiste faydalı göstergelerdir. Çalışmamıza KTS'nun klinik semptomlarıyla başvuran (örneğin., aralıklı elbileği ve kol ağrısı, me¬dian sinir alanına yayılan uyuşma, gece şikayeti olanlar ve benzerleri), bunu takiben standart sinir ileti kriterleriyle elektrofizyolojik olarak KTS olduğu tespit edilen 126 hasta eli dahil edildi. Çalışmamızda klinik olarak KTS olduğu düşünülen 126 üst ekstremiteye EMG yapıldı. Phalen ve Tinel testi yönünden değerlendirildi. Sonuç olarak; Tinel testi KTS'lu hastaların değerlendirilmesinde faydalı olmasına karşılık Phalen testi daha yüksek duyarlılık ve özgüllüğe sahiptir.The aim ofthis^tudy is evaluating sensitivity and speci&not;ficity of Tinel and Phalen tests which is often used in the clinical diagnosis of Carpal Tunnel Syndrome (CTS). CTS is seen the most common among focal entrapment syndromes. While CTS is diagnosed on the basis of pa&not;tients history and clinical examination and electrodiagnostic studies may be useful in confirming the diagnostic impression. Phalen and Tinel test are useful indicators of diagnosis. In this study 126 patient hands included, reffered with clinical symptoms of CTS (ie., intermittent wrist and arm pain, paresthesias in the median distribution, noc&not;turnal symptoms etc), who were subsequently proven to have electrophysiologic CTS by standard nerve con&not;duction criteria. All patient hands which clinically suspected of CTS were performed Phalen and Tinel test. We conclude that the Tinel test is useful in the evaluation of patients with CTS whereas Phalen test has greater sensitivity and specificty

The comparison of the efficacy aerobic exercises versus strengthening, stretching and mobilization exercises in subacute and chronic low back pain

The aim of this study was to investigate and compare the efficacy of aerobic exercises versus strengthening, stretching and mobilization exercises in patients with subacute or chronic low back pain. Forty patients were recruited for the study and randomly allocated to two groups. All patients were evaluated at admission, mid-treatment and termination of the program by visual analog scale (VAS), face scale, weekly analgesic intake and Million visual analog scale for pain. They were also scored by Roland-Morris scale and Oswestry scale for functional impairment. Beck depression inventory was used to evaluate depression and lumbar range of motion was measured by inclinometry, Schober, finger tip to floor distance. The aerobic exercise group was also evaluated for VO2max and anaerobic threshold levels. Both groups showed significant improvement in all parameters at termination. Comparison between groups showed a higher significant improvement in depression and functional improvement parameters in the group given strengthening, stretching and mobilization exercises by physiatrist

Aerobic capacity in patients with chronic low back pain

Bel ağrısı iş günü kaybına yol açan hastalıkların ikincisidir. Buna karşılık, diğer hastalıkların aksine daha çok iş veriminin azalmasına neden olur. Bel ağrısını ortaya çıkaran risk faktörlerinin bilinmesi, bel ağrısının önlenmesi açısından önemlidir. Son yıllarda aerobik kondisyon kaybının bel ağrısı için bir risk faktörü olduğu kabul edilmektedir. Aerobik kapasitenin en önemli göstergesi maksimal oksijen tüketimidir(VO2max). Bu çalışmanın amacı, kronik mekanik bel ağrılı hastalarda, aerobik kapasitenin direkt metodla ölçülerek, aynı yaş grubundaki sağlıklı kontrol grubu ile karşılaştırılmasıdır. Hasta grubu yaş ortalaması 37±6 olup, 6 erkek ve 14 kadından oluşmaktadır. Kontrol grubunun yaş ortalaması 36±6 olup, 5 erkek ve 10 kadından oluşmaktadır.Her iki grubun yaş, boy, kilo ve cins açısından karşılaştırılmasında aralarındaki fark anlamlı bulunmamıştır (p>0,05). Her iki grup hastaya İstanbul Tıp Fakültesi Sporcu Sağlık Merkezinde, "treadmill" üzerinde Bruce protokolüne göre "breath by breath" yöntemiyle efor testi yapılmış ve VO2max tespit edilmiştir. Kronik bel ağrılı hastalarda VO2max'ın kontrol grubuna göre anlamlı olarak az olduğu bulunmuştur(t=2, 48, p=0,019). Hastalarda yaşla V02max'ın azaldığı (r=-0,60,p=0,004) ve erkeklerde kadınlara göre daha fazla olduğu saptanmıştır (t= 4,74,p=0,009). Kronik mekanik bel ağrılı hastalarda aerobik kapasite azalmaktadır ve bu hem bir risk faktörü olarak önemlidir, hem de ağrıya bağlı kondisyon kaybının sonucudur.Aerobic capacity in patients with chronic low back pain. Low back pain stands in second place with regard to medical conditions causing work-day loss and is also the major cause of loss of productivity. Determining the risk factors in low back pain is the initial step in prevention and loss of aerobic capacity which is considered as a risk factor. The most important determinant in aerobic capacity is maximum oxygen consumption (V02max). The aim of this study is to measure the aerobic capacity in patients with chronic low back pain by a direct method and compare it with an age matched healthy control group. The study group consisted of 6 male and 14 female patients aged 37&plusmn;6. There was no significant difference in age, height, weight and gender between the groups (p&gt;0,05). Both groups were tested by Bruce protocol on the treadmill by breath-by-breath procedure for effort and VO2max was recorded. VO2max recordings were significantly lower in the patient group (t =2,48,p=0,019).VO2max decreased with older age.(r=-0,60,p=0,004) and was higher in males than in females (t=4,74,p=0,009). As a result, we have noted that aerobic capacity, an important risk factor, tends to decrease in patients with chronic low back pain and this may be related to deconditioning due to chronic pain