Cervical spondylotic myelopathy

Servikal spondilotik myelopati servikal spondilozun en ağır komplikasyonlarındandır. Servikal myelopatinin başlangıcı sinsidir, 50-60 yaşlarında görülür. Derin sızlama ve yanma hissi ile ince el becerilerinin azalması, üst ekstremitelerde güç azalması, dizestezi, yazı yazmada zorluk, yürüme zorluğu, denge bozukluğu ilk şikayetler arasındadır. Erken evrelerde radiküler/sinir kök tutulumlarıyla karışarak tanısı atlanır. Fizik muayenede lezyon seviyesinde alt motor nöron bulguları saptanırken, lezyon seviyesi altında üst motor nöron bulguları saptanır. L'Hermitte ve Spurling bulguları yanı sıra patolojik refleksler ortaya çıkabilir. SSM tanısında görüntüleme yöntemleri çok önemlidir ve bunlar lateral grafiler, intratekal kontrastlı bilgisayarlı tomografi, Myelografik bilgisayarlı tomografi ile manyetik rezonans görüntülemedir. Lateral grafide Torg veya Pavlov oranı ölçülür ve bu oranın 0,8-0,7'ye inmesi halinde premyelopatiden söz edilebilir. Tanıda diğer yöntemler arasında elektromiyografi, somatosensoriyel uyandırılmış potansiyeller, motor uyandırılmış potansiyeller ve ürodinamik incelemeler vardır. Yapılan çoğu çalışmada konservatif tedavinin etkinliğinin düşük olduğunu savunulurken, iyi bir muayene ardından yapılan yoğun konservatif tedavinin de başarılı sonuçlar vereceği söylenmektedir. Konservatif tedavide servikal traksiyon, servikal immobilizasyon ve diğer fizik tedavi ajanları kullanılabilir, ancak bunlara yönelik yapılan çalışmalar yetersizdir. Araştırıcılar cerrahinin semptomların başlangıcından itibaren ilk 18 ay içinde yapılmasının daha başarılı sonuçlar verdiğini bildirmişlerdir.Cervical spondylotic myelopathy is the most serious complication of cervical spondylosis and has an insidious onset at the fifth to sixth decades of life. The initial symptoms are deep aching and burning sensation, loss of fine motor control and muscular strength of the upper extremities, dysesthesias, difficulty in writing and walking as well as balance impairments. Early symptoms may mimic radicular/nerve root involvement leading to misdiagnosis. Physical examination demonstrates lower motor neuron symptoms at the lesion level and upper motor neuron symptoms below the level of the lesion. Pathological reflexes as well as L'Hermitte and Spurling signs may also be present. Lateral cervical roentgenograms and imaging studies, intrathecal contrast computerized tomography, myelo-computerized tomography and magnetic resonance imaging are the main tools for diagnosis. Lateral X-rays are helpful in measuring Torg and Pavlov ratio where the decrease to 0.8-0.7 may point out premyelopathy. Electromyography, somatosensory evoked potentials and motor evoked potentials as well as urodynamic investigations are also used in the diagnosis. In most studies it was concluded that conservative treatment had lower efficacy, however, intensive treatment following a comprehensive physical examination lead to better results. Cervical traction, cervical immobilization and other physical therapy agents may be used in conservative therapy, but there is limited evidence for this hypothesis. The researchers declared that during the first 18 months after diagnosis of surgical treatment may demonstrate positive outcome

Clinical diagnosis and management in traumatic brain injury

Travmatik beyin yaralanması (TBY) yüksek sıklık oranı, genç yetişkinleri daha çok etkilemesi ve hayatta kalanlarda ileri fonksiyonel kısıtlanmaların görülmesi nedeniyle önemli bir sosyal sağlık problemidir. Bu derlemede, travmatik beyin yaralanmasının epidemiyolojisi, pediatrik ve yaşlı popülasyonlar arası beyin yaralanması farklılıkları vurgulanmıştır. Travmatik beyin yaralanmasının sınıflandırması yapılmış; aynı zamanda sekonder beyin yaralanmasının altta yatan fizyolojik ve kimyasal mekanizmaları, yaralanmaları azaltmak için uygulanan stratejiler ve çalışmalar gözden geçirilmiştir. Kazanılmış beyin yaralanması sonrası sonucu etkileyen değişkenler ve hasta popülasyonları için en uygun değerlendirme ölçütleri tartışılmıştır. Bu derleme ayrıca, yeni görüntüleme yöntemleri ve bunların travmatik beyin yaralanmalı hastalardaki potansiyel klinik uygulamaları üzerine odaklanmıştır.Traumatic brain injury represents a significant public health problem. The importance of this problem derives from high incidence rates, young previously healthy adults comprising a large proportion of those injured and the possibility of persistent functional limitations in survivors. In this article, brain injury epidemiology is summarized, and differences of brain injury between pediatric and elderly persons are emphasized. Traumatic brain injury has been classified by various variables. Underlying physiologic and chemical mechanisms for secondary brain injury regarding strategies and research to minimize this injury are reviewed. Variables that affect outcome after acquired brain injury are described, and the outcome tools most appropriate for the patient populations are discussed. In addition, this article focuses on new neuro-imaging techniques and their potential clinical applications in patients with traumatic brain injury

Isokinetic evaluation of knee extensor/flexor muscle strength in patients with hypermobility syndrome

Benign joint hypermobility syndrome (BJHS) is a syndrome with musculoskeletal pain originating from the increased laxity of the joints and the ligaments. The study was to compare the isokinetic strength of knee extensor/flexor muscles of BJHS patients with healthy controls. Forty patients diagnosed as having BJHS with Brighton criteria and 45 years of age, height and weight-matched healthy controls were recruited for the study. Isokinetic testing was performed with isokinetic dynamometry of Biodex System 3Pro and measurements were recorded at knee extension/flexion pattern concentrically at 60, 180, and 240/s angular velocities. The study group was also evaluated for functional impairment and pain by HAQ and VAS respectively. Knee extensor muscle strength was significantly lower in the patient group compared with the controls. It was hypothesized that the muscle weakness in the study group was related to lengthening of the quadriceps muscle and pain-related inactivity as well as joint instability and proprioception defect

Efficacy of acupuncture in the treatment of chronic neck pain

Bu çalışmanın amacı kronik boyun ağrılı hastalarda akupunktur ve plasebo akupunkturun etkinliğini karşılaştırmaktı. Çalışma tasarımı: Prospektif, randomize kontrollü olarak yapılan çalışmaya 30 kronik boyun ağrılı hasta alındı. 15 hastaya geleneksel akupunktur, 15 hastaya yüzeyel plasebo akupunktur 20 dakika süreyle, haftada 2 seans toplam 8 seans uygulandı. Hastalar tedavi öncesi, tedavi sonrası ve tedavi bitiminden 1 ay sonra ağrı ve fonksiyonel durum yönünden Vizüel Analog Skala (VAS) ile değerlendirilerek karşılaştırıldı. Bulgular: Ağrı şiddeti yönünden hem akupunktur hem de plasebo aku- punktur grubunda tedavi öncesi-tedavi sonrası, tedavi öncesi-bir ay sonraki kontrol karşılaştırmalarında anlamlı iyileşme elde edildi. (p<0.001). Tedavi sonrası-bir ay sonraki kontrol karşılaştırmalarda ise akupunktur grubunda anlamlı farklılık saptandı (p<0.05). Plasebo aku- punktur grubunda ise anlamlı farklılık bulunmadı. Fonksiyonel kapasite yönünden karşılaştırıldığında hem akupunktur hem de plasebo aku- punktur grubunda tedavi öncesi-tedavi sonrası, tedavi öncesi-bir ay sonraki 'kontrol karşılaştırılmalarında anlamlı iyileşme elde edildi. (Aku- punktur grubunda p<0.001, Plasebo Akupunktur grubunda p<0.05). Tedavi sonrası-bir ay sonraki kontrol karşılaştırmalarında ise her iki grupta da anlamlı fark saptanmadı. Akupunktur ile plasebo akupunktur ağrı şiddeti ve fonksiyonel kapasite yönünden karşılaştırıldığında her üç karşılaştırmada da anlamlı farklılık bulunmadı. Sonuç: Çalışmamızda kronik boyun ağrısında akupunktur ve plasebo akupunkturun etkinliği arasında anlamlı farklılık bulunmadı. Bu konuda metodolojik kalitesi yüksek, geniş hasta gruplarını kapsayan randomize kontrollü çalışmalar? gereksinim vardır.Objectives: To compare the efficacy of acupuncture and placebo acupuncture in patients with mechanical chronic neck pain. Studydeslng: Thirty patients with chronic neck pain were randomiyal located into acupuncture and placebo acupuncture groups. Fifteen patients were treated with traditional acupuncture and 15 patients with placebo acupunture tor 20 minutes, twice a week of, total 8 sessions. Both groups were evaluated and compared lor pain and functional status before, at the end of treatment and &ouml;ne month after treatment. Pain and functional status were evaluated with Visual Analogue Scale (VAS). Results: Pain scores ofboth groups atbaseline and posttreatment, at baseline and &ouml;ne month after treatment showed significant difference (p&lt;0.001). Posttreatment and &ouml;ne month after treatment showed significant difference in acupunture group. VVhereas there was no significant difference in the placebo acupuncture group. The functional status scores of both acupuncture and placebo acupuncture group at baseline and posttreatment, at baseline and &ouml;ne month after treatment showed significant difference (p&lt;0.001 in acupuncture group, p&lt;0.05 in place-bo acupuncture group). Both acupuncture group and placebo group at posttreatment and one month after treatment did not show significant difference. When acupuncture group was compared with placebo acupuncture group according to pain and functional status, no significant difference was found. Conclusions: No significant difference mas found between efficacy of acupuncture and placebo acupuncture tor the treatment of chronic neck pain. Further randomized, controlled, high methodologic quality trials are needed

Demographics features, clinical findings and functional status in a group of subjects with cervical myofascial pain syndrome

Servikal bölgede miyofasyal ağrısı bulunan kişiler çeşitli klinik bulgularla karşımıza çıkabilirler. Bu çalışmanın amacı servikal miyofasyal ağrı sendromlu hastalarda demografik özellikler, klinik bulgular ve fonksiyonel durumu incelemektir. Kliniğimize başvuran 94 servikal miyofasyal ağrı sendromlu hasta değerlendirmeye alındı. Hastalarda kısa form-36 yaşam kalitesi (SF-36), ağrı, depresyon, demografik ve fiziksel özellikler değerlendirildi. Son durum ölçütleri; SF-36 yaşam kalitesi, görsel analog skala, Beck Depresyon İndeksi, anamnez ve fizik muayeneydi. Toplamda servikal miyofasyal sendrom tanısı almış 82 hasta çalışmaya dahil edildi. Hastaların hepsi genç olup yaş ortalamaları 37.4±9 ve %87.8’ I kadın idi. Hastaların %53.1’ i otonomik fenomen benzeri deri kızarıklığı, lakrimasyon ve vertigo ile birlikte trapezius kasında tetik noktaya sahipti. %58.5’ u önceden geçirilmiş servikal travmaya, %40.2’ si Fibromiyalji sendromuna ve %18.5’ u Benign eklem hipermobilite sendromuna sahipti. Otonomik fenomenler ve erken başlangıçlı servikal yaralanması bulunan genç, bayan hastalar servikal miyofasyal ağrı sendromu ve bu hastalarda da Fibromiyalji sendromu oranı yüksek olduğu için Fibromiyalji sendromu açısından değerlendirilmelidirler.Subjects with myofascial pain of muscles of the neck region may present with various clinical symptoms. The aim of this study was to explore the demographics features, clinical findings and functional status in a group of patients presenting with myofascial pain of the cervical muscles. 94 cervical myofascial pain syndrome patients were recruited from the out-patient clinic. Evaluated of patient short form health survey (SF-36), pain, depression, patient demographics and physical examinations. Outcome measures; SF-36 Health Survey, visual analog scale, Beck Depression Inventory, history, physical examination. A total of 82 patients with a diagnosis of cervical myofascial syndrome were included in the study. All patients were in the young age group 37.4&plusmn;9, and 87.8% were females. 53.1% had trigger points in the trapezius muscle with high percentage of autonomic phenomena like skin reddening, lacrimation, tinnitus and vertigo. 58.5% of the series had suffered from former cervical trauma and 40.2% also had Fibromyalgia syndrome and 18.5% had Benign Joint Hypermobility syndrome. Younger female patients presenting with autonomic phenomena and early onset cervical injury should be examined for cervical myofascial pain syndrome and also for Fibromyalgia syndrome since this study demonstrated a high percentage of Fibromyalgia syndrome in these patients

Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome

The first aim is to show if there is a disorder in proprioception in cases with benign joint hypermobility syndrome (BJHS) when compared to healthy subjects. The second aim is to evaluate the effect of proprioception exercise in BJHS cases. To evaluate the proprioceptive sensibility of the knee joint with 40 BJHS and 30 healthy subjects enrolled in the study. Then, cases with BJHS were randomized into two groups; proprioceptive exercises were applied to 15 patients for 8 weeks in clinic and 25 patients were taken as controls. Outcome measures included proprioceptive sensation, AIMS2 and VAS. Proprioception is significantly impaired in cases with BJHS. In BJHS group, significant decreases in VAS levels were detected in cases who did exercise compared with cases who did not, and statistically significant improvements were detected in occupational activity. For this reason proprioception exercises cause decrease in pain and improvement of functional status in BJHS group

A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome

A study to compare the therapeutic efficacy of aerobic exercise and paroxetine in fibromyalgia syndrome. The aim of this study is to compare the therapeutic efficacy of aerobic exercises versus paroxetine in a randomized, controlled study. Sixty female patients between ages 18-50, diagnosed as fibromyalgia syndrome by the 1990 American College of Rheumatology criteria were randomly allocated to one of three groups. Group I was given aerobic exercises on bicycle ergometer for 40 minutes, 3 times a week for 6 weeks, group II was given paroxetine 20 mg daily for 6 weeks and group III was given placebo Transcutaneous Electrical Nerve Stimulation for 20 minutes, 3 times a week for 6 weeks as a control group. All groups were evaluated at admission, termination and at the end of 6 months by Visual Analog Scale (VAS), pressure algometric testing, weekly analgesic consumption for pain intensity. They were also evaluated for psychological and social status, Beck Depression Inventory. Statistical analysis was done by the SPSS (Statistical Package for Social Sciences) program with T-test, Oneway-Anova, Mann-Whitney U, Wilcoxon Rank Sum Test and post-hoc. Pain threshold with pressure algometer, pain intensity by VAS and BDI scores showed significant decrease compared to scores of the group III at termination of the study and at 6 months follow-up while base-line evaluation parameters demonstrate no significant statistical differences between groups. Analgesic consumption was reduced only in group I. As a result this study shows that paroxetine and aerobic exercises have better therapeutic effect when compared to placebo group on short and long-term follow-up with no significant difference on evaluation parameters in two groups