Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients with Carpal Tunnel Syndrome: A Randomized Controlled Study

Objective The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome. Design A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment. Results Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups. Conclusions Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection. © Wolters Kluwer Health, Inc. All rights reserved

Vertebral Arter Darlıklarında Endovasküler Tedavi

Amaç: Vertebral arter darlığı olan hastalarda endovasküler stent tedavisinin endikasyon, teknik başarı, güvenilirlik ve etkinliğinin tartışılması amaçlandı.Gereç ve Yöntem: Haziran 2012 ve Aralık 2018 tarihleri arasında vertebral arter darlığı tanısı ile endovasküler stent yerleştirilen 10 hastanın 3 kadın, 7 erkek medikal kayıtları retrospektif olarak incelendi. Hastaların ortalama yaşı 63.9 yıl idi aralık: 47−78 yıl . Hastalara, mevcut semptomları, klinik öykü ve dijital subtraksiyon anjiyografi sonrası vertebral arter darlık oranına göre endovasküler stent tedavisi uygulandı. İşlemler lokal anestezi altında gerçekleştirildi.Bulgular: Çalışmaya dahil edilen dokuz hastada %90 %50’nin üzerinde vertebral arter orjin V0 ve proksimal V1 darlık saptanmış olup ortalama darlık oranı %65 olarak hesaplanmıştır. %50’nin altında darlık bulunan bir hastada baş-boyun kitlesinin neden olduğu bası ve invazyon nedeniyle profilaktik amaçlı kaplı stent uygulandı. Hastaların sadece birinde subklavian arterde yumuşak plak bulunması ve buna bağlı distal emboli riski nedeniyle distal koruyucu filtre sistemi kullanıldı. Ortalama stent uzunluğu ve çapı sırasıyla 21.8 mm aralık: 12-39 mm ve 4.5 mm aralık: 4-6 mm hesaplandı. İşlem sonrası tüm hastalarda yeterli lümen açıklığı sağlandı ve teknik başarı %100 olarak kabul edildi. Sonuç: Sonuç olarak vertebral arter darlıklarının endovasküler tedavisi, özellikle medikal tedavi başarısız ya da yetersiz olan hastalarda düşük komplikasyon oranları ve yüksek teknik başarı ile güvenli ve etkili bir tedavi yöntemidi

Percutaneous drainage of retroperitoneal abscesses: variables for success, failure, and recurrence

PURPOSEWe aimed to evaluate the success and failure rates and minor and major complications of percutaneous drainage of retroperitoneal abscesses.METHODSBetween 1990 and 2010, percutaneously drained 170 retroperitoneal abscesses in 150 patients (83 males, 67 females, median age 44.2 years, age range, 1–86 years) were included retrospectively. Percutaneous drainage of retroperitoneal abscesses was performed under the guidance of ultrasonography and fluoroscopy or computed tomography. Six abscesses were drained via single needle aspiration whereas 164 abscesses were drained via catheters of 6–14 F calibre using the Seldinger technique.RESULTSWhen all retroperitoneal abscesses are considered, success rates were found as follows: 75.3% cure (128/170), 7.7% temporization (13/170), 4.1% palliation (7/170). Failure rate was 12.9% (22/170). Recurrence rate was 10.6% (18/170), and 13 of the recurred abscesses were treated via second session percutaneous drainage. Mortality rate was 2.7% (4/150).CONCLUSIONPercutaneous drainage is the first treatment option for retroperitoneal abscesses due to procedural reliability, elimination of need for general anesthesia, better tolerability, and lower morbidity and mortality rates compared with the surgical methods. High cure, temporization, or palliation rates can be obtained via imaging-guided percutaneous drainage for all retroperitoneal abscesses with a safe access route

The contribution of vacuum-assisted modified Menghini type needle to diagnosis of US-guided fine needle aspiration biopsy of the thyroid

PURPOSEWe aimed to determine the contribution of vacuum-assisted modified Menghini type needle to diagnosis of ultrasound-guided fine needle aspiration biopsy (FNAB) of the thyroid evaluated by a pathologist at the bedside.METHODSA total of 147 thyroid nodules in 138 patients (122 women, 16 men) were included in this prospective study. Sonographic features of nodules, number of aspirations, pain and pain severity during the process, hemorrhage, and presence of sample obtained for cell block analysis were recorded and analyzed with the results of aspiration biopsy.RESULTSUsing the 21G modified Menghini type needle, a diagnosis could not be reached in 14.3% of nodules. Adequate samples for cell block analysis were obtained in 47 nodules (32%), 17 of which contributed to the diagnosis. While the difference between diagnostic cytopathology results and the contribution of the cell block were statistically significant, obtainability of cell block samples was not significantly correlated with the number of aspirations or the presence of a cystic component in the nodule.CONCLUSIONFNAB with 21G vacuum-assisted modified Menghini type needle is a safe procedure with very low complication rates. In addition to the cytologic smear samples, microtissue fragments obtained with this method help pathologists in the diagnosis of thyroid nodules

Causes of reoperation after mitral carpentier ring annuloplasty: report of five cases

Mitral kapak tamiri, mitral yetmezliğinde tercih edilen bir tedavi yöntemidir. Bu çalışmada Carpentier ringi ile mitral anüloplasti yapılan olgularda reoperasyon nedenleri tartışılmıştır. Carpentier ringi ile mitral anüloplasti uygulanan ve geç dönemde reoperasyon uygulanan toplam 5 olgu çalışmaya alınmıştır. Olguların tümü kadın ve yaş ortalaması 44.611.2 (32-58) yıl olup, iki cerrahi prosedür arasında geçen ortalama süre 3228.4 aydır (7-78 ay). Olguların tümünde romatizmal kardit öyküsü mevcut olup, mitral rekonstrüksiyon öncesi dördünde orta-ileri derecede mitral yetmezliği, birinde ise ileri mitral darlığı olduğu saptanmıştır. Mitral rekonstrüksiyon sırasında ilave prosedür olarak bir olguya aort valv replasmanı, diğer dört olguya trikuspit anüloplasti uygulanmıştır. Reoperasyon endikasyonu üç olguda ileri derecede mitral yetmezliği, diğer ikisinde 3. derece mitral yetmezliği ile birlikte mitral darlığının varlığıdır. Olguların birinde reoperasyon ilk ameliyattaki prosedür ile ilgili iken, dördünde romatizmal hastalığın kronik bulgularının ilerlemesine bağlı idi. Tüm olgulara mekanik bileaflet mitral kapak protezi ile replasman uygulandı. Reoperasyonda ek olarak bir olguya aort kapak re-replasmanı, beş olgunun tümünün trikuspid kapağına anüloplasti uygulandı, ikisinde ring kullanıldı. Postoperatif erken dönemde bir olgu kaybedildi. Dört olgunun erken dönem takiplerinde mitral protez kapaklarının normal fonksiyonda olduğu, bir olguda minimal, üç olguda orta derecede trikuspid yetmezliği olduğu, tüm olgularınNYHAfonksiyonel sınıf I-II olduğu görüldü. Bu çalışma Carpentier ringi ile mitral rekonstrüksiyonu yapılan olgularda, geç dönemde reoperasyon nedeninin daha çok kapaktaki patolojinin progresyonu veya yetersiz cerrahi teknik ile ilgili olduğunu ve bu olguların reoperasyon sonrası erken dönem sonuçlarının iyi olduğunu düşündürmektedir.Mitral valve reconstruction is the treatment of choice in mitral regurgitation. In this study, the causes of reoperation following mitral reconstruction with Carpentier ring annuloplasty are discussed. : Five patients who underwent reoperation late after mitral ring annuloplasty with Carpentier ring were reviewed. Patients were all female, mean age was 44.6 11.2 (range 32 58 years) and the mean interval between the two procedures was 32 28.4 (range 7-78) months. All patients had history of rheumatic fever. Prior to mitral reconstruction, four patients had moderate to severe mitral regurgitation, one patient had severe mitral stenosis. Associated procedures were aortic valve replacement in one patient, tricuspid annuloplasty in four patients during mitral reconstruction. Indications for reoperation were severe mitral regurgitation in three patients and third degree regurgitation with mitral stenosis in two. The reasons for reoperation for the failed mitral reconstruction were procedure related in one patient and progression of the rheumatic disease in four patients. All patients underwent mitral valve replacement with mechanical bileaflet prosthesis. Associated procedures were aortic valve re-replacement in one patient, tricuspid annuloplasty in all five patients, ring was used in two. One patient died in hospital. In early follow-up, all four surviving patients were found to be in NYHA functional class I-II and have normally functioning mitral prosthesis. One patient had minimal, three patients had moderate tricuspid regurgitation. This study considered that the reason for reoperation for failed mitral reconstruction is mainly related with the progression of mitral valve pathology or inadequate surgical technique and early results of reoperation of these patients are good

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Tip 1 diyabetli çocuklarda benlik saygısı ve psikopatoloj i

Amaç. Bu çalışmada Tip 1 Diyabetes Mellituslu (Tip 1 DM) çocuklarda psikiyatrik sorunlar ve benlik saygısının değerlendirilmesi amaçlanmıştır. Yöntem. Çalışmaya Tip 1 DM tanılı 8-12 yaş arasında 52 gönüllü çocuk ile sağlıklı gönüllülerden oluşan, hasta grubuyla yaş ve cinsiyet açısından eşleştirilmiş “psikiyatrik hastalığı olan grup” (PG) (n=28) ve “sağlıklı kontroller” (SK) (n=26) alındı. Sosyodemografik veriler standart sosyodemografik veri toplama formu ile elde edildi. Çocuklara yarı yapılandırılmış tanı görüşmesi (K-SADS-PL), Piers-Harris Çocuklarda Öz- Kavramı Ölçeği (PHÖKÖ), Rosenberg Benlik Saygısı Ölçeği (RBSÖ) uygulandı. Bulgular. DM’li çocukların %59,6’sında (n=31) en az bir psikiyatrik bozukluğun olduğu saptandı. Diabetik grupta psikiyatrik bozukluğu olanların HbA1C düzeylerinin olmayanlardan daha yüksek (p=0,024) olduğu görüldü. Psikiyatrik bozukluk grubundaki çocukların benlik saygılarının hem sağlıklı yaşıtlarından (p=0,00) hem de DM’lilerden (p=0,005) daha düşük olduğu saptandı. Çocukların öz kavramlarına bakıldığında ise gruplar arasında farklılık olduğu (p=0,02) ve bunun DM’li çocukların sağlıklı yaşıtlarına göre özkavramlarının daha olumsuz olmasına bağlı olduğu görüldü (p=0,04). DM’li çocuklarda kişilerarası ilişki sorunlarının daha yaygın alanlarda görüldüğü bulunmuştur. Sonuç. Tip I DM’li çocukların öz kavramlarının sağlıklı çocuklardan daha olumsuz olduğu, kişilerarası ilişki sorunlarının daha yaygın alanlarda görüldüğü ve psikiyatrik bir hastalık varlığında HbA1C düzeyini de arttığı görülmektedir. Bu sonuçlar diyabetli çocukların takipleri sırasında psikiyatrik değerlendirmenin yapılmasının gerekli olduğunu, böylece olası psikopatolojilerin tanınarak tedavisi edilmesi ve ileride gelişebilecek olası komplikasyonların önlenebileceğini düşündürmektedir.Aim. This study aims to evaluate psychiatric disorders and self-esteem in children with Type 1 diabetes mellitus (Type 1 DM). Methods. The study enrolled 52 volunteer children aged between 8 and 12-years-old, who have been diagnosed with Type 1 DM, and “group with psychiatric disease” (PG) (n=28) and “healthy controls” (HC) (n=26) consisted of healthy controls who are age- and sex-matched with patient group. Sociodemographic data were obtained using standard sociodemographic data collection form. The children were administered semi-structured diagnostic interview (K-SADS-PL), Piers-Harris children's self-concept scale (PHCSCS) and Rosenberg Self- esteem Scale (RSES). Results. It was observed that 59.6% of the children with DM (n=31) still had at least one psychiatric disorder. It was seen that, in the diabetic group, HbA1C levels were higher in those with psychiatric disorder compared to those without it (p=0.024). It was found that self-esteem of the children in the group with psychiatric disorder was lower compared to both healthy counterparts (p=0.00) and the children with DM (p=0.005). It was found that the children in the group with psychiatric disorder had lower self-esteem compared to healthy counterparts. When self-concept of the children was examined, it was seen that there was a difference across the groups (p=0.02), which was attributed to more negative self-concepts of the children with DM compared to healthy counterparts (p=0.04). In the children with DM, it was seen that interpersonal relation problems were seen in a wider range of areas. Conclusion. It is seen that, in the children with Type I DM, self-concept was more negative compared to healthy children, that problems in relation were seen in a wider range of areas and that the presence of a psychiatric disease increased HbA1C levels. These results suggest that psychiatric evaluation is required during the follow-up of the diabetic children, allowing the recognition and treatment of eventual psychopathologies and the prevention of the eventual complications that may develop in the future

The surgical together medical treatment of labial adhesions in prepubertal girls

OBJECTIVE: Labial fusion is a pathological condition seen mostly in prepubertal girls, claimed to be caused by low blood levels of estrogen and following inflammation. It is generally asymptomatic, however the adherence of labia minora may cause retention of urine leading to bacterial colonization and eventually causing urinary symptoms. The first choice of treatment is suggested as estrogen ointment. We aimed to investigate the success of surgical treatment together medical treatment with or without medical estrogen ointment before. MATERIALS and METHODS: Retrospective evaluation of 22 symptomatic with labial fusion patients who were admitted directly to our clinic or who were consulted following medical therapy by other clinics was made by means of the chart reviews. Mean age was 31 months. Labial adhesions were separated sharply by the help of a curved homeostatic clamp under local anaesthesia direction of anteroposterior. Following release of adhesion, estrogen ointment was applied topically. RESULTS: Among 22 patients, 19 of them had no problem in the post-management period. However, for three patients, re-release of adhesions by the same method was necessary. For all patients, follow-up revealed uneventful results. CONCLUSION: The first option in management of labial fusion is generally topical application of estrogen ointment; however the period necessary for treatment is long lasting. Mechanical release of adhesions under local anesthesia followed by topical estrogen ointment seems to lower recurrence rate and shorten the time necessary for treatment. Therefore, we suggest this treatment protocol since the treatment option for labial fusion may decrease the complication rate and build patient cooperation more easily