Ethical issues in decision making by hospital health committee members in Turkey

Hospital health committees (HHC) in Turkey review medical reports from clinical practitioners and decide whether or not they are justified. As a rule, each HHC member is expected to observe and examine each patient and then evaluate the report. If the report from the patient's doctor is approved, then the Social Security Administration, a state organisation, will meet all of the patient's expenses covering treatment, medication and operations. Justification of health expenditure is crucial for the state because health resources have to be carefully allocated. Conflicts of obligation also generate ethical issues which have to be resolved as well. However, HHCs are not designed to make ethical decisions. An overall concept of organisational ethics needs to be developed

Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component

There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7–T8 with calcifications of the T7–T8 and T8–T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified. Keywords: Calcification, Pathologic, Herniated disc, Intervertebral disc, Thoracic vertebra

Sacral Insufficiency Fracture Presenting as Lumbar Spinal Pathology in an Osteoporotic Patient: A Case Report

Sacral insufficiency fractures are a rare type of osteoporotic fracture which mainly occurs in elderly osteoporotic patients without specific trauma. Low back and hip pain are the most frequent complaints associated with sacral insufficiency fracture. Thus, if sacral insufficiency fracture is not considered in the differential diagnosis, the diagnosis may be difficult or delayed. In this case report, we present a patient who attended our outpatient clinic with low back and leg pain and who was first diagnosed as having lumbosacral pathology according to magnetic resonance imaging findings. Our aim was to point out the difficulty in diagnosing sacral fracture and the delay in diagnosis and treatment. Turk J Phys Med Rehab 2011;57 Suppl 2: 377-4

De Quervain's syndrome associated with osteopoikilosis: a case report and review of the literature

Osteopoikilosis is a rare, usually asymptomatic, autosomal-dominant bone disorder, which is generally diagnosed incidentally on X-ray. De Quervain's syndrome is a disorder characterized by pain on the radial (thumb) side of the wrist, impairment of thumb function and thickening of the ligamentous structure covering the tendons in the first dorsal compartment of the wrist. In this case report, we present a young woman with De Quervain's syndrome associated with osteopoikilosis

Cervical Myelopathy Induced by Ossification of Posterior Longitudinal Ligament

Ossification of Posterior Longitudinal Ligament (OPLL), despite being one of the common causes of cervical myelopathy in Asian subjects it also can be seen less in other races. Although OPLL etiology is still unclear, it is considered to be related to genetic, hormonal and environmental factors. As OPLL; that is encountered as a distinct clinical entity in the formation of cervical myelopathy; may not cause any symptom, it also can be presented with a serie of clinical symptoms like progressive neurological damage and disturbance of balance and gait. Direct X-ray, CT and MRI are important auxiliary method in terms of OPLL diagnosis, treatment planning and follow-up. In patients with no progressive neurological damage or mild symptoms of myelopathy conservative approach can be successful in the treatment. However, surgical approach is the main in patients with progressive myelopathy, the choice of surgical technique is still quite controversial. We therefore offer to discuss the diagnosis and treatment of OPLL that induced cervical myelopathy in our old aged male Turkish patient

Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case Report

Prostate cancer is one of the most common malignancies in men. Pelvic radiotherapy is commonly used in both radical and palliative treatment for prostate cancer. Radiation-induced adverse effects might be seen on adjacent healthy tissues (such as vessels, bones and soft tissues) with the exception of targeted area. Particularly several years after radiotherapy, low back and hip pain may occur due to bone edema, necrosis or fractures. In these cases, whether complaints due to the degenerative, metastatic or radiotherapy complications must be examined and appropriate treatment should be arranged. For this purpose, we present our elderly patient who received radiotherapy for prostate cancer, and thereafter, developed bilateral avascular hip necrosis and pelvic insufficiency fractures

Cauda Equina Syndrome Caused by Lumbar Vertebral Fracture in an Elderly Patient with Ankylosing Spondylitis

Background: Cauda equina syndrome [CES] in patients with ankylosing spondylitis [AS] is an important neurological complication characterized by low back and leg pain, impotence, urinary incontinence, sensory deficits, and motor dysfunction. Vertebral fractures in the course of AS have been found most often in the cervical region, followed in prevalence by the thoracic region but only rarely in the lumbosacral region