Is polysomnographic examination necessary for subjects with diaphragm pathologies?

OBJECTIVES: While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated. METHODS: This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014-2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared. RESULTS: Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement. CONCLUSION: All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented

İlk Atak Manide EEG Anormalliği: Çocukluk Çağı Travmalarının İzi

Amaç: Bu çalışmanın amacı ilk atak manide EEG anormalliği sıklığını araştırmak, EEG anormalliği olan ve olmayan olguları, iki uçlu bozukluğun klinik özellikleri yönünden karşılaştırmaktır. Yöntem: Bu çalışmada, ayaktan tedavi merkezimize veya acil servisimize son bir yıl içerisinde başvuran, 18-65 yaş arası, bilgilendirilmiş onam formu birinci derece yakınları tarafından onaylanan, DSM-IV’e göre iki uçlu bozukluk, Manik Dönem olarak değerlendirilen, ilk dönem 69 olgu ardışık olarak değerlendirilmiştir. Olgularda öncesinde depresif dönem bulundurmama, herhangi bir nörolojik hastalığı, kafa travması ve/ veya bilinç kaybı öyküsü olmama, EEG çekimi öncesi, elektroensefalografik aktiviteyi etkileyecek ilaç (antiepileptik, anksiyolitik, antidepresan ve antipsikotik) almamış olma şartları aranmıştır. Dışlama ölçütleri haricinde 50 olguya ait veriler değerlendirmeye alınmıştır. Tanı görüşmeleri SCID-I (DSM-IV Yapılandırılmış Klinik Görüşmesi) ile yapılmış, hastalıkla ilgili bilgiler SKIPTURK (Duygudurum Bozuklukları Tanı ve İzlem Formu) ile kaydedilmiş, manik belirtilerin şiddeti YMDÖ (Young Mani Derecelendirme Ölçeği) ile, çocukluk çağı travmasının varlığı ETI (Erken Travmatik Yaşantı Envanteri) ile belirlenmiştir. EEG çekimi digital EEG cihazı ile 16 kanal olarak yapılmış, 23 adet yüzey elektrodu uluslararası 10-20 sistemine göre yerleştirilmiştir. Bulgular: İlk manik dönem iki uçlu olgular arasında epileptik EEG 2 olguda (%4), epileptik olmayan anormal EEG 10 olguda (%20.8) saptanmıştır. İlk dönem manide EEG anormalliği kadın cinsiyette daha sıktır (p=0.012). Çocukluk çağı travması, çocukluk çağı psikiyatrik hastalık öyküsü, şimdiki fiziksel hastalık eştanısı, intihar girişimi öyküsü ve birinci derece yakınlarda aile öyküsü EEG anormalliği olan grupta daha sık bulunmuştur (p= 0.016, 0.012, 0.001, 0.005 ve 0.032). Çocukluk çağı travması, regresyon analizinde ilk atak mani olgularında EEG bozukluğunun öngörücüsü olarak saptanmıştır (p= 0.004). Sonuç: Bir kısım iki uçlu olguda anormal EEG, hastalığın başlangıcından itibaren mevcuttur ve klinik özellikler ile ilişkilidir

Differences between Epilepsy Patients Under Politherapy and Epilepsy Patients Under Monotherapy

AbstractObjective: This study aimed to evaluate demographical variables, clinicalfeatures, neurological examination and cranial imaging results which cause ordetermine the necessity for politherapy treatment in epilepsy patients.Patients and Methods: The patient files of 785 epileptic patients were followedby Marmara University Epilepsy Outpatient Clinic were scanned retrospectivelyand a questionnaire was filled in for each file. Patients were grouped asmonotherapy or politherapy, considering the number of antiepileptics theyused. The demographical variables, clinical features, neurological examinationand imaging results of the two groups were compared. The results wereanalyzed by Student's-t test and chi-square tests.Results: A history of craniotomy and intracranial tumors is more frequent inpolitherapy patients. Also, simple partial seizure, convulsive status epilepticus,pathological neurological examination findings, abnormal EEG, cranialimaging (MRI/CT) and SPECT results were found to be higher in politherapypatients.Conclusion: Politherapy is an important step in epilepsy treatment. However,because of drug-drug interactions and drug side effects it is not the first choice.Determining the differences between patients who use politherapy andmonotherapy will help recognizing the clinical data which may lead topolitherapy need

Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease (CJD) is a progressive, degenerative, and fatal disease of the central nervous system. It is caused by abnormal accumulation of prion proteins and is characterized mainly by progressive dementia, myoclonus, and cerebellar, pyramidal, and extrapyramidal findings. Psychiatric symptoms may also accompany CJD and are often the first signs of the disease. The incidence of CJD is approximately 1 in 1 000 000. In certain cases, a diagnosis can be made by demonstrating the accumulation of pathological prion proteins. However, in many cultures brain biopsies or post-mortem evaluations are not welcomed by either the patients or their relatives. In these cases, the importance of additional diagnostic tools increases. Herein, we report on a CJD patient who first consulted a psychiatrist with early psychiatric symptoms. The patient developed neurological symptoms later and was subsequently diagnosed as sporadic CJD based on clinical and laboratory findings rather than brain biopsy. Repeated electroencephalograms (EEG) played a pivotal role in our evaluation of the patient. This case is an interesting presentation of CJD both because of the timing of the symptoms and because of the typical EEG findings that led to the diagnosis

Is polysomnographic examination necessary for subjects with diaphragm pathologies?

OBJECTIVES: While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated. METHODS: This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014-2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared. RESULTS: Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement. CONCLUSION: All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented