Idiopathic hypertonicity as a cause of stiffness after surgery for developmental dysplasia of the hip

AbstractINTRODUCTIONThere are various complications reported with surgical treatment of DDH. Most studied complication is avascular necrosis of the femoral head and hip stiffness. The purpose of this report was to describe a case with severe stiffness of the hip due to hypertonicity in periarticular muscles after it was treated for developmental dysplasia of the hip (DDH).PRESENTATION OF CASEThree-year-old patient referred to our institution with bilateral DDH. Two hips were operated separately in one year with anterior open reduction, femoral shortening osteotomy. Third month after last surgery, limited right hip range of motion and limb length discrepency identified. Clinical examination revealed that patient had limited range of motion (ROM) in the right hip and compensated this with pelvis obliquity. Gluteus medius, sartorius and iliofemoral band release performed after examination under general anesthesia. Symptoms were persisted at 3rd week control and examination of the patient in general anesthesia revealed full ROM without increased tension. For the identified hypertonicity, ultrasound guided 100IU botulinum toxin A injection performed to abductor group and iliopsoas muscles. Fifth month later, no flexor or abductor tension observed, and there was no pelvic obliquity.DISCUSSIONStiffness as a complication is rare and is usually resolved without treatment or simple physical therapy. Usually it is related with immobilization or surgery associated joint contracture, and spontaneous recovery reported. Presented case is diagnosed as hip stiffness due to underlying local hypertonicity. That is resolved with anesthesia and it was treated after using botulinum toxin A injection.CONCLUSIONHypertonicity with hip stiffness after surgical treatment of DDH differ from spontaneous recovering hip range of motion limitation and treatment can only be achieved by reduction of the muscle hypertonicity by neuromuscular junction blockage

The culture of popular sports and religionPopüler spor kültürü ve din

Sport and religion had different definitions throughout the history. Roots of sport and religion phenomenon are as old as history of humanity, when common ground is searched.  Sport has a changing relationship with religion along the history and according to data of sport history, sport has an aspect comes from religion. Relation between sport and religion has continued in different periods, while in modern times this relation has become a contradiction. This study, which has themed Popular Sport Culture and Religion, investigates effects of popular culture, religion and sport on doing exercises. Relationship between ‘’ exercise for healthy life’’ phenomenon and tendency of being religious phenomenon which are ever-mounting in community has presented as descriptive in this applied research study. Universe of study is composed of people who are making sport/exercise for healthy life in Konya and 197 male, 112 female attendants are reached. Research findings has interpreted as statistically. Positive relationships and significant discrepancies has found between popular sport/exercise culture and piety, according to gained data.Extended English abstract is in the end of PDF (TURKISH) file. ÖzetTarih boyunca spor ve din çeşitli tanımlamalara konu olmuştur. Bu tanımlamaların ortak noktasına bakıldığında; spor ve din olgularının kökleri insanlık tarihi kadar eskidir. Spor tarihinin verilerine göre kökeninde dinsel bir yan bulunduğu sporun, tarih boyunca din ile değişen bir ilişkisi olmuştur. Çeşitli dönemlerde din ve spor ilişkisi birlikteliğini devam ettirirken, modern zamanlarda arasındaki ilişki neredeyse bir karşıtlık ilişkisi şeklinde düşünüle gelmiştir.  Popüler Spor Kültürü ve Din konulu bu çalışma, günümüzde popüler kültürün, din ve spor/egzersiz yapmaya etkilerini araştırmaktadır. Uygulamalı bir araştırma olan çalışmada, toplumda gittikçe yaygınlaşan ‘sağlıklı yaşam için egzersiz’ yapma ile gittikçe artan dindarlaşma eğilimi arasındaki ilişki betimsel olarak ortaya konulmuştur. Bu araştırmanın evrenini, Konya’da sağlıklı yaşam için spor/egersiz yapan insanlar oluşturmuş ve 197 erkek, 112 kadın katılımcıya ulaşılmıştır.  Elde edilen araştırma bulguları istatistiksel olarak yorumlanmıştır.  Elde edilen bulgulardan hareketle, popüler spor/egzersiz kültürü ile dindarlık göstergeleri arasında olumlu ilişkiler ve anlamlı farklılıklar bulgulanmıştır

Treatment of adolescent idiopathic scoliosis with global (ROD) derotation maneuver using pedicle screws

Introduction: Adolescent idiopathic scoliosis is a three dimensional deformity. For the treatment of deformity, nature of deformity should be well understood and treatment strategy has to be directed to the coronal, sagittal and axial components of deformity. Global Derotation (GD) maneuver is based on simple rod derotation from concave side aiming to correct the deformity on coronal, sagittal and axial profile. In this report we reviewed AIS surgery results treated by global derotation maneuver with all pedicle screw instrumentation.Material& Methods: Between 2003 and 2011, 253 patients had been operated using GD technique.80 of 253 patients was included to our study. The patients routinely evaluated with preoperative-postoperative and last follow up standing ortho-x-rays. Coronal and sagittal profile parameters measured on x-rays with digital software using Cobb method. Rotational component of the deformity was measured according to Nash-Moe method at the apical vertebra.Results: 80 patients (71 female ; 9 male)had been followed up average 19,8 (7-37) months. Patients age average were 15,1(12-21) at operation date. Coronal cobb angle measure in thoracic curves preoperative were 48,9° decreased to mean 3,2° postoperatively. The mean coronal thoracolumbar curve were 45,8° preoperatively and decreased to mean 2°. Apical vertebra rotation measure regressed to mean 0,68 (0-1). Thoracic kyphosis showed downward tendency from mean 37,8° to mean 27,8°.Conclusion: Rod derotation technique enable to correct coronal and axial profile. Coronal Cobb angle improvement seen obviously with correction of axial profile rotation. Sagittal hypokyphotic effect of GD should be kept in mind

Serumske razine prolaktina u diferencijalnoj dijagnostici pedijatrijskih epileptičnih i neepileptičnih (pseudo-)napadaja

The aim was to determine diagnostic value of serum prolactin levels in the diff erential diagnosis of epileptic and nonepileptic seizures in children. The study included 100 patients aged one month to 18 years, admitted to the hospital for seizure complaints. All patients underwent electroencephalography in the postictal period and their serum prolactin levels were measured at 10 min and 60 min of the postictal period. The mean 10-min serum prolactin level was 37.1±20.09 ng/mL and 16±14.59 ng/mL (p<0.01) in patients with epileptic and nonepileptic seizures, respectively. After grouping of patients with nonepileptic seizures, the mean 10-min serum prolactin level in patients with epileptic seizures and those with syncope was 37.1±20.09 ng/mL and 30.52±19.21 ng/mL (p>0.05), respectively. The mean 10-min prolactin level in patients with epileptic seizures and those with non-syncope epileptic seizures (night terror, conversion and breath holding spells) was 37.1±20.09 ng/mL and 10.9±5.95 ng/mL (p<0.01), respectively. In conclusion, serum prolactin level in the postictal period is an important marker in the diff erential diagnosis of epileptic and nonepileptic seizures. There was no signifi cant diff erence between serum prolactin levels in the diff erential diagnosis of epileptic seizures and syncope, but it had an important role in diff erentiating nonepileptic cases such as breath holding spells, night terror and hysterical conversions from epileptic seizures and syncope.Cilj ovoga ispitivanja bio je utvrditi dijagnostičku vrijednost serumskih razina prolaktina u diferencijalnoj dijagnostici epileptičnih i neepileptičnih napadaja u djece. U ispitivanje je bilo uključeno 100 djece u dobi od jednog mjeseca do 18 godina, primljenih u bolnicu zbog konvulzija. U svih bolesnika učinjena je elektroencefalografi ja u postiktalnom razdoblju, dok su njihove serumske razine prolaktina mjerene u 10. i 60. minuti postiktalnog razdoblja. Srednja 10-minutna razina prolaktina u serumu bila je 37,1±20,09 ng/mL i 16±14,59 ng/mL (p<0,01) u bolesnika s epileptičnim odnosno neepileptičnim napadajima. Nakon grupiranja bolesnika s neepileptičnim napadajima 10-minutna srednja serumska razina prolaktina u bolesnika s epileptičnim napadajima i onih sa sinkopom bila je 37,1±20,09 ng/mL odnosno 30,52±19,21 ng/mL (p>0,05). U bolesnika s epileptičnim napadajima i onih s ne-sinkopnim epileptičnim napadajima (noćne more, konverzija i epizode zadržavanja daha) srednja 10-minutna razina prolaktina bila je 37,1±20,09 ng/mL odnosno 10,9±5,95 ng/mL (p<0,01). Zaključuje se kako je serumska razina prolaktina u postiktalnom razdoblju važan biljeg u diferencijalnoj dijagnostici epileptičnih i neepileptičnih napadaja. Nije bilo značajne razlike među serumskim razinama prolaktina u diferencijalnoj dijagnostici epileptičnih napadaja i sinkope, ali je ta razina imala važnu ulogu u razlikovanju neepileptičnih slučajeva kao što su epizode zadržavanja daha, noćne more i histerične konverzije od epileptičnih napadaja i sinkope

Urodynamic findings of multiple sclerosis patients at a single institution

Aim: Multiple sclerosis (MS) is a chronic and progressive disease of the central nervous system (CNS). The destructive effect of MS on the urogenital system has been demonstrated in many studies especially in young adults. Urodynamic evaluation is recommended in the diagnosis of urogenital system pathologies for MS patients. Unfortunately, there are not enough studies evaluating the urodynamic examinations of MS patients in our country. In this study, urodynamic findings of patients with MS were evaluated. Material and Method: A total of 58 patients (39 female and 19 male) were included in the study. The urodynamic findings of the patients in the same center between January 2011 and October 2017 were evaluated retrospectively. Urodynamic evaluation was performed with 20 ml of infusion per minute according to the International Continence Society standards. Results: The mean age of the patients was 47.4 +/- 8.8 years. The mean duration of multiple sclerosis was 11.8 +/- 7.4 years. When the features of multiple sclerosis were evaluated, 13 (22.4%) patients had a progressive type, 20 (34.5%) had a secondary progressive type, and 25 (43.1%) had relapsing-remitting (with relapses and remissions). The urodynamic findings of the patients are shown in Table 1. Urodynamic evaluations of patients with urinary incontinence are reported as 'Urge type urinary incontinence' was observed in 30 (83.3%), 'stress type urinary incontinence' in 5 (13.9%) and 'mixed type urinary incontinence' in 1 (2.8%) patient. Discussion: Multiple sclerosis is a common neurological pathology which has different urinary system findings. Detrusor overactivity is the most common urinary manifestation, and patients may also have impaired contractility, detrusor sphincter dyssynergia, urodynamic stress incontinence, and bladder outlet obstruction

COMPARATIVE STUDY ON THE EVALUATION OF TEMPOROMANDIBULAR JOINT AND NECK STRUCTURES IN HEALTHY VOLUNTEERS AND IDIOPATHIC SCOLIOSIS PATIENTS

Objective: The aim of this study was to investigate the correlation of temporomandibular joint disorders (TMD) and neck structure changes in adolescents with idiopathic scoliosis (IS) by clinical examination. Material and Methods: The study included 51 patients affected by IS (24 males,27 females; mean age: 13.5± 2.1 years) selected using simple random sampling, and a healthy control group of 50 subjects (23 males, 27 females; mean age: 14.5± 2.3 years). The Diagnostic Criteria for Temporomandibular Disorders: Clinical Protocol and Assessment Instruments (DC/TMD) form was utilized to assess the signs and symptoms of TMD in the subjects. For the evaluation of neck structures,masseter and temporalis muscles, pressure pain threshold (PPT) values were measured with a hand-held pressure algometer.Obtained data were analyzed statistically applying Mann-Whitney U test, Wilcoxon, and chi-squared tests with a significance level of 0.05. Results: According to the DC/TMD form, the following parameters showed statistically significant differences between the groups (p≤0.001): presence of TMD, temporal headache, midline deviation, and right and left lateral movements. The PPT values were higher in the control group compared with the study group (p<0.001). Additionally, the type of pain-related TMD identified in the subjects was myalgia. The myalgia was significantly (p<0.001) higher in the study group (68.6%) than in the control group (22%). Conclusion: This study concluded that spinal diseases which cause postural changes, like IS, in the head and shoulder region are associated with muscle adaptation and alterations in the temporomandibular joint area

Perspectives of Young Otolaryngologists on Pediatric ENT and the Future of the Field in Turkey

Objective: The purpose of this study was to examine the current status and the future of pediatric otolaryngology in Turkey by evaluating the opinions of young otolaryngologists on pediatric otolaryngology.Methods: The study included 224 otolaryngology physicians who were senior residents registered with the Turkish Otolaryngology and Head-Neck Surgery Association (TORL-HNS). The physicians were in their last two years of otolaryngology training (154 physicians) or had completed their residency training and were in their first year of otolaryngology practice (70 physicians). They were approached via e-mail and Short Message Service (SMS) in October through December 2019 with a descriptive letter and asked to voluntarily complete an online questionnaire consisting of total 25 questions in five sections.Results: The online questionnaire was sent to 224 physicians, and 109 (49%) participated in the survey. All 109 participants answered all the questions. Overall, 71 participants (65.1%) were in training for residency and 38 (34.9%) were in their first year of expertise. According to their professional interests, the participants listed rhinology (45 participants, 41.3%), head and neck surgery (27 participants, 24.8%), facial plastic surgery (19 participants, 17%), otology-neurotology (16 participants, 14.7%), and laryngology-phoniatry (2 participants, 1.8%) as their first preference for subspecialty. Pediatric otolaryngology was never a first choice among the participants, although four (3.7%) listed pediatric otolaryngology as their second preference.Conclusion: The aim of this study was to shed light on the current and future status of pediatric otolaryngology in Turkey. We believe the establishment of exclusive pediatric otolaryngology clinics under the umbrella of general ear, nose and throat (ENT) clinics and the foundation of officially approved fellowship programs would bring this subspecialty field to its deserved and desired level in our country

Lumbar dynamic stabilization with 2-stage surgery: early results

Background: Screw loosening, which is a major problem in dynamic systems, can be easily overcome with 2-stage surgery. In this article, the clinical and radiological results of patients undergoing dynamic stabilization with a Dynesys device in 2 stages are discussed. Methods: A total of 10 male and 13 female adult patients were included in this single-center retrospective study conducted between 2018 and 2021. The mean age of the patients was 65.6 years. All of the patients had pain complaints that affected their daily lives. Bone density T scores were determined with the dual-energy x-ray absorptiometry method before patients were admitted for surgery. In the first surgery, Dynesys system pedicle screws were inserted. After 6 months of osteointegration, Dynesys system spacers and elastic bandages were placed. Preoperative, early postoperative, and late postoperative visual analog pain scale (VAS) scores and Oswestry Disability Index (ODI) scores were determined and statistically compared. Results: Patients were followed for an average of 30 months. Complications and recurrence were not observed. Neurological deficits were not observed after patients recovered from anesthesia. Significant improvement was observed in the ODI and VAS parameters in the preoperative (ODI: 66.2%, VAS: 7.8), early postoperative (ODI: 20.3%, VAS: 2.4), and late postoperative (ODI: 6.8% and VAS: 1.1) periods. Symptomatic improvement was seen in all patients. No screw breakage or loosening was detected by radiological evaluation in any of the patients during the 2-year follow-up period. Conclusions: In our experience, the insufficiency of the proximal and distal end screws is eliminated when 2 stages of dynamic system stabilizations are completed after osteointegration of the screws

Comparisons between ultrasonographic screening results and risk factors of developmental dysplasia of the hip

Amaç: Çalışmamızın amacı ultrasonografik taramanın seçilmiş hastalarda mı (risk faktörleri ya da muayene bulguları olan) ya da genel popülasyon üzerinde mi yapılması gerektiğini değerlendirmektir. Gereç ve Yöntem: Kliniğimize 2010-2012 gelişimsel kalça displazisi (GKD) taraması amacıyla başvuran 634 bebek çalışmaya dâhil edildi. Risk faktörleri olarak aile öyküsü, makat gelişi, tortikollis, ilk gebelik, oligohidramniyos, çarpık ayak, kız cinsiyet olarak belirlendi. Graf metodu ile yenidoğan kalçaları taranarak, hastalardaki risk faktörleri ve klinik muayene bulguları istatistiksel olarak duyarlılık ve özgüllük açısından karşılaştırıldı. Bulgular: Çalışmaya alınan 634 bebeğin 403'ü kız, 231'i erkekti. Hastaların ortalama yaşı 87,45±49,6 gündü. Ortalama anne yaşı 29,6±5,4 yıldı. Ultrasonografik tarama sonucunda 66 bebeğin 71 kalçası displazik bulundu. Bu kalçalardan 30'u Tip 2b, 8 kalça Tip 2c, 3 kalça Tip d, 23 kalça Tip 3, 7 kalça Tip 4 olarak tespit edildi. Sonuç: Çalışmamızda klinik bulguların GKD taraması açısından yeterli olmadığı sonucuna ulaşılmıştır. Bu nedenle de özellikle ülkemiz gibi GKD prevelansının sık görüldüğü ülkelerde seçilmiş hastalara ultrasonografik tarama yapmaktansa tüm popülasyonun ultrasonografik taramasının yapılması gerektiği düşüncesindeyiz.Objective: The aim of the study is to evaluate the efficacy of ultrasonographic screening in general population and selected patients (who had risk factors or clinical findings) for developmental dysplasia of the hip (DDH).Material and Methods: 634 babies who had been admittted to our clinic between 2010 and 2012 were included in the study. Family history, breech presentation, torticollis, first child, oligohydramnios, club foot, and female gender were accepted as risk factors. The newborns patients were evaluated with Graf method. Risk factors and clinical findings of the patients were compared with these results for sensitivity and specificity. Results: 403 patients were female and 231 patients were male. The mean age of the patients were 87.45&plusmn;49.6 days and the mean maternal age was 29.6&plusmn;5.4 years. In the screeening of the patients 66 babies with 71 hips were dysplasic (30 hips Type 2b, 8 hips Type 2c, 3 hips Type d, 23 hips Type 3, and 7 hips Type 4).Conclusion: According to our study, clinical examination of the patients is not sufficient for the screening of the babies for DDH. We think that the ultrasonographic screening of the babies for DDH is recommended for general population of high risk countries like Turkey