Pathophysiology and etiology of neurogenic heterotopic ossification

Neurogenic heterotopic ossification (NHO) is the formation of pathological bone tissue in the soft tissues around joints after neurological injury, where ossification is not observed normally. This condition, frequently seen in patients with spinal cord injury (SCI) and traumatic brain injury (TBI), can cause complications such as severe limitation of motion, difficulty in daily living activities, nerve compression and pressure ulcers. NHO etiopathogenesis was reviewed with current literature, to enlighten the research studies planned on treatment and the precautions to prevent it. Etiology of NHO is not completely revealed in patients with SCI and TBI, however humoral, neural, immunological and local factors probably play a role in the pathophysiology. In patients with SCI, complete lesion, immobilization, exercise, microtrauma and proprioceptive alterations may possibly take a role in NHO development. The most important risk factors for patients with TBI are: spasticity, prolongation of coma state more than 2 weeks, immobilization, fractures of long bones, limitation of range of motion, infection, and development of autonomic disregulation. However, it is not known which of the factors affect the severity and the long-term outcomes of the disease. Considering the etiopathogenesis of NHO, it is concluded that more comprehensive studies are needed to detect and prevent the risk factors before it develops, to determine the type of therapeutic exercises and the suitable timing of exercises. Turk J Phys Med Rehab 2010;56:81-7. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing

Lateral antebrakial kutanöz nöropatili bir asker: Temaruz ya da gerçek?

Introduction: Compression of the lateral antebrachial cutaneous nerve (LACN) is a rarely recognized but clearly definable syndrome. It should be taken into account in the differential diagnosis in the context of soldiers who are suspected of avoiding military duties by assuming the sick role. In this report, we describe a 23-year-old soldier who presented with avoidance of elbow extension due to a burning pain in the right forearm induced by extension. LACN neuropathy, which occurred after physical training including palm-away pull ups in the military camp and was initially suspected to be malingering, was later diagnosed according to the clinical and electrodiagnostic findings. People who are accused of malingering in military settings should be examined carefully also concerning the training-related injuries of the peripheral nervous and musculoskeletal systems. Especially for patients complaining of forearm pain that leads to inability to extend the elbow, LACN neuropathy should be considered in the differential diagnosis and confirmed by electrophysiological examination. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing

Dural Arteriovenöz Fistül (DAVF) Tedavisinde Kombine Yaklaşım: Süperselektif Embolizasyon ve Gamma Knife Radyocerrahisi

Dural arteriovenöz fistüller (DAVF) dural arterler ve venler veya sinüsler arasındaki anormal vasküler bağlantılardan oluşan lezyonlardır. Çok sayıda fistül içerebilmeleri ve venöz drenaj paternlerindeki değişiklikler tedavi kararında güçlüklere neden olabilmektedir. Biz bu yazıda sol eksternal karotid arterin orta meningeal ve oksipital dallarından dolan, önce süperselektif olarak embolize edilen ve 3 ay sonraki kontrolde oksipital besleyicilerinin rekanalize olduğu gözlenen DAVF’ li olguya ikinci kez uyguladığımız kombine süperselektif embolizasyon artı Gamma Knife tedavisini sunmaktayı

The effect of aerobic exercise program on pulmonary function and cardiorespiratory capacity in obese women

Objective: To examine the effects of a six-month aerobic exercise program on pulmonary function and cardiorespiratory capacity in obese women. Materials and Methods: A total of 50 subjects - 25 obese women who neither did regular exercise nor applied a special diet program, and 25 healthy controls - were included in the study. Body mass index (BMI), maximum oxygen consumption (VO2max) and pulmonary function tests (PFT) values were measured as evaluation parameters in both groups. Obese women were enrolled to a supervised hospital-based bicycle aerobic exercise program for six months at an individualized target heart rate range (50-85% of heart reserve), with an increasing frequency and duration. Evaluation parameters were reevaluated after the exercise program and were compared with the pre-exercise values. Results: VO2max, forced vital capacity (FVC), forced expiratory volume at first second (FEV1), FEV1/FVC, and maximum mid-expiratory flow rate (FEF25-75) were significantly lower in obese women (p<0.05). There was a statistically significant decrease at BMI and statistically significant increase at VO2max, FEV1, FEV1/FVC, and FEF25-75 among obese women after completing the 6-month exercise program. Conclusion: It was shown that obese women had lower cardiopulmonary capacity and PFTs when compared to non-obese ones and, aerobic exercise could improve cardiopulmonary capacity and PFTs in obese women. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing

Hetastarch and Hetastarch + 7.2% NaCl solution in the treatment of hypovolemic diarrheic calves

Objective. In this study, it was aimed to compare the effectiveness of Hydroxyethyl Starch (HTS), HTS +7.2% NaCl combination and Ringer Lactate solutions in the treatment of hypovolemic calves with diarrhea. Materials and methods. A total of 21 holstein calves (12 female, 9 male, weighted 28-52 kg), at the age of 0-30 days, were enrolled in the present study. The calves were randomly divided into 3 groups. Calves in the first group received HTS (10 mL / kg), calves in the second group received Hydroxyethyl starch + 7.2% NaCl combination (4 mL/kg) and calves in the third group were treated with lactated Ringer’s solution (32 mL/kg) intravenously. Calves in each group were administered with oral rehydration solution immediately, and at 8th and 16th hours after intravenous applications. Clinical examinations and laboratory findings were obtained at 0 hour, 30th minutes, 1st, 2nd, 4th, 12th and 24th hours respectively. Results. Calves in all groups achieved clinical remission with a positive response to treatment and there was no statistically significant difference in the vast majority of the variables examined, although dehydration, capillary refill time, mental status and pulse quality were better in hydroxyethyl starch group and especially in hydroxyethyl starch + 7.2% NaCl group than those of Ringer’s lactate group (p<0.05). Conclusions. In the present study, treatment of hypovolemic calves with diarrhea especially with Hydroxyethyl starch and Hydroxyethyl starch + 7.2% NaCl combination along with oral fluid therapy with the electrolyte solution was considered to be practical and effective Objetivo. En este estudio, que tuvo como objetivo comparar la eficacia de hidroxietil almidón (HEM), HEM + 7.2% en combinación con NaCl y soluciones lactato de Ringer en el tratamiento de los terneros hipovolémicos con diarrea. Materiales y métodos. Un total de 21 terneros Holstein (12 hembras, 9 machos, con pesos entre 28-52 kg) y edad de 0-30 días, fueron consideradas en el presente estudio. Los terneros fueron divididos aleatoriamente en 3 grupos. Terneros en el primer grupo recibieron HEM (10 ml/kg), los terneros en el segundo grupo recibieron almidón + combinación hidroxietil 7.2% de NaCl (4 ml/kg) y terneros en el tercer grupo fueron tratados con solución lactato de Ringer (32 ml/kg) por vía intravenosa. A los terneros en cada grupo se les administró Rev.MVZ Córdoba 21(2):5316-5327, 2016. ISSN: 0122-0268 ORIGINAL 5317 solución de rehidratación oral inmediatamente después, y las ocho y a las 16 horas después de las aplicaciones intravenosas. Los exámenes clínicos y de laboratorio se obtuvieron a las 0 h, 30 minutos, 1, 2, 4, 12 y 24 de horas respectivamente. Resultados. Los terneros en todos los grupos alcanzaron la remisión clínica con una respuesta positiva al tratamiento y no hubo diferencia estadísticamente significativa en la mayoría de las variables examinadas; a pesar de la deshidratación, el tiempo de llenado capilar, el estado mental y la calidad de pulso fueron mejores en el grupo tratado con hidroxietil almidón y especialmente en hidroxietil almidón + 7.2% NaCl que los del grupo de lactato de Ringer (p<0.05). Conclusiones. En el presente estudio, el tratamiento de los terneros con diarrea hipovolémicos especialmente con hidroxietil almidón y almidón + 7.2% NaCl combinación hidroxietil junto con la terapia de fluido oral con la solución de electrolito fue considerado práctico y eficaz.

The reliability and interobserver reproducibility of T2/FLAIR mismatch in the diagnosis of IDH-mutant astrocytomas

PURPOSE:The reliability and reproducibility of T2-weighted imaging/ fluid-attenuated inversion recovery (T2/FLAIR) mismatch were investigated in the diagnosis of isocitrate dehydrogenase (IDH) mutant astrocytoma between WHO grade II and III diffuse hemispheric gliomas.METHODS:WHO grade II and grade III diffuse hemispheric gliomas (n=133) treated in our institute were included in the study. Pathological findings and molecular markers of the cases were reviewed with the criteria of WHO 2016. The finding of mismatch between T2-weighted and FLAIR images in preoperative magnetic resonance imaging (MRI) of the cases was evaluated by two different radiologists. The readers reviewed MRIs independently, blinded to the histopathologic diagnosis or molecular subset of tumors. The cases were classified as IDH-mutant astrocytoma, oligodendroglioma and IDH-wildtype (IDH-wt) astrocytoma according to molecular and genetic features.RESULTS:T2/FLAIR mismatch positivity was observed in 46 patients (34.6%). T2/FLAIR mismatch positivity was observed in 42 of 75 IDH-mutant astrocytomas (56%) and 4 of 43 oligodendrogliomas (9.30%), while it was not seen among IDH-wt astrocytomas (0/15, 0%). The T2/FLAIR mismatch ratio was significantly different between IDH-mutant astrocytomas (WHO grade II and grade III) and oligodendrogliomas (chi-square, p <0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T2/FLAIR mismatch in predicting IDH-mutant astrocytomas were 58.7%, 90.7%, 91.7%, 61.4%, and 70.3% respectively. Radiologist 1 diagnosed T2/FLAIR mismatch in 48 of 133 cases (36.1%) and Radiologist 2 in 66 of 133 cases (49.6%). The interrater agreement for the T2/FLAIR mismatch sign was 0.61 (p <0.05), 95% CI (0.55, 0.67).CONCLUSION:T2/FLAIR mismatch appears to be an important MRI finding in distinguishing IDH-mutant astrocytomas from other diffuse hemispheric gliomas. However, it should be kept in mind that T2/FLAIR mismatch sign can be seen in a minority of oligodendrogliomas besides IDH-mutant astrocytomas

Neurogenic bladder in patients with traumatic spinal cord injury: Treatment and follow-up

Study design:Multi-center, cross-sectional study.Objectives:Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire.Setting: Turkey.Methods:Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management.Results:The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization ( IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation ( P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders ( P>0.05). The most common anticholinergic drug used was oxybutynin ( 40.3%), followed by trospium ( 32.6%), tolterodine ( 19.3%) darifenacin ( 3.3%), propiverine ( 3.3%) and solifenacin ( 1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists ( 76.2%), urologists ( 22.1%) and neurologists ( 1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients ( 77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital ( 15.3%) and monetary problems ( 7.7%). Of the patients, 42.7% did not experience urinary tract infections ( UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ≥3 clinical UTIs. The clinical characteristics of patients with and without UTI ( at least one symptomatic UTI during 1 year) were similar ( P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques ( P>0.05).Conclusion:The most frequently used technique for bladder rehabilitation in patients with SCI was IC ( 77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs. © 2014 International Spinal Cord Society

Intermittent catheterization in patients with traumatic spinal cord injury: Obstacles, worries, level of satisfaction

Objectives: The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. Methods: Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. Results: In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. Conclusion: In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization. © 2014 International Spinal Cord Society All rights reserved

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

Determination of The Effect of Using Gamma Irradiated and Enzyme Added Wheat and Barley in Layer Diets on The İntestinal Viscosity, Micro Flora and Radioactive Contamination of Eggs

In this study, the effect of using gamma irradiated barley and wheat (0, 10 and 100 kGy) and enzyme supplementation on the intestinal viscosity, micro flora and radioactive contamination of eggs was examined. In this experiment 36 weeks old, 324 Brown Nick laying hens were used for ten weeks. The study was a randomized complete block design with 9 dietary treatments within 6 blocks of 54 pens each 6 birds per pen. Intestinal micro flora was unaffected by the treatments. Intestinal viscosity was significantly decreased in wheat fed birds, especially 100 kGy gamma irradiation. The intestinal micro flora examined in the experiment was not significantly affected by gamma irradiation and enzyme supplementation. There was no observed radioactive contamination both in feeds and eggs under 10 and 100 kGy gamma irradiation of barley and wheat