SAPHO syndrome with adrenal deficiency: a case report

Introduction: The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteomyelitis) is a rare painful disorder, usually with a good long-term prognosis. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. Case presentation: A 46-year-old Caucasian female was referred for anterior chest wall and back pain. Physical examination was unremarkable except for skin lesions noted on soles of both feet, extremities and the face. A thoracic magnetic resonance imaging study demonstrated a lesion characterized with bone marrow edema and proliferation of soft tissue in the sternum. A brain MRI was requested secondary to the elevated prolactin level which was compatible with empty sella syndrome. Conclusion: The case presented here has the unique feature of adrenal deficiency presenting alongside the SAPHO syndrome and is presented as the first case reported. This syndrome could become complicated with different organ system involvement other than bone and skin. There is a need further studies that will explore the weak relationship between SAPHO syndrome and adrenal deficiency. © 2009 Eyigör et al.; licensee Cases Network Ltd

Diz osteoartriti olan yaşlı hastaların ev egzersiz tedavisine uyumu

Objectives: This study aims to evaluate the compliance to home-based exercise regimen by elderly patients with osteoarthritis of the knee. Patients and methods: Between May 2012 and May 2013 year, a total of 72 patients (54 females, 18 males) over 65 years old with knee osteoarthritis admitted to the Physical Medicine and Rehabilitation outpatient clinic were included in the study. The patients were given a home-based exercise program. They were recommended to perform the exercises 10 times twice a day, for a month. We evaluated the patients’ demographic data, comorbid diseases, whether they exercised previously and compliance to exercise. Results: All patients’ home exercise program compliance was 62.5%. Males were more compliant than female patients and high education and comorbidity were also associated with poor compliance. Conclusion: The compliance of the geriatric patients to home-based exercise program is difficult and multiple variables affect the compliance

LIMPRINT study - the Turkish experience

Background: Lymphedema and chronic oedema is a major healthcare problem in both developed and non-developed countries The LIMPRINT study is an international health service based study to determine the prevalence and functional impact in adult populations of member countries of the International Lymphoedema Framework (ILF). Methods: 1051 patients from 8 centers in Turkey were recruited using the LIMPRINT study protocol. Data were collected using the core and module tools which assess the demographic and clinical properties as well as disability and QoL. Results: Most of the Turkish patients were recruited from specialist lymphedema services and were found to be female, housewives and having secondary lymphedema due to cancer treatment. The duration of lymphedema was commonly less than 5 years and most of them had ISL Grade 2 lymphedema. Cellulitis, infection and wounds were uncommon. The majority of patients did not get any treatment or advice before. Most of the patients had impaired QoL and decreased functionality, but psychological support was neglected. Although most had social health security access to Lymphedema centres nevertheless access seemed difficult due to distance and cost. Conclusion: The study has shown the current status and characteristics of lymphedema patients, treatment conditions, the unmet need for the diagnosis and treatment as well as burden of the disease in both patients and families in Turkey. National health policies are needed for the prevention, diagnosis and treatment in Turkey that utilise this informative data

Necessity of palliative care in the intensive care

The number of individuals with serious or life-threatening diseases is gradually increasing because of the aging population and technologies that enable longer life expectancy. Palliative care programs are developed in order to improve quality of life during the course of these diseases. In palliative care, service is provided by experienced and educated healthcare personnel and a team of volunteers, and in hospital, first line treatment environment, house or hospices, depending on the conditions of each country. Intensive care units (ICUs) are unique environments where patients with critical condition receive rapid and aggressive life-saving interventions. In developed countries physical therapy and rehabilitation programs are integrated parts of intensive care units in many hospitals. Considering patient needs and complications in intensive care units, the importance of improving patients’ quality of life emerges as an issue to be kept in mind. Physical therapy and rehabilitation programs aim to maintain optimum respiratory and circulatory function in these patients, prevent muscular atrophy, muscular problems and joint contractures, control pain, optimize functioning and independency, educate patients and enable the participation of the caregiver. Physical therapy and rehabilitation specialists, physiotherapists and occupational therapies work together in a multidisciplinary palliative care team in order to increase patients’ mobility, independency and quality of life. Unfortunately it is observed that physical therapy and rehabilitation programs are largely ignored during the distribution of palliative care resources and that necessary transfer of funds is not provided. In this study we aim to highlight the role, necessity and benefit of rehabilitation, one of the important components of palliative care, in intensive care units.Yaşlanan popülasyon ve yaşam süresinin artmasını sağlayan teknolojiler nedeniyle ciddi veya yaşamı tehdit edici hastalıklara sahip bireylerin sayısı giderek artmaktadır. Bu hastalıklar sırasında yaşam kalitesini arttırmak için artan bir şekilde palyatif bakım programları geliştirilmektedir. Palyatif bakımda hizmet, deneyimli ve eğitimli sağlık personeli ve gönüllülerden oluşan bir ekip tarafından sunulmakta ve her ülkenin kendi koşulları içerisinde; hastane ortamında, birinci basamak sağlık alanlarında, ev ortamında ve son dönem evleri veya hospislerde verilmektedir. Yoğun bakım üniteleri, kritik hastaların hızlı ve hayat kurtarıcı müdahaleler aldığı özgün bakım ortamlarıdır. Fizik tedavi ve rehabilitasyon programları gelişmiş ülkelerde pek çok hastanede yoğun bakım ünitelerine entegre olmuş bir bölüm olarak yer almaktadır. Yoğun bakım ünitelerinde hastaların ihtiyaçları ve komplikasyonları göz önünde bulundurulduğunda, bu hastaların yaşam kalitelerinin iyileştirilmesinin önemi akılda tutulması geren bir durum olmalıdır. Fizik tedavi ve rehabilitasyon programları ile hastalardaki optimum respiratuar ve sirkulatuar fonksiyonun sürdürülmesi, kas atrofisi ve kas kısalmasının, eklem kontraktürlerinin önlenmesi, ağrının kontrol edilmesi ve giderilmesi, fonksiyonun ve bağımsızlığın optimize hale getirilmesi, hastaların eğitimi ve bakıcının katılımı hedeflenmektedir. Fizik tedavi ve rehabilitasyon uzmanları, fizyoterapistler ve iş-uğraşı terapistleri multidisipliner palyatif bakım ekibi içerisinde hastaların mobilitesinin, bağımsızlığının ve yaşam kalitesinin arttırılmasına yardımcı olmak için birlikte çalışmaktadırlar. Maalesef palyatif bakım kaynaklarının dağıtımı sırasında fizyoterapi ve rehabilitasyon olasılıklarının yüksek oranda göz ardı edilmekte olduğu ve gerekli kaynak aktarımının yeterince yapılmadığı gözlenmektedir. Biz bu yazımızda palyatif bakımın önemli bir bileşeni olan rehabilitasyonun, yoğun bakım ünitesindeki rolünü, gerekliliğini ve sağladığı faydanın vurgulanması amaçlamaktayız

Nöropatik ağrı açısından fibromyalji sendromu

Fibromyalgia Syndrome from the Perspective of Neuropathic Pain Fibromyalgia syndrome (FMS) is one of the several chronic pain syndromes and have been proposed to reflect some primary abnormality of the nervous system. Patients with FMS display common clinical features with neuropathic pain. the responsible mechanisms for symptoms and signs are still unknown. Mounting evidence was shown for central pain processing abnormalities in almost all FMS patients. These anomalies including hyperalgesia, allodynia, abnormal activation of pain-related brain regions and abnormal temporal summation of second pain in FMS patients strongly indicate a neuropathic pain syndrome. This new information led to the proposal that FMS may be a neuropathic pain syndrome maintained by central nervous system sensitization and sympathetic hyperactivity. This different perspective on FMS opens new avenues for research and treatment. in this review, a synthesis of the information about how FMS is related to neuropathic pain syndromes is provided.Klinik kullanımda lehte sonuçları olmasına rağmen, migren tedavisinde büyük oksipital sinir bloğunun (GON) etkisine dair az sayıda kanıt bulunmaktadır. Bir ön çalışmayla migren ataklarının önlenmesinde % 0,5 Fibromyalji sendromu (FMS), sinir sistemindeki primer anormalliklerin kliniğe yansıması ile karşımıza çıkan kronik ağrı sendromlarından biridir. FMS’lu hastalar, nöropatik ağrının yaygın klinik özelliklerini göstermektedirler. Bu semptom ve bulguları açıklayacak mekanizma halen anlaşılmış değildir. Santral ağrının hiperaljezi, allodini, ağrı ilişkili beyin bölgelerinin anormal aktivasyonu, anormal temporal sumasyon gibi nöropatik ağrı sendromu konusunda güçlü kanıtlara neden olan bir takım anormallikleri, FMS’lu hastaların çoğunda gözlenmektedir. Bu yeni bilgiler, santral sinir sisteminde sensitizasyon ve sempatik hiperaktiviteyle ilişkili, FMS’unun nöropatik ağrı sendromu olabileceğini düşündürmektedir. Bu farklı bakış açısı, tedavi ve çalışmalar için yeni kapılar açılmasına neden olmaktadır. Bu derlemede, FMS’unun nasıl nöropatik ağrı sendromu ile ilişkilendirildiğine dair bilgilerin sentezi yapılacaktır