Kör omuz enjeksiyonu yapmaya devam etmeli miyiz?

Objectives: This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain.Patients and methods: The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intraarticular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS).Results: According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients' preparation time were 0.8 minutes and 4.2 minutes, respectively.Conclusion: Although blind intra-articular shoulder injections are inexpensive and easily applicable, injections should be performed under fluoroscopy or another guide to ensure that the needle is intra-articular, not peri-articular.Amaç: Bu çalışmada omuz ağrısı olan hastalarda kör ve floroskopi rehberli eklem içi omuz enjeksiyonlarının doğruluğu ve etkinliği araştırıldı.Hastalar ve yöntemler: Çalışmaya üç aydan uzun süredir omuz ağrısı olan 17 hasta (6 erkek, 11 kadın; ort. yaş 52.6±9.9 yıl; dağılım 36-66 yıl) dahil edildi. İlk eklem içi enjeksiyonlar ön yaklaşım ile kör olarak uygulandı. Enjeksiyon sonrası iğne ucunun eklem içerisinde olduğu floroskopi ve kontrast dağılımı ile doğrulandıktan sonra işlem 3 mL lokal anestezik (prilokain ve bupivakain) ve 1 mL steroid (40 mg metilprednizolon) ile tamamlandı. İlk uygulamada kontrast dağılımının eklem dışı olduğu gözlendiğinde, ikinci enjeksiyona floroskopi eşliğinde devam edildi. İşlemin devam ettirilmesi ile tüm enjeksiyonlar eklem içi oldu. Ağrı yoğunluğu görsel analog ölçeği (GAÖ) ile ölçüldü.Bulgular: Floroskopi ile bakılan kontrast dağılımına göre, 17 omzun 11'inde (%64.7) birinci kör enjeksiyonlar eklem içi idi. Başlangıç GAÖ skoru ortalaması 7.11 idi. Klinik takiplerde birinci saatte (ortalama GAÖ: 2.35), üçüncü günde (ortalama GAÖ: 2.64) ve birinci ayın sonunda (ortalama GAÖ: 2.23) ağrıda iyileşme gözlendi. Kör ve floroskopi rehberli uygulama için hasta hazırlanma süresi dışındaki ortalama süre sırasıyla 0.8 dakika ve 4.2 dakika idi.Sonuç: Kör eklem içi omuz enjeksiyonları ucuz ve kolay uygulanabilir olsa da iğnenin eklem çevresinde değil eklem içinde olduğundan emin olmak için enjeksiyonlar floroskopi ya da başka bir rehber eşliğinde yapılmalıdır

F-18-Fdg Pet/Ct Findings in Differentiated Papillary Carcinoma of Thyroid and Determination of Metabolic Activity

DergiPark: 379076tmsjAims: In well differentiated thyroid cancers, FDG PET has a relatively low sensitivity. F-18 FDG PET/CT is an imaging method which is used before the treatment and in high risk patient groups with suspected recurrent disease. In this study we aim to determine the character of metabolic activity in differentiated thyroid cancer and in case of metastasis and to evaluate the findings of F-18-FDG PET/CT images in high risk patient group of differentiated thyroid cancer. Methods: The data of 79 patients who underwent imaging for staging or restaging and followed at Trakya Univerısity Faculty of Medicine from 2010 to 2015, were included in this study. Patient reports were analyzed retrospectively. Age, gender, size of thyroid lesion, presence of lymphadenopathy, other organ metastases (lung, liver, brain, bone) were included in the study. Results: The findings of 79 patients (29 male, 50 female) with papillary differentiated thyroid cancer were included in the analyses. The mean age of participants was 51±15 years. 14 patients (18%) were evaluated as normally. Recurırent disease was detected in the thyroid gland of 10 patients (13%) (SUVmax: 6.2±5.1; 2.3-19.3). In 54 patients (68%) lymph node metastasis was detected (SUVmax; 5.8±5.1; 2.1-24.2). 12 patients had liver metastasis (SUVmax: 5.7±3.9; 2.0-11.7), 12 patients had bone metastasis (SUVmax: 6.1±2.9; 2.2-13.9), 8 patients had lung metastasis (SUVmax: 4.3±4.5; 1.0-4.9) and one patient had brain metastasis (SUVmax: 10.2). Conclusion: Papillary differentiated thyroid cancer is associated with a tumor showing low glucose affinity, but it is understood that the tumor changes its behavior and gets metabolically active in the patients within the high risk group and in those with systemic metastasi

Human robot ınteraction network design with wearable wireless MIMU sensors for upper extremity exoskeleton robot

Bu araştırma kapsamında insan vücuduna uyumlu, insan hareketlerini destekleyen iki serbestlik dereceli bir üst-ekstremite dış iskelet robot sisteminin kontrolü için giyilebilir kablosuz sensörler MIMU (ivmeölçer, jiroskop) vasıtası ile insan robot etkileşim ağı tasarımı gerçekleştirilmiştir. Kişinin üst ve alt kol uzuvlarına bağlı iki adet MIMU sensörden açısal ivmelenme, jiroskop ve manyetometre bilgileri alınıp, AHRS (Attitude and Heading Reference Systems) algoritması ile bu sensör verileri bütünleştirilip kişinin üst ekstremite hareketine ilişkilin (üst kol, alt kol) kuaternion yönelim matrisi hesaplanmıştır. Kinematik analiz ile de kuaternion matrisi verileri kullanılarak omuz ve dirsek eklemlerine ait Euler yönelim açıları (x, y, z eksenleri için) hesaplanmıştır. Geliştirilen etkileşim ağı ile laboratuvar olanakları ile tasarlanan ve imalatı yapılan iki serbestlik dereceli prototip üst ekstremite dış iskelet robot kolun gerçek zamanlı hareket kontrolü gerçekleştirilmiştir. Sonuç olarak, kullanıcı kişi kolunu hareket ettirirken, dış iskelet robotta senkronize olarak aynı hareketi gerçekleştirmektedir.Within the scope of this research, human robot interaction network design was carried out by means of wearable wireless sensors MIMU (accelerometer, gyroscope, magnetometer) for the control of a two-degree upper-extremity exoskeletal robot system compatible with human body and supporting human movements. Angular acceleration, gyroscope information was obtained from two MIMU sensors connected to the upper and lower limbs of the subject, and AHRS (Attitude and Heading Reference Systems) algorithm was integrated with these sensor data and the upper extremity movement (upper arm, lower arm) quaternion orientation matrix was calculated. Euler orientation angles (for x, y, z axes) of shoulder and elbow joints were calculated by using kinematic analysis. With the developed interaction network, real time motion control of two degrees of freedom prototype upper extremity exoskeleton robot arm which is designed and manufactured with laboratory facilities was realized. As a result, the user performs the same movement synchronously in the exoskeleton robot as the person moves the arm

Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

Study DesignThe study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).PurposeTo clarify the evaluation of true diagnosis and to plane the surgical treatment.Overview of LiteratureMNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.MethodsPatients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.ResultsThere were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.ConclusionsThe spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system

Ekstrude lomber disk hernisinin rezorpsiyonu: Fizik tedavi yöntemlerinin etkisi

We would like to share our experience withextruded lumbar disc herniation which was treatedwith non-surgical spinal decompression and physicaltherapy.A 29-year-old man presented with a six-monthhistory of lower back and right leg pain. He could notrecall experiencing any trauma or initiating factorbefore the pain began, and the pain had increasedover the last month. His pain increased when he wasmoving and he experienced numbness in his rightfoot. Medication had not been beneficial, and as aresult surgery for a herniated disc was proposed. Uponexamination, he had right L4 and L5 dermatomalhypoesthesia. The strength of the L5 muscle was 4/5on the right side, and the right Achilles tendon reflexwas hypoactive. Magnetic resonance imaging (MRI)performed six months prior to this exam showedL4-L5 extruded disc herniation and right L5 rootcompression (Figure 1)

Late-onset tethered cord syndrome in a patient with spina bifida: A case report

Tethered cord is a clinical syndrome associated with short and thick filum terminale. It can occur because of congenital or acquired reasons and can lead to progressive neurological deficits. A thorough medical history, physcial examination, imaging, and electrophysiological tests are heplful in its diagnosis. An 11-year-old patient with a prior diagnosis of spina bifida was operated for pes ekinovarus at the age of 1.5 years. The patient visited our physical medicine and rehabilitation polyclinic with complaints of pain and weakness in the left ankle and region around the knee. She had been suffering from walking disruption, thinning of leg muscles, and pain for past 1 year. After imaging, a diagnosis of tethered cord syndrome was made. Follow-up of patients diagnosed with spina bifida during growth period is important to prevent complications such as syringomyelia and tethered cord syndrome

A pictorial view to tarsal coalition: The presentation of two children with foot pain

Two male patients aged 9 and 16 years were admitted with complaints of ankle pain and intoeing. There was no history of trauma and arthritis. In the first case, radiography examination revealed a “C sign” (a cortical continuity from the medial portion of the talus to the sustentaculum tali), a narrowing in the middle subtalar joint space, and convexity in the lower margin of the sustentaculum tali (Figure 1). Magnetic resonance imaging (MRI) showed triple coalition in the anterior subtalar joint (talocalcaneonavicular joint) in the first case (Figures 2 and 3) and fibrocartilaginous coalition at the posterior subtalar joint in the second case (Figure 4). Narrowing in the joint spaces, findings of early degeneration, and medullary edema in the adjacent bone were observed at the sites of coalition (Figures 3 and 4). Nonoperative treatment, such as physical therapy, exercises, and analgesic medication were applied

Karpal tünel sendromu hastalarında el bileği kas gücünün izokinetik değerlendirilmesi

Objectives: This study aims to investigate the isokinetic characteristics of wrist strength in flexion, extension, supination, pronation, radial, and ulnar deviation in patients with moderate or severe carpal tunnel syndrome (CTS).Patients and methods: Thirteen patients (23 hands) (2 males, 11 females; mean age 45 years; range 29 to 60 years) with moderate or severe CTS were compared to six healthy control subjects (12 hands) (2 males, 4 females; mean age 41 years; range 27 to 63 years) in this study, which was conducted between January 2016 and April 2016. Wrist flexion, extension, supination, pronation, radial, and ulnar deviation muscle strengths were measured at 30º/second (5 sets) angular velocity with isokinetic dynamometer. Grip strength was measured with hand dynamometer (kilograms). Boston Questionnaire was used for clinical assessment.Results: Grip strength (p=0.003); wrist flexion 30º/second (p=0.014); extension 30º/second (p=0.016); and ulnar deviation 30º/second (p=0.017) muscle strengths were lower in CTS patients compared with the control group. An evaluation according to symptom duration did not reveal any significant relationship in any of the isokinetic tests with the exception of pronation 30º/second (p=0.039, r= -0.432) and ulnar deviation 30º/second (p=0.034, r=0.443) in CTS patients. No significant relationship was found between Boston Questionnaire, grip strength, and isokinetic test results.Conclusion: Quantitative wrist strength measurements with isokinetic dynamometers are beneficial in conservative exercise treatments and motor assessments of CTS patients.Amaç: Bu çalışmada orta veya ağır karpal tünel sendromu (KTS) hastalarında el bileğinin fleksiyon, ekstansiyon, supinasyon, pronasyon, radial ve ulnar deviyasyon kas gücünün izokinetik özellikleri araştırıldı.Hastalar ve yöntemler: Ocak 2016-Nisan 2016 tarihleri arasında yapılan bu çalışmada orta veya ağır KTS olan 13 hasta (23 el) (2 erkek, 11 kadın; ort. yaş 45 yıl; dağılım 29-60 yıl) ile altı sağlıklı kontrol deneği (12 el) (2 erkek, 4 kadın; ort. yaş 41 yıl; dağılım 27-63 yıl) karşılaştırıldı. El bileği fleksiyon, ekstansiyon, supinasyon, pronasyon, radial ve ulnar deviasyon kas gücü izokinetik dinamometre ile 30º/saniye (5 set) açısal hızda ölçüldü. Kavrama gücü el dinamometresi ile (kilogram) ölçüldü. Klinik değerlendirme için Boston Anketi kullanıldı.Bulgular: Karpal tünel sendromu hastalarında kavrama gücü (p=0.003); el bileği fleksiyonu 30º/saniye (p=0.014); ekstansiyonu 30º/saniye (p=0.016) ve ulnar deviasyonu 30º/saniye (p=0.017) kas güçleri kontrol grubuna göre daha düşük idi. Semptom süresine göre yapılan değerlendirme, izokinetik testlerde pronasyon 30º/saniye (p=0.039, r= -0.432) ve ulnar deviasyon 30º/saniye (p=0.034, r=0.443) dışında KTS hastalarında anlamlı ilişki göstermedi. Boston Anketi, kavrama gücü ve izokinetik test sonuçları arasında anlamlı ilişki saptanmadı.Sonuç: El bileği kas gücünün izokinetik dinamometreler ile sayısal olarak ölçülmesi KTS hastalarının konservatif egzersiz tedavileri ve motor değerlendirmelerinde faydalıdır

Metaphor Perceptions of Pre-Service Teachers towards Mathematics and Mathematics Education in Preschool Education

The aim of this study was to identify the thoughts of pre-service teachers, who play an important role in the early preschool experience of children in mathematics, towards the concepts of mathematics and education of mathematics with the help of metaphors. The study group of the research consists of a total of 227 pre-service teachers at the Department of Preschool Education, Faculty of Education, Cukurova University in the 2013–2014 academic years. The data of the study were collected by asking preservice teachers to complete some sentences like “do you think, education of math is like …. in the preschool education; because Math is like …; because….”. The responses obtained from pre-service teachers were categorized by content analysis. As a result of the study, seven categories created by preservice teachers towards the concepts of mathematics and education of mathematics are as follows: the source of life-itself, mathematics using skills of mental processes, math facilitating the fun learning, cumulative math facilitates life, complicated math difficult to learn and boring math. There are 223 metaphors in 112 types in this category. Considering the categories created, there are five positive and two negative categories. The rates of positive categories were calculated as 88.8%, while the rates of negative categories were 11.2%,. This shows that pre-service teachers produce mostly positive metaphors about mathematics and education of math and they have positive beliefs. As a result of the research, the categories like the source of life-itself, mathematics using skills of mental processes and math facilitating the fun learning come to the forefront

Adolesan skolyoz dört haftada ne kadar iyileştirilebilir?

Scoliosis is a condition that leads to severe disability and an impaired cosmetic appearance in adolescence. This article presents x-ray images of a patient with adolescent idiopathic scoliosis (AIS) in whom the pain and posture improved dramatically over four weeks, emphasizing the importance of physical therapy. A 13-year-old male was admitted because of posture deformity and mild back and lower back pain. He was being followed with the diagnosis of scoliosis for two years and specific exercises were proposed for scoliosis. On physical examination, we observed paravertebral muscle spasm and significant asymmetry of the thoracolumbar region. Neurological examination and laboratory tests were normal. X-ray showed arcuate thoracolumbar scoliosis (cobb angle: 24°) with a leftward convexity. Electrical stimulation was applied to the convex and concave sides for 30 minutes, five times a week for four weeks and an exercise program was performed under the supervision of a therapist. The stimulation amplitude was the maximum stimulation intensity with which the patient was comfortable. Analgesic and myorelaxant drugs were not required, and no brace was used. After the treatment, significant improvements were observed in the patient's posture and radiography (cobb angle: 10°). This work demonstrates that well-planned physical therapy is a rapid and effective option for treating AIS.Skolyoz, adolesan dönemde ağır özürlülüğe ve kozmetik bozukluğa neden olabilen bir durumdur. Bu yazıda fizik tedavi uygulamalarının önemini vurgulamak için, adolesan idiyopatik skolyozu olan ve dört haftada belirgin iyileşme gösteren bir olgu grafileri ile birlikte sunulmuştur. On üç yaşındaki erkek hastamızın duruş bozukluğu ve hafif bel ağrısı şikayeti bulunmaktaydı. Hastamız iki yıldır skolyoz tanısıyla takip edilmekteydi ve hastaya skolyoza özel egzersizler önerilmişti. Fizik muayenede paravertebral kas spazmı ve belirgin torakolomber asimetrisi vardı. Nörolojik muayene ve laboratuvar testleri normaldi. X-ray grafisinde konveksitesi sola bakan torakolomber skolyozu (cobb açısı: 24°) tespit edildi. Hastaya haftada beş gün, dört hafta boyunca elektrik stimülasyonu (konveks ve konkav tarafa eş zamanlı olarak 30 dakika süre ile) ve terapist eşliğinde egzersiz programı uygulandı. Stimülasyonun amplitüdü hastanın rahatsızlık duymayacağı maksimum uyarı şiddetindeydi. Analjezik ve miyorelaksan ilaç ihtiyacı olmadı ve breys kullanılmadı. Tedavi sonunda yapılan değerlendirmede hastanın postüründe ve radyografisinde belirgin düzelme elde edildi (cobb açısı: 10°). Sonuç olarak, bu olgu iyi planlanmış fizik tedavi programının adolesan idiyopatik skolyoz tedavisinde hızlı ve etkin bir seçenek olduğunu göstermektedir.Anahtar­ Sözcükler:­ Elektrik stimülasyonu, egzersiz tedavisi, skolyoz