Emre Adiguzel

Intestinal Microbiota in Patients with Spinal Cord Injury

Human intestinal flora comprises thousands of bacterial species. Growth and composition of intestinal microbiota is dependent on various parameters, including immune mechanisms, dietary factors and intestinal motility. Patients with spinal cord injury (SCI) frequently display neurogenic bowel dysfunction due to the absence of central nervous system control over the gastrointestinal system. Considering the bowel dysfunction and altered colonic transit time in patients with SCI, we hypothesized the presence of a significant change in the composition of their gut microbiome. The objective of this study was to characterize the gut microbiota in adult SCI patients with different types of bowel dysfunction. We tested our hypothesis on 30 SCI patients (15 upper motor neuron [UMN] bowel syndrome, 15 lower motor neuron [LMN] bowel syndrome) and 10 healthy controls using the 16S rRNA sequencing. Gut microbial patterns were sampled from feces. Independent of study groups, gut microbiota of the participants were dominated by Blautia, Bifidobacterium, Faecalibacterium and Ruminococcus. When we compared all study groups, Roseburia, Pseudobutyrivibrio, Dialister, Marvinbryantia and Megamonas appeared as the genera that were statistically different between groups. In comparison to the healthy group, total bacterial counts of Pseudobutyrivibrio, Dialister and Megamonas genera were significantly lower in UMN bowel dysfunction group. The total bacterial count of Marvinbryantia genus was significantly lower in UMN bowel dysfunction group when compared to the LMN group. Total bacterial counts of Roseburia, Pseudobutyrivibrio and Megamonas genera were significantly lower in LMN bowel dysfunction group when compared to healthy groups. Our results demonstrate for the first time that butyrate-producing members are specifically reduced in SCI patients when compared to healthy subjects. The results of this study would be of interest since to our knowledge, microbiome-associated studies targeting SCI patients are non-existent and the results might help explain possible implications of gut microbiome in SCI.

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees

OBJECTIVES The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. METHODS One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. RESULTS Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p<0.05) than the controls. No difference was determined in terms of psychiatric symptoms between the phantom pain and no phantom pain groups (p>0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. CONCLUSIONS Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation.

Assessment of Spasticity With Sonoelastography Following Stroke: A Feasibility Study

To investigate the feasibility of sonoelastography to show muscle stiffness in poststroke spasticity, as well as the relationship between sonoelastography findings and muscle architecture features and clinical spasticity scores in the spastic gastrocnemius.

Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities

Bone modeling is a process that starts with fetal life and continues during adolescence. Complex factors such as hormones, nutritional and environmental factors affect this process. In addition to these factors, physical conditioning and medications that have toxic effects on bony tissue should be carefully considered in patient follow-up. Osteoporosis is a significant problem in pediatric population because of ongoing growth and development of skeletal system. Two types of osteoporosis are primary and secondary types and children with neuromuscular disabilities constitute a major group with secondary osteoporosis. Low bone mass in patients with cerebral palsy, spina bifida, and Duchenne muscular dystrophy cause increased bone fragility in even slight traumas. Maximizing peak bone mass and prevention of bone loss are very important to reduce the fracture risk in neuromuscular diseases. This article aims to review the determinants of bone physiology and bone loss in children with cerebral palsy, spina bifida, and Duchenne muscular dystrophy.

Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

Abstract Background: Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. Discussion: US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient’s compliance.

Sonoelastographic Assessment of the Median Nerve in the Longitudinal Plane for Carpal Tunnel Syndrome

A 35-year-old woman presented with a 3-month history of numbness and tingling over the inner aspect of her right wrist radiating to the thumb, index, and middle finger. Her complaints were worse at night and eased by shaking her hand. There was no history of trauma or concomitant disease. On physical examination, she had decreased sensation at her first 3 digits of right hand. There was mild muscle weakness of abductor pollicis brevis. Cervical range of motion was normal, and provocative tests for cervical radiculopathy were negative. Phalen maneuver was positive. Ultrasound (5-12 MHz linear transducer; GE LOGIQ S7, GE Healthcare, Yizhuang, China) assessment of the right wrist showed swelling of the median nerve indicating compression. The cross-sectional area of the right median nerve at the level of pisiform bone was

Role of Magnetic Resonance Imaging in Ascertaining the Success of Transforaminal Epidural Steroid Injection for Lumbar Radicular Pain.

Objective To explore the outcome differences of lumbar transforaminal epidural steroid injection (TFESI) according to magnetic resonance imaging (MRI) findings in patients with lumbar radicular pain. Design Retrospective study. Setting Single university-based interventional pain management unit. Patients Fifty-nine patients who had lumbar radicular pain with a recent lumbar MRI and three-month follow-up were included. Methods MRI findings were reviewed for the following items: herniation type (bulging, protrusion, extrusion), herniation location (central, subarticular, foraminal, extraforaminal), high intensity zone (HIZ), and nerve root impingement (NRI). Pain severity was evaluated using a visual analogue scale (VAS) at time of before injection, then two weeks and three months after. Results Pain scores improved significantly in each group ( P  < 0.05) at all time points, but there were no statistically significant differences in improvements according to type or location of disc herniation. Pain scores were significantly lower in patients with HIZ at the second week and in patients with NRI at the third month ( P  < 0.05). Conclusions TFESI was an effective treatment method in patients with radicular pain, irrespective of the type or location of disc herniation. However, greater improvement in pain may be expected at the second week in patients with HIZ and at the third month in patients with NRI.

Re: Quadriceps Fat Pad Impingement and Synovial Hypertrophy with Mild to Moderate Lipoma Arborescens.

A 40-yr-old male patient presented with pain and swelling in the left knee. He reported sudden onset of the knee pain 2 days previously, and the next day, swelling was noticed. There was no history of trauma or any rheumatologic disease. The patient recorded a pain score of 70 mm on a 100-mm visual analog pain scale. On physical examination, there was significant swelling predominantly on the lateral aspect of the left knee, mild heat, tenderness with palpation, and restricted range of motion. The whole blood count values and erythrocyte sedimentation rate were within the reference ranges. The C-reactive protein level was 21 mg/dL (reference range, 0Y6 mg/dL). Plain x-ray examination yielded normal results. Ultrasound scanning revealed fluid in the suprapatellar region and a 1721-mm hyperechoic mass beneath the quadriceps tendon and next to the upper margin of the patella (Fig. 1). Magnetic resonance imaging was then applied, which revealed suprapatellar effusion and a mild hyperintense lesion located posterior to the quadriceps tendon and projecting into the joint space (Fig. 2). The patient was diagnosed as having lipoma arborescens. The patient refused arthroscopic surgery and was managed conservatively with rest, cold packs, and nonsteroidal anti-inflammatory drugs. Lipoma arborescens is a rare benign condition defined as lipomatous proliferation of the synovium, characterized by villous proliferation of the fat cells. Although the etiology has not been fully defined, trauma, inflammation, and degenerative osteoarthritis have been reported as etiologic factors but there have also been case presentations without any causative factor. Most cases of lipoma arborescens are

Major Perirectal Hematoma Complicating Sacroiliac Joint Injection

Abstract Background: Sacroiliac joint injection is both a way of confirming sacroiliac joint pain and a therapeutic method. Findings: A 40-year-old woman was presumptively diagnosed as having sacroiliac joint dysfunction and we performed a fluoroscopically guided sacroiliac joint injection. Many hours after the procedure, the patient developed severe buttock pain spreading to the posterior aspect of the femur on the left side. A pelvic magnetic resonance imaging revealed a 9 × 4 × 5.5 cm sized hematoma extending from the left obturator to the perirectal region. Conclusions: Because of anatomical variations, the practitioner should be alert to the risk of damaging vascular structures when performing therapeutic injections.

Ultrasonographic Assessment of Femoral Cartilage Thickness in Patients With Cerebral Palsy

Cerebral palsy (CP) is one of the most disabling syndromes in children. To our knowledge, there has not yet been any reported evaluation by ultrasonography of the effect of CP on distal femoral cartilage. The value of understanding this effect on cartilage is that sonographic evaluation of cartilage thickness may help physicians to predict the joint health of these children.