Kurtulus Kaya

Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement

The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis. Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other. US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Effects of different bladder management methods on the quality of life in patients with traumatic spinal cord injury.

Study design:Multi-center, cross-sectional study.Objectives:To investigate the effects of different bladder management methods on the quality of life (QoL) in patients with spinal cord injury (SCI).Setting:Turkey.Methods:Consecutive SCI patients (n=195, 74.4% males), for whom at least 6 months had elapsed since the injury, were included and evaluated in five groups: normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization. The King’s Health Questionnaire was used to evaluate the patients’ QoL.Results:The bladder management groups were similar regarding age, time elapsed since injury, education level, marital and occupational status. There was no difference among the groups in general health perception, personal relationships and sleep/energy domain scores. While the NSM group had generally the lowest scores, that is, better QoL, the IC-A group had the highest scores, that is, poorer QoL, in most of the domains. When the patients were grouped according to the frequency of urinary incontinence or American Spinal Injury Association Impairment Scale grades, no difference was found in the domain scores of the groups except the symptom severity domain scores. No significant difference was found between paraplegic and tetraplegic patients in the King’s Health Questionnaire domains.Conclusion:The QoL was notably affected in SCI patients in IC-A group and negative effects on emotional status, physical and social activity limitations were observed, as well.

Fever During Rehabilitation in Patients With Traumatic Spinal Cord Injury: Analysis of 392 Cases From a National Rehabilitation Hospital in Turkey

Abstract Objective: To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage. Design/Subjects: A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program. Setting: A national rehabilitation center in Turkey. Outcome Measures: Incidence and etiology of fever, period of hospitalization (days). Results: A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P = 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P = 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (/> = 0.006). Conclusions: A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program.

Evaluation of bone mineral density in patients with spinal cord injury.

Abstract Background/Objective: This study was performed to evaluate the bone mineral density (BMD) values in patients with spinal cord injury (SCI) and determine the effects of the level, severity, and duration of the neurological lesion and spasticity on BMD values. Methods: A total of 75 patients with traumatic SCI and a healthy control group of 39 people were included in the study. The BMD values of the lumbar spine and 4 different regions of the hip (femoral neck, Wards triangle, trochanter, and femoral shaft) of all cases were measured using dual energy x-ray absorptiometry. The biochemical markers were also analyzed. Results: The BMD values in all measured regions were found to be decreased in patients compared with that of controls. The level and seventy of the lesion and the spasticity did not significantly affect BMD values in the regions analyzed. The BMD values of the hip decreased as the duration of SCI increased. The levels of plasma phosphorus and alkaline phosphatase, calcium in 24-hour urine samples, and the calcium/creatinine ratio in spot urines were found to be significantly higher in the patient group. Conclusion: All patients with SCI had lower BMD values than controls. The level and severity of SCI and spasticity did not significantly affect BMD values. The BMD values of the hip decreased as the duration of SCI increased.

EVALUATION OF IDEOMOTOR APRAXIA IN PATIENTS WITH STROKE: A STUDY OF RELIABILITY AND VALIDITY

OBJECTIVE This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls. SUBJECTS The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. METHODS The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. RESULTS Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. CONCLUSION It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.

Noninvasive evaluation of lower urinary tract function in children with cerebral palsy.

Ersoz M, Kaya K, Erol SK, Kulakli F, Akyuz M, Ozel S: Noninvasive evaluation of lower urinary tract function in children with cerebral palsy. Objective: The aim of this study was noninvasive evaluation of voiding function in children with cerebral palsy. Design: Sixty children with cerebral palsy were enrolled in the study. Urinary system symptoms were recorded. Uroflowmetric tests were carried out, and postvoid residual volume was measured immediately after voiding by using a portable ultrasonic device developed for children. The expected age-related bladder capacity was calculated and compared with the observed bladder capacity. Uroflowmetric curves were evaluated and classified as normal (bell-shaped) and abnormal. Results: Thirty-three of the children (55%) were symptomatic. In 17 (28.3%) of the children, postvoid residual urine was observed. There was a statistically significant difference between the expected bladder capacity (271.6 ± 38.3 ml) and the observed bladder capacity (154.5 ± 111.8 ml) (P < 0.001). Observed bladder capacity was lower than the expected bladder capacity in 56 (93.3%) of the children. In the evaluation of the uroflowmetric charts, 22 (36.7%) children had abnormal curves. Conclusions: Bladder capacity is decreased in most children with cerebral palsy, and postvoid residue is present in an important proportion. Uroflowmetry and portable ultrasonic device combination is a noninvasive, well-tolerated, and efficient method in the first line evaluation of lower urinary tract function in children with cerebral palsy.

Effects of ideomotor apraxia on functional outcomes in patients with right hemiplegia

The aim of this study was to investigate the effect of ideomotor apraxia on activities of daily living and to determine if the presence of apraxia interferes with rehabilitation. This study was conducted on 47 patients with right hemiplegia. All the patients were assessed at their admission and discharge, respectively, for apraxia by Ideomotor Apraxia Test, for daily living activities by Functional Independence Measure (FIM, Santa Clara Valley Medical Center, San Jose, California, USA), for cognitive functions by Mini Mental State Examination (MMSE), and for language components by Gulhane Aphasia Test (GAT). The effects of apraxia presence and time course on FIM, MMSE, and GAT scores were investigated. Presence of apraxia was found to have significant effect on all test scores (P<0.05). Time course had the main significant effect on FIM, MMSE, and GAT scores (P<0.05). Interaction effect of both presence of apraxia and time course on the test scores was not significant either. In other words, apraxic and nonapraxic patients seemed to gain benefits from the neurological rehabilitation. However, mean FIM scores of apraxic patients during discharge have failed to reach the mean FIM scores of nonapraxic patients during admission. Apraxia is considered as an important determinant in the dependence of patients with stroke in their activities of daily living. For this reason, during the initial assessment of patients with right hemiplegia, apraxia should be tested, and the presence of apraxia as well as its severity should be determined.