Levent Ozgonenel

A Double-Blind Trial of Clinical Effects of Therapeutic Ultrasound in Knee Osteoarthritis

A randomized double blind clinical trial was conducted to determine the effectiveness of ultrasound (US) therapy in knee osteoarthritis (OA). Sixty-seven patients (mean age 54.8 +/-7) were randomized to receive either 1 MHz frequency or 1 watt/cm(2) power continuous ultrasound for 5 min (n = 34) or sham US (n = 33) as a placebo. Ten sessions of treatment were applied to the target knee of the patient. A blinded evaluation at baseline and after treatment was made. Primary outcome was pain on movement assessed by visual analog scale (VAS). Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and 50 meters walking time. Both groups showed significant improvements in knee pain on movement. In the treatment group, the improvement in VAS score was statistically and significantly higher (p < 0.001) and more pronounced than in the placebo group. Pain reduction averaged 47.76% in the treatment group (p = 0.013). Secondary outcomes improved in both groups but reached statistical significance only in the treatment group: p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time. Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA.

Two rare involvement sites: synovial chondromatosis

Synovial chondromatosis (SC) is a rarely encountered benign disease of unknown etiology characterized by multiple joint mouse, as well as metaplastic cartilage points in the joint, bursa and tendon sheaths. Although single joint involvement is frequently encountered, multiple joint involvements may also occur. In this study, two patients with SC in the right shoulder joint and in both ankles were presented, reviewed according to literature.

Use of Game Console for Rehabilitation of Parkinson's Disease.

BACKGROUND Parkinsons disease (PD) predisposes to falls due to postural instability and decreased coordination. Postural and coordination exercises could ameliorate the incoordination and decrease falls. AIMS In this study, we explored the efficiency of a game console as an adjunct to an exercise program in treating incoordination in patients with PD. STUDY DESIGN Case-control study. METHODS In this single-blind, prospective clinical trial, rehabilitation with the Xbox (Microsoft; Washington, USA) game console was used as an adjunct to a standard rehabilitation program. Thirty-three patients with PD at stages 1-3 were enrolled in the study. All patients received the three-times weekly exercise program and electrotherapy to back and hip extensors for 5 weeks. Study patients played catch the ball and obstacle games on the Xbox in addition to the standard exercise program. Patients were evaluated based on the scores from the Timed Up-and-Go Test, the Berg Balance Scale (BBS), and the Unified Parkinsons Disease Rating Scale-II (UPDRS-II). Post-treatment scores were compared between groups. RESULTS Thirty-three patients were enrolled in the study (15 in the game-console group, and 18 controls). Patients in both groups had improvements in all scores. The end-of-treatment scores were significantly better in the study group compared to the control group in all parameters: UPDRS (10±5 versus 16±6, p=0.002), BBS (53±4 versus 47±8, p=0.004), and TUG (11±4 seconds versus 20±8 seconds, p<0.001). CONCLUSION Game-exercise with a game-console was noted to be a significant adjunct to the rehabilitation program in patients with PD in this study.

Comparison of static wrist splint with static wrist and metacarpophalangeal splint in carpal tunnel syndrome

BACKGROUND The position of metacarpophalangeal (MCP) joints may be an important factor affecting the efficacy of splinting in patients with carpal tunnel syndrome (CTS). OBJECTIVE The aim of the present study was to compare the efficacy of a neutral volar static wrist splint with a neutral volar static wrist and MCP splint in patients with CTS. METHODS Fifty-four hands were included into the study. A neutral volar static wrist splint was given to the symptomatic hands of the patients in group 1 while a neutral volar static wrist and MCP splint was given to the symptomatic hands of the patients in group 2. Evaluation parameters were Visual Analog Scale for pain severity (VASp), grip strength, pinch strength, electrophysiologic tests and CTS Questionnaire (CTSQ) at baseline and four weeks later. RESULTS At baseline there was no difference between groups. The intergroup comparison of the improvement showed significant differences in VASp at rest, grip strength, pinch strength and CTSQ functional capacity scores between groups in favor of wrist MCP splint. Although there were significant improvements with regard to sensory amplitude and motor latency in both groups after therapy, the differences between groups were not at the level of significance. CONCLUSIONS The position of MCP joints seems to be an important factor for the treatment of CTS and should be considered while prescribing a splint to the patients with CTS.

Where are we in terms of poststroke functional outcomes and risk factors

BACKGROUND Stroke is acute vascular deterioration of cerebral functions and 2nd leading cause of death. As population gets older, as well as the increasing prevalence of stroke and disability from chronic disease, the demand for rehabilitation care will continue to rise. There is need for evidence based rehabilitation approaches and rehabilitation outcomes should be proved by objective questionnairres to qualify the process. OBJECTIVE To present the functional outcomes of stroke rehabilitation process among functional impairment measure evaluation. Determine the contributing factors on functional gain. MATERIAL-METHODS Retrospectively assessment of data of 142 posttroke patients performed. In addition to demographical and clinical properties, functional outcomes with functional impairment measurement (FIM) and motor evaluation by Brunnstrom Motricitiy Index were recorded. Risk factors for stroke were questionned also. RESULTS The mean of ages was 64.30 ± 11.9 years, male/female ratios were 47.2%/ 52.8%. The functional gain was 20.4% in M-FIM, 14.7% in C-FIM. Better outcomes gained by the patients who stayed longer than 15 days (ANOVA, p: 0.000) and who had hemorrhagic etiology (MannWhitney U, p: 0.048), meanwhile there was no significant difference in gender and plegic side groups on both Motor-FIM and Cognitive-FIM gains (p > 0.05, MannWhitney U). Regression models exhibited highest impact on the M-FIM gain were the admission M-FIM scores and DM (adjusted Rsquare: 0.173, p: 0.000). Admission C-FIM scores had positive correlation with discharge C-FIM scores (r: 0.917, p: 0.000). Although older age was the negative determinant of C-FIM gain (r: -0.202, p: 0.016). We obtained the risk factor distribution 71.8% for HT, 29.6% for CAD, 25.6% for smoking, 16.2% for TIA and 33.1% for DM. All had negative impact on functional outcomes but DM had significantly (regression analysis p < 0.05). CONCLUSION Improvement by rehabilitation programme determined by FIM scores. Data provided about the poststroke patients and present risk factors. Still there exists similar ratios of risk factors as studies before eventhough prevention recommendations.

Demographic and Clinical Properties and Medical Treatments of Patients Followed as Ankylosing Spondylitis

Amaç: Ankilozan spondilit (AS) tanısı ile takip edilen hastalara ait demografik veriler, klinik özellikler ve medikal tedaviler değerlendirildi. Gereç ve Yöntem: 2007-2008 tarihleri arasında AS tanısı ile takip edilen 243 hastanın dosyası retrospektif olarak incelendi. Hastaların demografik özellikleri, hastalık takip parametreleri ve mevcut tedavileri değerlendirildi. Hastalık takibinde kullanılan Görsel Analog Skala (VAS), Bath AS Hastalık Aktivite İndeksi (BASDAI), Bath AS Fonksiyonel İndeksi (BASFI), Bath AS Metrolojik İndeksi (BASMI), Bath AS Radyolojik İndeksi (BASRI), AS Yaşam Kalitesi Anketi (ASQOL), Maastricht Entesopati Skoru (MASES), eritrosit sedimentasyon hızı (ESR), C-reaktif protein (CRP) değerleri incelendi. Bulgular: Erkek/kadın 3,4:1 idi. Yaş ortalaması, tanı yaşı ve tanıdaki gecikme süreleri sırasıyla, 37,1±9, 32,4±9 ve 4,6±6 yıl idi. Takip parametrelerimizin ortalama değerleri sırasıyla BASMI 7,9±2,5, BASFI 3,4±2,6, ASQOL 9,2±5,9, BASRI 6,7±2,8, VAS 45,9±28,2, entesopati skoru 2,5±3,8, ESR 24,9 mm/st, CRP 1,5±1,8 mg/dl idi. Hastaların %54,3’nün BASDAI skorları 4’ün altında olup ortalama 3,9±2,3 ile 4’e yakındı. Hastaların %12,8’inde üveit, %15,6’sında periferik artrit vardı. Hastaların %3,8’i hiçbir tedavi almıyor, %16,8’i sadece nonsteroid antienflamatuvar ilaç, %65,4’ü tekli modifiye edici anti romatizmal ilaç (DMARD), %6,6’sı ikili DMARD, %7,4’ü biyolojik ajan kullanıyordu. Tekli DMARD grubunun %61,3’ü sulfasalazin kullanıyordu. Sonuç: Cinsiyetler karşılaştırıldığında yaş ortalaması ve tanı yaşı açısından anlamlı fark olmazken, tanının gecikme süresi kadınlarda istatistiksel olarak anlamlı derecede fazlaydı. BASRI skorları erkeklerde yüksekti. Periferik artrit ve CRP değerleri erkeklerde daha fazla yoktu. Hastalık aktivitesini gösteren BASDAI yüksekliği ile periferik tutulum, entesopati, VAS, hastalık süresi, tanıda gecikme süresi, ESR ve CRP değerleri arasında anlamlı ilişki saptandı. Anahtar sözcükler: Ankilozan spondilit. SUMMARY

Comparison between Tc-99m DMSA and Renal Ultrasonography for the Evaluation of Renal Scarring and Function Loss in Children with Spina Bifida

Spina bifida (SB) refers to a wide range of neural tube defects, a neuro-urological disease affecting the spine and spinal cord. With a marked geographic and ethnic variation, SB has an incidence of 1–5 cases per 1000 live births. In Turkey, the incidence is 3 per 1000 live births (1), and in the eastern region of Turkey, it is 2.2 per 1000 live births (2). The basic urological problem in SB is neurogenic bladder dysfunction, resulting in urinary tract infections (UTI), incontinence, vesicoureteral reflux (VUR), hydronephrosis, chronic kidney disease (CKD), hypertension, and end-stage renal failure (3). The goal of treatment is to reduce bladder pressure and minimize urine stasis, thus preventing recurrent febrile UTI and consequent function loss. Patients should be followed up regularly against late referral because SB management is a dynamic and long-lasting process for a life time, and patient selection for aggressive treatment may prevent renal parenchymal deterioration (4).

Comparison of the Efficiency of Placebo and Ultrasound Therapy in Knee Osteoarthritis

Yöntemler: Kliniğimize diz ağrısı şikayeti ile başvuran Amerikan Romatoloji Derneği (ACR) kriterlerine uyan, primer diz OA tanısı konan, Kellgren-Lawrence evrelemesine göre, evre 2 ve 3 olan 60 hastanın her iki dizi birden tedaviye alınmıştır. Hastalar randomize olarak iki gruba ayrılmış, 1. Gruptaki 30 hastaya US (frekansı: 1 MHz, intensitesi: 1 Watt/cm2), 2. Gruptaki 30 hastaya plasebo US uygulanmış, hastalara 5 gün/hafta, günde tek tedavi olarak toplam 10 tedavi verilmiştir. Çalışmaya alınan 60 hastanın hepsi tedavi sonu, 10. gün ve 1. ay kontrolüne gelmiştir. Hastaların tedavi öncesi demografik verileri kaydedilmiştir. Tedavi öncesi ve sonrası diz çevresi ölçümü, 100 mm’lik VAS ile ağrı şiddeti ve hastalık şiddeti, EHA, manuel kas gücü, 20 m yürüme zamanı, fiziksel fonksiyonları değerlendirmek için, WOMAC, Lequesne, anketleri uygulanmış, tedavi etkinliği hasta ve doktor tarafından ayrı ayrı değerlendirilmiştir.