Mehmet Zeki Kıralp

Sacroiliac Joint Injections Performed With Sonographic Guidance

Objective. To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra‐articular sacroiliac joint injections in patients with sacroiliitis. Methods. Thirty‐four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra‐articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. Results. Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra‐articular), and 14 (23.3%) were missed. The successful intra‐articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. Conclusions. Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.

Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life, and emotional status

This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients’ perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients’ Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.

The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies.

OBJECTIVE The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS). BACKGROUND DATA CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS. MATERIALS AND METHODS In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography. RESULTS AND CONCLUSION The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.

Aortic elasticity in patients with ankylosing spondylitis.

Objective — Ankylosing spondylitis (AS) is a chronic inflammatory disease which may show cardiac involvement. The effect of AS on aortic elasticity has not been previously defined. The aim of this study was to determine whether there was any change in aortic elasticity in AS. Methods and results — Thirty-five AS patients without cardiovascular involvement and 30 healthy subjects were enrolled into the study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry.The mean aortic strain and distensibility indexes in the AS group were lower than those in the control group.The mean aortic stiffness index in the AS group was higher than that in the control group (p < 0.05). No correlation between the means and the duration was observed in the AS group. Conclusion — We found that in AS patients without cardiac involvement, aortic elasticity was decreased and this decrease was not correlated with the duration of AS.

A Sledgehammer on the Brachial Plexus: Thoracic Outlet Syndrome, Subclavius Posticus Muscle, and Traction in Aggregate

Reported here is a 30-year-old man who was seen because of pain and weakness in the upper extremities after a tractional injury. Physical examination revealed significant atrophy in the left deltoid and right intrinsic hand muscles, generalized hypoesthesia, decreased deep tendon reflexes bilaterally, and decreased strength in various muscle groups. Roos (right) and hyperabduction (bilateral) tests were positive. Electrodiagnostic studies were consistent with bilateral brachial plexopathy. Cervical radiographs showed long transverse process of C7 on the right side and a small rudimentary rib articulating with C7 on the left side. Brachial plexus magnetic resonance imaging demonstrated an aberrant muscle and compressive brachial plexus injury on the left side. Surgery via transaxillary approach was performed on the left side. The occurrence of traumatic brachial plexopathy in the presence of underlying thoracic outlet syndrome and subclavius posticus muscle is discussed for the first time in the literature.

A Novel Treatment Modality for Myofascial Pain Syndrome: Hyperbaric Oxygen Therapy

The aim of the present study was to evaluate the effects of hyperbaric oxygen (HBO) therapy on myofascial pain syndrome (MPS). Thirty patients with the diagnosis of MPS were divided into HBO (n=20) and control groups (n=10). Patients in the HBO group received a total of 10 HBO treatments in 2 weeks. Patients in the control group received placebo treatment in a hyperbaric chamber. Pain threshold and visual analogue scale (VAS) measurements were performed immediately before and after HBO therapy and 3 months thereafter. Additionally, Pain Disability Index (PDI) and Short Form 12 Health Survey (SF-12) evaluations were done before HBO and after 3 months. HBO therapy was well tolerated with no complications. In the HBO group, pain threshold significantly increased and VAS scores significantly decreased immediately after and 3 months after HBO therapy. PDI, Mental and Physical Health SF-12 scores improved significantly with HBO therapy after 3 months compared with pretreatment values. In the control group, pain thresholds, VAS score, and Mental Health SF-12 scores did not change with placebo treatment; however, significant improvement was observed in the Physical Health SF-12 test. We concluded that HBO therapy may be a valuable alternative to other methods in the management of MPS. Our results warrant further randomized, double-blinded and placebo-controlled studies to evaluate the possible role of HBO in the management of MPS.

Thoracic Outlet Syndrome in a Patient With Poland Syndrome

We report a 20-year-old man with Poland syndrome who suffered from weakness, pain, numbness, and discoloration in the left upper extremity. He was eventually diagnosed as also having thoracic outlet syndrome. The concomitance of these two disorders is discussed with a special emphasis on the underlying mechanisms.

Hepatitis B virus reactivation in a Juvenile Rheumatoid arthritis patient under treatment and its successful management: a complicated case

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.

Sonographic diagnosis of recurrent peroneal tendon subluxation.

SummaryA case of recurrent peroneal tendon subluxation is reported. Dynamic ultrasonography is the best imaging modality in the diagnosis of peroneal tendon subluxation.ZusammenfassungEs wird über einen Fall rezidivierender Subluxation der Peronealsehnen berichtet. Dynamischer Ultraschall ist das beste bildgebende Verfahren zur Diagnose von rezidivierender Subluxation der Peronäus Sehne.

Chronic low back pain caused by osteopetrosis type 2

Causes for low back pain usually involve damages in bone, muscle or nerve tissues of spine. Hereditary sclerosing bone disorders are rarely presented with low back pain. This report is intended to remind that osteopetrosis type 2, which is a rare disorder in differential diagnosis of low back pain, should be taken into consideration.