Murat Zinnuroglu

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.

Intraoperative neurophysiological monitoring during surgery for tethered cord syndrome.

AIM The tethered cord syndrome refers to a variety of lesions that can cause the conus medullaris to be low-lying or incapable of movement within the spinal canal. Permanent or temporary neurological complications were reported following surgical release. In this report, peri- and postoperative results in cases with tethered cord syndrome that were followed by multimodal intraoperative neurophysiological monitoring (MIONM) methods are presented. MATERIAL AND METHODS An IONM system (Nicolet CR Endeavor) was used for monitoring during tethered cord surgery. Somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs), direct nerve root/rootlet stimulation, free-run electromyography (EMG) and F-waves were used during tethered cord surgery of 10 cases to prevent possible nerve injuries. RESULTS MEP and SEP recordings did not change in any of the cases during surgery. The nervous tissue was identified and differentiated from connective tissue in three cases when motor responses were elicited with direct stimulation of nerve roots. None of the cases had neurological deficits following the operation. CONCLUSION Direct nerve root/rootlet stimulation should be one of the components of MIONM during surgery for tethered cord syndrome to prevent postoperative neurological deficits.

Is there a relationship between Eagle Syndrome and cervicofacial painful soft tissue rheumatisms

Objectives/Hypothesis: To investigate the incidence of locomotor system pathologies such as myofacial pain syndrome (MPS), fibromyalgia syndrome (FMS), and temporomandibular dysfunction in patients with Eagle Syndrome.

The Inhibitory Effect of Platelet-Rich Plasma on Botulinum Toxin Type-A: An Experimental Study in Rabbits

BackgroundCombination treatments of botulinum toxin type-A and other rejuvenation agents or instruments are gradually becoming more popular. After observing a high incidence of therapy failure following simultaneous applications of botulinum toxin type-A and platelet-rich plasma mesotherapy, we aimed to investigate whether PRP has an inhibitory effect on botulinum toxin type-A.MethodsTwenty-four New Zealand white rabbits were divided into 4 groups, and the anterior auricular muscle and overlying skin were used for injections. Groups I and II both received onabotulinumtoxinA intramuscular injections. In addition, autologous platelet-rich plasma mesotherapy was performed in Group I while Group II received saline mesotherapy. Group III was designed as the in vitro mixture group in which onabotulinumtoxinA and platelet-rich plasma were mixed and then administered intramuscularly. Group IV received saline within the mixture instead of platelet-rich plasma. The contralateral ears of all the rabbits served as control and were only treated with onabotulinumtoxinA. Visual evaluation of ear positions and electroneuromyographic studies were done prior to all procedures and at day 14. Anterior auricular muscles were harvested at day 14 and were evaluated with quantitative real-time PCR.ResultsVisual and electroneuromyographic studies revealed less onabotulinumtoxinA activity in Groups I and III. When platelet-rich plasma was administered through skin mesotherapy, onabotulinumtoxinA activity failure was more severe in comparison with direct contact. No significant difference in SNAP-25 mRNA expression through quantitative real-time PCR was observed between groups.ConclusionAlthough we could not explain the exact mechanism underlying this interaction, platelet-rich plasma applications result in less onabotulinumtoxinA muscle paralysis activity.No Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Femoral Nerve Injury Following a Lumbar Plexus Blockade

BACKGROUND Lumbar plexus blockade (LPB) combined with sciatic nerve block (SNB) is frequently used for lower extremity surgery. Perioperative nerve injury is a rarely encountered complication of peripheral nerve blocks (PNB). CASE REPORT Here we report a 44-year-old male patient who developed a partial femoral nerve injury (FNI) following a LPB which was performed before the surgery of a patellar fracture. The clinical and electroneuromyographic findings of the patient were recovered almost completely within the following six months. CONCLUSION The presented case demonstrated a FNI despite the absence of any pain or paresthesia sensation, with the disappearance of motor response under 0.3 mA of neurostimulation in the experienced hands.

Modic changes and spondylodiscitis at multiple levels of the thoracolumbar spine in a patient with ankylosing spondylitis

BACKGROUND AND OBJECTIVE Modic changes (MC) on magnetic resonance imaging (MRI) were described in 1988 by Modic et al. in a study among patients with chronic low back pain. Type 1 changes were shown to represent an acute inflammatory process while type 2 changes were found in chronic lesions. Since mechanical back pain is very common, it is often difficult to differentiate precisely the origin of the back pain in patients with ankylosing spondylitis (AS) based only on clinical assessment, laboratory findings and/or plain imaging. CASE REPORT We report a male patient with AS who presented with low back pain. MRI revealed MCs and spondylodiscitis, an uncommon manifestation of AS, at multiple levels of the thoracolumbar spine. CONCLUSION We believe that MRI may provide key information in addition to the clinical, laboratory and plain radiological assessments and can help to guide physicians in decision-making when treating patients with AS.

Impairment of upper trapezius branch of the spinal accessory nerve during bypass grafting: a stretch injury?

Internal jugular vein catheterization has been implicated in spinal accessory nerve (SAN) injuries after coronary artery bypass grafting (CABG). Stretch injury due to prolonged positioning during CABG has also been proposed as another mechanism of injury. Herein we describe a male patient with left shoulder pain and abduction difficulty following CABG, who displayed electromyographic abnormalities confined to the left upper trapezius muscle. Internal jugular vein catheterization had not been performed during surgery. Although unusual, the possibility of upper trapezius muscular branch paralysis should be considered in patients with shoulder pain or weakness after CABG. Muscle Nerve, 2010

Painful legs and moving toes following a traumatic medial plantar nerve injury

I read with great interest the article by Alvarez et al. In their review, they confirmed that Painful Legs and Moving Toes (PLMT’s) etiology is diverse although the majority of patients had evidence of peripheral nerve involvement or radiculopathy. However, in some patients, namely in patients with Wilson’s disease and myelitis, a structural central nervous system lesion is evoked to be associated with the development of PLMT. We reported a patient with Hashimoto’s disease who developed slight dystonia and bradykinesia and presented PLMT. The patient had any electrophysiological signs of neuropathy or any clinical sign indicative of a root or nerve disorder. MRI brain scan showed several small subcortical white matter fronto-parietal lesions, without diffusion restriction. Discrete and diffuse high signal in periventricular white matter was visible in T2-weighted images. These aspects are frequently found in Hashimoto’s encephalopathy. We also believe that at least in some cases PLMT has a central origin and is composed of a variety of dystonic movements. In our reported case, we think PLMT was associated with Hashimoto’s encephalopathy.

Carpal Lock and the Volar-Supporting Orthosis in Mild and Moderate Carpal Tunnel Syndrome

Zinnuroglu M, Baspinar M, Beyazova M: Carpal lock and the volar-supporting orthosis in mild and moderate carpal tunnel syndrome. Objective:The carpal lock, which is a hand/wrist orthosis that supports the dorsal aspect of the hand, was used in patients with mild-moderate carpal tunnel syndrome, and its clinical and electrophysiological effectiveness was compared with that of a volar-supporting orthosis. Design:Nerve conduction study and clinical evaluation of 24 patients (41 hands) with mild or moderate carpal tunnel syndrome were performed before and 3 mos after the use of the carpal lock or the volar-supporting orthosis. Results:Significant improvement was observed in electrophysiological parameters and clinical outcomes after use of both orthoses. There was no statistically significant difference between the two groups. Patients in the carpal lock group used the orthosis 89.6% of the prescribed time, whereas those in the volar-supporting orthosis group used the orthosis 79.2% of the prescribed time (P < 0.05). Conclusions:The carpal lock may be used as an alternative to the volar-supporting orthosis.

Osteopoikilosis: A case with osteopenia

Osteopoikilosis is a benign osteosclerotic dysplasia of unknown origin, which is an inherited autosomal disorder. It is usually asymptomatic and may only be recognized on radiological examination. We report a 20-year-old man who suffers from back and shoulder pain during the routine physical examinations performed prior to the military recruitment. Numerous symmetric, small, ovoid and circular sclerotic bone lesions were found on the X-rays of the spine and shoulder. Dual energy X-ray absorptiometry (DXA) examination revealed osteopenia. In conclusion, typical radiographic examination of osteopoikilosis is usually diagnostic. However, it may sometimes be difficult to rule out the other diseases like osteoblastic metastatic lesions as it is an uncommon disease. Physicians should be aware of possible coexisiting osteopenia or osteoporosis as reported in our case.