Raikan Buyukavci

Functional outcomes following ultrasound-guided botulinum toxin type A injections to reduce spastic equinovarus in adult post-stroke patients

Objective: The aim of this study is to identify the effect on spasticity and walking of US‐guided botulinum toxin type A (BoNT‐A) injections administered to improve equinovarus walking pattern commonly observed in patients after stroke. Material and method: Twenty‐three patients with post‐stroke spastic equinovarus deformity were recruited. The US‐guided BoNT‐A injections were administered into the spastic muscles (including gastrocnemius; GK, soleus; S and tibialis posterior; TP) using a specific approach, and all of the patients were enrolled in rehabilitation programmes after the injections. Modified Ashworth Scale (MAS), Brunnstrom stage of lower limb, Functional Ambulation Score (FAS), Preferred Gait Speed (PGS) and the six‐minute walk test (6MWT) were assessed at the baseline, 4 and 12 weeks after the BoNT‐A injection. Results: Significant decreases in the MAS scores of the lower limb muscle (GK, S and TP) tone were measured 4 and 12 weeks after the BoNT‐A injection when compared to the baseline scores (p < 0.05). In parallel with a reduction in spasticity there was an increase in 6MWT and PGS in the 4th and 12th weeks. Increases in motor improvement and functional ambulation score were ensured in the 12th week (p < 0.05). Conclusion: Spastic equinovarus deformity observed in patients after stroke creates significant limitations in the patients functional walking speed and distance. As a result, when BoNT‐A injections accompanied by ultrasound to improve equinovarus deformity considering the innervation zones of the muscles with a specific approach are administered directly into the muscle at the correct point, we can say it provides hopeful results from a functional point of view. HighlightsSpastic equinovarus deformity in patients after stroke creates significant limitations in the patients gain.US‐guided BoNT‐A injection considering the innervation zones with a specific approach is a practical and effective method.US‐guided BoNT‐A injection combined with rehabilitation exercises may have functional benefits for post‐stroke patients.

Metastatic gastric adenocarcinoma in a pregnant woman

Gastric cancers occur in only 0.025% to 0.1% of all pregnancies. We present a pregnant woman with gastric adenocarcinoma associated with bone metastasis. She is 36-year-old (gravida:4, para:0) 16-week pregnancy, complaining of nausea, vomiting, weight loss (~15 kg) and low back pain. Although the patient considered the condition to be related with pregnancy and underestimated its importance. She had high erythrocyte sedimentation rate (107 mm/h) and anemia (hemoglobin = 9.4 gr/dl). Lumbar magnetic resonance imaging showed L4 vertebrae malign compression fracture and diffuse bone metastasis. Because of the patients melena, esophagogastroduodenoscopy was performed and biopsy result was reported as stomach adenocarcinoma. It is important to evaluate the symptoms of low back pain and pregnancy related symptoms carefully and do not cause delays in diagnosis due to overlapping symptoms.

Comparison of high-intensity laser therapy and combination of transcutaneous nerve stimulation and ultrasound treatment in patients with chronic lumbar radiculopathy: A randomized single-blind study

Objective: To compare the effects of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) with ultrasound (US) therapy on pain and functionality in patients with chronic lumbar radiculopathy. Methods: This prospective randomized comparative study was conducted in Department of physical medicine and rehabilitation, Turgut Ozal Medicine Center, Malatya, Turkey from April 2016 to September 2016. A total of 54 patients with chronic lumbar radiculopathy were enrolled in this study. The patients were randomly divided into two groups: Group 1 (n:27) received 10 sessions of a combination of hot pack, TENS, US and exercise, and Group 2 (n:27) received hot pack, HILT and exercise. The outcomes measured were low back with unilateral leg pain level measured by visual analog scale (VAS) and functionality measured with the Oswestry Disability Index (ODI) at the end of the therapy and four weeks later. p-value less than 0.05 considered statistically significant. Results: In two groups, VAS (low back with unilateral leg pain) and ODI scores showed significant changes. At the end of the 2 weeks intervention, participants in Group-1 showed a significantly greater decrease in pain than participants in Group-2. Statistically significant differences in pain variation and functionality (VAS and ODI) were observed four weeks after treatment sessions for participants in the TENS+US therapy group compared with participants in the HILT group. Conclusion: HILT and TENS+US combined with exercise were effective treatment modalities in decreasing the VAS and ODI scores. TENS+US combined with exercises were more effective than HILT combined with exercise.

Radial nerve neuropathies: a retrospective analysis

Aim: Radial nerve neuropathy is a less common neuropathy among other upper extremity entrapment neuropathies. The aim of this study was to evaluate patients referred to our electrophysiology laboratory with a diagnosis of radial nerve neuropathy. Material and Methods: Electrophysiological finding of the 42 patients who were referred to the electrophysiology laboratory with the preliminary diagnosis of radial nerve lesion between 2017-2018 were retrospectively scanned. Results : Forty-two patients were included in the study. 36 patients were male (85.7%), 6 were female (14.3%) and the mean age was 36.09 ± 14.26. Evaluating the relationship between the etiology of the nerve injury showed that the highest rate was consisted of radial nerve sensory and motor axonal lesions which occurred after traffic accidents. The majority of the patients had dropped hand and finger (85.7%). Conclusion : In the etiology of radial nerve lesions, the causes such as trauma and work accidents are at the forefront and this may explain the increased incidence in men. Electromyography can provide valuable contributions to diagnosis, treatment planning and prognosis.

Median nerve ultrasound in carpal tunnel syndrome with normal electrodiagnostic tests

Introduction To evaluate the ultrasound findings of the median nerve in patients with clinical assigned carpal tunnel syndrome but normal nerve conduction studies. Methods This prospective, cross-sectional study involved 41 patients (51 hands) with clinically assigned CTS and normal nerve conduction studies and 20 healthy controls (30 hands). Ultrasonography was performed in all participants, and cross-sectional area (CSA), hypoechogenicity, and mobility of the median nerve were evaluated. All patients were assessed with Boston Carpal Tunnel Questionnaire (BCTQ). Results CSA of the median nerve in the wrist was significantly higher in the patient group when compared to the control group. Echogenicity and mobility were significantly decreased in the patient group. Ultrasound abnormalities were positively correlated with clinical features. A significant correlation was observed among sensory loss, provocative tests, body mass index, BCTQ, and high CSA. Conclusion US can help the clinicians with the diagnosis of carpal tunnel syndrome in patients with clinical symptoms but negative nerve conduction study results.

Does Osteoporosis with Type 2 Diabetes Mellitus (Diabetoporosis) increase the risk of fracture

Our aim was to investigate whether the association of diabetes and osteoporosis caused an increased risk of fracture or not. The study included 120 patients with osteoporosis aged between 40-90 years. Age, gender, body mass index (BMI), history of fracture and presence of Type 2 diabetes mellitus (T2DM) were recorded. 10-year major fracture and hip fracture risks were calculated with FRAX-WHO Fracture Risks Assessment Tool. Bone mineral density (BMD) measurements were made from femur neck and lumbar 1-4 vertebrae. All of the 120 patients included in the study, 21 were male and 99 were female. Twenty patients had T2DM diagnosis. The patient group with T2DM was older than the non-T2DM group in terms of mean age (p0.05). The number of patients with previous history of fracture was 24, and two of them were suffering from T2DM. In this study, Our results showed that osteoporosis with Type 2 Diabetes Mellitus may not significantly affect the fracture risk. The relationship between diabetes and bone metabolism should be screened in larger quantities, and T2DM should be positioned among the algorithms that assess the risk of fracture.

Evaluation of blood neutrophil-lymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia

Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain and systemic symptoms. The aetiology and pathogenesis of fibromyalgia are not yet fully understood. Blood neutrophil/lymphocyte ratio (NLR) is a marker of systemic inflammatory response. Platelet distribution width (PDW) and mean platelet volume (MPV) are the determinants of platelet activation and studied as markers in inflammatory diseases. The aim of the present study was to evaluate levels of NLR,PDW and MPV in patients with fibromyalgia. A total of 197 FMS patients and 53 healthy controls are included in the study. Demographic characteristics, erythrocyte sedimentation rate, C-reactive protein, neutrophil, lymphocyte and platelet counts, platelet distribution width and mean platelet volume levels were recorded. In the patient group, the blood NLR and MPV were significantly higher and the PDW was significantly lower compared to the control group. In the roc curve analysis, blood PDW ≥had 90.4% sensitivity and 90% specificity in predicting fibromyalgia. The results of this study suggest NLR and PDW as promising inflammatory markers indicating fibromyalgia and may be beneficial in facilitating the diagnosis of FMS patients.