Selim Akarsu

Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients

Background: It is difficult for the lower limb amputee patients to adapt to their new lifestyles. Objective: To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. Study Design: Cross-sectional study. Methods: Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. Results: Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. Conclusion: Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.

Long-term outcome of Osgood-Schlatter disease: not always favorable

Osgood-Schlatter disease (OSD), which named for the doctors that first described it in 1903, is a disease of preadolescent children (usually boys with 11–15 years of age) whereby tractional injury of the tibial tuberosity leading to avulsion of a proximal part of it occurs [1, 2]. Clinically, it is characterized by pain, swelling and enlargement of the proximal tibia at the site of the patellar tendon’s insertion. The prognosis of OSD is usually self-limiting course. Long-term outcome is good for the majority of the patients. Complications (i.e., pseudarthrosis, genu recurvatum, patella alta, fragmentation/migration of the ossicle) potentially leading to early osteoarthritis can occur in the chronic stage [3]. Although OSD disease is a well-known clinical entity, management with long-term follow-up remains controversial. In this report, we presented the long-term outcome of a patient with untreated OSD. A 21-year-old man was seen for mild swelling in his left knee (that did not affect his daily activities) for the last 10 years. He denied any episode of trauma and the medical history was otherwise noncontributory. Physical examination revealed tenderness and swelling at the left knee. Both active and passive knee motions provoked pain. Moderate restriction of movement in the left knee (30 of flexion and 5 of extension lag) was present. Neurological examination was unremarkable. Current and past knee radiographs of the patient are seen in Fig. 1, which showed a major fragmented bone of a proximal part of the tibial tuberosity. The patient was consulted to the orthopedic surgeons, and they suggested surgery due to the presence of limitations in his knee motions, but the patient did not accept surgery. In the relevant literature, there seems to be a single study that has reported on the long-term follow-up of OSD patients [4]. Fifty subjects with 69 affected knees had been followed for 9 years (range 3–30). During the acute phase of OSD, the patients were reevaluated and followed under conservative treatment. Forty-seven subjects had various degrees of knee limitations, and only three patients had no limitation in the acute phase, and at the end of their study, all patients were free of any limitations. On the other hand, presenting our patient, we imply that despite its mild symptoms (not affecting patients’ daily activities), OSD may cause knee joint

Ultrasound imaging for neurofibromatosis: from the dermatologist's perspective.

Recently, musculoskeletal ultrasound (US) has received increased attention in the field of dermatology [1]. While ultrasound can be used to image the skin (epidermis, dermis, subcutaneous fat), nail and the nearby soft tissues/joints [2, 3], it can be particularly useful in patients with leprosy and neurofibromatosis (NF) to demonstrate the extent of peripheral nervous system involvement [4, 5]. We have previously shown the role of ultrasound in the diagnosis and follow-up of several complications in leprosy (submitted data); and similarly in this short report describing two military, we underscore the convenient role of ultrasound for imaging the peripheral nerves in NF. Neurofibromatosis, described by Friedrich Daniel von Recklinghausen in 1882, is a neuroectodermal abnormality Clinical letter comprised of a set of clinical symptoms that compromise the skin, nervous system, bones, eyes and other sites [6]. It is believed that at least one million individuals worldwide are living with neurofibromatosis [7]. It is inherited in an autosomal-dominant pattern and considered one of the most common disorders in humans inherited in this manner [6, 7]. Neurofibromas are the hallmark tumors of NF and predominantly involve the peripheral nerves [8]. They can be of different types such as localized (90 %), diffuse and plexiform [9]. The localized form presents as an ovoid or a fusiform mass through which the nerve trunk passes. The diffuse form grows in an infiltrative pattern and entraps adjacent normal structures. The plexiform neurofibroma has a serpentine-like appearance and characteristically involves a long segment of the nerve with its branches. This form is pathognomonic for NF type 1 and can potentially be malignant [4, 5]. For peripheral nerve problems, a thorough physical examination combined with nerve conduction studies usually suffices for the diagnosis. However, imaging may be needed to identify the underlying cause of nerve dysfunction or to assess the extent for more widespread disease. Ultrasound using a linear array high frequency probe, 7–12 MHz offers numerous advantages (patient and physician friendly, costeffective, no ionizing radiation, dynamic imaging) has become the method of choice for peripheral nerve imaging – not only for diagnosis but also for guiding possible surgery or

Quality of Life and Functionality of Patients With Heel Reconstruction After Landmine Explosions

Landmine injuries cause extensive soft and bony tissue loss of the weight‐bearing areas, particularly the heel. Reconstruction of these injuries is challenging, and there are no studies that report long‐term functional results.

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.

A 22-year-old man with severe osteoporosis due to prolactinoma.

Prolactin-secreting adenomas represent nearly 40% to 60% of all pituitary adenomas. Prolactin inhibits the secretion of gonadotropin-releasing hormone that is responsible for the synthesis and secretion of gonadotropins. Sex steroids have an important effect on the regulation of bone metabolism in men. Decreased libido and impotence are the most common presenting symptoms of hyperprolactinemia in males. These symptoms are easily neglected by both patients and some physicians. We present a 22-year-old man with multiple osteoporotic fractures associated with prolactinoma despite the use of teriparatide for 18 months. We emphasize and highlight the importance of hyperprolactinemia and fractures caused by high prolactin levels.

Efficacy of Omalizumab in a Patient with Angioedema Clinically Resembling a Hereditary Angioedema.

Dear Editor: A 20-year-old man was referred to our allergy and immunology department with complaints of recurring angioedema attacks, lasting 48~96 h, on his lips, eyes, and face, as well as swelling of the extremities and testicles during the last 1 year. Regular use of antihistamine and steroid drugs was generally ineffective against the frequency and severity of the angioedema attacks. He experienced recurrent abdominal pain attacks during the evaluation period. He was hospitalized in another center with a prediagnosis of familial Mediterranean fever; however, that diagnosis was excluded later. Urticarial lesions were not observed during the angioedema attacks. He did not have a history of drug or food allergy, and no specific family history for angioedema was reported. A detailed evaluation for arthritis and rheumatologic disorder was done but no specific findings were found. Furthermore, rheumatologic markers were negative (IRB No. 1491-21-16/1539). Routine laboratory tests for the management of chronic urticaria-angioedema and for anti-nuclear antibody, rheumatoid factor, anti-cyclic citrullinated peptide antibodies, C3, and C4 were within the reference limits. The total immunoglobulin E (IgE) value was 213 IU/ml, and the C4 levels during the attacks were normal. However, C1 esterase inhibitor was measured to be 28.3 mg/dl (reference, 32~39 mg/dl), and hereditary angioedema (HAE) was clinically considered. Danazol treatment up to 400~600 mg/day was started; however, no significant benefit was observed. As the 1,000 U C1 esterase inhibitor administered during the attacks (Cetor, 500 U; Sanquin, Amsterdam, The Netherlands) was ineffective, the diagnosis of HAE was excluded. Because the urticarial complaints started in addition to the angioedema complaints, our patient received 300 mg omalizumab (Xolair 150 mg; Novartis Pharmaceuticals, Basel, Switzerland) subcutaneously every 4 weeks according to conventional asthma treatment protocols. He was treated with omalizumab for 6 months. His angioedema attacks ceased completely within 2 weeks after the start of this treatment. Except for the very short period for the formal procedures required for the procurement of the drug, he had no other complaints during the 6 months follow-up. In randomized, placebo-controlled trials, omalizumab was shown to have excellent efficacy in chronic spontaneous urticaria1. A growing number of case reports and series suggest that anti-IgE treatment may also be beneficial for patients with physical urticarias and chronic angioedema. Recently, omalizumab treatment for inducing and maintaining long-term remission in patients with severe chronic urticaria has been demonstrated2. Unfortunately, for such disorders with complex and unclear etiology, no randomized placebo-controlled trial has been performed yet3. The mechanism of omalizumab activity in angioedema is currently not well defined. However, several mechanism may be considered. Even if the pathogenesis of angioedema in the present case may not be directly mediated by IgE, omalizumab may be effective through an unidentified and indirect anti-inflammatory manner. Sayama et al.4 reported that the stimulation of high-affinity IgE receptor (FceRI) in human umbilical cord mast cells causes substantial change in the expression of many genes, including Interleukin-11 (IL-11), and at least 30 other cytokines and chemokines and several adhesion molecules involved in potential interactions with T cells, B cells, or dendritic cells. Another work, in which the anti-inflammatory activity of omalizumab was mediated, has provided evidence showing the efficacy of this drug in idiopathic angioedema through eosinophil apoptosis induction and downregulation of the inflammatory cytokines IL-2 and IL-135. In conclusion, it seems that therapeutic efficacy spectrum of anti-IgE treatment comprises many allergic disorders with unknown etiology, including angioedema.

A Case of Hodgkin Lymphoma With Polyarthralgia After Completion of Chemotherapy

©2017 Turkish League Against Rheumatism. All rights reserved. There are various musculoskeletal manifestations that may develop in a patient after chemotherapy. These manifestations may be due to metastasis to musculoskeletal structures, paraneoplastic syndrome or immune reactions as well as adverse reactions to cancer specific chemotherapy.1 One of these symptoms is post-chemotherapy rheumatism which is a non-inflammatory and selflimiting condition that manifests as symmetric or asymmetric arthralgia, arthritis and stiffness that involves both large and small joints.2 It has been described in patients with some types of cancer including breast cancer, ovarian cancer, and nonHodgkin’s lymphoma within a few months after the completion of chemotherapy.2 In this article, we report a patient with polyarthralgia after chemotherapy for Hodgkin lymphoma.

An Atypical Complex Regional Pain Syndrome Type 1 Following Diphtheria-Tetanus Vaccination -

A 20-year-old male patient was admitted to Infectious diseases outpatient clinic with 25 days’ history of pain and swelling of the left hand and forearm. He had received a single dose of diphtheria tetanus-diphteria toxoid vaccine (Td; vaccines with reduced content of diphtheria toxoid) in the left deltoid muscle. The patient was diagnosed as Complex regional pain syndrome type 1. He was administered gabapentin (initial dose 1200 mg per day in two divided doses and maintenance dose 1800 mg per day, in three divided doses), etodolac 600 mg per day, acetylcystein 1200 mg per day, 3000 mg calcium carbonate with 8.8 mg colecalciferol at bed time and left upper extremity physiotherapy, including whirlpool, contrast bath and range of movement exercises. As a result, although complex regional pain syndrome type 1 (CRPS I) is a rare entity, it should be recognized in patients with severe pain, swelling and restricted extremity movement that occurred after immunization.

Self-induced cutaneous lesions in a patient with spinal cord injury.

immunoglobulin in the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: a meta-analysis with meta-regression of observational studies. Int J Dermatol 2015; 54: 108–115. 28 Paradisi A, Abeni D, Bergamo F, et al. Etanercept therapy for toxic epidermal necrolysis. J Am Acad Dermatol 2014; 71: 278–283. 29 Kirchhof M, Miliszewski M, Sikora S, et al. Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. J Am Acad Dermatol 2013; 71: 941–947. 30 Singh G, Chatteriee M, Verma R. Cyclosporine in Stevens Johnson syndrome and toxic epidermal necrolysis and retrospective comparison with systemic corticosteroid. Indian J Dermatol Venereol Leprol 2013; 79: 686–692.