Semih Akkaya

Comparison of injection modalities in the treatment of plantar heel pain: a randomized controlled trial.

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean +/- SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 +/- 1.1, 7.6 +/- 1.3, and 7.28 +/- 1.2 to 2.0 +/- 2.2 (P < .001), 2.4 +/- 1.8 (P < .001), and 2.57 +/- 2.9 (P < .001), respectively. Mean +/- SD rearfoot scores in the same groups improved from 64.1 +/- 15.1, 71.6 +/- 1, and 65.7 +/- 12.7 to 78.2 +/- 12.4 (P = .018), 80.9 +/- 13.9 (P = .025), and 80.07 +/- 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain.

Distribution of the metatarsophalangeal sesamoids in Turkish subjects.

No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52-4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (kappa = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001).

Comparison of effects of supervised physiotherapy and a standardized home program on functional status in patients with total knee arthroplasty: a prospective study.

[Purpose] The aim of this study was to determine the functional differences between total knee arthroplasty (TKA) patients who were treated with supervised physiotherapy or a standardized home program and perform a cost analysis. [Subjects and Methods] Patients who received total knee arthroplasty between January 2009 and June 2011 were enrolled in this study; those with mean ages of 64.25±3.86 (60–68) years (n=18) and 68.08±6.25 (61–79) years (n=16) were placed in the supervised physiotherapy and standardized home program groups, respectively. All patients were evaluated by the same researcher before and after surgery, and the therapy programs were applied by another physiotherapist. All patients were evaluated for joint range of motion (ROM), pain, functional status (WOMAC), overall quality of life (SF-36), and depressive symptoms (BECK Depression Scale). [Results] A significant clinical improvement was observed in postoperative assessments. A statistically significant difference could not be found between ROM and functional levels of the patients in both groups. [Conclusion] No difference was found between the patients performing supervised or standardized home program with respect to the effects on functional status. A home exercise program can be used in the rehabilitation of patients with TKA, and implementation of home exercise programs can also reduce health-care spending.

Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial:

Objective: To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy. Design: Randomized, prospective, controlled single-blind trial. Setting: Department of physical medicine and rehabilitation, university hospital. Subjects: Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group. Interventions: The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise. Main measures: The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion–extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after. Results: The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017). Conclusions: The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Relationship between the body image and level of pain, functional status, severity of depression, and quality of life in patients with fibromyalgia syndrome

The aims were to investigate how the body image is affected in fibromyalgia syndrome (FMS) in comparison to healthy people, as well as to explore the relationship of the body image with the level of pain, functional status, severity of depression, and quality of life (QoL). Demographic variables, symptoms of fibromyalgia, and number of fibromyalgia tender points for 51 patients with FMS and 41 control subjects were recorded. All patients were asked to mark the level of pain on visual analogue scale (VAS). Six-minute walking test was recorded for functional assessment. The impact of the disease was evaluated by fibromyalgia impact questionnaire (FIQ). All patients were asked to complete body image scale (BIS), Beck depression inventory (BDI), and short form-36 (SF-36). There were no differences between groups with regard to demographic variables (p > 0.05). Mean VAS was 7.5 ± 1.4 for the patients with FMS and 0.3 ± 0.4 for control subjects (p < 0.05). Mean FIQ was 70.8 ± 13.2 and 8.2 ± 9.6 for the FMS and control groups, respectively (p < 0.05). Mean BIS and BDI were 106.5 ± 24.0 and 20.2 ± 11.2 for FMS group and 66.3 ± 23.4 and 3.4 ± 4.0 for control group, respectively (p < 0.05). SF-36 subscores were found to be significantly lower in patients with FMS than control subjects (p < 0.05), except for the social function subscore. BIS score had significant relationships both with VAS (r = 0.843) and FIQ (r = 0.290) in patients with FMS (p < 0.05). There were significant relationships between BIS scores and SF-36 pain (r = −0.288), energy/vitality (r = −0.519), mental health (r = −0.442), and general health (r = −0,492) subscores (p < 0.05). Body image was associated with VAS in the multivariate linear regression analysis. The results of the present study indicate that body image is disturbed in patients with FMS compared to control subjects. For the evaluation of the level of pain, impact of the disease, and QoL in patients with FMS, it would be useful to consider the relationship of the body image disturbance with these parameters.

The effects of human umbilical cord blood transplantation in rats with experimentally induced spinal cord injury.

OBJECT Even though there have been many efforts to recover neuronal dysfunction following spinal cord injuries, there are limitations to the treatment of these injuries. The purpose of this laboratory investigation was to determine the clinical and neurophysiological effects of human umbilical cord blood (HUCB) transplantation in a rat hemisection model of spinal cord injury. METHODS In this study, experimental hemisection of the thoracic spinal cord was performed in rats. The rats were divided into 4 groups (6 rats in each group). One group of rats (Group 1) underwent thoracic laminectomy only. Rats in Group 2 underwent laminectomy and right hemisection of the thoracic spinal cord. Rats in Group 3 underwent right hemisection and implantation of freshly obtained HUCB on Day 0 postinjury. Rats in Group 4 underwent hemisection and implantation of freshly obtained HUCB on Day 4 postinjury. Clinical evaluations of rat motor function included the following: neurological examination, Rotarod performance, and inclined plane tests. Rats also underwent reflex evaluation. RESULTS The neurological examinations revealed that the frequency of plegic rats was 70.8% at the beginning of the study across all 4 groups; this value decreased to 20.8% by the end of the study. The percentage of rats with a normal examination increased from 25% to 50%. The results of Rotarod performance and 8-week inclined plane performance tests showed statistical significance (p < 0.05) in an overall group comparison across all time points. At the end of the 8 weeks, a statistically significant difference was found in the inclined plane test results between rats in Groups 1 and 2. There were no statistically significant differences between Groups 1, 3, and 4 (p < 0.05). When the reflex responses of the hemisectioned sides were compared, statistically significant differences were detected between groups (p < 0.05). All groups were significantly different with regard to the right-side reflex response score (p < 0.05). Spinal cord preparations of rats in all groups were examined for histopathological changes. CONCLUSIONS Human umbilical cord blood is stem cell rich and easily available, and it carries less risk of inducing a graft-versus-host reaction in the recipient. Human umbilical cord blood serum is also noted to contain stem cell–promoting factors, which is why cell isolation was not used in this study. Freshly obtained cord blood was also used because storage of cord blood has been reported to have some negative effects on stem cells. Transplantation of freshly obtained HUCB into the hemisectioned spinal cord experimental model demonstrated clinical and neurophysiological improvement.

Helicobacter pylori seropositivity in fibromyalgia syndrome

Although there are some studies suggesting relation between different types of infection and fibromyalgia syndrome (FM), there is presently no proof that FM is caused by an infection. Helicobacter pylori (HP) infection may cause extragastric manifestations. Inflammation is an important mediator of increased sympathetic nervous system activity and may lead to pain in fibromyalgia patients. In this study, we aimed to investigate the HP seropositivity in fibromyalgia patients compared with controls for possible role of HP infection in FM. Sixty-seven patients with fibromyalgia were evaluated. Two of them were excluded from the study because of high level of acute phase reactants. Sixty-five female patients with fibromyalgia and 41 randomly selected age-matched female healthy controls were enrolled to study. Serum HP IgA and IgG antibodies were measured by enzyme-linked immunosorbent assay technique. Fibromyalgia Impact Questionnaire was assessed in patients and controls. Seropositivity of HP IgG antibody in the fibromyalgia patients was significantly higher than in the control group. No statistically significant differences were found regarding the clinical features between fibromyalgia patients with HP IgG antibody and patients without IgG antibody. Our study suggests that former HP infection may have a role in the etiopathogenesis of fibromyalgia syndrome or may act as a triggering factor. However, high seroprevalence of HP in general population and prevalent asymptomatic infection make it difficult to interpret these results for the definite role of HP in FM. Highlighting the pathophysiologic mechanisms of FM will result in more effective treatment regimens.

A Concise Review on the Use of Mesenchymal Stem Cells in Cell Sheet-Based Tissue Engineering with Special Emphasis on Bone Tissue Regeneration

The integration of stem cell technology and cell sheet engineering improved the potential use of cell sheet products in regenerative medicine. This review will discuss the use of mesenchymal stem cells (MSCs) in cell sheet-based tissue engineering. Besides their adhesiveness to plastic surfaces and their extensive differentiation potential in vitro, MSCs are easily accessible, expandable in vitro with acceptable genomic stability, and few ethical issues. With all these advantages, they are extremely well suited for cell sheet-based tissue engineering. This review will focus on the use of MSC sheets in osteogenic tissue engineering. Potential application techniques with or without scaffolds and/or grafts will be discussed. Finally, the importance of osteogenic induction of these MSC sheets in orthopaedic applications will be demonstrated.

Ultrasonographic measurement of the distal femoral cartilage thickness in patients with unilateral transtibial amputation.

Background: Lower limb amputation sometimes predisposes to degenerative secondary disorders. Objectives: To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters. Study Design: Cross-sectional study. Methods: Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28–60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated. Results: Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05). Conclusions: Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients. Clinical relevance The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.

Is there a treatment protocol in which platelet-rich plasma is effective?

AIM We aimed to reveal whether there are prospective suggestions for effective and standard platelet-rich plasma applications. METHODS We searched for clinical trials and traced all the references of incorporated documents. RESULTS In literature, there was no study indicating which disease is treated by which mechanism of action, how much dose and content are prepared and applied, when the treatment is applied and how many cures are applied. CONCLUSION Guides introducing which concentrations of PRP are used for which diseases are to be prepared immediately by a committee which is comprised of primarily orthopedists, clinical pharmacologists and toxicologists.