Seyhan Sözay

The Effect of Abdominal Massage on Bowel Function in Patients with Spinal Cord Injury

Ayaş Ş, Leblebici B, Sözay S, Bayramoğlu M, Niron EA: The effect of abdominal massage on bowel function in patients with spinal cord injury. Am J Phys Med Rehabil 2006;85:951–955. Objectives:To investigate the effect of abdominal massage on clinical aspects of bowel dysfunction and colonic transit time in patients with spinal cord injury. Twenty-four patients were placed on a standard bowel program (phase I), after which abdominal massage was added to the regimen (phase II). Parameters of gastrointestinal system function and colonic transit times were evaluated. Design:Uncontrolled clinical study. Results:Eleven (45.8%) of the 24 patients had abdominal distention, and 10 (41.7%) had fecal incontinence in phase I; corresponding results for phase II were three (12.5%) and four (16.7%) (P = 0.008 and 0.031, respectively). There were no significant differences between the proportions of patients with difficult intestinal evacuation or abdominal pain or in mean time required for bowel evacuation in phase I vs. phase II. The mean frequencies of defecation in phases I and II were 3.79 ± 2.15 (2.75–4.55) and 4.61 ± 2.17 (3.67–5.54) bowel movements per week, respectively (P = 0.006). Mean total colonic transit time decreased from 90.60 ± 32.67 (75.87–110.47) hrs in phase I to 72 ± 34.10 (58.49–94.40) hrs in phase II (P = 0.035). Conclusions:Abdominal massage has positive effects on some clinical aspects of neurogenic bowel dysfunction in patients with spinal cord injury.

Hemorrhagic transformation in stroke patients.

Bayramoğlu M, Karataş M, Leblebici B, Çetin N, Sözay S, Turhan N: Hemorrhagic transformation in stroke patients. Am J Phys Med Rehabil 2003;82:48–52. Objective To identify the predictors of hemorrhagic transformation in stroke patients and to evaluate the impact of hemorrhagic transformation on rehabilitation outcome. Design The records of 203 hemiplegic patients hospitalized for rehabilitation after the acute phase of stroke were retrospectively analyzed. In 121 cases, the first computed tomographic scan and a repeat scan were compared to determine whether hemorrhagic transformation occurred. Correlations between the occurrence of hemorrhagic transformation and use of anticoagulants, antiaggregants, and antiedema drugs were evaluated. Admission and discharge FIM™ and Adapted Patient Evaluation Conference System scores were noted, and functional gain was calculated from these. These data were also analyzed for associations with hemorrhagic transformation. Results Hemorrhagic transformation was detected in 39 of the 121 cases. There was no significant difference in functional outcome between patients who did and did not show hemorrhagic transformation. Although not statistically significant, the use of antiedema drugs was found to increase the risk of hemorrhagic transformation, whereas the use of anticoagulants and antiaggregants had no influence. Conclusions Hemorrhagic transformation of an ischemic lesion does not affect rehabilitation outcome in stroke survivors. The study results favor the use of anticoagulants and antiaggregants in the acute phase unless these drugs are contraindicated by the patient’s condition. Still, prospective trials are needed to make definite conclusions.

Prolonged P300 latency in thyroid failure: a paradox. P300 latency recovers later in mild hypothyroidism than in severe hypothyroidism.

This study was performed to analyze quantitatively the cognitive functions of patients with mild and severe hypothyroidism by measuring P300 event-related evoked potentials before and after euthyroidism was established. Patients diagnosed as having Hashimatos thyroiditis with thyroid stimulating hormone (TSH) levels between 5 and 10 mU/L (mild thyroid failure; n = 24) and those with severe hypothyroidism (n = 13) were enrolled randomly to the study protocol. P300-event related potentials were recorded during thyroid insufficiency, and in the first and sixth month of euthyroidism. P300 latencies were prolonged in both the mild and severe hypothyroid patients compared to controls (p = 0.042, p < 0.001, respectively). The overt hypothyroid patients showed significant decrease in their P300 latencies after the first month of euthyroidism (p = 0.001). These P300 latency values did not differ in the subsequent 6-month period. The mild hypothyroid group, however, displayed no improvement of P300 latency in the first month but normalized at the sixth month of euthyroidism. In conclusion, both the overt and the mild hypothyroid patients revealed prolonged P300 latencies. Unexpectedly, P300 latencies in the patients with mild thyroid failure required more time to recover compared to the overt hypothyroid patients. This finding indicates different clinical outcomes of various thyroid insufficiency states on the brain.

Diffuse idiopathic skeletal hyperostosis in a patient with idiopathic retroperitoneal fibrosis: a case report

Abstract. Idiopathic retroperitoneal fibrosis (IRF) is a rare rheumatologic disease with obscure pathogenesis. Its manifestations depend upon the structures involved. Diffuse idiopathic skeletal hyperostosis (DISH) is usually seen in male patients over 45 years of age and characterized by new bone formation at the entheses. The dorsal spine is most commonly involved, but radiographic findings in both the spine and extraspinal structures suggest a generalized disorder of ossification rather than a localized spinal disease. The association of IRF and DISH has not been reported before. There is proliferation of connective tissue in both of these diseases, and they may share a common etiopathogenetic basis. We describe a patient having features of both IRF and DISH.

Diurnal variation in clinical and electrophysiologic parameters associated with carpal tunnel syndrome.

Objective:Patients with carpal tunnel syndrome (CTS) often report aggravated symptoms in the early morning. In this study, we aimed to identify diurnal variations in clinical and electrophysiologic parameters of patients with CTS. Design:A cross-sectional clinical and electrophysiologic study was designed. First, electrophysiologic examinations were performed at 2 p.m. to confirm the diagnosis of patients who had been clinically labeled with CTS. Patients who were electrophysiologically and clinically diagnosed with CTS were included in the study, and electrophysiologic examinations were repeated at 7 p.m. and 7 a.m. A total of 64 hands with CTS (27 bilateral, 10 unilateral) and 40 control hands were studied. Grip and pinch strength of all the patients included in the study were measured using a hand dynamometer. Finally, a CTS clinical symptom severity scale and functional status scale were used to measure the symptoms and functional impairment, respectively. Results:The median motor nerve distal latency and median F-minimum latency were found to be prolonged in the CTS group in the morning, and the grip strength was also markedly reduced at this time. Similar results were obtained for the median palm mixed nerve conduction velocity and amplitude. Conclusions:This study demonstrated that the clinical and electrophysiologic parameters of CTS patients were clearly different in the morning hours, with the symptoms of CTS manifesting at that time.

The effects of two different water exercise trainings on pain, functional status and balance in patients with knee osteoarthritis

METHODS Eighty-nine female patients who had been diagnosed with knee osteoarthritis were divided into three groups as two experimental and a control group. All groups have received the standard therapy (hotpack, ultrasound, TENS). Both experimental groups underwent water exercise program. While Group 1 performed lower extremity exercise training, Group 2 performed upper extremity exercises as well as trunk exercises in addition to the lower extremity exercises used in the Group 1. The third group was control group who did not receive water exercise treatment. The pain severity was measured with the Visual Analog Scale (VAS). Functional status was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Balance was evaluated by using the single leg stance test. RESULTS The change in VAS scores from pre-to post-treatment was highest in Group 1 (p < 0.001). On the other hand, the change in WOMAC pain, stiffness and physical function values from pre-to post-treatment was highest in Group 2 (p < 0.001). DISCUSSION Water exercise training was found to be beneficial in the treatment of knee osteoarthritis in both groups. Moreover, adding upper extremity and trunk exercises to the lower extremity exercises was found to be more effective for improving the function.

Complex Regional Pain Syndrome in an Adult Following Tetanus–Diphteria Toxoid Vaccine: Case Report and Review of the Literature

Abstract Background: Complex regional pain syndrome [CRPS] is a painful and disabling chronic neuropathic disorder, and unfortunately, due to its wide spectrum of clinical manifestations, the diagnosis may often be missed by primary-care physicians. To the authors’ knowledge, there are no reported cases of CRPS following immunization with tetanus–diphteria toxoid booster vaccine in an adult. Findings: We present a 26-year-old woman with severe pain, swelling, and limited range of motion of the left forearm following a booster dose of the tetanus–diphteria toxoid vaccine. Conclusion: Disease awareness among practitioners, early recognition, and appropriate treatment is essential to minimize the risk of adverse outcome.

The Turkish experience of poliomyelitis before and after a vaccination campaign.

It is very important that the poliovirus is eradicated as it has caused serious and permanent disabilities during the present century. In order to achieve success in the rehabilitation of poliomyelitis patients the role of vaccination campaigns as an essential part of preventive medical care should be appreciated. After every vaccination campaign successful results have been obtained. Thus we are optimistic that if these vaccination campaigns are carried out successful results will be achieved as was obtained after the 1985 vaccination campaign. As is understood from our report, according to the results of the 1985 vaccination campaign successful long-term results have been achieved. The results of the 1995 campaign will also be seen at a future date as this article does not report them. We appreciate the cooperation and support given by WHO during the staging of these campaigns.