Cardiovascular disease risk in people with spinal cord injury: is there a possible association between reduced lung function and increased risk of diabetes and hypertension?

STUDY DESIGN: Retrospective, descriptive study of medical files 253 patients with chronic traumatic spinal cord injury (SCI). OBJECTIVES: To determine the frequency of cardiovascular disease (CVD) risk factors in SCI people, to estimate CVD risk in this population according to the Framingham Risk Score (FRS) and to determine whether reduced lung function parameters are significant predictors of diabetes mellitus (DM) and hypertension. SETTING: Academic Rehabilitation Hospital. METHODS: Demographic and clinical records of the patients and lung function parameters were obtained. RESULTS: The FRS could not be calculated in 26 (10.3%) patients because this tool is designed for adults aged 20 years and older. According to the FRS guideline, ~6.7% of the SCI patients had high risk, 5.9% of them had intermediate risk and 77.1% of the study group had low risk for CVD. Regression analysis showed that impaired lung function parameters (FEV1, FVC and MVV) were significant predictors for the future development of hypertension (odds ratio (OR): 0.483 (0.258-0.903 95% confidence interval (CI)), OR: 0.549 (0.319-0.946 95% CI) and OR: 0.981 (0.965-0.998 95% CI), respectively) and DM (OR: 0.335 (0.140-0.801 95% CI), OR: 0.391 (0.183-0.839 95% CI) and OR: 0.970 (0.947-0.993 95% CI), respectively) in the SCI population. CONCLUSION: This study showed that there might be a significant relationship between reduced lung function and the risk of DM and hypertension in people with SCI. Therefore, systematic measurement of these parameters should be performed in the routine clinical follow-up of SCI patients. Once reduced lung parameters are determined, the higher risk for developing hypertension and DM should be considered.

Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study.

BACKGROUND AND PURPOSE: We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following categories: Demographic features, American Society of Anesthesiologists (ASA) classification, Mallampati score, type of anesthetic drug used during the operation, type of intubation used, any difficulties with tracheal intubation, presence of systemic diseases, and recovery times after ending general anesthesia. MATERIALS AND METHODS: A total of 348 patients were selected from the Department of Maxillofacial Surgery and the Department of Pedodontics who underwent surgery with general anesthesia. Medical histories of all patients were taken, and their electrocardiography, chest X-rays, complete blood count, and blood clotting tests were checked during a preoperative assessment. Mallampati evaluations were also performed. Patients were grouped into ASA I, II, or III according to the ASA classification and were treated under general anesthesia. RESULTS: There was no significant difference between normal and intellectually disabled patients in terms of gender, Mallampati scores, intubation difficulties, mean anesthetic period, time to discharge, or postoperative nausea and vomiting. Epilepsy and genetic diseases in intellectually disabled patients were significantly more common than in non-ID (NID) patients. However, the frequency of diabetes and chronic obstructive pulmonary disease in NID patients was significantly higher than in the intellectually disabled patients. CONCLUSION: Dental treatment of intellectually disabled patients under general anesthesia can be performed just as safely as that with NID patients.

Trajectory prediction of oil spill with Pisces 2 around Bay of Izmir, Turkey.

The purpose of this study is to determine the risky areas by simulating trajectory of ship based oil spill in Bay of Izmir. To get well informed about fate, this study makes the best possible use one trajectory model. PISCES 2 (Potential Incident Simulation, Control and. Evaluation System), has been conducted for simulation of main weathering processes of oil spill. Hence in order to identify the risky areas, two scenarios have been developed depending on the type and amount of pollutants. In this study it is concluded that Yenikale, Inciralti and Guzelbahce will be at risk of contamination in case of accidental oil spill at Yenikale Entrance. Finally, the PISCES 2 software provided highly reliable solutions in evaporation rate and dispersion rate calculations when compared to approaches accepted in the literature. However in the surface area calculations, there is a serious difference between the size of the area calculated by the software and the size of the area proposed by oil spill science.

Is Ultrasonography a Useful Method to Evaluate the Effectiveness of Complex Decongestive Therapy in Breast Cancer-related Lymphedema?

In recent years the use of ultrasonography has become widespread in the field of lymphedema especially as an aid for diagnosis. The aim of this study was to evaluate whether ultrasonography is a useful method to assess the efficacy of complex decongestive therapy (CDT). Circumferences and ultrasonographic evaluations (cutis and subcutis thickness) were performed at 10 cm proximal and distal to the elbow and limb volume (upper and forearm) was calculated from circumferences at six anatomic landmarks by using truncated cone formula. Measurements were recorded before and after CDT on both sides. A total of twenty-six women (mean age 51.3 ± 10.8) with the diagnosis of breast cancer-related lymphedema (BCRL) were enrolled in the study. Significant reduction in the subcutis thickness was observed on the affected side after the treatment period, and the percentage change in subcutis thickness was correlated with the percentage change in edema. This study also demonstrated that the soft tissue thickness was higher in the affected arm and ultrasonographic findings were consistent with the other measurement methods (circumferences and limb volumes). Considering that ultrasound imaging is patient-friendly, non-invasive, and cost-effective, we recommend its more widespread use for evaluating treatment efficacy in BCRL.

Odontogenic tumours in Istanbul: 527 cases.

We retrieved and analysed the records of 527 odontogenic tumours from a total of 62,565 cases in the department of tumour pathology in the Institute of Oncology, University of Istanbul, from 1971 to 2003. Of these 527 tumours, 521 were benign and 6 were malignant. The most common lesions were ameloblastomas (n=133) followed by odontomas (n=109), odontogenic myxomas (n=83) and others. There were more female patients (n=278, 53%) than male, and nearly half the patients (n=253, 48%) were between the ages of 10 and 29 years. The posterior mandible was the commonest site (n=184, 35%), followed by the premolar area of the mandible (n=98, 19%), and the anterior maxilla (n=84, 16%).

Penopubic flaps technique for the repair of epispadias with or without exstrophy: a preliminary report.

Six patients (average age, 2 1/2 years; range, 4 months to 8 years) with the exstrophy-epispadias complex and isolate epispadias were treated using an alternative method. An inverted U-shaped incision (with a length of approximately 3 to 5 cm and a width of approximately 0.7 to 1.0 cm) was prepared, extending from the penopubic urethral meatus toward the umbilicus. The two incisions were extended along the urethral plate toward the ventral face of the glans. The pubic flap was prepared from the skin or scar tissue on the pubic area. The neourethra was reconstructed using penopubic flaps. A fistula occurred in one patient, which healed spontaneously. The penopubic flaps enabled us to form a wide-enough urethral tube and to perform a better dissection on the pubic area.

Laparoscopic-assisted pneumatic reduction of intussusception.

The nonoperative treatment of intussusception is done by fluoroscopy, however, false-positive and negative images may lead to unnecessary operations. The aim of this study was to evaluate the feasibility of laparoscopy in pneumatic reduction. Surgical ileoileocolic intussusception was performed in 27 dogs. Sixteen dogs were observed for 3 days (group A), and 11 were observed for 5 days (group B). Laparoscopy was performed in the intussuscepted dogs during pneumatic reduction. Under general anesthesia, a 10-mm trocar was inserted supraumblically in the midline, and the laparoscope was introduced. The intussuscepted bowel was observed on the video monitor. A 5-mm trocar was inserted in the right upper quadrant. The mesentery of the terminal ileum was manipulated using grasping forceps to assist reduction. CO2 was insufflated into the rectum using a Foley catheter, and the reduction was observed on the video monitor. The success rate was 94% (mean reduction time, 2.5 minutes +/- 1.0) for group A and 100% (mean reduction time, 3.7 minutes +/- 0.8) for group B. Bowel perforation was observed in one dog, and recurrence of intussusception in another. The authors claim that observing the bowel on the video monitor may help in the differential diagnosis and reduction of difficult cases such as ileoileocolic and delayed intussusceptions. Therefore, unnecessary open surgery may be prevented.

Splenic abscess, pleural effusion and severe anemia caused by Salmonella typhi.

Various complications related to gastrointestinal system, central nervous system, and skeletal system may be observed during typhoid fever, but splenic abscess and pleural effusion are rarely encountered. A 12-year-old boy was admitted with fever, fatigue and pallor. On examination he had hepatosplenomegaly and severe anemia. He was diagnosed as having Salmonella typhi infection complicating with splenic abscess, pleural effusion and severe anemia, and successfully treated with percutaneous drainage with ultrasonography and antibiotics. In conclusion we would like to emphasize that typhoid fever should also be considered in patients with hepatosplenomegaly and severe anemia, and percutaneous drainage with ultrasonography may successfully be used in management of splenic abscess in typhoid fever.

Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

Clinimetric properties of the Duruoz hand index in patients with stroke.

OBJECTIVE: To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. DESIGN: Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. SETTING: Three different inpatient rehabilitation centers. PARTICIPANTS: A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. RESULTS: The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05). CONCLUSIONS: The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.

Cardiopulmonary and metabolic functions, aerobic capacity, fatigue and quality of life in patients with multiple sclerosis.

OBJECTIVES: The objectives of this study were to evaluate cardiopulmonary and metabolic functions in patients with multiple sclerosis (MS) and to clarify the relationship between these functions and neurological deficits, respiratory involvement, fatigue and quality of life. MATERIALS AND METHODS: Twenty-five patients with MS and 15 healthy controls were included in the study. Cardiopulmonary and metabolic responses to maximum exercise were investigated with an electronically braked arm crank ergometer. A computerized gas analysis system collected and analysed expired gases during exercise. RESULTS: In the present study, significant respiratory muscle weakness, and decreased aerobic performance and cardiopulmonary and metabolic responses to maximum exercise were determined in patients with MS. CONCLUSIONS: As respiratory muscle function plays a strong role in aerobic capacity and in most of the cardiopulmonary and metabolic responses to exercise, measurement of respiratory muscle strength and endurance should also be carried out in the MS population.

Our experience in eight cases with urinary hydatid disease: a series of 372 cases held in nine different clinics.

OBJECTIVES: Hydatid disease, a parasitic infestation caused by the larval stage of the cestode Echinococcus granulosus, is diagnosed commonly in the east and south-east regions of Turkey. The aim of this study is to emphasize the relatively frequent occurrences of echinococcosis in our region, and to discuss therapeutic options and treatment results according to current literature. METHODS: A retrospective 10-year review of nine different clinics' records of the Research Hospital of the Medical School of Yüzüncü Yil University revealed 372 hydatid disease cases that were localized in various organs and treated surgically (271 cases) or drained percutaneously (99 cases). Hydatid disease was diagnosed by ultrasonography (US) and computed tomography scans (CT) and confirmed histopathologically. RESULTS: The involved organ was lung in 203 cases (131 adults, 72 children), liver in 150, spleen in 9, brain in 2, kidneys in 7 cases and the retrovesical area in 1 case. The urogenital system is involved at a rate of 2.15%. Two hundred and seventy-one cases were treated surgically and 99 percutaneously. Two cases with renal hydatid cyst refused the surgical procedure (one had a solitary kidney with hydatid cyst). Albendazole was administered to 192 patients; 93 patients had open surgical procedure and 99 patients underwent percutaneous procedure. Cysts were excised totally in the open surgical procedure; however, involved kidneys were removed totally (four cases) except one. Cystectomy and omentoplasty was performed in one case. Complications were as follows: in six cases, cystic material was spilled into the bronchial cavity during the dissection and a renal hydatid cyst ruptured and spilled retroperitoneally. CONCLUSION: Hydatid disease is a serious health problem in Turkey. The mainly affected organs are liver and lung. It can be treated surgical or by percutaneous aspiration.

Simultaneous upper and lower extremity complex regional pain syndrome type I in tetraplegia.

STUDY DESIGN: Clinical case report. OBJECTIVES: To present the first case of incomplete tetraplegic spinal cord injury (SCI) in which complex regional pain syndrome (CRPS) type I was present in all four of the patient's extremities. SETTING: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey. METHODS: A 49-year-old man with incomplete tetraplegia (American Spinal Injury Association (ASIA) C) was admitted to our clinic for rehabilitation. According to the patient's history, pain and edema began in his right foot 1(1/2) months after his injury. After 10 days later the same symptoms appeared in his left foot as well. In the third week after pain and edema appeared in the right foot, these were also observed in both hands, markedly in the left. RESULTS: Three-phase bone scan images supported a diagnosis of stage 3 CRPS type I in all four extremities. After the diagnosis was made, passive range of motion (PROM) exercises were started. Transcutaneous electrical nerve stimulation and whirlpool sessions were used for pain and edema control. Drug therapy included Calcitonin, Naproxen sodium and Amitriptyline. After 6 weeks of treatment, the patient's visual analog scale pain score had decreased to 38 mm from an initial score of 85 mm at the onset of the treatment, and PROM of wrists/hands, fingers and ankles had become full and painless. CONCLUSION: We conclude that CRPS type I might be more common in SCI than is usually suspected, and that tetraplegic patients should be carefully evaluated for the presence of CRPS type I in upper and lower extremities.

Ultrasound-guided percutaneous drainage in the treatment of children with hepatic hydatid disease.

The present study was designed to establish the safety and efficacy of ultrasound-guided percutaneous drainage in the treatment of hepatic hydatid cysts in children. A total of 14 cysts in eight patients were drained under aseptic conditions and continuous ultrasound guidance. An 18-G needle was used for puncture and silver nitrate solution as the scolecoidal agent. All procedures were successful. During follow-up, repeated ultrasound examinations revealed a progressive decrease in cyst size and an alteration in the cyst echopattern. None of the patients had a rise in hydatid antibody titer. There were no immediate or late complications. We conclude that the safety and efficacy of ultrasound-guided percutaneous drainage are satisfactory for the treatment of hepatic hydatid cysts in children.

Reversed seromuscular gastrocystoplasty for bladder augmentation.

The aim of this study was to prevent the complications of gastrocystoplasty by using reversed seromuscular gastrocystoplasty for bladder augmentation. Healthy mongrel dogs were used in the study. A diamond shaped segment was separated from the remainder of the stomach preserving the right gastroepiploic artery in 11 dogs. The gastric mucosa was removed. A reversed seromuscular gastrocystoplasty was performed. The animals were observed for a mean of 7.7 months. Thereafter, relaparotomy was performed in all animals. A bladder stone was found in 1 dog. In the histopathological evaluation of the urinary bladder, it was seen that the gastric serosal surface was covered with the urothelium in all dogs. Transitional epithelial hyperplasia in 1 dog (12.5%) and squamous metaplasia in 2 dogs (25%) were identified. There were no statistical differences between preoperative and postoperative values of urine and blood pH and serum sodium, potassium, chloride, and bicarbonate levels. Complications of gastrocystoplasty such as hypochloremic metabolic alkalosis and hematuria and dysuria syndrome, are prevented by this procedure. The shrinkage of the gastric patch surface may also be prevented by facing the smooth gastric serosa to the internal surface of the urinary bladder.

Clinical characteristics and genetic screening of an extended family with MEN2A.

MEN-2A is characterized by medullary thyroid carcinoma (MTC) with pheochromocytoma and sometimes parathyroid adenoma. In affected members of the family, the risk of MTC is about 100%. Biochemical screening allows tumors to be detected early but even at this stage treatment is not always curative. Missense mutations in exon 10 and 11 of the RET proto-oncogene are associated with MEN-2A. Early detection of this mutation by DNA analysis allows the identification of the carriers of the gene. We performed genetic screening in 88 members of an extended family with MEN-2A and found 18 members positive for RET mutation (Cys634Gly). Only three of these 18 RET positive cases had a previous diagnosis of medullary cancer and/or pheochromocytoma. Up to now, 12 of the RET positive cases have undergone thyroidectomy. There was extended disease with cervical lymph node metastasis in 6 of them, bilateral medullary microcancer in 3 and c-cell hyperplasia in the remaining 3. Three of the 18 RET positive patients had also pheochromocytoma. Primary hyperparathyroidism was present in only one patient. The mean age of diagnosis of medullary cancer was between 25-50 yr and mean age of death was between 35-95 yr in affected members of the family. The family had many other affected members in other cities in Turkey and in other countries throughout the world from Australia to the Netherlands. So this family is perhaps one of the most extended families with MEN-2A.