Carcinoid tumor of the cecum presenting with acute appendicitis: a case report.

BACKGROUND: Acute appendicitis is the most common cause of acute abdomen. Carcinoid tumor of the appendix is a rare incidental finding that can present with the clinical picture of acute appendicitis. CASE REPORT: During open surgery for acute appendicitis, a 3 cm solid mass, not noticed externally, was palpated at the base of the appendix. The mass and the appendix were excised by en-bloc wedge resection. The histopathological examination of the lesion revealed carcinoid tumor. CONCLUSION: The aim of this presentation is to remind that neoplasms of the appendix may, although rarely, present the clinical picture of acute appendicitis, and to highlight that they, particularly those located at the base of the appendix and in cecum, may be overlooked during laparoscopy. The importance of preoperative computerized tomography ins uch cases has to be underlined.

Is thrombin-activatable fibrinolysis inhibitor antigen (TAFIag) level significant in recurrent miscarriage?

OBJECTIVE: The aim of this study was to evaluate the plasma thrombin-tat fibrinolysis inhibitor antigen (TAFIag) levels in women with recurrent miscarriage (RM) and age-matched healthy parous women as controls. MATERIALS AND METHODS: A total of 80 patients were enrolled in this study. As a study group (group 1), the authors evaluated 49 RM patients who had two or more consecutive abortions with unknown etiology before 12 weeks of gestation. The remaining 31 patients (group 2) were age-matched healthy parous women with no history of miscarriage and experienced at least one live baby. RESULTS: Comparisons of blood TAFIag levels revealed no statistically significant difference between women with recurrent miscarriages and control group. CONCLUSIONS: The findings of the present study indicated that TAFIag level was not associated with recurrent miscarriages.

A comparison of isokinetic muscle strength in patients with chondromalacia patella: a cross-sectional study.

OBJECTIVE: Chondromalacia patella (CMP), which is one of the most common causes of anterior knee pain in young adults, is often accompanied by reflex inhibition of the quadriceps muscle. In this respect, a significant correlation between isokinetic parameters and knee muscle strengths would be expected. We hypothesized that an isokinetic dynamometer, which objectively evaluates muscle strength, may be an important guide in detecting muscle weakness in new-onset CMP and determining early treatment strategies. PATIENTS AND METHODS: A total of 113 participants (mean age 30.33 ± 6.96 years, min: 18, max: 44) were recruited and divided into two groups, thus a CMP group (n=48) and a control group (n=65). The symptom duration of the CMP group and the demographic characteristics of all participants were recorded. Knee flexion and extension muscle strengths were measured at angular velocities of 60°/s and 180°/s [Knee extension Peak Torque at 60°/s (PTE60), Knee flexion Peak Torque at 60°/s (PTF60), Knee extension Peak Torque at 180°/s (PTE180), Knee flexion Peak at 180°/s (PTF180) respectively] (five sets) using an isokinetic dynamometer. We also recorded the total work done in flexion and extension (TWDF and TWDE). A modified MRI staging system based on the Outerbridge arthroscopy system was used to stage CMP. Isokinetic dynamometric parameters were compared between CMP patients and healthy volunteers. RESULTS: 59 healthy volunteers (90.8%) were right-side dominant and 6 (9.2%) left-side dominant. 33 CMP patients (68.8%) were right-side dominant, and 15 (31.3%) left-side dominant. 20 (41.7%) CMP patients were classified as Stage 1, 20 (41.7%) as Stage 2, and 8 (16.7%) as Stage 3. All the PTF60, PTE60, PTF180, and PTE180 values were significantly lower in the CMP group than in healthy controls (all p < 0.05). CMP symptom duration ≥ 6 months was associated with significantly lower knee muscle strength than with symptom duration < 6 months (p < 0.05). Also, a statistically negative correlation was found between MRI stages and PTE60 values (p < 0.05). CONCLUSIONS: In conclusion, our findings show that the isokinetic dynamometer reveals muscle weakness in CMP patients, and weakness in isokinetic parameters was negatively correlated with symptom duration and MRI stages. Isokinetic knee muscle strength testing, together with other functional tools, enables the assessment of muscle weakness and early rehabilitation planning for patients with CMP.

Persistent abdominal pain after exercise: an unexpected diagnosis.

Painful conditions of the musculoskeletal system are encountered quite frequently and are generally benign. However, clinicians should be careful to exclude rare malignant disorders and soft tissue sarcomas such as rhabdomyosarcoma, which have no specific symptoms or findings. This paper presents a case that was initially consistent with a hematoma but was then diagnosed as a rhabdomyosarcoma upon clinical examination and ultrasonography at follow-up shortly after.

Microphthalmia in a case of Edward syndrome.

AIM: To present an infant of trisomy 18 (Edwards Syndrome) with unilateral microphthalmia. METHODS: A female infant who was born at 41 weeks of gestation had been diagnosed with Edwards Syndrome (ES). On ophthalmic examination, microphthalmia, microcornea, optic disc coloboma, and persistent hyaloid artery were determined in the left eye. In addition, abnormalities in the ears, hands, feet, and cardiovascular system were present. DISCUSSION: With this case report, we aimed to highlight the relationship between ocular disgenesis and chromosomal disorders and the importance of prenatal testing and genetic counseling for parents.

The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.

BACKGROUND: Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post-stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemiparetic patients who had mild to moderate spasticity. AIM: To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. DESIGN: A cross-over interventional study SETTING: The Department of PMR of a tertiary hospital. POPULATION: Twenty-five chronic post-stroke long duration hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk independently without an assistive device. METHODS: Berg Balance Scale (BERG), and the postural stability test (PST) and the fall risk test (FRT) of Biodex balance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. RESULTS: The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (P<0,001). CONCLUSION: It was found that the prefabricated thermoplastic PLS-AFO improve balance and provide fall risk reduction in chronic post-stroke ambulatory hemiparetic patients who had mild to moderate spasticity on their affected lower limb. CLINICAL REHABILITATION IMPACT: These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk.

Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.

AIM: The objective of this study was to determine whether regular combined exercise program, which consists strength, stretching and aerobic exercises and additional jumping training, improve balance, fall risk, quality of life and depression status of older people living in a residential care. METHODS: A total of 168 residents who live in a long term care facility were screened. The trial began with 78 eligible participants and they were randomly grouped as combined exercises program (COM) group that includes stretching, strength and aerobic exercises, and COM plus jumping (COMpJ) group. 66 of the participants finished the trial. The groups were convened three times a week for six weeks. Each group had a warm-up, effective training and a cooling down periods. The total exercising time was no longer than 45 minutes in each group. Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk, short form 36 (SF 36) for the health related quality of life and Geriatric Depression Scale (GDS) for evaluation of the depression status were used. RESULTS: The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial; however, the improvements were statistically better in jumping combined group. Also health related quality of life improved in both groups. CONCLUSION: Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement, fall risk reduction and quality of life. The addition of jumping to strength, stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction.