The efficacy of intermittent pneumatic compression as a substitute for manual lymphatic drainage in complete decongestive therapy in the treatment of breast cancer related lymphedema.

The aim of this study is to evaluate the efficacy of intermittent pneumatic compression (IPC) as a substitute for manual lymphatic drainage (MLD) in complete decongestive therapy (CDT) for treatment of advanced stages of breast cancer-related lymphedema. In this randomized, single-blind, controlled study, 46 patients with breast cancer-related lymphedema were divided into 2 groups. Both MLD with compression bandage (CB) group (n=24) and IPC with CB group (n=22) received treatment 3 days a week for 5 weeks. Home exercise program was also given to all patients. At the end of the 5th week, patients were treated with a daily 23-hour compression garment and home exercise routines. Assessments were taken at baseline, the fifth week, and the third month. Arm circumference was measured at 5 different areas, shoulder range of motion (ROM) was evaluated with a goniometer, pain, and tightness, and heaviness sensations were assessed with visual analog scale. Both groups had similar demographic and clinical characteristics (p<0.05). There were no significant differences between groups and both groups showed significant improvement (p<0.05) in the five measurement levels of the arm circumference at the fifth week and third month. Similarly, shoulder ROM, pain, tightness, and heaviness sensations improved in both groups (p<0.05). Both MLD and IPC as a component of CDT were found successful at 5 weeks and 3 months without superiority to each other.

Efficacy of kinesio taping in early stage breast cancer associated lymphedema: A randomized single blinded study.

This study was designed to evaluate the effectiveness of kinesio taping compared to compression garment in treatment of early stage breast cancer-associated lymphedema (BCAL). Patients between 18-70-years old who had unilateral stage 1 BCAL were randomized into group I kinesio taping (KT) and group II compression garment (CG) for this single blinded study. KT was applied with a lymphatic correction technique in three-four day intervals for four weeks. At the end of the fourth week, patients were suggested to wear CGs. Patients in group II were treated daily for 23-hours in CGs. Education, preventive measures, and exercises were given to both groups. All patients were evaluated before the treatment (T0), immediate post treatment (T1), and three months after treatment (T2). Circumference differences were measured between the extremities with a nonelastic tape at five levels. Additionally, shoulder range of motion (ROM) was measured, and pain, heaviness, and sensation of tightness were evaluated with a visual analog scale (VAS). Thirty-five patients with stage 1 BCAL were included and randomized to the KT (n= 16) and CG (n= 19) groups. Demographic data and baseline clinical characteristics were similar. Both groups had reductions in all levels of arm circumference differences at immediate post-treatment and three months after treatment. Pain, tightness, and heaviness scores significantly decreased for both groups at immediate post-treatment and third month. Patients in the KT group had significantly lower pain sores than patients in the CG group. Results demonstrated that both modalities had similar effects in the treatment of early stage BCAL. For patients with early stage BCAL, KT can be an alternative treatment to CG for patients who have difficulties in obtaining and wearing CGs.

Sonographic Measurements Can Be Misleading for Diagnosing Carpal Tunnel Syndrome in Patients with Rheumatoid Arthritis.

OBJECTIVES: To compare the nerve cross sectional areas (CSA) of patients with RA without any sign of peripheral neuropathy to healthy controls. METHODS: Clinical, electrophysiological and sonographic assessments were done by three blinded researchers. The patients who had an electrodiagnostic or clinical of peripheral neuropathy were excluded from the study. Nerve CSA were measured in various levels; hamatum hook, pisiform bone, radio-ulnar joint, distal 1/3 of forearm, and elbow for median nerve; radio-ulnar joint, pisiform bone, distal 1/3 of forearm, and medial epicondyle for ulnar nerve. RESULTS: The study was completed with 30 women with RA and 30 healthy women. Despite both groups had neither clinical nor electrophysiological neuropathy, the sonographic measurements showed that median nerve CSA at radioulnar joint, pisiform and hamatum levels of patients with RA were larger in rheumatoid arthritis patients than healthy controls. Ulnar nerve CSA at radioulnar joint, pisiform and distal 1/3 forearm and medial epicondyle levels of patients with RA were also increased (p<0.05). If the pisiform level median nerve CSA>10 mm2 was used as sonographic carpal tunnel syndrome (CTS) criterion, 23/60 hands of 30 patients with RA and 5/60 hands of 30 healthy controls could be diagnosed as CTS. CONCLUSION: Median and ulnar nerve CSA were larger than healthy control in patients with rheumatoid arthritis without clinical and electrophysiological peripheral neuropathy. The rheumatologists should be careful to diagnose CTS in patients with RA while using US.

The role of somatosensory evoked potentials in the diagnosis of lumbosacral radiculopathies.

Electrophysiologic studies have an important role in the diagnosis of lumbosacral radiculopathies. Electrophysiologic methods which are used conventionally are needle electromyography (EMG), late responses (F wave and H reflex), and nerve conduction studies. Somatosensory evoked potentials (SEPs) are also important complementary diagnostic methods in the electrophysiologic evaluation of lumbosacral radiculopathies. In this study, we aimed to determine whether SEPs have an advantage over the conventional electrophysiologic methods or whether sensory nerve stimulated SEPs over mixed nerve stimulated ones or the lumbar recordings over the scalp recordings in diagnosing lumbosacral radiculopathies. For this reason, the study included 20 patients with unilateral and unilevel S1 radiculopathy due to intervertebral disc herniation confirmed by clinical examination and magnetic resonance imaging (MRI) as the patient group. And a control group of 18 healthy subjects were also included in the study. Nerve conduction studies, late responses and scalp and lumbar-recorded SEPs after sural and posterior tibial nerve stimulation were studied in both groups, while needle EMG was performed only in the patient group. Patients who manifested abnormal findings on needle EMG or on late responses also showed abnormal findings on at least one type of the SEPs. SEPs detected abnormalities in 5 patients (25%) in whom needle EMG or late responses did not suggest any abnormality. In this study we concluded that SEPs may provide diagnostic information beyond conventional electrodiagnostic methods and that lumbar-recorded SEPs may have an advantage over scalp-recorded ones and sensory nerve stimulated SEPs over mixed nerve stimulated ones.

Psychiatric morbidity in murder and attempted murder crime convicts: a Turkey study.

In the present, the morbidity of psychiatric disorders of homicide/attempted homicide crime convicts imprisoned in Turkey, Sivas maximum security prison was investigated. Seventy imprisoned homicide/attempted homicide crime convicts included in this study. Sociodemographic information form, structured clinical interview for DSM-IV Axis-I disorders and structured clinical interview for DSM-III-R personality disorders applied to the participants. Most commonly diagnosed disorders among those convicts were current Axis-I disorders, depressive disorders (7.1%) and anxiety disorders (5.7%). Among Axis-I disorders, the most diagnosed one was the substance use disorders (45.7%). The most diagnosed Axis-II disorder was found as to be antisocial personality disorder (48.6%). The rate of convicts who were diagnosed as having both Axis-I and Axis-II disorders was 51.4%. The most prevalently accompanying lifetime Axis-I disorders to antisocial personality disorder with respect to Axis-I, and Axis-II comorbidity was substance use disorders. As a result, it was thought that the substance use disorders and antisocial personality disorder among the homicide/attempted homicide crime convicts were the most prevalent lifetime psychiatric disorders.

The effect of calcitonin on beta-endorphin levels in postmenopausal osteoporotic patients with back pain.

The purpose of this study was to evaluate the efficacy of calcitonin on beta-endorphin levels in female patients experiencing back pain associated with postmenopausal osteoporosis. The secondary purpose was to assess the pain and quality of life in these patients. There were 30 patients with a mean age of 58.2+/-5.4 years in the treatment group and 26 patients with a mean age of 58.8+/-5.2 years in the placebo group in this randomized, placebo-controlled study. The patients subcutaneously received 100 IU salmon calcitonin or placebo injections and 1,000 mg elementary calcium for 2 weeks. Baseline plasma beta-endorphin levels were measured and repeated after 2 weeks. Patients' pain and quality of life (QOL) were evaluated by using the Visual Analogue Scale, Modified Face Scale, Beck Depression Index, and Nottingham Health Profile. Patients' global assessment of disease activity was also performed at baseline and at the end of the first and second week. We found that plasma beta-endorphin levels in the treatment group were significantly higher than the placebo group at the end of the second week (p<0.001). Although pain and QOL scores were improved at the end of the second week in both groups (p<0.05), the improvement in the treatment group was more significant when compared with the placebo group (p<0.05). Therefore, calcitonin is an analgesic agent, as it increases the plasma beta-endorphin levels in patients with postmenopausal osteoporosis, which consequently improves QOL.

Ulnar nerve entrapment at wrist associated with carpal tunnel syndrome.

In this study, ulnar nerve entrapments at the wrist were investigated using nerve conduction studies in cases with established diagnosis of carpal tunnel syndrome (CTS). Cases with cervical radiculopathy and polyneuropathy as well as patients with ulnar nerve entrapment at elbow were excluded from the study. Fifty-three cases (46 females, seven males) whose ages ranged between 20 and 72 years (mean: 49.31 +/- 13.78) were evaluated. Among 53 cases, 12 (22.6%) bilateral and 41 (77.3%) unilateral CTS were detected. Totally 65 wrists evaluated and prolongation of median nerve wrist-3rd digit distal sensory latencies (DSL; N: 59; 90.7%) and wrist-abductor pollicis brevis distal motor latencies (N: 48; 73.8%) were seen. In six wrists, diagnoses were established with the detection of an increase in the differences between wrist-4th digit DSL of median and ulnar nerve. This test was used if other test results were in normal limits. Prolongation of ulnar nerve wrist-5th digit DSL were found in 12 wrists (18.4%) in cases with CTS. Among these 12 wrists mild (N: 2), moderate (N: 7) and severe (N: 3) CTS were detected. Ulnar nerve motor conduction studies provided normal results. In conclusion, we are in the opinion that for the detection of associated ulnar nerve wrist entrapments, ulnar nerve conduction studies paying special attention to DSL convey importance in established cases with CTS.

A-waves and electrophysiologically established diagnoses.

The aim of this study was to investigate the presence of A-waves in cases referred to our electromyography laboratory with various diagnoses and documentation of electrophysiologic diagnoses with A-waves. In cases where at least 3 motor nerves were analysed, during F response studies, A-waves having stabile latencies and amplitudes from minimum one third of submaximal and supramaximal stimuli were evaluated. Electrophysiologic diagnoses and the related nerves of cases with A-waves were recorded. A-waves were obtained from 38 out of 1604 cases (2.36%). Most of the cases (57.8%) with established A-waves consisted of patients with radiculopathies. A-waves were detected mostly in tibial nerve. Electrophysiologic analysis of 5 cases with A-waves has given normal results. Although mechanism of A-waves is not known completely, we suggest when obtained it must be remarked during routine electrophysiologic examination.

Sympathetic skin response and R-R interval variation in cases with rheumatoid arthritis.

To investigate the autonomic nervus system involvement in cases with rheumatoid arthritis (RA) by assesing sympathetic skin response (SSR) and R-R interval variation (RRIV), 14 healthy women and 10 women with RA, all of them without clinic dysautonomies were examined. SSR's were recorded palmar surface of both hands and soles of both feet, after stimulating median and tibial nerves individually. RRIV's were assessed at rest and during six deep breathing in one minute with electrodes placed on dorsal surfaces of both hands. SSR could not be obtained from lower extremities of one case with RA. We could not find any significant difference between two groups in terms of SSR latencies. RRIV values obtained during deep breathing to those recorded at rest (D%/R%) was found to be significantly lower in RA cases than healthy controls. RRIV values increased with deep breathing in healthy subjects, while they decreased in 50% of the RA cases. We conclude that assessment of SSR and RRIV are valuble methods for revelation of subclinical autonomic involvement in cases with RA.

Evaluation of autonomic nervous system functions in post-stroke patients.

OBJECTIVE: In this study, we aimed to investigate whether there is a sympathetic and parasympathetic system dysfunction in hemiplegic or hemiparetic patients after a cerebrovascular accident. DESIGN: Sympathetic skin response and R-R interval variation were evaluated in a total of 65 subjects: 37 hemiparetic or hemiplegic patients due to a cerebrovascular accident, seven acute (<30 days) and 30 chronic, with a mean age of 59.16 yr (32-76 yr), and 28 healthy subjects with a mean age of 57.07 yr (45-75 yr). Disease duration was 6.89 mo (1-32 mo) in the patient group. Bilateral sympathetic skin responses were recorded with stimulation of median nerves in both affected and unaffected sides. R-R interval variation was evaluated at rest (R%) and during deep breathing (DB%) at six times per minute. RESULTS: Although there was no significant difference between sympathetic skin response latencies of the patient and the control groups, the amplitude values of sympathetic skin response in patients were significantly lower than those in controls (P < 0.05). Both R% and DB% in patients significantly increased as compared with controls (P < 0.001 and P < 0.05, respectively). CONCLUSION: In conclusion, our results suggest that both sympathetic and parasympathetic functions in post-stroke survivors were partially inhibited, and this finding may be useful in the prediction of possible complications during rehabilitation.

Anterior tarsal tunnel syndrome.

Three hundred twenty patients complaining of pain and/or numbness of their feet were evaluated in our Clinical Neurophysiology Laboratory. Nerve conduction studies of deep peroneal, superficial peroneal, sural and posterior tibial nerves were studied bilaterally. Needle electromyography (EMG) of anterior tibial, long peroneal, abductor hallucis longus, extensor hallucis longus, gastrocnemius and extensor digitorum brevis muscles were examined bilaterally. Nerve conduction studies of 25 healthy volunteer subjects (16 female, 9 male, age range 36-70, mean age 52.82 +/- 8.8) with no complaint composed the control group. Fourteen of these patients (8 female, 6 male, age range 40-70, mean age 55.73 +/- 12.04) were found to have anterior tarsal tunnel syndrome (anterior TTS) bilaterally or unilaterally. In the patients with anterior TTS, the nerve conduction studies revealed deep peroneal nerve distal latency as 6.5 +/- 1.9 msec; the amplitude as 1.8 +/- 1.3 mV at the ankle level; and the conduction velocity as 41.5 +/- 5.9 m/sec in the distal segment. When these values were compared with the control group statistically, results were found highly significant (p < 0.005). Needle EMG findings in the anterior TTS group showed only in the extensor digitorum brevis muscle. Other nerves and muscles were normal. All patients with anterior TTS were performing Namaz for years, and none of them had the predisposing factor which may cause entrapment neuropathy. So, we suggest that chronic prolonged stretching of the deep peroneal nerve on the dorsum of the foot during Namaz may cause anterior TTS.

Normative data of sympathetic skin response and RR interval variation in Turkish children.

Sympathetic skin response (SSR) and RR interval variation (RRIV) are used commonly for the assessment of sympathetic and parasympathetic nervous system function, respectively. We determined the normal values of SSR and RRIV in 23 (14 females, nine males) Turkish children aged 5 to 14 (mean 9.86, SD 2.48) years. SSR was recorded on the hands and feet during the electrical stimulation of both median and posterior tibial nerves, respectively. Similar response was elicited on both feet during the stimulation of the right median nerve. RRIV testing was performed during rest on the supine position and deep inspiration at a frequency of 6 times/min. The SSR was elicited in all children. The mean SSR latencies recorded on the feet during the stimulation of median or posterior tibial nerve were significantly more prolonged than those recorded at the hands (P < 0.001). There was no significant difference between the mean latencies of SSR recorded at the ipsilateral and contralateral palms or soles. The mean latencies recorded at the sole during stimulation of the median nerve were not significantly different compared to those that recorded at the sole during the posterior tibial nerve (P > 0.05). The SSR amplitudes were not assessed because of great variability and rapid habituation. The mean RRIV (46.54+/-11.29%) during deep breathing was significantly increased as compared to that (35.90+/-10.63%) during rest (P < 0.003). As a result, SSR and RRIV are preferred non-invasive tests for evaluation of autonomic nervous system in children. The SSR is useful and reliable if it is obtained in the optimum technical conditions. Further research is necessary to establish strict criteria for abnormality.

Frequency of dissociative identity disorder in the general population in Turkey.

This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7+/-6.1 (mean +/- SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.

The effects of age, height and gender on the somatosensory evoked potentials in man.

Somatosensory evoked potentials (SEPs) reflect the activity of somatosensory pathways mediated through the dorsal columns of the spinal cord and the specific somatosensory cortex. In this study we aimed to demonstrate the effects of physiologic parameters such as height, age and gender on N9, N13, N20 SEP components and the central conduction time (CCT) to median nerve stimulation in Turkish population. The results revealed a statistically significant correlation between height, gender and SEP latencies (p < 0.05 and p < 0.0005 respectively) whereas no significant age related changes was found in SEPs. In all groups CCT was not influenced by these parameters.

The effect of conventional transcutaneous electrical nerve stimulation on somatosensory evoked potentials.

Transcutaneous electrical nerve stimulation (TENS) is an electrotherapeutic modality used for analgesia. We planned to demonstrate selective stimulation of large diameter fibers with conventional type TENS by way of somatosensory evoked potentials (SEP). We have analyzed index finger-wrist segment median nerve sensory potential and SEP recordings obtained from C2 and Cc before TENS and at 5, 10 and 15 minutes of TENS application of 14 adult healthy volunteers. SEP and finger-wrist segment sensory nerve conduction amplitudes were significantly decreased compared to pre-TENS values during 5, 10, and 15 minutes of TENS application (p < 0.05). These results reflect the selective stimulation of large diameter afferent fibers of conventional type TENS.