Effect of an early supervised rehabilitation programme compared with home-based exercise after temporomandibular joint condylar discopexy: a randomized controlled trial.

The goal of rehabilitation after temporomandibular joint (TMJ) surgery is to achieve a normal range of motion. The aim of this study was to compare the impact of a comprehensive and early supervised rehabilitation programme with home-based exercise after TMJ condylar discopexy. Patients diagnosed with disc displacement without reduction were randomized to the study and control groups. After baseline assessments, the same surgical condylar discopexy procedure was applied to both groups. Following surgery, the study group patients underwent a supervised exercise programme conducted by a physiotherapist in the outpatient clinic. This comprised 30-min sessions 3 days per week for 8 weeks in the hospital. The control group patients performed the same exercise programme at home. Maximum mouth opening (MMO), protrusion, and right and left lateral movements were measured. Based on the results, the supervised rehabilitation programme yielded significantly better outcomes for pain at rest and with activity, MMO, and protrusion compared with the home-based exercise programme. Also certain parameters of quality of life improved significantly in the study group. In conclusion, exercise therapy is the cornerstone of rehabilitation of the TMJ, and a supervised rehabilitation programme after TMJ surgery is effective in improving functional parameters.

The Effect of Thyroid-Stimulating Hormone on Tumor Size in Differentiated Thyroid Carcinoma.

We evaluated the correlation between serum thyroid-stimulating hormone (TSH) levels and tumor size and other invasiveness parameters of tumor in patients with differentiated thyroid carcinoma (DTC). Several clinical studies have reported that TSH may also have a role as a regulator of the development and function of the thyroid gland. It is currently not clear whether TSH is involved in the existence of thyroid cancer or progression of thyroid cancer or both. Patients with DTC who underwent thyroid surgery between 2003 and 2008 were included this study. Preoperative serum T3, T4, and TSH levels were compared with the size and invasiveness of cancer, retrospectively. DTC was observed in 110 patients over the 5-year period. Seventy-seven (70 %) of them were euthyroid and classified as the "normal-TSH group" (NTG), and 33 (30 %) have an overt or subclinical hyperthyroidism, classified as the "low-TSH group" (LTG). The mean tumor diameter in the LTG was found to be 8.91 ± 8.03 mm; however, it was found to be 18.19 ± 16.24 mm in the NTG. There were significantly differences among the groups related to the diameter of tumor (p = 0.001). Microcarcinoma was determined in 36 patients (46.8 %) in the NTG and 23 patients (69.7 %) in the LTG (p = 0.027). Although there were no significant differences, tumor capsule invasion (33.8 vs. 18.2 %, p = 0.099) and lymphovascular invasion (16.9 vs. 6.1 %, p = 0.130) rates were higher in the NTG. These findings suggest that TSH has effects on growing and proliferation of not only normal thyroid cells but also cancer cells in DTC. This study revealed that serum TSH level can be explored as an important factor that affects the size and invasiveness of tumor in DTC.

Single-incision laparoscopic cholecystectomy: a new retraction technique.

BACKGROUND: Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. SURGICAL TECHNIQUE: Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS port was placed through an open approach. We inserted a 10-mm 30 degrees camera through the SILS port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose needle. This device provided retraction of the gallbladder in every direction. CONCLUSIONS: Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Isokinetic evaluation of ankle muscle strength and fatigue in patients with ankylosing spondylitis.

AIM: The aim of the study was to compare the strength and fatigue of ankle plantarflexor/dorsiflexor muscles using isokinetic dynamometer in patients with ankylosing spondylitis (AS) versus healthy control subjects. DESIGN: A controlled study. SETTING: Outpatients clinic of our Department of Physical Medicine and Rehabilitation. POPULATION: Twenty-six AS patients and 26 control subjects participated in this study. METHODS: In both groups the isokinetic tests are conducted by isokinetic dynamometer.The evaluations were made in plantarflexion/dorsiflexion patterns;peak torque, agonist/antagonist ratio and work fatigue isokinetic parameters were evaluated for the ankle 30 º/s, 60º/s, 120º/s angular velocities. Pain severity, clinical findings, and functional status were also evaluated in the study group. RESULTS: In the patient group, ankle plantarflexion muscle strength was significantly lower compared to the control group in all angular velocities (P<0.05). Agonist/antagonist ratio was significantly lower in the patient group compared to the control group in all angular velocities (P<0.01). The work fatigue was decreased for bilateral ankle plantarflexors at 120º/s angular velocities (P<0.05). There was no significant difference between the measurements of ankle dorsiflexors (P>0.05). There was no relation between the decreased muscle strength and pain severity, clinical findings, and functional status of AS patients. CONCLUSION: We found ankle muscles fatigue and decreased ankle plantarflexor muscle strength in patients with AS compared to control subjects.

Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy.

BACKGROUND: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. METHODS: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n=25) underwent conventional posterolateral thoracotomy, while Group II (n=25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. RESULTS: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences (P<0.05). CONCLUSION: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.

[A case of primary intestinal lymphoma associated with intestinal perforation]. / Primer intestinal lenfomaya bagli intestinal perforasyon olgusu.

A 17 year old male with symptoms of acute abdomen was operated upon. The preoperative diagnosis was peptic ulcus perforation but at the operation there were multiple perforations throughout the small bowels, multiple lymphadenopathies in the mesentery of the jejunum. 60 cm small bowel resection-end to end anastomosis, raphe omentoplasty, primary repair with suture were performed. The patient got well after the operation and was discharged postoperative 14th day. The pathological diagnosis was diffuse grand cell lymphoma. We conclude that, this rare condition which we could be able to find only one case in the literature must be thought among the reasons of acute abdomen.

Age-specific seroprevalence of hepatitis B virus infection.

In this study, we have tried to determine the age-specific seroprevalence of hepatitis B virus (HBV) infection and to make some conclusions about the mode of transmission and vaccination strategy which should be chosen in Turkey. Eight hundred and one patients between the ages of six months and 60 years of age were included in this study. According to the HBV serologic markers, (HBsAg, Anti-HBc and Anti-HBs), HBsAg positivity and HBV exposure rates were 6.5% and 32.8%, respectively. HBsAg positivity was 6.6% under one year of age. The highest rate of HBsAg positivity was in the 6-10 year age-group (p < 0.05). The prevalence of total hepatitis B virus seropositivity increased with age (p < 0.05). The HBV exposure rate was higher in males than in females (p < 0.05). It was concluded that HBV infection is an important infection in Turkey and is acquired very early in life. A mass hepatitis B vaccination strategy should be thus chosen in Turkey.