Fibrous dysplasia and McCune-Albright syndrome: A case report with review of literature on the rehabilitation approach.

McCune-Albright syndrome is classically defined by the clinical triad of fibrous dysplasia (FD) of the bone, café-au-lait macules, and endocrinopathies. We report the case of a 15-year-old male with a diagnosed with McCune Albright syndrome. McCune-Albright syndrome remains a diagnostic challenge, and delayed diagnosis may have significant consequences. Routine musculoskeletal screening along with other endocrinopathies should be kept in mind. The rehabilitation programs that provides significant improvement in their quality of life. The treatment of McCune-Albright syndrome is directed toward the specific symptoms that are apparent in each individual.

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm.

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

Does locomotor training improve pulmonary function in patients with spinal cord injury?

OBJECTIVES: The aim of this study was to compare the effects of a locomotor training (LT) combined rehabilitation program with a rehabilitation-only program on pulmonary function in spinal cord injury (SCI) patients by investigating spirometric analyses of the patients. SETTING: Rehabilitation center in Ankara, Turkey. METHODS: Fifty-two patients (40 male, 12 female) with SCI enrolled in the study. The subjects were divided into two groups: the first group (group A) received both LT and a rehabilitation program and the second group (group B) received only the rehabilitation program for 4 weeks. The LT program was prescribed as three 30-min sessions per week. Pulmonary function was evaluated spirometrically in both groups before and after the rehabilitation program. RESULTS: The spirometric values of the SCI patients, including forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow rate and vital capacity (VC) and VC%, increased significantly with LT in the first group (all P<0.05). Maximum voluntary ventilation values increased significantly in both groups (both P<0.05). CONCLUSION: These findings suggest that LT is effective for improving pulmonary function in SCI patients. We also highlight the useful effects of LT, which are likely the result of erect posture, gait and neuroplastic changes that prevent potential complications in SCI patients.

What do patients really know about cardiopulmonary rehabilitation: a cross-sectional survey study.

BACKGROUND: Although it is known that cardiopulmonary rehabilitation (CPR) reduces mortality and morbidity, it is not widely implemented as is in Turkey. One factor might be lack of demand since the levels of knowledge and awareness among patients who are eligible for CPR seem to be insufficient. AIM: It is aimed to investigate the level of awareness and knowledge of CPR among patients with cardiopulmonary problems. DESIGN: Cross-sectional survey study. SETTING: Outpatient. METHODS: Knowledge regarding CPR was assessed by questionnaires given to 690 patients recruited in seven university hospitals and six training and research hospitals in which either comprehensive or limited CPR services are available. POPULATION: Patients who have cardiopulmonary problems RESULTS: Of the patients, 34.7% were given information on CPR by healthcare staff, and 25.3% reported that their source of information was physicians. Although 49.9% of the patients knew that they needed to exercise for their cardiac/pulmonary problems, only 23.4% and 32.1% of those were aware that fast walking and climbing stairs, respectively, would not pose a risk to their cardiac/pulmonary health. The majority of the patients believed that activities of daily living, which comprise the most important component of exercise-based CPR, were harmful for their cardiopulmonary health. We found that 31.1% of the patients exercised regularly. During their stay at the hospital, certain kinds of exercises were suggested to 62.7% of the patients, and 34.7% of these patients performed various exercises. Of the patients who were given detailed information on cardiopulmonary rehabilitation, 69% stated that they would be willing to participate in a similar program. CONCLUSION: Although nearly half of the patients stated that they needed CR, it was observed that the ratio of patients who had true knowledge of CPR was low among patients. It is imperative to furnish patients with information on CPR, both in the field of PMR and throughout Turkey, and to put more effort into running those services effectively. Furthermore, we should make an effort to increase the level of liaison between patients and physicians and other healthcare professionals who participate in the treatment of cardiac/pulmonary patients.

Pain and quality of life (QoL) in elderly: the Turkish experience.

PURPOSE: The aims of this study were to evaluate the effects of demographic and clinical determinants on pain and to investigate the possible risk factors that disrupt QoL. MATERIALS AND METHODS: The design of this research was a prospective study performed in tertiary care hospital-based physical medicine and rehabilitation departments. A comprehensive geriatric pain assessment (Geriatric Pain Scale, GPS) and health-related quality of life (HR-QOL) assessment (Nottingham Health Profile, NHP) were performed. RESULTS: Of the 275 patients, 76% were female and 59.6% were older than 70 years of age. Two hundred seventy four patients (99.7%) had various levels of pain. The mean age of the patent group was 72.77 ± 5.7 (min: 65, max: 96) years. The overall GPS was 60.41 ± 22 (min: 0, max: 99.9), and the total NHP score was 49.01 ± 22.4 (min: 0, max: 100). Correlation analyses showed that for the total GPS score, female gender, lower education, and economic status were significant determinants of higher levels of pain. The multiple linear regression analysis showed that the NHP, GPS, Self-Reported Disability Index (SRDI), and Geriatric Depression Scale (GDS) were significant determinants of poorer HR-QOL. CONCLUSIONS: There was a high prevalence of pain and being female, having low income, having low social support, having a higher rate of disability with related multiple comorbidities, and depression as related factors of HR-QOL. Strengthening these negative predictors of HR-QOL might enhance the efficiency of pain therapies in this population.

Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy.

OBJECTIVE: To evaluate musculoskeletal pain (MSP) in mothers of children with cerebral palsy (CP), and to determine the effects of zone of pain on health-related quality of life (QoL) and symptoms of depression. PATIENTS AND METHODS: The study included a total of 81 children with CP, together with their mothers (group 1), and a total of 60 healthy children, together with their mothers (group 2). Presence of MSP, and the zone of pain in mothers were evaluated [lower back pain (LBP), pain in other zones, without pain]. Mothers' QoL was assessed with Short Form-36 (SF-36) scale, and presence of symptoms of depression was assessed with Beck Depression Inventory (BDI). Multivariate analysis of variance test analysis was performed to see the main effects of the factors mother having a child with CP (group 1, group 2) and zone of pain (LBP, other, no pain) on the BDI scores and SF-36 QoL sub parameters of mothers. Logistic regression analysis was performed to determine the parameters predicting the presence of LBP in mothers in group 1. RESULTS: MSP and LBP were found to be significantly higher in group 1. Main effect of the mother having a child with CP on BDI score and physical role (PR) and mental health (MH) parameters was found to be significant. Mean BDI scores of mothers in group 1 was found to be significantly higher as compared to the other group, and mean PR parameter and MH values were found to be significantly lower. Main effect of the zone of pain (arising from the group of mothers with LBP) was found to be significant on physical functioning, bodily pain, general health perception, MH parameters and BDI. Logistic regression analysis showed that MH and bodily pain parameters significantly predicted the presence of LBP. CONCLUSION: Deterioration of MH in mothers with cerebral palsied child may be causing them to experience more LBP. Experience of increased LBP causes deterioration of health-related QoL.

Reduced aerobic capacity in patients with severe osteoporosis: a cross sectional study.

AIM: It has been previously shown that pulmonary function (PF) is significantly diminished in patients with osteoporosis (OP). But there are few data about the relationship between PF and aerobic capacity of osteoporotic patients and the severity of thoracic kyphosis and time since the diagnosis of OP. The aim of the present study was to investigate the resting spirometric values and cardiopulmonary test (CPET) results of women with osteoporosis and to evaluate the effects of the various degrees of OP on these parameters. METHODS: Fifty six outpatient subjects were included in the study. All patients underwent a standardized interview, physical examination, bone mineral density (BMD), anteroposterior and lateral x-rays of thoracic spine, resting PF test and CPET evaluation. To evaluate the effects of the severity of osteoporosis on these parameters patient group divided according to diagnosis time of OP, degree of kyphosis, and spinal deformity index. Demographic and clinical data were compared between the groups with the use of independent-sample t test analysis (two groups) and analysis of variance (ANOVA) was used to estimate the between-group differences and changes by severity of osteoporosis and regression analyses to find predictors for changes. Correlation coefficients were used to examine the relationship between variables. RESULTS: According to diagnosis time, newly diagnosed groups; according to degree of kyphosis, the kyphotic groups; according to spinal deformity index, the higher spinal deformity index groups showed statistically significant and declining results in PF tests and CPET parameters. CONCLUSION: This study pointed out a significant impaired PF, aerobic capacity and a serious deconditioning for various reasons in these OP patients Therefore, the evaluation of CPET should be included in the management of OP patients and in these patients ventilatory muscle training and aerobic exercises may offer a potential therapeutic adjunct to current OP therapies in the future.

Complex regional pain syndrome (CPRS type I) after a burn injury of the hand.

Complex regional pain syndrome (CRPS) type I is a clinical condition characterized by persistent pain in one part or the entire extremity after a minor trauma, fracture, or after an operation which does not involve nerve damage and/or sympathetic hyperactivity. Despite large-scale studies on the complications that arise after burns, literature reveals few reports on neurological problems and CRPS developing after burns. It is a rare complication of a burn injury to an extremity. Its early signs and symptoms are similar to those of burn wound itself. This study describes an unusual cause of complex regional pain syndrome in burn patients. The report highlights physical examination findings, the new diagnostic criteria of complex regional pain syndrome, and difficulties in diagnosis.

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.