Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center.

OBJECTIVE: To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey. DESIGN: Retrospective study. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. METHODS: Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury. RESULTS: Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31 : 1). Mean age was 38.3 ± 17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1 ± 25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay. CONCLUSION: The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.

The analysis of serum lipid levels in patients with spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: The purposes of this investigation were to evaluate the serum lipid profile among a broad sample of patients with spinal cord injury (SCI), examining the impact of disease duration, lesion level, lesion grade and functional activity level on serum lipid levels of patients with SCI. SETTING: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Turkey. METHODS: Serum lipid profiles of 269 participants with SCI were analyzed and correlated to disease duration, lesion level, lesion grade and ambulation status. RESULTS: Total cholesterol (TC) was higher than normal in 21.2%, low density lipoprotein cholesterol in 24.4%, and triglycerides levels in 31% of the patients. The high density lipoprotein cholesterol (HDL-c) level was found to be lower than 40 mg/dl in 79.5% of the patients, TC/HDL-c ratio was 4.5 and above in 65.7% of the patients in our study. TC/HDL-c ratio was significantly higher in patients with SCI with a disease duration of 0-12 months than the group with a longer disease duration (P = 0.009). TC/HDL-c ratio was significantly higher in patients who could not be community ambulated than the patients who were community ambulated (P = 0.005). HDL-c levels in patients with motor complete SCI were significantly lower than patients with motor incomplete SCI (P = 0.028). CONCLUSION: Dyslipidemia is observed in a large number of patients with SCI. The risk of dyslipidemia was seen to have increased in motor complete SCI patients, in patients who can not be community ambulated and whose disease duration is between 0 to 12 months.

Pregabalin: A New Adjunct in Calcineurin Inhibitor Pain Syndrome Treatment.

Tacrolimus and cyclosporin are calcineurin inhibitors (CIs) commonly used in organ transplants. These agents rarely cause a severe, debilitating pain syndrome of especially lower extremities, known as CI pain syndrome (CIPS). Although the pathogenesis is not well understood, neuropathic pain mechanisms have started to be discussed in the recent literature. Here, presenting a 48-year-old male with CIPS who recovered after pregabalin 150 mg twice daily, we aimed to emphasize the importance of this syndrome and offer a new approach for the treatment. This is the first report in the literature where pregabalin is demonstrated to be effective in CIPS.

Coexistence of Deep Vein Thrombosis, Heterotopic Ossification, and Complex Regional Pain Syndrome due to Hemorrhagic Stroke.

CASE: A patient who developed hemiplegia related to a hemorrhagic stroke and who had not been started on venous thromboembolism prophylaxis or a physical medicine and rehabilitation program was admitted to our clinic on the 4th month after the event. Our patient had pain, swelling, redness, increased temperature at the right lower extremity, range of motion limitation at the hip and knee, deep vein thrombosis (DVT) and complex regional pain syndrome (CRPS) at the same side lower extremity, and heterotopic ossification (HO) at the hip. CONCLUSIONS: Our case is presented to emphasize the HO that is not frequently seen after stroke, the importance of DVT prophylaxis in hemorrhagic stroke, and the association between DVT, HO, and CRPS.

Bilateral quadriceps and triceps tendon rupture in a hemodialysis patient.

This paper presented a 58-year-old hemodialysis patient who had bilateral quadriceps and triceps tendon rupture, whereby the role of rehabilitation in functional parameters has been highlighted.

Heterotopic ossification and cubital tunnel syndrome in traumatic brain injury: Ultrasound 'sees' both.

Reported here is a 50-year-old man with cubital tunnel syndrome due to heterotopic ossification after traumatic brain injury. Herein, underscoring the role of ultrasonographic evaluations in the diagnosis of our patient, we suggest that ultrasonographic imaging can be a useful first-line diagnostic method for the possibility of HO and its complications. Further, due to its high spatial resolution, lack of radiation and easy applicability, we imply that US seems to overweigh in the daily practice of rehabilitation physicians.

A challenging case of diffuse diabetic musculoskeletal system involvement: diagnostic confusion with rheumatoid arthritis.

A diabetic patient who was misdiagnosed as rheumatoid arthritis because of complicated musculoskeletal manifestations of diabetes is reported here. A 57 year old woman had been on sulphasalazine treatment with a diagnosis of rheumatoid arthritis for 3 years but failed to respond. Her past medical history disclosed that she had been using metformin due to diabetes mellitus for 8 years. On physical examination there was no evidence of arthritis. Her clinical picture was compatible with diffuse idiopathic skeletal hyperostosis (DISH), shoulder periarthritis, carpal tunnel syndrome, limited joint mobility of diabetes and furthermore myalgia due to metformin induced by hypovitaminosis D. Finally rheumatoid arthritis was excluded and a diagnosis of diabetes mellitus originated diffuse musculoskeletal system involvement was made. Diabetic musculoskeletal complications are common and sometimes cause clinical dilemmas. This case is also important for highlighting the contribution of low vitamin D status to the clinical status.