GÝRÝÞ ve AMAÇ: Klonik hemifasiyalspazm (HFS) yüzün bir yarýsýnda fasiyal sinir inervasyonlu kaslarda istemsiz çekilmelerin olduðu ve hastanýn günlük yaþamýnýn olumsuz olarak etkilendiði bir durumdur. Bu çalýþmada klonik HFS tanýsý konan olgularda kranial MR bulgularýnýn deðerlendirilmesi amaçlandý.
YÖNTEM ve GEREÇLER: Klinik olarak klonik HFS tanýsý konulan 53’ü kadýn (%57,6), 39’u erkek (%42,3) olmak üzere toplam 92 hastanýn kraniyal MR görüntülemeleri incelendi.
BULGULAR: Olgularýn yaþ daðýlýmý 23-81 ve yaþ ortalamasý 55,5 ± 13,1 idi. Kýrk olguda (%43.4) kraniyal MR normal bulundu. Kýrkaltý olguda (%50) küçük damar hastalýðý ile uyumlu bulgular, 7 olguda (%7,6) dolikoektazik baziler arter, 6 olguda (%6,5) serebral atrofi, 2 olguda (%2,1) benign tonsiller ektopi, 1 olguda (%1,08) pontoserebellar köþede araknoid kist, 1 olguda (%1,08) pontoserebellar köþe tümörü, 1 olguda (%1,08) periventriküler demiyelinizan plaklar görüldü.
TARTIÞMA ve SONUÇ: Klonik HFS fasiyal sinirin seyri boyunca oluþan herhangi bir lezyona baðlý olarak ortaya çýkabilir. Bizim olgularýmýzýn sadece 9’unda(%9,7) kranial MR ile direkt olarak fasiyal siniri irrite eden patolojik bulgu (dolikoektazik baziler arter, pontoserebellar köþede araknoid kist, pontoserebellar köþe tümörü) gösterilebilmiþtir. Olgularýn yarýsýnda küçük damar hastalýðýnýn varlýðý aterosklerotik sürecin klonik hemifasiyal spazmýn oluþumuna zemin hazýrladýðýný göstermektedir.

INTRODUCTION: Clonic hemifacial spasm (HFS) is a disorder characterized by involuntary contractions of muscles innervated by facial nerve on one side of face and it negatively affects daily life. The aim of this study was to investigate cranial MRI findings in patients with HFS.
METHODS: Cranial MRI findings of 92 patients (53 female, 39 male) who have HFS were evaluated radiologically.
RESULTS: Age range and mean ages of cases were 23-81 and 55,5 ± 13,1, respectively. Cranial MRI was normal in 40 (43,4%) patients. We detected small vessel disease in 46 (50%), dolicoectasic basilar artery in 7 (7,6%), cerebral atrophy in 6 (6,5%), benign tonsillar ectopi in 2 (2,1%), arachnoid cyst in pontocerebellar angle in 1 (1,08%), pontocerebellar angle tumor in 1 (1,08%), and periventricular demyelinating plaque in 1 (1,08%) of the patients.
DISCUSSION AND CONCLUSION: Clonic HFS can occur due to any pathology in the course of facial nerve. In our patients cranial MRI showed direct irritation of facial nerve in only 9 (9,7%) cases (dolicoectasic basilar artery, arachnoid cyst and tumor in pontocerebellar angle). The presence of small vessel disease in half of the patients suggests relationship between atherosclerotic process and occurrence of clonic HFS.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Piriformis sendromu (PS) olan hastalarda ultrason (US) eþliðinde steroid ve lokal anestezik (LA) enjeksiyonunun kýsa dönem etkinliðini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Piriformis sendromlu 17 hasta (14/3: kadýn/erkek; yaþ ortalamasý 56.2±10.2 yýl) çalýþmaya dahil edildi. PS tanýsý klinik anamnez, piriformis kasý üzerinde hassasiyet, Freiberg test, Pace bulgusu ve fleksiyon-adduksiyon-internal rotasyon (FAIR) test sonuçlarý ile konuldu. US eþliðinde enjeksiyon öncesi ve enjeksiyondan 1 hafta sonra tedavinin etkinliði; uzun süreli oturma sonrasý vizüel aðrý skalasý (VAS: 0-10), piriformis kasý üzerinde derin palpasyonla hassasiyet (var/ yok), Freiberg testi (pozitif/negatif), Pace bulgusu (pozitif/negatif) ve FAIR testi (pozitif/negatif) ile deðerlendirildi. Ýstatistiksel analizlerde McNemar test ve Wilcoxon test kullanýldý.
BULGULAR: VAS aðrý skorlarýnýn ortalamasý 9.2±1.4’den 3.7±0.1’e geriledi (p<0.001). Piriformis kasý üzerindeki hassasiyet %82, Freiberg testi %80, Pace bulgusu %75 ve FAÝR testi %82 oranýnda istatistiksel olarak anlamlý derecede negatifleþti (p<0.001).
TARTIÞMA ve SONUÇ: Ultrason eþliðinde LA ile kombine steroid enjeksiyonu pirifomis sendromlu hastalarda etkili bir tedavi seçeneðidir.

INTRODUCTION: The purpose of this study was to evaluate the short-term efficacy of ultrasound (US)-guided steroid and local anaesthetic (LA) injections in patients with piriformis syndrome (PS).
METHODS: 17 patients (14/3: female/male; mean age 56.2 years) were diagnosed with PS based on clinical history, tenderness on piriformis muscle, Freiberg test, Pace sign and flexion-adduction-internal rotation (FAIR) test results. Patients who had all tests positive were considered as PS. The therapeutic effect was evaluated at baseline and 1 week after the US-guided injection by visual analog scale (VAS: 0-10) during sitting, tenderness on the piriformis muscle (absent/present), Pace sign (absent/present), Freiberg test (absent/present) and FAIR test (absent/present). Statistical analysis were done with McNemar test and Wilcoxon test.
RESULTS: VAS improved from 9.2±1.4 to 3.7±0.1 (p<0.001). Tenderness (82%), Freiberg test (80%), Pace sign (75%) and FAIR test (82%) significantly dissapeared (p<0.001).
DISCUSSION AND CONCLUSION: US-guided steroid combined with LA injection may be an effective treatment option for patients with PS.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Acil servise herhangi bir nedenle baþvuran ve klinik kuþku sonrasýnda D-Dimer (DD) bakýlan hastalarda; DD kullaným alaný ve sýklýðý; pulmoner emboli (PE) ön tanýlý 50 yaþ üstü hastalarda DD eþik deðeri için “yaþ x 10” formülünün kullanýlmasý ile DD’nin yaþa göre duyarlýlýðý ve özgüllüðü araþtýrýldý.
YÖNTEM ve GEREÇLER: 1 Ocak–31 Aralýk 2014 tarihleri arasýnda Saðlýk Bilimleri Üniversitesi Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi’ne baþvuran 1593 hasta çalýþmaya dâhil edildi. DD immunoturbidimetrik yöntemle ölçüldü ve 500 ng/ml eþik deðer olarak alýndý.
BULGULAR: DD düzeyi olgularýn 747’sinde (%46,9) 500 ng/ml altýnda, 846’sýnda (%53,1) 500 ng/ml ve üzerinde saptandý. DD 500 ng/ml ve üzeri olan olgularýn yaþ ortalamasý 62,17±20,36 (15-113) yýldýr. %54,1’i (n=458) kadýndý. DD≥500 ng/ml olanlarýn taný daðýlýmýnda en yüksek oran %19.1 ile akciðer hastalýklarýnda, görüntüleme yöntemi olarak en fazla %43,9 ile (n=371) PAAC istendiði saptandý. DD’nin pulmoner emboli için duyarlýlýðý % 90, özgüllüðü % 88, negatif öngörü deðeri ise % 99 olarak saptandý. Derin ven trombozu için ise DD’nin duyarlýlýðý % 93, özgüllüðü % 97, negatif öngörü deðeri ise % 99 olarak saptandý.
TARTIÞMA ve SONUÇ: Pulmoner emboli ve derin ven trombozu için DD’nin duyarlýlýk, özgüllük ve özellikle negatif öngörü deðeri oldukça yüksektir. Pulmoner emboli þüphesi olan 50 yaþ ve üzeri hastalarda D-dimer eþik deðeri için “yaþ x 10 ng/ml” formülü kullanýldýðýnda DD’nin duyarlýlýðý ile özgüllüðü artmaktadýr.

INTRODUCTION: To investigate D-dimer’s area and frequency of use in patients admitted to emergency department. In addition; D-dimer’s sensitivity and specificity by age with the use of the formula “age x 10” in patients older then fifty years old suspected of pulmonary embolism.
METHODS: One thousand and five hundred and ninety three patients admitted to University of Health Sciences Kartal Dr. Lütfi Kýrdar Education and Research Hospital Emergency Department between 1st January and 31st December 2014 were included in the study. Plasma D-dimer levels were measured by immunoturbidimetric assay and cut-off value is considered 500 ng/ml.
RESULTS: Plasma D-dimer level of 747 patients’ (46,9%) were less than 500 ng/ml, 846 patients (53,1%) had a D-dimer above 500 ng/ml. In the high measured D-dimer group, the mean age of the patients 62,17±20,36 (15-113) years. 54,1% (n=458) were female. Pulmonary disease (19.1%) was the most frequent diagnosis and most required imaging modality was chest x-ray (43,9%) in the high measured D-dimer group. Sensitivity, specificity and negative predictive value of D-dimer for pulmonary embolism were 90%, 88% and 99%, respectively. Sensitivity, specificity and negative predictive value of D-dimer for deep vein thrombosis were 93%, 97% and 99%, respectively.
DISCUSSION AND CONCLUSION: Sensitivity, specificity and especially negative predictive value of D-dimer for pulmonary embolism and deep vein thrombosis are very high. In patients older than fifty years old suspected of pulmonary embolism, the formula “age x 10 ng/ml” can be used for the D-dimer’s cut-off value therefore sensitivity and specificity of D-dimer’s are increased.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Retina ven týkanýklýðýna (RVT) baðlý tekrarlayan makula ödemi olan olgularda uygulanan bir intravitreal deksametazon implant (IDI) sonrasý 6 aylýk sonuçlarýn deðerlendirilmesi.
YÖNTEM ve GEREÇLER: RVT’ye baðlý makula ödemine sahip naif olmayan 20 gözde IDI sonrasý santral makula kalýnlýðý (SMK), en iyi düzeltilmiþ görme keskinliði (EÝDGK) ve diðer yan etkiler 1. hafta, 1.ay ve nüksten dolayý (3-6 ay arasý) enjeksiyon tekrarý yapýlana kadar her ay olmak üzere retrospektif olarak incelendi. Nüks kararý 1 sýra EÝDGK kaybýna eþlik eden OCT’de sývýnýn tekrar belirmesi olarak belirlendi.
BULGULAR: Çalýþmadaki 14 göz retina ven dal týkanýklýðý (RVDT) ve 6 göz retina ven kök týkanýklýðýna (RVKT) sahipti. Ortalama yaþ 63.7±10.3 iken hastalarýn %60’ý kadýndý. Hem ortalama EÝDGK hem de SMK deðerleri 1. hafta, 1, 2, 3 ve 4. aylarda (p<0.05) anlamlý bir þekilde düzelmiþti. Ayrýca hastalarýn %70‘inde nüks zamanýnda bile görme artýþýnýn korunabildiði görüldü. IDI’ya maksimum yanýt 2. ayda alýnmýþ olup görme keskinliði ve retina kalýnlýðýnda elde edilen olumlu geliþmeler 3. aydan itibaren azalmaya baþladý. IDI sonrasý elde edilen maksimum göz içi basýncý (GIB) deðeri 34 mmHg idi ve o da 2. ayda ölçülmüþtü. GIB yükselmeleri topikal antiglokomatöz ilaçlarla kolaylýkla kontrol altýna alýndý. Takip boyunca herhangi bir ciddi yan etki gözlenmedi.
TARTIÞMA ve SONUÇ: Kýsa dönem sonuçlarýmýza göre, deksametazon implant RVT’ye baðlý tekrarlayan makula ödeminde maksimum etkinin 2. ayda görüldüðü etkili ve güvenilir bir tedavidir.

INTRODUCTION: To evaluate 6-month results after a single application of intravitreal dexamethasone implant (IDI) for recurrent macular edema in retinal vein occlusion(RVO).
METHODS: Twenty non-naive eyes with macular edema secondary to RVO underwent assessments for central macular thickness (CMT), best corrected visual acuity (BCVA) and adverse events at baseline, week 1 and monthly until reinjection due to recurrence (range 3-6 months) retrospectively following IDI. Retreatment criterion was recurrence on OCT and related to loss of BCVA at least 1 line.
RESULTS: Fourteen eyes with branch retinal vein occlusion, and 6 eyes with central retinal vein occlusion were eligible for the study. The mean age was 63.7±10.3 and 60% of the patients were women. Both mean BCVA and CMT significantly improved 1 week, 1, 2, 3 and 4 months (p<0.05) after injection. Moreover, the increase of visual acuity was sustained in 70% of the patients even in case of recurrence. The maximum response to IDI was observed in the second month and improvements in visual acuity and retinal thickness began to decrease from the third month. The maximum value of IOP after IDI was 34 mmHg and measured at month 2 as well. IOP rises were well controlled with topical antiglaucoma therapy. No serious adverse events were observed during follow-up period.
DISCUSSION AND CONCLUSION: According to our short-term results, IDI seems to be an effective and safe treatment for recurrent macular edema in RVO with the maximum effect at month 2.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Preoperatif ve postoperatif düþük hemoglobin deðerlerinin kalça cerrahisi sonrasý morbidite, mortalite, erken fonksiyonel sonuçlara ve yürüme mesafesine olan etkisine dair farklý sonuçlar bildirilmiþtir. Biz bu çalýþmada ameliyat öncesi aneminin kalça kýrýklý hastalarda cerrahi sonrasý mortalite ve hastanede kalýþ süresi üzerinde etkisi olup olmadýðýný inceledik.
YÖNTEM ve GEREÇLER: Çalýþmaya kliniðimizde parsiyel protez yapýlarak tedavi edilen 135 kalça dahil edildi.
BULGULAR: Hasta dosyalarý retrospektif olarak incelendi ve hastalara ameliyat öncesi anemisi olanlar ve olmayanlar olarak iki gruba ayrýldý. Heriki hasta grubu ortalama yaþ, morbidite daðýlýmý, preoperatif ve postoperatif hemoglobin deðerleri, cerrahi öncesi ve sonrasý hastane yatýþ
süreleri ve transfüzyon gerekliliði açýsýndan istatistiksel olarak deðerlendirildi.
TARTIÞMA ve SONUÇ: Yaptýðýmýz çalýþmada anemisi olan hastalarda preoperatif dönemde yatýþ süresinin anemisi olmayan gruba göre anlamlý derecede fazla olduðunu, ancak iki grup arasýnda postoperatif yatýþ süresi arasýnda anlamlý fark olmadýðýný saptadýk.

INTRODUCTION: The objective of this study was analysing the correlation between preoperative anemia and duration of hospitay stay at preoperative and postoperative stage among patients that had been treated with partial endoprosthesis for treatment of pertrochanteric femoral fractures.
METHODS: Medical records of 152 individuals were reviewed retrospectively and 135 patients were included to the study. Preoperative anemia was detected in 87 of patients. Remaining 48 patients hemoglobin levels were within normal ranges. Both patient groups were statistically examined with respect to mean age, distribution of morbidity, preoperative and postoperative hemoglobin values, duration of hospital stay before and after surgery and transfusion requirement.

RESULTS: When hypertension, coronary artery disease, diabetes mellitus, Alzheimer’s disease and transfusion ratios are examined, no statistically significant difference was found between groups (p>0,05). No statistically significant difference was found between the age averages of anemic and non-anemic patients (p>0,05). Preoperative and postoperative hemoglobin values of patients in the anemic group were found to be significantly low compared to the averages of patients in the non-anemic group (p<0,05). Preoperative and postoperative hemoglobin value differences of patients in the non-anemic group were found to be significantly high compared to the differences of patients in the non-anemic group (p<0,05). Preop hospital stay periods of patients with anemia were found to be significantly higher in comparison to those of patients without anemia (p<0,05).
DISCUSSION AND CONCLUSION: Our results showed that there is no statistically significant difference between anemic and nonanemic groups by the means of postoperative hospitalstay consistent with the current literature. However we have detected statistically significant longer preoperative hospital stay in anemic group. We believe that this finding is valuable since the fact that duration of preoperative hospital stay increases postoperative mortality.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Lateral epikondilit (LE)’li hastalarda aðrý, eklem hareket açýklýðý ve kas kuvvetinin günlük yaþam aktiviteleri üzerine olan etkisini deðerlendirmek.
YÖNTEM ve GEREÇLER: Çalýþmaya Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi Fizik Tedavi ve Rehabilitasyon Kliniðinde Ocak-Nisan 2014 tarihleri arasýnda, LE tanýsý almýþ 60 olgu dahil edildi. Olgularýn gece, istirahat, aktivite ve zorlu kullanýmdaki aðrý þiddeti Vizüel Anolog Skala (VAS) ile, eklem hareket açýklýðý gonyometre ile, kas kuvveti el kavrama kuvvetinin dinamometrik ölçümü ile aktivite ve katýlým Kol Omuz ve El Yaralanmasý Anketi Kýsa Form (Quick-DASH) ve Hasta Bazlý Önkol Deðerlendirme Anketi (HBÖKDA) ile ve yaþam kalitesi ise Kýsa Form-36 (SF-36) ile deðerlendirildi.
BULGULAR: Olgularýn yaþlarý 19-64 yýl arasýnda deðiþmekte olup yaþ ortalamasý 47,95±8,6 yýldý. Aðrý þiddeti ile Quick-DASH, DASH-W, HBÖKDA ve SF-36 arasýnda anlamlý iliþki bulundu (p˂0,05). Eklem hareket açýklýðý ile Quick-DASH, DASH-W, HBÖKDA ve SF-36 arasýnda anlamlý iliþki görülmedi (p˃0,05). Sað dirsek etkilenen olgularda; el kavrama kuvveti ile HBÖKDA’nýn aðrý bölümü, sol dirsek etkilenen olgularda; el kavrama kuvveti ile Quick-DASH, DASH-W ve HBÖKDA’nýn iþlev bölümü arasýnda anlamlý iliþki bulundu (p<0,05). Sað dirsek etkilenen olgularda; el kavrama kuvveti ile SF-36 skorlarý arasýnda anlamlý iliþki görülmezken (p>0,05), sol dirsek etkilenen katýlýmcýlarda; el kavrama kuvveti ile SF-36’nýn canlýlýk bölümü hariç tüm bölümleri arasýnda anlamlý iliþki bulundu (p<0,05).
TARTIÞMA ve SONUÇ: LE’de aðrý ve zayýflamýþ el kavrama kuvveti günlük yaþam aktivitelerinde kýsýtlýlýða neden olmakta ve yaþam kalitesini azaltmaktadýr.

INTRODUCTION: To evaluate the effect of pain, range of motion and muscle strength in the patients with lateral epicondylitis on activities of daily living.
METHODS: Sixty people who were admitted to outpatient clinic of Physical Medicine and Rehabilitation within the Fatih Sultan Mehmet Education and Research Hospital on dates between January - April 2014, and diagnosed as LE were included in the study. The severity of pain during night, rest, activity, and forced activity was assessed with Visual Analog Scale (VAS), the range of motion was measured by a goniometer, muscle strength was assessed by measuring hand grip strenght using a dynamometer, activity and participation were assessed with Short form of the Disabilities of Arm, Shoulder and Hand Questionnaire (Quick-DASH) and Forearm Evaluation Questionnaire Based with Patient (HBÖKDA), and Quality of Life was assessed with Short Form 36 (SF-36).
RESULTS: The age of subjects were between 19 and 64 years and mean age was 47,95±8,6 years. There was a significant relationship between the severity of pain and the Quick-DASH, DASH-W, HBÖKDA, and SF-36 (p ˂ 0,05). There was no significant relationship between the range of motion and the Quick-DASH, DASH-W, HBÖKDA and SF-36 (p > 0,05). There was a significant relationship between the hand grip strength and the pain section of HBÖKDA in subjects whom right elbow was affected and there was a significant relationship between the hand grip strength and the Quick-DASH, DASH-W, and function section of HBÖKDA in subjects whom left elbow was affected (p< 0,05). There wasn’t any significant relationship between the hand grip strength and the SF-36 scores in subjects whom right elbow was affected (p> 0,05) but, there was a significant relationship between the hand grip strength and the SF-36 scores other than vitality scores in subjects whom left elbow was affected (p< 0,05).
DISCUSSION AND CONCLUSION: Pain and weakness in grip strength cause limitation at the activities of daily living and decrease the quality of life in patients with lateral epicondylitis.

Abstract | Full Text PDF