Open Journal of Rheumatology and Autoimmune Diseases, 2013
Backgrounds: To observe the effects of aerobic exercise program on the illness symptoms and cardi... more Backgrounds: To observe the effects of aerobic exercise program on the illness symptoms and cardiopulmonary capacity of the patients with primary Fibromyalgia Syndrome (FMS) and to find out whether there is a difference or not in terms of cardiovascular capacity among the patients with primary FMS and sedentary healthy people. Materials and Methods: The study has been done on 20 female patients with primary FMS. Before the study and after a 6-week controlled aerobic exercise program, a cardiopulmonary exercise test has been applied on all cases. The symptoms, psychological state and life quality of the cases have been evaluated before and after the exercise program. The first cardiopulmonary results of the cases with FMS have been compared with a control group of 15 sedentary healthy. Results: When the patient and control groups are compared, although maksimal oxygen uptake (VO2 max) was lower in the patient group, this was not a significant difference. VO2 max showing the aerobic condition after the exercise increased significantly in the patients. Conclusions: Aerobic exercise programs lasting six to eight weeks are quite effective for the patients with FMS. There is not any limitation in the increase of the cardiopulmonary capacity of the patients after the exercise program.
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Kronik bel ağrısı nedeniyle ultrasonografi (US) eşliğinde kaudal epidural steroid enjeksiyonu yap... more Kronik bel ağrısı nedeniyle ultrasonografi (US) eşliğinde kaudal epidural steroid enjeksiyonu yapılan hastalarda tedavinin ağrı ve fonksiyonel durum üzerine olan etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Ocak 2015-Haziran 2015 tarihleri arasında kronik bel ağrısı nedeniyle US eşliğinde kaudal epidural steroid enjeksiyonu yapılan, dosyasında VAS(vizüel analog skala)'ya göre ağrı ve fonksiyonel durumu değerlendiren Oswestry Disabilite İndeksi (ODİ) bulunan hastalar dahil edildi. Hastaların enjeksiyon öncesi, enjeksiyon sonrası 2.hafta, 1 ve3.ay VAS ve ODİ'leri değerlendirildi. Bulgular: Çalışmaya dahil edilen 12 hastanın 5'i erkek,7'si kadın olup ortalama yaşları 53,83±14,62 idi. Hastaların ortalama hastalık süresi 3,58±2,74 yıl olarak bulundu. Enjeksiyon öncesi hastaların ortalama VAS skoru 61,25 iken enjeksiyon sonrası 2. haftada VAS skorunun 25,83'e gerilediği saptandı. ODİ skoru enjeksiyon öncesi hastalarda 19,5 iken enjeksiyon sonrası 2.haftada 10,33 olarak bulundu. Enjeksiyon öncesine göre 2. hafta,1.ay ve 3.ayda VAS ve ODİ skorlarında istatistiksel olarak anlamlı azalma saptandı. Sonuç: Kronik bel ağrılı hastalarımızda kaudal epidural steroid enjeksiyonunun ağrı ve fonksiyonel durum üzerinde etkin olduğunu ve bu etkinliğin 3 ay boyunca devam ettiğini saptadık. US eşliğinde yapılan kaudal epidural steroid enjeksiyonunun etkili olduğunu ve radyasyon maruziyeti olmadığı için avantajlı ve güvenilir bir yöntem olduğunu düşünüyoruz.
Journal of the American Podiatric Medical Association, May 1, 2017
Background: We compared the long-term clinical and ultrasonographic effects of radial extracorpor... more Background: We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy. Methods: Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n ¼ 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n ¼ 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment. Results: Significant improvements were observed in the rESWT group in VAS, HTI, and FFI scores and PFT at the end of treatment and were maintained during follow-up. Posttreatment improvements in VAS, HTI, and FFI scores and PFT were also seen in the corticosteroid group but were not maintained for VAS and FFI scores after the completion of therapy and were lost at 1 and 6 months, respectively. No serious treatment-related complications occurred. Conclusions: Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.
Türk osteoporoz dergisi-Turkish journal of osteoporosis, Jun 6, 2017
Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteop... more Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteoporotic vertebral fracture and posture problems in parkinson's disease patients with and without vertebral fracture. Materials and Methods: In this study 59 Parkinson's disease patients (aged ≥40 years) were included. Patients with a disease that may impair their vitamin D metabolism were not included to the study. 25-OH Vitamin D levels in plasma, Ca, P, ALP, PTH, TSH, BUN and Cr values and DXA values were measured from the obtained blood samples by high performance liquid chromatography method. Bone mineral density was measured. Lateral thoracic and lumbar vertebra radiographs were obtained, and vertebra fracture were recorded in as lumbar thoracic fracture with degree and level. Parkinson's disease staging was done using Hoehn Yahr Scale. Results: There were 33 men and 26 women patients. In the study population, mean age was 66.1±10.2 years while mean body mass index was 29.5±5.1 kg/m 2. Osteoporotic vertebral fracture was detected in 35 patients and it was not detected in 24 patients. Vitamin D level was less than 10 IU/dL in 46.9% of the patients and it was less than 20 IU/dL in 83.7% of them. This was lower than the normal population value. Mean vitamin D concentration was 15.0±1.84 in Parkinson's disease patients with vertebral fracture and posture problems while it was 12.7±1.1 in patients without vertebral fracture. There was no significant relation between vitamin D and fracture presence (p>0.005). In our study, no significant correlation was found between posture problem and vitamin D levels. However, it was shown that vitamin D levels were lower in Parkinson's disease patients than in general population.
Objective: We aimed to compare the kinesio taping (KT) technique and static wrist resting splint ... more Objective: We aimed to compare the kinesio taping (KT) technique and static wrist resting splint therapy in terms of clinical symptoms, hand grip strengt and daily living activities in patients with carpal tunnel syndrome. Methods: In this study, 25 of 42 patients with mild/moderate carpal tunnel syndrome received KT for 4 weeks, while the remaining 17 patients used a static wrist resting splint for the same period. For all the patients, details on age, sex, occupation, and degree of carpal tunnel syndrome were recorded. Tinel's test, Phalen's test, hand grip strength, and visual analogue scale (VAS) score for pain during the day and night were assessed before the treatment and in the first and third months after the treatment. The patients also completed a QuickDASH questionnaire. Results: No significant differences were found between the groups in terms of age, sex, and degree of carpal tunnel syndrome. In both groups, the VAS-day, VAS-night, and QuickDASH scores significantly decreased, while hand grip strength significantly improved after the treatment as compared with their pretreatment values. These effects were maintained for 3 months (p<0.005). The decrease in VAS-night score in month 1 and the improvement in hand grip strength in months 1 and 3 were statistically significant in the group who received KT, while the decrease in QuickDASH score was statistically significant in the group who received static wrist resting splint therapy (p<0.005). Conclusion: This study shows that treatment with KT and static wrist resting splint therapy improved the symptoms, daily living activities, and hand grip strength of the patients with mild/moderate carpal tunnel syndrome. In conclusion, we think that KT should be kept in mind as an alternative to conservative therapies in the treatment of carpal tunnel syndrome.
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic f... more Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic foot ulcers are associated with increased morbidity, impaired quality of life, substantial treatment costs and high rates of lower extremity amputations. Management of diabetic foot ulcers include conventional treatments such as patient education, preventive measures, treatment of concomitant infection, local surgical debridement as well as alternative treatments such as hyperbaric oxygen therapy and negativepressure wound therapy. Here, we report a case of diabetic foot ulcer treated with extracorporeal shock wave therapy (ESWT). We applied ESWT every other day for a total of 9 sessions to a 65-year-old male patient with a history of diabetes mellitus for 15 years and insulin use for treatment of a 2.3 x 3.8 cm wound in the lateral side of his right foot which was present for six months. ESWT was applied with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. No serious adverse reactions or complications occurred during the course of treatment. At the posttreatment follow-up visit at 3 months, a significant reduction in perceived pain and a decrease in the wound size (to 1.5 x 2.2 cm) and depth were observed. We believe that ESWT is an inexpensive, easy to administer and effective treatment modality for management of diabetic foot ulcers which are associated with high costs, treatment challenges, and require amputation in most patients.
Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovi... more Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovial joints. It is characterized with joint cartilage degeneration, subchondral bone changes, and synovitis. 1 Nonsteroid antiinflammatory drugs, glucosamine, chondroitin sulfate and hyaluronic acid are generally used for reducing inflammation and relieving pain in patients with OA. However, these have limited effect on reducing chondrocyte degeneration and improving regeneration. 2 Medications protecting or healing the cartilage are still at experimental stage. These include applications of cytokine inhibitors, gene therapy, artificial chondrocytes, and growth factor (GF). 3 Growth factor increases the synthesis of chondrocyte matrix and stimulates chondrogenic cell proliferation. 4 It reduces the activation of nuclear factor kappa B which has an important role in the pathogenesis of OA, by inhibition of inflammatory process which is induced by interleukin-1 beta. 5 Platelet alpha granules contain ABSTRACT Objectives: This study aims to evaluate the efficacy of autologous platelet rich plasma applications on pain, functional status, and cartilage regeneration in advanced knee osteoarthritis. Patients and methods: A total of 82 patients (13 males, 69 females; mean age 63.5±9.3 years; range 40 to 88 years) with chronic knee pain for the last one year, who had grade 3-4 knee osteoarthritis according to Kellgren-Lawrence Scale and visual analog scale value of higher than 5, who did not receive physical therapy for the last six months, and did not respond to treatment despite use of nonsteroidal antiinflammatory drugs and analgesics at least for the last three months were enrolled in the study. Totally 103 knee joints of 82 patients were applied intra-articular platelet rich plasma in the beginning, and first and second weeks of treatment. Platelet rich plasma was applied to both knees in 20 patients. Patients were evaluated clinically with visual analog scale, functionally with Western Ontario and McMaster Universities Osteoarthritis Index, and six-minute walk test before application and after application at first and second weeks, and third and sixth months. Cartilage thicknesses were measured by ultrasound before treatment and at third and sixth months after treatment. Obtained results were compared. Results: Compared to values before treatment, patients' visual analog scale values were significantly decreased at third and sixth months after treatment (p<0.001). When compared according to Western Ontario and McMaster Universities Osteoarthritis Index, all values improved significantly after treatment (p<0.001). Results of six-minute walk test improved at third and sixth moths after treatment compared to results before treatment (p<0.05). Cartilage thicknesses increased significantly after treatment at third and sixth months compared to before treatment (p<0.05). Conclusion: We believe that platelet rich plasma treatment is an effective, reliable, easily applied and low cost application in terms of pain, functional status as well as cartilage regeneration even in patients with advanced osteoarthritis.
There are increasing numbers of studies regarding robot-assisted gait training thanks to technolo... more There are increasing numbers of studies regarding robot-assisted gait training thanks to technological developments and whether it is superior to conventional physiotherapy methods draws attention. This study aimed to compare the effectiveness of conventional physiotherapy methods and robot-assisted gait training in children with cerebral palsy receiving botulinum toxin injection of lower extremities. A total of 28 patients who were followed up in our clinic and had received botulinum toxin injection of lower extremities in the last month were randomized into two groups in the study. First group received conventional physiotherapy (range of joint motion (ROM), stretching, gait training, etc.), and the other group received robot-assisted gait training. The study population was evaluated pre- and posttreatment regarding their ROM, spasticity, gross motor function, balance, functional independence, and gait analyses. When we look at the responses of the patients before and after treatm...
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Amac: Kronik bel agrisi nedeniyle ultrasonografi (US) esliginde kaudal epidural steroid enjeksiyo... more Amac: Kronik bel agrisi nedeniyle ultrasonografi (US) esliginde kaudal epidural steroid enjeksiyonu yapilan hastalarda tedavinin agri ve fonksiyonel durum uzerine olan etkilerini degerlendirmeyi amacladik. Gerec ve Yontemler: Calismaya Ocak 2015-Haziran 2015 tarihleri arasinda kronik bel agrisi nedeniyle US esliginde kaudal epidural steroid enjeksiyonu yapilan, dosyasinda VAS(vizuel analog skala)’ya gore agri ve fonksiyonel durumu degerlendiren Oswestry Disabilite Indeksi (ODI) bulunan hastalar dahil edildi. Hastalarin enjeksiyon oncesi, enjeksiyon sonrasi 2.hafta, 1 ve3.ay VAS ve ODI’leri degerlendirildi. Bulgular: Calismaya dahil edilen 12 hastanin 5’i erkek,7’si kadin olup ortalama yaslari 53,83±14,62 idi. Hastalarin ortalama hastalik suresi 3,58±2,74 yil olarak bulundu. Enjeksiyon oncesi hastalarin ortalama VAS skoru 61,25 iken enjeksiyon sonrasi 2. haftada VAS skorunun 25,83’e geriledigi saptandi. ODI skoru enjeksiyon oncesi hastalarda 19,5 iken enjeksiyon sonrasi 2.haftada 10,...
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karekterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, ikibuçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile or...
Journal of the American Podiatric Medical Association, 2017
Background:We compared the long-term clinical and ultrasonographic effects of radial extracorpore... more Background:We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy.Methods:Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n = 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment.Results:Significant improvements were observed in the rESWT group in VAS, HTI, and FFI score...
Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteop... more Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteoporotic vertebral fracture and posture problems in parkinson's disease patients with and without vertebral fracture. Materials and Methods: In this study 59 Parkinson's disease patients (aged ≥40 years) were included. Patients with a disease that may impair their vitamin D metabolism were not included to the study. 25-OH Vitamin D levels in plasma, Ca, P, ALP, PTH, TSH, BUN and Cr values and DXA values were measured from the obtained blood samples by high performance liquid chromatography method. Bone mineral density was measured. Lateral thoracic and lumbar vertebra radiographs were obtained, and vertebra fracture were recorded in as lumbar thoracic fracture with degree and level. Parkinson's disease staging was done using Hoehn Yahr Scale. Results: There were 33 men and 26 women patients. In the study population, mean age was 66.1±10.2 years while mean body mass index was 29.5±5.1 kg/m 2. Osteoporotic vertebral fracture was detected in 35 patients and it was not detected in 24 patients. Vitamin D level was less than 10 IU/dL in 46.9% of the patients and it was less than 20 IU/dL in 83.7% of them. This was lower than the normal population value. Mean vitamin D concentration was 15.0±1.84 in Parkinson's disease patients with vertebral fracture and posture problems while it was 12.7±1.1 in patients without vertebral fracture. There was no significant relation between vitamin D and fracture presence (p>0.005). In our study, no significant correlation was found between posture problem and vitamin D levels. However, it was shown that vitamin D levels were lower in Parkinson's disease patients than in general population.
Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic f... more Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic foot ulcers are associated with increased morbidity, impaired quality of life, substantial treatment costs and high rates of lower extremity amputations. Management of diabetic foot ulcers include conventional treatments such as patient education, preventive measures, treatment of concomitant infection, local surgical debridement as well as alternative treatments such as hyperbaric oxygen therapy and negativepressure wound therapy. Here, we report a case of diabetic foot ulcer treated with extracorporeal shock wave therapy (ESWT). We applied ESWT every other day for a total of 9 sessions to a 65-year-old male patient with a history of diabetes mellitus for 15 years and insulin use for treatment of a 2.3 x 3.8 cm wound in the lateral side of his right foot which was present for six months. ESWT was applied with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. No serious adverse reactions or complications occurred during the course of treatment. At the posttreatment follow-up visit at 3 months, a significant reduction in perceived pain and a decrease in the wound size (to 1.5 x 2.2 cm) and depth were observed. We believe that ESWT is an inexpensive, easy to administer and effective treatment modality for management of diabetic foot ulcers which are associated with high costs, treatment challenges, and require amputation in most patients.
Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovi... more Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovial joints. It is characterized with joint cartilage degeneration, subchondral bone changes, and synovitis. 1 Nonsteroid antiinflammatory drugs, glucosamine, chondroitin sulfate and hyaluronic acid are generally used for reducing inflammation and relieving pain in patients with OA. However, these have limited effect on reducing chondrocyte degeneration and improving regeneration. 2 Medications protecting or healing the cartilage are still at experimental stage. These include applications of cytokine inhibitors, gene therapy, artificial chondrocytes, and growth factor (GF). 3 Growth factor increases the synthesis of chondrocyte matrix and stimulates chondrogenic cell proliferation. 4 It reduces the activation of nuclear factor kappa B which has an important role in the pathogenesis of OA, by inhibition of inflammatory process which is induced by interleukin-1 beta. 5 Platelet alpha granules contain ABSTRACT Objectives: This study aims to evaluate the efficacy of autologous platelet rich plasma applications on pain, functional status, and cartilage regeneration in advanced knee osteoarthritis. Patients and methods: A total of 82 patients (13 males, 69 females; mean age 63.5±9.3 years; range 40 to 88 years) with chronic knee pain for the last one year, who had grade 3-4 knee osteoarthritis according to Kellgren-Lawrence Scale and visual analog scale value of higher than 5, who did not receive physical therapy for the last six months, and did not respond to treatment despite use of nonsteroidal antiinflammatory drugs and analgesics at least for the last three months were enrolled in the study. Totally 103 knee joints of 82 patients were applied intra-articular platelet rich plasma in the beginning, and first and second weeks of treatment. Platelet rich plasma was applied to both knees in 20 patients. Patients were evaluated clinically with visual analog scale, functionally with Western Ontario and McMaster Universities Osteoarthritis Index, and six-minute walk test before application and after application at first and second weeks, and third and sixth months. Cartilage thicknesses were measured by ultrasound before treatment and at third and sixth months after treatment. Obtained results were compared. Results: Compared to values before treatment, patients' visual analog scale values were significantly decreased at third and sixth months after treatment (p<0.001). When compared according to Western Ontario and McMaster Universities Osteoarthritis Index, all values improved significantly after treatment (p<0.001). Results of six-minute walk test improved at third and sixth moths after treatment compared to results before treatment (p<0.05). Cartilage thicknesses increased significantly after treatment at third and sixth months compared to before treatment (p<0.05). Conclusion: We believe that platelet rich plasma treatment is an effective, reliable, easily applied and low cost application in terms of pain, functional status as well as cartilage regeneration even in patients with advanced osteoarthritis.
Journal of Clinical and Experimental Investigations, 2015
Karpal tünel sendromu olan hastalarda ortalama trombosit hacmi ve diğer hemogram sonuçlarının kar... more Karpal tünel sendromu olan hastalarda ortalama trombosit hacmi ve diğer hemogram sonuçlarının karşılaştırılması The comparison of mean platelet volume and other hemogram results in patients with carpal tunnel syndrome
Open Journal of Rheumatology and Autoimmune Diseases, 2013
Backgrounds: To observe the effects of aerobic exercise program on the illness symptoms and cardi... more Backgrounds: To observe the effects of aerobic exercise program on the illness symptoms and cardiopulmonary capacity of the patients with primary Fibromyalgia Syndrome (FMS) and to find out whether there is a difference or not in terms of cardiovascular capacity among the patients with primary FMS and sedentary healthy people. Materials and Methods: The study has been done on 20 female patients with primary FMS. Before the study and after a 6-week controlled aerobic exercise program, a cardiopulmonary exercise test has been applied on all cases. The symptoms, psychological state and life quality of the cases have been evaluated before and after the exercise program. The first cardiopulmonary results of the cases with FMS have been compared with a control group of 15 sedentary healthy. Results: When the patient and control groups are compared, although maksimal oxygen uptake (VO2 max) was lower in the patient group, this was not a significant difference. VO2 max showing the aerobic condition after the exercise increased significantly in the patients. Conclusions: Aerobic exercise programs lasting six to eight weeks are quite effective for the patients with FMS. There is not any limitation in the increase of the cardiopulmonary capacity of the patients after the exercise program.
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Kronik bel ağrısı nedeniyle ultrasonografi (US) eşliğinde kaudal epidural steroid enjeksiyonu yap... more Kronik bel ağrısı nedeniyle ultrasonografi (US) eşliğinde kaudal epidural steroid enjeksiyonu yapılan hastalarda tedavinin ağrı ve fonksiyonel durum üzerine olan etkilerini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmaya Ocak 2015-Haziran 2015 tarihleri arasında kronik bel ağrısı nedeniyle US eşliğinde kaudal epidural steroid enjeksiyonu yapılan, dosyasında VAS(vizüel analog skala)'ya göre ağrı ve fonksiyonel durumu değerlendiren Oswestry Disabilite İndeksi (ODİ) bulunan hastalar dahil edildi. Hastaların enjeksiyon öncesi, enjeksiyon sonrası 2.hafta, 1 ve3.ay VAS ve ODİ'leri değerlendirildi. Bulgular: Çalışmaya dahil edilen 12 hastanın 5'i erkek,7'si kadın olup ortalama yaşları 53,83±14,62 idi. Hastaların ortalama hastalık süresi 3,58±2,74 yıl olarak bulundu. Enjeksiyon öncesi hastaların ortalama VAS skoru 61,25 iken enjeksiyon sonrası 2. haftada VAS skorunun 25,83'e gerilediği saptandı. ODİ skoru enjeksiyon öncesi hastalarda 19,5 iken enjeksiyon sonrası 2.haftada 10,33 olarak bulundu. Enjeksiyon öncesine göre 2. hafta,1.ay ve 3.ayda VAS ve ODİ skorlarında istatistiksel olarak anlamlı azalma saptandı. Sonuç: Kronik bel ağrılı hastalarımızda kaudal epidural steroid enjeksiyonunun ağrı ve fonksiyonel durum üzerinde etkin olduğunu ve bu etkinliğin 3 ay boyunca devam ettiğini saptadık. US eşliğinde yapılan kaudal epidural steroid enjeksiyonunun etkili olduğunu ve radyasyon maruziyeti olmadığı için avantajlı ve güvenilir bir yöntem olduğunu düşünüyoruz.
Journal of the American Podiatric Medical Association, May 1, 2017
Background: We compared the long-term clinical and ultrasonographic effects of radial extracorpor... more Background: We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy. Methods: Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n ¼ 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n ¼ 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment. Results: Significant improvements were observed in the rESWT group in VAS, HTI, and FFI scores and PFT at the end of treatment and were maintained during follow-up. Posttreatment improvements in VAS, HTI, and FFI scores and PFT were also seen in the corticosteroid group but were not maintained for VAS and FFI scores after the completion of therapy and were lost at 1 and 6 months, respectively. No serious treatment-related complications occurred. Conclusions: Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.
Türk osteoporoz dergisi-Turkish journal of osteoporosis, Jun 6, 2017
Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteop... more Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteoporotic vertebral fracture and posture problems in parkinson's disease patients with and without vertebral fracture. Materials and Methods: In this study 59 Parkinson's disease patients (aged ≥40 years) were included. Patients with a disease that may impair their vitamin D metabolism were not included to the study. 25-OH Vitamin D levels in plasma, Ca, P, ALP, PTH, TSH, BUN and Cr values and DXA values were measured from the obtained blood samples by high performance liquid chromatography method. Bone mineral density was measured. Lateral thoracic and lumbar vertebra radiographs were obtained, and vertebra fracture were recorded in as lumbar thoracic fracture with degree and level. Parkinson's disease staging was done using Hoehn Yahr Scale. Results: There were 33 men and 26 women patients. In the study population, mean age was 66.1±10.2 years while mean body mass index was 29.5±5.1 kg/m 2. Osteoporotic vertebral fracture was detected in 35 patients and it was not detected in 24 patients. Vitamin D level was less than 10 IU/dL in 46.9% of the patients and it was less than 20 IU/dL in 83.7% of them. This was lower than the normal population value. Mean vitamin D concentration was 15.0±1.84 in Parkinson's disease patients with vertebral fracture and posture problems while it was 12.7±1.1 in patients without vertebral fracture. There was no significant relation between vitamin D and fracture presence (p>0.005). In our study, no significant correlation was found between posture problem and vitamin D levels. However, it was shown that vitamin D levels were lower in Parkinson's disease patients than in general population.
Objective: We aimed to compare the kinesio taping (KT) technique and static wrist resting splint ... more Objective: We aimed to compare the kinesio taping (KT) technique and static wrist resting splint therapy in terms of clinical symptoms, hand grip strengt and daily living activities in patients with carpal tunnel syndrome. Methods: In this study, 25 of 42 patients with mild/moderate carpal tunnel syndrome received KT for 4 weeks, while the remaining 17 patients used a static wrist resting splint for the same period. For all the patients, details on age, sex, occupation, and degree of carpal tunnel syndrome were recorded. Tinel's test, Phalen's test, hand grip strength, and visual analogue scale (VAS) score for pain during the day and night were assessed before the treatment and in the first and third months after the treatment. The patients also completed a QuickDASH questionnaire. Results: No significant differences were found between the groups in terms of age, sex, and degree of carpal tunnel syndrome. In both groups, the VAS-day, VAS-night, and QuickDASH scores significantly decreased, while hand grip strength significantly improved after the treatment as compared with their pretreatment values. These effects were maintained for 3 months (p<0.005). The decrease in VAS-night score in month 1 and the improvement in hand grip strength in months 1 and 3 were statistically significant in the group who received KT, while the decrease in QuickDASH score was statistically significant in the group who received static wrist resting splint therapy (p<0.005). Conclusion: This study shows that treatment with KT and static wrist resting splint therapy improved the symptoms, daily living activities, and hand grip strength of the patients with mild/moderate carpal tunnel syndrome. In conclusion, we think that KT should be kept in mind as an alternative to conservative therapies in the treatment of carpal tunnel syndrome.
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic f... more Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic foot ulcers are associated with increased morbidity, impaired quality of life, substantial treatment costs and high rates of lower extremity amputations. Management of diabetic foot ulcers include conventional treatments such as patient education, preventive measures, treatment of concomitant infection, local surgical debridement as well as alternative treatments such as hyperbaric oxygen therapy and negativepressure wound therapy. Here, we report a case of diabetic foot ulcer treated with extracorporeal shock wave therapy (ESWT). We applied ESWT every other day for a total of 9 sessions to a 65-year-old male patient with a history of diabetes mellitus for 15 years and insulin use for treatment of a 2.3 x 3.8 cm wound in the lateral side of his right foot which was present for six months. ESWT was applied with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. No serious adverse reactions or complications occurred during the course of treatment. At the posttreatment follow-up visit at 3 months, a significant reduction in perceived pain and a decrease in the wound size (to 1.5 x 2.2 cm) and depth were observed. We believe that ESWT is an inexpensive, easy to administer and effective treatment modality for management of diabetic foot ulcers which are associated with high costs, treatment challenges, and require amputation in most patients.
Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovi... more Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovial joints. It is characterized with joint cartilage degeneration, subchondral bone changes, and synovitis. 1 Nonsteroid antiinflammatory drugs, glucosamine, chondroitin sulfate and hyaluronic acid are generally used for reducing inflammation and relieving pain in patients with OA. However, these have limited effect on reducing chondrocyte degeneration and improving regeneration. 2 Medications protecting or healing the cartilage are still at experimental stage. These include applications of cytokine inhibitors, gene therapy, artificial chondrocytes, and growth factor (GF). 3 Growth factor increases the synthesis of chondrocyte matrix and stimulates chondrogenic cell proliferation. 4 It reduces the activation of nuclear factor kappa B which has an important role in the pathogenesis of OA, by inhibition of inflammatory process which is induced by interleukin-1 beta. 5 Platelet alpha granules contain ABSTRACT Objectives: This study aims to evaluate the efficacy of autologous platelet rich plasma applications on pain, functional status, and cartilage regeneration in advanced knee osteoarthritis. Patients and methods: A total of 82 patients (13 males, 69 females; mean age 63.5±9.3 years; range 40 to 88 years) with chronic knee pain for the last one year, who had grade 3-4 knee osteoarthritis according to Kellgren-Lawrence Scale and visual analog scale value of higher than 5, who did not receive physical therapy for the last six months, and did not respond to treatment despite use of nonsteroidal antiinflammatory drugs and analgesics at least for the last three months were enrolled in the study. Totally 103 knee joints of 82 patients were applied intra-articular platelet rich plasma in the beginning, and first and second weeks of treatment. Platelet rich plasma was applied to both knees in 20 patients. Patients were evaluated clinically with visual analog scale, functionally with Western Ontario and McMaster Universities Osteoarthritis Index, and six-minute walk test before application and after application at first and second weeks, and third and sixth months. Cartilage thicknesses were measured by ultrasound before treatment and at third and sixth months after treatment. Obtained results were compared. Results: Compared to values before treatment, patients' visual analog scale values were significantly decreased at third and sixth months after treatment (p<0.001). When compared according to Western Ontario and McMaster Universities Osteoarthritis Index, all values improved significantly after treatment (p<0.001). Results of six-minute walk test improved at third and sixth moths after treatment compared to results before treatment (p<0.05). Cartilage thicknesses increased significantly after treatment at third and sixth months compared to before treatment (p<0.05). Conclusion: We believe that platelet rich plasma treatment is an effective, reliable, easily applied and low cost application in terms of pain, functional status as well as cartilage regeneration even in patients with advanced osteoarthritis.
There are increasing numbers of studies regarding robot-assisted gait training thanks to technolo... more There are increasing numbers of studies regarding robot-assisted gait training thanks to technological developments and whether it is superior to conventional physiotherapy methods draws attention. This study aimed to compare the effectiveness of conventional physiotherapy methods and robot-assisted gait training in children with cerebral palsy receiving botulinum toxin injection of lower extremities. A total of 28 patients who were followed up in our clinic and had received botulinum toxin injection of lower extremities in the last month were randomized into two groups in the study. First group received conventional physiotherapy (range of joint motion (ROM), stretching, gait training, etc.), and the other group received robot-assisted gait training. The study population was evaluated pre- and posttreatment regarding their ROM, spasticity, gross motor function, balance, functional independence, and gait analyses. When we look at the responses of the patients before and after treatm...
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karakterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, iki buçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile ortaya çıktığından, eklemde mevcut olan problemin göz ardı edilmesine neden olduğundan bu vakayı sunmak istedik.
Amac: Kronik bel agrisi nedeniyle ultrasonografi (US) esliginde kaudal epidural steroid enjeksiyo... more Amac: Kronik bel agrisi nedeniyle ultrasonografi (US) esliginde kaudal epidural steroid enjeksiyonu yapilan hastalarda tedavinin agri ve fonksiyonel durum uzerine olan etkilerini degerlendirmeyi amacladik. Gerec ve Yontemler: Calismaya Ocak 2015-Haziran 2015 tarihleri arasinda kronik bel agrisi nedeniyle US esliginde kaudal epidural steroid enjeksiyonu yapilan, dosyasinda VAS(vizuel analog skala)’ya gore agri ve fonksiyonel durumu degerlendiren Oswestry Disabilite Indeksi (ODI) bulunan hastalar dahil edildi. Hastalarin enjeksiyon oncesi, enjeksiyon sonrasi 2.hafta, 1 ve3.ay VAS ve ODI’leri degerlendirildi. Bulgular: Calismaya dahil edilen 12 hastanin 5’i erkek,7’si kadin olup ortalama yaslari 53,83±14,62 idi. Hastalarin ortalama hastalik suresi 3,58±2,74 yil olarak bulundu. Enjeksiyon oncesi hastalarin ortalama VAS skoru 61,25 iken enjeksiyon sonrasi 2. haftada VAS skorunun 25,83’e geriledigi saptandi. ODI skoru enjeksiyon oncesi hastalarda 19,5 iken enjeksiyon sonrasi 2.haftada 10,...
Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kord... more Siringomyeli spinal kordun kronik, dejenaratif, progresif bir hastalığı olup, servikotorasik kordun santralinde longutidinal kavitasyonlarla karekterizedir. Siringomiyelide, kas atrofisi, güçsüzlük, denge bozukluğu, yüzeyel ve derin duyu bozukluğu gibi belirtiler görülebilir ve ilerleyen dönemlerde hastalarda nöropatik artropati gelişebilmektedir(1,2). Bu vaka sunumunda siringomyeli tanısıyla takip edilen erkek hastada sol dirsekte saptanan nöropatik artropati sunulmaktadır. 2008 yılından beri siringomyeli tanısıyla takip edilen 64 yaşında erkek hasta, ikibuçuk aydır sol dirsekte şişlik ve sol kola doğru yayılan elektriklenme hissi şikayetleri ile fiziksel tıp ve rehabilitasyon polikliniğine başvurdu. Yapılan fizik muayene ve radyolojik değerlendirmeler sonucunda nöropatik artropati saptanan hastaya eklem hareket açıklığını korumaya yönelik fizik tedavi programı uygulandı. Dirsek ekleminde nöropatik artropatinin nadir görülmesi nedeniyle ve hastalarda özellikle ağrısız şişlik ile or...
Journal of the American Podiatric Medical Association, 2017
Background:We compared the long-term clinical and ultrasonographic effects of radial extracorpore... more Background:We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy.Methods:Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n = 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment.Results:Significant improvements were observed in the rESWT group in VAS, HTI, and FFI score...
Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteop... more Objective: In our study, we aimed to clarify the relationship between vitamin D levels and osteoporotic vertebral fracture and posture problems in parkinson's disease patients with and without vertebral fracture. Materials and Methods: In this study 59 Parkinson's disease patients (aged ≥40 years) were included. Patients with a disease that may impair their vitamin D metabolism were not included to the study. 25-OH Vitamin D levels in plasma, Ca, P, ALP, PTH, TSH, BUN and Cr values and DXA values were measured from the obtained blood samples by high performance liquid chromatography method. Bone mineral density was measured. Lateral thoracic and lumbar vertebra radiographs were obtained, and vertebra fracture were recorded in as lumbar thoracic fracture with degree and level. Parkinson's disease staging was done using Hoehn Yahr Scale. Results: There were 33 men and 26 women patients. In the study population, mean age was 66.1±10.2 years while mean body mass index was 29.5±5.1 kg/m 2. Osteoporotic vertebral fracture was detected in 35 patients and it was not detected in 24 patients. Vitamin D level was less than 10 IU/dL in 46.9% of the patients and it was less than 20 IU/dL in 83.7% of them. This was lower than the normal population value. Mean vitamin D concentration was 15.0±1.84 in Parkinson's disease patients with vertebral fracture and posture problems while it was 12.7±1.1 in patients without vertebral fracture. There was no significant relation between vitamin D and fracture presence (p>0.005). In our study, no significant correlation was found between posture problem and vitamin D levels. However, it was shown that vitamin D levels were lower in Parkinson's disease patients than in general population.
Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic f... more Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic foot ulcers are associated with increased morbidity, impaired quality of life, substantial treatment costs and high rates of lower extremity amputations. Management of diabetic foot ulcers include conventional treatments such as patient education, preventive measures, treatment of concomitant infection, local surgical debridement as well as alternative treatments such as hyperbaric oxygen therapy and negativepressure wound therapy. Here, we report a case of diabetic foot ulcer treated with extracorporeal shock wave therapy (ESWT). We applied ESWT every other day for a total of 9 sessions to a 65-year-old male patient with a history of diabetes mellitus for 15 years and insulin use for treatment of a 2.3 x 3.8 cm wound in the lateral side of his right foot which was present for six months. ESWT was applied with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. No serious adverse reactions or complications occurred during the course of treatment. At the posttreatment follow-up visit at 3 months, a significant reduction in perceived pain and a decrease in the wound size (to 1.5 x 2.2 cm) and depth were observed. We believe that ESWT is an inexpensive, easy to administer and effective treatment modality for management of diabetic foot ulcers which are associated with high costs, treatment challenges, and require amputation in most patients.
Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovi... more Osteoarthritis (OA) is a chronic, non-inflammatory rheumatologic disease which affects the synovial joints. It is characterized with joint cartilage degeneration, subchondral bone changes, and synovitis. 1 Nonsteroid antiinflammatory drugs, glucosamine, chondroitin sulfate and hyaluronic acid are generally used for reducing inflammation and relieving pain in patients with OA. However, these have limited effect on reducing chondrocyte degeneration and improving regeneration. 2 Medications protecting or healing the cartilage are still at experimental stage. These include applications of cytokine inhibitors, gene therapy, artificial chondrocytes, and growth factor (GF). 3 Growth factor increases the synthesis of chondrocyte matrix and stimulates chondrogenic cell proliferation. 4 It reduces the activation of nuclear factor kappa B which has an important role in the pathogenesis of OA, by inhibition of inflammatory process which is induced by interleukin-1 beta. 5 Platelet alpha granules contain ABSTRACT Objectives: This study aims to evaluate the efficacy of autologous platelet rich plasma applications on pain, functional status, and cartilage regeneration in advanced knee osteoarthritis. Patients and methods: A total of 82 patients (13 males, 69 females; mean age 63.5±9.3 years; range 40 to 88 years) with chronic knee pain for the last one year, who had grade 3-4 knee osteoarthritis according to Kellgren-Lawrence Scale and visual analog scale value of higher than 5, who did not receive physical therapy for the last six months, and did not respond to treatment despite use of nonsteroidal antiinflammatory drugs and analgesics at least for the last three months were enrolled in the study. Totally 103 knee joints of 82 patients were applied intra-articular platelet rich plasma in the beginning, and first and second weeks of treatment. Platelet rich plasma was applied to both knees in 20 patients. Patients were evaluated clinically with visual analog scale, functionally with Western Ontario and McMaster Universities Osteoarthritis Index, and six-minute walk test before application and after application at first and second weeks, and third and sixth months. Cartilage thicknesses were measured by ultrasound before treatment and at third and sixth months after treatment. Obtained results were compared. Results: Compared to values before treatment, patients' visual analog scale values were significantly decreased at third and sixth months after treatment (p<0.001). When compared according to Western Ontario and McMaster Universities Osteoarthritis Index, all values improved significantly after treatment (p<0.001). Results of six-minute walk test improved at third and sixth moths after treatment compared to results before treatment (p<0.05). Cartilage thicknesses increased significantly after treatment at third and sixth months compared to before treatment (p<0.05). Conclusion: We believe that platelet rich plasma treatment is an effective, reliable, easily applied and low cost application in terms of pain, functional status as well as cartilage regeneration even in patients with advanced osteoarthritis.
Journal of Clinical and Experimental Investigations, 2015
Karpal tünel sendromu olan hastalarda ortalama trombosit hacmi ve diğer hemogram sonuçlarının kar... more Karpal tünel sendromu olan hastalarda ortalama trombosit hacmi ve diğer hemogram sonuçlarının karşılaştırılması The comparison of mean platelet volume and other hemogram results in patients with carpal tunnel syndrome
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