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Öğe Acute ulnar neuropathy at the wrist: a case report and review of the literature(Springer, 2006) Erkin, Gülten; Uysal, Hilmi; Keles, Işık; Aybay, Canan; Özel, SumruAcute ulnar neuropathy at the wrist is an extremely uncommon condition, at times requiring a high index of suspicion for the diagnosis. Clinical presentations of ulnar nerve lesions at the wrist and hand show variations due to the complex anatomic course of the nerve in distal sites. We report a case of acute ulnar neuropathy at the wrist caused by a ganglion in Guyon's canal, being initially misinterpreted as flexor tenosynovitis. The accurate diagnosis of selective distal motor neuropathy of ulnar nerve was made electrophysiologically. Magnetic resonance imaging revealed a well defined soft tissue mass consistent with a ganglion, compressing the ulnar nerve in Guyon's canal. Entrapment neuropathies are one of the common conditions handled by physiatrists. Ulnar nerve lesions at the wrist should be kept in mind in the differential diagnosis of patients with wrist or hand pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of acute focal neuropathies.Öğe Delayed cervical spinal cord injury after high voltage electrical injury: A case report(Lippincott Williams & Wilkins, 2007) Erkin, Gülten; Akinbingoel, Meltem; Uysal, Hilmi; Keles, Işık; Aybay, Canan; Özel, SumruHigh voltage electrical injuries usually cause devastating consequences for patients, most of which result in permanent disability. Spinal cord injury (SCI) caused by high voltage electrical injury is uncommon in the literature. We present a 29-year-old male patient who was diagnosed as having delayed SCI after high voltage electrical injury. The patient developed muscle weakness in the lower extremities with the loss of pinprick sensation below the fifth cervical spinal segment, 2 days after the high voltage electrical injury. Magnetic resonance imaging of the brain, cervical and thoracic spine was normal. Nerve conduction and needle electromyography studies were normal, except for bilateral tibial and left median somatosensoryevoked potentials. The findings on initial examination and neurophysical investigation showed incomplete cervical SCI at the C5 level. He was able to walk with a pair of canes and bilateral ankle-foot orthosis at the end of the 2-month rehabilitation. Follow-up physical and electrophysiological examination of the patient 15 months after injury showed further improvement. The patient was able to walk with a pair of canes without orthoses. Electrophysiological studies are useful instruments in the diagnosis and follow-up of these patients. Early rehabilitation is essential to obtain a favorable outcome in patients with SCI caused by high voltage electrical injury.Öğe Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome(Lippincott Williams & Wilkins, 2005) Keles, Işık; Kendi, A. Tuba Karagülle; Aydin, Gülümser; Zög, Ş. Gülfer; Orkun, SevimObjective: To evaluate the diagnostic value of ultrasonography in patients with electrophysiologically confirmed carpal tunnel syndrome. Design: A prospective ultrasonographic study of 35 wrists with electrophysiologically confirmed carpal tunnel syndrome and of 40 normal wrists. Receiver-operating-characteristics curves for the ultrasonographic measurements of median nerve were plotted to identify the most optimal cutoff values. Results: The ultrasonographic measurements of median nerves were found to be increased significantly in patients with carpal tunnel syndrome when compared with controls, particularly in terms of cross-sectional area (P < 0.001) and the bowing of the flexor retinaculum (P < 0.01) but not in the flattening ratio (P > 0.05). According to receiver-operating-characteristics curve results, the most optimal cutoff value for the cross-sectional area of the median nerve was obtained at the level of middle carpal tunnel, which was 9.3 mm(2), with a sensitivity of 80% and specificity of 77.5%. The optimal cutoff value for the bowing of the flexor retinaculum was 3.7 mm, with a sensitivity of 71.4% and specificity of 55%. No optimum cutoff value could be identified from the receiver-operating-characteristics curves for the flattening ratio of median nerve. Conclusion: Ultrasonographic examination of the median nerve seems to be a promising method in the diagnosis of carpal tunnel syndrome, evaluating the morphologic changes of the median nerve in patients with clinical signs and symptoms. Further studies with wider series are needed to confirm our preliminary results.Öğe Multifocal osteoarticular tuberculosis: a case report(Springer Heidelberg, 2005) Keles, Işık; Aydin, Gülümser; Kendi, Tuba K.; Orkun, SevimOsteoarticular tuberculosis is a quite uncommon form of extrapulmonary tuberculosis. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. We report herein a case of multifocal osteoarticular tuberculosis of insidious onset with no history of prior health problems or constitutional signs and symptoms. Despite widespread osteoarticular involvement, the outcome of the patient was favorable after the management. Osteoarticular tuberculosis must be considered in patients with insidious musculoskeletal symptomatology.Öğe Relationship between serum sex steroids and Aging Male Symptoms score and International Index of Erectile Function(Elsevier Science Inc, 2005) Başar, M. Murad; Aydın, Gülümser; Mert, H. Çağatay; Keles, Işık; Çağlayan, Osman; Orkun, Sesim; Batislam, ErtanObjectives. To determine the relationship between the total and subscale scores of the Aging Male Symptoms (AMS) and International Index of Erectile Function (IIEF) questionnaires, age, and serum sex steroids levels. Methods. A total of 348 patients enrolled in the study answered the AMS and IIEF questionnaires. Hormonal analysis, including total testosterone, free testosterone (FT), estradiol (EA and dehydroepiandrosterone-sulphate (DHEA-S) measurement, were performed. The patients with a total AMS score of 29 were considered to have aging male symptoms and the patients with an I IEF score of less than 26 were considered to have sexual dysfunction. Results. Although DHEA-S levels were significantly lower and E-2 levels were greater in the men with aging male symptoms according to the AMS, the DHEA-S and FT levels were significantly lower in the men with sexual dysfunction, as determined by the IIEF score. Serum DHEA-S and FT levels and age correlated significantly with the IIEF scores. The total AMS score correlated significantly only with age. Although serum total testosterone, FT, and DHEA-S levels correlated significantly with the andrologic symptoms of AMS, the serum E-2 levels correlated with psychological symptoms of AMS., Conclusions. Although aging male symptoms and the effects of hormonal changes on these symptoms have been controversial, DHEA-S and E-2 might play some important roles in the symptoms of aging men.Öğe Transcutaneous electrical nerve stimulation versus baclofen in spasticity: Clinical and electrophysiologic comparison(Lippincott Williams & Wilkins, 2005) Aydin, Gülümser; Tomruk, Serap; Keles, Işık; Demir, Sibel O.; Orkun, SevimObjectives: Clinical and electrophysiologic comparison of the efficacy of transcutaneous electrical nerve stimulation (TENS) and oral baclofen in the treatment of spasticity. Design: Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. TENS was applied to the tibial nerve for 15 days at a frequency of 100 Hz. Clinical (spasm frequency scale, painful spasm scale, lower limb Ashworth score, clonus score, deep tendon reflex score, plantar stimulation response score) and electrophysiologic evaluations (H-reflex response at the highest amplitude, latency of maximum H-reflex, and ratio of H-reflex response at the highest amplitude to M response at maximum amplitude) of the lower limb and functional evaluations (functional disability score and FIM (TM)) were carried out in baclofen and TENS groups before and after treatment. Posttreatment evaluation was made 24 his after the 15th session in the TENS group. In addition, clinical spasticity scores and electrophysiologic variables were measured 15 mins after the first application and 15 mins after the 15th session. Results: Significant improvement was detected in lower limb Ashworth score, spasm frequency scale, deep tendon reflex score, functional disability score, and FIM in the baclofen (P = 0.011, P = 0.014, P = 0.025, P = 0.004, and P = 0.005, respectively) and TENS (P = 0.020, P = 0.014, P = 0.025, P = 0.003, and P = 0.003, respectively) group after treatment. Decrease in H-reflex maximum amplitude was significant in the TENS group (P = 0.026). Most marked improvement was observed in the third evaluation, 15 mins after the 15th session, particularly in lower limb Ashworth score (P = 0.006) and H-reflex maximum amplitude (P = 0.006) in the TENS group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05). Conclusion: TENS may be recommended as a supplement to medical treatment in the management of spasticity.
