Acute bilateral foot drop in a chronic alcoholic patient.

Peroneal palsy is compression neuropathy of the peroneal nerve, which presents with foot drop. Patients with unilateral peroneal nerve palsy are frequently encountered in clinical practice. Although bilateral peroneal nerve palsy is rare, bilateral foot drop due to peroneal nerve palsy is much less common. The main complaint is often walking difficulty due to weakened ankle dorsiflexor muscles. Medical history and physical examination are always a part of the diagnosis, and the most useful method is electroneuromyography to evaluate the degree of the lesion. In this report, we present a 52-year-old male unconscious patient with chronic alcoholism admitted with acute bilateral foot drop and discuss clinical assessment, diagnosis, and treatment planning of this rare case of peroneal palsy after lying in the prone position in the light of literature data.

Is kinesiophobia associated with lymphedema, upper extremity function, and psychological morbidity in breast cancer survivors?

OBJECTIVES: This study aims to the effects of kinesiophobia on lymphedema, upper extremity function, depression/anxiety, and quality of life in breast cancer survivors. PATIENTS AND METHODS: Between January 2015 and January 2016, a total of 81 breast cancer survivors (mean age 54.1±10.8 years; range 44 to 70 years) were included. Lymphedema was evaluated based on the circumference measurements. The Tampa Scale for Kinesiophobia (TSK), the Quick Disabilities of Arm, Shoulder, and Hand (Q-DASH) Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 (SF-36) were applied to all patients. RESULTS: We found a significantly higher rate of lymphedema in the patients with kinesiophobia. Kinesiophobic patients had also significantly higher mean scores of TSK, Q-DASH, HADS-A, and HADS-D and lower mean scores of the SF-36 physical scores. Correlation analysis demonstrated that presence of lymphedema, Q-DASH, HADS-A, and HADS-D scores were significantly associated with the TSK scores. CONCLUSION: Kinesiophobia increases the risk for lymphedema, depression/anxiety, and decreased upper extremity functioning in breast cancer survivors. Identifying kinesiophobia in breast cancer survivors, psychosocial providers may help to prevent undesirable effects of kinesiophobia.

Migraine in patients with fibromyalgia and outcomes of greater occipital nerve blockage.

OBJECTIVES: The aim of this study is to evaluate the efficacy of greater occipital nerve (GON) blockage in patients with migraine and fibromyalgia (FM) comorbidity. PATIENTS AND METHOD: 20 patients who were diagnosed as FM according to 2010 American College of Rheumatology (ACR) diagnostic criteria and migraine according to International Classification of Headache Disorers II criteria and did not recieve any medication or GON block for both disorders were included for the study. GON blocks were repeated every week in the first month and repeated montly for the following 2 months. The frequency and duration of the migraine attacks, pain severity with visual analogue scale (VAS), quality of life (QoL) with revised fibromyalgia impact questionnaire (FIQR) and migraine disability assesment questionnaire (MIDAS) before,1 st month and 3rd months after treatment were recorded and compared. RESULTS: 95% of 20 patients were female (n = 19) and 5% was male (n = 1). The affected site was left in 60% of the patients (n = 12) and 40% was right (n = 8). There was significant improvement in terms of all evaluation parameters both at 1 st month and 3rd months after treatment compared to the baseline. Likely, all parameters were significantly improved at 3rd month compared to the 1 st month. CONCLUSIONS: GON blockage reduces pain severity, headache frequency and duration and increases QoL in patients with migraine and FM comorbidity.

Effect of Primary Hypertension on Treatment Outcomes of Patients with Postmenopausal Osteoporosis: A 5 Year Follow Up Retrospective Study.

AIM: To investigate the efficacy of primary hypertension (HTN) on the treatment prognosis of patients with postmenopausal osteoporosis (PMOP). METHODS: 45 patients who were diagnosed as PMOP with lumbar and/or femur neck bone mineral density screening (BMD) but have no history of PMOP treatment including calcium and vitamin D, have comorbid primary HTN and treated with a vasodilator antihypertensive drug at least a year were included to the study. Control group was constituted with 44 patients with PMOP at same age but have no comorbidity. Demographic features including age, height, weight, occupation, educational level menarche and menopause age, clothing style, daily intake of calcium, smoking and/or alcohol consumption, daily physical activity level, personal history of fragility fracture or in mother and duration of primary HTN diagnosis were recorded. Biochemical parameters were also recorded. Patients were treated with bisphosphonate, calcium and vitamin D and same parameters were evaluated at the end of first and fifth year. RESULTS: Demographic and disease characteristics were not different between groups before treatment (p > 0.05). In group analysis, there was significant improvement in lumbar and femur neck T scores of PMOP + HT and PMOP groups after 1 and 5 years of treatment compared to baseline (p < 0.05) Lumbar and femur neck T score variations between the baseline, first and fifth years of treatment were not significantly different in PMOP + HT and PMOP groups (p < 0.05). CONCLUSIONS: Although the results vary between populations, primary HTN does not have an impact on the prognosis of PMOP treatment in Turkish population.

Early Detection and Treatment of Subclinical Lymphedema in Patients with Breast Cancer.

Background: Early identification and treatment of subclinical lymphedema may prevent development of advanced stages and its related complications. We aimed to detect subclinical lymphedema and to evaluate the effects of early treatment program on the development of clinical lymphedema, upper extremity functions, and quality of life in patients with subclinical lymphedema. Methods and Results: Twenty-five women who were diagnosed having subclinical lymphedema were enrolled in the study. The patients were informed about lymphedema and its risk factors, and skin care and exercises to prevent the development of lymphedema. Self-reported symptoms, arm volumes, upper extremity functions, quality of life were evaluated before and after treatment. Tightness and numbness were found to have a good correlation with affected arm volume. Volume of the affected arm, percentage volume difference between the arms, upper extremity functions, and quality-of-life scores improved significantly at the end of the treatment. Conclusions: It is crucial to have early detection and treatment of subclinical lymphedema to prevent the development of established lymphedema in breast cancer survivors. Information about lymphedema and its risk factors, skin care, and home-based specific exercise program improves self-reported symptoms, volume measurements, functioning, and quality of life in patients with subclinical lymphedema.

An unexpected side effect: Wartenberg syndrome related to the use of splint during carpal tunnel syndrome treatment.

Isolated superficial radial neuropathy is a sensorial mononeuropathy and a rare clinical condition. In case of trapping of the sensorial branch of the radial nerve, symptoms such as burning type pain at proximal forearm and hand dorsoradial, hypoesthesia, numbness and tingling at hand dorsum and thumb radial side are observed. Muscular weakness and trophic changes are not seen, and electrophysiological assessment revealed normal motor nerve conduction values. Therefore, hand motor functions are not affected. The etiology of the isolated superficial radial nerve neuropathy is often associated with repeated use of wrist watches, forearm fractures, use of handcuffs, repetitive activities. In this report, we present a 59-year-old female case of isolated superficial radial nerve neuropathy diagnosed by electrophysiological evaluation who was treated for two months with carpal tunnel syndrome with altered symptoms and increased numbness. This is the first case of superficial radial nerve neuropathy following the splint use in the literature.

Effects of isokinetic muscle strengthening on balance, proprioception, and physical function in bilateral knee osteoarthritis patients with moderate fall risk.

OBJECTIVES: This study aims to assess the effects of isokinetic quadriceps and hamstring strengthening exercises on balance, proprioception, and physical function in patients with moderate-to-severe knee osteoarthritis and moderate fall risk. PATIENTS AND METHODS: Between November 2011 and December 2012, a total of 39 participants (30 females, 9 males; mean age 61.7±8.6 years; range, 18 to 79 years) with Grade 2 or 3 knee osteoarthritis according to the Kellgren-Lawrence radiographic grading system and moderate risk of fall with active knee pain were included in this study. All participants received isokinetic quadriceps and hamstring strengthening exercises for six weeks. Pre-treatment quadriceps and hamstring muscle strength (peak torque and total work value) and quadriceps to hamstring muscle strength ratio at angular velocities of 60°/sec and 180°/sec, range of motion (ROM), average proprioceptive errors at 15-45° and 30-60°, the Berg Balance Scale (BBS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale scores, the Visual Analog Scale (VAS) scores, and physical function tests results were compared with the post-treatment results. The correlations of pre- and post-treatment BBS and average proprioceptive error at 15-45° and 30-60° changes to other pre- and post-treatment clinical measurements changes were calculated. RESULTS: Post-treatment quadriceps and hamstring muscle strength at angular velocities of 60°/sec and 180°/sec and quadriceps to hamstring muscle strength ratios at angular velocity of 60°/sec, ROM, average proprioceptive errors at 15-45° and 30-60°, BBS scores, WOMAC subscale scores, VAS scores, and physical function tests significantly improved compared to the pre-treatment results (p<0.001). Statistically significant correlations were found between the pre- and post-treatment BBS score changes and pre- and post-treatment VAS (p=0.015), WOMAC-Pain (p=0.017), WOMAC-Physical Function (p=0.005) scores and Timed Up and Go Test (p=0.036) scores. CONCLUSION: Inclusion of isokinetic quadriceps and hamstring strengthening exercises into the rehabilitation programs for the patients with knee osteoarthritis may improve the quality of life and contribute to the decreased risk of fall.

Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-α therapy on sleep problems: A polisomnographic study.

INTRODUCTION: This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders. MATERIALS AND METHODS: A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n = 15) with high DA and receiving anti-TNF-α therapy, and Group II (n = 19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I. RESULTS: Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P = 0.0001, P = 0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P = 0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P > 0.05). CONCLUSION: Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

Reliability and validity study of a Turkish version of the fatigue severity scale in Parkinson's disease patients.

The aim of this study was to assess the validity and reliability of the Turkish version of the Fatigue Severity Scale (FSS) in Parkinson's disease (PD) patients for use in clinical settings. A consecutive 106 patients with PD were included in the study. The Turkish version of FSS was analyzed for reliability (internal consistency and reproducibility) and validity (convergent and discriminant). The Turkish version of FSS yielded an acceptable internal consistency (Cronbach's α=0.960 and corrected item-total correlations: 0.761-0.891), and it was established as reproducible (test-retest intraclass correlations for items: 0.887-0.936). The FSS total score was correlated significantly with PD-related variables. Between-group differences on both items and the total score of FSS by modified Hoehn and Yahr staging were found to be statistically significant. The present study has shown that the Turkish version of the FSS is a valid and reliable tool for the assessment of fatigue in PD patients.

Assessment of Risk Factors in Patients who presented to the Outpatient Clinic for Breast Cancer-Related Lymphedema.

OBJECTIVE: Lymphedema is one of the most debilitating outcomes of breast cancer treatment. We aimed to compare the demographic and clinical characteristics of breast cancer patients with and without lymphedema, to assess risk factors for lymphedema, and to evaluate treatment outcomes in lymphedema patients. MATERIALS AND METHODS: Demographic and clinical characteristics of 84 women with previous surgery for breast cancer who presented to the outpatient clinic between March 2014 and May 2015 were retrospectively extracted from patient records. RESULTS: Upper extremity lymphedema was detected in 34 of 84 patients (40.5%). The mean age, body mass index, the number of positive lymph nodes and the number of patients with postoperative radiotherapy were significantly higher among patients with lymphedema than those without (p<0.05). Educational level of patients with lymphedema was significantly lower than the other group (p<0.05). The correlation analysis revealed an association between age, educational level, body mass index, tumor stage, number of positive lymph nodes, postoperative radiotherapy and presence of lymphedema. Postoperative radiotherapy was detected as the only independent risk factor by logistic regression analysis. Fourteen out of 26 lymphedema patients were assigned to education, skin care, exercise and compression bandaging therapy. Upper extremity volumes and volume differences were significantly improved after treatment. CONCLUSION: Advanced age, low educational level, obesity, tumor size, the number of positive lymph nodes and postoperative radiotherapy correlated with the development of lymphedema. Within these factors, postoperative radiotherapy was detected as an independent risk factor for the development of lymphedema. Patient education, skin care, exercise and compression bandage therapy are effective treatment options in breast cancer-related lymphedema.