Validity and reliability study of the Turkish version of Spinal Cord Independence Measure-III.

STUDY DESIGN: This is a multicenter, prospective study. OBJECTIVES: The objective of this study was to assess the validity and reliability of the Turkish version of Spinal Cord Independence Measure-III (SCIM-III). SETTING: This study was conducted in rehabilitation centers of three hospitals in Turkey. METHODS: Two-hundred and four (n=204) consecutive patients with spinal cord injury (SCI) were included in the study. Each patient was examined by two physicians. Neurologic impairment was measured according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria. Backward and forward translation of SCIM-III was performed by native speakers in both languages. To measure the validity of SCIM-III, the scores were compared with patients' AIS grades, total motor scores and the Health Survey Short Form-36 (SF-36) subscale scores. SCIM-III was analyzed for test-retest reliability by the same rater on 49 patients during the follow-up evaluations. RESULTS: Total agreement values between raters changed between 75.9 and 100%. Kappa values were all above 0.6, and they were statistically significant. The Pearson's correlation values between the raters were very high and statistically significant. The Cronbach's α-values for the two consecutive raters were 0.865 and 0.896. Test-retest reliability was assessed by paired samples t-test, and no significant difference was observed. SCIM-III and SF-36 physical (r=0.339, P<0.005) and general health scores (r=0.200, P<0.005) showed correlation. All subscales of the SCIM-III, with the exception of self-care, had significant differences in comparison with the AIS grades. SCIM-III total and total motor scores showed correlation (r=0.585, P<0.001). CONCLUSION: The Turkish version of SCIM-III was found to be valid and reliable.

Growth and process conditions of aligned and patternable films of iron(III) oxide nanowires by thermal oxidation of iron.

A simple, catalyst-free growth method for vertically aligned, highly crystalline iron oxide (α-Fe(2)O(3)) wires and needles is reported. Wires are grown by the thermal oxidation of iron foils. Growth properties are studied as a function of temperature, growth time and oxygen partial pressure. The size, morphology and density of the nanostructures can be controlled by varying growth temperature and time. Oxygen partial pressure shows no effect on the morphology of resulting nanostructures, although the oxide thickness increases with oxygen partial pressure. Additionally, by using sputtered iron films, the possibility of growth and patterning on a range of different substrates is demonstrated. Growth conditions can be adapted to less tolerant substrates by using lower temperatures and longer growth time. The results provide some insight into the mechanism of growth.

Thin films of hard cubic Zr3N4 stabilized by stress.

Hard, refractory thin films consisting of group IVB element mono-nitrides deposited using various chemical and physical vapour-deposition techniques are widely used in wear-resistant applications. As the demand for performance exceeds the capabilities of existing materials, new materials with superior properties must be developed. Here we report the realization and characterization of hard cubic Zr3N4 (c-Zr3N4) thin films. The films, deposited using a novel but industrially viable modified filtered cathodic arc (FCA) method, undergo a phase transformation from orthorhombic to cubic above a critical stress level of 9 GPa as determined by X-ray diffraction and Raman spectroscopy. The c-Zr3N4 films are significantly harder (approximately 36 GPa) than both the orthorhombic Zr3N4 (o-Zr3N4) and ZrN films (approximately 27 GPa). The ability to deposit this material directly onto components as a thin film will allow its use in wear- and oxidation-resistant applications.

Atypical intradural spinal tuberculosis: report of three cases.

OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.

Quality of life of primary caregivers of spinal cord injury survivors living in the community: controlled study with short form-36 questionnaire.

OBJECTIVE: To compare the quality of life scores of primary caregivers of spinal cord injury survivors living in the community with healthy age matched-population based controls and to determine the relationship between some severity parameters related with spinal cord injury and the quality of life scores of primary caregivers. SETTING: University hospital, rehabilitation centre. METHODS: Fifty primary caregivers of spinal cord injured patients living in the community and 40 healthy age-matched controls completed SF-36 (short form-36) questionnaire forms. Questionnaires were administered by interviewers who were physiatrists and the authors of the present study. All the patients were rehabilitated by the authors and data about the duration of injury, lesion levels, ASIA scores, degree of spasticity, presence of bladder and bowel incontinence and pressure sores were gathered from the hospital recordings and/or by physical examinations during control visits when the primary caregivers were administered the questionnaires. RESULTS: Quality of life scores measured by SF-36 were significantly low in the primary caregivers group compared to age-matched healthy population based controls. No significant relation was demonstrated between the quality of life scores of primary caregivers and parameters such as the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively. CONCLUSION: According to the results of the present study, being a primary caregiver of a spinal cord injured victim significantly interferes with quality of life; some severity parameters related to the injury however do not seem to have an additional impact on the primary caregiver's life quality.

Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study.

STUDY DESIGN: An epidemiological study conducted all over the country. OBJECTIVE: The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey. SETTING: Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals. METHODS: Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors. RESULTS: Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/-14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies. CONCLUSION: Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey.

The role of acromioclavicular arthritis in impingement syndromes.

The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.

Melorheostosis: report of a new case with linear scleroderma.

Melorheostosis is a very rare bone disease of unknown etiology characterised by linear hyperostosis and associated with fibrosis of soft tissues and the skin. This uncommon sclerosing bone dysplasia was first described by Leri and Joanny in 1922, and since then, until 1993, approximately 300 cases were reported in the literature. Linear scleroderma is a localised proliferation of connective tissue and has rarely been associated with melorheostosis. In this paper, we present a new case of melorheostosis with linear scleroderma which, to the best of our knowledge, is the first case reported in Turkey.

Biofeedback assisted relaxation in essential hypertension: short-term follow-up of contributing effects of pharmacotherapy on blood pressure and heart rate. "Brief communication".

The present study was designed to evaluate the possible beneficial effects of biofeedback-assisted relaxation to pharmacotherapy on blood pressure and heart rate in patients with essential hypertension. Twenty patients with essential hypertension and without any complications or end-organ damage participated in the study. All the patients were using anti-hypertensive drugs. The study protocol consisted of an interview, 10 days baseline, 10 biofeedback-assisted relaxation sessions and a 10-day post-treatment period. Interview blood pressure (BP) and heart rate (HR) measurements, baseline mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR recorded during the 1st, 10th and 20th minutes of each session and the post-treatment mean values were evaluated. Significant differences were found between the mean values of SBP, DBP and HR after the whole treatment protocol (Wilcoxon signed-ranks test). The mean values of SBP, DBP and HR measurements recorded during the 1st, 10th and 20th minutes of the biofeedback-assisted relaxation sessions, which were evaluated by repeated measures of ANOVA on ranks test, showed a significant decrease only for the 10th minute values at the end of the whole treatment program. Despite a short follow-up, it was suggested that these results were encouraging considering the fact that once the patients are thoroughly instructed in home practice of relaxation and encouraged to develop their own strategies for relaxation, the long term outcome may also be promising.

Comparison of the effects of tenoxicam and mid-laser irradiation on chronic adjuvant arthritis in rats.

OBJECTIVE: This controlled experimental study was designed to compare the effects of a well-known NSAID, tenoxicam, with mid-laser irradiation on the inflammatory component of adjuvant-induced arthritis (AIA). Four groups of animals, each consisting of 10 Wistar rats, were included in the study. The primary concern was not to investigate the antiinflammatory effects of tenoxicam, but to compare the previously proven effects of this drug with a physical therapy agent which might be considered to have fewer side effects and/or contraindications. METHOD: The first group received only 0.1 ml of complete Freund's adjuvant (CFA) and served as the control for the other groups. The 2nd, 3rd and 4th groups, after having CFA injected into the plantar surfaces of their right paws, were treated with tenoxicam alone, mid-laser alone, or with a combination of the two, respectively. RESULTS AND CONCLUSION: All 3 groups showed significantly reduced paw edema compared with the control group. Although the reduction in paw edema in the animals treated with tenoxicam or with tenoxicam+ mid-laser was more significant, mid-laser is proposed as an alternative therapy for symptomatic relief in certain conditions well known to limit the use of NSAIDs.

[Measurement of the in vitro immune response of live attenuated measles virus vaccine and antibody levels in 0 to 10-year-old children]. / Canli attenüe kizamik virus asisinin bagisiklik cevabinin in vitro arastirilmasi ve 0-10 yas grubu çocuklarda kizamik antikor düzeyleri.

The present study was carried out in order to test the antigenic effectiveness of the live attenuated meales vaccine which is routinly employed in our country. Sera obtained from 11 children before and after measles vaccination were tested for measles antibodies by complement fixation and neutralization tests. Sera samples were also collected from 0-10 years old children with history of vaccination, passed measles infection and none at all. These sera were also tested for measles antibody by complement fixation test. Virus isolation and seroconversion studies in children who were admitted to the outpatient clinics of Hacettepe hospital is also presented in this communication.