ABSTRACT:The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.

The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.

Amaç: USG kılavuzluğunda kaudal steroid enjeksiyonları (KSE), radyasyon maruziyeti olmaksızın daha kolay uygulanabilme avantajına sahiptir. Bu çalışmanın amacı, USG kılavuzluğunda yapılan KSE'nin aksiyel veya radiküler bel ağrısı tedavisinde etkinliğini değerlendirmektir. Hastalar ve Yöntem: Bu çalışma retrospektif kesitsel olarak tasarlanmıştır. Aralık 2022-Mayıs 2023 tarihleri arasında, diskojenik veya radiküler karekterde kronik bel ağrısı olan ve USG eşliğinde kaudal epidural steroid enjeksiyonu yapılan 21 hasta çalışmaya dahil edildi. İşlemden 2 ve 6 hafta sonra, hastaların vizüel analog skala (VAS-ağrı), hasta memnuniyet ölçeği, uyku kalitesi düzeyi ve Roland Morris Özürlülük Anketi (RMÖA) düzeyleri değerlendirildi. Bulgular: Tedavi öncesi düzeylere göre, 2. ve 6. hafta kontrollerde VAS-ağrı skorlarında belirgin gerileme saptandı (p<0.001). Anlamlı ağrı azalması olarak kabul edilen, %50'den fazla ağrı rahatlaması oranı 2. haftada %57,1, 6. haftada ise %38,1’idi. RMÖA skorlarında, benzer şekilde 2. ve 6. haftada anlamlı iyileşme gözlendi (p<0.001) ancak; 2. hafta ile 6. hafta arasında anlamlı fark gözlenmedi (p=0.447). Hastaların %71,4'ü başvuruda uyku kalitesini kötü olarak bildirirken, bu oran 2. ve 6. haftalarda sırasıyla %19,0 ve %23,8'e düşmüştü. Memnuniyet açısından hastaların %91,5'i 2. haftada daha iyi olduklarını belirtirken, bu oran 6. haftada %71,4'e düşmüştür. Sonuç: USG kılavuzluğunda yapılan KSE, primer konservatif tedaviye dirençli diskojenik-radiküler bel ağrısı olan hastalarda ağrıyı, uyku kalitesini ve dizabiliteyi iyileştirmek ve aynı zamanda yüksek hasta memnuniyetini sağlamak için kısa-orta süreli takipte oldukça etkili ve güvenli bir tedavi seçeneğidir.

Ibandronic acid (IA) is a potent bisphosphonate drug used in the prevention and treatment of osteoporosis. It may also be used to treat hypercalcemia (elevated blood calcium levels). Arthralgia, femur fracture, pain in extremity, diarrhea, myalgia, nausea, back pain, pain, and bone pain are most common adverse events of the IA reported to the FDA. We discourse a case of IA extravasation in this presentation. An osteoporotic woman who was using bifosfonate medications had applied intravenous IA, but almost all of the solution was extravasated accidentally. Two hours later she noticed burning and moderate itching sensation and slight millimeter erythema at the flexure of the right elbow in the region of venipuncture but she had decided not to inform. Although the day after the erythematous area had increased to 5-6 cm and the symptoms worsened, she revisited the outcome clinic. Also, she had a complaint of vomiting and diarrhea. Also, we want to discuss the question of “How this patient's osteoporosis treatment should be continued after this situation?”

Dear Editor, As a physician practicing auriculotherapy, I follow and read with interest the publications on this subject. Recently, I have noticed the article by Valiani et al .[1] published in the March–April issue of your journal. While the authors successfully mention the effects of ear acupuncture, they fail to provide details on the most important piece of the puzzle in auriculotherapy, i.e., describing acupoints and defining how they were chosen, etc. Auriculotherapy is a treatment modality based on normalizing the body’s dysfunction through stimulation of definite reflex points, namely the acupoints, on the ear. Identifying the precise acupoints and applying accurate stimulus to these points by an experienced practitioner is the key to successful auriculotherapy. I believe that the impact of the article would be maximized if these aspects are addressed .......

Survival rates for burn injuries have been increasing, thanks to the progress of modern medicine, and rehabilitation activities have gained more significance. Burn rehabilitation begins with the admission of patients to the hospital and may require a long time. Good nursing care and a multidisciplinary approach are of primary importance during the acute phase of burn cases, whereas rehabilitation activities constitute a major part of the treatment following the healing of wounds. Positioning, exercises, splinting and pain control are the primary rehabilitation activities that need to be planned by a multidisciplinary team. The rehabilitation program should be designed in line with each individual case, and the treatment modelities should be reviewed in the follow-up period. This paper presents burn rehabilitation practices in the light of the current literature.

There are various musculoskeletal manifestations that may develop in a patient after chemotherapy. These manifestations may be due to metastasis to musculoskeletal structures, paraneoplastic syndrome or immune reactions as well as adverse reactions to cancer specific chemotherapy.(1) One of these symptoms is post-chemotherapy rheumatism which is a non-inflammatory and self- limiting condition that manifests as symmetric or asymmetric arthralgia, arthritis and stiffness that involves both large and small joints.(2) It has been described in patients with some types of cancer including breast cancer, ovarian cancer, and non- Hodgkin’s lymphoma within a few months after the completion of chemotherapy.(2) In this article, we report a patient with polyarthralgia after chemotherapy for Hodgkin lymphoma. A 39-year-old male patient presented with a six-week history of symmetric arthralgia on his bilateral hand and foot joints. Roughly eight months prior to these symptoms, he had Hodgkin lymphoma diagnosis and was treated with chemotherapy, including palonosetron, doxorubicin, cyclophosphamide, etoposide, and vincristine. His last chemotherapy session was six weeks prior to the onset of arthralgia. Physical examination revealed no swelling on any joints but there was tenderness on bilateral hand and foot joints with palpation (at the proximal interphalangeal, metacarpophalangeal, ankle and metatarsophalangeal joints). There was no synovitis on ultrasonographic joint evaluation. He had no history of any other systemic disease and no family history of rheumatic disease. Laboratory results were as follows: erythrocyte sedimentation rate 65 mm/hour, C-reactive protein 41 mg/L, negative results for rheumatoid factor, anti-cyclic citrullinated peptide antibodies, antinuclear antibodies, ribonucleoprotein antibodies, anti-Sjögren’s syndrome A, anti-Sjögren’s syndrome B, anti-systemic sclerosis topoisomerase I, anti-jo1, anti-double stranded deoxyribonucleic acid and anti-histone antibodies. Other laboratory findings were unremarkable. Oral acemetacin 60 mg twice-a-day was commenced and continued for three weeks. Inflammatory markers and articular symptoms improved after treatment. In conclusion, post-chemotherapy rheumatism may be seen after completion of chemotherapy in patients with Hodgkin lymphoma. Clinicians should keep this possibility in mind to speed up the diagnosis process without unnecessary investigation and it would be advisable if the patients are informed about this complication before chemotherapy treatment for relieving their concerns.

Medical AcupunctureVol. 28, No. 2 Letters to the EditorRe: “Battlefield Acupuncture in the U.S. Military: A Pain-Reduction Model for NATO” by Niemtzow et al. (Med Acupunct. 2015;27(5):344–348)Levent Tekin and Mehmet Fuat AbutLevent TekinDepartment of Physical Medicine and Rehabilitation, GATA Haydarpasa Training Hospital, Istanbul, Turkey.Search for more papers by this author and Mehmet Fuat AbutPrivate acupuncture clinic, Istanbul, Turkey.Search for more papers by this authorPublished Online:13 Apr 2016https://doi.org/10.1089/acu.2016.1167AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Re: “Battlefield Acupuncture in the U.S. Military: A Pain-Reduction Model for NATO” by Niemtzow et al. (Med Acupunct. 2015;27(5):344–348)." Medical Acupuncture, 28(2), p. 69FiguresReferencesRelatedDetails Volume 28Issue 2Apr 2016 InformationCopyright 2016, Mary Ann Liebert, Inc.To cite this article:Levent Tekin and Mehmet Fuat Abut.Re: “Battlefield Acupuncture in the U.S. Military: A Pain-Reduction Model for NATO” by Niemtzow et al. (Med Acupunct. 2015;27(5):344–348).Medical Acupuncture.Apr 2016.69-69.http://doi.org/10.1089/acu.2016.1167Published in Volume: 28 Issue 2: April 13, 2016PDF download

BACKGROUND:Cardiovascular diseases, among which atherosclerotic heart disease, are known to be one of the most important mortality and morbidity causes in patients with rheumatoid arthritis (RA). Ischemia modified albumin (IMA) is a potential marker that can be used to assess atherosclerosis-related myocardial ischemia. Another frequently used marker for the assessment of atherosclerotic lesions is the carotid intima media thickness (CIMT).AIM:To evaluate the role that IMA has on atherosclerosis development and its clinical usability in patients with RA, by assessing the values of IMA and CIMT.METHODS AND MATERIALS:Our prospective study was conducted between June 2012 and March 2013 at the Rheumatology Department of Necmettin Erbakan Meram Medical School, Turkey. Fifty-two RA patients, diagnosed according to the 1987 criteria of the American College of Rheumatology, and an age- and sex-matched control group of 46 healthy subjects were included in this study.RESULTS:No significant difference was detected between the groups with respect to age, sex and body mass index. In the patient group the IMA and CIMT values were found to be 0.37 ± 0.12 absorbance units (ABSU) and 0.80 ± 0.22 mm, respectively, while in the control group they were 0.31 ± 0.11 ABSU and 0.51 ± 0.18 mm, respectively. The IMA and CIMT values were significantly higher in the patient group (P = 0.022 and P < 0.0001, respectively). A positive correlation was found between IMA, CIMT and Disease Activity Score of 28 joints (P = 0.016 and P = 0.002, respectively).CONCLUSION:Since the values of IMA were higher in the patient group compared to controls and because of its correlation with CIMT, we suggest the use of IMA as an early marker of atherosclerosis in RA patients.

OBJECTIVE:The aim of this study was to assess flexor pollicis longus tendon by using ultrasound imaging in frequent mobile phone texters.SUBJECTS:In total, 149 subjects, aged 18-40 yrs, were recruited as frequent mobile phone texters (n = 71) and infrequent texters (n = 78).METHODS:Demographic data and estimate frequency of texting were noted. Thumb pain during activity, range of motion for thumb joints, grip and pinch strengths, and Quick Disabilities of arm, shoulder, and hand were evaluated. Standardized bilateral ultrasound evaluations were performed using a linear array probe, and tendon area measurements were done with axial imaging at midthenar region and midproximal phalangeal region with manual trace technique.RESULTS:The groups were similar except for the mean estimate number of messages/month (P = 0.001). Whereas grip and pinch strength values were significantly higher (frequent texter group, P = 0.001; infrequent texter group, grip strength P = 0.018; pinch strengths, P = 0.001) on the texting side in both groups, flexor pollicis longus tendons were larger (P = 0.001) and the activity pain was higher (P = 0.005) on the texting sides only in the frequent texter group. Flexor pollicis longus thickness significantly correlated with messages/month only in the frequent texter group (r = 0.592, P = 0.001).CONCLUSIONS:Flexor pollicis longus tendons seem to be thicker at the midthenar level in subjects who frequently use mobile phone texting. Because this increase in thickness parallels the number of messages per day, the authors believe that further studies are needed to elucidate whether such changes become problematic later on in life.

Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature.

As a physician applying ear acupuncture in daily practices, I follow and read with pleasure the publications on this subject.I would like to comment on a technical issue, which is usually ignored.Auriculotherapy is a treatment modality applied by stimulation of acupoints which are the peripheral reflex points on the ear.Perhaps the most important thing in auriculotherapy is to determine acupoints and apply to the most appropriate stimulus on these points.While authors mention about the effects of auriculotherapy, they don't provide details describing how reactive points were located, i.e. inspection, palpation or other diagnostic methods, and why these points were chosen.If these aspects are addressed, I believe, the article will be much useful for readers.

Objective: In this study, it was aimed to determine the rates of multiple drug use in the patients with osteoporosis as well as the use of drugs affecting bone metabolism and balance.Materials and Methods: We included outpatients from Physical Medicine and Rehabilitation Policlinics diagnosed with primary or secondary osteoporosis between January 2014 and May 2014. Written consent of the participants was obtained. Data of the first 1000 patients who agreed to participate in the study were evaluated. Data regarding age, history, drugs currently being used and newly initiated were recorded. The drugs that affect bone metabolism were determined. The drugs that heva side effects including dizziness, somnolence, distractibility, decrease in the visual acuity, orthostatic hypotension and ototoxicity and were recorded because these can cause a balance disorder.Results: In this study, 64% of the participants were on five or more drugs. The most commonly used drugs were analgesics (65.4%), anti-hypertensives (52.6%), and drugs for digestive system (37.3%). We found that 65.5% of the participants were using drugs that may have side effects on bone metabolism and 93.7% were using drugs that may have side effects on balance.Conclusion: Multi-drug use and drug interactions should be considered during the treatment of osteoporosis and the drugs used should be recorded. Drugs that affect bone metabolism should only be used over the short term. Also, patients should be informed about side effects that might affect visuality, somatosensorial system and vestibular system and their daily activities should be regulated.

Background: Plantar skin has similar histologic features to the palmar area and appears to be the ideal tissue for reconstruction of the palmar region. In this study, an anatomic examination was performed to determine the superficial venous architecture of the instep area, and the use of arterialized venous instep flaps for palmar contracture release was assessed.Methods: The anatomical study was performed on 12 fresh cadaver feet. The arterialized venous instep flap, including the skin, subcutaneous tissue and superficial venous plexus, was harvested. To determine the venous structure, dissection (n = 6) and injection-corrosion (n = 6) techniques were used. In the clinical study, nine arterialized venous instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia and included skin, subcutaneous fat, and the superficial venous plexus. At the plantar site of the flap, two or three veins, one of which was used, were dissected for a sufficient length for the arterial anastomosis. The saphenous vein was used for the venous anastomosis.Results: Dissection and injection-corrosion techniques revealed that the flap had 7-12 and 4-6 veins at its plantar and superior edges, respectively, with numerous anastomoses and interconnections between the veins.The flap dimensions were between 3 x 5 cm and 4 x 6 cm. All flaps survived, with two partial flap necrosis that healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps adapted well to the recipient site.Conclusions: The arterialized venous instep flap is a good alternative to reconstruct palmar contractures by adding similar tissue that is thin and pliable with minimal donor site morbidity. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Sir, We read the article entitled “Effect of Platelet-Rich-Plasma (PRP) Implant Surface Topography on Implant Stability and Bone” [1] published in the Journal of Clinical and Diagnostic Research by Renu Kundu and Manu Rathee with great interest. We would like to comment on a technical issue, which is usually misdescribed. There are important differences between the terms “RPM”, which stands for ‘revolutions per minute’ and “G”, which refers to the gravitational force. RPM should not be used as an expression of unit, because the force actually varies depending on the radius of the machine. The acceleration applied on samples from two different centrifuges differing in size but identical in RPM levels is actually not the same. This condition follows the rule of “the bigger the radius, the more acceleration with identical RPMs”.The force exerted on the substance in a given mixture in any centrifugation is the relative centrifugal force (RCF) and RCF is responsible for the separation of the components in the mixture. The rotor, regardless of its size, revolves at that rate. The force applied to the contents, however, varies according to the size of the centrifuge. This condition may further be explained as follows: RCF or G-force= 1.12 x R x (RPM/1000)2 Where R is the radius of rotation measured in millimeters. G describes the amount of gravity applied on the samples and two centrifuges with the same RPM but different radius do not apply the same G force on the same samples. G is universal and may be calculated to develop an experiment. RPM, on the other hand, will not always represent the same force in different machines. For example, when revolving at 2000 RPM, a larger centrifuge with a longer radius length will spin samples at a higher g-force than a smaller centrifuge with a shorter radius length. RCF is a constant that is independent of the apparatus used.

Deterioration of left and right atrial strain is remarkable in patients with prolonged duration of ankylosing spondilitis.

Dear Editor,A 37-year-old man was seen due to low back pain for the last two weeks. On detailed questioning, he declared that he had been treated for lung TB 16 years ago. Family history was unremarkable. On physical examination, lumbar extension was minimally limited and painful. Straight leg raising test was negative. He did not have any neurological or other joint and systemic findings. Radiologic evaluation showed a fusion deformity between the third and fourth vertebral bodies (Figure 1). But he was unaware of this deformity. There was no abnormality in laboratory tests including erythrocyte sedimentation rate, C-reactive protein and TB tests. Upon we were confident that TB was not reactivated, we prescribed rest, non-steroidal anti-inflammatory drug and myorelaxants. His symptoms resolved completely after 1 week and he was instructed lumbar range of motion and strengthening home exercises.Tuberculosis (TB) is still a common infectious disease with 95% of cases in developing countries (1). Spinal TB is seen in 3%-5% of the patients and is the most dangerous form of skeletal TB (2). The infection destroys the bone, commonly resulting with kyphosis. Nerve roots may be compressed, sometimes spinal cord or cauda equina compression may lead to paraplegia. It may also occur years after the initial TB infection, with or without reactivation of the infection (1). The cause of spinal TB, mycobacterium tuberculosis, reach the spine by hematogenous way, thus firstly affecting the vertebral bodies (3). The infection destroys the bone, vertebral bodies collapse and it commonly results with kyphosis (1). In the presented case it resulted with a silent vertebral fusion deformity. Most likely, the patient had experienced lung TB and a neglected TB spondylitis at the same time and due to medical treatment his spinal TB limited itself with a vertebral fusion without any symptoms.Reporting this patient of ours we call attention of clinicians to the spinal TB which is often a neglected diagnosis, also seen in our case. Additionally, we wanted to highlight once more that detailed questioning of medical history is an important part of physical examination.Conflict of interest: None.

In November 2013, a 37-year-old woman with lumbar disc herniation (LDH) presented with pain in her lower back, right hip and leg, persisting for 2 years. She also had a pricking sensation radiating from the hip to the foot. On examination, she had hypoaesthesia on the right side, on the dermatome consistent with S1 radiculopathy. A straight leg raise test was positive at 35°. The strength of dorsiflexion of the toe was 4/5. Neurological examination and laboratory findings were otherwise normal. The patient had received two courses of physical therapy. Upon detailed questioning, she also reported a history of non-steroidal anti-inflammatory drug-induced gastric bleeding 2 months previously. The patient was vulnerable and anxious and complained …