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Öğe Botulinum toxin A in the treatment of spasticity - An open label study(Ios Press, 2002) Turhanoglu, AD; Karabulut, Z; Bayram, H; Turhanoglu, S; Erdogan, F; Apak, I; Yayla, VPurpose: To assess the efficacy of botulinum toxin type A in spasticity in upper-motor neuron syndromes. Methods: Twenty-three patients with spasticity resulted from stroke-related hemiplegia, transverse myelitis and multiple sclerosis took part in the study. Following the history and physical examinations of the patients, injections of botulinum toxin-A were applied. The dose ranged from 80 to 400 mouse unit (MU) depending on the size of the muscle injected. In all patients, spasticity, spasms and pain were measured using the Ashworth Scale, Spasm Frequency Score, and Visual Analogue Scale prior to the therapy, at the 1st week, 1st month and 3rd month of the therapy. Results: In all patients, botulinum toxin type A led to a significant decrease in spasticity, spasms and pain after the 1st week, 1st and 3rd months of the treatment when compared to the baseline values (p < 0.001). No significant side effects or complications were observed. Conclusion: Our results have demonstrated that botulinum toxin type A is effective in the management of patients with spasticity due to stroke-related hemiplegia, transverse myelitis and multiple sclerosis, without major adverse effects.Öğe Clenched fist syndrome with palmar lichen planus(Wiley, 2005) Aytekin, S; Turhanoglu, AD; Ozkan, M; Uzunlar, AKA 16-year-old girl had a 4-year history of hyperkeratosis and fissures on the palm. The skin lesions had gradually progressed to thick hyperkeratosis with mild pruritus, diffusely covering the right palm, and leading to flexion contractures of the fingers with mild pain. There was no family history of similar lesions. Her father had died 4 years previously. Dermatologic examination revealed hyperkeratosis, scaling, a mild yellow color, fissures, and maceration on the palm and volar surface of the fingers of the right hand ( Fig. 1). There was an approximately 3 cm x 4 cm hyperkeratotic lesion on the palm of the left hand. Flexion contractures were found at the metacarpophalangeal and proximal interphalangeal joints of the three fingers of the right hand ( Fig. 1). There was no pain, tenderness in the joints of the fingers, or palpable nodular lesions on the palmar surface of the hand. Forced extension was difficult, and there was pain with passive extension. Radiography of the patient's hands revealed no abnormality, other than the clenched fingers. Electromyography of the upper extremities was normal. There were no lesions of the oral mucosa. The nails and scalp were normal. The patient showed very poor eye contact, and responded tersely and somewhat reluctantly to questions about her medical history. The patient was evaluated by psychiatry, but did not meet the diagnostic criteria for any mental disorder. There was a schizoid personality characteristic on both the structured clinical interview for DSM-IV personality disorders (SCID-II) and the Minnesota Multiphasic Personality Inventory ( MMPI). In addition, there was an increase in scores on the hostility and resentment/ aggression subscales of the MMPI. The results of routine laboratory tests were within normal limits or negative, including the venereal disease research laboratory ( VDRL) test. A skin biopsy specimen showed histopathologic changes of lichen planus ( orthokeratotic hyperkeratosis, focal hypergranulosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo- epidermal junction) ( Fig. 2). The patient was treated with topical 5% salicylic acid and 0.1% methylprednisolone aceponate ointment. Static splinting plus stretching was used for hand therapy. Active assisted motion was employed. The treatment produced a remarkable reduction in the skin lesions ( Fig. 3), but no improvement in the flexion posture of the hand. The psychiatric and clinical findings were thought to be consistent with clenched fist syndrome and lichen planus.Öğe Lung perfusion in hemorrhagic shock of rats: The effects of resuscitation with whole blood, saline or Hes 6%(Tohoku Univ Medical Press, 2001) Turhanoglu, S; Kaya, S; Kararmaz, A; Turhanoglu, ADThis study was undertaken to determine the effects of various resuscitation regimens on lung perfusion following resuscitation from hemorrhagic shock. Fourty male Sprague-Dawley rats (250-300 g) were used. The rats were divided randomly into four groups (n = 10 for each) and were sedated with intramuscular ketamine (100 mg/kg). We measured blood pressure, rectal temperature and lung perfusion using radioscintigraphy with a technetium colloid indicator. The systolic blood pressure was decreased 75% by removing blood via v. jugularis in the first three groups and group 4 was accepted as the control group, and blood volume was not diminished. Then the first three groups were resuscitated with autologous blood containing 125 units heparine/ml in group 1, saline in group 2, and hydroxyethyl starch (HES) 6% in group 3. After the correction of hypovolemia, all animals were injected 100 Bg (0.1 cc) technetium 99 in macroaggregated albumin (Tc-99m MAA) via penil vein. After injection of Tc-99m MAA, 3 minutes fixed images were detected by a gamma camera in posterior position at 15 minutes and 5 hours. Tc-99m MAA wash out rate in lung was determined quantitatively at 5 hours. Compared to a control group, lung perfusion was decreased significantly in groups resuscitated with saline, and HES 6% while perfusion was restored with autologous blood. We conclude that heparinized autologous blood saved lung capillary circulation in hemorrhagic shock in rats. (C) 2001 Tohoku University Medical Press.Öğe Reaction time and movement time in patients with carpal tunnel syndrome: an electromyographic study(Elsevier Sci Ltd, 2003) Turhanoglu, AD; Beyazova, MObjective. To measure the motor performance of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles using the parameters electromyographic muscle reaction time and movement time in patients with carpal tunnel syndrome during key turning function. Method. A total of 37 female patients with right hand pain were divided into two groups: 21 with an electrophysiologically confirmed diagnosis of carpal tunnel syndrome (Group 1), and 16 with normal electrophysiological findings (Group II). The reaction time and movement time values obtained by surface electromyography of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles were compared between groups. Results. Of the 21 patients in Group 1, 15 had mild, four moderate, and two severe median nerve lesions. No significant difference between groups was found in the electromyographic reaction time and movement time values of the right flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during key turning (P > 0.05). There was also no significant difference in electromyographic reaction time and movement time between six patients with severe or moderate carpal tunnel syndrome and 15 patients with mild carpal tunnel syndrome in Group I (P > 0.05). Sixteen patients in Group II did not have carpal tunnel syndrome. Conclusion. The results indicate that patients with and without carpal tunnel syndrome have similar values of reaction time and movement time of the flexor pollicis brevis, first dorsal interosseus, and flexor pollicis longus muscles during the pinch grasp function of the hand.
