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Papers by mustafa turgut yıldızgören

Medical gas research, 2020

Dear Editor, Pigmented villonodular synovitis (PVNS) is a benign proliferative condition that dev... more Dear Editor, Pigmented villonodular synovitis (PVNS) is a benign proliferative condition that develops in the synovial membranes of joints, bursa or tendon sheaths most frequently in the knee joints. The patient usually has mono-articular pain and swelling. Aspiration of the joint characteristically reveals blood-tinged fluid. The synovial tissue has a characteristic brownish discoloration due to hemosiderin deposits. As the condition reaches an advanced stage, erosive lesions can be detected in the adjacent bony structures. As the weight-bearing extremities are most prone to this, the knee joint (70%) is particularly affected, although there can be involvement of the ankle, shoulder, wrist, and other joints. Patients usually complain of progressive joint swelling and discomfort with insidious onset. PVNS can occur in all age groups, but those aged 20–50 years are the most frequently affected.1 Plain radiographs usually show non-specific features such as bony erosions or soft tissue swelling. Computed tomography and ultrasonography can also show the hypertrophic synovium as a slightly hyper dense/echogenic soft-tissue mass. In the differentiation of PVNS from other synovial diseases, magnetic resonance imaging is of benefit as hyperplastic synovium or localized mass lesions are indicated by an abnormally low signal intensity on both T1 and T2 weighed images. Magnetic resonance imaging has the advantages of showing mass-like synovial proliferation with lobulated margins, with low signal intensity and hemosiderin deposits seen as “blooming” artifact on gradient echo.2 Here, the case is described of a patient with a history of knee pain and swelling, who was diagnosed with localized PVNS, and was treated successfully with local ozone therapy. This is the first case which describes treatment with ozone of PVNS in a patient refractory to surgical treatment. A 30-year old female presented with complaints of pain and swelling in the left knee which had been ongoing for 3 years. Initial assessment of pain was 7 on the Numeric Rating Scale. The patient had a history of arthroscopic synoviectomy 10 years previously because of PVNS and the pain was relieved after surgery. On examination, the range of motion of the knee joint was limited to 120° of active flexion, with full extension. Laboratory test results showed: C-reactive protein = 2 mg/L (normal range: 0–5 mg/L), erythrocyte sedimentation rate = 15 mm/h (normal range: 0–20 mm/h), rheumatoid factor = 9 IU/mL (normal range: 0–20 IU/mL), anti-cyclic citrullinated peptide = 0.5 U/mL (normal range: 0–20 U/mL). In addition, complete blood count, hepatic panel, blood urea nitrogen and creatinine levels were within normal limits. Radiographs were normal. Magnetic resonance imaging showed a 22 mm × 12 mm hypodense nodular lesion around the posterior longitudinal ligament (Figure 1A). PVNS was diagnosed based on these findings. The patient was treated with arthroscopic plica excision and synoviectomy. Two months after surgery, the symptoms had not decreased. A total of 15 sessions of intra-articular injections of 15 mL local ozone (O2-O3 mixture) were applied to the patient (Figure 1B). The first five sessions were applied at 3-day intervals at a dosage of 15 μg/mL, and the subsequent five sessions at 20 μg/mL. The final five sessions were applied at 10-day intervals at dosages of 20, 30, 40, 50, and 60 μg/mL. The pain gradually relieved and at the end of 3 months the Numeric Rating Scale was 0. The patient has not suffered even mild knee pain since January 2020 to date. There are two types of PVNS: the localized form affects just one area of the joint or only the tendons that support the joint. The diffuse form, which is seen more frequently (80%) involves the whole joint lining, and can be more difficult to treat than local PVNS. Recurrence is a reported problem with the diffuse form of PVNS, whereas only a few cases of recurrence of the local variety have been reported.3 PVNS treatment depends on the degree of injury in the joint and patient age. The most favorable treatment modality of PVNS is surgical removal of all pathological tissue. This can be applied by open or arthroscopic methods. Local recurrence after treatment has been reported in 18–46% of patients. In the event of residual or recurrent disease, other treatment modalities can be applied, such as radiotherapy, radiation synovectomy, cryosurgery, total joint arthroplasty and immune or targeted therapy.4 Ozone therapy in Turkey is regulated by the “Regulation of Traditional and Complementary Medicine Practice” issued by the Ministry of Health in the Official Gazette of the Republic of Turkey.5 Ozone therapy can be used as a supportive therapeutic method for various diseases including soft tissue injuries, osteoarthritis, rheumatologic diseases, referred pain associated with vertebrae and disc pathologies (paravertebral or intradiscal injections), myofascial pain syndrome, fibromyalgia syndrome, diabetic…

Turkiye Klinikleri Physical Medicine Rehabilitation - Special Topics, 2018

Journal of Ultrasound in Medicine, May 10, 2023

Türk osteoporoz dergisi-Turkish journal of osteoporosis, Apr 24, 2023

Dear Editor; Myofascial trigger points constitute a common and complex entity that manifests with... more Dear Editor; Myofascial trigger points constitute a common and complex entity that manifests with different symptoms depending on their localization. Conventional techniques and invasive treatment approaches are used (1). Invasive treatment modalities include dry needling, local anesthetic administration, and botox injections. During treatment, side effects may appear directly depending on the needle penetration sites or indirectly in autonomic nervous system activation. Complications like neurovascular injuries, pneumothorax damage, and abdominal wall damage are side effects of the needle penetration site (2). On the contrary, vasovagal syncope is an indirect side effect caused by autonomic nervous system activation (3). Vasovagal syncope is the transient loss of consciousness resulting from instantaneous cerebral hypoperfusion characterized by rapid onset, short duration, and complete spontaneous recovery. Various conditions, including pain, stress, needle phobia, and prolonged standing, can trigger it. Vasovagal syncope can be observed after prodromal symptoms like nausea, pallor, sweating, dizziness, tinnitus, gray out, and faintness (3). Therefore, the physician should be aware of this and monitor the patient for such symptoms. Notably, vasovagal syncope can be encountered both during and after treatment. Therefore, monitoring the patient for up to 10 minutes following treatment would be beneficial. An important issue that should be addressed while applying myofascial trigger point therapy is ensuring the physician's and patient's correct positioning during needling. This way, the physician can ensure procedural ergonomics and access the treatment site easily. Another critical issue, which can be overlooked, includes the practices adopted at outpatient clinics wherein myofascial trigger point therapy is administered. At the same time, the patient is in a seated position (Figure 1a). Considering this, the authors recommend administering the treatment while the patient lies, regardless of the involved muscle (Figure 1b) (4). Although unnecessary, this approach minimizes the possibility of vasovagal syncope. Although case presentations in the literature suggest the association of thicker needles with vasovagal syncope, there is no clear information about such an association (3). The algorithm suggested here is to ensure verbal or physical communication with the patient during treatment. If prodromal symptoms appear, the first step is to provide the patient with a safe environment, not overreact, and elevate the patient's legs (4). Nothing is probably required other than terminating treatment and observing the patient (5). It is recommended to refer the patient to the emergency department if the symptoms persist or the patient does not feel well. In relatively rare cases, when the patient loses consciousness, the patient's head should be turned to one side to facilitate breathing. It is recommended to check the vital signs, perform electrocardiography, and immediately conduct necessary medical interventions (4). In conclusion, vasovagal syncope is not a rare occurrence.

Journal of Ultrasonography, Sep 28, 2020

Medical ultrasonography, Sep 5, 2020

Turkiye Klinikleri Physical Medicine Rehabilitation - Special Topics, 2018

Journal of Medical Ultrasound, 2021

A source of shoulder pain and dysfunction, which is often underestimated, is suprascapular nerve ... more A source of shoulder pain and dysfunction, which is often underestimated, is suprascapular nerve neuropathy. This may originate from entrapment of a ganglion or paralabral cyst at the spinoglenoid notch, which has led to weakness and atrophy of the infraspinatus muscle.[2] Suprascapular nerve entrapment accounts for 1%–2% of shoulder pain, and mainly affects patients younger than 40 years of age. There are various treatment options, such as ultrasound-guided aspiration, drainage, surgical excision, or arthroscopic decompression of the cyst. In cases where conservative management has not been successful, surgery may be considered.[3]

Medical ultrasonography, May 11, 2020

Complementary Therapies in Clinical Practice, Nov 1, 2017

Please cite this article as: Sayılır Selç, Yıldızgören MT, The medium-term effects of diadynamic ... more Please cite this article as: Sayılır Selç, Yıldızgören MT, The medium-term effects of diadynamic currents in chronic low back pain; TENS versus diadynamic currents: A randomised, follow-up study,

Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi

The main purpose of this study is to compare the efficacy of radial-extracorporeal shock wave the... more The main purpose of this study is to compare the efficacy of radial-extracorporeal shock wave therapy (r-ESWT) and traditional physiotherapy (TP) in the treatment of myofascial trigger points in the upper trapezius muscle. Material and Methods: A total of 74 patients with myofascial trigger points were randomly separated into the ESWT (n=37) group and the TP (n=37) group. The groups received treatment for 2 weeks. A total of 66 (r-ESWT, n=30; TP, n=36) patients completed the study. Neck pain and disability were evaluated with Visual Analogue Scale (VAS), Quick-Disabilities of Arm, Shoulder and Hand Questionnaire (Q-DASH), and the Nottingham Health Profile (NHP). Active trigger points were evaluated using ultrasound shear wave elastography (SWE). All outcome measurements were assessed before treatment, then at 2 weeks, and 1 month after the completion of the treatment. Results: Significant improvements of VAS, Q-DASH, NHP, and SWE scores were observed at all time points after treatment in both treatment groups. When the change levels were compared between the groups, the decrease in VAS, and the improvement in Q-DASH and NHP scores were significantly higher in the TP group than in the ESWT group. There was no significant difference between the groups in terms of the amount of change in SWE. Conclusion: The both methods were useful in alleviating pain, improving function, and reducing shear modulus in myofascial trigger points, although TP seemed to be more effective than ESWT.

Balneo Research Journal, 2020

Introduction. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum t... more Introduction. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion.(1) As a result of the injury, the functions performed by the spinal cord are interrupted at the distal level of the injury. SCI causes serious disability among patients.(2) The treatment and rehabilitation period is long, expensive and exhausting in SCI. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI.(3) Material and method. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee’s approval, a 48 years old patient, co...

Journal of Exposure Science and Environmental Epidemiology, Sep 24, 2014

The objective of the present study is to compare distal femoral cartilage thicknesses of patients... more The objective of the present study is to compare distal femoral cartilage thicknesses of patients with occupational lead exposure with those of healthy subjects by using ultrasonography. A total of 48 male workers (a mean age of 34.8 ± 6.8 years and mean body mass index (BMI) of 25.8 ± 3.1 kg/m 2) with a likely history of occupational lead exposure and age-and BMI-matched healthy male subjects were enrolled. Demographic and clinical characteristics of the patients, that is, age, weight, height, occupation, estimated duration of lead exposure, and smoking habits were recorded. Femoral cartilage thickness was assessed from the midpoints of right medial condyle (RMC), right lateral condyle (RLC), right intercondylar area (RIA), left medial condyle (LMC), left lateral condyle (LLC), and left intercondylar area (LIA) by using ultrasonography. Although the workers had higher femoral cartilage thickness values at all measurement sites when compared with those of the control subjects, the difference reached statistical significance at RLC (P = 0.010), LMC (P = 0.001), and LIA (P = 0.039). There were no correlations between clinical parameters and cartilage-thickness values of the workers. Subjects with a history of lead exposure had higher femoral cartilage thickness as compared with the healthy subjects. Further studies, including histological evaluations, are awaited to clarify the clinical relevance of this increase in cartilage thickness and to explore the long-term follow-up especially with respect to osteoarthritis development.

Clinical Neurology and Neurosurgery, Jun 1, 2020

OBJECTIVES To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DB... more OBJECTIVES To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) and to compare low-frequency versus high-frequency STN-DBS on hemodynamic parameters of the middle cerebral artery between patients with advanced Parkinson's disease and age-sex matched healthy controls. PATIENTS AND METHODS Eighteen patients with advanced Parkinson's disease (PD) with bilateral STN-DBS and 18 control subjects underwent Transcranial Doppler Ultrasound (TCDU) were included in the study. The hemodynamic parameters including blood flow velocity (FV), pulsatility index (PI) and, resistance index (RI) of the right middle cerebral artery (MCA) were measured and compared during the phases using TCDU. The first DBS-off, the second low-frequency DBS of 60 Hz, and the third high-frequency DBS of 130 Hz were compared. RESULTS PD patients had significantly higher MCA-PI values compared with controls (0.99 ± 0.27 vs. 0.82 ± 0.14) (p = 0.031). Also, the MCA-PI values were higher in the low-frequency DBS (0.94 ± 0.14) and high-frequency DBS (0.93 ± 0.16) than in the controls (0.82 ± 0.14) (p = 0.022 and p = 0.041, respectively). There were no significant differences of FV and RI values among the DBS-on, DBS-off and, controls. The RI values were higher in the PD patients than in the controls, although these were not statistically significant. Also, PI values of the MCA decrease in different frequencies (60 Hz or 130 Hz). CONCLUSION The results of this study showed that MCA-PI values are higher in advanced PD compared with controls. These indices indicate that MCA resistances and impedances are increased in advanced PD. Low- or high-frequency DBS treatment have beneficial effect to reduce high PI in advanced PD patients.

Archives of Rheumatology, Aug 17, 2016

Objectives: This study aims to investigate the effects of bosentan on the prevention and treatmen... more Objectives: This study aims to investigate the effects of bosentan on the prevention and treatment of digital ulcers in systemic sclerosis (SSc) patients. Patients and methods: The study included 30 patients (4 males, 26 females; mean age 49.6±15.4 years; range 23 to 71 years) diagnosed with SSc and treated with bosentan for digital ulcers. Bosentan was administered to all patients for a mean of 14±10.3 months. All SSc cases were refractory to calcium channel antagonists or angiotensin II inhibitors. The diagnosis of SSc was based on the American College of Rheumatology criteria and patients were classified as limited or diffuse cutaneous SSc according to the LeRoy classification. Results: Mean disease duration was 8.8±8.0 years and mean duration of digital ulcers was 29.4±6.6 months. Under the bosentan treatment, eight patients (26.7%) developed new digital ulcers; all of these patients had diffuse cutaneous SSc. Health Assessment Questionnaire scores improved after 12 months and 24 months of treatment (p<0.001). Three patients (10%) developed pulmonary arterial hypertension under bosentan treatment [two patients (6.6%) had SSc-associated pulmonary arterial hypertension and one patient (3.3%) had interstitial fibrosis-associated pulmonary arterial hypertension]. The anti-centromere antibody positive patients were predominantly classified as limited cutaneous SSc. Of the patients positive for anti-topoisomerase-1 antibodies, a high proportion was classified as diffuse cutaneous SSc. Pulmonary fibrosis was most frequent in the anti-topoisomerase-1 antibody subset. New digital ulcers developed mainly in the anti-topoisomerase-1 antibody positive patients. Conclusion: Bosentan may be used either alone or in combination with other treatments when digital ulcers worsen and may be expected to suppress the development of new ulcers and severe pain. Further preclinical studies are required shedding light on the etiopathogenesis of SSc and larger clinical trials are needed for more definitive treatment strategies.

American Journal of Physical Medicine & Rehabilitation, Jul 1, 2015

Context: Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACL... more Context: Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACLR). Monitoring changes in femoral cartilage size after ACLR may be a way to detect the earliest structural alterations before the radiographic onset of osteoarthritis. Diagnostic ultrasonography (US) offers a clinically accessible and valid method for evaluating anterior femoral cartilage size. Objective: To compare the US measurements of anterior femoral cross-sectional area and cartilage thickness between limbs in individuals with a unilateral ACLR and between the ACLR limbs of these individuals and the limbs of uninjured control participants. Design: Case-control study. Setting: Research laboratory. Patients or Other Participants: A total of 20 volunteers with an ACLR (37.0 6 26.6 months after surgery) and 28 uninjured volunteers. Main Outcome Measure(s): We used US to assess anterior femoral cartilage cross-sectional area and thickness (ie, medial, lateral, and intercondylar) in the ACLR and contralateral limbs of participants with ACLR and unilaterally in the reference limbs of uninjured participants. Results: The ACLR limb presented with greater anterior femoral cartilage cross-sectional area (96.68 6 22.68 mm 2) than both the contralateral (85.69 6 17.57 mm 2 ; t 19 ¼ 4.47, P , .001) and uninjured (84.62 6 15.89 mm 2 ; t 46 ¼ 2.17, P ¼ .04) limbs. The ACLR limb presented with greater medial condyle thickness (2.61 6 0.61 mm) than both the contralateral (2.36 6 0.47 mm; t 19 ¼ 2.78, P ¼ .01) and uninjured limbs (2.22 6 0.40 mm; t 46 ¼ 2.69, P ¼ .01) and greater lateral condyle thickness (2.46 6 0.65 mm) than the uninjured limb (2.12 6 0.41 mm; t 46 ¼ 2.20, P ¼ .03). Conclusions: Anterior femoral cartilage cross-sectional area and thickness assessed via US were greater in the ACLR limb than in the contralateral and uninjured limbs. Greater thickness and cross-sectional area may have been due to cartilage swelling or hypertrophy after ACLR, which may affect the long-term health of the joint.

American Journal of Physical Medicine & Rehabilitation, Aug 1, 2014

All correspondence and requests for reprints should be addressed to Mustafa Turgut YNldNzgö ren, ... more All correspondence and requests for reprints should be addressed to Mustafa Turgut YNldNzgö ren, MD, AtlNlar street No: 45, Keçiö ren/Ankara 06280 Turkey.

The Turkish journal of gastroenterology, Mar 17, 2020

Background/Aims: To establish the prevalence of the single nucleotide polymorphisms (SNPs) of end... more Background/Aims: To establish the prevalence of the single nucleotide polymorphisms (SNPs) of endoplasmic reticulum aminopeptidase 1 (ERAP1), IL-23 receptor (IL-23R), signal transducer and activator of transcription 3 (STAT-3) and Janus kinase 2 (JAK-2) in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) in a Turkish population. Materials and Methods: A total of 562 subjects who presented at the Ankara University internal medicine departments of rheumatology and gastroenterology outpatient clinics were recruited in this study, including 365 patients with AS, 197 patients with IBD and 230 healthy controls. ERAP1, IL-23R, STAT-3 and JAK-2) were genotyped in competitive allele-specific polymerase chain reactions. Results: The ERAP1 (rs26653) polymorphism was found to increase the disease risk in patients with AS and IBD compared with the control group (p=0.02 and p=0.01, respectively). In addition, this polymorphism revealed a significant relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) in patients with AS (r=0.829, p<0.001 and r=0.731, p<0.001, respectively). Conclusion: The ERAP1 gene polymorphism might be a risk factor in the pathogenesis of AS and IBD. In contrast, IL-23R gene polymorphisms may serve a protective role in AS and IBD.

Medicine International

the aim of the present study was to investigate the effects of pregabalin plus exercise vs. prega... more the aim of the present study was to investigate the effects of pregabalin plus exercise vs. pregabalin treatment alone on the electromyographic nociceptive flexion reflex (NFr) threshold in patients with fibromyalgia (FM). For this purpose, the present study included a total of 40 patients diagnosed with FM according to the american College of rheumatology 2010 criteria. the patients were divided into two groups as follows: Group 1 received pregabalin treatment only and group 2 received exercise therapy in addition to pregabalin treatment. assessments were made at baseline and at the 1st month using a visual analog scale (VaS) to measure pain, the Fibromyalgia Impact Questionnaire (FIQ) to measure the severity of FM, Beck's Depression Inventory (BDI) to measure depression and the NFr to measure the compressive forces on peripheral nerves. In both groups, the NFR threshold following treatment was significantly higher than that at the baseline results (P<0.001). there was no significant difference between the groups as regards the difference from pre-to post-treatment NFr threshold values (P=0.610 and P=0.555, respectively). there was a strong, negative correlation between the pre-treatment NFr threshold and VaS resting, VaS motion and FIQ scores (rho=-0.62, rho=-0.69 and rho=-0.60, respectively). there was a moderate negative correlation between the pre-treatment NFr threshold and BDI scores (rho=-0.35). on the whole, the present study demonstrates that in the treatment of FM, pregabalin improves the clinical scores and leads to an increase in the NFr threshold. Herewith, it should be noted that short-term exercise therapy does not appear to provide additional benefits.

Medical gas research, 2020

Dear Editor, Pigmented villonodular synovitis (PVNS) is a benign proliferative condition that dev... more Dear Editor, Pigmented villonodular synovitis (PVNS) is a benign proliferative condition that develops in the synovial membranes of joints, bursa or tendon sheaths most frequently in the knee joints. The patient usually has mono-articular pain and swelling. Aspiration of the joint characteristically reveals blood-tinged fluid. The synovial tissue has a characteristic brownish discoloration due to hemosiderin deposits. As the condition reaches an advanced stage, erosive lesions can be detected in the adjacent bony structures. As the weight-bearing extremities are most prone to this, the knee joint (70%) is particularly affected, although there can be involvement of the ankle, shoulder, wrist, and other joints. Patients usually complain of progressive joint swelling and discomfort with insidious onset. PVNS can occur in all age groups, but those aged 20–50 years are the most frequently affected.1 Plain radiographs usually show non-specific features such as bony erosions or soft tissue swelling. Computed tomography and ultrasonography can also show the hypertrophic synovium as a slightly hyper dense/echogenic soft-tissue mass. In the differentiation of PVNS from other synovial diseases, magnetic resonance imaging is of benefit as hyperplastic synovium or localized mass lesions are indicated by an abnormally low signal intensity on both T1 and T2 weighed images. Magnetic resonance imaging has the advantages of showing mass-like synovial proliferation with lobulated margins, with low signal intensity and hemosiderin deposits seen as “blooming” artifact on gradient echo.2 Here, the case is described of a patient with a history of knee pain and swelling, who was diagnosed with localized PVNS, and was treated successfully with local ozone therapy. This is the first case which describes treatment with ozone of PVNS in a patient refractory to surgical treatment. A 30-year old female presented with complaints of pain and swelling in the left knee which had been ongoing for 3 years. Initial assessment of pain was 7 on the Numeric Rating Scale. The patient had a history of arthroscopic synoviectomy 10 years previously because of PVNS and the pain was relieved after surgery. On examination, the range of motion of the knee joint was limited to 120° of active flexion, with full extension. Laboratory test results showed: C-reactive protein = 2 mg/L (normal range: 0–5 mg/L), erythrocyte sedimentation rate = 15 mm/h (normal range: 0–20 mm/h), rheumatoid factor = 9 IU/mL (normal range: 0–20 IU/mL), anti-cyclic citrullinated peptide = 0.5 U/mL (normal range: 0–20 U/mL). In addition, complete blood count, hepatic panel, blood urea nitrogen and creatinine levels were within normal limits. Radiographs were normal. Magnetic resonance imaging showed a 22 mm × 12 mm hypodense nodular lesion around the posterior longitudinal ligament (Figure 1A). PVNS was diagnosed based on these findings. The patient was treated with arthroscopic plica excision and synoviectomy. Two months after surgery, the symptoms had not decreased. A total of 15 sessions of intra-articular injections of 15 mL local ozone (O2-O3 mixture) were applied to the patient (Figure 1B). The first five sessions were applied at 3-day intervals at a dosage of 15 μg/mL, and the subsequent five sessions at 20 μg/mL. The final five sessions were applied at 10-day intervals at dosages of 20, 30, 40, 50, and 60 μg/mL. The pain gradually relieved and at the end of 3 months the Numeric Rating Scale was 0. The patient has not suffered even mild knee pain since January 2020 to date. There are two types of PVNS: the localized form affects just one area of the joint or only the tendons that support the joint. The diffuse form, which is seen more frequently (80%) involves the whole joint lining, and can be more difficult to treat than local PVNS. Recurrence is a reported problem with the diffuse form of PVNS, whereas only a few cases of recurrence of the local variety have been reported.3 PVNS treatment depends on the degree of injury in the joint and patient age. The most favorable treatment modality of PVNS is surgical removal of all pathological tissue. This can be applied by open or arthroscopic methods. Local recurrence after treatment has been reported in 18–46% of patients. In the event of residual or recurrent disease, other treatment modalities can be applied, such as radiotherapy, radiation synovectomy, cryosurgery, total joint arthroplasty and immune or targeted therapy.4 Ozone therapy in Turkey is regulated by the “Regulation of Traditional and Complementary Medicine Practice” issued by the Ministry of Health in the Official Gazette of the Republic of Turkey.5 Ozone therapy can be used as a supportive therapeutic method for various diseases including soft tissue injuries, osteoarthritis, rheumatologic diseases, referred pain associated with vertebrae and disc pathologies (paravertebral or intradiscal injections), myofascial pain syndrome, fibromyalgia syndrome, diabetic…

Turkiye Klinikleri Physical Medicine Rehabilitation - Special Topics, 2018

Journal of Ultrasound in Medicine, May 10, 2023

Türk osteoporoz dergisi-Turkish journal of osteoporosis, Apr 24, 2023

Dear Editor; Myofascial trigger points constitute a common and complex entity that manifests with... more Dear Editor; Myofascial trigger points constitute a common and complex entity that manifests with different symptoms depending on their localization. Conventional techniques and invasive treatment approaches are used (1). Invasive treatment modalities include dry needling, local anesthetic administration, and botox injections. During treatment, side effects may appear directly depending on the needle penetration sites or indirectly in autonomic nervous system activation. Complications like neurovascular injuries, pneumothorax damage, and abdominal wall damage are side effects of the needle penetration site (2). On the contrary, vasovagal syncope is an indirect side effect caused by autonomic nervous system activation (3). Vasovagal syncope is the transient loss of consciousness resulting from instantaneous cerebral hypoperfusion characterized by rapid onset, short duration, and complete spontaneous recovery. Various conditions, including pain, stress, needle phobia, and prolonged standing, can trigger it. Vasovagal syncope can be observed after prodromal symptoms like nausea, pallor, sweating, dizziness, tinnitus, gray out, and faintness (3). Therefore, the physician should be aware of this and monitor the patient for such symptoms. Notably, vasovagal syncope can be encountered both during and after treatment. Therefore, monitoring the patient for up to 10 minutes following treatment would be beneficial. An important issue that should be addressed while applying myofascial trigger point therapy is ensuring the physician's and patient's correct positioning during needling. This way, the physician can ensure procedural ergonomics and access the treatment site easily. Another critical issue, which can be overlooked, includes the practices adopted at outpatient clinics wherein myofascial trigger point therapy is administered. At the same time, the patient is in a seated position (Figure 1a). Considering this, the authors recommend administering the treatment while the patient lies, regardless of the involved muscle (Figure 1b) (4). Although unnecessary, this approach minimizes the possibility of vasovagal syncope. Although case presentations in the literature suggest the association of thicker needles with vasovagal syncope, there is no clear information about such an association (3). The algorithm suggested here is to ensure verbal or physical communication with the patient during treatment. If prodromal symptoms appear, the first step is to provide the patient with a safe environment, not overreact, and elevate the patient's legs (4). Nothing is probably required other than terminating treatment and observing the patient (5). It is recommended to refer the patient to the emergency department if the symptoms persist or the patient does not feel well. In relatively rare cases, when the patient loses consciousness, the patient's head should be turned to one side to facilitate breathing. It is recommended to check the vital signs, perform electrocardiography, and immediately conduct necessary medical interventions (4). In conclusion, vasovagal syncope is not a rare occurrence.

Journal of Ultrasonography, Sep 28, 2020

Medical ultrasonography, Sep 5, 2020

Turkiye Klinikleri Physical Medicine Rehabilitation - Special Topics, 2018

Journal of Medical Ultrasound, 2021

A source of shoulder pain and dysfunction, which is often underestimated, is suprascapular nerve ... more A source of shoulder pain and dysfunction, which is often underestimated, is suprascapular nerve neuropathy. This may originate from entrapment of a ganglion or paralabral cyst at the spinoglenoid notch, which has led to weakness and atrophy of the infraspinatus muscle.[2] Suprascapular nerve entrapment accounts for 1%–2% of shoulder pain, and mainly affects patients younger than 40 years of age. There are various treatment options, such as ultrasound-guided aspiration, drainage, surgical excision, or arthroscopic decompression of the cyst. In cases where conservative management has not been successful, surgery may be considered.[3]

Medical ultrasonography, May 11, 2020

Complementary Therapies in Clinical Practice, Nov 1, 2017

Please cite this article as: Sayılır Selç, Yıldızgören MT, The medium-term effects of diadynamic ... more Please cite this article as: Sayılır Selç, Yıldızgören MT, The medium-term effects of diadynamic currents in chronic low back pain; TENS versus diadynamic currents: A randomised, follow-up study,

Fiziksel Tıp ve Rehabilitasyon Bilimleri Dergisi

The main purpose of this study is to compare the efficacy of radial-extracorporeal shock wave the... more The main purpose of this study is to compare the efficacy of radial-extracorporeal shock wave therapy (r-ESWT) and traditional physiotherapy (TP) in the treatment of myofascial trigger points in the upper trapezius muscle. Material and Methods: A total of 74 patients with myofascial trigger points were randomly separated into the ESWT (n=37) group and the TP (n=37) group. The groups received treatment for 2 weeks. A total of 66 (r-ESWT, n=30; TP, n=36) patients completed the study. Neck pain and disability were evaluated with Visual Analogue Scale (VAS), Quick-Disabilities of Arm, Shoulder and Hand Questionnaire (Q-DASH), and the Nottingham Health Profile (NHP). Active trigger points were evaluated using ultrasound shear wave elastography (SWE). All outcome measurements were assessed before treatment, then at 2 weeks, and 1 month after the completion of the treatment. Results: Significant improvements of VAS, Q-DASH, NHP, and SWE scores were observed at all time points after treatment in both treatment groups. When the change levels were compared between the groups, the decrease in VAS, and the improvement in Q-DASH and NHP scores were significantly higher in the TP group than in the ESWT group. There was no significant difference between the groups in terms of the amount of change in SWE. Conclusion: The both methods were useful in alleviating pain, improving function, and reducing shear modulus in myofascial trigger points, although TP seemed to be more effective than ESWT.

Balneo Research Journal, 2020

Introduction. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum t... more Introduction. Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion.(1) As a result of the injury, the functions performed by the spinal cord are interrupted at the distal level of the injury. SCI causes serious disability among patients.(2) The treatment and rehabilitation period is long, expensive and exhausting in SCI. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI.(3) Material and method. Having the patient’s consent and The Teaching Emergency Hospital “Bagdasar-Arseni” Ethics Committee’s approval, a 48 years old patient, co...

Journal of Exposure Science and Environmental Epidemiology, Sep 24, 2014

The objective of the present study is to compare distal femoral cartilage thicknesses of patients... more The objective of the present study is to compare distal femoral cartilage thicknesses of patients with occupational lead exposure with those of healthy subjects by using ultrasonography. A total of 48 male workers (a mean age of 34.8 ± 6.8 years and mean body mass index (BMI) of 25.8 ± 3.1 kg/m 2) with a likely history of occupational lead exposure and age-and BMI-matched healthy male subjects were enrolled. Demographic and clinical characteristics of the patients, that is, age, weight, height, occupation, estimated duration of lead exposure, and smoking habits were recorded. Femoral cartilage thickness was assessed from the midpoints of right medial condyle (RMC), right lateral condyle (RLC), right intercondylar area (RIA), left medial condyle (LMC), left lateral condyle (LLC), and left intercondylar area (LIA) by using ultrasonography. Although the workers had higher femoral cartilage thickness values at all measurement sites when compared with those of the control subjects, the difference reached statistical significance at RLC (P = 0.010), LMC (P = 0.001), and LIA (P = 0.039). There were no correlations between clinical parameters and cartilage-thickness values of the workers. Subjects with a history of lead exposure had higher femoral cartilage thickness as compared with the healthy subjects. Further studies, including histological evaluations, are awaited to clarify the clinical relevance of this increase in cartilage thickness and to explore the long-term follow-up especially with respect to osteoarthritis development.

Clinical Neurology and Neurosurgery, Jun 1, 2020

OBJECTIVES To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DB... more OBJECTIVES To investigate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) and to compare low-frequency versus high-frequency STN-DBS on hemodynamic parameters of the middle cerebral artery between patients with advanced Parkinson's disease and age-sex matched healthy controls. PATIENTS AND METHODS Eighteen patients with advanced Parkinson's disease (PD) with bilateral STN-DBS and 18 control subjects underwent Transcranial Doppler Ultrasound (TCDU) were included in the study. The hemodynamic parameters including blood flow velocity (FV), pulsatility index (PI) and, resistance index (RI) of the right middle cerebral artery (MCA) were measured and compared during the phases using TCDU. The first DBS-off, the second low-frequency DBS of 60 Hz, and the third high-frequency DBS of 130 Hz were compared. RESULTS PD patients had significantly higher MCA-PI values compared with controls (0.99 ± 0.27 vs. 0.82 ± 0.14) (p = 0.031). Also, the MCA-PI values were higher in the low-frequency DBS (0.94 ± 0.14) and high-frequency DBS (0.93 ± 0.16) than in the controls (0.82 ± 0.14) (p = 0.022 and p = 0.041, respectively). There were no significant differences of FV and RI values among the DBS-on, DBS-off and, controls. The RI values were higher in the PD patients than in the controls, although these were not statistically significant. Also, PI values of the MCA decrease in different frequencies (60 Hz or 130 Hz). CONCLUSION The results of this study showed that MCA-PI values are higher in advanced PD compared with controls. These indices indicate that MCA resistances and impedances are increased in advanced PD. Low- or high-frequency DBS treatment have beneficial effect to reduce high PI in advanced PD patients.

Archives of Rheumatology, Aug 17, 2016

Objectives: This study aims to investigate the effects of bosentan on the prevention and treatmen... more Objectives: This study aims to investigate the effects of bosentan on the prevention and treatment of digital ulcers in systemic sclerosis (SSc) patients. Patients and methods: The study included 30 patients (4 males, 26 females; mean age 49.6±15.4 years; range 23 to 71 years) diagnosed with SSc and treated with bosentan for digital ulcers. Bosentan was administered to all patients for a mean of 14±10.3 months. All SSc cases were refractory to calcium channel antagonists or angiotensin II inhibitors. The diagnosis of SSc was based on the American College of Rheumatology criteria and patients were classified as limited or diffuse cutaneous SSc according to the LeRoy classification. Results: Mean disease duration was 8.8±8.0 years and mean duration of digital ulcers was 29.4±6.6 months. Under the bosentan treatment, eight patients (26.7%) developed new digital ulcers; all of these patients had diffuse cutaneous SSc. Health Assessment Questionnaire scores improved after 12 months and 24 months of treatment (p<0.001). Three patients (10%) developed pulmonary arterial hypertension under bosentan treatment [two patients (6.6%) had SSc-associated pulmonary arterial hypertension and one patient (3.3%) had interstitial fibrosis-associated pulmonary arterial hypertension]. The anti-centromere antibody positive patients were predominantly classified as limited cutaneous SSc. Of the patients positive for anti-topoisomerase-1 antibodies, a high proportion was classified as diffuse cutaneous SSc. Pulmonary fibrosis was most frequent in the anti-topoisomerase-1 antibody subset. New digital ulcers developed mainly in the anti-topoisomerase-1 antibody positive patients. Conclusion: Bosentan may be used either alone or in combination with other treatments when digital ulcers worsen and may be expected to suppress the development of new ulcers and severe pain. Further preclinical studies are required shedding light on the etiopathogenesis of SSc and larger clinical trials are needed for more definitive treatment strategies.

American Journal of Physical Medicine & Rehabilitation, Jul 1, 2015

Context: Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACL... more Context: Developing osteoarthritis is common after anterior cruciate ligament reconstruction (ACLR). Monitoring changes in femoral cartilage size after ACLR may be a way to detect the earliest structural alterations before the radiographic onset of osteoarthritis. Diagnostic ultrasonography (US) offers a clinically accessible and valid method for evaluating anterior femoral cartilage size. Objective: To compare the US measurements of anterior femoral cross-sectional area and cartilage thickness between limbs in individuals with a unilateral ACLR and between the ACLR limbs of these individuals and the limbs of uninjured control participants. Design: Case-control study. Setting: Research laboratory. Patients or Other Participants: A total of 20 volunteers with an ACLR (37.0 6 26.6 months after surgery) and 28 uninjured volunteers. Main Outcome Measure(s): We used US to assess anterior femoral cartilage cross-sectional area and thickness (ie, medial, lateral, and intercondylar) in the ACLR and contralateral limbs of participants with ACLR and unilaterally in the reference limbs of uninjured participants. Results: The ACLR limb presented with greater anterior femoral cartilage cross-sectional area (96.68 6 22.68 mm 2) than both the contralateral (85.69 6 17.57 mm 2 ; t 19 ¼ 4.47, P , .001) and uninjured (84.62 6 15.89 mm 2 ; t 46 ¼ 2.17, P ¼ .04) limbs. The ACLR limb presented with greater medial condyle thickness (2.61 6 0.61 mm) than both the contralateral (2.36 6 0.47 mm; t 19 ¼ 2.78, P ¼ .01) and uninjured limbs (2.22 6 0.40 mm; t 46 ¼ 2.69, P ¼ .01) and greater lateral condyle thickness (2.46 6 0.65 mm) than the uninjured limb (2.12 6 0.41 mm; t 46 ¼ 2.20, P ¼ .03). Conclusions: Anterior femoral cartilage cross-sectional area and thickness assessed via US were greater in the ACLR limb than in the contralateral and uninjured limbs. Greater thickness and cross-sectional area may have been due to cartilage swelling or hypertrophy after ACLR, which may affect the long-term health of the joint.

American Journal of Physical Medicine & Rehabilitation, Aug 1, 2014

All correspondence and requests for reprints should be addressed to Mustafa Turgut YNldNzgö ren, ... more All correspondence and requests for reprints should be addressed to Mustafa Turgut YNldNzgö ren, MD, AtlNlar street No: 45, Keçiö ren/Ankara 06280 Turkey.

The Turkish journal of gastroenterology, Mar 17, 2020

Background/Aims: To establish the prevalence of the single nucleotide polymorphisms (SNPs) of end... more Background/Aims: To establish the prevalence of the single nucleotide polymorphisms (SNPs) of endoplasmic reticulum aminopeptidase 1 (ERAP1), IL-23 receptor (IL-23R), signal transducer and activator of transcription 3 (STAT-3) and Janus kinase 2 (JAK-2) in ankylosing spondylitis (AS) and inflammatory bowel disease (IBD) in a Turkish population. Materials and Methods: A total of 562 subjects who presented at the Ankara University internal medicine departments of rheumatology and gastroenterology outpatient clinics were recruited in this study, including 365 patients with AS, 197 patients with IBD and 230 healthy controls. ERAP1, IL-23R, STAT-3 and JAK-2) were genotyped in competitive allele-specific polymerase chain reactions. Results: The ERAP1 (rs26653) polymorphism was found to increase the disease risk in patients with AS and IBD compared with the control group (p=0.02 and p=0.01, respectively). In addition, this polymorphism revealed a significant relationship with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath AS Functional Index (BASFI) in patients with AS (r=0.829, p<0.001 and r=0.731, p<0.001, respectively). Conclusion: The ERAP1 gene polymorphism might be a risk factor in the pathogenesis of AS and IBD. In contrast, IL-23R gene polymorphisms may serve a protective role in AS and IBD.

Medicine International

the aim of the present study was to investigate the effects of pregabalin plus exercise vs. prega... more the aim of the present study was to investigate the effects of pregabalin plus exercise vs. pregabalin treatment alone on the electromyographic nociceptive flexion reflex (NFr) threshold in patients with fibromyalgia (FM). For this purpose, the present study included a total of 40 patients diagnosed with FM according to the american College of rheumatology 2010 criteria. the patients were divided into two groups as follows: Group 1 received pregabalin treatment only and group 2 received exercise therapy in addition to pregabalin treatment. assessments were made at baseline and at the 1st month using a visual analog scale (VaS) to measure pain, the Fibromyalgia Impact Questionnaire (FIQ) to measure the severity of FM, Beck's Depression Inventory (BDI) to measure depression and the NFr to measure the compressive forces on peripheral nerves. In both groups, the NFR threshold following treatment was significantly higher than that at the baseline results (P<0.001). there was no significant difference between the groups as regards the difference from pre-to post-treatment NFr threshold values (P=0.610 and P=0.555, respectively). there was a strong, negative correlation between the pre-treatment NFr threshold and VaS resting, VaS motion and FIQ scores (rho=-0.62, rho=-0.69 and rho=-0.60, respectively). there was a moderate negative correlation between the pre-treatment NFr threshold and BDI scores (rho=-0.35). on the whole, the present study demonstrates that in the treatment of FM, pregabalin improves the clinical scores and leads to an increase in the NFr threshold. Herewith, it should be noted that short-term exercise therapy does not appear to provide additional benefits.