Amaç: Bu çalýþmada, ankilozan spondilitli (AS) hastalarda uyku kalitesini araþtýrmak ve AS’de uyku kalitesi ve depresyonu ön-gören klinik parametreleri ortaya koymak amaçlandý.

Gereç ve Yöntem: Bu çalýþmaya, 100 AS’li hasta ve hasta grubuyla yaþ/cinsiyet açýsýndan uyumlu 100 saðlýklý birey dahil edildi. AS aktivitesi, Bath AS Hastalýk Aktivite Ýndeksi (BASHAÝ), AS Hastalýk Aktivite Skoru (ASDAS-ESH, ASDAS-CRP) ve Görsel Analog Skala (GAS) ile deðerlendirildi. Fonksiyonel durum Bath AS Fonksiyonel Ýndeksi (BASFÝ) ile deðerlendirildi. Hastalýða baðlý yaþam kalitesinin deðerlendirilmesi için Ankilozan Spondilit Yaþam Kalitesi Anketi (ASYKA) kullanýldý. Tüm katýlýmcýlara uyku deðerlendirmesi için Pittsburgh Uyku Kalitesi Ýndeksi (PUKÝ) ve psikolojik deðerlendirme için Beck Depresyon Envanteri (BDE) uygulandý.

Bulgular: AS’li hastalarda uyku sorunlarý ve depresif belirtiler saðlýklý bireylere göre anlamlý derecede yüksekti. Uyku kalitesi kötü olan AS’li hastalarda AS klinik parametrelerinin tümü, uyku kalitesi iyi olan AS’li hastalara göre anlamlý olarak daha yük-sekti. Korelasyon analizinde kötü uyku kalitesi, depresif belirtiler ve düþük yaþam kalitesinin birbirleriyle ve AS klinik parametreleriyle güçlü bir þekilde iliþkili olduðu belirlendi. Uyku sorunlarý için en etkili yordayýcý, yüksek BASDAÝ puanlarýydý ve bunu yüksek BASFÝ, GAS, ASDAS-ESH puanlarý ve genç yaþ izledi. Yüksek BASFÝ ve GAS skorlarý depresif belirtilerin yordayýcýlarýydý.

Sonuç: Bulgular, kötü uyku, depresif belirtiler ve düþük yaþam kalitesinin AS kliniðini olumsuz etkileyebileceðini ve bu nedenle AS’li hastalarýn muayenelerinde uyku kalitesi ve depresyonun göz ardý edilmemesi gerektiðini göstermektedir.

Objectives: This study aimed to explore sleep quality in patients with ankylosing spondylitis (AS) and to reveal the clinical parameters that predict sleep quality and depression in AS.

Methods: This study included 100 AS patients and 100 age/sex-matched healthy individuals. The AS activity was assessed by Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS-ESR, ASDAS-CRP), and Visual Analog Scale (VAS). The functional status was assessed by the Bath AS Functional Index (BASFI). AS Quality of Life Questionnaire was administered for the assessment of the disease-related quality of life. Pittsburgh Sleep Quality Index for sleep assessment and Beck Depression Inventory for psychological assessment were administered to all participants.

Results: Sleep problems and depressive symptoms were significantly higher in AS patients compared to healthy individuals. All of the AS clinical parameters were significantly higher in AS patients with poor sleep quality than in AS patients with good sleep quality. In the correlation analysis, it was determined that poor sleep quality, depressive symptoms and low quality of life were strongly correlated with each other and AS clinical parameters. The most effective predictor for sleep problems was higher BASDAI scores, followed by higher BASFI, VAS, ASDAS-ESH scores, and younger age. Higher BASFI and VAS scores were predictors for depressive symptoms.

Conclusion: The findings indicate that poor sleep, depressive symptoms and low quality of life may negatively affect the AS clinic, and therefore sleep quality and depression should not be ignored in the examinations of AS patients.

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Amaç: Ultrasonografi bölgesel anestezi sýrasýnda kullanýlan önemli bir görüntüleme tekniðidir. Görüntü kalitesinin artmasý sonuçlarý iyileþtirir. Bu çalýþmanýn amacý, yapay renklendirmenin görüntü kalitesine ve uygulayýcý seçimlerine etkisini deðerlendirmektir.

Gereç ve Yöntem: Ýnterskalen, supraklaviküler, infraklaviküler, femoral ve popliteal bölge olmak üzere beþ blok bölgesine ait ultrasonografi görüntüleri gri skalada alýndý. Takiben görüntüler yapay renklendirme kullanýlarak yedi farklý renge çevrilerek katýlýmcýlar tarafýndan yapýlandýrýlmýþ anket kullanýlarak deðerlendirildi.

Bulgular: Görüntüler üç uzman ve 14 araþtýrma görevlisi tarafýndan deðerlendirildi. Sinirin tanýnmasý, çevre dokudan ayýrt edilebilmesi ve fasiküllerin görülmesinin netliði hakkýnda en yüksek skor mavi skalayla oldu. Ancak bulgular gri skaladan istatistiksel olarak farklý deðildi (p>0,05). Mavi skala katýlýmcýlarýn %53’ü tarafýndan favori renk olarak tercih edildi.

Sonuç: Ultrason eþliðinde bölgesel anestezi yapýlýrken görüntü kalitesi ve çözünürlüðün artmasý baþarýyý artýrýr, komplikasyonlarý azaltýr. Yapay renklendirme görüntü kalitesini artýrabilecek ayarlamalardan biridir. Çalýþmamýzda mavi renk ile renklendirmenin sonuçlarý dikkat çekiciydi. Ancak, seçilen renkten daha önemlisi bu ayarýn kazanç, derinlik ve odaklama gibi rutin yapýlmasýnýn önemli avantajlarý da beraberinde getireceði kanaatindeyiz.

Objectives: Ultrasonography (US) is an important visualization technique in regional anesthesia. Increasing in quality of images may lead to better conclusions. Our aim in this study was to evaluate the effect of artificial-coloring on image quality and practitioner’s preferences.

Methods: Ultrasound images of five block regions, interscalene, supraclavicular, infraclavicular, femoral, and popliteal were taken on a volunteer using gray scale. Then, the images were colored in seven different color scales using artificial-coloring technique. All participants were asked to fill in the structured questionnaire.

Results: All created images were assessed by three specialist and 14 resident anesthesiologists. The highest scores about nerve recognition, distinguishing nerve from surrounding tissues, and visual clarity of fascicles were obtained with blue scale images; however, these findings were not significant compared to gray scale (p>0.05). Blue scale was chosen as a favorite scale by 53% of participants.

Conclusion: Increasing the image quality and resolution while performing regional anesthesia under ultrasound guidance increases success and reduces complications. Artificial-coloring is one of the adjustments that can improve image quality. In our study, the results of coloring with blue were remarkable. However, more importantly than the color chosen, we believe that routine adjustments such as gain, depth, and focusing will bring important advantages.

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Amaç: Miyofasiyal tetik noktalar ve spazm gibi servikal kas bozukluklarý servikojenik baþ aðrýlý hastalarda yaygýn faktörlerdir. Bu çalýþmada, üst servikal kas gruplarýndaki bozukluklara baðlý servikojenik baþ aðrýlý hastalarda ultrason eþliðinde trapezius kasý interfasiyal blokunun etkinliðini deðerlendirmeyi amaçladýk.

Gereç ve Yöntem: Çalýþmada, 23 hasta prospektif gözlemsel deðerlendirildi. 25 gauge, 10 cm Quincke tip spinal iðne ile trapezius kasý ile levator skapula kaslarýnýn fasiyalarý arasýna ultrason eþliðinde ilerlendi. 10 mL %0,125’lik bupivakain enjekte edildi. Numeric Rating Scale (NRS), Neck Disability Index (NDI), aðrý sýklýðý ve analjezik tüketimi tedavi öncesi ve tedavi sonrasý dönemde deðerlendirildi.

Bulgular: NRS skorlarý tedavi sonrasý 10. dakika, birinci, ikinci ve dördüncü haftalarda tedavi öncesi NRS skorlarýndan anlamlý olarak daha düþüktü. NDI skorlarý tedavi sonrasý birinci, ikinci ve dördüncü haftalarda tedavi öncesi skorlara göre anlamlý olarak daha iyiydi. Aðrý sýklýðý birinci ve ikinci haftalarda tedavi öncesine göre anlamlý olarak daha düþüktü. Analjezik tüketiminde birinci, ikinci ve dördüncü haftalarda tedavi öncesi dönemle karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý azalma vardý.

Sonuç: Ultrason eþliðinde yapýlan trapezius kasý interfasiyal blokunun kas problemlerine baðlý servikojenik baþ aðrýlý hastalarýn tedavisinde faydalý olacaðýný düþünüyoruz.

Objectives: Disorders in the cervical muscles, such as myofascial trigger points and tightness, are common factors in patients with cervicogenic headache (CEH). We aimed to evaluate the effectiveness of ultrasound-guided interfascial blocks of the trapezius muscle in patients with CEH who showed tenderness in the upper cervical muscle groups.

Methods: A total of 23 patients were evaluated in the prospective observational trial. The injection was performed between the trapezius muscle and levator scapula muscle fascia with a disposable 25-gauge, 10-cm Quincke-tip spinal needle. 10 mL of 0.125% bupivacaine was injected between the muscle fascia. Numeric rating scale (NRS), neck disability index (NDI), pain frequency, and analgesic consumption in the pre-treatment and post-treatment period were evaluated.

Results: The NRS scores at 10 min, 1 week, 2 weeks, and 4 weeks after treatment were significantly better than the pre-treatment NRS score. The NDI scores at 1, 2, and 4 weeks after treatment were significantly better than the pre-treatment NDI score. The pain frequency at 1 and 2 weeks after treatment was significantly lower than that recorded in the pre-treatment period. Statistically significant reductions were observed in analgesic consumption at 1, 2, and 4 weeks after treatment, in comparison with consumption in the pre-treatment period.

Conclusion: We suggest that an ultrasound-guided interfascial block of the trapezius muscle is effective for the treatment of CEH caused by muscle disorders.

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Amaç: Aðrý, öznel bir deneyimdir. Duyusal, duygusal ve davranýþsal tepkilerin yaný sýra otonomik tepki, aðrýlý uyaranlara verilen tepkinin bir parçasýdýr. Pupil çapýnýn pupillometre ile deðerlendirilmesi, aðrý deðerlendirmesi için alternatif bir yöntem olarak kullanýldý. Bu çalýþmada, giriþimsel baþ aðrýsý yönetimi sýrasýnda aðrý deðerlendirmesi için pupil çapýndaki deðiþiklikler araþtýrýldý.

Gereç ve Yöntem: Bilateral majör oksipital sinir blokajý (MONB) iþlemi öncesi hastalarýn demografik verileri toplandý. Numerik derecelendirme puaný (NRS) ve pupillometre ile göz bebeði çapý ölçümleri, MONB’den önce kaydedildi. Tüm hastalara standart MONB prosedürü uygulandý. Sinir blokajý sonrasý aðrý deðerlendirmesi ve pupil çapý ölçümleri alýndý.

Bulgular: Çalýþmaya 28 hasta dahil edildi. Hastalarýn yaþ ortalamasý 41,03±12,63 yýl idi. Ýþlem öncesi ve sonrasý hemodinamik parametreler arasýnda fark yoktu. Ýþlem sonrasý NRS ve göz bebeði çapý deðerleri iþlem öncesi deðerlerden önemli ölçüde düþüktü. NRS puanlarýndaki deðiþiklikler ile sað ve sol göz bebeði çaplarýndaki deðiþiklikler arasýnda pozitif bir iliþki vardý.

Sonuç: MONB uygulanan hastalarda NRS skoru ile göz bebeði çapý arasýnda anlamlý bir iliþki vardý. Baþ aðrýsý tedavisi sýrasýnda aðrý deðerlendirmesi için göz bebeði çapýnýn izlenmesi kullanýlabilir. Pupil çapýnýn deðerlendirilmesi aðrý palyasyonunda yeni bir yaklaþýmdýr. Cinsiyet, yaþ, aðrýnýn kaynaðý, akut ve kronik aðrý gibi diðer parametrelerin göz bebeði çapý üzerindeki etkisini incelemek ve farklý algolojik prosedürlerde uygulanmasýný deðerlendirmek için gelecekteki araþtýrmalara ihtiyaç vardýr.

Objectives: Pain is a subjective experience. Besides, sensory, affective and behavioral responses, and autonomic response are part of pain response to noxious stimuli. Evaluation of pupil diameter by pupillometry has been used as an alternative method for pain assessment. In algologic procedures like interventional headache management have not been addressed in the literature. Herein, we investigated changes in pupil diameter during interventional headache management as an objective method for pain assessment.

Methods: Demographic data of the patients were collected before the bilateral major occipital nerve blockage (MONB) procedure. Numeric rating score (NRS) and pupil diameter measurements by pupillometer were recorded before MONB. Standard MONB procedure was applied to all patients. Pain assessment and pupillary diameter measurements were obtained after nerve blockage.

Results: Twenty-eight patients were included in this study. Mean age was 41.03±12.63 years. There is no difference between the hemodynamic parameters before and after the procedure. Post-procedure NRS and pupil diameter values were significantly lower than pre-procedure values. There was a positive correlation between changes in NRS scores and changes in the right and left pupil diameters.

Conclusion: There was a significant correlation between NRS score and pupil diameter in patients who underwent MONB. Monitoring of pupil diameter can be used for pain assessment during headache treatment. Evaluation of pupil diameter is a new approach in pain palliation. Future research is needed to study the effect of other parameters, that is, gender, age, origin of pain, acute, and chronic pain on pupil diameter and to evaluate its application in different algological procedures.

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Amaç: Çalýþmada, dejeneratif lomber stenozu olan geriatrik hastalarda ne zaman fizik tedavi veya cerrahi yapýlacaðýnýn araþ-týrýlmasý amaçlandý.

Gereç ve Yöntem: Aralýk 2014 ile Nisan 2017 tarihleri arasýnda lomber dejeneratif stenoz nedeniyle fizik tedavi gören 250 hasta retrospektif olarak analiz edildi. Hastalar santral kanal darlýðý ve lateral reses/foraminal darlýk olmak üzere iki gruba ayrýldý. Her iki hasta grubunun vizüel analog skala ve nörolojik kladikasyo deðerleri fizik tedavi öncesi ve sonrasý deðerlendirildi. Komorbid hastalýklar ile ameliyat sýklýðý arasýndaki iliþki de deðerlendirildi.

Bulgular: Hastalarýn 142’si kadýn 108’i erkek olup, yaþ ortalamasý 69’du. Semptomlarýn ortalama baþlangýcý 55 aydý. Fizik tedavi sonrasý hastalarýn vizüel analog skala deðerlerinde santral kanal darlýðý olan hastalarda 4–6°, lateral reses/foraminal stenozu olan hastalarda 2–3° düþüþler gözlemlendi. Ayrýca, diabetes mellitus ile birlikte lateral reses/foraminal stenozu olan hastalarýn fizik tedaviden daha az fayda saðladýðý tespit edildi.

Sonuç: Fizik tedavi ve rehabilitasyon lomber darlýðýn tedavisinde önemli bir rol oynamaktadýr. Motor kas gücü kayýplarý ve inkontinansý olmayan ve ilaçlarla aðrý kontrolü olan hastalar için fizik tedavi birincil tedavi seçeneðidir. Fizik tedaviden tatmin edici düzeyde fayda görmeyen lateral reses/foraminal stenozlu hastalarda cerrahi giriþim düþünebilir.

Objectives: The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis.

Methods: The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated.

Results: 142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4–6° in patients with central canal stenosis and 2–3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy.

Conclusion: Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.

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Ýskemik monomelik nöropati, etkilenmiþ ekstremitede multipl sinirlerin iskemisi sonucu oluþan nadir bir akut aksonal nöropatidir. Elektronöromiyografi bu nöropatinin karakteristik özelliklerini saptamak için çok yardýmcýdýr. Burada akciðer kanseri ve/veya alýnan kemoterapi nedeniyle oluþan ilk iskemik monomelik nöropati olgusu sunuldu ve bu az tanýnan duruma dikkati çekmek hedeflendi.

Ischemic monomelic neuropathy (IMN) is a rare type of acute axonal neuropathy which results from ischemia of multiple nerves in affected limb. The electroneuromyography is useful in detecting characteristic features of this neuropathy. It usually occurs after vascular interventions. Here, we present the first case who has IMN secondary to lung cancer and/or chemo-therapy and aim to draw attention to this infrequently recognized entity.

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Spinal kord stimülasyonu (SKS), yaklaþýk 50 yýldýr kronik aðrý tedavisinde kullanýlmaktadýr. Torakal ve lomber SKS ile ilgili birçok yayýn bildirilmiþ iken, servikal SKS ile ilgili daha az yayýna rastlanmaktadýr. Bu yazýmýzda servikal SKS uygulamasýnýn üç hastamýzdaki sonuçlarýný sunmayý amaçladýk. Servikal spinal sinir veya brakiyal pleksus hasarý olan, diðer konservatif tedavi yöntemleri ile aðrý palyasyonu saðlanamayan üç hastaya perkütan servikal SKS implantasyonu uygulandý. Birinci ve ikinci hastada VAS skorlarýnda, ilaç gereksiniminde azalma, yaþam kalitesinde artýþ gözlenirken, üçüncü hastada yeterli aðrý palyasyonu gözlenmemiþtir. Torakolomber SKS ile tedavi edilen alt ekstremite aðrý sendromlarýnda olduðu gibi, kronik üst ekstremite aðrýsý olan hastalarda da servikal SKS’nin tedavi seçeneði olabileceði düþünülmektedir. Gelecekteki çalýþmalar servikal SKS etkinliði ve uygulanabilirliði açýsýndan yol gösterici olacaktýr.

Spinal cord stimulation (SCS) has been used for the treatment of chronic pain for almost 50 years. There have been several reports regarding to thoracic and lumbar SCS, while fewer publications have been documented for cervical SCS administration. In this article, we presented patient satisfaction after cervical SCS application in patients with chronic upper extremity pain. Three patients with cervical spinal nerve root or brachial plexus injury who reported no pain relief with the previous treatment modalities were identified. The patients were performed percutaneous cervical SCS. Cervical SCS implantation was successful in the first and the second patients, and with respect to decrease in VAS scores, analgesic drug requirements, and an increase in their quality of life, while the third patient had no pain relief. Cervical SCS may be an effective treatment option in upper extremity chronic pain syndromes as in the lower extremity pain syndromes treated with thoracolumbar SCS.

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Postherpetik nevraljide etkilenen dermatomlara yönelik interlaminar epidural steroid enjeksiyonlarýnýn aðrýyý azaltmada etkili olduðu bulundu. Diffüz idiyopatik iskelet hiperostozu esas olarak anterior ve posterior longitudinal ligament, interspinöz, supraspinöz ligament ve ligamentum flavum gibi spinal ligamentlerin kalsifikasyonu ve kemikleþmesi ile ortaya çýkan inflamatuvar olmayan bir durumdur. Bu olguda, 73 yaþýnda postherpetik nevraljisi olan bir erkek hastada, torakal diffüz idiyopatik iskelet hiperostoza eþlik eden supra/interspinöz ligament kalsifikasyonu ve kemikleþme nedeniyle T7-T8 interlaminar epidural alana eriþimin baþarýsýz olma durumu sunuldu.

Interlaminar epidural steroid injections corresponding to dermatomes affected by post-herpetic neuralgia (PHN) were found effective in reducing pain. Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition that mainly occurs with calcification and ossification of spinal ligaments such as anterior and posterior longitudinal, interspinous, supraspinous ligament, and ligamentum flavum. In this case, it is presented that the failure of the access to the T7-T8 interlaminar space due to the supra/interspinous ligament calcification and ossification accompanied by thoracic DISH in a 73-year-old male for the treatment of PHN.

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Karotid endarterektomi cerrahisi genellikle karotis arterin týkanýklýðýndan dolayý iskemik serebro-vaskuler olay riski altýndaki hastalara uygulanýr. Cerrahi sýrasýnda iskemik komplikasyonlar geliþebilir. Bu nedenle cerrahi sýrasýnda hastanýn uyanýklýðý çok önemlidir. Cerrahi sýrasýnda þant yerleþimi için genel anestezi yerine rejyonal anestezi teknikleri tercih edilebilir. Bu makalemizde karotid endarterektomi cerrahisi sýrasýnda anestezi yönetimi için ultrason eþliðinde uyguladýðýmýz baþarýlý karotis kýlýf bloðu deneyimimizi paylaþmayý amaçladýk.

Carotid endarterectomy (CEA) surgery is generally performed for patients who under the risk of ischemic cerebral stroke due to the critical obstruction of the carotid artery. Ischemic complications may occur during the surgery. So, the awakeness of the patient is very important during the surgery. Regional anesthesia techniques may be performed instead of general anesthesia for shunt placement during CEA surgery. Herein, we aimed to share our successful US-guided carotid sheath block experience for anesthesia management during CEA surgery.

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