Piriformis syndrome is a clinical picture of non-discogenic sciatica caused by compression of the sciatic nerve by the piriformis muscle. It has variable etiologies and the patho-physiology is not fully understood. The major etiology was known to be the spasm, edema and inflammation of the piriformis muscle and sciatic nerve compression of the muscle later on. Patients can be diagnosed immediately with a comprehensive clinical examination and early diagnosis makes the treatment much easier. Diagnosis of the piriformis syndrome, a very rare cause of low back pain, first requires that this syndrome is remembered, and then a differential diagnosis should be performed. A case of piriformis syndrome diagnosed in a patient who presented with low back pain is reported in this study.
Fractional anisotropic changes of corpus callosum associated with antipsychotic treatment in first-episode antipsychotic drug-naive patients with schizophrenia Objective: Schizophrenia involves white matter abnormalities that might have a central role in the pathophysiology. Abnormal brain connectivity especially in prefrontal and temporal heteromodal cortex has been suggested as the leading structural impairment in patients with schizophrenia. In this study we examined the relationship between potential white matter changes and clinical response, as well as associations with antipsychotic treatment follow-up. Methods: 18 first-episode schizophrenia (FES) patients were recruited from the outpatient unit of the GATA (Gulhane Military Medical Academy) Haydarpasa Research and Training Hospital, between June 2009-February 2010. Fourteen patients with FES were recruited, and 16 healthy control subjects were recruited from the community. Diffusion tensor MRI (DT-MRI) was obtained from participants at baseline and after 4 weeks of standard antipsychotic treatment. A color-coded fractional anisotropy map for each 11 patient was extracted from the 4-week follow-up and the baseline splenium and genu FA measurements. According to Basser and others major eigenvector linear maps were transformed into the color-coded maps. Differences in Positive and Negative Syndrome Scale (PANSS) scores and Brief Psychiatric Rating Scale (BPRS) scores between baseline and follow up were also evaluated. Results: In this study; in the FES patients, both genu FA (p=0.001) and the splenium FA (p=0.013) values were statistically significantly lower than the healthy control group. There were mild FA increases respectively genu and splenium (p=0.533, p=0.318) in the FES patients after the treatment. But the FA changes did not correlate with the changes in clinical symptoms. A negative, moderate, statistically significant correlation (Pearson's r=-0.569, p=0.034) was found between baseline splenium FA values and BPRS scores. The duration of illness prior to treatment was negatively, weak, statistically non-significantly correlated (r=-0.066; p=0.846) between baseline and follow-up splenium FA changes. Conclusions: The reduced mean Callosal FA (CFA) values might indicate myelination defects and problems in axonal transport. The existence of white matter changes even in first episode drug-naive schizophrenia patients supports the view that these problems occurs in earlier stages of development. Although the callosal FA changes did not correlate with symptom improvement or the dose of antipsychotic medication, there was a mild increase in follow-up FA measurements. These findings show that CC which is the main conduit of interhemispheric connection is affected distinctly in patients with schizophrenia. Further collaborative studies are needed to clarify the potential long-term effects of antipsychotics on white matter microstructure and also its reversibility.
Pilonidal sinüs etyolojisinde obezite, oturarak çalışma, derin intergluteal sulkus başta olmak üzere birçok risk faktörü tanımlanmıştır. Çalışmamızın amacı Lumbo-sakro-koksigeal bölge açılanmalarının ve koksiks anatomisinin pilonidal sinüs açısından değerlendirilmesidir. Gereç ve Yöntem Pilonidal sinüs nedeni ile başvuran ve koksiks grafisi çekilen hastalar ile herhangi bir şikâyeti olmayan heyet muayenesine başvuran hastaların lateral lumbosakral grafilerinde koksiks görülen hastalar çalışmaya dâhil edildi. Hastaların yaş, cinsiyet, koksiks tip ve patolojileri, lumbosakral, sakrokoksigeal, interkoksigeal ve sakrokoksigeal sinüs açıları geriye dönük değerlendirildi. Bulgular 66 pilonidal sinüs, 94 kontrol olmak üzere toplam 160 hasta çalışmaya dâhil edildi. Tüm hastalar erkekti ve yaş ortalaması 23,87± 2.47 yıldı. Her iki grupta en sık Tip II koksiks gözlendi (sırasıyla %45,5 ve %85,1), Tip I (%27,3) sadece Pilonidal sinüste görülürken, Tip III (%21,2) ensık Pilonidal sinüste, Tip IV (%11,7) en sık kontrol grubunda gözlendi. Koksiks tiplerinde her iki grup arasında istatistiksel fark saptanmadı. Pilonidal sinüste koksiks patoloji %27,3 görülürken, kontrol grubunda %19,1 görüldü, fakat istatistiksel olarak anlamlı fark saptanmadı. Açılardan ise lumbosakral ve sakrokoksigeal açılar arasındaki fark istatistiksel olarak anlamlı saptanırken (sırasıyla, p=0,0001, p=0,001), interkoksigeal ve sakrokoksigeal sinüs açısı açılar arasındaki fark istatistiksel olarak anlamlı saptanmadı (p>0,05). Sonuç Pilonidal sinüs etyolojisinde diğer risk faktörleri ile birlikte, özellikle Tip I koksiks, kısmen Tip III koksiks, koksiks patolojileri, lumbosakral ve sakrokoksigeal açıların önemli risk faktörü olduğunu değerlendirmekteyiz.
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