Background: Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short-and mid-term effectiveness of intra-articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. Methods: This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra-articular PRF were retrospectively reviewed. The antero-lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra-articularly. PRF was started as 42 C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. Results: Although the mean initial VAS scores of the patients were 6.1 AE 0.9 cm, it was found, respectively, to be 3.9 AE 1.9 cm and 4.1 AE 1.9 cm at the first-and sixth-month follow-ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow-up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of !50% in their pain was calculated as 35.5%. Conclusion: PRF applied to the knee joint appears to be an effective and safe method.

Study Design: Prospective observational study.Objective: Our aim is to investigate the efficacy and safety of TransDiscal Biacuplasty.Summary of Background Data: Chronic discogenic pain is one of the leading causes of low back pain; however, the condition is not helped by most non-invasive methods. The results of major surgical operations for these patients are unsatisfactory. Recently, attention has shifted to disk heating methods for treatment. TransDiscal Biacuplasty is one of the minimally invasive treatment methods. The method was developed as an alternative to spinal surgical practices and Intradiscal Electrothermal Therapy for treatment of patients with chronic discogenic pain.Methods: The candidates for this study were patients with chronic discogenic pain that did not respond to conservative treatment. The main criteria for inclusion were: the existence of axial low back pain present for 6 months; disc degeneration or internal disc disruption at a minimum of one level, and maximum of two levels, in MR imaging; and positive discography. Physical function was assessed using the Oswestry Disability Index when measuring the pain with VAS. Patient satisfaction was evaluated using a 4-grade scale. Follow-ups were made 1, 3, and 6 months after treatment.Results: 15 patients were treated at one or two levels. The mean patient age was 43.1±9.2 years. We found the mean symptom duration to be 40.5±45.7 months. At the sixth month, 57.1% of patients reported a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. In the final check, 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values. No complications were observed in any of the patients.Conclusions: TransDiscal Biacuplasty is an effective and safe method.

SummaryBackgroundOver the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year.Material/MethodsPatients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index.ResultsMean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating “good” and “excellent” satisfaction was 66% (23 persons) on the last follow-up.ConclusionsWhile it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

We describe a case of paraplegia following combined spinal-epidural anaesthesia. It was postoperatively determined that a tumour of the vertebrae which was compressing the spinal cord was responsible for this complication. We suggest that the pre-existing pathology of the spine must be borne in mind as a differential diagnosis of acute postoperative paraplegia.

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Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

Licorice root has glycyrrhizic acid as the active ingredient and is responsible for a primary hyperaldosteronism-like syndrome with hypokalemia, metabolic alkalosis, and hypertension, typically accompanying low aldosterone. Herein, we present a rare complication of licorice consumption with acute renal failure.A 49-year-old male patient was admitted to emergency department with generalized muscle pain/ weakness, nausea, and dark urine. He was suffering from confusion and somnolence and the general condition was moderate. At laboratory assessment, potassium was 2.3 mEq/L, sodium 141 mEq/L, urea 146 mg/dl , creatinine 6.24 mg/dl, and total creatine kinase 4597 U/L. He had metabolic alkalosis (pH 7.59, HCO 3-37.2 mmol/L). Hemodialysis was performed because of uremic neurological symptoms. His detailed anamnesis revealed consumption of herbal medication for the last 1.5 years to treat gastric complaints. The herbal medication included 16 gr licorice root powder (~600-750 mg glycyrrhizic acid) per 100 gr. The plasma aldosterone concentration was significantly suppressed [1.6 pg/ml (normal; 38.1-300 pg/mL)]. Under these conditions, our final diagnosis was hypokalemic rhabdomyolysis and acute renal failure due to licorice ingestion. We present a rare life-threating effect of licorice ingestion in this report. Furthermore, we want to draw attention to the importance of a detailed medical history, including the use of herbal medications and regional traditional characteristics to confirm the diagnosis.Key wORdS: Licorice, Rhabdomyolysis, Acute renal failure Öz Meyan kökü; Güneydoğu Anadolu'da geleneksel bir içecek olmasının yanı sıra gıda/bitkisel ilaç endüstrisinde kullanılır. Aktif maddesi gliserizik asittir, primer hiperaldestronizim benzeri tablo ile hipokalemi, metabolik alkaloz ve hipertansiyona neden olabilir. Bu olgu sunumunda meyan köküne bağlı gelişen, literatürde nadir olan, bir rabdomiyoliz ve akut böbrek yetmezliği olgusu sunulmuştur. 49 yaşında erkek; kas güçsüzlüğü/ağrısı, bulantı, idrarda koyulaşma yakınmaları ile acil servise başvurdu. Fizik muayenesinde bilinç bulanıklığı ve uykuya meyil vardı. Hastanın laboratuvar bulguları; potasyum 2,3 mEq/L, sodyum141 mEq/L, üre 146 mg/dl, kreatin 6,24 mg/dl, total kreatin kinaz 4597 U/L idi, ayrıca metabolik alkalozu (pH 7,59, HCO 3-37.2 mmol/L) mevcuttu. Hasta üremik nörolojik bulguları nedeniyle hemodiyalize alındı. Bilinç durumu düzelince alınan detaylı anamnezde yaklaşık 1,5 yıldır mide yakınması nedeniyle bitkisel ilaçlar kullandığı ve bitkisel ilacın 100 gr'nın 16 gr meyan kökü (~600-750 mg gliserizik asit) içerdiği öğrenildi. Bu bulgular ışığında kesin tanımız; meyan kökü alımına bağlı hipokalemi, rabdomiyoliz ve akut böbrek yetmezliği oldu. Hastanın plazma aldosteron düzeylerindeki baskılanma da tanımızı destekler nitelikteydi [1,6 pg/ml (normal; 38,1-300 pg/ml)].Bitkisel ilaçlar ve gıda endüstrisinde yaygın olarak kullanılan meyan kökü yaşamı tehdit edici düzeyde akut böbrek yetmezliğine neden olabilir. Ayrıca bu olgu doğrultusunda hekimlere, bitki...

ÖzetPerianal bölgesinden yaralanan 26 yaşında erkek hasta genel cerrahi servisinde takip edilirken kasılmaları olması nedeniyle tarafımızdan konsülte edildi. İnşaat işçisi olan hasta iki gün önce perianal bölgeden demir bir çubukla yaralanmış ve aynı gün acil servisde sadece tetanoz aşısı yapılmıştı. Hastaya klinik olarak tetanoz tanısı konuldu ve yoğun bakıma alındı. Hastaya 5000 Ü insan tetanoz immünglobulini uygulandı. Kasılmaları olması nedeniyle diazepam infüzyonu başlandı. Hastaya yatışında metronidazol başlanmıştı ve tedaviye devam edildi. Takibinde mekanik ventilatör ihtiyacı duyabileceği düşünülerek başka bir merkeze sevk edilen hastanın 7 gün takip sonrası komplikasyon gelişmeksizin taburcu edildiği öğrenildi. Sonuç olarak; tetanoz uygun aşılamayla önlenebilmesine rağmen günümüzde hala sorun olan bir enfeksiyondur. Yaralanma sonrası tetanoz gelişebileceği akılda tutulmalı ve tetanoz aşısının yanısıra immünglobulin uygulamasının da yapılması korunma da önemlidir. Anahtar sözcükler: Tetanoz, kasılma, immünglobulin AbstractA 26 year-old man who were followed up in a general surgical service as a result of perineal injury was consulted by us due to muscle spasms. The patient was a construction worker and had injured by an iron bar from the perianal region two days ago. In emergency department, tetanus vaccine had been only applied in same day. He was diagnosed as tetanus and admitted to intensive care unit. He was given 5000 U human tetanus ımmune globulin. Intravenous diazepam was given for muscle spasms. Intravenous metronidazole had been applied since the first day of hospitalization. We thought that he might need mechanical ventilation, therefore, patient was referred to another hospital. It was learned that patient had no complications and he was discharged on the 7th day of hospitalization. In conclusion, tetanus is still a problematic infection, although it can be prevented by vaccination. It should kept in mind that tetanus may develop after injury and in addition to tetanus vaccine, application of ımmune globulin is also important.