Münevver Serdaroğlu Beyazal

Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

[Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

The effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome.

[Purpose] The aim of the present study was to investigate and compare the effects of whirlpool bath and neuromuscular electrical stimulation on complex regional pain syndrome. [Subjects and Methods] Sixty outpatients (30 per group) with complex regional pain syndrome participated. They received 15 treatment 5 days per week for 3 weeks. The outcome measures were the visual analogue scale for pain, edema, range of motion of the wrist (flexion and extension), fingertip-to-distal palmar crease distance, hand grip strength, and pinch strength. All parameters were measured at baseline (week 0) and at the trial end (week 3). [Results] There were significant improvements in all parameters after therapy in both groups. The whirlpool bath group showed significantly better improvements in the visual analogue score, hand edema, hand grip strength, wrist range of motion (both flexion and extension), fingertip-to-distal palmar crease distance, and the three-point and fingertip pinch strengths than the neuromuscular electrical stimulation group; however, the lateral pinch strengths were similar. [Conclusion] Both whirlpool bath and neuromuscular electrical stimulation are effective in the treatment of complex regional pain syndrome, but the efficacy of the whirlpool bath treatment was better.

Coexistence of Systemic Lupus Erythematosus and Familial Mediterranean Fever

Sir, Systemic lupus erythematosus (SLE) is a chronic, systemic, autoimmune disease characterized with fatigue, fever and weight loss, malar rash, arthritis, polyserositis, proteinuria, erythema nodosum, and vasculitic lesions. Familial Mediterranean Fever (FMF) is an autosomal recessive, chronic, autoimmune inflammatory disease characterized by periodic fever, abdominal pain, polyserositis, and arthritis. Here, we present a rare case with concurrent SLE and FMF. A 46-year-old female patient admitted with complaints of recurrent fever, abdominal pain, skin rash, oral aphthous ulcers, fatigue, diffuse joint pain, and morning stiffness. Malar rash, oral ulcers, polyarthritis and diffuse joint pain were observed during physical examination. Her medical and family histories were unremarkable. The abdominal ultrasound was normal. The urine analysis was nonspecific, and the proteinuria levels in the 24-hour urine sample were normal. The blood test results were as follows: serum C-reactive protein 2.3mg/dl; erythrocyte sedimentation rate 47mm/hour; and uric acid; 3.8mg/dl. Kidney and liver function tests were normal. The antinuclear antibodies were positive, while the anti-dsDNA antibody and rheumatoid factor were negative. The patient was diagnosed with SLE based on the American College of Rheumatology diagnostic criteria, and began treatment with hydroxychloroquine and prednisolone. The patient’s symptoms decreased after treatment, although her recurrent fever and abdominal pain attacks continued. Additional tests were performed with consideration of a coexistence of another autoimmune disease, and a heterozygous M694V mutation was found in the MEFV gene. 0.5mg Colchicine three times daily treatment was added to the regimen. The patient had significant improvements in fever and attacks of abdominal pain in the follow-up. SLE and FMF are autoimmune diseases that are often characterized by chronic peritonitis, arthritis and polyserositis. SLE patients often have gastrointestinal symptoms, and 8–40% of SLE patients have reported having abdominal pain. The abdominal pain may be caused by medications that are used to treat SLE-induced pancreatitis, vasculitis, serositis, and acute peritonitis. FMF and SLE have similar clinical signs and symptoms. When FMF occurs with an inflammatory disease such as SLE, the fever attacks and/or serositis are often considered to be signs of SLE, and therefore, the diagnosis of FMF may be overlooked. Fever attacks are seen in both SLE and FMF, but the duration of the attacks are shorter in FMF than in SLE. Arthritis is one of the most important clinical features of FMF, and is seen in 50–70% of FMF patients. In FMF, arthritis is generally seen as acute monoarthritis in the lower extremity, while in SLE, it is usually seen as polyarthritis and arthralgia. The arthritis symptom in our cases was identified as polyarthritis. The MEFV gene mutation associated with FMF has also been found in patients with SLE. The SLE disease activity index score has been correlated with the probability of carrying the mutation. In a Turkish study with 2716 FMF patients, 4 cases (0.1%) of SLE were identified. In conclusion, other autoimmune diseases should be considered in cases when chronic inflammatory disease does not respond to treatment.

The effect of gadolinium-based contrast agents on rat testis

Previous studies have reported that repeated administrations of linear gadolinium‐based contrast agents lead to their accumulation in the brain and other tissues in individuals with normal renal functions. The purpose of this prospective animal study was to investigate the effect of multiple administrations of macrocyclic ionic (gadoteric acid) and linear nonionic (gadodiamide) gadolinium‐based contrast agents (GBCAs) on rat testis tissue and to compare these molecules in terms of tissue damage. Thirty‐two male Sprague‐Dawley rats were kept without drugs for 5 weeks after administration of 0.1 mmol mg−1 kg−1 (0.2 ml/kg) gadodiamide and gadoteric acid for 4 days over 5 weeks. Biochemical, histopathological and immunohistochemical changes in testis tissue were evaluated at the end of 10 weeks. When used in repeated clinical doses, gadolinium was observed to increase apoptosis in the Leydig cells of the rat testis, and to increase serum Ca+2 levels and reduce testosterone levels (p < .05). Although the difference was not statistically significant, a greater loss of spermatozoa and immature germinal cell accumulation were observed in the seminiferous tubule lumen in the GBCA groups compared with the control and saline groups (p > .05). Both linear and macrocyclic contrast agents have toxic effects on testis tissue, irrespective of the type of drug.

Renal Artery Dissection in a Patient With Degenerative Scoliosis: A Rare Complication Caused by Lumbar Vertebra Osteophyte

Isolated spontaneous renal artery dissection (RAD) without known trauma is rare, and its etiology has not been determined. However, notable risk factors including hypertension, strenuous exercise, connective tissue disorders, atherosclerosis, extracorporeal shock wave lithotripsy, and cocaine abuse have been reported. To the best of our knowledge, isolated RAD caused by lumbar vertebra osteophytes in patients with degenerative lumbar scoliosis has not been reported in the literature. In this article, we present a case of RAD caused by lumbar vertebra osteophyte in a patient with degenerative scoliosis and discuss the management of the disease.

Three Case Reports of Rhupus Syndrome: An Overlap Syndrome of Rheumatoid Arthritis and Systemic Lupus Erythematosus

We present the clinical and serological characteristics of three patients with rhupus. The 3 patients with rhupus presented ACR criteria for SLE as well as for RA, ANA positive with a titer of 1/100 in all patients, and positive anti-DNA in 2 of the 3 patients, with the predominance of symmetrical polyarthritis. We found anti-CCP positivity and rheumatoid factor positivity and high titers in all patients, positive anti- anti-SSA in one patient, and positive anti- anti-Sm in one patient. Renal and liver function tests were normal in all patients. The 3 patients achieved clinical remission with DMARD treatment.

The effect of cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in postmenopausal women

SummaryVitamin D deficiency has been reported in patients with gastrointestinal disorders. Little is known on the potentially deleterious effect of cholecystectomy on vitamin D levels and osteoporosis. We found that 25-hydroxyvitamin D levels and bone mineral density were lower in patients with prior cholecystectomy.PurposeThe influence of bile salts on vitamin D absorption is well-known, and increased incidence of vitamin D deficiency has been reported in patients with gastrointestinal disorders. Little is known on the potentially deleterious effect of cholecystectomy on vitamin D levels and osteoporosis. Herein, we aimed to investigate the effects of cholecystectomy on vitamin D levels and osteoporosis in postmenopausal women.MethodsThe study group comprised 50 postmenopausal women who had previously undergone cholecystectomy; the control group comprised 50 age-matched postmenopausal women. Serum vitamin D, calcium, and phosphorus levels were determined. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry.ResultsThe study group had significantly higher parathyroid hormone levels (94.4 ± 45.1 vs. 69.2 ± 37.5, p < 0.001) but significantly lower 25-hydroxyvitamin D levels (16.3 ± 7.6 vs. 19.8 ± 8.7, p = 0.03). Compared with the control group, the BMDs of both the lumbar spine (− 1.5 ± 1.0 vs. − 0.9 ± 1.0, p = 0.004) and femur (− 0.5 ± 0.8 vs. 0.19 ± 1.1, p = 0.001) were significantly lower in the study group. Body mass index [B = 0.81 (CI 0.67–0.98), p = 0.03] and prior cholecystectomy [B = 7.9 (CI 1.0–71.7), p = 0.04] were independent predictors of osteoporosis.ConclusionIn postmenopausal women, prior cholecystectomy is associated with lower serum 25-hydroxyvitamin D levels and BMD.

Ultrasonographic evaluation of the femoral cartilage thickness in patients with hypothyroidism.

[Purpose] The aim of this study was to investigate the effects of hypothyroidism on femoral cartilage thickness by using ultrasound, which has been found to be useful in the early diagnosis of knee osteoarthritis. [Subjects and Methods] Forty patients diagnosed with hypothyroidism and 30 age-, gender-, smoking status, physical activity-, and body mass index-matched healthy subjects were enrolled. The thickness of the femoral articular cartilage was measured using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee at the lateral condyle, intercondylar area, and medial condyle. [Results] Age, gender, body mass index, smoking status, and physical activity were similar between the groups, but patients with hypothyroidism had thinner femoral cartilage than the healthy controls at all measurement sites. Nonetheless, the differences were not statistically significant (except in the case of the left medial condyle). [Conclusion] Ultrasonographic measurement of femoral cartilage thickness may be useful in the early diagnosis of knee osteoarthritis in patients with hypothyroidism.