Osman Hakan Gunduz

Hypermobility in women with fibromyalgia syndrome

The purpose of this study was to evaluate the relationship between hypermobility and fibromyalgia syndrome (FS) in women. Ninety-three women with FS who met the American College of Rheumatology criteria for FS and 58 healthy women without FS were included in this study. All women were examined for hypermobility by blinded observers using the Beighton criteria. The mean age was 43.5±9.9 (21–68) and 40.2±11.1 (21–63) years in the FS and control groups, respectively, and the two groups were statistically similar (p>0.05). The mean Beighton total score was 4.7±2.1 and 2.9±2.4 in the FS and control groups, respectively (p<0.0001). The frequency of joint hypermobility was 64.2% in the FS group and 22% in the control group. In accordance with the Beighton criteria (p<0.05), we found that the joint hypermobility ratio was significantly higher in patients with FS than in subjects without FS. Additionally, we evaluated the correlation between the total Beighton score and the age and number of trigger points. There were negative correlations between the total Beighton score and the age (r=−0.42, p<0.001) and number of trigger points (r=−0.24, p=0.03) in all patients. Hypermobility syndrome is more common in women with FS than in those in the control group. Therefore, the relationship between hypermobility and FS should be taken into consideration in the diagnosis and follow-up of women, especially those with widespread pain.

Hearing loss and middle ear involvement in rheumatoid arthritis

Abstract. In this controlled study, hearing and middle ear functions were investigated in 37 patients with rheumatoid arthritis (RA) and 35 controls in order to study the prevalence and the nature of hearing loss in RA. The prevalence of the hearing impairment was significantly higher in the RA group, and the majority was bilateral (P<0.001). Of the patients, 35.1% had sensorineural (SN), 24.3% had conductive loss, and 10.8% had a mixed type of hearing loss. The hearing loss was positively correlated to the Steinbrocker functional index. The prevalence of abnormal tympanograms was 37.8%, while it was 17.1% in the control group. The probable site of involvement responsible for the SN loss was the cochlea, and discontinuity of the ossicles, rather than stiffness, was responsible for the conductive hearing loss. The presence of a mixed type of hearing loss suggested a multifocal involvement of the audiologic system in RA.

Alendronate in rheumatoid arthritis patients treated with methotrexate and glucocorticoids.

Abstract Rheumatoid arthritis (RA) is a systemic inflammatory disease. Along with synovial joint inflammation, extra-articular involvement is a common feature of RA. Periarticular and generalized osteoporosis are seen both as an extra-articular feature of the disease itself and due to various medications like glucocorticoids and methotrexate (MTX). In this study, we investigated the effects of oral alendronate in RA patients treated with MTX and prednisolone by comparing the effects of “alendronate+calcium” and “only calcium” on bone mineral density (BMD). Fifty RA patients classified according to American Rheumatism Association (ARA) criteria were included in the study. The control group consisted of 20 postmenopausal osteoporotic patients. The RA patients were divided randomly into two groups. All patients were started on MTX 7.5 mg/week, 2.5-mg daily folic acid, and 7.5-mg daily prednisolone. The first group, consisting of 25 female RA patients, was also given 10-mg daily alendronate and 1000-mg daily calcium. The second group also consisted of 25 female patients and was given only 1000-mg calcium per day. The postmenopausal control group was given daily 10-mg alendronate and 1000-mg calcium. Bone mineral densities were measured by dual-energy x-ray absorptiometry (DEXA) and again at the end of the sixth month. At the end of the study, RA patients given only calcium had reduced mean BMD, and patients treated with alendronate and calcium showed increased mean BMD almost in all regions. This increase was significant in the L2 and L1–4 total regions. In postmenopausal osteoporotic patients, we saw statistically significant increases in BMD in all regions. The increase in BMD values in RA patients treated with alendronate was smaller than in those of the control group of postmenopausal osteoporosis patients. In conclusion, RA itself has a risk factor for osteoporosis in addition to the risks of the medications like corticosteroids and MTX. In the prevention and treatment of RA-associated osteoporosis, alendronate and calcium therapy is effective and well tolerated.

Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation

We investigated the effects of continuous lumbar traction in patients with lumbar disc herniation on clinical findings, and size of the herniated disc measured by computed tomography (CT). In this prospective, randomized, controlled study, 46 patients with lumbar disc herniation were included, and randomized into two groups as the traction group (24 patients), and the control group (22 patients). The traction group was given a physical therapy program and continuous lumbar traction. The control group was given the same physical therapy program without traction, for the same duration of time. Data for the clinical symptoms and signs were collected before and after the treatment together with calculation of a herniation index, from the CT images that showed the size of the herniated disc material. In the traction group, most of the clinical findings significantly improved with treatment. Size of the herniated disc material in CT decreased significantly only in the traction group. In the traction group the herniation index decreased from 276.6±129.6 to 212.5±84.3 with treatment (p<0.01). In the control group, pretreatment value was 293.4±112.1, and it decreased to 285.4±115.4 after the treatment (p>0.05). Patients with greater herniations tended to respond better to traction. In conclusion, lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.

Systemic sclerosis with renal crisis and pulmonary hypertension: a report of eleven cases.

OBJECTIVE To describe a series of systemic sclerosis (SSc) patients with the unusual combination of scleroderma renal crisis (SRC) and pulmonary hypertension (PHT) without interstitial lung disease. METHODS The medical records of 2,459 SSc patients in the University of Pittsburgh Scleroderma Databank first evaluated between 1972 and 1999 were reviewed. RESULTS Eleven patients (0.45%) had both SRC and PHT. All had been evaluated since 1979, when angiotensin-converting enzyme (ACE) inhibitor therapy for SRC became available. Seven had SSc with limited cutaneous involvement, and 4 had SSc with diffuse cutaneous involvement. SRC occurred first in all patients except 1, in whom the onsets of SRC and PHT were simultaneous. SRC preceded PHT by a mean of 4.3 years. Four patients had anti-Th/To antibody, 5 had anti-RNA polymerase III antibody, 2 had anti-U3 RNP antibody, and none had anticentromere or antitopoisomerase I antibody. Ten of the 11 patients died, 8 from PHT. Ten patients were being treated with ACE inhibitor drugs when PHT developed. CONCLUSION In SSc, SRC and PHT are not mutually exclusive complications. SSc patients surviving SRC who have serum antibodies to Th/To, RNA polymerase III, or U3 RNP are at increased risk to develop PHT. ACE inhibitor therapy did not prevent the development of PHT.

The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis.

Yagci I, Gunduz OH, Ekinci G, Diracoglu D, Us O, Akyuz G: The utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Objective:The aim of this prospective, blinded and controlled study is to evaluate the utility of lumbar paraspinal mapping in the diagnosis of lumbar spinal stenosis. Design:The subjects were assessed and allocated into three groups according to clinical and radiologic features with a standardized assessment protocol. These three groups were clinical and radiologic lumbar spinal stenosis, radiologic lumbar spinal stenosis, and the control group. The measurements of magnetic resonance imaging studies were performed by a blinded radiologist. An electromyographer who was masked to patients’ data performed all the nerve conduction tests, lower-limb needle electromyography, and lumbar paraspinal mapping. The relations of clinical, radiologic, and electrophysiologic findings were investigated. Results:Sixty-two patients were enrolled in the study. Two patients were eliminated because electrophysiologic studies showed polyneuropathy. There were 28, 16, and 16 patients in clinical and radiologic lumbar spinal stenosis, radiologic lumbar spinal stenosis, and control groups, respectively. In the clinical and radiologic lumbar spinal stenosis group, the findings of limb needle electromyography were inconsistent with 50% acute and 46.4% chronic radiculopathy. However, the paraspinal mapping showed that there were fibrillation potentials and positive sharp waves in at least two levels in 92.8% of the patients in clinical and radiologic lumbar spinal stenosis. The mean total paraspinal mapping score was 33.64 ± 21.17, which was significantly higher than the radiologic lumbar spinal stenosis and control groups. In the radiologic lumbar spinal stenosis group, the findings of paraspinal mapping were normal in 93.8% of the patients. Paraspinal mapping technique was found to be better correlated to the clinical findings than magnetic resonance imaging in asymptomatic patients. In the control group, 6 of 14 patients had high total paraspinal mapping scores (range, 0–9). Those patients with higher paraspinal mapping scores in the control group were mostly diagnosed with acute monoradiculopathy caused by disc herniation. Conclusions:Paraspinal mapping technique is a sensitive method in the diagnosis of lumbar spinal stenosis and reflects physiology of nerve roots better than the limb electromyography.

Bone mineral density in patients with stroke.

Şahin L, Özoran K, Gündüz OH, Uçan H, Yücel M: Bone mineral density in patients with stroke. Am J Phys Med Rehabil 2001;80:592–596. ObjectiveStroke is an acute neurologic dysfunction of vascular origin, characterized by loss of voluntary movement, sensory disturbances, and neurologic findings in the contralateral half of the body. Acute and long-term complications because of immobilization are seen in all organ systems. The aim of this study was to determine any differences between the affected and unaffected sides’ bone mineral densities of acute and chronic stroke patients. DesignIn this study, we determined the bone mineral densities (BMD) of 30 male patients with acute (0-20 days) and 30 male patients with chronic (6 months or longer) stroke and compared the densities with the normal side. Upper and lower limb BMDs were measured by dual-energy x-ray absorptiometry. Additionally, patients were evaluated for the degree of spasticity, the phases of motor improvement, and the activities of daily living. ResultsIn acute-phase stroke patients, BMD of the affected side was not significantly different from BMD of the normal side. BMD of both upper limbs of acute stroke patients was not different from normal side upper limb BMD of chronic stroke patients. In both acute and chronic stroke patients, affected and unaffected side lower limb BMDs (femur total BMD scores) were not significantly different. However, in chronic stroke patients, affected side BMD of Ward’s region was significantly higher compared with the normal side. There is no correlation between BMD and Brunnstrom phases, Ashworth scales, and the degree of activities of daily living. ConclusionsHigher BMD of the affected side Ward’s region in chronic cerebrovascular accident patients may be related to spasticity and changes in walking pattern, which increase the mechanical stress loading of the Ward’s region.

Pain Relief due to Transsacrococcygeal Ganglion Impar Block in Chronic Coccygodynia: A Pilot Study.

OBJECTIVE Coccygodynia is a distressing condition that presents with pain around the coccyx. Impar (Walther) ganglion is a sympathetic ganglion located at the end of lumbosacral sympathetic chain. The objective of this study is to share our results and follow up of 34 ganglion impar blocks in 22 patients. DESIGN Retrospective pilot study. SETTING Interventional Pain Clinic in the Department of Physical Medicine and Rehabilitation in a university hospital. SUBJECTS Twenty-two patients with coccygodynia who did not respond to conservative treatment and then presented to interventional pain clinic of a PM&R department in a university hospital METHODS Pain was evaluated via 10-cm visual analog scale (VAS). VAS values were obtained before, 1 hour and 3 weeks after injection and during this study was conducted. RESULTS For achieving at least 50% relief of pain, the success rate of a first injection was 82%, but accounted for three technical failures. In patients with a successful outcome, relief lasted for a median duration of 6 months. Relief was reinstated for a median period of 17 months by a second injection in nine patients who presented for repeat treatment. No relief was achieved in two of these patients when they presented for a third treatment. CONCLUSIONS Ganglion impar block appears to be effective in patients who have coccygodynia resistant to conservative therapy, with high success rates and prolonged duration of effect. Controlled studies are required to reveal the mechanism of this effect.

Protracted familial Mediterranean fever arthritis

Abstract Familial Mediterranean fever (FMF) is an inherited disorder characterized by recurrent attacks of fever and abdominal, chest, and articular pain. The articular attack of FMF is typically an acute, self-limited, large joint monoarthritis most often affecting the knee or hip. Rarely, a more protracted arthritis may occur. We describe two unusual cases of long-standing FMF arthritis with excellent response to synovectomy.

Comparative electrophysiological techniques in the diagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy

OBJECTIVE To determine utility of comparative electrophysiological techniques in differentiating carpal tunnel syndrome (CTS) in the background of diabetic polyneuropathy (DPN). DESIGN Ninety diabetic patients were classified into three groups: normal, CTS, and DPN according to nerve conduction studies (NCSs). The patients in the DPN group were divided into two subgroups of DPN and DPN-CTS according to clinical criteria. The comparative electrophysiological parameters including median-radial sensory distal latency difference (M-RSLD), median-ulnar sensory distal latency difference (M-USLD) and lumbrical-interosseous median-ulnar distal latency difference (LIMULD) were compared in subgroups of DPN, DPN-CTS and CTS. RESULTS Thirty-five (38.8%), 47 (52.3%), and 8 (8.9%) patients were diagnosed as CTS, DPN, and normal, respectively, according to NCS. After clinical stratification, 25 patients were diagnosed as DPN and 22 patients were diagnosed as DPN-CTS. The mean M-USLD and LIMULD values were similar in CTS and DPN-CTS groups, but larger than DPN statistically (p<0.05 for all). LIMULD, M-RSLD and M-USLD were positive in 88.4, 73 and 54% in the DPN-CTS group, respectively. CONCLUSIONS Electrophysiological abnormalities were common in diabetic patients and LIMULD can identify CTS in diabetic DPN patients better than M-RSLD and M-USLD.