Özlem Taşoğlu

Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity.

Abstract Osteoarthritis (OA) is a low grade systemic inflammatory disease in which many inflammatory mediators are known to be elevated in the peripheric blood. Blood platelet lymphocyte ratio (PLR) and mean platelet volume (MPV) are accepted as novel markers in many of the systemic inflammatory disorders, but have not been investigated in synovitis-free radiographic OA yet. The aim of this study was to evaluate the levels of blood PLR and MPV in radiographic hip OA. A total of 880 patients were evaluated retrospectively and after certain exclusion criteria, 237 of them who have primary hip OA were included. Age, sex, height, weight, body mass index, neutrophil, lymphocyte and platelet counts, erythrocyte sedimentation rate (ESR), PLR, and MPV levels were recorded, Kellgren–Lawrence (KL) grading of the hip joints were performed. Patients were then divided into 2 groups as KL grades 1 to 2 (mild–moderate) and KL grades 3 to 4 (severe) hip OA. Mean age, mean neutrophil, lymphocyte and platelet counts, mean MPV, mean PLR, and mean ESR were statistically significantly different between mild/moderate hip OA group and severe hip OA group. In univariate analysis, older age and higher MPV, PLR, and ESR were severely associated with severe hip OA. In multiple logistic regression analysis, MPV, PLR, and ESR emerged as independent predictors of severe hip OA. The results of the present study, for the first time in the literature, suggest blood PLR and MPV as novel inflammatory markers predicting the radiographic severity of hip OA in the daily practice.

Low bone density in achondroplasia

To the editor, A 39-year-old female achondroplastic patient was admitted to our outpatient clinic for her back and lower extremity pain. Her height and weight were 125 cm and 38 kg, respectively (Fig. 1). She had a body mass index of 24.3 kg/m. She had undergone leg lengthening on bilateral tibias when she was 12. On physical examination, she had bilateral paravertebral muscle spasm at her back. She also had painful hip internal rotation and knee flexion on both sides with bilateral positive Clarke’s sign. Her physical examination was otherwise noncontributory. X-ray examination revealed early degenerative changes, especially at the hip joints and strikingly osteopenia. On detailed questioning, it was understood that she had been advised to receive 300,000 IU vitamin D3 (the form of vitamin D available in our country) once a year and to exercise regularly for low bone density 2 years ago. The past two bone mineral density (BMD) measurements, performed by a single technician using dual-energy X-ray absorptiometry (DEXA) on a Lunar DPX-IQ scanner in our center, were analyzed, and a new BMD measurement was performed under similar conditions with the ones referred above (Table 1, Fig. 2). The laboratory tests was as follows: serum total calcium, 9.3 mg/dl (8.2–10.6); inorganic phosphate, 3.2 mg/dl (2.5–4.5); alkaline phosphatase (ALP), 47 U/l (30–126); type 1 collagen C terminal telopeptide (CTX), 0.253 (25–573); osteocalcin, 3.46 ng/ml (3.1–13.7); parathormone, 34.23 pg/ml (15–65), and vitamin D3, 20.1 ng/ml (>30). Risk factor examination for low bone density yielded no results. Low bone density was considered as a consequence of altered bone metabolism due to achondroplasia. She was prescribed 300,000 IU oral vitamin D3 and recommended to continue on her exercises. She was also included in a physical therapy program for her symptoms due to degenerative changes. Achondroplasia is the most common form of skeletal dysplasias. A spontan or inherited mutation in the fibroblast growth factor receptor 3 (FGFR3) gene on the fourth chromosome brings out the disease [1]. The primary defect is abnormal endochondral ossification [2]. It has a number of wellknown neuromusculoskeletal manifestations [3]. Recently, Arita et al. reported low bone density, diagnosed with spinal BMD analysis and panoramic radiographic measurements, in 5 of 11 achondroplastic patients for the first time in the literature [4]. To the best of our knowledge, our report is the second one referring the relationship between

Pregabalin: A New Adjunct in Calcineurin Inhibitor Pain Syndrome Treatment.

Tacrolimus and cyclosporin are calcineurin inhibitors (CIs) commonly used in organ transplants. These agents rarely cause a severe, debilitating pain syndrome of especially lower extremities, known as CI pain syndrome (CIPS). Although the pathogenesis is not well understood, neuropathic pain mechanisms have started to be discussed in the recent literature. Here, presenting a 48-year-old male with CIPS who recovered after pregabalin 150 mg twice daily, we aimed to emphasize the importance of this syndrome and offer a new approach for the treatment. This is the first report in the literature where pregabalin is demonstrated to be effective in CIPS.

Bilateral quadriceps and triceps tendon rupture in a hemodialysis patient

This paper presented a 58‐year‐old hemodialysis patient who had bilateral quadriceps and triceps tendon rupture, whereby the role of rehabilitation in functional parameters has been highlighted.

An Unusual Case of Cervical Spinal Schwannoma

T.E. Department of Physical Medicine and A 42-year-old woman was admitted to our clinic with cervical pain, progressive weakness, and numbness in her left upper extremity for the past 3 months. The neurologic examination was consistent with weakness (3/5) of the left biceps brachii, wrist extensors/flexors, fifth digit abduction, and distal interphalangeal flexion. Left arm muscles were globally atrophic. Sensory examination yielded diffuse paresthesias, and deep tendon reflexes were absent at the left upper extremity. Laboratory results, including complete blood cell count and liver and kidney functions were all normal. Cervical spine radiographs revealed nodular density in the left pulmonary apex (Figure 1). Magnetic resonance imaging demonstrated a contrast-enhancing, intradural extramedullary mass, which was arising from C6-7 and C7-T1 neural foramina and elongating through the left C7-T1 neural foramen to the left apex pulmonis (Figure 2). She underwent C6-T1 hemilaminectomy, and the mass was surgically excised. The histopathology of the mass was consistent with schwannoma. After surgery, intensity modulated radiation therapy with a target volume technique was applied and then she participated in a rehabilitation program. Schwannoma is a benign, slow-growing, uncapsulated, mostly uninodular nerve sheath neoplasm that arises from Schwann cells [1-3]. Most of the schwannoma cases are diagnosed between the third and fifth decades; it is seen equally in both genders [4]. Symptom and findings of schwannoma are associated with the location of the mass and nerve being involved because it can also be asymptomatic [4]. Paraganglioma, lymphoma, branchial cleft cyst, and cervical lymphadenopathy must be considered in a differential diagnosis. Although schwannomas are common in the head and neck region, extracranial presentation is rare [2]. Magnetic resonance imaging is essential, but, for an exact diagnosis of nerve sheath tumors, a histopathologic examination should be performed [2,5]. The classic treatment of schwannoma includes surgical excision of the tumor. However, radiotherapy (with limited effects) can be performed when considering its location [4]. It is important to

Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center

Objective: To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey. Design: Retrospective study. Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey. Methods: Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury. Results: Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31 : 1). Mean age was 38.3 ± 17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1 ± 25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay. Conclusion: The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.

Comment on "Abdominal Aortic Aneurysm as a Long Time Cause of Low Back Pain and Vertebral Scalloping".

Dear Editor, We have read Yildizgoren et al.’s [1] article on a patient with a chronic contained rupture of an abdominal aortic aneurysm (AAA) with great interest. The authors described the patient’s pain as “even at rest, especially during lying down,” besides standing and walking. We have just had a similar experience. A 76-year-old male had been admitted to our outpatient clinic with non-radiating low back pain persisting for the last 2 or 3 months and characteristically different from the former types of pain he had experienced. He clearly defined that the pain was worse when he was lying supine and in a lateral decubitus position, and diminished when lying prone. He had no pain during walking or any kind …

Hypospadias in spinal cord injury: association with indwelling catheter drainage and disturbance of behavior: a report of three cases.

Study design:Case series.Objective:To present three cases of paraplegic patients with hypospadias and psychiatric comorbidities.Setting:Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey.Cases:Three spinal cord injured male patients with hypospadias are presented. All three patients had a history of psychiatric disorders that is thought to be a precipitating factor.Conclusion:This is the first report in the literature of three cases of hypospadias associated with indwelling catheter drainage and behavioral disturbance.