Şenay Özdolap

Regional bone density changes in anterior cruciate ligament deficient knees: A DEXA study

Bone mineral density (BMD) loss is one of the secondary problems occurring in knee joint after injury of anterior cruciate ligament (ACL). The effect of this injury on BMDs of specific regions is not clear. The aim of this study was to investigate BMD changes in unreconstructed ACL-deficient knees with subregion analysis of dual energy X-ray absorptiometry (DEXA). Precision and reliability studies of DEXA revealed that two region of interests (ROI) in medial condyle, two ROIs in lateral femoral condyle (LFC) and one ROI in medial tibial plateau (MTP) in anteroposterior (AP) DXA view and one ROI for each of distal femur, proximal tibia and patella in lateral view had high reproducibility and reliability. Thirty-two patients with complete ACL ruptures were collected for the study and uninjured sides served as the control. All the patients were male with a mean age of 30 years. Mean duration of ACL rupture was 24 months. There were significant BMD losses in both ROIs of LFC and ROI of MTP in AP view and all three ROIs of lateral view. Greatest BMD losses in AP and lateral views were at MTP and patella respectively. There was a significant association between patellar BMD loss and duration after trauma. Bone bruises in lateral condyle might be the cause of selective involvement of LFC. Periarticular bone mineral loss in ACL-deficient knees has a predilection for the specified region of interest rather than uniform periarticular loss. This may be important for graft fixation or a factor in tunnel enlargement.

Upper Limb Tendinitis and entrapment neuropathy in coal miners

BACKGROUND It is well-known that work-related upper limb musculoskeletal disorders, particularly tendinitis and nerve entrapment, remain a difficult and costly problem in industrialized countries. The aim of this study was to evaluate tendinitis and entrapment neuropathy of the upper limb of Turkish coal miners. METHODS Eighty coal miners and 43 age-matched clerical workers were included in the study. The evaluation procedures included collection of personal and clinical data, physical examination and bilateral electrodiagnostic testing. Subjects were examined to diagnose tendinitis and nerve entrapment of the upper limb. Bilateral median and ulnar nerves conduction tests were performed on all subjects. Data were collected between August 2011 and December 2011. RESULTS There were 33 subjects with lateral epicondylitis, 10 with medial epicondylitis, and 22 with De Quervains disease among the coal miners. There were seven subjects with lateral epicondylitis, eight with medial epicondylitis, and four with De Quervains disease in the control group. The two groups significantly differed in the prevalences of lateral epicondylitis and De Quervains disease (P = 0.024 and P =0.029, respectively). Sixteen subjects in the coal miners and 12 subjects in the controls had carpal tunnel syndrome (P = 0.66). Thirty-seven subjects in the coal miners had ulnar neuropathy of the elbow (UNE), while four subjects in the controls had UNE; this difference was statistically significant (P < 0.001). CONCLUSION Lateral epicondylitis, De Quervain disease, and ulnar neuropathy are common work-related upper limb disorders among coal miners.

Splenic Vein Aneurysm Demonstrated by Magnetic Resonance Angiography

Splenic vein aneurysm (SVA) is an extremely rare vascular abnormality (1, 2). We report a SVA in a rheumatoid arthritis (RA) patient which was demonstrated by Doppler sonography, contrast-enhanced computed tomography (CT), and magnetic resonance angiography (MRA). The present case is the tenth SVA patient reported in the English literature. Furthermore, this is the first case of a SVA which was demonstrated by MRA. The literature regarding this entity is discussed and the characteristic MR angiographic appearance of a nonthrombosed splenic vein aneurysm is presented.

Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment

Objective: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. Design: Survey study. Setting: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. Participants: Consecutive MS patients scheduled for outpatient follow-up (n = 309). Intervention: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. Results: The mean age ± SD was 39.3 ± 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P < 0.001), upper urinary tract assessment by ultrasound (P < 0.001), urodynamic assessment (P < 0.001), admitted to a doctor for urinary symptoms (P < 0.001), and current or past catheter use (P = 0.002). Conclusion: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.

Evaluation of Bone Mineral Density and Bone Turnover Markers in Patients with non-Cirrhotic Chronic Hepatitis B

Objective: To evaluate the bone mineral density (BMD) and the biochemical markers of bone turnover in non-cirrhotic chronic hepatitis B patients. Material and Methods: We compared 18-65 years old non-cirrhotic chronic hepatitis B patients and healthy controls for BMD and biochemical markers of bone turnover. BMD was measured at the lumbar spine and the left hip using DXA. Results: There were 31 hepatitis B patients (19 males, 12 females) and 72 healthy controls (56 males, 16 females) in the study. Their mean age was 37.4 ± 10.0 years in the study group and 38.5 ± 7.1 years in the controls. There were no differences between the two groups for the mean BMD levels and T scores. However, left hip BMD and T scores were significantly lower in male patients with chronic hepatitis B infection when compared to males in the control group. Serum calcium, phosphate, osteocalcine, intact parathyroid hormone, deoxypyridinoline and 25-hydroxycholecalciferol levels did not differ between the groups. Conclusion: In our study, left hip BMD and T scores were found to be significantly lower in the male patients with chronic hepatitis B infection when compared to males in the control group, however a significant difference was not detected when all cases were compared with the control group. Therefore, we suppose that further studies on a larger population are needed in this issue.