Sevim Orkun

Transcutaneous electrical nerve stimulation versus baclofen in spasticity: clinical and electrophysiologic comparison.

Aydın G, Tomruk S, Keleş I, Özbudak Demir S, Orkun S: Transcutaneous electrical nerve stimulation versus baclofen in spasticity: Clinical and electrophysiologic comparison. Am J Phys Med Rehabil 2005;84:584–592. Objectives:Clinical and electrophysiologic comparison of the efficacy of transcutaneous electrical nerve stimulation (TENS) and oral baclofen in the treatment of spasticity. Design:Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. TENS was applied to the tibial nerve for 15 days at a frequency of 100 Hz. Clinical (spasm frequency scale, painful spasm scale, lower limb Ashworth score, clonus score, deep tendon reflex score, plantar stimulation response score) and electrophysiologic evaluations (H-reflex response at the highest amplitude, latency of maximum H-reflex, and ratio of H-reflex response at the highest amplitude to M response at maximum amplitude) of the lower limb and functional evaluations (functional disability score and FIM™) were carried out in baclofen and TENS groups before and after treatment. Posttreatment evaluation was made 24 hrs after the 15th session in the TENS group. In addition, clinical spasticity scores and electrophysiologic variables were measured 15 mins after the first application and 15 mins after the 15th session. Results:Significant improvement was detected in lower limb Ashworth score, spasm frequency scale, deep tendon reflex score, functional disability score, and FIM in the baclofen (P = 0.011, P = 0.014, P = 0.025, P = 0.004, and P = 0.005, respectively) and TENS (P = 0.020, P = 0.014, P = 0.025, P = 0.003, and P = 0.003, respectively) group after treatment. Decrease in H-reflex maximum amplitude was significant in the TENS group (P = 0.026). Most marked improvement was observed in the third evaluation, 15 mins after the 15th session, particularly in lower limb Ashworth score (P = 0.006) and H-reflex maximum amplitude (P = 0.006) in the TENS group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05). Conclusion:TENS may be recommended as a supplement to medical treatment in the management of spasticity.

Cricoarytenoiditis in rheumatoid arthritis: radiologic and clinical study.

The cricoarytenoid (CA) joint involvement in rheumatoid arthritis (RA) is not uncommon. In this study, clinical assessment, laryngeal endoscopy, and high-resolution computed tomography (HRCT) were used in 15 patients with RA to evaluate the diagnostic criteria of CA joint involvement. Symptoms owing to CA joint involvement were present in 66.6% of the patients. The frequency of involvement was 13.3% on laryngeal endoscopy but 80.0% with HRCT assessment. The most common HRCT findings were CA prominence (46.6%), density and volume changes (46.6%), and CA subluxation (39.9%). In some of the patients, soft tissue swelling (20%) near the CA joint and narrowing in the piriform sinus (33.3%) were also observed. Radiologic abnormalities related to CA joint involvement generally precede clinical symptomatology. Therefore, HRCT evaluation may be a useful method in the assessment of CA joint involvement in RA patients to exclude possible causes of laryngeal signs and symptoms.

Effects of ovariectomy and ascorbic acid supplement on oxidative stress parameters and bone mineral density in rats.

Objectives The aim of this study is to investigate the effects of ovariectomy on bone mineral density (BMD) and oxidative state in rats, and the alterations in these effects that vitamin C supplementation may produce. Materials and methods Twenty female Wistar albino rats were randomly divided into three groups: control (C, n=6); ovariectomy (O, n=7); and ovariectomy + vitamin C supplement (OV, n=7). Oxidative stress (OS) was assessed 100 days postovariectomy by measuring the activity of several enzymes, including catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase, as well as the concentrations of malondialdehyde (MDA), nitric oxide (NO), and total sulfhydryl groups in plasma and bone homogenates. Results A significant decrease in BMD was observed in O group compared with C group (p = 0.015), and a significant increase was observed in OV compared with O group (p=0.003). When groups were compared with respect to parameters of OS, MDA and NO levels in bone tissue were significantly higher in O than in C (p=0.032, p=0.022) and were significantly lower in OV than in O (p=0.025, p=0.018). SOD activity was significantly higher in O than in C (p=0.032). In plasma, MDA activity was significantly higher in O than in C (p = 0.022) and NO level was significantly higher in O than in C and OV (p=0.017, p=0.018). Conclusions Our results suggest that ovariectomy may produce osteoporosis and OS in females, and vitamin C supplementation may provide alterations regarding improvement in OS and BMD values. We assume that studies including more subjects are needed to make a decisive conclusion about OS–BMD relation.

PLASMA LEPTIN CONCENTRATIONS IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS

Osteoporosis is less common in obese individuals with increased bone mineral density (BMD) and plasma leptin concentrations. The aim of this study was to determine the correlation between leptin levels and BMD in postmenopausal women. The study consisted of 90 postmenopausal women with a mean age of 53.45 ± 0.87 years who visited our outpatient clinic for the evaluation of BMD. Thirty-six postmenopausal women with osteoporosis (mean age: 54.52 ± 1.41 years and mean body mass index (BMI, kg/m2) 29.33 ± 0.66), 30 age- and BMI-matched postmenopausal women with normal BMD, and 24 postmenopausal women (mean age: 52.79 ± 1.48 years and mean BMI: 29.45 ± 0.89) with osteopenic BMD were included in the study. Plasma concentrations of leptin after an overnight fast were measured by radioimmunoassay. BMD values were measured by dual-energy X-ray absorptiometry (DEXA) at the L2-L4 lumbar spine and femoral neck. The median spine BMD value in the patient group (0.67 ± 0.08 g/cm2, mean ± SEM) was significantly lower than that in the control group (1.02 ± 0.25 g/cm2, mean ± SEM ) and osteopenic group (0.87 ± 0.05 g/cm2, mean ± SEM) (p < 0.005). The mean spine BMD value (T score −3.63 ± 0.25, mean ± SEM) and the mean femur neck BMD value (T score −2.55 ± 0.18, mean ± SEM) of the osteoporosis group were significantly lower than that in the normal BMD group (+ 0.33 ± 0.14 and + 0.27 ± 0.18, p < 0.001) and in the osteopenia group (−1.74 ± 0,1 and –1.18 ± 0.05, p < 0.005). The mean plasma leptin concentration in the osteoporotic group (17.03 ± 1.40 ng/ml) was not significantly different from that in the normal BMD group and the osteopenia group (16.55 ± 1.50 ng/ml; 16.16 ± 1.60, respectively, p < 0.150). Plasma leptin concentrations were correlated with BMI in three groups (r(s) = 0.450, p = 0.025 in normal BMD group and r(s) = 0.4254, p = 0.009 in the osteoporotic group, and r(s) = 395, p = 0.015 in the osteopenia group. There was no correlation between plasma leptin concentrations and BMD values in three groups (r(s) = −0.89 in normal BMD group, r(s) = −0.124 in osteopenia group, and r(s) = −0.195 in osteoporosis group). From this study we conclude that circulating plasma leptin does not have a significant direct influence on bone mass in postmenopausal women.

Factors affecting bone mineral density in men

In this study, in 131 men aged 20–75 years, we investigated correlations between bone mineral density (BMD) in the lumbar spine and femoral neck and endogenous factors (age, body mass index) as well as exogenous factors (calcium intake, physical activity, smoking, caffeine, socioeconomic and educational levels). The age had a negative effect on femoral neck BMD in patients overall, and on both lumbar spine and femoral neck BMD in patients under 50. Physical activity has effects on femoral neck BMD in men above 50. Lumbar vertebral BMD negatively correlated with smoking in patients overall, and this correlation persisted when patients aged 50 and older were analyzed separately. Femoral neck BMD was positively correlated with body mass index in men aged 50 and older. Given the variety of findings in the research literature regarding risk factors for low BMD, we suggest that genetic and geographic factors should be considered.

Tuberculous sacroiliitis: a case report

Tuberculosis can affect sacroiliac joints, but only a few such cases have been reported. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report herein a culture-proven case of tuberculous sacroiliitis which initially mimicked neoplastic infiltration on CT scan.

Extensive erosive arthropathy in a patient with Behçet’s disease: case report

Behçet’s disease (BD) is a multisystem disease with typically nondeforming articular manifestations. Erosive arthropathy is an uncommon condition in patients with BD. We report herein an unusual case of long-standing BD with extensive erosive arthropathy radiologically mimicking psoriatic arthritis.

Does autonomic dysfunction exist in postmenopausal osteoporosis

Objective: The aim of this study was to investigate the presence of autonomic dysfunction in patients with osteoporosis. Design: This is a prospective controlled trial. Sixteen postmenopausal female patients with osteoporosis and 10 age-matched postmenopausal nonosteoporotic controls were included in the study. Participants were divided into the postmenopausal osteoporosis group and the nonosteoporotic control group according to bone mineral densities. Heart rate variability parameters and sympathetic skin responses were studied to evaluate autonomic functions. Results: The latencies of sympathetic skin responses obtained from both hands were significantly increased in the patient group when compared with the control group. The sympathetic skin response amplitude of the right hands and both feet of the patient group were found to be decreased significantly when compared with that of the control group. A 24-hr high-frequency value was significantly decreased in the patient group than in control group. A 24-hr low-/high-frequency value was significantly higher in the patient group than in the control group. Conclusions: Autonomic dysfunction characterized with increased sympathetic and decreased parasympathetic activity may be present in osteoporosis, and cardiac functions in patients with osteoporosis may also be affected by accompanying autonomic dysfunction.

Multifocal osteoarticular tuberculosis: a case report

Osteoarticular tuberculosis is a quite uncommon form of extrapulmonary tuberculosis. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. We report herein a case of multifocal osteoarticular tuberculosis of insidious onset with no history of prior health problems or constitutional signs and symptoms. Despite widespread osteoarticular involvement, the outcome of the patient was favorable after the management. Osteoarticular tuberculosis must be considered in patients with insidious musculoskeletal symptomatology.

Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies

AIM Inguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions. METHODS Patients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant. RESULTS Seventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9), undescended testicle (n:14), retractile testicle (n:12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group (P = .028). Although the latencies were shortened in undescended testicle group, no significant difference detected (P > .05). CONCLUSION Prolonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in younger age groups with large number of patients are needed to support our suggestions.