Ülkü Akarırmak

Computed tomographic evaluation of lumbar spinal structures during traction.

In the previous studies, it is reported that traction diminishes the compressive load on intervertebral discs, reduces herniation, stretches lumbar spinal muscle and ligaments, decreases muscle spasm, and widens intervertebral foramina. The aim of this study was to evaluate the effects of horizontal motorized static traction on spinal anatomic structures (herniated area, spinal canal area, intervertebral disc heights, neural foraminal diameter, and m.psoas diameter) by quantitative measures in patients with lumbar disc herniation (LDH). At the same time the effect of traction in different localizations (median and posterolateral herniation) and at different levels (L4-L5 and L5-S1) was assessed. Thirty two patients with acute LDH participated in the study. A special traction system was used to apply horizontally-motorized static lumbar traction. Before and during traction a CT- scan was made to observe the changes in the area of spinal canal and herniated disc material, in the width of neural foramina, intervertebral disc heights, and in the thickness of psoas muscle. During traction, the area of protruded disc area, and the thickness of psoas muscle decreased 24.5% (p = 0.0001), and 5.7% (p = 0.0001), respectively. The area of the spinal canal and the width of the neural foramen increased 21.6% (p = 0.0001) and 26.7% (p = 0.0001), respectively. The anterior intervertebral disc height remained unchanged with traction however the posterior intervertebral disc height was significantly expanded. This study is the first to evaluated in detail and quantitatively the effect of motorized horizontal lumbar spinal traction on spinal structures and herniated area. According to detailed measures it was concluded that during traction of individuals with acute LDH there was a reduction of the size of the herniation, increased space within the spinal canal, widening of the neural foramina, and decreased thickness of the psoas muscle.

De Quervain’s syndrome associated with osteopoikilosis: a case report and review of the literature

Osteopoikilosis is a rare, usually asymptomatic, autosomal-dominant bone disorder, which is generally diagnosed incidentally on X-ray. De Quervain’s syndrome is a disorder characterized by pain on the radial (thumb) side of the wrist, impairment of thumb function and thickening of the ligamentous structure covering the tendons in the first dorsal compartment of the wrist. In this case report, we present a young woman with De Quervain’s syndrome associated with osteopoikilosis.

Evaluation of Effects of Cervical Traction on Spinal Structures by Computerized Tomography

The aim of this study was to evaluate the biomechanical efficacy of cervical spinal traction on spinal structures in cervical disc herniation patients. Thirteen patients diagnosed with acute cervical disc herniation by computerized tomography (CT) and clinical findings were treated by a special traction system consisting of a traction device placed on a traction board fitted on the CT table. Spinal structures were evaluated before and after 20 min of traction. The herniated disc level was C5-C6 in eight of the patients. Changes following traction were: regression of herniated disc area, increase in spinal canal area (11.21 mm2), spinal column elongation between C2 and C7 (l.39 mm) and intervertebral discal space widening at the C5-C6 level. Cervical traction has a significant biomechanical effect on spinal structures, which can be demonstrated by CT evaluation before and after traction.

Osteopoikilosis associated with fibromyalgia and active myofascial trigger point in upper trapezius muscles

Osteopoikilosis is a sclerosing bone dysplasia, characterized by multiple oval spots of radiodensities within the trabecular bone. It occurs equally common among men and women. Prevalence is estimated to be as high as 1:50,000. Most reported cases have been found incidentally on roentgenograms taken for other purposes. We present a 58-year-old woman with OPK associated with fibromyalgia and active myofascial trigger point in upper trapezius muscles.

Experimental Study on Static Ultrasound [High-Power Pain Threshold Ultrasound] Application: Potential Adverse Effects on Rats

ABSTRACT Objectives: To investigate the probable tissue damage after the application of static ultrasound in the intensities, durations, and session numbers identical to the originally defined high-power pain threshold ultrasound technique that has been shown to be effective in the treatment of myofascial trigger points. Methods: Twenty-four male Wistar-albino rats were used in a controlled single-blinded experimental model. The animals were assigned into three groups and underwent the static ultrasound applications in intensities ranging from 0.5 watt/cm2 to 1.5 watt/cm2. Muscle, peripheral nerve, spinal cord, and bone tissue were pathologically assessed for the signs of any possible damage. Blood samples were analyzed for abnormal creatine kinase level. Results: Creatine kinase levels were normal in all the cases. Pathological analyses of the tissue samples taken from the nerve, muscle, spinal cord, and bone tissues revealed no abnormal findings. Conclusion: The static ultrasound technique applied in identical intensities and durations to the high-power pain threshold ultrasound technique used in the treatment of myofascial trigger points in an original experimental model did not lead to tissue damage.

Cauda Equina Syndrome Caused by Lumbar Vertebral Fracture in an Elderly Patient with Ankylosing Spondylitis

Abstract Background: Cauda equina syndrome [CES] in patients with ankylosing spondylitis [AS] is an important neurological complication characterized by low back and leg pain, impotence, urinary incontinence, sensory deficits, and motor dysfunction. Vertebral fractures in the course of AS have been found most often in the cervical region, followed in prevalence by the thoracic region but only rarely in the lumbosacral region. Findings: We present an elderly patient with AS who developed spondylolisthesis at the L4–L5 level and CES following a low-energy fracture. Conclusion: Vertebral fractures in course of AS is especially more common in elderly patients with long-standing disease. Early diagnosis and treatment might improve the clinical outcome and might prevent complications.

Comparison of bone mass in primary school children at different socioeconomic levels

The aim of this study was to assess the effect of nutritional habits and physical activity on bone formation and bone structure in primary school children from two schools at different socioeconomic levels. Sixty children with a mean age of 8.9 ± 1.3 years were included in the study. Thirty children at a high socio economic level from school A were compared with 30 children at a lower level from school B in terms of their bone speed of sound values (SOS). Children from school A were found to have significantly higher values for their length of tibia, span across both arms, height, weight, and head circumference. No association was found between skeletal development and nutrition. Children from school A spent significantly more time at play, while children from school B spent more time on sports (P < 0.001). When total time spent on both sports and play was considered (P < 0.05), school A was ahead of school B. It was also found that SOS values were higher in children who drank milk before sleeping. It can be concluded that with respect to SOS, school A was superior to school B although the difference was not statistically significant.

Prevalence of Rheumatoid Arthritis and Spondyloarthritis in Turkey: A Nationwide Study

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis

Objective In our study, we aimed to evaluate the influence of training on compliance and persistence with bisphosphonate treatment given on a weekly vs. monthly basis in postmenopausal osteoporosis patients. Methods A total of 979 patients with postmenopausal osteoporosis (mean age: 63.2 ± 7.2 years) were included in this national, multicenter, prospective non-interventional observational cohort registry study. Patients were randomized into training (n = 492, 50.3%, mean age: 63.4 ± 7.2 years) and control (n = 487, 49.7%, mean age: 63.0 ± 7.1 years) groups. Patients in each intervention group were given weekly (44.9% and 44.6% for training and control subjects, respectively) or monthly (55.1% and 55.4%, respectively) bisphosphonate regimens. After the initial visit, patients were followed up at three-month intervals throughout 12 months of treatment for evaluation of persistence, compliance and adverse events. Results On average, 79.4% of the patients were persistent with the treatment with a mean of 350.4 days of duration during the 12-month follow-up period. The mean compliance in the compliant and fully compliant group remained at an average of 86.6%. No significant difference was detected between the training and control groups in terms of compliance and persistence. Significantly longer persistence (360.0 ± 89.0 vs. 345.0 ± 108.0 days; p = 0.035), higher percentage of persistent patients (83.4% vs. 74.2%; p = 0.012) and higher compliance rates (88.8% vs. 83.3%; p = 0.002) were noted in monthly regimen patients in comparison to those given weekly regimen. Conclusion Our findings revealed remarkably high rates for persistence and compliance with bisphosphonate treatment in postmenopausal osteoporosis, with no impact of training on compliance and persistence rates. Longer persistence and better compliance rates were achieved with the monthly bisphosphonate regimen when compared to the weekly regimen.

Aggressive vertebral hemangioma as a rare cause of myelopathy

Vertebral hemangiomas (VHs) are common lesions in the adult population. They are usually asymptomatic and found incidentally on radiological imaging. New-onset back pain followed by subacute progression of thoracal myelopathy is the most common presentation in patients with neurological deficit. Differential diagnoses would include metastasis, multiple myeloma, lymphoma, Paget disease, osseous tumors such as Ewing sarcoma or hemangioblastoma and blood dyscrasia. We present a 41 year-old-male patient with thoracal VH causing myelopathy that completely improved after rehabilitation program with embolization and vertebroplasty procedures.