Comparison of thicknesses of talar cartilage, tibialis anterior, and gastrocnemius muscles between high-activity patients with unilateral traumatic transtibial amputation and nonamputated individuals: A clinical and sonographic study.

BACKGROUND: The aim of this study was to compare the thicknesses of intact talar cartilage, tibialis anterior (TA), gastrocnemius medialis (GCM), and gastrocnemius lateralis (GCL) muscles of traumatic unilateral transtibial amputees with that of nonamputated individuals by ultrasound and to investigate the relationship between cartilage and muscle thickness measurements with clinical parameters. METHODS: Thirty-six patients with unilateral traumatic transtibial amputation, and 36 age-matched, sex-matched, and body mass index-matched nonamputated controls were included in this cross-sectional study. Subjects' talar cartilage, TA, GCM, and GCL muscle thickness measurements were performed using musculoskeletal ultrasound. Other outcome measures were 6-minute walking test, the Foot and Ankle Outcome Score, and Short Form-36. RESULTS: TA and GCM muscles were thicker on the intact limbs of the patients than those of the controls (p = 0.015 and p = 0.014, respectively). There was no statistically significant difference in talar cartilage and GCL muscle thicknesses when patients were compared with control subjects. Talar cartilage thickness was positively correlated with body mass index, 6-minute walking test, and sport and recreation subscale score of the Foot and Ankle Outcome Score. TA and GCM muscle thicknesses were positively correlated with the duration of prosthesis use and role limitations because of the physical health subscale score of Short Form-36. CONCLUSIONS: TA and GCM muscles were found to be thickened on the intact sides of traumatic unilateral transtibial amputees. The correlations between lower leg muscle thicknesses and clinical parameters suggest that the observed thickness change is not necessarily pathological and has potential impact on function at least in our young cohort.

Temporomandibular disorders in ankylosing spondylitis: a cross-sectional, monocentric study.

There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS patients and its relationship with craniocervical posture. AS patients aged between 18 and 50 years consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)'. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. Craniocervical posture was assessed on lateral cervical X-ray by measuring the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, and anterior translation distance. A total of 98 (58.2% female) patients with a mean age of 37.4 ± 8.2 years were enrolled in this study. TMD was diagnosed in 58 (59.2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups. Smoking, bruxism (in females), neck disability and AS disease activity (in males) were higher in TMD patients. Multivariate analysis revealed active smoking (aOR 6.9; 95% CI 1.8-25.6; p = 0.004), bruxism in females (aOR 17.9; 95% CI 2.0-159.2; p = 0.01), high ASDAS in males (aOR 11.8; 95% CI 1.2-122.5; p = 0.038) and neck disability (aOR 12.7; 95% CI 3.8-42.9; p < 0.001) as independent risk factors for TMD in AS patients. No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients.

Association analysis of Glutathione S-transferase omega-1 and omega-2 genetic polymorphisms and ischemic stroke risk in a Turkish population.

OBJECTIVES: Oxidative stress is a known risk factor for the pathogenesis of atherosclerosis, the main cause of ischemic stroke. Glutathione S-transferase (GST) omega-1 and omega-2, members of phase II enzymes, play a role in the antioxidant system. The single nucleotide polymorphisms (SNPs), C419A and A424G in GST omega genes can cause a decrease in enzyme activity. The aim of this study was to investigate the possible association between these polymorphisms and ischemic stroke risk in a Turkish population. METHODS: The genotypes and allele frequencies for 239 patients and 130 controls were determined by the PCR/RFLP method. No significant differences were found between patients and controls in terms of genotype and allele frequencies. RESULTS: The frequency of the polymorphic 'A' allele was 0.358 in patients and 0.342 in controls for the C419A polymorphism in the GSTO1 gene. The frequency of the polymorphic 'G' allele for GSTO2 A424G SNP was 0.370 in patients and 0.404 in controls. The combined homozygous wild type genotype 'CCAG' was significantly higher in control group than in the patients. CONCLUSION: No significant difference was observed between the stroke patients and controls in terms of genotypes and allele distributions. Double combine haplotype CCAA was found to be protective against ischemic stroke when compare to other haplotypes. However, different genotypes of GSTO1 and GSTO2 were observed to have effects on stroke risk in subgroups of diabetics and smokers. In conclusion, the current study is the first to report this finding.

Quick Diagnosis in Obstructive Sleep Apnea Syndrome: WatchPAT-200.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevelant disorder and found in approximately 2-4% of middle-aged adults. OBJECTIVES: To assess the efficacy of Watch-PAT-200 in the diagnosis of obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Patients suspected of having OSAS underwent overnight Level I polisomnography and simultaneously wore Watch-PAT-200 in the sleep laboratory. RESULTS: 51 adult patients included in the study. The average age was 45.3±10.5 years and the average body mass index (BMI) was 29.4±4.0 kg/m2. There was a high agreement between PSG and Watch PAT regarding apnea-hypopnea index, respiratory disturbance index and oxygen desaturation index. Significant but a low agreement was found in stage 1 and 2 of non-REM sleep when two methods compared. No agreement was found between PSG and Watch-PAT regarding stage 3 and 4 of non-REM sleep. Very low agreement was found between PSG and Watch-PAT regarding the REM sleep. CONCLUSIONS: Watch-PAT-200 is an effective method in the diagnosis of OSAS.

[Asymptomatic vena cava inferior aneurysm, case report]. / Asemptomatik inferior vena kava anevrizmali olgu.

Venous aneurysms are uncommon, whereas localized aneurysms of the inferior vena cava are extremely rare. Localized aneurysm of inferior vena cava was first publisheded in 1973 by Oh et al. Though venous aneurysms are generally asymptomatic, it is clinically important because of showing the symptoms of abdominal pain, gastrointestinal bleeding, acute venous obstruction, pulmonary embolism and even sudden death. Our case is also asymptomatic and localized aneurysm of the inferior vena cava is detected incidentally.

Hepcidin: A useful marker in chronic obstructive pulmonary disease.

PURPOSE: This study was designed to evaluate the levels of hepcidin in the serum of patients with chronic obstructive pulmonary disease (COPD). METHODS: In the study, 74 male patients (ages 45-75) in a stable period for COPD were grouped as Group I: Mild COPD (n:25), Group II: Moderate COPD (n:24), and Group III: Severe COPD (n:25). Healthy non-smoker males were included in Group IV (n:35) as a control group. The differences of hepcidin level among all the groups were examined. Also, in the patient groups with COPD, hepcidin level was compared with age, body mass index, cigarette (package/year), blood parameters (iron, total iron binding capacity, ferritin, hemoglobin, hematocrit [hct]), respiratory function tests, and arterial blood gas results. RESULTS: Although there was no difference between the healthy control group and the mild COPD patient group (P=0.781) in terms of hepcidin level, there was a difference between the moderate (P=0.004) and the severe COPD patient groups (P=0.002). The hepcidin level of the control group was found to be higher than the moderate and severe COPD patient groups. In the severe COPD patients, hepcidin level increased with the increase in serum iron (P=0.000), hct (P=0.009), ferritin levels (P=0.012), and arterial oxygen saturation (SaO(2), P=0.000). CONCLUSION: The serum hepcidin level that is decreased in severe COPD brings into mind that it may play a role in the mechanism to prevent hypoxemia. The results suggest that serum hepcidin level may be a useful marker in COPD. Larger prospective studies are needed to confirm our findings between hepcidin and COPD.

Patent foramen ovale among patients with mild chronic obstructive pulmonary disease and unexplained hypoxia.

PURPOSE: To evaluate whether patent foramen ovale (PFO) is a contributing factor to hypoxia in patients with chronic obstructive pulmonary disease (COPD). METHODS: Twenty-one patients over 40 years of age with mild COPD (Forced expiratory volume (FEV1)/Forced Vital Capacity (FVC): > 50%) who had hypoxia (PO(2) < 80 mmHg, SaO(2) < 95%) that could not be explained by COPD alone were included in this study. Arterial oxygen pressures (PO(2)) and arterial oxygen saturations (SaO(2)) were recorded from laboratory evaluations of arterial blood gases. Respiratory function tests were performed to analyze the degree of COPD. Standard and contrast echocardiography was used to calculate pulmonary artery pressure (PAP) levels and to determine patients with a PFO. RESULTS: The mean age of the patients was 64 +/- 12 years. Four patients (19%) had a PFO. The mean PO(2), mean SaO(2), and mean PAP levels were 57.4 +/- 6.8 mmHg, 90 +/- 3.2%, and 33.8 +/- 5.4 mmHg, respectively, in patients without PFO. The mean PO(2), mean SaO(2), and mean PAP levels were 46.5 +/- 13.7 mmHg, 79.3 +/- 12.8%, and 42.5 +/- 6.5 mmHg, respectively, in patients with PFO. There were no statistically significant differences noted between the two groups in the PO(2) levels (P = 0.172) and SaO(2) levels (P = 0.065). A comparison of the PAP levels revealed a statistically significant difference between the two groups, with values that were more elevated in the PFO group than in the non-PFO group (P = 0.031). CONCLUSION: This study demonstrated that PFO is not a contributing factor to deep hypoxia in COPD patients with lower PO(2) and SaO(2) levels; however, higher PAP levels were detected in patients with a PFO. Further studies involving a larger number of patients are needed to be conclusive.

[Vocal cord functions in patients with asthma attack]. / Astim atakli hastalarda vokal kord fonksiyonlari.

This study was planned to evaluate vocal cord functions and to establish underlying vocal cord dysfunctions (VCD) in patients with asthma attack. All patients admitted to emergency service of our hospital with asthma attack between February 01, 2007 and June 01, 2007 were included in the evaluation. After the evaluation, all patients regarded to have asthma attacks based on GINA 2006 guide were enrolled in the study. After first intervention, patients underwent endoscopic larynx examination for the evaluation of vocal cord functions. Twenty four (65.7%) male and 11 female (31.4%), overall 35 patients diagnosed with asthma and who did not have the history of another disease were included in the study. At endoscopic larynx examination carried out after first medical examination, at the moment of asthma attack, tongue, tongue base, epiglottis and arytenoid were observed to be within normal limits. In 9 (25.7%) patients, upper respiratory tract was hyperemic and in 2 (5.7%) odematous. One patient had nasal polyposis (p> 0.05). In the evaluation of vocal cord functions, restriction in adduction was observed in merely one patient. All other functions were normal. Rima opening width was established to be mean 8.34 + or - 0.725. VCD was deteced in none of the patients included in the study. Although we did not detect VCD in any patient, VCD should be borne in mind in cases which presents with the clinical picture of asthma and responds weakly to the treatment or in cases of unexplained shortness of breath. This may prevent many unnecessary procedures such as medication, entubation, tracheostomy and iatrogenic mortality. Further longutudial studies are required in order to shed light on the assocation of asthma with VCD.