Does the combination of inhaled steroids with long acting beta2 agonists decrease the risk for osteoporosis? A 1-year prospective follow-up study.

Combination of inhaled corticosteroids (ICS) with long acting beta2 agonists has been used increasingly in the treatment of moderate-severe asthma, however there is indefinitive data about their effect on bone loss. The aim of this study was to compare the effects of treatment with single ICS and combination of ICS with long acting beta2 agonists (combination therapy) on BMD and biomarkers of bone metabolism in adult patients with asthma over 1 year period. Forty-three patients with asthma were enrolled. Patients were separated into two groups according to their use of asthma drugs: single ICS or combination therapy (ICS plus long-acting inhaled beta2-agonist). Change in bone mineral density (BMD) and biochemical markers of bone metabolism were measured at baseline and at the end of 1 year. Mean ages and basal BMD of patients did not differ between the two groups (P > 0.05). The decrease in BMD was higher in the single ICS group than the combination therapy group, however there was no significant difference between them (P > 0.05). One year change (%) in BMD and biochemical markers of bone metabolism were not different between two groups (P > 0.05). In conclusion, use of ICS-in the range of doses used- does not seem to have an effect on the change of BMD. However, our data indicate a nonsignificant trend towards reducing bone loss with the use of combination therapy. Future studies are needed to provide definitive evidence for this trend to allow us suggesting combination therapy for minimizing bone loss.

Effects of intra-articular hylan G-F 20 injections on clinical and biomechanical characteristics of the knee in osteoarthritis.

The objectives of this study were to investigate the effects of Hylan G-F 20 (Synvisc; Genzyme Biosurgery, Ridgefield, New Jersey, USA) injections on clinical and biomechanical gait characteristics of patients with knee osteoarthritis. The design was a before-after trial, set in the gait laboratory of the rehabilitation unit of a university hospital. Twelve patients participated with an average age (+/-SD) of 63.2+/-4.4 years, and Kellgren and Lawrence grade II or III knee osteoarthritis. The main outcome measures were the Western Ontario McMaster Universities Osteoarthritis Index, and time-distance, kinematic and kinetic parameters of gait. The intervention used was a single course of three bilateral intra-articular injections of 2 ml Hylan G-F 20. One week after the treatment, the pain subscore and total score of WOMAC decreased from 9.2+/-2.7 to 4.8+/-3.1 and from 42.1+/-15.2 to 37.9+/-13.5, respectively. There was improvement in sagittal plane excursions of the knee (from 40.2+/-8.1 to 43.3+/-8.5), in extensor and adductor moments (from 0.26+/-0.2 to 0.14+/-0.1 and from 0.45+/-0.1 to 0.41+/-0.1, respectively), and in scaled vertical forces (from 85.8+/-4.5 to 88.4+/-5.4). All these differences were statistically significant. In conclusion, intra-articular Hylan G-F 20 injections not only decrease pain in patients with knee osteoarthritis, but can alter the natural history of the disease by decreasing excessive loads in the knees.

The peak oxygen uptake of healthy Turkish children with reference to age and sex: a pilot study.

Maximal oxygen uptake (VO2max) has an important place in the assessment of cardiopulmonary fitness. Currently there is insufficient normative data for Turkish children. With this preliminary study, we aimed to set up a normative data for our lab which may also serve as a basis for future large population based studies in Turkey. We assessed the peak oxygen consumption of 80 healthy Turkish children aged 5-13 years and examined the cardiopulmonary responses to exercise test in relation to their age, sex and body size. Dynamic lung functions were positively and significantly correlated with age. A similar correlation was observed for the peak VO2. A significant positive correlation between peak VO2 and body size was demonstrated only in boys for height. There were no differences in all of the test parameters with reference to sex except in the age group of 13 years. Boys who were 13 years old had higher mean values of maximal voluntary ventilation (MVV), oxygen uptake at anaerobic threshold, peak VO2, and exercise test duration than those of girls of the same age (p < 0.05). VO2 plateau was detected only in 25%, and when two groups with and without VO2 plateau were compared, there were no differences regarding the age, sex, weight, height and exercise test results. Assessment of VO2 by graded exercise stress testing by treadmill is accepted as a safe and effective method of evaluating the physical fitness of children. Current study presents normal data for a limited subpopulation of healthy Turkish children.

Comparison of sensory conduction techniques in the diagnosis of mild idiopathic carpal tunnel syndrome: which finger, which test?

To compare the sensitivity of different electrodiagnostic tests on the same hand affected by mild carpal tunnel syndrome (CTS), 189 hands with the clinical diagnosis of CTS and 61 hands of healthy persons were evaluated prospectively. On all hands, median sensory studies from digits 1, 2, 3, 4, and the palm-to-wrist segment from digit 3 and medial motor latency were recorded. Sixty-two hands with delayed motor latency (>4.2 ms) were excluded to ensure that only mild cases were enrolled. Sensory median-radial latency differences from the thumb, median-ulnar latency difference between second and fifth digits, and median-ulnar latency difference from the fourth digit were calculated in each limb. Sensory studies of only one median innervated digit failed to diagnose 15-20% of hands. Conduction velocity at the palm-to-wrist segment was the most sensitive, diagnosing 99% of cases. In comparative tests, median radial sensory latency difference from the first digit was the most sensitive (94%), and median ulnar latency difference from the fourth digit was the least (85%) sensitive. Segmental measurement has the highest diagnostic yield and may be used first in the evaluation of CTS.

Serum levels of IL-1 beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies.

OBJECTIVES: Some immunological abnormalities have been described in seronegative spondyloarthropathies (SpA). The aim of this study is to determine the serum levels of IL-1beta, TNF-alpha and IL-8, which are proinflammatory cytokines in active and inactive patients with SpA, to compare the results with those of controls and to investigate a relationship with clinical activity and acute phase proteins. METHODS: Forty-two patients (34 males and eight females) and 22 healthy controls (17 M and 5 F) were included in the study. All patients fulfilled Amor criteria for the classification of SpA. Among patients 23 had active and 19 had inactive disease. IL-1beta, TNF-alpha and IL-8 were determined by enzyme-linked immunosorbent assay ( ELISA), acute phase proteins were measured by nephelometric assay. RESULTS: There was no statistically significant difference between mean IL-1beta levels of patient groups and controls. Serum mean TNF-a levels in active and inactive patients were significantly increased as compared to that in the controls (P < 0.05, P < 0.05, respectively). Serum mean IL-8 levels in active patients was significantly increased as compared to that in the controls and in inactive patients (P < 0.01, P < 0.01, respectively). High serum IL-8 levels correlated well with C-reactive protein and haptoglobulin, but there was no correlation between IL-1beta or TNF-alpha levels and acute phase proteins such as C-reactive protein, alpha-1 acid glycoprotein, alpha-1 antitrypsin and haptoglobulin. CONCLUSIONS: These results suggest that serum IL-8 may reflect clinical activity of the disease and may be helpful for monitoring patients with SpA.

Localization of extrapulmonary tuberculosis in the synovial membrane, skin, and meninges in a patient with systemic lupus erythematosus and IgG deficiency.

We report on a 31-year-old female patient with systemic lupus erythematosus (SLE) for 24 years who had a past history of skin tuberculosis (lupus vulgaris), long-term corticosteroid therapy, and IgG deficiency. She presented with monoarthritis and concomitant meningitis from skin tuberculosis after 5 years. The diagnosis of joint and meningeal tuberculosis was defined with clinical symptoms--signs and typical histopathological findings of involved synovium. Clinical improvement was achieved with antituberculous therapy. Cutaneous, articular, and cerebral manifestations of tuberculosis might have been confused with some of the lupus manifestations or lupus activation. It should be kept in mind that tuberculosis may be encountered in SLE due to the nature of the underlying disease and/or its therapy. It is also worth mentioning that, in this patient, tissues involved with extrapulmonary tuberculosis were the primary areas of involvement with SLE.

Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee.

Osteoarthritis (OA) of the knee is a very common rheumatological disease, and there are various treatment modalities for it. The aim of this study was to investigate the effects of home-based exercise and walking programs in the treatment of OA. A total of 90 patients with knee osteoarthritis were included. Their ages ranged between 48 and 71 years. The patients were separated into three groups. None of them had practiced a daily simple exercise program during the previous year. Group 1 ( n=30) was given a home-based exercise program. Group 2 ( n=30) had regular a walking program three times per week, starting with 10-min duration. Group 3 ( n=30) was accepted as the control group. Patients were assessed according to pain, functional capacity, and quality of life parameters. Pain was evaluated by the Western Ontario McMaster osteoarthritis index (WOMAC) of pain score and visual analogue scale (VAS). Functional capacity was measured by WOMAC physical function index. Quality of life was assessed by the Nottingham Health Profile questionnaire (NHP). All groups continued the program for 3 months. At the end of the therapy, the patients were called and 81 were accepted to come to the hospital. Although WOMAC pain and physical functional scores and VAS scores were statistically lower in both groups than in the control group ( P<0.001), the difference between groups 1 and 2 was not statistically significant ( P>0.05). But the result of the NHP showed a statistically significant improvement in the walking group when compared to the home-based exercise and control groups ( P<0.001). As a result, we conclude that a simple home-based exercise therapy and a regular walking program are effective in treating the symptoms of OA.

Osteoblastoma of the lumbar spine as a cause of chronic low back pain.

We report a case of osteoblastoma in the uncommon location of the L5 lumbar vertebra, detailing the clinical and radiologic aspects. Although the plain radiographs of the patient were normal, computed tomographic scans of the lumbar region confirmed the diagnosis of osteoblastoma or osteoid osteoma of the L5 vertebra. The patient was referred to the orthopedic department for operation. Histologic examination revealed osteoblastoma of the L5 vertebra. Following surgery, the patient's pain resolved completely. Although osteoblastoma is extremely rare in the spine, it should be included in the differential diagnosis as a cause of chronic back pain, especially in young males with painful scoliosis and/or radicular-type leg pain. The tumor is often not readily apparent on plain radiographs. Therefore, advanced radiological investigation is necessary to establish the correct diagnosis.

Cavanagh's syndrome (congenital thenar hypoplasia).

Thenar hypoplasia can be an isolated defect, as in Cavanagh's syndrome, can be present with cardiac (Holt-Oram syndrome) or eye (Okihiro's syndrome) disorders, or can be associated with hand anomaly, as in Haas's malformation. Vascular abnormality may be associated with thenar hypoplasia, which has been demonstrated in Okihiro's syndrome. Cavanagh's syndrome is a rare anomaly of the upper extremities that presents with unilateral or bilateral hypoplasia of the thenar eminence. Typical clinical, radiographic, and electrophysiologic findings emphasize the diagnosis. Differentiation from carpal tunnel syndrome is important to prevent unnecessary intervention. Electrophysiologic and radiographic findings are necessary tools for the physician to establish a correct diagnosis and make an appropriate referral. Because of its rarity, we present the case of an 8-year-old girl with this syndrome.

Epileptic and non-epileptic cerebral palsy: EEG and cranial imaging findings.

The aims of the study were to compare the clinical types, electroencephalogram (EEG) and cranial magnetic resonance imaging/computed tomography findings of epileptic and non-epileptic cerebral palsy (CP) patients. Seventy-four patients with CP were evaluated in 2 years. Tetraplegic CP had a higher incidence of epilepsy (60.5%). EEG was confirmed abnormal in epileptic CP as 90.3%, and in non-epileptic CP as 39.5%. Focal epileptiform activity, generalized slowing, and multifocal epileptiform activity were significantly frequent in epileptic CP. There were cranial imaging abnormalities of 74.2% in epileptic and 48.8% in non-epileptic CP. Although there was not any statistically significant difference between the two groups, epileptic group revealed more structural abnormalities. Further studies concerning a possible risk of epilepsy development and its relations with the EEG and cranial imaging findings are needed in presenting the other risk factors involved and the factors affecting the CP prognosis.