Evaluation of aortic elastic properties in patients with fibromyalgia.

BACKGROUND: Chronic high sympathetic activity may lead to various negative cardiovascular responses in fibromyalgia. We aimed to investigate the elastic properties of the aorta in patients with fibromyalgia enrolled in this study. METHODS: One hundred and twelve women with fibromyalgia and 50 healthy controls were enrolled. Elastic parameters of aorta (aortic distensibility, aortic stiffness index) were calculated by predetermined formulas. Additionally fibromyalgia patients were subdivided into two groups as severely symptomatic (group A) and less symptomatic patients (group B). RESULTS: Aortic distensibility was significantly lower in group A than group B and control (3.18±1.35 vs. 4.00±0.99 and 4.03±0.6, P=0.03 and 0.007 respectively). Aortic Stiffness Index was significantly higher in group A than group B and control group (5.85±1.48 vs. 3.97±1.23 and 3.79±0.72, P=0.001 and P<0.001 respectively). CONCLUSION: These findings suggest that elastic properties of aorta are impaired in patients with severely symptomatic fibromyalgia.

Adult case of acrodysostosis with severe neurologic involvement.

OBJECTIVE: Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia and frequently mental retardation. Only one adult case of acrodysostosis has been reported to have neurologic symptoms. We report one further adult case of acrodysostosis with severe neurologic findings including myelopathy and spastic paraparesis due to diffuse spinal stenosis and recurrent deep vein thrombosis possibly caused by neurologic deficits. RESULTS: We report a 43-year-old woman who had back and neck pain with weakness in the extremities of several years. 1~year before admission to our hospital, she had been treated with a missed diagnosis of sero (-) spondyloarthropathy but had not benefited. She became unable to walk, thereafter she underwent decompression surgery with a diagnosis of degenerative spinal stenosis. She presented at our outpatient department complaining of lowback pain and difficulty walking. She had marked facial and peripheral appearance of acrodysostosis. Spinal MRI revealed extensive spinal stenosis. A diagnosis was made through the genetic investigation, clinical and radiological findings. Spastic paraparesis were detected. There was widespread neuropathic pain. 15 days after admission, she developed swelling and redness of the left lower extremity and the venous doppler ultrasonography showed left acute and right past DVT. We treated DVT with anticoagulant therapy. Gabapentin and Baclofen were initiated for neuropathic pain and spasticity. A conventional rehabilitation program was performed. She left walking with a walker without pain and spasticity. CONCLUSIONS: We would like to remind physicians to be aware of peripheral malformations as signs of skeletal dysplasias and to consider acrodysostosis in the differential diagnosis. Although it is a rare condition, if diagnosed early, possible complications can be treated and outcomes may be improved.

Spinal cord injury associated with thoracic osteoporotic fracture.

This report details a case of sudden neurologic deficit attributable to acute thoracic fractures associated with senile osteoporosis. A 73-yr-old female patient with a history of occasional back pain during the past 4 mos had sudden thoracic vertebral fracture with spinal cord injury. The patient, who had a benign past medical history, had not been evaluated for osteoporosis. Thoracic spine radiographs showed a compression fracture at T8. Thoracic magnetic resonance imaging exposed a compression fracture at T7-T8. She was treated operatively. She was found to have spinal cord injury with American Spinal Injury Association classification C (T7), and she had poor sitting balance. She was discharged in a wheelchair and was administered clean intermittent catheterization every 6 hrs. Six months after discharge, she ambulated with a walker and had spontaneous micturition. Vertebral fractures are a common presentation of senile osteoporosis. The risk of neurologic impairment attributable to vertebral fracture is a rare but potentially severe complication. Besides medical therapy and suitable rehabilitation programs, surgical treatment is an integral part of the management of patients with osteoporotic vertebral fractures.