Evaluation of Ankle Joint Position Sense in Patients with Type 2 Diabetes Mellitus with Peripheral Neuropathy by Isokinetic Dynamometer.

BACKGROUND: Proprioceptive disorders may occur when thick fibers are affected in diabetic neuropathy. This can lead to impaired joint stabilization and increased risk of falls and fractures. We evaluated joint position sense (JPS) in diabetic patients to detect those at risk for neuropathy earlier. METHODS: Sixty diabetic patients and 30 healthy individuals aged 30 to 60 years were included in the study and divided into three groups: 30 diabetic patients with peripheral neuropathy, 30 diabetic patients without peripheral neuropathy, and 30 nondiabetic control patients. Presence of neuropathy was determined electrophysiologically. Passive ankle JPS was evaluated by an isokinetic system in all three groups. Both 10° and 30° plantarflexion and 10° dorsiflexion were determined as target angles. The mean absolute angular error (MAAE) values for three trials with each angle were assessed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: The MAAEs with all of the angles were significantly higher in diabetic patients with peripheral neuropathy compared with diabetic patients without peripheral neuropathy and the control group (P < .001 for all of the comparisons). The MAAEs with right ankle 10° plantarflexion (P = .004) and 10° dorsiflexion (P = .007) and left ankle 10° plantarflexion (P = .008) were significantly higher in diabetic patients without peripheral neuropathy than in the control group. CONCLUSIONS: According to these results, ankle JPS may be deteriorated before determination of neuropathy electrophysiologically.Therefore, we believe that prophylactic programs in terms of the risk of falls and fractures by evaluating JPS need to be developed in the early stages of diabetes.

An Uncommon Presentation of a Rare Syndrome: Parsonage-Turner Syndrome Presenting With C8 Root Involvement.

Parsonage-Turner syndrome or neuralgic amyotrophy is a rare syndrome that presents with sudden and severe pain in the shoulder girdle and may cause loss of muscle strength, atrophy, and sensory deficits. We discuss the clinical and electroneuromyographic findings in a young woman who presented with left-sided arm pain and was diagnosed with Parsonage-Turner syndrome with C8 root involvement, which is a rare presentation of the disease.

Effect of Platelet-Rich Fibrin on Peripheral Nerve Regeneration.

PURPOSE: This study aimed to evaluate the effect of platelet-rich fibrin (PRF) on peripheral nerve regeneration on the sciatic nerve of rats by using functional, histopathologic, and electrophysiologic analyses. MATERIALS AND METHODS: Thirty female Wistar rats were divided randomly into 3 experimental groups. In group 1 (G1), which was the control group, the sciatic nerve was transected and sutured (n = 10). In group 2 (G2), the sciatic nerve was transected, sutured, and then covered with PRF as a membrane (n = 10). In group 3 (G3), the sciatic nerve was transected, sutured by leaving a 5-mm gap, and then covered by PRF as a nerve guide (n = 10). Functional, histopathologic, and electrophysiologic analyses were performed. RESULTS: The total histopathologic semiquantitative score was significantly higher in G1 compared to G2 and G3 (P < 0.05). Myelin thickness and capillaries were significantly lower in G3 compared to G1 (P < 0.05). There was no statistically significant difference between the groups with regard to the functional and electrophysiologic results. CONCLUSION: The study results suggest that PRF decreases functional recovery in sciatic nerve injury. Further studies are required to determine the efficacy of PRF on peripheral nerve regeneration.

Evaluation of intraabdominal hypertension and genitofemoral nerve motor conduction.

BACKGROUND/AIM: The aim of this study was to electrophysiologically evaluate the effect of increased intraabdominal pressure (IAP) on genitofemoral nerve (GFN) motor conduction. MATERIALS AND METHODS: Seven Wistar albino rats were included. After anesthetization, latency and duration of GFN conduction was recorded with a needle-probe at rest. IAP was increased to 15 mmHg by insufflating atmospheric air with a percutaneous intraperitoneal needle. At 30 min of IAP, GFN motor conduction was recorded. Abdominal pressure was then increased to 20 mmHg. At 60 min, GFN motor conduction was recorded again. The consecutive recordings of latency and duration of GFN conduction (rest, 30 min, 60 min) were evaluated statistically. RESULTS: There was a significant difference between latencies at rest (1.90 ± 0.22 ms), at 30 min (2.3 ± 0.36 ms), and at 60 min (2.74 ± 0.57 ms) (Friedman test, P = 0.001). The latency was significantly increased at 60 min compared to rest (post hoc Tukey test, P = 0.003). No similar difference was detected between the recordings at 30 and 60 min. The duration of GFN motor conduction showed no difference between consecutive recordings (P = 0.067). CONCLUSION: Both increased and prolonged IAP causes prolonged latency of GFN conduction, probably due to a compression effect on GFN. Neuropraxial consequences of increased IAP are thought to be related to the compression effect of peripheral nerves.

Conservative treatment of femoral neuropathy following retroperitoneal hemorrhage: a case report and review of literature.

Anticoagulant drugs are used to reduce the incidence of thromboembolic events in patients at risk. However, minor and major bleeding complications may occur during anticoagulation therapy. Femoral neuropathy secondary to retroperitoneal hematoma is a well known complication of anticoagulant drugs. However, treatment of these patients is still controversial, both conservative and surgical treatments have been advocated. Herein, we report a male patient receiving warfarin for 7 years who developed femoral neuropathy due to retroperitoneal hematoma and was successfully treated with conservative methods. We suggest that conservative treatment and appropriate rehabilitation program should be given to the patients who do not demonstrate any signs of a continued bleeding and any progressive neurological deficits.

Electrophysiologic evaluation of cremasteric reflex in experimental orchitis.

AIM: Absent cremasteric reflex (CR) is a well known but not reliable sign of testicular torsion. We hypothesized that CR can also be altered in other causes of acute scrotum in children. An experimental study was performed to evaluate the clinical and electrophysiological features of CR in orchitis. METHOD: Eighteen Wistar albino rats were allocated into three groups: control (CG), sham (SG) and orchitis (OG). In CG, after anesthetization with ketamine hydrochloride, the medial site of the anterior superior iliac spine was stimulated to obtain CR electrophysiologically, and latency and duration were recorded with a needle electrode placed in the cremasteric muscle. Electrophysiologic evaluations were performed 24 h after injection of 0.1 ml of 10(6) cfu/ml Escherichia coli (0:6 strain) in 1 ml of physiologic saline into the right testicle in OG, and 1 ml of saline only in SG. All testicles were sampled to check for orchitis after the electrophysiologic evaluations. RESULTS: CR was obtained in all rats in CG and in 83.3% and 66.6% in SG and OG respectively (p < 0.05). The latency of CR was significantly higher in OG (15.1 ± 0.9 ms) and SG (15.5 ± 1.2 ms) than CG (10.5 ± 0.7 ms) (p < 0.017). The duration of CR was 15.1 ± 3.2 ms in CG, 16.2 ± 4.9 ms in SG and 18.5 ± 3 ms in OG (p > 0.05). Histopathologic confirmation of orchitis was obtained in all testicle samples in OG, and number of neutrophils and total orchitis score was significantly higher in OG than the other groups (p < 0.05). CONCLUSION: Electrophysiologic parameters of CR may be altered in orchitis. Prolonged latency of CR in orchitis may be due to inflammation of the genitofemoral nerve or cremasteric muscle.

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.

Electrophysiologic evaluation of genitofemoral nerve in children with inguinal hernia repair.

AIM: Genitofemoral nerve (GFN) injury may occur because of chronic pressure of hernia sac or surgical intervention. A prospective study was performed to evaluate GFN electrophysiologically in children with inguinal hernia repair. METHODS: Children with inguinal hernia were evaluated for GFN electrophysiologically before and after (3-6 months postoperatively) inguinal hernia repair. Bilateral GFN motor response latencies and durations were investigated electrophysiologically by surface electrodes. Wilcoxon signed ranked test was used for statistical analysis, and P values lower than .05 was considered to be significant. RESULTS: Eleven patients with a mean age of 4.45 +/- 2.16 were enrolled in the study. Mean latency of patients was 2.37 +/- 0.89 milliseconds preoperatively and 3.14 +/- 1.02 milliseconds postoperatively. Latency of GFN was found prolonged after hernia repair (P = .008). Duration of GFN motor response was 9.94 +/- 1.49 milliseconds and 11.18 +/- 2.44 milliseconds, respectively, in preoperative and postoperative recordings. There was no significant difference detected in mean durations (P > .05). CONCLUSION: Latency of GFN may prolong after inguinal hernia repair. Prolongation of GFN latency may be the result of surgical injury during hernia repair and consequently also related with chronic groin pain.

Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: A case report and review of the literature.

The association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously.