Ultrasonographic assessment of the femoral cartilage in osteoarthritis patients with and without osteoporosis.

BACKGROUND: The relationship between osteoporosis (OP) and osteoarthritis (OA) is yet unclear. AIM: To evaluate the possible effect of OP on the femoral cartilage thickness in female patients with knee OA. MATERIALS AND METHODS: Eighty patients with a diagnosis of knee OA were enrolled. Forty subjects who also had OP comprised Group I and the remaining 40 OA subjects comprised Group II. Antero-posterior knee radiographs were obtained in standing position and they were evaluated according to Kelgren-Lawrence (K-L) grading scale. Femoral cartilage evaluations were performed using a linear array US probe (7-12 MHz). In addition, ultrasonographic femoral cartilage grading was also performed for each knee. RESULTS: Left knee scores pertaining to both gradings were found to be lower (p = 0.02, p = 0.04, respectively) in Group I when compared with those of Group II. The two grading scores were positively correlated for both knees-statistically significant only for the right side (r = 0.727, p = 0.01). No significant difference was found between the groups in terms of femoral cartilage thicknesses (all p > 0.05). DISCUSSION: Ultrasonographic and roentgenographic gradings were consistent and patients with OP had lower scores for both gradings. On the other hand, the presence of OP did not seem to have any effect on cartilage thickness measurements. CONCLUSIONS: To the best knowledge of the authors, this study is the first to have explored the impact of OP on OA using US in the literature.

Sonographic diagnosis of recurrent peroneal tendon subluxation.

A case of recurrent peroneal tendon subluxation is reported. Dynamic ultrasonography is the best imaging modality in the diagnosis of peroneal tendon subluxation.

The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome.

OBJECTIVE: Chronic fatigue syndrome (CFS) is a chronic disease with social components that ensue secondary to the incapacity of the person to fulfill work, social and family responsibilities. Currently, there is no consensus regarding its treatment. The aim of this study was to determine the efficacy of hyperbaric oxygen (HBO2) therapy in CFS. DESIGN: Sixteen patients included in the study were diagnosed with CFS according to the Fukuda criteria. Patients received 15 treatment sessions of HBO2 therapy over a period of three consecutive weeks (five days per week). The outcome measures (visual analog fatigue scale (VAFS). Fatigue Severity Scale (FSS) and Fatigue Quality of Life Score (FQLS) were assessed before the treatment and after completion of the 15 sessions. RESULTS: HBO2 therapy was well tolerated, with no complications. After treatment, patients' scores were found to have improved with respect to VAFS, FSS and FQLS (all p<0.005). CONCLUSIONS: We ,may infer that HBO2 therapy decreases the severity of symptoms and increases the life quality of CFS patients. It may be a new treatment modality for the management of CFS. However, further studies with larger sample sizes and control groups are definitely awaited.

The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial.

The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome (MPS). This was a prospective, double-blinded, randomized-controlled study conducted in an outpatient clinic. Thirty-nine subjects with established myofascial trigger points were randomized into two groups: study group (N = 22) and placebo group (N = 17). Dry needling was applied using acupuncture needles, and sham dry needling was applied in the placebo group. The treatment was composed of six sessions which were performed in 4 weeks; the first four sessions were performed twice a week (for 2 weeks) and the last two, once a week (for 2 weeks). The visual analog scale (VAS) and Short Form-36 (SF-36) were used. When compared with the initial values, VAS scores of the dry needling group following the first and sixth sessions were significantly lower (p = 0.000 and p < 0.000, respectively). When VAS scores were compared between the groups, the first assessment scores were found to be similar, but the second and third assessment scores were found to be significantly lower in the dry needling group (p = 0.034 and p < 0.001, respectively). When SF-36 scores of the groups were compared, both the physical and mental component scores were found to be significantly increased in the dry needling group, whereas only those of vitality scores were found to be increased significantly in the placebo (sham needling) group. The present study shows that the dry needling treatment is effective in relieving the pain and in improving the quality of life of patients with MPS.

Chronic low back pain caused by osteopetrosis type 2.

Causes for low back pain usually involve damages in bone, muscle or nerve tissues of spine. Hereditary sclerosing bone disorders are rarely presented with low back pain. This report is intended to remind that osteopetrosis type 2, which is a rare disorder in differential diagnosis of low back pain, should be taken into consideration.

Hepatitis B virus reactivation in a juvenile rheumatoid arthritis patient under treatment and its successful management: a complicated case.

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.

A sledgehammer on the brachial plexus: thoracic outlet syndrome, subclavius posticus muscle, and traction in aggregate.

Reported here is a 30-year-old man who was seen because of pain and weakness in the upper extremities after a tractional injury. Physical examination revealed significant atrophy in the left deltoid and right intrinsic hand muscles, generalized hypoesthesia, decreased deep tendon reflexes bilaterally, and decreased strength in various muscle groups. Roos (right) and hyperabduction (bilateral) tests were positive. Electrodiagnostic studies were consistent with bilateral brachial plexopathy. Cervical radiographs showed long transverse process of C7 on the right side and a small rudimentary rib articulating with C7 on the left side. Brachial plexus magnetic resonance imaging demonstrated an aberrant muscle and compressive brachial plexus injury on the left side. Surgery via transaxillary approach was performed on the left side. The occurrence of traumatic brachial plexopathy in the presence of underlying thoracic outlet syndrome and subclavius posticus muscle is discussed for the first time in the literature.

Nerve conduction studies in patients with ankylosing spondylitis.

OBJECTIVES: The objective of this study was to investigate any relationship between peripheral neuropathy and ankylosing spondylitis (AS), and to evaluate the peripheral nervous system of AS patients and disclose any relationship between neuropathy and disease-related parameters. PATIENTS AND METHODS: Thirty-two AS patients without any symptoms of neuropathy were prospectively recruited in 2 centers. They were substantially evaluated both for AS and evidence of peripheral neuropathy. Motor and sensory nerve conduction studies with regard to median, ulnar, common peroneal, tibial, and sural nerves were performed. Nerve conduction study results of AS patients were compared with those of 30 healthy subjects. RESULTS: Six patients (18.8%) were diagnosed to have involvement of the peripheral nervous system (5 sensory and 1 sensorimotor), and 7 patients (21.9%) had focal nerve involvements (6 had prolonged median distal sensory latency and 1 patient had slowing of the right ulnar nerve motor conduction velocity at the cubital tunnel). Tibial nerve motor conduction velocity was positively correlated with Schober (r = 0.48, p = .03) and chest expansion tests (r = 0.44, p = .05). Sural nerve sensory action potential amplitude was found to be negatively correlated with age (r = -0.53, p = .02) and disease duration (r = -0.55, p = .02). Ulnar nerve motor conduction velocity at the forearm was positively correlated only with Schober values (r = 0.48, p = .03). CONCLUSIONS: We imply that the peripheral nervous system can as well be involved as the central nervous system in asymptomatic AS patients. Further studies with larger samples and with longer disease duration are awaited to confirm our results and to unravel its clinical relevance. Other types of neuropathies or the burden of several drugs on peripheral neuropathy also remains to be deciphered.

Neurological symptoms after a provocative dive: spinal DCS or anterior spinal artery syndrome?

Reported here is a 37-yr-old professional diving instructor who had developed complaints of back pain and weakness in the lower extremities after diving. He was eventually diagnosed as having spinal cord decompression sickness along with a likely diagnosis of anterior spinal artery (artery of Adamkiewicz) syndrome. Additionally, since the transthoracic echocardiography revealed patent foramen ovale, we hypothesized that it might have been a potential route for gas bubbles to occlude the anterior spinal artery in this diver.

Thoracic outlet syndrome in a patient with Poland syndrome.

We report a 20-year-old man with Poland syndrome who suffered from weakness, pain, numbness, and discoloration in the left upper extremity. He was eventually diagnosed as also having thoracic outlet syndrome. The concomitance of these two disorders is discussed with a special emphasis on the underlying mechanisms.

Work disability in ankylosing spondylitis: differences among working and work-disabled patients.

Ankylosing spondylitis (AS) is a systemic chronic inflammatory disease primarily affecting the axial skeleton. Work disability can be one of the major consequences of AS, and the knowledge about the burden of AS to the patient and society is not well-established yet. The objective of this study was to investigate work disability among patients with AS in the national service and to put forward the related factors and differences among disabled and nondisabled groups. A total of 121 male AS patients were included in the study. Patient demographics and duration of disease were noted, and employment status and disability were questioned. Measures of functionality, axial mobility, health-related quality of life, and depression were used. It was found that 38 patients (31.4%) continued their work lives with no change, 54 patients (44.6%) changed to a lighter job, and 29 patients (24%) were retired due to AS. Differences in age at onset of the disease, time since the diagnosis, C-reactive protein (CRP) levels, and hip involvement were statistically significant. The mean retirement age of the patients was 36 +/- 4.2 years. Frequency of hip involvement was higher in the work-disabled group. Spine was evidently affected more seriously, and CRP values were higher in the work-disabled group. Older age at onset, longer time since the diagnosis, longer diagnosis delay, and some physical impairments like decrease in spinal mobility and hip involvement may preclude AS patients from leading a productive work life.