Predictors of successful treatment after transforaminal epidural steroid injections in patients with lumbar disc herniation.

BACKGROUND: Epidural steroid injections are common procedures used to treat lumbosacral radicular pain due to lumbar disc herniation (LDH). It is crucial for the clinician to anticipate which patients can benefit from interventional treatment options. OBJECTIVE: This study aimed to examine the effect of radiological and clinical parameters on lumbar transforaminal epidural steroid injections (TFESI)/local anesthetic injection outcomes in patients with LDH. METHODS: This study included 286 patients with LDH (146 males and 140 females). All patients received a fluoroscopically guided TFESI (triamcinolone acetonide 40 mg, lidocaine 2%, and 2.5 ml of physiological saline). Patients were evaluated according to radicular pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale at baseline and 3 months after the injections. Demographic, clinical and magnetic resonance imaging (MRI) findings were recorded to assess the predictive factors for TFESI outcomes. Pfirrmann Grades 1 and 2 were classified as low-grade nerve root compression and Grade 3 was classified as highgrade nerve root compression. RESULTS: Compared to baseline measurements there were significant improvements in radicular pain, ODI score, Laseque angle, and Schober test scores 3 months after injection. Improvements of at least 50% in radicular pain relief and the ODI functionality index were (n= 214) 82%, (n= 182) 70% respectively at 3 months. Correlation analyses revealed that a shorter duration of symptoms, lowgrade nerve root compression and foraminal/extraforaminal location on MRI findings were associated with a favorable response. CONCLUSIONS: Lowgrade nerve root compression was a predictor of a favorable response to TFESI.

Sleep quality and associated factors in ankylosing spondylitis: relationship with disease parameters, psychological status and quality of life.

The aim of this study is to investigate sleep quality in patients with ankylosing spondylitis (AS) and to evaluate the relationship of the disease parameters with sleep disturbance. Eighty AS patients (60 males and 20 females) fulfilling the modified New York criteria, and 52 age- and gender-matched controls (33 males and 19 females) were enrolled in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Pain was measured by visual analogue scale. The disease activity and functional status were assessed by the Bath AS disease Activity Index and the Bath AS Functional Index. The Bath AS Metrology Index was used to evaluate mobility restrictions, and the Bath AS Radiology Index was employed to evaluate the radiological damage. The psychological status and quality of life were assessed with the hospital anxiety-depression scale and AS quality of life scale. The patients with AS had significantly more unfavourable scores in the subjective sleep quality, habitual sleep efficiency domains (p < 0.001) and the total PSQI score (p < 0.05). Poor sleep quality (total PSQI score) was positively correlated with increased pain, poor quality of life, higher depressed mood, higher disease activity and mobility restrictions. Pain was also an independent contributor to poorer sleep quality (p = 0.002). The sleep quality is disturbed in patients with AS. The lower quality of sleep is greatly associated with the pain, disease activity, depression, quality of life and increased limitation of mobility.

Relationship of the sexual functions with the clinical parameters, radiological scores and the quality of life in male patients with ankylosing spondylitis.

The aim of this study was to explore the impact of ankylosing spondylitis (AS) and the disease-related variables on the patients' sexual function according to the International Index of Erectile Function (IIEF) scoring system. A total of 70 sexually active male AS patients and 60 healthy controls were enrolled in this study. Their demographic data were evaluated, and the pain was assessed according to the visual analogue scale (VAS). Laboratory tests were conducted in order to measure the C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) of the patients. The disease activity was evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional statement was evaluated with the help of the Bath Ankylosing Spondylitis Functional Index (BASFI) and with the scores obtained from the spinal measurements with the Bath Ankylosing Spondylitis Metrology Index (BASMI). The Bath Ankylosing Spondylitis Radiology Index (BASRI) was used to evaluate the radiological damage. The disease-related quality of life was measured with the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). The anxiety and depression level of the patients was revealed through the Hospital Anxiety and Depression Scale (HADS). In comparison with the healthy control group, patients with AS had significantly lower scores in each of the 5 domains of the IIEF (p < 0.0001). The BASDAI, BASFI, BASMI, BASRI, ASQoL, HADS scores and CRP levels were negatively correlated with IIEF (p < 0.05). Orgasmic function and sexual desire scores were significantly lower in patients with peripheral arthritis (p < 0.05). No significant correlation was observed with the disease duration, smoking status, pain (VAS), and ESR levels when the total scores and the scores from the domains of IIEF were compared. The multivariate regression analyses indicated that BASFI and BASMI were independently associated with the sexual function. The sexual function is impaired in male patients with AS. This impairment in the sexual function is especially correlated with the BASFI and BASMI among the clinical and laboratory parameters.

Sexuality of men with fibromyalgia: what are the factors that cause sexual dysfunction?

The purpose of the present study is to compare male patients with the fibromyalgia syndrome (FMS) with healthy individuals in terms of the sexual function. For the purposes of this study, 37 sexually active male FMS patients and 30 healthy controls were enrolled. The demographic data of the patients were recorded, and the widespread pain observed in FMS was graded with the help of the visual analogue scale (VAS 0-100 mm). Sexual function was assessed according to the international index of erectile function (IIEF) scoring system. The disease-related quality of life was measured with the help of the Short Form-36 quality of life questionnaire (SF-36 QoL). Levels of anxiety and depression observed in the patients were graded through the Hospital Anxiety and Depression Scale (HADS). Patients with FMS had significantly lower scores in each of the five domains of the IIEF in comparison with the healthy control group (p < 0.001). Patients' age and widespread pain were negatively correlated with the IIEF scores (p < 0.05). The SF-36 scores (physical functioning, role limitations due to physical problems, pain and general health perception) were observed to be positively correlated with the IIEF scores (p < 0.05). No significant relationship has been observed between the scores obtained from the domains of IIEF and the psychological status (p > 0.05). FMS leads to an impairment in the sexual function in male patients, which is especially strongly associated with the age, widespread pain and the quality of life.

Sleep quality in patients with systemic sclerosis: relationship between the clinical variables, depressive symptoms, functional status, and the quality of life.

The aim of this study is to evaluate the relationship between the sleep quality and the disease-related variables, functional status, quality of life, and depressive symptoms in patients with systemic sclerosis (SSc). Forty-eight patients diagnosed with SSc and 42 healthy control subjects were enrolled in the study. The demographic and clinical characteristics of the patients such as the Raynaud's phenomenon, SSc subtype, digital ulcers, gastrointestinal and lung involvement, and disease activity were recorded. All patients were assessed using the short form 36 (SF-36) quality of life scale, the health assessment questionnaire and the beck depression inventory. Generalized pain and fatigue were assessed with the Visual Analoge Scale. For the evaluation of the sleep disturbance, the SSc and control groups were assessed with the help of the Pittsburgh Sleep Quality Index (PSQI). The patients with SSc had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, daytime dysfunction domains, and in terms of the total PSQI score compared to the healthy control group (p < 0.05). According to the results of spearman's analysis, there was a significantly higher correlation between the generalised pain, fatigue, depressive symptoms, functional status, and physical score of the SF-36 and the sleep disturbance (p < 0.01). There was also a significantly lower correlation between the menopause status, dyspnoea, gastroesophageal reflux, dysphagia, the mental score of the SF-36, and the sleep disturbance (p < 0.05). The sleep quality is disturbed in patients with SSc. The lower quality of sleep is especially associated with the pain, fatigue, depressive symptoms, and functional status.

Assessment of sexual function and quality of life in patients with lower limb amputations.

BACKGROUND: Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial. OBJECTIVE: The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function. METHODS: Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36). RESULTS: Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01). CONCLUSION: The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.

The effectiveness of transforaminal epidural steroid injections on radicular pain, functionality, psychological status and sleep quality in patients with lumbar disc herniation.

BACKGROUND: The significance of fluoroscopy-guided transforaminal epidural steroid injections (TFESI) in the treatment of lumbar disc herniation (LDH) is well known. The aim of our study is to investigate the effectiveness of TFESI on radicular pain, functionality, psychological status, and sleep quality in patients with LDH. METHODS: Seventy-five LDH patients (36 males, 39 females) were enrolled in the study. All patients received a fluoroscopically guided TFESI (betamethasone 40 mg, lidocaine 2%). Also all patients were evaluated according to (with the visual analogue scale) radicular pain, Oswestry disability index (ODI), hospital axiety and depression scale, and Pittsburgh sleep quality index (PSQI) at baseline, at two weeks, and 12 months post injections. RESULTS: Mean age was 46.4 ± 12.5. When compared to baseline measurements there were significant improvements in radicular pain, ODI, modified schober, Laseque angle, finger to floor distance, depressive symptoms and PSQI scores at two weeks and 12 months after injection. Improvement of at least 50% in radicular pain relief, ODI score and sleep quality index was detected at two weeks 83%, 71%, 69% respectively. This rate showed regression at 12 months of 73%, 65% and 62% respectively. Duration of symptoms was significantly negatively correlated with changes in scores of radicular pain, ODI, depressive symptoms, and PSQI. There were no significant correlations with symptom duration and anxious symptoms. CONCLUSION: Fluoroscopy guided TFESI had positive effects on radicular pain, functionality, depressive symptoms and sleep quality in management of LDH.

Serum GDF-15 level in rheumatoid arthritis: relationship with disease activity and subclinical atherosclerosis.

OBJECTIVES: Growth differentiation factor (GDF)-15 was originally identified as a factor secreted by activated macrophages, and plays an important role in cell growth and differentiation. GDF-15 plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate the serum GDF-15 levels and their relationship with disease-related characteristics in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Forty-six patients diagnosed with RA and 36 demographically matched healthy control subjects participated in this study. GDF-15 levels were measured in blood samples from patients and controls. The disease activity score-28 (DAS28) was used to evaluate the disease activity of RA. The quality of life was evaluated using the disease-specific rheumatoid arthritis quality of life (RAQoL) scale. The health assessment questionnaire (HAQ) was used to evaluate the functional status. The degree of joint damage was assessed according to Larsen's method. Atherosclerosis was assessed by a cardiologist with the help of echocardiography according to the carotid intima media thickness (CIMT) method; vascular stiffness was assessed by using the flow mediated dilatation (FMD) method. RESULTS: Serum GDF-15 levels were significantly higher in RA patients when compared to the control subjects (p< 0.05). RA patients were divided into two groups according to the disease activity; while 26 subjects (57%) were in the active group, 20 patients were in the non-active group (43%). Serum GDF-15 levels were significantly higher in the group that was considered to have an active disease. According to Pearson's correlation, serum GDF-15 levels were positively correlated with erythrocyte sedimentation rate (ESR) levels, morning stiffness, DAS28 score, tender joint count, and CIMT (p<0.05). CONCLUSION: GDF-15 may play a role in the pathway of disease activity, joint involvement, and atherosclerosis in patients with rheumatoid arthritis.

Sockets Manufactured by CAD/CAM Method Have Positive Effects on the Quality of Life of Patients With Transtibial Amputation.

OBJECTIVE: Patients with amputation need prosthesis to comfortably move around. One of the most important parts of a good prosthesis is the socket. Currently, the most commonly used method is the traditional socket manufacturing method, which involves manual work; however, computer-aided design/computer-aided manufacturing (CAD/CAM) is also being used in the recent years. The present study aimed to investigate the effects of sockets manufactured by traditional and CAD/CAM method on clinical characteristics and quality of life of patients with transtibial amputation. DESIGN: The study included 72 patients with transtibial amputation using prosthesis, 36 of whom had CAD/CAM prosthetic sockets (group 1) and 36 had traditional prosthetic sockets (group 2). Amputation reason, prosthesis lifetime, walking time and distance with prosthesis, pain-free walking time with prosthesis, production time of the prosthesis, and adaptation time to the prosthesis were questioned. Quality of life was assessed using the 36-item Short Form Health Survey questionnaire and the Trinity Amputation and Prosthesis Experience Scales. RESULTS: Walking time and distance and pain-free walking time with prosthesis were significantly better in group 1 than those in group 2. Furthermore, the prosthesis was applied in a significantly shorter time, and socket adaptation time was significantly shorter in group 1. Except emotional role limitation, all 36-item Short Form Healthy Survey questionnaire parameters were significantly better in group 1 than in group 2. Trinity Amputation and Prosthesis Experience Scales activity limitation scores of group 1 were lower, and Trinity Amputation and Prosthesis Experience Scales satisfaction with the prosthesis scores were higher than those in group 2. CONCLUSION: Our study demonstrated that the sockets manufactured by CAD/CAM methods yield better outcomes in quality of life of patients with transtibial amputation than the sockets manufactured by the traditional method.

Sleep quality in patients with psoriatic arthritis.

AIM: The purpose of this study was to determine the effects of psoriatic arthritis (PsA) on sleep quality and investigate the association between sleep quality and clinical parameters of PsA, quality of life and psychological state in patients with PsA. METHOD: Forty-one patients with PsA and 38 healthy volunteers were included in this study. In both patients and healthy controls, sleep quality was assessed by means of the Pittsburgh Sleep Quality Index (PSQI) and anxiety and depression were assessed by means of the Hospital Anxiety and Depression Scale (HADS). In addition, PsA Quality of Life (PsAQoL) Index and Psoriasis Area and Severity Index (PASI) were used on patients. Generalized pain was assessed by means of a visual analogue scale (VAS). RESULTS: Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, daytime dysfunction and total PSQI scores were significantly higher in patients with PsA compared to healthy controls. Total PSQI scores significantly correlated with anxiety, generalized pain, PsAQoL scores, enthesitis and levels of C-reactive protein (CPR) and erythrocyte sedimentation rate (ESR) (P < 0.05). Also, multiple regression analysis indicated that ESR level was independently associated with total PSQI score (P < 0.05, R2  = 0.325). CONCLUSION: Sleep quality is diminished in patients with PsA. Sleep disturbance is particularly associated with generalized pain, anxiety, enthesitis and levels of CRP and ESR in patients carrying the diagnosis of PsA.

Posterior Epidural Migration of a Sequestered Lumbar Intervertebral Disc Fragment.

AIM: Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF. MATERIAL AND METHODS: This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria. RESULTS: As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%). CONCLUSION: The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits.

Kinesio taping in patients with lateral epicondylitis.

BACKGROUND: Lateral epicondylitis (LE) is a painful condition that affects the tendinous tissue of the lateral epicondyle of the humerus and leads to loss of function of the affected limb. Therefore it can have a major impact on the patient's social and personal life. Many treatments are recommended for lateral epicondylitis; unfortunately the evidence is limited. OBJECTIVES: The aim of study was to investigate the effect of kinesio taping (KT) on pain, grip strength and function in patients LE. METHODS: Thirty-one (23 females, 8 males) patients with LE were included. KT was applied twice a week for 2 weeks. Pain at rest, activity of daily living (ADL), night and palpation on lateral epicondyle was evaluated with the visual analog scale (VAS 0-10 cm), and the grip strength was measured with a hand held dynamometer. The stage of the disease was evaluated by the Nirschl score and the functional status was assessed with Patient-Rated Forearm Evaluation Questionnaire (PRTEQ) score. These parameters were evaluated before, at 2 weeks and 6 weeks after treatment. Patients' satisfaction was also recorded on a Likert scale after treatment at 2 weeks and 6 weeks. RESULTS: The average age of the patients was 43.58 ± 9.02. The dominant limb was affected in 64.5% (20) of the patients. After the application of KT on lateral epicondyle, there was a significant improvement in all parameters in terms of pain, Nirschl score, hand grip strength, patient satisfaction, and PRTEQ scores at 2 and 6 weeks. CONCLUSIONS: Kinesio taping can be an effective treatment method in LE. This application improves pain, grip strength and functional status of the patients with LE.

High Frequency of Fibromyalgia in Patients With Acne Vulgaris.

OBJECTIVES: This study aims to investigate the frequency of fibromyalgia syndrome and to specify fibromyalgia syndrome-associated clinical symptoms in patients with acne vulgaris. PATIENTS AND METHODS: Eighty-eight patients (28 males, 60 females; mean age 23.2±5.1 years; range 18 to 40 years) with acne vulgaris and age, sex- and body mass index-similar 76 healthy controls (14 males, 62 females; mean age 24.5±2.9 years; range 18 to 35 years) were included. Acne vulgaris was evaluated by using the Global Acne Scale, while Hospital Anxiety and Depression Scale was used to evaluate anxiety. RESULTS: Fibromyalgia-associated pain, sleep disturbance, anxiety, and menstrual cycle disturbance were significantly more frequent in patients with acne vulgaris than controls. Also, the severity of anxiety and the number of tender points were significantly higher in the acne vulgaris patients than controls. CONCLUSION: This study indicates that patients with acne vulgaris have increased frequency of fibromyalgia syndrome than healthy controls (21.6% versus 5.3%, respectively).

Efficiency of therapeutic ultrasound on pain, disability, anxiety, depression, sleep and quality of life in patients with subacromial impingement syndrome: A randomized controlled study.

BACKGROUND: Subacromial impingement syndrome (SIS) is characterized by pain and disability of shoulder. Various treatment methods have been used for SIS. OBJECTIVES: The aim of our study was to evaluate efficacy of therapeutic ultrasound (US) on pain, disability, anxiety, depression, sleep quality and quality of life in patients with SIS. METHODS: Patients with SIS were randomly divided into two groups, including the group 1 (continuous US group; 3 MHz, 1.5 W/cm2, n = 26) and group 2 (sham US group, n = 24). Additionally, transcutaneous electrical nerve stimulation (TENS) + exercise program were added in both groups. Pain and disability of the shoulder were assessed by the Shoulder Pain and Disability Index (SPADI), while anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Quality of life was evalutaed by the Nottingham Health Profile (NHP). Patients were evaluated at baseline and after end of three weeks. RESULTS: Both groups had significantly improvements in terms of SPADI-pain, SPADI-disability, SPADI-total, NHP-pain and NHP-sleep scores after the three weeks interventions. There were significantly improvements in the Group 1 in terms of PSQI-total, and NHP-physical activity. Group 2 had significantly improvements in terms of anxiety-HADS, depression-HADS and NHP-emotional reaction scores. In the inter-group comparison, there were no significantly differences in the change scores were observed in any domains of SPADI scores, anxiety, depression and sleep scores, or any NHP scores. CONCLUSIONS: Our study showed that US does not have any benefits on SIS. TENS + exercise program are not effective on anxiety, depression and fatigue, however TENS +$ exercise program are effective on pain, disability and sleep disturbance in patients with SIS.

Ultrasonographic evaluation of femoral cartilage thickness in patients with psoriatic arthritis.

BACKGROUND: Psoriatic arthritis (PsA) is a common form of arthritis that may vary from asymmetric oligoarthritis to symmetric polyarthritis and spondyloarthritis. OBJECTIVES: To evaluate femoral cartilage thickness using ultrasonography in patients with PsA. METHODS: Thirty-three patients (24 female, 9 male) with a diagnosis of PsA and 31 age-, sex- and body mass index-similar healthy subjects were enrolled in this study. Demographic and clinical characteristics of the patients were recorded, including disease duration, morning stiffness and medications. The femoral cartilage thicknesses of both knees (while held in maximum flexion) were measured with a 7-12 MHz linear probe. Three mid-point measurements were taken from both knees (at the lateral condyle, intercondylar area and medial condyle). RESULTS: Cartilage thicknesses were similar between PsA patients and healthy control subjects. However, there were significant correlations between cartilage thickness and the Maastricht Ankylosing Spondylitis Enthesitis Score, Bath AS functional index and Bath AS disease activity index scores. CONCLUSION: Femoral cartilage thickness is similar between PsA patients and healthy controls. The femoral cartilage thickness in PsA patients is associated with disease activity, functional inadequacy, and enthesopathy scores.

Serum GDF-15 level in Behçet's disease: relationships between disease activity and clinical parameters.

Growth differentiation factor-15 (GDF-15), a member of the transforming growth factor-ß superfamily of cytokines, plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate serum GDF-15 levels and their relationships with disease-related variables in patients with Behçet's disease (BD). Forty-six patients diagnosed with BD and 30 demographically matched healthy control subjects participated in the study. GDF-15 levels were measured in blood samples from patients and controls. The Behçet's Disease Current Activity Form (BDCAF) was used to evaluate the disease activity of BD. There were no significant differences between the two groups in C-reactive protein (CRP) level, mean erythrocyte sedimentation rate (ESR), age, body mass index, and mean GDF-15 levels (P > 0.05). Serum GDF-15 levels were positively correlated with findings for peripheral arthritis and CRP, and with BDCAF erythema nodosum, BDCAF arthralgia, and BDCAF arthritis scores. Patients with BD were divided into two groups according to the presence of peripheral arthritis; nine subjects (20%) were positive for peripheral arthritis. Serum ESR, CRP, white blood cell counts, and GDF-15 levels were significantly higher in the group that was positive for peripheral arthritis (P < 0.05). GDF-15 may play a role in the progression and pathway of Behçet's joint involvement and erythema nodosum that is independent of classic inflammatory response measures.

Ultrasonographic measurement of femoral cartilage thickness in acromegalic patients.

Joint involvement is one of the most frequent clinical complications of acromegaly. The aim of this study was to evaluate the femoral cartilage thicknesses of acromegalic patients using ultrasound (US). Sixty-two patients diagnosed with acromegaly (30 F, 32 M) were included. Patients' demographic and clinical characteristics were recorded. The thickness of the femoral articular cartilage was measured using a 6- to 18-MHz linear probe. Measurements were performed bilaterally from three points (medial condyle, intercondylar area, and lateral condyle). Of the patients, 14 (22.5 %) reported pain in the knee joints. A significantly higher femoral articular cartilage thickness was determined in the patients compared with the controls (all parameters, p < 0.001). US measurements results from all points were consistent, but these values were not correlated with levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Analysis of acromegaly patients as active (n = 37) or inactive (n = 25) revealed no significance with respect to femoral cartilage thickness. Acromegalic patients seem to have thicker femoral articular cartilages irrespective of disease activity state.

Serum relaxin levels in benign hypermobility syndrome.

OBJECTIVE: In this study, we investigated the activity of serum relaxin in female patients with benign joint hypermobility syndrome (BJHS), locomotor system findings accompanying BJHS, and its relation to relaxin. METHODS: Into the study, female patients with BJHS and healthy women as the control group were included. The patients were diagnosed by using the Brighton 1998 criteria. Examination of the locomotor system for study groups were performed. Serum relaxin levels of both patient and control group were measured. RESULTS: There were 48 female patients with BJHS and 40 healthy women in the study. With respect to the control group, the level of serum relaxin was higher in the patients (47.1 ± 20.3, 34.4 ± 22.1; p> 0.05). Again compared with the control group, arthralgia (p= 0.00), myalgia (p= 0.01), shoulder impingement syndrome (p= 0.05), pes planus (p= 0.01), and hyperkyphosis (p= 0.000) were higher in the patients. The level of relaxin median was significantly higher in the patients with pesplanus and hyperkyphosis than those who did not have them (p= 0.05, p= 0.01, respectively). CONCLUSIONS: Although serum relaxin level is not considered a causative factor for BJHS, the significant increases found in those patients with hyperkyphosis and pes planus suggest the hypothesis that relaxin has a limited and indefinite role in patients with BJHS.

Serum levels of alpha-1 acid glycoprotein and pentraxin 3 in patients with Behçet's disease and relationship with disease activity.

BACKGROUND: To evaluate the relationship between disease activity and levels of alpha 1-acid glycoprotein and pentraxin 3 in patients with Behçet's disease (BD). METHODS: Forty-eight patients with BD and 29 age- and gender-matched healthy control subjects were included in the study. Serum pentraxin 3 levels were measured using enzyme-linked immunosorbent assay (ng/ml), and alpha 1-acid glycoprotein levels were measured using nephelometry (mg/dl). Disease activity was assessed using the BD Current Activity Form (BDCAF). RESULTS: Serum alpha-1 acid glycoprotein levels were significantly higher in patients with BD compared to the control group (P = 0.048). There were no significant differences between two groups in terms of levels of pentraxin 3 (P = 0.697). According to Pearson's analysis, alpha 1-acid levels are significantly positively correlated with erythrocyte sedimentation rate, C-reactive protein, and skin lesions and arthritis of BDCAF scores. Pentraxin 3 levels did not correlate with erythrocyte sedimentation rate, C-reactive protein, or any domains of BDCAF scores. CONCLUSION: The results of the present study demonstrate that serum levels of alpha-1 acid glycoprotein were significantly higher in patients with BD relative to the control group. Alpha-1 acid glycoprotein is greatly associated with skin lesions and arthritis in patients with BD. We did not find high serum levels of PTX3 in patients with BD compared to healthy controls, and pentraxin 3 is not associated with disease activity in BD.

Brachial plexus injury complicating the labor: mother is the victim at this time.

OBJECTIVE: Postpartum nerve injuries are rare complications of labor and the lower extremity peripheral nerves are the frequently affected ones. In this case report, we are presenting a patient who developed brachial plexus injury after a forceful vaginal delivery. CASE REPORT: The patient is a 28-year-old woman with right upper extremity pain, numbness and weakness, whose symptoms started just after labor. According to the clinical evaluation, electrodiagnostic study and magnetic resonance imaging, it was diagnosed as the brachial plexus injury. CONCLUSION: We concluded that similar to the ones seen after some surgeries, brachial plexus may be injured also during delivery and the labor positions should be considered.