The relations of circulating agouti-related peptide and leptin with altered sleep architecture in patients with active Cushing's disease: a pilot study

AIM

To evaluate sleep architecture of patients with Cushing's disease (CD) and to explore whether agouti-related peptide (AgRP) and/or leptin play a permissive role in sleep alterations in patients with active CD.

METHODS

We performed polysomnography on 26 patients with active CD and age 26 age- and sex-matched control subjects. Blood samples were obtained from all participants for the analyzes of AgRP and leptin. The laboratory and sleep-related parameters were compared.

RESULTS

The groups were similar in age, gender, and body mass index. The CD group had reduced sleep efficiency (71.6 ± 12.1% vs. 78.8 ± 12.6%, p = 0.042) and increased wake after sleep onset (WASO%) (24.7 ± 13.1% vs. 17.4 ± 11.6%, p = 0.040) as compared to control group. Seventeen patients with CD (65.4%) and 18 control subjects (69.2%) had obstructive sleep apnea. Serum AgRP (13.2 ± 7.4 pg/ml vs. 9 ± 3.1, p = 0.029), leptin (59.5 mcg/l, [IQR] 32.6-94.6 vs. 25.3 mcg/l, [IQR] 12.9-57.5, p = 0.007) were higher in CD group. AgRP and leptin correlated negatively with total sleep time, sleep efficiency, stage N2 sleep (%), and positively with WASO%. In multiple regression analyses, serum cortisol (ß =  - 0.359, p = 0.042) and AgRP (ß =  - 0.481, p = 0.01) were significant predictor of sleep efficiency. AgRP was also significant predictor of WASO% (ß = 0.452 and p < 0.05).

CONCLUSIONS

Active CD carries an increased risk of impaired sleep efficiency and continuity which may worsen health-related quality of life. Elevated circulating AgRP and, to a lesser extent, leptin may be associated with decreased sleep efficiency and continuity in patients with CD. Patients with CD who have subjective sleep symptoms should be screened with polysomnography.

Efficacy of Kinesio® tapes in obstetrical brachial plexus injury: a randomized controlled trial

OBJECTIVES

The purpose of this study was to investigate the effectiveness of Kinesio® tape application associated to exercise in patients with obstetric brachial plexus injury (OBPI).

MATERIALS AND METHODS

Ninety patients with Erb-Duchenne palsy secondary to OBPI participated in a 3-month study, in 2 groups; study group (n = 50) and control group (n = 40). Both followed the same physical therapy program, while the study group also received Kinesio® taping over the scapula and forearm. The patients were evaluated, pre- and post-treatment, using the Modified Mallet Classification (MMC), Active Movement Scale (AMS), and active range of motion (ROM) of the plegic side.

RESULTS

There were no statistically significant intergroup differences in age, gender, birth weight or plegic side (p > 0.05), or in pre-treatment MMC and AMS scores (p > 0.05). There were significant differences in favor of the study group for Mallet 2 (external rotation) (p = 0.012), Mallet 3 (hand on the back of the neck) (p < 0.001), Mallet 4 (hand on the back) (p = 0.001) and total Mallet score (p = 0.025), and for AMS shoulder flexion (p = 0.004) and elbow flexion (p < 0.001). ROM results before and after treatment (within groups) showed significant improvement in both groups (p < 0.001).

CONCLUSION

Since this a was a preliminary study, the results should be interpreted with caution in terms of clinical efficacy. The results suggest that associating Kinesio® taping to conventional treatment helps functional development in patients with OBPI.'

Pleiotropic effects of pitavastatin: a pilot study using the saphenous vein endothelial cell model of endothelial injury and prevention of atherosclerosis

OBJECTIVE

Cardiovascular diseases are responsible for the majority of deaths on a global scale. Atherosclerosis is the main risk factor for cardiovascular disorders and represents a complex phenomenon associated with endothelial dysfunction and inflammation. Statins, especially atorvastatin (ATV) and pitavastatin (PTV), are common agents used to control ongoing atherosclerotic events in the body to minimize cardiovascular disease-based deaths.

MATERIALS AND METHODS

The present study aimed at comparing the efficacy of ATV and PTV in a cell line model of inflammation. Human saphenous vein cells were treated with TNF-alpha to mimic atherosclerotic conditions, and the cells were divided into 7 groups, including control, DMSO, TNF-alpha (10 ng/mL-6 hours), ATV (50 μM/24 hours), PTV (2 μM/24 hours), ATV (50 μM/24 hours)+TNF-alpha (10 ng/mL-6 hours) and PTV (2 μM/24 hours)+TNF-alpha (10 ng/mL-6 hours). The expression levels of 20 proinflammatory cytokines and chemokines were investigated in these groups using a human atherosclerosis antibody array.

RESULTS

Possible pathway interactions were determined by STRING and PANTHER analyses. Comparison with the effect of ATV indicated that PTV reduced the levels of 4 proinflammatory cytokines: CCL11, CSF2, CCL20, and TGFB1 (p<0.05).

CONCLUSIONS

Pleiotropic effects of pitavastatin against cardiovascular diseases appeared to be better; however, additional studies are required to compare statins and to identify new drugs that maintain broader protection from the risks of cardiovascular diseases.

Full-mouth Rehabilitation of Hypocalcified-type Amelogenesis Imperfecta With Chairside Computer-aided Design and Computer-aided Manufacturing: A Case Report

BACKGROUND

This case report describes the complete full-mouth treatment of hypocalcified amelogenesis imperfecta (AI) by chairside computer-aided design and computer-aided manufacturing (CAD/CAM).

CASE SUMMARY

After several years of interrupted dental care, a 17-year-old female patient presented with pain and also esthetic and functional discomfort. With loss of enamel and dyschromia affecting all teeth, the diagnosis was hypocalcified AI. Affected tissues were eliminated, gingivectomy with laser was performed, an indented jig was used to record the centric relationship during optical impressions, and 28 full ceramic crowns were created by chairside CAD/CAM in four sessions. The patient reported rapid pain relief and an overall improvement of well-being.

CONCLUSION

AI sequelae can be treated promptly and conservatively with chairside CAD/CAM, obtaining esthetic and functional results.

Rhinoscintigraphic analysis of nasal mucociliary function in patients with Bell's palsy

OBJECTIVE

Mucociliary transport (MCT) is an important defense mechanism of the respiratory tract. One of the major factors determining MCT is the ciliary activity of the respiratory epithelium. Rhinoscintigraphy is the most commonly used method for the analysis of mucociliary activity. The aim of this study was to investigate the effect of facial paralysis on the nasal mucociliary clearance.

MATERIALS AND METHODS

This study included 38 Bell's palsy patients as the study group and 10 subjects without any history of paranasal sinus disease or facial paralysis as the control group. A drop of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) was placed posterior to the head of the inferior turbinate and followed with a gamma camera. MCT rate was measured as the velocity of Tc-99m MAA drop.

RESULTS

The mean MCT rate was 4.27 ± 0.76 millimeters per minute (mm/min) on 20 sides of 10 healthy controls, 4.11 ± 2.91 mm/min on the affected sides of the patients with Bell's palsy, and 6.03 ± 3.13 mm/min on the nonparalyzed sides of the patients. MCT rate was statistically significantly faster in the nonparalyzed side when compared to the paralyzed side in Bell's palsy patients (P = 0.001). MCT rates were not significantly different in the control group and paralyzed sides of the Bell's palsy patients (P = 0.810). The MCT rate was statistically significantly faster in the nonparalyzed sides of Bell's palsy patients when compared to the controls (P = 0.017).

CONCLUSION

This study showed a faster MCT rate on the nonparalyzed side in Bell's palsy patients when compared to the paralyzed side and the control subjects. A compensatory mechanism could be the underlying reason for faster MCT on the nonparalyzed side. Further studies on larger patient groups are needed to investigate the effect of facial paralysis on the MCT and changes of facial nerve function on the opposite, nonparalyzed side of the face.

Medial olivocochlear reflex in ankylosing spondylitis patients

OBJECTIVE

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease. Via autoimmune mediators, AS can damage the auditory system similar to other systems. Otoacoustic emission studies in AS patients showed that the damage that causes hearing loss was in the outer hair cells. The medial olivocochlear (MOC) reflex is used to evaluate the MOC efferent system (MOES), which includes the outer hair cells. The aim of this study was to evaluate the presence of subclinical damage in the inner ear with the aid of the MOC reflex test in AS patients with no hearing complaints.

PATIENTS AND METHODS

Thirty-four patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. Otoacoustic emission responses, MOC reflex results, and frequency-specific and total suppression findings were compared between the groups. The relationship between clinical and laboratory findings for the AS patients, and the MOC reflex data were also investigated.

RESULTS

Reduced MOC reflex response (p = 0.04) and suppression (p = 0.019) were detected in AS patients. When the clinical and laboratory findings for the AS patients and the MOC reflex test results were compared, a significant correlation was found only between the MOC reflex and the erythrocyte sedimentation rate.

CONCLUSION

The results showed that AS can damage the inner ear, especially the MOES, and can reduce the MOC reflex response without clinical hearing loss.

Evaluation of hyaluronic matrix efficacy in sinus augmentation: a randomized-controlled histomorphometric and micro-computed tomography analysis

The objective of the present study was to test the hypothesis that the addition of hyaluronic acid-based matrix to collagenated heterologous bone graft for sinus augmentation would enhance bone formation compared to collagenated heterologous bone graft alone in the early healing period, by micro-computed tomography and histomorphometry. Thirteen systemically healthy patients requiring bilateral two-stage maxillary sinus augmentation (residual crest height≤4mm) were enrolled in this split-mouth prospective randomized controlled study. One sinus side as a control group was grafted with only collagenated heterologous bone graft; the other region as a test group was grafted with hyaluronic matrix and collagenated heterologous bone graft. Bone biopsy samples were taken after 4 months during the dental implant surgery and analyzed using micro-computed tomography and histomorphometric parameters. According to the micro-computed tomography and histomorphometric results, a significantly higher percentage of new bone was observed in the test group when compared to the control group after 4 months of healing. This study confirmed the hypothesis that the addition of hyaluronic matrix to collagenated heterologous bone graft for sinus augmentation enhances bone formation compared to collagenated heterologous bone graft alone in the early healing period.

Management of Amelogenesis Imperfecta: A 15-Year Case History of Two Siblings

OBJECTIVE

Amelogenesis imperfecta (AI) is a heterogenous genetic disorder that interferes with normal enamel formation in the absence of systemic disorders. The patients' main concerns are caries susceptibility, poor esthetics, and generalized sensitivity. There is a broad clinical spectrum, from discolorations to consequent enamel alterations. This case report describes the 15-year case study and the full-mouth rehabilitation of two siblings affected by a hypocalcified AI. Clinical Considerations: In these two patients, conservative care with stainless steel crowns and direct composite restorations was undertaken to restore function and esthetics and to reduce sensitivities in primary and mixed dentitions. The difficulties in monitoring resulted in severe infectious complications (dental abscess with cutaneous fistula), important dental defects, and loss of spaces with subsequent malocclusion. In the young adult dentition, they were treated by extractions, root canal therapies, and new restorations: stainless steel crowns for permanent molars, direct composite restorations (with strip crowns) for incisors and maxillary canines (to improve the crown morphology as well as to mask the discolorations and the malpositions), and adjusted composite crown molds using a thermoforming procedure for premolars and the mandibular canines. The main difficulties were rapid tooth surface loss, bonding to atypical enamel, developing dentition, long-term follow-up.

CONCLUSION

Restoring function and esthetics in AI-affected patients is a challenge from primary to adult dentition. Early corrections are essential to avoid dental damage and for psychological benefits. This clinical report highlights the adhesive rehabilitation for anterior and premolar areas and the difficulty of patient follow-up.

Surface Treatments of Zirconia to Enhance Bonding Durability

This article reviewed the surface treatments used most often to improve adhesion between zirconia and adhesive cements, focusing on their capacity to provide long-term bonding. Traditional and new treatments for zirconia bonding were searched. Some new treatments were discussed along with topographical views of the modified zirconia. New methods, such as selective infiltration etching and the low-fusing glassy porcelain application are promising, but more research is needed.

'Vitamin D and cognition in older adults': updated international recommendations

BACKGROUND

Hypovitaminosis D, a condition that is highly prevalent in older adults aged 65 years and above, is associated with brain changes and dementia. Given the rapidly accumulating and complex contribution of the literature in the field of vitamin D and cognition, clear guidance is needed for researchers and clinicians.

METHODS

International experts met at an invitational summit on 'Vitamin D and Cognition in Older Adults'. Based on previous reports and expert opinion, the task force focused on key questions relating to the role of vitamin D in Alzheimer's disease and related disorders. Each question was discussed and voted using a Delphi-like approach.

RESULTS

The experts reached an agreement that hypovitaminosis D increases the risk of cognitive decline and dementia in older adults and may alter the clinical presentation as a consequence of related comorbidities; however, at present, vitamin D level should not be used as a diagnostic or prognostic biomarker of Alzheimer's disease due to lack of specificity and insufficient evidence. This population should be screened for hypovitaminosis D because of its high prevalence and should receive supplementation, if necessary; but this advice was not specific to cognition. During the debate, the possibility of 'critical periods' during which vitamin D may have its greatest impact on the brain was addressed; whether hypovitaminosis D influences cognition actively through deleterious effects and/or passively by loss of neuroprotection was also considered.

CONCLUSIONS

The international task force agreed on five overarching principles related to vitamin D and cognition in older adults. Several areas of uncertainty remain, and it will be necessary to revise the proposed recommendations as new findings become available.

Effect of chlorhexidine application on the long-term shear bond strength to dentin of a resin-modified glass ionomer

PURPOSE

The aim of this study was to investigate the effect of chlorhexidine digluconate (CHX) application on the shear bond strength (SBS) of a resin-modified glass ionomer cement (RMGIC) to polyalkenoic acid-preconditioned dentin after 24 hours, six months, and 12 months of water storage at 37°C.

MATERIALS AND METHODS

Cylindrical molds, placed on flat, polyalkenoic acid (Cavity Conditioner® [GC]) preconditioned dentin surfaces of 90 human teeth embedded in resin, were filled with Fuji II LC® (GC), a RMGIC, with (n=45) or without (n=45) the prior application of a 0.05% CHX solution. Within each group, SBS was determined after 24 hours (n=15), six months (n=15), and 12 months (n=15) of storage in water at 37°C. The results were analyzed with two-way analysis of variance followed by Tukey multiple means comparisons (p<0.05). The type of bond failure (adhesive/cohesive/mixed) was noted and the results were analyzed with chi-square test (p<0.05).

RESULTS

After 24 hours, the SBS of RMGIC was not significantly different with (9.0 ± 2.8 MPa) or without (8.3±0.6 MPa) the application of CHX. After six months, however, SBS increased significantly in the group without CHX (12.7±3.4 MPa) but remained unchanged in the CHX group (9.4±4.0 MPa). Similar results without CHX (12.6±3.8 MPa) and with CHX (9.5±3.2 MPa) were obtained after 12 months. No significant differences in the type of debonding were found between the various groups tested.

CONCLUSION

The application of 0.05% CHX after dentin preconditioning did not seem to have affected the 24-hour SBS of RMGIC. However, the six- and 12-month SBS was significantly lower for CHX-treated samples, possibly as a result of CHX interference with both the bonding mechanism and the maturation reaction of RMGIC.

Constraint induced movement therapy: efficacy in a Turkish stroke patient population and evaluation by a new outcome measurement tool

AIM

The purpose of this study was to show if constraint induced movement therapy (CIMT) is effective in a Turkish stroke patient population and whether the effectiveness could be measured by a different evaluation tool, i.e. Kocaeli Functional Evaluation Test (KFET).

METHODS

Twenty-five patients with subacute or chronic stroke were included in the study. At the beginning, all the patients received a conventional rehabilitation programme for 3 weeks. Seventeen patients who had no improvement in upper extremity functioning with this conventional programme received CIMT for 3 weeks. Active range of motion (ROM) and modified Ashworth scale of the plegic upper extremity were noted; Wolf Motor Function Test (WMFT) and KFET were performed to each patient before and after CIMT.

RESULTS

Active ROM of shoulder flexion (P<0.001), abduction (P<0.001), and external rotation (P=0.005), wrist flexion (P=0.025), and extension (P<0.01) of the plegic upper extremity improved significantly after CIMT. There were significant improvements in functional ability scale (P<0.05 for all parameters) and performance time results of 13 (P<0.05 for all parameters) out of 15 parameters of WMFT. Significant improvements were observed in quality-ability scores of every subunit of each activity (P<0.05 for all parameters) and performance time scores (P<0.05 for all parameters) of KFET.

CONCLUSIONS

CIMT is found to be a noteworthy treatment for improving the function of the hemiplegic upper extremity in this Turkish patient population.

A mass at fat density in the parotid gland: dermoid cyst or lipoma

A mass at fat density in the parotid gland: dermoid cyst or lipoma. Dermoid cysts (DC) of the head and neck are uncommon and account for only 7% of all dermoid cysts in the body. DCs of the parotid gland are even rarer. In this article, a 42-year-old female patient with DC of the parotid gland is presented and discussed with a brief review of the literature. Radiologic findings suggested that the mass was a lipoma, but observation of a hair in the cyst during surgery changed the clinical diagnosis to DC; this suspicion was confirmed by pathological analysis. Although DCs are rare among the parotid masses, they should be kept in mind during the differential diagnosis.

An aberrant internal carotid artery in the temporal bone presenting as a middle-ear mass: a case report

Objective:

To draw attention to the possibility of an aberrant internal carotid artery behind an intact tympanic membrane presenting as a middle-ear mass.

Case:

A 48-year-old female patient presented with a hearing impairment in her right ear that had started 10 years ago. Otoscopic examination revealed a retro-tympanic mass. A high resolution computed tomography scan of the temporal bone was performed that showed protrusion of the internal carotid artery into the middle ear. Magnetic resonance angiography provided excellent visualisation of the internal carotid artery. Finally, a diagnosis of an aberrant internal carotid artery was made and the patient was evaluated with a conservative approach.

Conclusion:

All retro-tympanic masses should ideally be visualised with a computed tomography scan of the temporal bone before any middle-ear surgery, such as tympanotomy and biopsy, and it is essential for every otologist who undertakes myringotomy and middle-ear surgery to know about this rare entity.

Iloprost-induced sudden hearing loss

We report a patient who developed sudden, bilateral, sensorineural hearing loss during therapeutic use of iloprost for Raynaud's phenomenon. The sudden hearing loss was attributed to iloprost use and completely reversed in eight days with conservative therapy. Iloprost may be a potentially ototoxic drug, causing sudden hearing loss.

Human papilloma virus prevalence in laryngeal squamous cell carcinoma

PURPOSE

To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma.

METHODS

We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls.

RESULTS

Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case).

CONCLUSION

In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.

Influence of duration of total breast-feeding on bone mineral density in a Turkish population: does the priority of risk factors differ from society to society?

INTRODUCTION

Despite numerous studies on risk factors for osteoporosis the effect of breast-feeding on bone mineral density (BMD) is unclear. In this study our aim was to determine the influence of total duration of breast-feeding on BMD, and subsequent risk of osteoporosis.

METHODS

A total of 1,486 postmenopausal women over the age of 40 were included in the study. Women with diseases or who were under drug treatments known to affect bone metabolism were excluded. The BMD of the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry technique, using either the Norland XA-26 or Lunar DPX-IQ densitometers and were transferred to standard values. Patients were placed in groups of five with respect to the duration of their breast-feeding as never, 1-12 months, 12-24 months, 24-60 months, >60 months.

RESULTS

One-way ANOVA test showed a significant difference between the lumbar spine and femoral neck BMD of these groups of women (p<0.001, p<0.001). Post hoc Bonferroni correction revealed that both the lumbar spine and femoral neck BMD results of women with longer duration of total breast-feeding were significantly lower than those of women with less duration of total breast-feeding. In subsequent analysis other potential risk factors were also considered in a multiple linear stepwise regression model. Years since menopause (p<0.001), weight (p<0.001), total duration of breast-feeding (p<0.001), and body mass index (p=0.001) were found to be the most important predictors for lumbar spine BMD; and age (p<0.001), weight (p<0.001), years since menopause (p<0.001), and total duration of breast-feeding (p<0.001) for femoral neck BMD.

CONCLUSIONS

This study showed significant associations between total duration of breast-feeding and BMD. In conclusion, total duration of breast-feeding might be an important risk factor besides age, weight, and years since menopause in postmenopausal osteoporosis.

Effect of haemodialysis on the oxidative stress and antioxidants in diabetes mellitus

Oxidative stress has been defined as a loss of counterbalance between free radical or reactive oxygen species (ROS) production and antioxidant systems. It is involved in the pathogenesis of different chronic diseases. High levels of ROS production via different biochemical mechanisms accompany diseases like type 2 diabetes mellitus (DM) and end-stage renal disease (ESRD). Elevated oxidative status and reduced antioxidant defence systems in patients with DM and ESRD accelerate the prevalence of atherosclerosis and other chronic complications. Our aim was to reveal the effects of diabetes and haemodialysis (HD) separately and together on oxidative stress. In our study, we included 20 diabetic (DM) patients with no renal disease, 20 non-diabetic haemodialysis (HD), 20 diabetic haemodialysis (DHD) patients and 20 healthy volunteers. We have determined the levels of lipid peroxidation expressed as thiobarbituric acid-reactive substances (TBARS), oxidative protein damage as indicated by protein carbonyl (PCO) content and activities of antioxidant enzymes including superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSHPx) in all patient groups and healthy subjects. We found enhanced oxidative stress in all patient groups due to an increase in lipid peroxidation (TBARS) and increased oxidative protein damage in terms of PCO content and reduced activities of SOD, CAT and GSH-Px. Oxidative stress was more profound in diabetic patients undergoing haemodialysis. We conclude that both diabetes and dialysis increase oxidative stress and their combined effect on oxidative stress is the highest in magnitude as observed in diabetic patients undergoing haemodialysis.

Protein oxidation in Type 2 diabetic patients on hemodialysis

BACKGROUND

Oxidative stress is considered to be a unifying link between diabetes mellitus (DM) and its complications, including nephropathy. There have been many reports on increased production of oxidants and decreased level of antioxidants in diabetic patients. The dialysis procedure contributes to oxidative stress. An increase in oxidative stress may contribute to the development of oxidative protein damage in diabetic patients. Our aim was to reveal the effects of diabetes and hemodialysis (HD) on oxidative modifications of plasma proteins.

METHODS

We measured reactive carbonyl derivates (PCO), protein thiol (P-SH), and reduced glutathione (GSH) levels in Type 2 diabetic (DM) and diabetic hemodialysed patients (DHD) and in healthy control participants.

RESULTS

Protein carbonyl (PCO) content increased significantly in all patient groups relative to the controls. The dialysis procedure caused an additional increase in PCO levels in DHD patients before and after dialysis compared with the level in DM patients. There was a significant decrease in P-SH levels in DHD patients compared with the level in healthy participants and DM patients. There was no significant difference in the whole blood GSH levels between the DM patients and control participants. It was significantly higher in DHD patients in comparison to the DM patients.

CONCLUSIONS

We conclude that PCO level increases in DM patients, and this increase is more profound in DHD patients, indicating that both diabetes and dialysis contribute to increased protein oxidation. The low P-SH level in DHD patients, but not in DM patients, suggests that dialysis is responsible for this decrease. We propose plasma PCO derivate as a novel specific marker for oxidative protein damage.

The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy

This study aimed to determine the effects of botulinum toxin-A (btA) on spasticity in children with cerebral palsy (CP). Thirty-five children with spastic CP were evaluated. The injection group consisted of 25 patients who were injected with btA and received conventional physical therapy. The control group consisted of 10 patients who were treated with conventional physical therapy only. In the injection group, btA was applied to the lower extremity spastic muscles at a total dose of 8-10 lU/kg. Spasticity was measured by the Ashworth scale. Gait function was evaluated by clinical gait assessment in all patients and temporal distance factors in 16 patients. All the parameters were recorded before treatment, after three days and after one month of therapy. Following injection of btA, significant improvement in all parameters was observed. No statistically significant progression was noted in the control group except clinical gait analysis scores. Comparing the three-day and one-month measurements of spasticity of the two groups, statistically significant results were obtained in favour of the injection group in all parameters except for clinical gait analysis scores. The findings of this study showed btA injection to be an effective treatment for reducing spasticity and improving gait function in patients with spastic CP

Acute infantile haemorrhagic oedema associated with hepatitis A

Acute infantile haemorrhagic oedema (AIHO) is characterised by purpura, ecchymosis and inflammatory oedema of the face and extremities. It is seen in children aged 4-24 months. The atiology is not known. We report a case of AIHO diagnosed by skin biopsy demonstrating leukocyte-elastic vasculitis. Laboratory studies showed positive hepatitis A IgM and IgG antibodies. The liver function tests were normal, indicating subclinical hepatitis. Cryoglobulinaemia was detected, suggesting that the disease was related to hepatitis A.

Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome

OBJECTIVE

To determine the effects of electromyographic biofeedback treatment in patients with patellofemoral pain syndrome.

DESIGN

Randomized controlled trial.

SETTING

A physical medicine and rehabilitation department in a research hospital of a university referral center.

PATIENTS

Sixty patients with patellofemoral pain syndrome. Patients were randomly placed into 2 groups: biofeedback group (n = 30) and a control group (n = 30).

INTERVENTION

The biofeedback group received electromyographic biofeedback training and a conventional exercise program, whereas the control group received a conventional exercise program only.

MAIN OUTCOME MEASURES

Maximum and mean contraction values of the vastus medialis and the vastus lateralis muscles were assessed with the biofeedback device. Pain and functional status of the patients were measured by a visual analog scale (VAS) and the Functional Index Questionnaire (FIQ), respectively.

RESULTS

Contraction values improved significantly at the end of the first month, compared with the pretreatment values in both groups. Mean contraction values in the biofeedback group of the vastus medialis muscles in all 3 monthly measurements, and the vastus lateralis muscles at the end of the first month, were significantly higher than those of the control group. Significant improvements were shown for both the VAS and the FIQ in both groups. Monthly follow-ups showed no VAS and FIQ differences between the groups.

CONCLUSION

Electromyographic biofeedback treatment did not result in further clinical improvement when compared with a conventional exercise program in patients with patellofemoral pain syndrome.

Comparison of alendronate, calcitonin and calcium treatments in postmenopausal osteoporosis

The present study was planned to assess the safety, tolerability and efficacy on bone mineral density (BMD), pain, quality of life and fracture risk of alendronate, calcitonin and calcium treatments. A total of 151 postmenopausal women with lumbar spine BMD 2 SD or more below the young adult mean were randomly assigned to one of three groups: 51 patients received oral alendronate 10 mg and calcium 1000 mg (alendronate group), 50 patients intranasal salmon calcitonin 100 IU and oral calcium 1000 mg (calcitonin group), and 50 patients oral calcium 1000 mg (calcium group) daily for one year. BMD was assessed by dual energy X-ray absorbtiometry, pain by a visual analogue scale, and quality of life by the Nottingham health profile. Significant increases in BMD at all sites were obtained in the calcitonin and alendronate groups, but not in the calcium group. Pain and quality of life improved significantly in both the calcitonin and alendronate groups, but not in the calcium group. New vertebral fractures were seen in 31.58% of the alendronate, 37.5% of the calcitonin, and 40% of the calcium groups, representing no statistical difference. No serious side-effects were seen in any of the patients during follow-up.

Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients

OBJECTIVE

To examine the relation between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients.

DESIGN

Case-control study.

SETTING

Inpatient rehabilitation hospital.

PATIENTS

Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in the study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded.

MAIN OUTCOME MEASURES

Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points.

RESULTS

Glenohumeral subluxation was found in 74.3% of the RSD and 40% of the non-RSD group (p = .004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (p = .019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (p = .152).

CONCLUSION

Findings from this study suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients.

Prognostic importance of lymphatic reaction pattern in laryngeal carcinoma

PURPOSE

Cervical lymph node status is a widely accepted important prognostic parameter in laryngeal carcinoma.

PATIENTS AND METHODS

In this study, we retrospectively reviewed neck specimens of 46 laryngeal carcinoma patients operated in our clinic. Presence of neck metastasis and pattern of reactivity in nonmetastatic nodes was correlated with recurrence and survival during a follow-up period of at least 2 years.

RESULTS

Fourteen of the patients had at least one metastatic node and survival was 64%; 32 of the patients had reactional nodes only and the survival was 81%. Pattern of lymph node reactivity was evaluated as stimulated in type I (lymphocyte predominance) and type II (germinal center predominance); as unstimulated in type III (histiocytosis and/or normal) and type IV (lymphocyte depletion). Thirty two neck [-] patients had reactional nodes--16 of them were classified as stimulated and 16 of them as unstimulated; the 2-year survivals were 94% and 68%, respectively. In the 14 patients with cervical metastasis (classified according to nonmetastatic reactional nodes) 9 were stimulated and 5 were unstimulated with 2-year survivals of 100% and 0%, respectively.

CONCLUSION

Stimulated lymphatic pattern reflects a better prognosis, especially in N+ neck laryngeal cancer patients.

Follow-up results of 415 patients after endoscopic sinus surgery

Endoscopic sinus surgery (ESS) is a method used with success in the treatment of chronic inflammatory paranasal sinus diseases. Between February 1991 and June 1995 the Messerklinger technique for ESS was used in 415 patients who had been pre-operatively evaluated in detail according to the staging system used in our clinic. Average post-operative follow-up was 23 months. Our general success rate was found to be 86.3% upon evaluating the subjective improvements in the patients' symptoms in the post-operative period. The major and minor complication rates in our series were 0.24 and 20.24%, respectively.

A quantitative study of genital skin flora and urinary colonization in spinal cord injured patients

This study was performed to define the relation between colonization of genital skin flora and bacteriuria in spinal cord injured patients with neurogenic bladder dysfunction. Twenty-seven female and 23 male spinal cord injured patients were included in the study. Patients were evaluated regarding their type of bladder management, educational status, level and degree of the spinal cord lesion. Quantitative cultures were obtained from the perineum labium/dorsum of penis, external meatus of urethra, and urine. We investigated whether the organisms isolated from urine were also present in one or more skin sites in every patient. In total 54 identical bacterial isolates were observed both from urine and one or more skin sites in 43 of the patients. Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Proteus stuartii were the most common bacterial isolates. The distribution of identical colonization of genital skin flora with urine were as follows: 30 in urethra, one in perineum, four in urethra and perineum, nine in urethra and labium/dorsum of penis, and 10 in both three skin sites. Identical colonization of both perineum and labium/dorsum of penis with urine were significantly higher in female patients than those of males (P = 0.037, P = 0.003, respectively). No significant difference was found in the presence/distribution of colonization with respect to type of bladder management, educational status, and neurologic status. These results demonstrate the importance of the urethra, perineum, and labium/dorsum of penis as a source of bacteria causing urinary infection in spinal cord injured patients.

A comparison of spiral and conventional computerized tomography methods in diagnosing various laryngeal lesions

Although endoscopic procedures with tissue biopsy are the mainstay in the evaluation of laryngeal lesions, radiological imaging studies remain important. Computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) are the most reliable methods, especially for deep laryngeal compartments, cartilage, extralaryngeal structures and neck nodes. However, the larynx is a difficult organ for radiological imaging because respiration and swallowing can cause several artifacts and distort image. In this report we studied the role of a spiral CT technique and compared this with conventional CT in 32 patients. We used the Hitachi W950SRBT machine and took both conventional and spiral sections of the larynx and neck in all 32 patients. The scans were taken with a 5-mm table motion and 5-mm section thickness in both studies. In the spiral technique the raw data acquired were used retrospectively for 2-mm and 5-mm reconstructions. Anatomic details, motion artifacts and vascular enhancements were compared by a scoring system. The mean values were then analyzed statistically by the paired t-test. The average examination time was 3 min 18 s for conventional CT and 28 s for spiral CT. Anatomic detail scores were better in the 2-mm section spiral CT studies compared to 5-mm section spiral and conventional CT groups. Motion artifact scores were better in the 2-mm and 5-mm spiral CT groups compared to the 5-mm conventional CT group. Vascular enhancement scores were better in the spiral CT group. Overall, the thinner (2-mm) sections of the spiral CT studies further improved image quality regarding both anatomic details and motion artifacts. Scanning time for spiral CT was very short, motion artifacts were less, and vascular enhancement and anatomic details were better. Volumetric data could also be reconstructed for thinner sections in all planes retrospectively for further evaluation. Our findings showed that spiral CT was a better method than conventional CT for evaluating laryngeal lesions.

Dispersion of ventricular repolarization: a new marker of ventricular arrhythmias in patients with rheumatoid arthritis

OBJECTIVE

To determine the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias in patients with rheumatoid arthritis (RA).

METHODS

We examined 42 patients with RA (age 44+/-4.8 yrs; 32 women and 10 men) and 42 age matched healthy subjects as the control group. Repolarization dispersion variables were calculated based on the difference between maximal and minimal values of QT, QTc, JT, and JTc (QTd, QTc-d, JTd, and JTc-d, respectively) from 12 lead electrocardiographic (ECG) recording at 50 mm/s. The frequency of ventricular arrhythmias by means of 24 h ambulatory ECG monitoring was investigated. A grade of > 3 ventricular arrhythmias according to modified Lown and Wolf classification was accepted as complex arrhythmias.

RESULTS

We found QT and QTc intervals 392+/-20 and 409+/-38 ms in patients; values in controls were 387+/-22 and 400+/-14 ms, respectively; p > 0.05. QTd, QTc-d, JTd, and JTc-d intervals were 61.6+/-1.6, 77.6+/-1.1, 72.5+/-1.8, and 93.3+/-1.5 ms in patients and 40.3+/-0.9, 55+/-1.2, 42.6+/-0.4, and 52.9+/-0.8 ms in controls, respectively; p < 0.001. Thirty-two of the patients had complex premature ventricular complexes during 24 h ECG and the prevalence of premature ventricular complexes was found to be higher than in controls (p < 0.001). No correlation was found between complex premature ventricular complexes and QT, but there was a correlation between complex premature ventricular complexes and dispersion variables in patients with RA.

CONCLUSION

Striking increases in QT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with RA. QT dispersion might be a useful marker of cardiovascular morbidity and mortality due to complex ventricular arrhythmias in patients with RA.

Abnormal QT dispersion in Behçet's disease

Behçet's disease, which was originally described by Hulusi Behçet in 1937, is a generalized chronic inflammatory disease characterized by recurrent oral and genital ulcerations, ocular and dermal manifestations. Cardiac manifestations include pericarditis, myocarditis, conduction system disturbances, coronary arteritis, mitral valve insufficiency, dilated cardiomyopathy, ventricular arrhythmias and sudden cardiac death. There is little knowledge about the mechanism of ventricular arrhythmias in Behçet's disease. In this study, we examined the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias and sudden cardiac death in Behçet's disease. We examined 38 patients (age: 34 +/- 4.6 years, 20F, 18M) with Behçet's disease and 30 age-matched healthy subjects were selected to serve as the control group. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT, QTc, JT and JTC from 12-lead ECG recordings at 25 or 50 mm/s. We found QTd, QTc-d, JTd and JTc-d intervals of 60.65 +/- 16.1, 78.45 +/- 11.4, 71.51 +/- 18.3 and 92.33 +/- 15.4 ms in Behçet's disease patients, these values in control subjects were 40.1 +/- 9.7, 56.36 +/- 7.5, 41.66 +/- 4.3 and 53.92 +/- 9.2 ms respectively (p < 0.001). Striking increases in QT and JT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with Behçet's disease. This new finding suggests a possible explanation for the presence of ventricular arrhythmias in patients with Behçet's disease.

Calcitonin treatment in reflex sympathetic dystrophy: a preliminary study

Reflex sympathetic dystrophy is one of the important complications effecting the rehabilitation programmes of hemiplegic patients in a negative manner by causing pain and function loss. In this study, the aim was to investigate the effects of salmon calcitonin treatment in reflex sympathetic dystrophy that develops in hemiplegia. Forty-one patients with hemiplegia resulting from cerebrovascular events and stage 1-2 reflex sympathetic dystrophy were included in the study. Salmon calcitonin, 1 x 100 IU/day intramuscularly for 4 weeks, was administered to 25 of these patients (calcitonin group) to the other 16 patients physiological saline, 1 ml/day intramuscularly for 4 weeks, was administered (control group). At the end of the fourth week of treatment the pain score of the calcitonin group was significantly lower than that of the control group. Shoulder abduction and external rotation, wrist flexion and metacarpophalangeal extension of the calcitonin group were found to be significantly better than those of the control group. In the calcitonin group the significant decrease in pain and tenderness resulted in improvement of range of motion and motor functions.

Angular biofeedback device for sitting balance of stroke patients

BACKGROUND AND PURPOSE

Impaired sitting balance is an important and time-consuming complication for stroke patients. We examined the effect of the use of an angular biofeedback device in addition to physical therapy in training stroke patients with impaired sitting balance compared with outcome in patients receiving conventional physical therapy only.

METHODS

The biofeedback group consisted of 24 patients who received angular biofeedback training in addition to conventional physical therapy. The number of biofeedback signals and the lengths of time a patient could sit balanced throughout a period of 5 minutes before the training program, after 10 days of treatment, and at discharge were recorded and compared with those of the control group of 13 patients who received conventional physical therapy only.

RESULTS

It was found that 75% of the biofeedback group gained sitting balance after 10 days of treatment in comparison with 15.4% of the control group (P < .001). At discharge, 91.6% of the biofeedback group and 84.6% of the control group gained sitting balance (P = .510), and 45.8% of the biofeedback group and 46.2% of the control group managed independent ambulation (P = .985). The mean rehabilitation periods among the ambulatory patients of the biofeedback and control groups were 9.45 +/- 0.71 and 13.83 +/- 1.70 weeks, respectively (P = .049). The mean training time in which the biofeedback group gained sitting balance was significantly shorter than that of the control group (P < .001).

CONCLUSIONS

Angular biofeedback intervention, by providing earlier postural trunk control, is a useful adjunct to conventional physical therapy in the rehabilitation of stroke patients with impaired sitting balance.