Intracranial Dural Arteriovenous Fistula Draining into Spinal Perimedullary Veins: A Rare Cause of Myelopathy

We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible

Diz osteoartritinde ağrı ve özürlülükle ilişkili faktörler

Objective: To evaluate the risk factors associated with pain and disability in the patients with knee osteoarthritis (OA). Materials and Methods: One hundred and forty-one patients, ranging in age from 40 to 80 years, with knee OA were included into the study. Pain was measured by WOMAC (Western Ontario and McMaster Universities Arthritis Index) and VAS (visual analog scale). Disability was measured by WOMAC. Detailed demographic, social, morphologic and medical history was taken from all patients. the knee radiographs were evaluated by using the Kellgren-Lawrence grading system. Results: There were middle-high correlations between the demographic data (age, body mass index-BMI, education level and pain duration) and WOMAC-pain and function, VAS and radiological grade (p;lt;0.05). Obese patients had significantly worst scores for all evaluation parameters (p;lt;0.05). Kellgren-Lawrence radiological grade was correlated with VAS and WOMAC-function. WOMAC-pain and function subscales and radiological grade were significantly higher in the women when compared with men (p;lt;0.05). Among the medical problems, there was no relation to disability and pain. Conclusion: This study showed that old age, increased BMI, low education level, female sex and high radiological grade were related factors with pain and disability in the knee OA.Amaç: Diz osteoartritli (OA) hastalarda ağrı ve özürlülükle ilişkili faktörleri değerlendirmek. Gereç ve Yöntem: Diz OA'li, 40-80 yaş aralığındaki 141 hasta çalışmaya dahil edildi. Ağrı WOMAC (Western Ontario and McMaster Universities Arthritis Index) ve vizüel analog skala (VAS) ile ölçüldü. Özürlülük WOMAC ile değerlendirildi. Tüm hastalardan detaylı demografik, sosyal, morfolojik ve tıbbi öyküleri alındı. Diz radyografileri Kellgren-Lawrence evreleme sistemi kullanılarak değerlendirildi. Bulgular: Demografik verilerle (yaş, vücut kütle indeksi-VKİ, eğitim düzeyi ve ağrı süresi) WOMAC-ağrı ve fonksiyon, VAS ve radyolojik evre arasında orta-yüksek evreli korelasyonlar mevcuttu (p0,05). Obez hastalar tüm değerlendirme parametreleri için anlamlı olarak daha kötü skorlara sahipti (p0,05). Kellgren-Lawrence radyolojik evresi VAS ve WOMAC-fonksiyon ile koreleydi. Erkeklerle karşılaştırıldığında, WOMAC-ağrı ve fonksiyon ve Kellgren-Lawrence radyolojik evresi anlamlı olarak kadınlarda daha yüksekti (p0,05). Tıbbi problemler arasında, ağrı ve özürlülükle bir ilişki mevcut değildi. Sonuç: Bu çalışma diz OA'da; ileri yaşın, artmış VKİ'nin, düşük eğitim düzeyinin, kadın cinsiyetin ve yüksek radyolojik evrenin ağrı ve özürlülükle ilişkili faktörler olduğunu göstermektedir

Karaciğer transplantasyonunun kemik metabolizması ve gonad fonksiyonları üzerine etkisi

The present study was designed to evaluate the effects of liver transplantation (LT) on the bone mineral density (BMD), characteristics of bone turnover, mineral metabolism and sex hormons. Fifty one patients (34 men, 11 women) aged 43.5 ;plusmn; 12.1, who underwent LT were studied, assessing the following parameters: lumbar spine and proximal femur BMD, osteocalcin, deoxypyridinoline (DPD), parathyroid hormone (PTH), free testesterone (FT), gonadotropins (FSH, LH), tyroid hormones, growth hormone (GH) and blood/ 24-hours urine Ca and P. All the measures were obtained at baseline and at 3rd month after LT. At baseline, 12 patients (%23.5) had osteoporosis, 22 patients (%43.1) had osteopenia and the mean BMD was 0.892 ;plusmn; 0.1 for lumbar spine. Whereas, osteoporosis was seen less at femoral neck and total femur: 5 (%9.8) and 4 (%7.8), respectively. Three months after LT, 3.9% drop for lumbar spine, 5.3% drop for femur neck, 6.3% drop for total femur were observed, in BMD these decreases were statistically significant for all sites (p;lt;0.05). The thyroid hormones, GH, PTH, blood Ca, P and osteocalcin levels and urinary DPD excretion were within normal range, while the levels of FSH and LH in women and level of FT in men were lower than normal range. After LT, statistically significant increases were observed in the PTH, osteocalcin, DPD, FSH, LH and FT levels (p;lt;0.05). There was a highly significant negative correlation between duration of liver disease and all the BMD measures (p;lt;0.01). Consequently, the increased osteoporosis ratio which was characterized by high bone turnover was found in patients who underwent LT in this study. The normalization of liver functions following LT was characterized by an early rise in sex hormones.Bu çalışma karaciğer transplantasyonunun (KCTx) kemik mineral yoğunluğu (KMY), kemik döngüsü, mineral metabolizması ve sex hormonları üzerine etkisini değerlendirmek amacıyla planlanmıştır. Lomber omurga ve kalça proksimali KMY’si, osteokalsin, deoksipridinolin (DPD), paratiroid hormon (PTH), serbest testesteron (ST), gonadotropinler, tiroid hormonları, büyüme hormonu (BH) ve kan / 24 saatlik idrarda Ca ve P değerlendirmesi yapılmak üzere, KCTx geçiren yaş ortalaması 43.5 ± 12.1 olan 51 hasta (34 erkek, 17 kadın) ile çalışılmıştır. Tüm ölçümler transplantasyon öncesi ve postoperatif 3.ayda olmak üzere 2 kez yapılmıştır. Başlangıçta lomber omurga T skorlarına göre 12 (%23.5) hasta osteoporoz, 22 (%43.1) hasta osteopenik olup, ortalama lomber omurga KMY’u 0.892 ± 0.1’di. Bununla birlikte, kalça boynu ve kalça totalinde osteoporoz daha az sayıda hastada izlenmiştir: 5 (%9.8) ve 4 (%7.8). KCTx sonrası 3.ayda KMY ölçümlerinde lomber omurga için %3.9, femur boynu için %5.3, total femur için %6.3’lük bir azalma saptandı, bu azalma tüm bölgeler için istatiksel olarak anlamlıydı (p0.05). Tüm hastalarda tiroid hormonları, BH, PTH, kan Ca’u ve P’u, osteokalsin ve idrarla DPD atılımı normal sınırlardayken, kadınlarda FSH ve LH, erkeklerde ST değerleri normalden azdı. KCTx sonrası PTH, osteokalsin, DPD ve gonadotropinlerle erkeklerde ST düzeylerinde istatiksel olarak anlamlı bir artış saptandı (p0.05). Hastaların ortalama karaciğer hastalığı süresiyle tüm bölgelerin KMY’ları arasında yüksek dereceli negatif bir korelasyon mevcuttu (p0.01). Sonuç olarak bu çalışmada KCTx geçiren hastalarda artmış kemik döngüsüyle karakterize osteoporoz oranı yüksek bulunmuştur. KCTx sonrası karaciğer fonksiyonlarının normale dönmesi sex hormonlarının erken dönemde yükselmesi ile karakterizedir

The effects of liver transplantation on the bone metabolism and gonadal functions

Bu çalışma karaciğer transplantasyonunun (KCTx) kemik mineral yoğunluğu (KMY), kemik döngüsü, mineral metabolizması ve sex hormonları üzerine etkisini değerlendirmek amacıyla planlanmıştır. Lomber omurga ve kalça proksimali KMY’si, osteokalsin, deoksipridinolin (DPD), paratiroid hormon (PTH), serbest testesteron (ST), gonadotropinler, tiroid hormonları, büyüme hormonu (BH) ve kan / 24 saatlik idrarda Ca ve P değerlendirmesi yapılmak üzere, KCTx geçiren yaş ortalaması 43.5 ± 12.1 olan 51 hasta (34 erkek, 17 kadın) ile çalışılmıştır. Tüm ölçümler transplantasyon öncesi ve postoperatif 3.ayda olmak üzere 2 kez yapılmıştır. Başlangıçta lomber omurga T skorlarına göre 12 (%23.5) hasta osteoporoz, 22 (%43.1) hasta osteopenik olup, ortalama lomber omurga KMY’u 0.892 ± 0.1’di. Bununla birlikte, kalça boynu ve kalça totalinde osteoporoz daha az sayıda hastada izlenmiştir: 5 (%9.8) ve 4 (%7.8). KCTx sonrası 3.ayda KMY ölçümlerinde lomber omurga için %3.9, femur boynu için %5.3, total femur için %6.3’lük bir azalma saptandı, bu azalma tüm bölgeler için istatiksel olarak anlamlıydı (p<0.05). Tüm hastalarda tiroid hormonları, BH, PTH, kan Ca’u ve P’u, osteokalsin ve idrarla DPD atılımı normal sınırlardayken, kadınlarda FSH ve LH, erkeklerde ST değerleri normalden azdı. KCTx sonrası PTH, osteokalsin, DPD ve gonadotropinlerle erkeklerde ST düzeylerinde istatiksel olarak anlamlı bir artış saptandı (p<0.05). Hastaların ortalama karaciğer hastalığı süresiyle tüm bölgelerin KMY’ları arasında yüksek dereceli negatif bir korelasyon mevcuttu (p<0.01). Sonuç olarak bu çalışmada KCTx geçiren hastalarda artmış kemik döngüsüyle karakterize osteoporoz oranı yüksek bulunmuştur. KCTx sonrası karaciğer fonksiyonlarının normale dönmesi sex hormonlarının erken dönemde yükselmesi ile karakterizedir.The present study was designed to evaluate the effects of liver transplantation (LT) on the bone mineral density (BMD), characteristics of bone turnover, mineral metabolism and sex hormons. Fifty one patients (34 men, 11 women) aged 43.5 &plusmn; 12.1, who underwent LT were studied, assessing the following parameters: lumbar spine and proximal femur BMD, osteocalcin, deoxypyridinoline (DPD), parathyroid hormone (PTH), free testesterone (FT), gonadotropins (FSH, LH), tyroid hormones, growth hormone (GH) and blood/ 24-hours urine Ca and P. All the measures were obtained at baseline and at 3rd month after LT. At baseline, 12 patients (%23.5) had osteoporosis, 22 patients (%43.1) had osteopenia and the mean BMD was 0.892 &plusmn; 0.1 for lumbar spine. Whereas, osteoporosis was seen less at femoral neck and total femur: 5 (%9.8) and 4 (%7.8), respectively. Three months after LT, 3.9% drop for lumbar spine, 5.3% drop for femur neck, 6.3% drop for total femur were observed, in BMD these decreases were statistically significant for all sites (p&lt;0.05). The thyroid hormones, GH, PTH, blood Ca, P and osteocalcin levels and urinary DPD excretion were within normal range, while the levels of FSH and LH in women and level of FT in men were lower than normal range. After LT, statistically significant increases were observed in the PTH, osteocalcin, DPD, FSH, LH and FT levels (p&lt;0.05). There was a highly significant negative correlation between duration of liver disease and all the BMD measures (p&lt;0.01). Consequently, the increased osteoporosis ratio which was characterized by high bone turnover was found in patients who underwent LT in this study. The normalization of liver functions following LT was characterized by an early rise in sex hormones

A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis

WOS: 000238546600002PubMed ID: 16416102The aim of this study was to compare the effects of physical therapy agents (PTA) and two different intra-articular hyaluronan drugs (sodium hyaluronate (NaHA) and hylan G-F 20) on knee osteoarthritis (OA). The randomised, single-blind study, with 12 months of follow-up, was performed on 80 patients diagnosed as knee OA. The patients were randomly divided into two treatment groups: patients in group 1 were given weekly intra-articular hyaluronan treatment which consisted of either hylan G-F 20 or NaHA during the first 3 weeks and in the sixth month; PTA was applied to each patient in group 2 five times a week for 3 weeks with a series of infrared, short-wave diathermy-pulsed patterns and interferential therapy. Clinical assessments for each patient were made at 1, 3, 6, 9 and 12 months using the following measures: spontaneous pain, pain at rest, pain at night, pain on touch, pain on movement, 15 m walking time, range of motion, short form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) global assessment. There was significant improvement in all variables measured in both groups during the follow-up except the WOMAC-stiffness and range of the motion. The improvement of pain (at night, at rest, SF-36) and SF-36 social functioning subscales was greater in the PTA group. Consequently, in the subgroup analyses, there was no difference between PTA and hylan groups for this improvement. In the comparison of two drugs, the reduction of pain on touch and WOMAC-function was greater in hylan group than that of NaHA. No serious local or systemic effects were observed following injections. Although all patients had improvement, PTA was superior to hyaluronan group for no activity-related pain and functional performance. On the other hand, this study supports the preferential use of hylan over NaHA in patients with knee OA