Türkiye Romatizma Araştırma ve Savaş Derneği ankilozan spondilit ulusal tedavi önerileri

Objectives: To develop Turkish League Against Rheumatism (TLAR) National Recommendations for the management of ankylosing spondylitis (AS). Materials and methods: A scientific committee of 25 experts consisting of six rheumatologists and 19 physical medicine and rehabilitation specialists was formed by TLAR. Recommendations were based on the 2006 ASsessment in Ankylosing Spondylitis International Working Group(ASAS)/European League Against Rheumatism (EULAR) recommendations and a systematic review of associated publications between January 2005 and September 2010. A Delphi process was used to develop the recommendations. Twelve major recommendations were constructed for the management of AS. Voting using a numerical rating scale assessed the strength of each recommendation. Results: The 12 recommendations include patient assessment, patient follow-up along with pharmacological and non-pharmacological methods. Some minor additions and changes have been made to the ASAS/EULAR recommendations. All of the recommendations had sufficient strength. Conclusion: National recommendations for the management of AS were developed based on scientific evidence and consensus expert opinion. These recommendations will be updated regularly in accordance with recent developments.Türkiye Romatizma Araştırma ve Savaş Derneği᾽nin (TRASD) Ankilozan Spondilit (AS) için ulusal tedavi önerilerinin oluşturulmasıdır. Gereç ve yöntemler: TRASD tarafından altı Romatoloji ve 19 Fiziksel Tıp ve Rehabilitasyon uzmanı olmak üzere toplam 25 kişiden oluşan bir bilimsel kurul oluşturuldu. Önerilerde 2006 yılında yayınlanan Ankilozan Spondilit Değerlendirme Uluslararası Çalışma Grubu (ASAS)/Romatizmaya karşı Avrupa Ligi (EULAR) önerileri ve Ocak 2005 - Eylül 2010 arasında yayınlanmış olan ilişkili yayınlar konusundaki sistematik bir inceleme temel alındı. Öneriler oluşturulurken Delphi süreci kullanıldı. Ankilozan spondilit tedavisi ile ilgili 12 ana öneri oluşturuldu. Oylama yapılarak önerilerin güçlülük düzeyi bir nümerik derecelendirme skalası ile belirlendi. Bulgular: On iki öneri hasta değerlendirilmesini, hasta takibini ve farmakolojik ve non-farmakolojik yöntemleri içermektedir. ASAS/EULAR önerilerine bazı ilaveler ve önerilerde bazı küçük değişiklikler yapılmıştır. Tüm öneriler yeterli kuvvete sahipti. Sonuç: Bilimsel kanıtlar ve uzmanların görüş birliği ile AS tedavisine yönelik ulusal öneriler oluşturulmuştur. Bu öneriler, yeni gelişmeler doğrultusunda düzenli olarak güncellenmelidi

Isolated Deep Infarcts: Which Size Indicates Single Penetrating Artery Disease?

OBJECTIVE: The relationship between infarction size determined in the acute stage and the probability of the presence of large artery stenosis or cardiac source of emboli in patients with isolated deep infarcts was evaluated. METHODS: Maximum transverse diameters of the infarcts seen in 59 consecutive patients’ T2 weighted MRI scans were prospectively recorded. Receiver operating characteristic curves were generated to analyze the optimal size that discriminate IDI with and without underlying large artery stenosis or cardiac source of emboli (LAS/CSE). RESULTS: Twenty-six IDI were in the medial cerebral artery (MCA) territory, 24 in pons and 9 in thalamus. Optimal infarct diameter for MCA IDIs was 25 mm. One of the 10 cases with small (2-14 mm) and half of the 14 cases (50%) with large (17-25 mm) pontine infarcts had LAS/CSE, but only 2 patients, one in each group had severe (≥70%) basilar artery stenosis. None had major CSE. None of the 9 cases with thalamic infarcts (8-20 mm) had LAS/CSE. CONCLUSION: : IDIs in different anatomical locations should be assessed separately. Middle cerebral artery territory IDIs with a maximum diameter of less than 25 mm are rarely associated with LAS/CSE and possibly develop due to occlusion of single lenticulostriate artery. Large unilateral pontine infarcts are usually not associated with severe basilar artery stenosis or major CSE and are probably caused by basilar artery atheromatous branch occlusio

Gender differences in acute stroke: Istanbul Medical School Stroke Registry

Background: We aimed to investigate gender differences in Turkish stroke patients. Material and Methods: Demographics, risk factors, clinical and etiologic subtypes, laboratory findings, clinical course, and in-hospital prognosis of 1 522 patients with ischemic stroke (IS) and 320 patients with intracerebral hemorrhage prospectively registered in the Istanbul Medical School Stroke Registry (1994-2004) were analyzed separately. Results: The mean age of IS patients was higher in females (n : 751) (P<0.0001). In males, smoking, ischemic heart disease, peripheral arterial disease, posterior circulation syndromes, and strokes due to large-artery atherosclerosis were more common (P<0.0001 for each). Prestroke disability, atrial fibrillation (P<0.0001), hypertension (P=0.041), modified Rankin Scale (mRS) 3-5 at admission (P<0.0001), total anterior circulation syndrome (P<0.0001), and cardioembolic stroke (P<0.0001) were more frequent in females. Female gender was an independent predictor of poor outcome (mRS 3-6). Conclusion: Gender differences were observed exclusively in patients with IS. Although our patients were younger than those reported, gender differences were similar

Postmenopausal women with osteoporosis may be associated with high endothelin-1

Aim. We aimed to find out if there was any difference of the endothelin-1 (ET-1) and asymmetric dimethylarginine (ADMA) levels between osteoporotic and non-osteoporotic healthy postmenopausal women and whether there were any associations between ET-1 and ADMA levels and bone mineral density (BMD)

Transtentoryal herniasyondaki hastalarda dekompresif hemikranyektomi

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Objective: To present the results, technique and indications of decompressive hemicraniectomy in patients with unilateral transtentorial herniation. Methods: Ten consecutive patients with intracranial hypertension refractory to medical management and transtentorial herniation were treated with decompressive hemicraniectomy over a 3-year period with the following diagnoses: malignant infarction (3 patients), subarachnoid hemorrhage and vasospasm (2 patients), traumatic brain injury (3 patients), spontanous intracerebral hemorrhage, and venous thrombosis. Neurological status was assessed by the Glasgow Coma Scale (GCS) and by the modified Rankin Scale (mRS) on admission, and by the mRS on discharge, and on follow-up examinations. Computerized tomography (CT) scans performed preoperatively, and on the first, 7th postoperative days, and at one month were assessed for trastentorial herniation and midline shift. A decompressive hemicraniectomy, at least 14 by 11 cm was performed in all patients.Amaç: Unilateral transtentoryal herniasyonu olan hastalarda dekompresif hemikranyektominin sonuçlarını, tekniğini ve endikasyonlarını ortaya koymak. Yöntem: Üç yıl içinde, medikal tedaviye dirençli intrakranyal hipertansiyonlu ve transtentoryal herniasyonda, habis infarct (3 olgu), subaraknoid kanama ve vazospazm (2 olgu), travmatik beyin hasarı (3 olgu), spontan intraserebral kanama ve venöz tromboz tanıları olan 10 ardışık hastaya dekompresif hemikranyektomi yapıldı. Nörolojik durum girişte Glasgow Koma Skalası (GKS) ve modifiye Rankin Skalası (mRS) ile, çıkışta ve kontrollerde mRS ile değerlendirldi. Operasyon öncesinde, 1. ve 7. postoperatif günlerde ve 1.ayda yapılan bilgisayarlı tomografi (BT) incelemeleri değerlendirildi. Hastaların hepsinde en az 14x11 cm’lik dekompresif hemikranyektomi yapıldı

A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease

A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease

Glycoprotein Ib-alpha Kozak polymorphism in ischemic stroke

WOS: 000298667900010PubMed ID: 22196864Background: Recently, a T/C polymorphism in the Kozak sequence of glycoprotein Ib-alpha (GPIb-alpha) gene at position 25 from the initiator ATG codons, has been identified. The presence of -5C allele increases the surface expression of GPIb-IX-V complex in a gene dosage-dependent manner. It has been suggested that higher receptor levels might increase the adhesiveness of the platelets and confer risk for thrombosis. In this study, we aimed to investigate the association between GPIb-alpha Kozak polymorphism and ischemic stroke. Methods: We prospectively and consecutively recruited 231 patients (118 women and 113 men; mean age: 65 +/- 14.2 years) with first ever ischemic stroke admitted to Istanbul Faculty of Medicine Edip Aktin Stroke Unit between April 2007 and June 2009. Demographic features, risk factors, clinical, and etiological subtypes were analyzed. As the control group, 220 unrelated healthy subjects were included. Results: We found that 156 patients had TT, 70 patients had TC, and 5 patients had CC genotype. At least one copy of C allele carriers were overrepresented in the ischemic stroke group (32.5%) compared with controls (23%) [odds ratio (OR): 0.61; 95% confidence interval (CI): 0.40-0.93; P=0.03]. Among etiologic subtypes, the distribution of C allele carriers was the highest in patients with undetermined etiology (45%) and it was significantly higher than controls (OR: 0.36; 95% CI: 0.20-0.65; P=0.0008). In other subtypes, there was no association with Kozak -5C allele. Conclusion: In conclusion, these encouraging preliminary results show that GPIb-alpha T/C polymorphism might increase the risk of ischemic stroke, especially in those with undetermined etiology.Istanbul University Scientific Research [1476]This work was supported by Istanbul University Scientific Research Projects Unit (BAP - project number 1476)