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Öğe Case report: Lipoma arborescens in childhood(2004) Aydin, Gülümser; Keleş, Işık; Karagülle Kendi, A.Tuba; Yilmaz L., Özlem; Orkun, SevimLipoma arborescens (LA) is a rare intraarticular lesion of unknown etiology, mostly described in adult patients. Unilateral knee joint is the most frequent site of involvement. LA may be associated with osteoarthritis in some patients. Magnetic resonance (MR) imaging findings are extremely characteristic in the diagnosis. We report herein a 15-year-old female patient with LA; who has atrial septal defect, and who presented with pain and swelling of bilateral knee joints. MR imaging showed characteristic signs of LA and mild osteoarthritis. In childhood patients with mono/oligoarticular effusion and synovial hypertrophy without systemic involvement; LA should be considered in differential diagnosis. MR imaging is a sensitive modality in the diagnosis of LA.Öğe Clinical and laboratory features of patients with musculoskeletal brucellosis(Turkiye Klinikleri, 2005) Aydin, Gülümser; Keleş, İlayda Ceren; Atalar, Ebru; Ayaşlioğlu, Ergin; Tosun, Aliye; Orkun, S.Objective: To evaluate the demographic, clinical and laboratory features of patients with musculoskeletal brucellosis in urban and rural areas of Kirikkale, Turkey. Material and Methods: Twenty-eight patients with the diagnosis of musculoskeletal brucellosis were included in the study. All patients were questioned for demographic characteristics, duration and characteristics of complaints and possible source of infection. The findings of detailed systemic and musculoskeletal examinations were noted. Routine blood chemistries, complete blood count, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, blood culture and standard tube agglutination tests were carried out. Radiographs of the sacroiliac joints and lumbosacral spine of all patients and, if required, radiographs of peripheral joints were evaluated. Magnetic resonance imaging was performed on those in whom deep joint involvement was suspected clinically and radiographically. Results: Patient mean age was 39.4±14.4 yr, mean duration of disease was 10.1 ± 12.7 yr, and 64.3% of the patients were male. The most frequent symptom was arthralgia (85.7%), and the most prevalent sign was splenomegaly (32.1%). Blood cultures were positive in 39.3% of the patients. Peripheral arthritis had the highest incidence with a rate of 71% in joint manifestations, and the most frequent involvement sites were hip and knee with a ratio of 35%. Sacroiliitis was detected in 32% and was unilateral in 89% of the patients. Spondylitis was found in 14% of the patients, most frequently in lumbar segments (75%). Each musculoskeletal involvement site in terms of all parameters were compared with the others and only the sacroiliac test in the sacroiliitis group and age, vertebral tenderness with percussion and the presence of painful spinal movements in spondylitis group were significantly different from the others (p<0.05). Conclusion: Peripheral joints are the most common articular involvement sites in patients with musculoskeletal brucellosis in our region. Specific sacroiliac joints tests may serve as guides to sacroiliitis. Spinal involvement should be kept in mind in elderly patients with brucellosis, particularly when spinal movements are painful or tenderness is elicited with percussion over the spine. Brucellosis should be included in the differential diagnosis of patients with spinal or peripheral joint pain and in those presenting with complaints due to soft tissue rheumatism. Copyright © 2005 by Türkiye Klinikleri.Öğe Diagnostic precision of ultrasonography in patients with carpal tunnel syndrome(Lippincott Williams & Wilkins, 2005) Keles, Işık; Kendi, A. Tuba Karagülle; Aydin, Gülümser; Zög, Ş. Gülfer; Orkun, SevimObjective: To evaluate the diagnostic value of ultrasonography in patients with electrophysiologically confirmed carpal tunnel syndrome. Design: A prospective ultrasonographic study of 35 wrists with electrophysiologically confirmed carpal tunnel syndrome and of 40 normal wrists. Receiver-operating-characteristics curves for the ultrasonographic measurements of median nerve were plotted to identify the most optimal cutoff values. Results: The ultrasonographic measurements of median nerves were found to be increased significantly in patients with carpal tunnel syndrome when compared with controls, particularly in terms of cross-sectional area (P < 0.001) and the bowing of the flexor retinaculum (P < 0.01) but not in the flattening ratio (P > 0.05). According to receiver-operating-characteristics curve results, the most optimal cutoff value for the cross-sectional area of the median nerve was obtained at the level of middle carpal tunnel, which was 9.3 mm(2), with a sensitivity of 80% and specificity of 77.5%. The optimal cutoff value for the bowing of the flexor retinaculum was 3.7 mm, with a sensitivity of 71.4% and specificity of 55%. No optimum cutoff value could be identified from the receiver-operating-characteristics curves for the flattening ratio of median nerve. Conclusion: Ultrasonographic examination of the median nerve seems to be a promising method in the diagnosis of carpal tunnel syndrome, evaluating the morphologic changes of the median nerve in patients with clinical signs and symptoms. Further studies with wider series are needed to confirm our preliminary results.Öğe Endogenous sex steroids and bone mineral density in healthy men(Elsevier France-Editions Scientifiques Medicales Elsevier, 2006) Keles, ışık; Aydin, Gülümser; Basar, M. Murad; Hayran, Mutlu; Atalar, Ebru; Orkun, Sevim; Batislam, ErtanObjective. - To evaluate the role of endogenous sex steroids on bone mineral density (BMD) in healthy Turkish men. Methods. - Serum total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate and estradiol levels were assayed in 174 healthy men of 240 volunteers, aged 22-76 years. Dual-energy X-ray absorptiometry was used to measure the BMD (g/cm(2)) of lumbar spine, femoral neck and non-dominant proximal and distal radius-ulna sites. Linear regressions were conducted using each BMD site as the dependent variable and each sex. steroid as the independent variable. Four models were run for each bone site and sex steroid; crude, age-adjusted, adjusted for age and body mass index (BMI), and adjusted for age, BMI and cigarette-smoking. Results. - The mean age and BMI of men enrolled in the study were 47.7 +/- 13.7 years and 26.9 +/- 3.6 kg/m(2). Log of FT was significantly associated with the BMD of distal forearm in all models analyzing the crude and adjusted effects. Dehydroepiandrosterone sulfate effect on BMD of proximal forearm came closer to the level of statistical significance when adjusted with age, BMI and cigarette-smoking. Estradiol and TT levels were not found to be associated with BMD of any sites measured. Conclusion. - Among the endogenous sex steroids in men, predominantly FT seems to be one of the determinants of BMD. Therefore a decrease in serum levels of testosterone in aging male or secondary causes may negatively affect BMD. (c) 2005 Published by Elsevier SAS.Öğe Evaluation of erythrocyte deformability in experimentally induced osteoporosis in female rats and the effects of vitamin C supplementation on erythrocyte deformability(Comenius Univ, 2011) Arslan, Ayşe; Aydin, Gülümser; Keleş, İlayda; Çomu, Faruk Metin; Arslan, MustafaObjective: The aim of this study was to evaluate the possible variations in antioxidant enzymes, lipid peroxidation and erythrocyte deformability in experimentally induced osteoporosis in female rats and to assess the effects of vitamin C supplementation on those variations. Material: A total of 20 female Wistar Albino Rats were randomized into the three groups as controls (Group C, n=6), ovariectomized rats (Group 0, n=7) and ovariectomized rats receiving vitamin C supplementation (Group OVC, n=7). After the surgical procedure of ovariectomy, group OVC received 1 g ascorbic acid in 500mL water daily. After 100 days following the ovariectomy, bone mineral density (BMD) was measured by using dual-energy X-ray absorptiometry. Results: BMD was significantly lower in the group 0 than in the group C (p=0.015), whereas it was significantly higher in the group OVC than in the group 0 (p=0.003). MDA activity was significantly higher in the group 0 than in the group C (p=0.032), whereas it was significantly lower in the group OVC than in the group 0 (p=0.025). SOD activity was significantly higher in the group 0 than in the group C (p=0.032). Erythrocyte deformability was significantly higher in the group 0 than in the group C and OVC (p=0.008, p=0.021, respectively). Conclusion: Erythrocyte deformability may show negative variations, suggesting a causative role in disruption of blood flow and tissue perfusion, which also negatively affect bone metabolism. Vitamin C supplementation seems to reverse those negative effects of variations in erythrocyte deformability. However, our preliminary results should be confirmed in more experimental studies and clinical trials (Tab. 3, Ref. 28). Full Text in free PDF www.bmj.sk.Öğe Factors affecting bone mineral density in men(Springer Heidelberg, 2009) Atalar, Ebru; Aydin, Gülümser; Keleş, Işık; İnal, Elem; Zog, Gulfer; Arslan, Ayşe; Orkun, SevimIn this study, in 131 men aged 20-75 years, we investigated correlations between bone mineral density (BMD) in the lumbar spine and femoral neck and endogenous factors (age, body mass index) as well as exogenous factors (calcium intake, physical activity, smoking, caffeine, socioeconomic and educational levels). The age had a negative effect on femoral neck BMD in patients overall, and on both lumbar spine and femoral neck BMD in patients under 50. Physical activity has effects on femoral neck BMD in men above 50. Lumbar vertebral BMD negatively correlated with smoking in patients overall, and this correlation persisted when patients aged 50 and older were analyzed separately. Femoral neck BMD was positively correlated with body mass index in men aged 50 and older. Given the variety of findings in the research literature regarding risk factors for low BMD, we suggest that genetic and geographic factors should be considered.Öğe Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: a case report and review of the literature(Springer Heidelberg, 2006) Keleş, Işık; Aydin, Gülümser; Tosun, Aliye; İnal, Elem; Keles, Hatice; Orkun, SevimThe association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously.Öğe Functional and cognitive progress in aphasic patients with traumatic brain injury during post-acute phase(Taylor & Francis Ltd, 2006) Demir, Sibel Özbudak; Altınok, Nermin; Aydin, Gülümser; Köseoğlu, FüsunObjectives: To investigate the relationship between language functions and cognitive and functional outcome and to evaluate the effects of a conventional language rehabilitation programme on aphasic adult patients in the post-acute stage of traumatic brain injury (TBI). Design: Non-concurrent prospective study. Patients were assessed pre-treatment and post-treatment with standardized assessment tools. Subjects: Sixty-one aphasic patients with TBI who were admitted to a rehabilitation centre in the post-acute phase for a late inpatient rehabilitation programme. Methods: The motor sub-scales of the Functional Independence Measures and Disability Rating Scale were used to assess functional status and disability. Cognitive status was evaluated with the Mini-Mental Status Examination and the Functional Independence Measure cognitive sub-scale. The language function was evaluated with the Gulhane Aphasia Test. Results: All functional, cognitive and language scores increased significantly during the rehabilitation programme. Language functions at admission were correlated with the Functional Independence Measure motor change scores and the Mini-Mental Status Examination change scores. Regression analyses revealed that auditory comprehension at admission was the most important independent determinant of functional and cognitive gain during rehabilitation. Conclusion: Post-acute language functions after late admission to a rehabilitation centre appear to be related to measures of cognitive and functional progress in patients with TBI. Functional and cognitive outcome is mainly affected by auditory comprehension. Results also showed the effectiveness of post-acute conventional rehabilitation in improving language functions.Öğe Multifocal osteoarticular tuberculosis: a case report(Springer Heidelberg, 2005) Keles, Işık; Aydin, Gülümser; Kendi, Tuba K.; Orkun, SevimOsteoarticular tuberculosis is a quite uncommon form of extrapulmonary tuberculosis. Difficulties in diagnosis often lead to delayed treatment, sometimes with devastating consequences for patients. We report herein a case of multifocal osteoarticular tuberculosis of insidious onset with no history of prior health problems or constitutional signs and symptoms. Despite widespread osteoarticular involvement, the outcome of the patient was favorable after the management. Osteoarticular tuberculosis must be considered in patients with insidious musculoskeletal symptomatology.Öğe Transcutaneous electrical nerve stimulation versus baclofen in spasticity: Clinical and electrophysiologic comparison(Lippincott Williams & Wilkins, 2005) Aydin, Gülümser; Tomruk, Serap; Keles, Işık; Demir, Sibel O.; Orkun, SevimObjectives: Clinical and electrophysiologic comparison of the efficacy of transcutaneous electrical nerve stimulation (TENS) and oral baclofen in the treatment of spasticity. Design: Patients with spinal cord injury and spasticity were included in the study. Ten patients were assigned to oral baclofen and 11 to TENS groups. For the comparison of H-reflex variables, 20 healthy individuals were allocated to a control group. TENS was applied to the tibial nerve for 15 days at a frequency of 100 Hz. Clinical (spasm frequency scale, painful spasm scale, lower limb Ashworth score, clonus score, deep tendon reflex score, plantar stimulation response score) and electrophysiologic evaluations (H-reflex response at the highest amplitude, latency of maximum H-reflex, and ratio of H-reflex response at the highest amplitude to M response at maximum amplitude) of the lower limb and functional evaluations (functional disability score and FIM (TM)) were carried out in baclofen and TENS groups before and after treatment. Posttreatment evaluation was made 24 his after the 15th session in the TENS group. In addition, clinical spasticity scores and electrophysiologic variables were measured 15 mins after the first application and 15 mins after the 15th session. Results: Significant improvement was detected in lower limb Ashworth score, spasm frequency scale, deep tendon reflex score, functional disability score, and FIM in the baclofen (P = 0.011, P = 0.014, P = 0.025, P = 0.004, and P = 0.005, respectively) and TENS (P = 0.020, P = 0.014, P = 0.025, P = 0.003, and P = 0.003, respectively) group after treatment. Decrease in H-reflex maximum amplitude was significant in the TENS group (P = 0.026). Most marked improvement was observed in the third evaluation, 15 mins after the 15th session, particularly in lower limb Ashworth score (P = 0.006) and H-reflex maximum amplitude (P = 0.006) in the TENS group. The percentage change in clinical, electrophysiologic, and functional variables caused by baclofen was not different from that caused by repeated applications of TENS in the short- and long-term evaluations (P > 0.05). Conclusion: TENS may be recommended as a supplement to medical treatment in the management of spasticity.
