Browsing by Author "Tüzün Ç."
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Item Low back pain and posture(1999) Tüzün Ç.; Yorulmaz I.; Cindaş A.; Vatan S.This study was designed to analyse postural aberrations of the back and lower back region in patients with acute and chronic low back pain and to investigate the accordance of clinical and radiological assessments. Fifty patients with acute and 50 with chronic low back pain and 50 controls were studied and a detailed spinal physical examination was performed. In addition, the angles of thoracic kyphosis, lumbar lordosis and sacral inclination were assessed radiologically. Differences among the three groups, correlations of radiological parameters with each other and with clinical parameters such as age, gender and body mass index, and the accordance of clinical and radiological postural assessments were investigated. It was concluded that there were no statistically significant differences among the groups for angles of thoracic kyphosis, lumbar lordosis and sacral inclination; however, we found significant correlations among all radiological parameters, especially between lumbar lordosis and sacral inclination. Both lumbar lordosis and sacral inclination were increased with body mass index, and lumbar lordosis and thoracic kyphosis were increased with age. Clinical assessments of thoracic kyphosis and lumbar lordosis were not in accordance with radiological assessments.Item A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations(Taylor and Francis Inc., 2000) Güevenol K.; Tüzün Ç.; Peker Ö.; Göktay Y.The purpose of this investigation of lumbar disc herniation patients was to compare the efficacy of the inversion spinal traction and the conventional mechanical spinal traction on several clinical parameters and computed tomography. This investigation consisted of 29 patients with low back pain and sciatica due to lumbar disc herniation. Patients were randomly assigned into two groups: an inversion spinal traction that was applied to 15 patients, and a conventional traction that was applied to 14 patients for ten sessions. The efficacy of the treatments was evaluated based upon clinical parameters before, immediately after, and three months after the treatment. Computed tomographic (CT) investigation was done before and immediately after the treatment. Both methods of traction were found to be clinically effective. Although there was no statistically significant difference between the two groups based upon the clinical parameters, CT findings of the conventional traction group tended to show more improved parameters than the inverted spinal traction group. Reasons for better results of the conventional traction are discussed and the necessity for further investigations on this topic is emphasized.Item Low back pain and scoliosis; [Bel aǧrisi ve skolyoz](2000) Yorulmaz I.; Cindaş A.; Vatan S.; Tüzün Ç.In this study we aimed to investigate the factors that could be effective in the evolution of scoliosis in adults and the relation of scoliosis and low back pain by comparing the presence of scoliosis in healthy volunteers. 209 patients with low back pain were scheduled together with 50 volunteers. All of them underwent clinical evaluation and then A-P and lateral dorsal and lumbosacral vertebrae radiograms were obtained. The status of sacroiliac joints were also observed in the radiographs. No significant difference was detected concerning the presence of scoliosis, the degree of scoliotic curves, localizations and directions between patients with low back pain and controls. Significant increase in the radiolucency of vertebrae was detected in the scoliotic group; apart from this no relation was found regarding osteoporosis and degenerative disease of the spine between patients with and without scoliosis. Degenerative stigmata in sacroiliac joints were present more often in patients with scoliosis. As a result although no direct relation could be found between low back pain and adult dorsolumbar scoliosis, the fact that detecting radiolucency of vertebrae significantly higher in scoliotics could put osteoporosis as a factor responsible in the older age groups. The degeneration of sacroiliac joints and its relation to scoliosis apparently need further investigations.Item Depression and anxiety in patients with fibromyalgia syndrome; [Fi̇bromyalji̇ sendromlu hastalarda depresyon ve anksi̇yete](2000) Tüzün Ç.; Cindaş A.; Esen A.Several observations showed that psychiatric disorders may be involved in the pathogenesis of Fibromiyalgia Syndrome (FMS). In this study we aimed to compare the depression and anxiety levels among FMS, major depression and healthy controls and to investigate which depression and anxiety features are especially discriminating. We also investigated the relationship between clinical features and depression and anxiety. The study included 34 female patients with FMS, 21 patients with major depression and 14 educational status, age and sex matched healthy controls. Beck Depression Scale (BDS), Hamilton Depression Rating Scale (HDRS) and State Anxiety Inventory (SAI) were significantly lower than major depression, and were higher than healthy controls in FMS (p<0.05). Results of discrimant analysis for SAI showed that nervousness was exactly, and patient discomfort was low level discriminating for FMS. Similarly, in analysis of HDRS and BDS, It was found that somatic anxiety and patient discomfort was low level discriminating for FMS. We found statistically significant correlation between BDS and HDRS scores and intensity of general pain, intensity of pain after physical activity, intensity of pain with palpation (p<0.05). We also found positive significant correlation between HDRS scores and sleep disturbance scores (p<0.05). But there was no correlation between SAI scores and clinical features (p>0.05). Our study indicates that depression and anxiety levels are higher than healthy controls, but don't reach levels of major depression, and nervousness is the major discriminating psychiatric feature of FMS. We concluded that there was a relationship between psychiatric disorders and FMS and psychiatric disturbance may play role in the pathogenesis of FMS.Item Serum growth hormone and insulin-like growth factor-I levels in fibromyalgia syndrome; [Fi̇bromyalji̇ sendromlu hastalarda serum growth hormon ve insulin-like growth faktör-I düzeyleri̇](2000) Cindaş A.; Tüzün Ç.; Uyanik B.S.; Yiǧitoǧlu R.It has been hypothesized that depressed levels of Insulin-Like Growth Factor-I (Somatomedin C) (IGF-I), caused by a deficit of stage-4-sleep-dependent release of Growth Hormone (GH) may play role in pathophysiology and muscle pain in fibromyalgia syndrome (FMS). In this study we aimed to measure the serum levels of GH and IGF-I in patients with FMS and to investigate the relationship between GH and IGF-I levels and clinical features. The study included 32 female patients with FMS and 22 age and sex matched healthy controh. Two way radioimmunoassay method was used to measure serum concentrations of IGF-I and chemiluminans method was used to measure GH. Visual Analog Scale (VAS) was used for subjective assessment of pain and sleep disturbance. Mann-Whitney U test and Pearson Correlation Analysis were used for statistical analysis. The mean serum levels of GH (0,36±0,63 ng/ml in fibromyalgia group and 0,97±1,11 ng/ml in control group) and IGF-I (107.38±25.32 ng/ml in fibromyalgia group and 174.50±41.52 ng/ml in control group) were significantly lower in fibromyalgia group (p<0.001). But there were no statistically significant correlation between sleep disturbance, intensity of general pain, intensity of pain after physical activity, intensity of resting pain, intensity of pain with palpation, intensity of morning stiffness, number of tender points, tender points, tender point palpation scores, Beck Depression Scale scores, Hamilton Depression Rating Scale scores and State Anxiety inventory scores with serum levels of IGF-I and GH. We concluded that the disruption of GH and IGF-I secretion may play role in the pathophysiology of FMS however it does not effect the intensity of clinical findings.Item Clinical features of female patients with fibromyalgia syndrome; [Fi̇bromyalji̇ sendromlu kadin hastalarin kli̇ni̇k özelli̇kleri̇](2002) Cindaş A.; Tüzün Ç.Patients with fibromyalgia have been reported to display high rates of several concomitant disorders and symptoms, including irritable bowel syndrome (IBS), migraine, raynaud fenomen (RF), primer dysmenorrhea, anxiety, depression, fatigue, paresthesia and sleep disorder. In this study we aimed to identify clinical features of female patients with FMS. The study included 105 female patients with FMS according to ACR 1990 criteria. Their mean age was 40.27±10.38. Mean tender point number was 14.81±2.50 and mean tender point score was 27.89±10.51. We found mean pain severity scores as 64.86±19.52, 66.76±22.92 and 53.54±24.34 for general pain, night pain and resting pain respectively. Fibromyalgia patients were displayed high rates of fatigue (%95), headache (%90), sleep disorder (%89), morning stiffness (%89), anxiety (%87) and paresthesia (%84). Stress (%98) and overactivity (%93) were the most detected modulating factors in FMS. We concluded that modulating factors, concomitant disorders and symptoms were important clinical features of female patients with FMS.Item The effect of simvastatin on serum cytokine levels and bone metabolism in postmenopausal subjects: Negative correlation between TNF-α, and anabolic bone parameters(Springer Japan, 2004) Tikiz C.; Ünlü Z.; Tikiz H.; Ay K.; Angin A.; Onur E.; Var A.; Tüzün Ç.In this prospective study, we aimed to evaluate the effect of simvastatin on bone metabolism and the correlation between changes in bone turnover parameters and serum cytokine levels. For this purpose, 38 postmenopausal subjects with hypercholesterolemia (>240mg/dl), not on osteoporosis treatment, were studied. Simvastatin was started at a dose of 20mg daily and continued for 3 months. Six patients were excluded from the study during the follow-up period. Pre- and post-treatment samples were analyzed for bone alkaline phosphatase (BAP) and osteocalcin (OCL), as markers of bone formation; for carboxyterminal telopeptide of collagen I (CTX), as a marker of bone resorption; and for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) cytokine levels. Total cholesterol level was decreased from 262.1 ± 30.9 to 210.2 ± 35.6mg/dl after simvastatin treatment (P < 0.0001). While no significant change was observed in serum CTX level, BAP and OCL levels were significantly increased (from 120.8 ± 56.6 to 149.5 ± 57.6 IU/I [P = 0.008], and from 20.8 ± 12.6 to 34.7 ± 18.4 μg/l [P = 0.015], respectively). In the analysis of cytokines, while no significant change was observed in IL-6 levels, the TNF-α level was found to be significantly decreased after simvastatin treatment (from 77.9 ± 31.6 pg/ml to 23.5 ± 12.6 pg/ml [P = 0.021]). Individual changes in TNF-α levels showed a moderate negative correlation with the individual changes in BAP and OCL levels (r = -0.550 [P = 0.001], and r = -0.497 [P = 0.004], respectively). In conclusion; 20-mg daily simvastatin treatment for 3 months significantly increased BAP and OCL levels (markers of bone formation) in hypercholesterolemic postmenopausal subjects, without affecting bone resorption. These findings support the idea that simvastatin has an anabolic effect on bone formation. Additionally, the presence of a negative correlation between TNF-α levels and the anabolic bone parameters suggests that a cytokine-lowering effect of simvastatin may also be involved in the remodeling process and could exert some additive beneficial effect on bone metabolism.Item Transcutaneous electrical nerve stimulation therapy in the children with nocturnal enuresis; [Enüresis nokturnali çocuklarda transkütan elektri̇ksel si̇ni̇r sti̇mülasyonu (TENS) tedavi̇si̇](Nobelmedicus, 2005) Ünlü Z.; Tüzün Ç.; Taneli C.; Firat A.We evaluated the efficacy of transcutaneous nerve stimulation (TENS) therapy on wetting behaviors, social functioning and bladder storage capacities in children with enuresis nocturna. A total of 8 enuretic children aged 8-16 years old were selected for study on basis of poor outcome despite extensive trials of conventional treatments. 15 seances of TENS therapy applied on the suprapubic region. Changes in wetting behaviors and social functioning before and after the therapy were assessed with a 7-point scale. Patients were asked to record their urine output using a frequency/volume chart for two consecutive days before and after the therapy. Two of the children became dry two months after the therapy. The total scores of wetting behaviors and social status were increased in two patients at two months after the therapy. Maximum functional bladder capacity, mean day-time bladder capacity, maximum nocturnal bladder capacity were increased only in two patients after the treatment. Number of daytime voids were decreased in these patients. According to our preliminary results, it seems that TENS therapy in the children with nocturnal enuresis showed improvement in some degree. Further studies are needed which are performed in larger series.Item Effects of simvastatin on bone mineral density and remodeling parameters in postmenopausal osteopenic subjects: 1-year follow-up study(2005) Tikiz C.; Tikiz H.; Taneli F.; Gümüşer G.; Tüzün Ç.Observational studies suggest that statin use may be associated with lower incidence of fracture. However, there are conflicting data for their effects on bone remodeling parameters and bone mineral density (BMD). In the present study, we aimed to investigate the effects of simvastatin on bone metabolism and BMD in subjects with hypercholesterolemia (> 240 mg/dl). For this purpose, 32 postmenopausal osteopenic subjects who were given simvastatin treatment (20 mg/day) and not on osteoporosis treatment were included in the study. During the 1-year follow-up period, the total cholesterol level decreased from 262.1 ± 30.9 to 202.2 ± 30.1 mg/dl (p < 0.0001). At a period as early as the 3rd month, levels of the anabolic markers, e.g., bone-specific alkaline phosphatase (BSAP) and osteocalcin (OCL), were found to be significantly increased (from 120.8 ± 56.6 to 149.5 ± 57.6 IU/l, p = 0.008, and from 20.8 ± 12.6 to 34.7 ± 18.4 μg/l, p = 0.015, respectively) while no significant change was observed in the resorptive marker of serum N-telopeptide of type I collagen (CTX). At the 6th and 12th month, BSAP and OCL were both found to be decreased below the pretreatment values. While a significant reduction was found in BSAP levels (from 120.8 ± 56.6 to 55.9 ± 18.8 IU/l, p < 0.001), no significant change was observed in CTX levels after the 6-month treatment period. Parathyroid hormone showed a gradual profound increase during the follow-up period (from 62.7 ± 41.5 to 108.4 ± 51.7 pg/ml, p < 0.001). No significant change was found in BMD levels at the spine, femoral neck, Ward's triangle, and trochanter at the end of the 1-year follow-up period. In conclusion, simvastatin treatment showed a short-lasting anabolic effect on bone metabolism. However, this effect was lost by prolongation of therapy. The decrease in both anabolic and resorptive markers at the 6th and 12th month suggests that simvastatin affects bone metabolism mostly in favor of inhibition of the bone turnover in a long-term observation period although this inhibitory effect was not reflected in BMD. © Clinical Rheumatology 2005.Item Efficacy of low level laser treatment in plantar calcaneal enthesophytosis(2006) Tikiz C.; Ünlü Z.; Ay K.; Tüzün Ç.The present study was conducted to assess the efficacy of low-intensity laser therapy in the treatment of plantar calcaneal enthesophytosis (PCE). Forty patients suffering from pain at least for more than one month with the diagnosis of PCE were included in the study. Patients were randomized into two groups as; active laser group (ALG, n=20, mean age 49±10 years) and placebo laser group (PLG, n=20, mean age 54±5 years). Gallium-aluminum-arsenide (GaAlAs) infrared diode device (30mW, 830 nm) was used for low-level laser treatment (LLLT). Patients were treated five times weekly for 3 weeks. Baseline evaluation consisted of the severity of resting pain, morning pain, pain after activity, pain on palpation, and the effect of pain on daily activities and walking ability. Assessments were done before treatment, at the end of treatment and at 1-month follow-up. Baseline patient characteristics were similar in both groups. In intra-group comparisons, significant improvements were detected in all outcome measurements at both post-treatment and one-month follow-up period in ALG (p<0.05), however no significant difference was observed in PLG concerning the same time intervals. Inter-group comparisons also revealed significant difference in favor of ALG except walking period without pain at 1-month follow-up period. In conclusion, we suggest that low-level laser is an effective treatment modality for PCE and it can be used as an alternative treatment method to other conventional treatment modalities.Item Prevalence of depressive disorders among patients with fibromyalgia seeking help for the first time and its relationship with alexithymia; [Fizik tedavi ve rehabilitasyon polikliniǧine ilk kez başvuran ve fibromiyalji tanisi konan hastalarda depresif bozukluklarin görülme sikliǧi ve aleksitimi ile ilişkisi](2007) Taşkin E.O.; Tikiz C.; Gürlek Yüksel E.; Firat A.; Tüzün Ç.; Aydemir Ö.Objective: In this study, it was aimed to determine the prevalence of depression and its relationship with alexithymia among patients with fibromyalgia who apply to the Physical Therapy and Rehabilitation outpatient clinic for the first time. Methods: The research included 50 patients who applied to the Physical Therapy and Rehabilitation outpatient clinic for the first time and diagnosed as FM according to the American College of Rheumatology Scale. The subjects were evaluated with the SCID-I affective disorders module, 20-item Toronto Alexithymia Scale (TAS-20), 17-item Hamilton Depression Scale (HAM-D) and a demographic data form. Data were analyzed using t-test for continuous numerical parameters and chi-square test for categorized parameters. Pearson correlation test was used for determination of correlation between HAM-D and TAS-20 scores. Results: The prevalence of major depressive episode, depressive disorder NOS and dysthymia were found to be 44%, 10% and 14% respectively. None of the patients were seeking help for their depressive disorder and were using antidepressant treatment. TAS-20 scores of the patients with depression were higher (p=0.022) than scores of the non-depressive patients. Alexithymic patients had higher HAM-D mean values (p=0.035) and there was a positive correlation between TAS-20 and HAM-D scores (p=0.014). Conclusion: In fibromyalgia, the prevalence rate of depression is found to be significant. The prevalence rate of depression was even higher in alexithymic patients. Patients with fibromyalgia seem to have difficulty in experiencing their depression, and thus they do not seek psychiatric help. Therefore, these patients must be evaluated additionally for depression during the management of fibromyalgia.