Browsing by Author "Unlu, Z"
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Item Sonographic training in rheumatology: a self teaching approachFilippucci, E; Unlu, Z; Farina, A; Grassi, WObjective: To evaluate a self teaching approach to be followed by a novice without previous practical experience in musculoskeletal ultrasonography. Methods: The novice was given short general training (two hours) by an experienced sonographer focusing on the approach to the ultrasound equipment, and asked to obtain the best sonographic images of different anatomical areas as similar as possible to the gold standard pictures in the online version of the guidelines for musculoskeletal ultrasonography in rheumatology (free access at http://www.sameint.it/eular/ultrasound). At the end of each scanning session, both novice and tutor scored blindly all the images from 0 (the lowest quality) to 10 (the highest quality), with a minimum quality score of 6 considered acceptable for standard clinical use. The tutor then explained how to improve the quality of the pictures. Fourteen consecutive inpatients (seven with rheumatoid arthritis, three with psoriatic arthritis, two with reactive arthritis, and two with osteoarthritis) and five healthy subjects were examined. Ultrasound examinations were performed with a Diasus (Dynamic Imaging Ltd, Livingston, Scotland, UK) using two broadband linear probes of 5-10 and 8-16 MHz frequency. Results: Sonographic training lasted one month and included 30 scanning sessions (24 hours of active scanning). 243 images were taken of the selected anatomical areas. The mean time required to produce each image was 6 minutes (SD 4.2; range 1-30). At the end of the training, the novice scored greater than or equal to6 for each standard scan. Conclusion: A novice can obtain acceptable sonographic images in 24 non-consecutive hours of active scanning after an intensive self teaching programme.Item Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitusUnlu, Z; Ozmen, B; Tarhan, S; Boyvoda, S; Goktan, CObjective. To assess musculoskeletal ultrasonographic (US) findings in patients with type 2 diabetes mellitus (DM) with and without pes anserinus (PA) tendinitis or bursitis syndrome; and to determine possible etiologic factors such as systemic diabetic microvascular disease complications in these patients. Methods. The knee joints were examined with an ultrasound real-time scanner using a 10 MHz electronic linear transducer in 48 patients with type 2 DM and 25 controls. The presence of systemic diabetic microvascular disease complications was evaluated. Results. On examination 23 (23.9%) knees of the 14 (29.1%) patients with type 2 DM were found to have PA tendinitis or bursitis syndrome. US revealed that only 4 (8.3%) of the diabetic patients with PA tendinitis or bursitis syndrome had PA tendonitis findings. There were no significant differences in the thickness of PA tendons between the diabetic patients with bilateral knee PA tendinitis or bursitis syndrome (9 patients) and controls, or between the asymptomatic and symptomatic knees in patients with unilateral PA tendinitis or bursitis syndrome (5 patients). The prevalence of morphologic changes of the medial meniscus, effusion and synovitis in the suprapatellar recess, popliteal cyst, and radiographic osteoarthritis (OA) in the diabetic patients with PA tendinitis or bursitis syndrome was found to be increased. Conclusion. The prevalence of PA tendinitis or bursitis syndrome is not uncommon on examination in patients with type 2 DIM. However, patients with clinically diagnosed PA tendinitis or bursitis syndrome less frequently have morphologic US changes of the PA tendons. Our results also suggest that structural changes such as meniscus lesions that occur in consequence of OA might have a role in the etiology of medial knee pain in diabetic patients.Item Additional contribution of phonophoresis and low-level laser therapy to exercise in the treatment of carpal tunnel syndrome: A clinical, electrophysiological, and ultrasonographic evaluationKaraman, N; Unlu, Z; Selçuki, D; Cerrahoglu, LObjectives: Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression syndrome. This study aims to evaluate the additive contribution of phonophoresis and low-level laser therapy (LLLT) to tendon and nerve gliding exercises electrophysiologically, ultrasonographically, and clinically in the treatment of moderate CTS. Methods: The sample consisted of 45 patients with moderate CTS, randomized into three groups. Group 1 received phonophoresis and exercise, Group 2 received LLLT and exercise, and Group 3 received exercise alone. Participants were evaluated electrophysiologically, clinically, and ultrasonographically before treatment and at the 6th and 12th weeks after the treatment. Results: An improvement was observed in clinical parameters (Boston Functional Status Scale, Boston Symptom Severity Scale, visual analog scale at rest, and visual analog scale during activity) for all groups at the 6th and 12th weeks after the treatment (p<0.05). An improvement was also noted in the ultrasonographic parameter (cross-sectional area) for all groups at the 12th week after the treatment (p=0.017). Conclusion: Phonophoresis and LLLT do not provide additional effects to exercise therapy. Exercise therapy alone may positively contribute to ultrasonographic and clinical outcomes in the treatment of moderate CTS.Item Comparison of the effects of alendronate and risedronate on bone mineral density and bone turnover markers in postmenopausal osteoporosisSarioglu, M; Tuzun, C; Unlu, Z; Tikiz, C; Taneli, F; Uyanik, BSThe aim of the study was to compare the effects of once-weekly alendronate sodium and daily risedronate sodium treatment on bone mineral density (BMD) and bone turnover markers in postmenopausal osteoporotic subjects. For this purpose, 50 patients were included in this study and randomly classified into two groups. Group I (n=25) received risedronate (5 mg/day) and group II (n=25) received alendronate Na (70 mg/week). The study duration was limited to 12 months. The efficacy of the treatment was evaluated by BMD measurements at spine and hip at 6th and 12th months of the treatment, as well as by the measurement of bone turnover markers such as serum osteocalcin (OC), bone-specific alkaline phosphatase (BASP), urine deoxypyridinoline (DPD) and calcium/creatine ratio in 24-h urine at 1st, 3rd, 6th and 12th months. The evaluation of the changes in BMD in all regions revealed a significant increase in BMD in both groups compared to baseline values except for spine (L2-L4) in alendronate group at 6th and 12th month and femoral neck in risedronate group at 6th month. However, the difference in percentage increase in BMD measurements was not statistically significant between the two groups at 6th and 12th months. In both groups, serum OC, BSAP and urine DPD were found to be significantly attenuated at 1st month of the treatment period, and continued to be lowered throughout the 3rd, 6th and 12th months (P < 0.05). However, there was no statistically-significant difference between both groups of patients (P > 0.05). In conclusion, our results suggest that both treatment protocols provide treatment options of similar efficiencyfor postmenopausal osteoporosis, and have almost-similar effects in enhancing the BMD and in slowing the bone turnover. Risedronate seems to havea more potent effect in the spinal region than that of alendronate, although this potency was not statistically significant.Item Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitisCerrahoglu, L; Unlu, Z; Can, M; Goktan, C; Celik, PInvolvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence of involvement of the CV joint in 80% of patients and of the CT joint in 60%. We found a direct relation between the severity of CV, CT and SI joint affliction, and the severity of CV and SI joints were related to time of evolution of the disease. Pulmonary function tests revealed neither restrictive nor obstructive defects. No relation was found between pulmonary function and CV and CT joint affliction. Patients with stiffer spines had a tendency to have pulmonary function tests within the lower limit of the normal range. In patients with AS diaphragmatic breathing might compensate the chest respiration to some extent.Item Elongated Styloid Process and Cervical SpondylosisUnlu, Z; Orguc, S; Eskiizmir, G; Aslan, A; Bayindir, PBackground: Dysphagia, is a significant sign of many different lesions in upper digestive system especially in proximal esophagus. Tumors, gastroesophageal reflux, achalasia and extrinsic compressions are the most common causes that may lead to dysphagia in geriatric population. Cervical osteophyte induced dysphagia, is one of the uncommon reasons of dysphagia, therefore other causes of dysphagia must be excluded to establish the exact diagnosis. Eagle syndrome is one of the considerable reason which may lead to misdiagnosis in patients with cervical osteophytes. In this case report, we represent four patients who had dysphagia due to anteriorly located cervical osteophytes and evaluate the patients with special reference to Eagle syndrome. Material and methods: After a detailed anamnesis and ENT examination, cervical plain radiographs in four projections and Towne radiographs were obtained for every patient. After that, magnetic resonance imaging (MRI) of cervical spine and barium swallowing studies were performed to evaluate the presence of esophageal compression. Results: Eagle syndrome was excluded due to absence of other symptoms and physical signs, eventhough unilateral or bilateral elongation of styloid processes was found in all of the patients. Conclusion: Cervical osteophytes induced dysphagia is a rare clinical entity, diagnosis should be done by a careful examination, intensive radiologic evaluation. Moreover, all the other causes like Eagle syndrome should be excluded during the diagnosis of cervical osteophyte induced dysphagia.Item Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imagingUnlu, Z; Tascl, S; Tarhan, S; Pabuscu, Y; Islak, SObjective: This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). Methods: A total of 60 patients were enrolled in this study and randomly assigned into I of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at I and 3 months after treatment. Results: There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups. Conclusions: This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.Item Intra-articular injection of tenoxicam in the treatment of osteoarthritis of the kneeUnlu, Z; Ay, KObjectives: The aim of this study was to determine whether tenoxicam, administered by the intra-articular route, is useful for the treatment of osteoarthritis [OA] of the knee. Methods: Patients with knee OA were placed into three groups. Patients with no evidence of inflammation were randomized into Groups 1 and 2. Group 3 consisted of patients with knee OA with associated signs of inflammation. Groups 1 and 3 received three weekly intra-articular injections of tenoxicam, whereas only physical exercise was applied to Group 2. The Western Ontario McMaster Universities Index [WOMAC], the Lequesne Index for knee OA, and physical examination findings of the knee joint were used in the clinical and functional evaluations at baseline and months 1, 3, and 6. Results: A total of 63 subjects participated in this study. Statistically significant improvements from baseline were detected in Group I and Group 3, but not in Group 2. There was no lasting benefit from tenoxicam therapy since Groups I and 2 showed no significant differences at the six-month conclusion of the study. Similarly, Group 1 and Group 3 did not differ significantly. Conclusions: Intra-articular tenoxicam therapy seemed to show greater efficacy for pain and improvement of functional performance than exercise therapy alone, but the effects were no longer present. Tenoxicam, given intra-articularly, may provide benefit from the symptoms of OA, but the effects are transient.Item The role of phonophoresis in dyshpagia due to cervical osteophytesUnlu, Z; Orguc, S; Eskiizmir, G; Aslan, A; Tasci, SObjective: Treatment of patients with anterior cervical osteophytes causing dysphagia includes conservative treatment with anti-inflammatory drugs, muscle relaxants, antibiotics, and an appropriate soft diet. Physical therapy with its advantages may be an alternative method in the treatment, which was not reported previously. Case description: Phonophoresis therapy is applied in nine patients with dysphagia due to cervical osteophytes. Results: The symptom of dysphagia regressed in various degrees in all patients after phonophoresis therapy. Conclusions: Phonophoresis might be an alternative method for the non-steroidal anti-inflammatory drug (NSAID) treatment in patients with dysphagia due to cervical osteophytes.Item Relationship between ossification of the stylohyoid ligament and enthesopathy: A comparative studyUnlu, Z; Tarhan, S; Gunduz, K; Goktan, CObjective Stylohyoid apparatus might be an anatomic region in the cervical spine involved by enthesopathy. The aim of this study was to assess the elongation and/or ossification at the stylohyoid apparatus in the degenerative or inflammatory diseases such as ankylosing spondylitis (AS), psoriatic arthropathy (PsA) and cervical spondylo-arthrosis (CS) in which cervical spine involvement can be seen. Methods Twenty-eight patients with AS, 25 patients with PsA, 31 patients with CS and 50 controls who did not have any complaints or symptoms related with elongated styloid process (SP) were included in the study. On the lateral cervical radiographs, the anterior and posterior aspects of each vertebral body and intervertebral disk were carefully. evaluated for the presence and severity of syndesmophytes, osteophytes or ossification of the adjacent longitudinal ligaments in the patient group. The entire osseous length of the SP was measured on the lateral and lateral oblique mandibular or cervical views or the anteroposterior views radiographs in the patients and controls. Results There were statistically significant differences between the patients with AS and control group and between the patients with PsA and control group with respect to the length of SP. The dimension of syndesmophytes or ligamentous ossification of the cervical spine involving C5-6 intervertebral disk level were significantly correlated with length of SP in the patients with AS. Conclusion Elongated SP might be another manifestation of enthesopaty in cervical spine of the spondyloarthropathies.Item Magnetic resonance imaging and ultrasonographic evaluation of the patients with knee osteoarthritis: a comparative studyTarhan, S; Unlu, Z; Goktan, CThe objectives of the present work were (1) to establish the prevalence of the abnormalities detected by magnetic resonance imaging (MRI) and ultrasonography (US); and (2) to compare these imaging techniques in detail. The study group consisted of 58 patients with symptomatic knee OA and 16 volunteer control subjects. Knee joint was evaluated for femoral condylar cartilage changes, effusion, synovial thickening and popliteal cysts using MRI and US. All knees with OA had cartilage abnormalities on US examinations and normal cartilage was detected in less than 3% of these knees by MRI. Majority of the knees with OA had effusion using US (70%) or MRI (85%). Synovial thickening observed on US (34%) and MRI (50%) were common in the knees with OA. Popliteal cysts were detected in 40% of the knees with OA using US and 35% using MRI. This study confirmed that there was a significant correlation between the MRI and US techniques for evaluating the cartilage and soft tissue changes in the patients with knee OA. There were more significant differences between the controls and the symptomatic knees which had Kellgren-Lawrence (K-L) grade 2 or more OA for the cartilage and soft tissue abnormalities on MRI and US. The prevalence of cartilage changes, effusion, synovial thickening and popliteal cyst using MRI and US were increased as the radiographic grade of OA increased. US examinations could be an alternative to initial evaluation tool to MRI in patients with knee OA.Item The correlation between magnetic resonance detected cartilage defects and spiking of tibial tubercles in osteoarthritis of the knee jointUnlu, Z; Tarhan, S; Goktan, C; Tuzun, CThe aim of the study was to ascertain whether spiking of the tibial tubercle is associated with cartilage defects detected by magnetic resonance imaging (MRI) in patients with osteoarthritis (OA) of the knee joint. Angulation of the tip of the medial and lateral tubercles, and the height of the tubercles above the tibial plateau were measured on a standard anteroposterior radiograph of the knee joint. Cartilage defects in the tibiofemoral joint (TFJ) were determined by MRI examination. The lengthening and sharpening of the angles of the tubercles were significantly more prominent in the patients than controls. A strong association was found between angulation (if less than 70 degrees) and especially the height (if more than 0.16) of the medial tibial spike and MRI-detected cartilage defects in the medial tibiofemoral compartment. The predictive value of the spiking of tibial tubercles for MRI-detected cartilage defects in TFJ is related to the degree and size of the spiking. The presence of tibial spiking itself may not be a reliable sign of early OA.Item Unusual long bone and metacarpo-carpal abnormalities in a case of pseudo-pseudohypoparathyroidismUnlu, Z; Orguc, S; Ovali, GY; Bayindir, PA case of pseudo-pseudohypoparathyroidism (PPH) with shortening of the left femur and tibia and coalition of the base of the fourth metacarpals with capitatum and hamatum in bilateral wrist joints was presented. Involvement of the fourth digits both in hands and feet were more prominent on the left side, with shortening of the left leg.Item Magnetic resonance imaging findings in a case of remitting seronegative symmetrical synovitis with pitting edemaUnlu, Z; Orguc, S; Ovali, GY; Tarhan, S; Dayan, I; Angin, AWe describe a case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome) in a 66-year-old man. This report discusses magnetic resonance imaging findings of RS3PE syndrome and the changes after steroid therapy.Item Osteochondroma of the posterior nasal septum managed by endoscopic transnasal transseptal approachUnlu, HH; Unlu, Z; Ayhan, S; Egrilmez, MA case of osteochondroma of the posterior nasal septum is presented. A 57-year-old female patient presented with a history of bilateral nasal obstruction for 20 years. To the best of our knowledge, this is the second reported case of an osteochondroma of the nasal septum. It was treated by endoscopic transnasal transseptal surgery.Item Sonographic-Guided Injection of Corticosteroid in the Treatment of Lateral EpicondylitisUnlu, Z; Tarhan, S; Ovali, GY; Pabuscu, YObjective: In this study the advantage of ultrasonography [US] in diagnosis and therapy of lateral epicondylitis [LE] was investigated in patients with lateral elbow pain and clinically diagnosed as LE. Methods: Fifty-two patients with LE were examined using sonography. For the patients in whom normal US examination was found, a blind injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine was performed [Group 1]. The patients whose clinical diagnosis was confirmed with US received a sonographic-guided injection of methylprednisolone 20 mg and 0.5 ml one percent lignocaine [Group 2]. Outcome measurements were performed at baseline, two weeks, one month, and three months. Pain and functional status were assessed using a visual analog scale, physical functioning and bodily pain scales of the Medical Outcomes Study 36 Item Short-Form Health Survey, a patient-rated forearm evaluation questionnaire, and a patient-specific functional scale. Painless grip strength bilaterally was also measured. Results: Twenty-four [46.2 percent] patients had a normal-appearing common extensor origin on US. The group in which diagnosis of LE was confirmed on US and sonographic-guided corticosteroid injections improved significantly from the baseline to the third month follow up [P 0.000] in both clinical assessment and physical examination findings. Conclusions: Our case series suggested that sonography of the common extensor origin can be used to confirm LE in patients with lateral elbow pain. Although sonographic-guided injections produced more clinical improvement, further studies are needed to determine effectiveness of sonographic-guided injections.Item Comparison of intra-articular tenoxicam and oral tenoxicam for pain and physical functioning in osteoarthritis of the kneeUnlu, Z; Ay, K; Tuzun, CThis study was designed to compare efficacy of local administration of a nonsteroidal anti-inflammatory drug with systemic administration in patients with osteoarthritis (OA) of the knee. For this purpose, intra-articular tenoxicam and oral tenoxicam therapies were applied and the improvement in control of pain and physical functioning were evaluated. A total of 69 patients with OA of the knee were randomized into three groups. Patients in the first group (41 knees of 23 patients) were treated for 1-3 weeks with once weekly intra-articular injection of tenoxicam 20 mg. Patients in the second group (45 knees of 26 patients) received 20 mg/day tenoxicam orally for 3 weeks and only physical exercises were applied to the third group (32 knees of 20 patients). Physical examination of the knee joint, Western Ontario and McMaster Universities Index and the Lequesne Algofunctional Index were used as outcome measurements at baseline, and the 1st, 3rd and 6th months. More significant improvement in pain and disability parameters was observed in groups 1 and 2 than group 3 compared with baseline measures. Among the patients' responses a few of the differences were statistically significant, more in favour of tenoxicam, and tenoxicam seemed to be superior to exercise alone especially at the final evaluation. There was no significant difference between the oral and intra-articular tenoxicam treatment regimens. The results of this study showed that treatment of OA of the knee with intra-articular tenoxicam is as effective as that with oral tenoxicam. It can be thought that intra-articular administration can be preferred to oral therapy due to minimal possibility of systemic side effects.Item An Idiopathic Case of Calcium Pyrophosphate Dihydrate Crystal Deposition Disease with Crowned Dens Syndrome in a Young PatientUnlu, Z; Tarhan, S; Ozmen, EMCalcium pyrophosphate dihydrate (CPPD) crystal deposition disease is rare in patients under the age of 40 in the absence of metabolic or familial predisposition. A high incidence of involvement of the transverse ligament of the atlas in CPPD deposition disease was reported. However, involvement of the craniocervical junction is rarely symptomatic. We report a rare case in a young male with severe idiopathic CPPD crystal deposition disease, including crowned dens syndrome in the cervical spine.Item Evaluation of the joint hyperlaxity in a homogeneous populationUnlu, Z; Karcioglu, M