Effectiveness of spinal manipulation in addition to pharmacological treatment in fibromyalgia: A blinded randomized trial.

BACKGROUND: It has been suggested that spinal manipulation may alter sensorimotor integration in the central nervous system and therefore may be used to treat central sensitization syndromes. OBJECTIVE: To investigate the effectiveness of spinal manipulation in addition to pharmacological treatment in patients with fibromyalgia. DESIGN: A single-center, randomized, and placebo-controlled trial with three parallel arms SETTING: Outpatient clinics at a tertiary health care facility. PARTICIPANTS: Female patients aged 18-55 years receiving pharmacological treatment. INTERVENTIONS: Spinal manipulation, sham manipulation, and control groups. Patients in the spinal manipulation group received high-velocity low-amplitude manipulation treatment twice a week for 3 weeks. Patients in the sham group received an application that was very similar to the active treatment but was not expected to have any real therapeutic effect. Patients in the control group continued to receive pharmacological therapy. MAIN OUTCOME MEASURES: The primary outcome, pain score (visual analog scale), and secondary outcomes, pressure pain threshold (PPT), Revised Fibromyalgia Impact Questionnaire (FIQR), Widespread Pain Index (WPI), and Fibromyalgia Severity Score (FSS) were measured before, 1 month, and 3 months after randomization. RESULTS: Sixty patients with a mean age of 41.7 years (SD = 8.0) were enrolled in the study. A mixed-design repeated analysis of covariance was used to test the data. At 1 month after randomization, pain scores did not differ between groups. At 3 months after randomization, the spinal manipulation group had a significantly lower pain score (adjusted mean = 4.3 cm, SE: 0.4) than the control group (adjusted mean = 6.8 cm, SE: 0.4) and the sham manipulation group (adjusted mean = 5.7 cm, SE: 0.4). PPT did not differ between groups at any time point. FIQR, WPI, and FSS showed some improvement 1 or 3 months after randomization in favor of the spinal manipulation group. CONCLUSIONS: Spinal manipulation used in addition to pharmacological treatment in young/middle-aged female patients with fibromyalgia could be an effective treatment for pain, disease severity, and functionality.

Evaluation of the effect of intra-articular platelet-rich plasma and hyaluronic acid injections on femoral cartilage thickness in chronic knee osteoarthritis.

Femoral cartilage thickness may be an important objective parameter in detecting the progression of knee osteoarthritis(KOA). In this study, we aimed to examine the possible effects of intra-articular Hyaluronic Acid(HA) and platelet-rich plasma(PRP) injections on femoral cartilage thickness and to investigate their possible superiority over each other in KOA. A total of 40 KOA patients were included in the study and randomized to the HA and PRP groups. Pain complaints, stiffness, and functional status were evaluated with the Visual Analog Scale(VAS) and Western Ontario and Mc Master Universities Osteoarthritis(WOMAC) indices. Ultrasonography was used for measuring the femoral cartilage thickness. At the 6th month measurements, significant improvements were observed in VAS-rest, VAS-movement, and WOMAC scores in both HA and PRP groups compared to the measurements performed before the treatment. No significant difference was observed between the effects of the two treatment methods. There were significant changes in the medial, lateral and mean cartilage thicknesses on the symptomatic knee side in the HA group. The most important finding of this prospective randomized study, in which we compared the effects of PRP and HA injections on KOA, was the increase in knee femoral cartilage thickness in the HA injection group. This effect started in the 1st month and continued until the 6th month. No similar effect was detected with PRP injection. In addition to this basic result, both treatment approaches had significant positive effects on pain, stiffness, and function and no superiority was observed over each other.

Investigating the correlation between pulmonary function tests and ultrasonographic diaphragm measurements and the effects of respiratory exercises on these parameters in hemiplegic patients.

OBJECTIVE: To investigate the correlation of DUS and pulmonary function tests (PFTs), and investigate the effects of respiratory exercises on the above parameters. METHODS: For the treatment group (n=20), neurological rehabilitation and respiratory exercise program, and for the control group (n=21), only a neurological rehabilitation program was implemented for 30 sessions. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), end-inspiration diaphragm thickness (IDT), end-expiratory diaphragm thickness (EDT), and diaphragm thickening ratio (DTR) were measured pre- and post-treatment. RESULTS: IDTs and EDTs as well as DTRs of affected side (p < .001, .001, and .03, respectively) and intact side (p < .001, .001, and .02, respectively) were found to improve post-treatment than before treatment in the treatment group. Similarly, FVC, FEV1, and FEV1/FVC, were better post-treatment than before treatment in the treatment group. Moreover, the affected side IDT was positively correlated with FVC and FEV1 before treatment (r = .38, p = .03 and r = .35, p = .02) and post-treatment (r = .46, p = .02 and r = .39, p = .03). The affected side DTR was positively correlated with FVC and FEV1 before treatment (r = .44, p = .01 and r = .40, p = .02) and post-treatment (r = .32, p = .03 and r = .40, p = .04). CONCLUSION: DUS can be used for the evaluation of respiratory problems in stroke patients. Moreover, breathing exercises improve these parameters in stroke patients, and they can be followed up by DUS.

Cross-cultural adaptation and validation of the Turkish version of the Functional Index for Hand Osteoarthritis (FIHOA).

BACKGROUND: To perform reliability and validity study of the Functional Index for Hand Osteoarthritis (FIHOA) in the Turkish language. METHODS: FIHOA was translated into Turkish following the principles of cross-cultural adaptation. Our translation was firstly tested in 40 patients with hand osteoarthritis. Adapted FIHOA questionnaire was then administrated to 100 hand OA patients successively with Modified Health Assessment Questionnaire (mHAQ), Numerical Rating Scale (NRS), and Short Form-36 (SF-36). Patients filled out the FIHOA questionnaire one more time after five days for test-retest assessment. Patients were divided into two groups as symptomatic or asymptomatic, with a NRS score of 5 or above defining symptomatic OA. Internal consistency was assessed by Cronbach's alpha and intraclass correlation coefficient (ICC) of test-retest reliability. Spearman correlation analysis was used to determine the correlation and validity between data. External construct validity was assessed using the correlation between FIHOA, mHAQ, hand pain NRS, and negative correlation with SF-36 subgroups. RESULTS: According to the total score, Cronbach-alpha was found as 0.90, while ICC was determined as 0.98 for test-retest reliability. When the correlations between the FIHOA questionnaire, mHAQ, and NRS questionnaires were examined, significant correlations were determined, and negative correlations between FIHOA and SF-36 subgroups were observed. CONCLUSION: Turkish FIHOA is a reliable and valid method for assessing functionality in Turkish patients with hand osteoarthritis.

Evaluating the strength of spinal and proximal girdle muscles in patients with axial spondyloarthritis: Correlation with activity, disability, and functionality.

AIM: To compare the muscle strength of muscle groups in axial spondyloarthritis (axSpA) patients with the muscle powers of healthy volunteers and to examine the relationship of muscle strengths with disease activity, functionality, and disability. METHOD: One hundred males (50 axSpA, 50 healthy) were included in the study. Bath Disease Activity Index (BASDAI), Functional Index (BASFI), and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were recorded. The maximum (max) and mean cervical flexion, extension, lateral flexion (CF, CE, CLF), truncal flexion, extension (TF, TE), root joint flexion, extension, abduction, internal and external rotation (SF, SE, SAB, SIR and SER for the shoulder; HF, HE, HAB, HIR and HER for the hip) muscle strengths of the patients in both groups were measured by a handheld dynamometer. Total muscle strength (CT, TT, ST, HT) was found according to the sum of the max and mean values for each region. RESULTS: All muscle strengths were lower in the axSpA group compared to the healthy volunteers. The symptom duration was found to have a weak-moderate negative correlation with CT, TT, ST, HT and all individual muscle strengths except for the TE, CF, HIR, and HER. BASDAI and HAQ-DI had weak-moderate negative correlations with HIR and HER. BASFI had a weak-moderate negative correlation with cervical measurements, TE, TF, SF, SER, SIR, and hip measurements. CONCLUSION: All muscle strengths were lower in patients compared to healthy volunteers. Strengthening specific muscle groups for the desired goal can be a reasonable strategy. The study is prospectively registered and available at www.clinicaltrials.gov (NCT04435860).

How does cross-education affects muscles of paretic upper extremity in subacute stroke survivors?

INTRODUCTION: This study aimed to evaluate the benefits of adding electromuscular stimulation (EMS) to the flexors of wrist muscles on the nonparetic limb in conventional stroke training to strengthen homologous agonist and antagonist muscles on the paretic side in patients with subacute stroke. METHODS: The EMS group patients (n = 15) received conventional therapy for 30 sessions for 6 weeks (60 min/session) with 30 min of electrical stimulation to their nonparetic forearm using wrist flexors, with 5 min of pre- and post-warm-up. The transcutaneous electrical nerve stimulation (TENS) group patients (n = 15) received the same conventional rehabilitation training with 30 min of conventional antalgic TENS at a barely sensible level to their nonparetic forearm. The Fugl-Meyer motor function assessment for upper extremity (FMA-UE), functional independence measure (FIM), Brunnstrom staging of recovery for hand, maximum and mean wrist flexion force (flexionmax and flexionmean), and wrist extension force (extensionmax and extensionmean) of paretic untrained limb were evaluated before and after the treatment. RESULTS: EMS and TENS group patients improved similarly in terms of FMA-UE, FIM, and Brunnstrom staging for hand recovery. However, flexionmax and flexionmean of the paretic limb increased more in the EMS group than in the TENS group. Extensionmax and extensionmean on the paretic side increased in the EMS group but did not differ in the TENS group. CONCLUSION: Cross-education via EMS may have a beneficial effect as an adjunct to conventional treatment methods. This study is retrospectively registered and is available at www.clinicaltrials.gov (ID: NCT04113369).

Effectiveness of home exercise in pregnant women with carpal tunnel syndrome: Randomized Control Trial.

OBJECTIVE: To evaluate the effectiveness of a home exercise programme in pregnant patients with carpal tunnel syndrome. METHODS: The randomised, single-blind, controlled clinical study was conducted at Vakif University School of Medicine, Istanbul, Turkey, From December 2017 to June 2018 and comprised pregnant women with carpal tunnel syndrome (CTS) . Clinical evaluation of each patient was performed by a blind researcher and (EMG) Electromyography measurements were performed by another blind researcher. Patients were divided into two groups with normal and (mild or moderate) CTS based on EMG results and clinical examination. Patients with symptoms, clinical signs and CTS in EMG were included in group 1, while patients whose symptoms and clinical evaluation (such as Tinel, Phalen, Reverse Phalen and Durkan's test) were positive but not CTS in EMG were included in group 2. Exercise forms were given to both groups and they were asked to perform the exercises stated in the form in 3 sets each day and 10 repetitions in each set. The Sick Boston Carpal Tunnel Syndrome Questionnaire was administered face-to-face to collect data which was analysed using SPSS 22. RESULTS: Of the 33 subjects, 19(57.6%) were in patient group 1 and 14(42.4%) in control group 2. The overall mean age of the sample was 28.84±3.62 years. There were no significant differences between the groups in terms of symptoms and clinical tests (p>0.05). The symptom severity scale between the groups was significantly high in group 1 (p<0.05). Patients receiving treatment showed a decrease in symptom severity and functional capacity, but only the former showed a significant decrease in group 2 (p>0.05). CONCLUSIONS: Nerve and tendon slip exercises for patients with mild to moderate carpal tunnel syndrome symptoms were found to be simple and reliable methods that could be applied to patients to increase their functionality and to reduce the severity of the disease.

Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs.

OBJECTIVES: This study aims to investigate medication adherence in Turkish patients with ankylosing spondylitis (AS) and analyze the related factors for non-adherence. PATIENTS AND METHODS: Ninety-nine patients with AS (60 males, 39 females; mean age 41.3±8.4 years; range, 18 to 66 years) were included in the study. Sociodemographic and clinical data were collected. Disease activity (Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate), functional status (Bath Ankylosing Spondylitis Functional Index), spinal pain and fatigue (visual analog scale), quality of life (Ankylosing Spondylitis Quality of Life), and depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. Adherence to anti-rheumatic drugs was elicited using the Compliance Questionnaire on Rheumatology (CQR). Medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ), and illness perception using the Brief Illness Perception Questionnaire (B-IPQ). RESULTS: Non-adherence was reported in 64 patients (64.6%). No significant relationship between demographic, clinical, or psychological factors and adherence was found, except for disease duration (p=0.031). High B-IPQ treatment follow-up, illness coherence, and BMQ-Specific necessity scores were associated with good adherence (p=0.007, p=0.039, and p=0.002, respectively). BMQ-General overuse and harm scores showed an inverse correlation with the CQR score (p=0.005 r=-0.278; p=0.029 r=-0.219, respectively). Longer disease duration [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99] and higher B-IPQ item-1 score regarding the effect of the illness on the individual's life (OR: 0.58, 95% CI: 0.42- 0.81) were important predictors of low adherence. CONCLUSION: Nearly three out of five AS patients were identified as at risk for non-adherence with the CQR. Medication adherence is influenced by the patient's beliefs about medicines and illness perceptions, and these may be key targets for future interventions to improve medication adherence.

Neuropathic Pain Questionnaire and Neuropathic Pain Questionnaire-Short Form: Translation, Reliability, and Validation Study of the Turkish Version.

AIM: To perform reliability and validity studies of the Neuropathic Pain Questionnaire (NPQ) and NPQ-Short Form (SF) in the Turkish language. MATERIAL AND METHODS: The Turkish translation and cross-cultural validation were performed. Then, 101 patients (36 males, 65 females; mean age: 50.4 ± 14.49; range: 20-87) with chronic pain were asked to fill out a pack of questionnaires, including the NPQ, NPQ-SF, Douleur Neuropathique 4 (DN4), Leeds Assessment of Neuropathic Symptoms (LANSS), and Numeric Rating Scale (NRS). A subgroup of 41 patients (11 males, 30 females) completed the NPQ and NPQ-SF for the second time after 3 days by telephone. Internal consistency was tested by Cronbach's-α and test-retest reliability was assessed by calculating the intraclass correlation coefficients (ICC). Construct validity was assessed by comparing NPQ, NPQ-SF, and NRS. Concurrent validity was tested by comparing NPQ, NPQ-SF, DN4, and LANSS. RESULTS: Internal consistency by Cronbach's-I± was 0.84 and 0.67 for the NPQ and NPQ-SF, respectively, indicating adequate and low internal consistency, respectively. ICC was 0.96 (p < 0.001; 95% confidence interval [CI], 0.95-0.97) for NPQ and 0.97 (p < 0.001; 95% CI, 0.95-0.97) for NPQ-SF, indicating a high test-retest reliability for both questionnaires. CONCLUSION: The Turkish versions of NPQ and NPQ-SF were reliable and valid for patients with chronic pain. To our knowledge, this is the first Turkish adaptation and test of the reliability and validity of the NPQ and NPQ-SF (short-form). These questionnaires could potentially help clinicians who seek to assess neuropathic pain for clinical and investigational purposes.

Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire: a cross-cultural adaptation and validation to the Turkish language.

In chronic inflammatory rheumatic diseases (CIRD), it is important to understand patients' fears towards their disease in order to improve patient-physician dialog, to raise the quality of care offered, and to optimize treatment adherence. In this study, we aimed to translate the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire into Turkish and evaluate its psychometric properties in patients with CIRD. One hundred fifteen patients filled the provided socio-demographic information form, FAIR-Tr questionnaire, Hospital Anxiety and Depression Scale (HADS), and Beck's Hopelessness Scale (BHS). For the analysis of short-term reliability, 50 patients re-filled the FAIR-Tr questionnaire 1 week later. Internal consistency was evaluated with Cronbach's α coefficient and test-retest reliability was evaluated with intraclass correlation coefficients (ICC). Construct validity analysis was investigated based on the correlation with HADS and BHS. All patients found FAIR-Tr easily understandable and acceptable. FAIR-Tr internal consistency (Cronbach's α = 0.93) and test-retest reliability (ICC = 0.91) were excellent. Psychometric validation was proved upon observing high correlation with HADS (Anxiety, r = 0.77; Depression, r = 0.70) and moderate correlation with BHS (r = 0.65). FAIR-Tr is a questionnaire that has excellent internal consistency and test-retest reliability. The successful correlation with HADS and BHS supported its psychometric validity in terms of evaluating the fear in CIRD cases. We think that FAIR-Tr is a specific scale that can help to evaluate the disease- and treatment-related fears of the Turkish patients with CIRD and may be useful in both routine practice and clinical studies.

Evaluation in terms of dietary habits of rheumatic process: A clinical study.

OBJECTIVE: This study compared the dietary habits of patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). METHODS: The nutritional status of 56 patients, seen at the Rheumatology Outpatient Clinic and diagnosed with RA based on the ACR-2010 criteria, was compared with that of 28 patients diagnosed with AS using the modified New York criteria. Nutritional status was determined using a form that was filled out during face-to-face interviews with all patients. Patient demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration and nutritional status were determined using a questionnaire. RESULTS: RA patients consumed butter on 2 days a week, and AS patients on 1 day per month. Yoghurt was consumed by RA patients daily and by AS patients 3 days a week. CONCLUSIONS: Compared to the diet of AS patients, the diet of RA patients was richer in protein and lipids. The impact of diet on these two diseases remains to be determined in large-scale studies.

A Rare Complication of Tuberculosis: Acute Paraplegia.

BACKGROUND: Tuberculous radiculomyelitis(TBRM) is one of the complications of neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of tuberculous meningitis (TBM). Here, we report a case of TBRM which presented with acute paraplegia. CASE DETAILS: Neurological examination on admission revealed flaccid paralysis, bilateral extensor plantar responses, and exaggerated deep tendon reflexes. Cerebrospinal fluid analysis showed xanthochromic fluid that contained 600 cells/mm3, 98% lymphocytes, protein 318 mg/dl and glucose 51 mg/dl (blood glucose 118 mg/dl). On thorax CT, calcified lymph nodes that were sequelae of primary tuberculosis infection was detected. Antituberculosis and intravenous corticosteroids treatment was started. Seven weeks from the onset, on-control spinal MRI myelomalacia was determined, and there was no leptomeningeal enhancement. After six weeks of rehabilitation, lower limb total motor score was increased from 0/50 to 15/50. CONCLUSIONS: Tuberculous radiculomyelitis is a complication of TBM. It is rarely seen.

Functional limitations due to foot involvement in spondyloarthritis.

[Purpose] Spondyloarthritis is a major inflammatory disease followed-up in the rheumatology clinics, foot involvement in spodyloarthritis is common. The functional states of patients with spondyloarthritis are usually evaluated globally. The aim of this study was to assess the foot involvement-related functional limitations in patients with spondyloarthritis. [Subjects and Methods] Patients with ankylosing spondylitis and psoriatic arthritis with foot pain more than 4 weeks who underwent anteroposterior and lateral feet radiography were enrolled into the study. A "clinical findings score" was calculated by assigning 1 point for every finding of swelling, redness, and tenderness. C-reactive protein and erythrocyte sedimentation rate were used as serum markers for disease activity. Foot radiograms were evaluated using the spondyloarthropathy tarsal radiographic index and the foot-related functional state of patients was determined by the Turkish version of the Foot and Ankle Outcome Score. [Results] There were no relationships between Foot and Ankle Outcome Score subscales and clinical findings score, serum markers, or radiologic score. Pain and symptoms subscale scores were result positively correlated with activity of daily living, sport and recreation, and quality of life subscale scores. [Conclusion] Pain and symptoms are the main determinants of foot-related functional limitations in spondyloarthritis.

Association between nutritional status and Modic classification in degenerative disc disease.

[Purpose] This study was conducted to examine the association between Modic classification and the eating habits in patients with degenerative disc disease (DDD) and to determine the influence of nutrition on disease severity. [Subjects and Methods] Sixty patients with DDD visiting a low back pain outpatient clinic were enrolled. Through face-to-face interviews, they completed questionnaires regarding their demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration, and nutritional status.Exclusion criteria were age <20 years or >65 years, other comorbidities, missing MRI data, and inability to speak Turkish. [Results] Forty patients were finally included in the study. The frequency with which they consumed water, salt, fast food, eggs, milk, yogurt, cheese, whole wheat bread, white bread, butter, and margarine was recorded. A weak negative correlation was observed between the Modic types and fish and egg consumption. [Conclusion] Modic changes, which indicate the severity of DDD, seem to be correlated to patients' dietary habits. However, studies with comparison groups and larger samples are needed to confirm our promising results before any cause-and-effect relationship can be proposed.

Association of Vogt Koyanagi Harada Syndrome and Seronegative Rheumatoid Arthritis.

BACKGROUND: Vogt Koyanagi Harada (VKH) Syndrome is a rarely-seen multi-systemic, autoimmune and inflammatory disease. It observed frequently with neurologic, auditory and skin manifestations and characterized with bilateral, chronic and diffused granulomatous panuveitis. It generally affects women in young-adult period. CASE: A 57 year-old female patient applied to a special center one year ago with a complaint of decrease in the sight acuity of the right eye. The right eye was operated on with cataract diagnosis. Uveitis was developed firstly in the right eye and then in the left eye after the operation. Having complaints about uveitis, tinnitus and hear loss, the patient was diagnosed with VKH syndrome. The pains started to be felt in small hand joints and both of the two ankles. The pains were increasing especially in the mornings and during rest. The duration of morning stiffness was two hours in hand and foot joints. The patient had had lumbar pain with mechanic characteristic for five years. CONCLUSION: Being diagnosed with seronegative rheumatoid arthritis (RA), our case is presented because VKH syndrome is rarely seen in Turkey, and the joint findings are at the forefront.

Functional independence measure scores of patients with hemiplegia followed up at home and in university hospitals.

[Purpose] Our purpose was to create awareness among of social rehabilitation at the university and in local governments, to identify gaps in social rehabilitation, and to increase the effectiveness of social rehabilitation. [Subjects and Methods] This study included stroke patients undergoing physical rehabilitation from the stroke outpatient clinic (43 patients) and the Istanbul Metropolitan Municipality Home Care Service (101 patients); face-to-face interviews were conducted to collect patient information regarding nutritional status. In addition, baseline functional independence measure (FIM) scores at baseline and during three months of follow-up were also compared. [Results] The average FIM motor scores at three months did not differ significantly between the home and hospital treatment groups. However, there were significant differences in baseline FIM motor and cognitive scores and three-month follow-up scores as well as average FIM total baseline scores between groups. In addition, month-to-month analysis of changes in FIM values between the two groups also revealed significant differences. [Conclusion] The results of our study were concordant with those of previous studies of stroke patients receiving rehabilitation, in demonstrating improved patient functional and cognitive capacity.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with ankylosing spondylitis.

OBJECTIVE: The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). METHODS: Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. RESULTS: Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. CONCLUSION: Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety).

Radioprotectant and Cytotoxic Effects of Spirulina in Relapsed Verrucous Vulvar Cancer: A Case Report.

CONTEXT: The treatment of relapsed verrucous vulvar cancer (VVC) is difficult. When vulvar cancer relapses, the treatment response is low for second-line treatments. Conversely, toxicity is high. Therefore, scientists need to identify different treatment methods. OBJECTIVES: The case study was intended to examine the benefits of combining treatment with microalgae and metronidazole with radiotherapy to increase the response to treatment. SETTING: The study took place in the Department of Radiation Oncology at Bezmialem Vakif University, in Istanbul, Turkey. PARTICIPANT: The case study involved an 81-y-old female patient whose vulvar tumor was excised and who came to the research team's radiation oncology service for postoperative radiation. She had 2 comorbid disorders: Alzheimer's disease and cardiovascular disease. INTERVENTION: A relapse had occurred in the 15-d postoperative period. Because of the patient's age and comorbid disorders, the research team decided to treat the new tumor only with concurrent radiochemotherapy and a weekly dose of cisplatin that contained chemoradiotherapy, for a total of 25 mg. At the 52.2 Gy dose level, grade 3 radiation skin toxicity occurred in the radiated area, although the research team had obtained an 80% response to the radiochemotherapy. The treatment was interrupted because of toxicity but also due to a deterioration in the patient's general health. Progression of the tumor continued, and the tumor's diameter increased to 7 cm after a 4-mo period. The research team then initiated radiotherapy again, combining it with spirulina in a 750 mg/dose at 2 doses/d and metronidazole in a 500 mg/dose at 3 doses/d, to decrease radiation toxicity and increase radiosensitivity. Radiotherapy was applied at 200 cGy per fraction with a total dose of 2400 cGy, with only 1 anterior local-tumor field. RESULTS: The patient showed a complete response to radiotherapy, and the tumor disappeared at the 2400 cGy radiation dose. No toxicity occurred related to the skin or the woman's general health. Her Karnofsky performance score increased to 90% from 50%, which was the initial score of the second treatment.

Concomitance of fibromyalgia syndrome and cervical disc herniation.

[Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2-3, 16.6% C5-6, 16.6% C6-7, 33.3% C4-5, C5-6 (two levels in two patients) and 16.6% C4-5, C5-6, C7-1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population.

Medical ozone and radiotherapy in a peritoneal, Erlich-ascites, tumor-cell model.

CONTEXT: Medical ozone therapy is used for treatment of inflammation in alternative and complementary medicine. It has been reported that the beneficial effects of radiotherapy increased with the addition of medical ozone therapy. OBJECTIVES: This study intended to investigate the antitumor and antiedema effects of ozone therapy when applied in different concentrations in mice with peritoneal carcinomatosis (PC) and to evaluate the contribution of medical ozone therapy to the outcomes for radiotherapy in vivo. DESIGN: Ehrlich ascites carcinoma (EAC) cells were inoculated intraperitoneally (IP) to develop peritoneal carcinomatosis in 60 adult male Swiss albino mice. The animals were divided into 5 groups. Groups 1 and 2 were treated IP for a period of 10 d with daily medical ozone therapy. Group 3 received radiotherapy into the abdomen for 5 d. Groups 4 and 5 were treated with medical ozone therapy for 10 d and radiotherapy for 5 d. Groups 1 and 4 received a 20 mg/L concentration of ozone and groups 2 and 5 received a 40 mg/L concentration. A sixth group acted as controls, and serum physiologic was given to them IP. OUTCOME MEASURES: Changes in body weight and abdominal circumference were measured daily for each mouse. Survival rates of the groups of mice were also determined. The results were compared between groups and were statistically analyzed. RESULTS: Changes in body weights and abdominal circumferences in the different groups were statistically different. The longest survival rates were found for groups 3 and 5, and survival rates for the 5 experimental groups were significantly higher than for the control group. CONCLUSIONS: Medical ozone therapy or radiotherapy was found to be effective when administered alone or concurrently to mice with PC, suggesting that medical ozone therapy might serve as a method of obtaining antiedema and antitumor effects, providing a longer survival time.