An unusual case report of gingival overgrowth associated with the use of leflunomide.

Leflunomide is an immunomodulatory agent with antiproliferative activity that is used for the treatment of rheumatoid arthritis. Leflunomide induced side effects are hepatotoxicity, immunosuppression, skin reactions, peripheral neuropathy, hypertension, diarrhea, interstitial lung disease, and rarely oral mucosal lesions. Here, we presented an unusual case of gingival overgrowth associated with the use of leflunomide, which improved after ceasing the drug.

Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes.

STUDY DESIGN: Retrospective, comparative 7-year study. OBJECTIVES: To identify the clinical characteristics of patients with spinal cord injury (SCI) resulting from gunshot wound (GSW). SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The study included 1043 consecutive patients with SCI who were divided into two groups according to etiology: patients with gunshot-induced spinal cord injury (GSWSCI) constituted the study group, and randomly selected patients with non-gunshot-induced spinal cord injury (NGSWSCI) who were matched for gender and for week of admission constituted the control group. The demographic and clinical characteristics of the patients were recorded, compared and analyzed. RESULTS: The study group included 102 patients (mean age: 26.93±9.11 years). The vast majority of the patients were aged 16-30 years (68.6%) and 90.2% were male. The majority of the lesions were at the thoracic level (58.8%) and a complete injury (60.8%). Surgical stabilization of the spine was performed in 50 patients (49%). The most prevalent associated injury was intra-abdominal injury followed by chest injury. Compared with the NGSWSCI group, the GSWSCI patients were more likely to have a complete lesion (60.8% vs 45.1%, P=0.025), had a lower rate of surgical stabilization (49 vs 88.2%, P=0.0001) and had a higher rate of associated injuries (54.9% vs 25.5%, P=0.0001). Compared with the civilian GSWSCI group, the military GSWSCI patients had a higher rate of surgical stabilization and associated injuries (60% vs 40%, P=0.049, 68.9% vs 43.9%, P=0.012, respectively). CONCLUSION: The results revealed that GSWSCI and military GSWSCI patients may have different demographic and clinical features compared with NGSWSCI and civilian GSWSCI patients, respectively.

The effect of knee joint loading and immobilization on the femoral cartilage thickness in paraplegics.

BACKGROUND: Femoral cartilage thickness has been used as an indicator for immobilization and unloading in patients with spinal cord injury (SCI). However, conflicting results have been reported on this subject. OBJECTIVES: (i) To determine femoral cartilage thickness alterations after prolonged immobilization, (ii) to demonstrate the effect of the daily standing or ambulation time on the cartilage and (iii) to analyze the predictors of the femoral cartilage in patients with SCI. METHODS: A total of 50 patients with SCI and 50 healthy age and sex-matched volunteers were enrolled in the study. A physician scanned both knees of all participants and measurements were taken at three locations: trochlear notch, midpoints of the medial and lateral condyle. RESULTS: The trochlear notch, medial and lateral condyle femoral cartilage thickness of both sides were significantly thicker in the control group (P<0.05). Patients with <1 h daily standing/walking time had higher thickness measurements in all sub parameters than patients with >1 h daily standing/walking time (P<0.05). Daily standing/walking time and the Walking index for SCI score were statistically significant predictors for cartilage thickness. CONCLUSION: SCI patients had thinner knee cartilage compared with healthy individuals in ultrasonographic assessment. More than 1 h daily standing/walking time may have a negative effect on the femoral cartilage thickness. Thus, ultrasonographic evaluation of the femoral cartilage should be considered in clinical practice to detect early cartilage thinning in patients with SCI.

Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document urinary tract abnormalities (UTAs) in patients with spinal cord injury (SCI) and to assess demographic and clinical features associated with UTA detected via ultrasound (US). SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The medical and radiological records of all patients with SCI were screened. Variables in each patient with SCI, including age at the time of the US examination, gender, etiology, level and severity of SCI, time since injury, bladder management methods and findings of urinary tract US, were reviewed and analyzed. RESULTS: Data were obtained from 1005 patients during the 6-year study period (2008-2013). The mean age was 35.67 ± 14.79 years and the male-female ratio was 2.84:1. Trabeculated bladder (TB) was observed in 35.1% of the patients, bladder calculi in 6%, renal calculi in 6%, hydronephrosis in 5.5% and renal atrophy in 1.2%. Bladder calculi, renal calculi and renal atrophy were observed in patients with TB at higher rates than in those without TB (P = 0.001, 0.036 and 0.004, respectively). The association of TB with hydronephrosis was very close to significance level (P = 0.052). CONCLUSION: A large number of SCI patients had UTAs including TB, renal and bladder calculi, hydronephrosis and renal atrophy. The time since injury, level and severity of SCI and bladder management method may influence development of UTA. In addition, TB may be a helpful parameter for predicting UTA in SCI patients.

Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury: a Turkish hospital-based study.

STUDY DESIGN: Retrospective study. OBJECTIVES: To determine the demographic and clinical characteristics of patients with cervical spinal cord injury (CSCI) admitted to a single Center. SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The medical records of all patients with spinal cord injury admitted from January 2009 to December 2013 were screened. Variables of each patient with cervical injury (CSCI), such as age at the time of injury, gender, etiology, degree and level of neurological impairment, associated injuries, surgical stabilization and length of rehabilitation stay (LOS), were analyzed. RESULTS: In all, there were 804 patients with traumatic spinal cord injury (SCI) during the 5-year study period, of which 562 (69.9%) were paraplegic and the remaining 242 (30.1%) had a CSCI (C1-C8) and were included in the study. Among the CSCI patients, 80.6% were male (male:female ratio is 4.15:1), mean age at the time of injury was 32.58±14.71 years (range: 4-79 years), the largest age group was 16-30 years (n=117, 48.3%), followed by 31-45 years (n=70, 28.9%). Motor vehicle accident (MVA) was the most common cause of injury (49.2%), followed by falls (21.5%) and diving accidents (18.2%). Low CSCI (C5-8; 61.2%) and incomplete injury (55%) occured more often than high CSCI (C1-4) and complete injury. In total, 202 (83.5%) patients underwent surgical stabilization. Thirty-seven (15.3%) had associated injuries. CONCLUSION: The present findings show that most of the CSCI patients were aged 16-30 years. In addition, based on the frequency of the causes of injuries we think that prevention efforts should mainly focus on MVA, falls and diving accidents.

Exacerbation of myasthenia gravis by alendronate.

Myasthenia gravis is an important indication for the long-term prescription of corticosteroids. We present a patient with myasthenia gravis who had worsening of symptoms associated with the use of alendronate. A 24-year-old patient with myasthenia gravis had been administered oral systemic corticosteroid (deflazacort 40 mg/day) for 3 years in order to control his myasthenic symptoms. One year earlier, his lumbar spine bone mineral density was decreased. He was started on oral calcium/vitamin D3 and alendronate (70-mg tablets once a week) for osteoporosis. He reported an exacerbation of muscle weakness and extreme fatigue on days when he took alendronate. He could not work on these days and has to be on leave. Alendronate was stopped, and he was started on intravenous ibandronate injections given every 3 months. He did not experience muscle weakness and fatigue with ibandronate therapy. Alendronate should be used with caution in patients with myasthenia gravis who have corticosteroid-induced osteoporosis.

Spinal cord injury in older population in Turkey.

STUDY DESIGN: Retrospective, comparative 4-year study. OBJECTIVES: To identify the clinical characteristics unique to older patients with spinal cord injury (SCI). SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. METHODS: The study included 870 consecutive patients with SCI that were divided into two groups according to age. Patients aged ⩾60 years at the time of injury constituted the study group, and randomly selected patients aged <60 years that were matched for gender, week of admission and time since injury constituted the control group. Patients' demographic and clinical characteristics were recorded, compared and analyzed. RESULTS: The study group included 73 SCI patients (mean age: 66.98±6.28 years) and the control group included 75 SCI patients (mean age: 33.93±10.67 years). Among the 148 patients, 98 (66.2%) were male. The vast majority of lesions were at the thoracic level (47.3%). In the older group, falls were the most frequent etiology (32.9%), simple falls predominated (62.5%). 49.3% of the study group vs 18.6% of the control group had a non-traumatic cause of SCI. Older patients were found to be less likely to have complete injury (27.4 vs 44%, P=0.035). The most common bladder management method was intermittent catheterization (69.6%) and the number of patients in each group treated with this method did not differ significantly (P>0.05). More patients in the study group had neuropathic pain (50.7 vs 34.7%, P=0.049) and abnormal urinary ultrasound findings (23.3 vs 9.3%, P=0.021). CONCLUSION: RESULTS revealed that older patients with SCI may have different demographic and clinical features compared with younger patients.

Reversible post-pregabalin peripheral edema in a spinal cord injury patient.

STUDY DESIGN: Case report. OBJECTIVES: To report a case of paraplegia with limb edema caused by pregabalin. SETTING: Turkish Armed Forces Rehabilitation Center, Ankara, Turkey. CASE REPORT: A 40-year-old male patient with T11 paraplegia had the complaint of swelling in both the lower limbs. He had been given pregabalin because of the neuropathic pain in both the lower limbs. At 10 months, the patient has experienced edema in lower limbs. There was severe edema in both legs, ankles and feet, more evident on the left. Venous Doppler ultrasound was normal on both sides. Blood tests for possible etiologies were normal. No other etiology could be found. The edema was considered to be caused by pregabalin and the medicine was ceased gradually. The edema resolved completely in 2 weeks. CONCLUSION: Pregabalin, which is one of medications used for neuropathic pain, might cause limb edema, that is, a condition needs differential diagnosis. This is particularly important for patients with spinal cord injuries (SCIs). Such adverse effect of pregabalin should be kept in mind as an etiology of limb edema in SCI management.