Reduced vital capacity leads to exercise intolerance in patients with ankylosing spondylitis.

BACKGROUND: It is well-known that pulmonary function is altered in patients with ankylosing spondilitis (AS) owing mainly to the restriction of chest expansion. In addition to musculoskeletal factors, development of pulmonary function abnormalities may also deteriorate exercise tolerance of the patients. AIM: The aim of this study was to examine the pulmonary function and exercise tolerance of AS patients. DESIGN: A case controlled study. SETTING: Outpatient clinic of an university hospital. POPULATION AND METHODS: Twenty-two men with the diagnosis of definite AS and 20 healthy controls matched according to age, sex, smoking habits and physical activity level were enrolled in this study. After a detailed physical examination, pulmonary function and exercise tolerance were assessed by "Sensormedics-Vmax 229" ergospirometry system. Maximal exercise testing was performed on a cycle ergometer using "10 watt ramp" protocol. RESULTS: Patients with AS had lower chest expansion, vital capacity and exercise tolerance than healthy subjects. Exercise tolerance strongly correlated with the patients' age, disease duration, chest expansion, modified Schober test, and vital capacity. In stepwise regression analysis, the best regression model for explaining the total variation of exercise tolerance selected only vital capacity as an independent variable (R²=54.9%). CONCLUSION: Rather than musculoskeletal manifestations, exercise intolerance was mainly explained by pulmonary function impairment in AS patients. CLINICAL REHABILITATION IMPACT: These results suggest that efforts should be directed not only towards improving spinal mobility but also towards increasing cardiopulmonary fitness in AS patients.

Clinical trial: interferential electric stimulation in functional dyspepsia patients - a prospective randomized study.

BACKGROUND: There are several studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with gastroparesis and chronic constipation. AIM: To analyse whether transcutaneous electrical stimulation is an effective procedure in functional dyspepsia patients. METHODS: Functional dyspepsia patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Upper gastrointestinal system symptoms were documented at the beginning, during and after the treatment sessions. RESULTS: Patients in therapy (23 cases) and placebo (21 cases) groups were homogeneous with respect to demographic data and upper gastrointestinal system symptoms. In the therapy group, all symptoms other than early satiation improved significantly during and after the treatment sessions, whereas in the placebo group, symptoms including heartburn and vomiting did not change significantly. IFC therapy was superior to placebo with respect to epigastric discomfort, pyrosis, bloating, early satiation and postprandial fullness during the treatment sessions. One month after the treatment sessions, vacuum IFC proved to be superior to placebo with regard to early satiation and heartburn. CONCLUSIONS: Vacuum IFC is a non-invasive and effective therapy for functional dyspepsia. Transcutaneous electrical stimulation may represent a new treatment modality for drug-refractory functional dyspepsia patients.

Hand strengths in carpal tunnel syndrome.

The purpose of this study was to determine whether a measurable decrease in isokinetic (dynamic) and isometric (static) hand strengths occurs in carpal tunnel syndrome (CTS) patients. Eighteen CTS patients and 20 healthy controls were included in the study. Isokinetic (eccentric and concentric) and isometric grip and pinch strengths were measured with a Biodex System 3 dynamometer (Biodex Medical System, Inc. New York). All strength measurements, except isometric and isokinetic (concentric/eccentric) three-point pinch and isokinetic (concentric) tip pinch, revealed statistically significant differences between CTS patients and controls. Measurable decrease in hand strengths may exist in CTS despite normal manual assessments. Although both isokinetic (dynamic) and isometric (static) dynamometers are capable of detecting this decrease, neither technique seems better than the other.

Relation between foot arch index and ankle strength in elite gymnasts: a preliminary study.

BACKGROUND: Gymnasts usually start intensive training from early childhood. The impact of such strenuous training on the musculoskeletal system is not clear. OBJECTIVES: To evaluate the relation between muscle strength of the ankle joint and foot structure in gymnasts. METHODS: The study population comprised 20 high level male gymnasts and 17 non-athletic healthy male controls. Arch indices were measured using a podoscope. Ankle plantar/dorsiflexion and eversion/inversion strengths were measured using a Biodex 3 dynamometer within the protocol of concentric/concentric five repetitions at 30 degrees /s velocity. RESULTS: The mean arch index of the right and left foot of the gymnasts and the controls were respectively: 31.4 (29.1), 34.01 (34.65); 60.01 (30.3), 63.75 (32.27). Both the arch indices and the ankle dorsiflexion strengths were lower in the gymnasts. Although no correlation was found between strength and arch index in the control group, a significant correlation was observed between eversion strengths and arch indices of the gymnasts (r = 0.41, p = 0.02). CONCLUSIONS: Whether or not the findings indicate sport specific adaptation or less training of the ankle dorsiflexors, prospective data are required to elucidate the tendency for pes cavus in gymnasts, for whom stabilisation of the foot is a priority.

Quantification of the weakness and fatigue in thoracic outlet syndrome with isokinetic measurements.

OBJECTIVES: Patients with thoracic outlet syndrome (TOS) complain of many subjective symptoms that are difficult to measure and quantify. In this study we have tried to assess the weakness (muscle strength) and fatigue (endurance) of these patients with an objective measurement method, isokinetic muscle testing. METHODS: Twenty three TOS patients and 15 age matched healthy controls were enrolled in the study. Detailed histories of the patients were taken and the patients underwent complete physical examinations. Cervical radiographies, Doppler ultrasonography, electromyography, and isokinetic measurements were carried out. The isokinetic measurements were carried using the Biodex System 3 dynamometer during concentric shoulder flexions and extensions at velocities of 60 degrees /s, 180 degrees /s, and 240 degrees /s. RESULTS: Although the muscle strengths of both groups seemed to be similar, the fatigue ratios of TOS patients at 60 degrees /s and 180 degrees /s were found to be higher compared with those of healthy controls (p = 0.029, p = 0.007). CONCLUSIONS: TOS patients were found to have muscular performance similar to controls, but their upper extremities developed fatigue more easily than those of healthy individuals.

Comprehensive isokinetic knee measurements and quadriceps tendon evaluations in footballers for assessing functional performance.

OBJECTIVES: To ascertain whether detailed isokinetic knee muscle testing reflects the results of other functional measurements in footballers and to look for any correlations between quadriceps tendon thickness and knee strength. METHODS: Ultrasonographic evaluation of the quadriceps tendon (Hitachi EUB-405), isokinetic knee testing (Biodex System 3), and sprint measurements using telemetric photoelectric cells (Chronometre Prosport ESC TX02) were carried out on 29 elite footballers. Jumping capacity was evaluated using Bosco's jumping mat (Ergojump). Anaerobic fitness was assessed by auricular capillary blood lactate measurements (YSI Model 1500 Sport Lactate Analyzer). RESULTS: Quadriceps tendon thickness correlated positively with jumping and sprint measurements and negatively with extensor and flexor strength. However, these correlations did not reach statistical significance. There were significant correlations between knee extensor strength at 60 degrees /s and jumping or sprint measurements and between the extension acceleration values of both knees during isokinetic tests at 240 degrees /s and the sprint measurements. No significant correlation was found between the fatigue ratio values of both knees at 240 degrees /s and the calculated fatigue ratios from the sprint measurements. CONCLUSIONS: Apart from a few variables which correlated with the performance tests, the isokinetic studies did not fully predict the various functional measurements. Neither was there any relation between the quadriceps tendon measurements and the knee strength values nor with the functional performance.

The role of quantitative ultrasound in predicting osteoporosis defined by dual X-ray absorptiometry.

The aim of this study was to establish whether quantitative ultrasound (QUS) parameters could identify patients classified as osteoporotic and osteopenic on the basis of dual energy X-ray absorptiometry (DEXA). One hundred and twenty-three patients (39 male, 84 female) with osteoporosis and suspected of having osteoporosis were included in this study. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured and bone mineral densities (BMD) of the lumbar spine and left hip was measured by DEXA. Subjects were classified into three groups (normal, osteopenic and osteoporotic) on the basis of BMD T-scores measured by DEXA. QUS parameters of the osteoporotic group were significantly lower than those of osteopenic and normal groups; there was no difference in QUS parameters between the normal and osteopenic groups. Correlations of both right and left SOS and BUA with the spine and femoral neck BMD were moderate (r = 0.343-0.539, P < 0.001). There was also reasonable correlation between DEXA and QUS T-scores (r = 0.364-0.510, P < 0.001). QUS had a sensitivity of 21% and a specificity of 95% for diagnosing osteoporosis. We concluded that, although DEXA and QUS parameters were significantly correlated, QUS parameters can not predict osteopenia as defined by DEXA, and sensitivities and specificities of QUS parameters were not sufficiently high for QUS to be used as an alternative to DEXA.

In vivo effects of non-steroidal antiinflammatory drugs on oxidative stress-related parameters of human erythrocytes.

In this study, we evaluated the effects of commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on oxidative stress and anti-oxidant system. Sixteen healthy volunteers and 35 patients diagnosed as one of musculoskeletal disorders were included in the study. Patients were treated with one of the three NSAIDs (i.e. naproxen, tiaprofenic acid, acemetacin) or paracetamol for 15 days. Erythrocyte glutathione S-transferase, erythrocyte and plasma glutathione peroxidase, and erythrocyte catalase (CAT) activities and plasma malondialdehyde level as lipid peroxidation index were detected in the blood samples of the patients, at the beginning of the study (0 week), after treatment for 15 days (2nd week), and at the end of 1 week-washout period (3rd week). The most affected enzyme by NSAIDs was erythrocyte catalase, which tended to increase at the end of 2 weeks treatment, and decrease at the end of 1 week-washout period. In the groups treated with acemetacin, naproxen and tiaprofenic acid, plasma malondialdehyde levels were decreased at some extent, but at the end of washout period a rebound increase was observed in acemetacin group. Our results suggest that NSAIDs have different influences on oxidative stress and anti-oxidant system related parameters. These effects seem to be related with the mechanisms of some of the adverse effects, which are not well understood yet. Further studies with larger groups are needed to illuminate the relationship between adverse effects of NSAIDs and the effects of these drugs on anti-oxidant system, and to clarify their mechanisms of therapeutic action, as well.

Muscle performance in fibromyalgia syndrome.

The objective of the study was to examine the muscle performance, isokinetic muscle strength, muscle endurance ratio, and submaximal aerobic performance in fibromyalgia syndrome (FMS) patients, to evaluate the relation between muscle performance, pain severity, clinical findings, and physical activity level, and to compare the results with healthy control subjects. Twenty-four FMS patients and 15 control subjects participated in this study. Data were obtained about the symptoms, location and onset of pain, treatment, and associated symptoms. Patients and controls underwent an examination of isokinetic muscle strength of right quadriceps on a Cybex dynamometer, and submaximal aerobic performance tests (PWC-170) were done for all subjects. Maximal voluntary muscle strength of the quadriceps was significantly lower in patients compared with the control group. Endurance ratios showing the work capacity were not statistically different between two groups. Submaximal aerobic performance scores were higher in the control group. There was not a relation between the decreased muscle performance and clinical findings, including pain severity, number of tender points, and duration of the symptoms of FMS patients. We found a reduced quadriceps muscle strength and submaximal aerobic performance in patients with FMS, indicating that patients have impaired muscle function.

Urinary neopterin excretion and dihydropteridine reductase activity in rheumatoid arthritis.

Neopterin and biopterin are two products of the pteridine pathway. Even though their roles and interrelationships have not been exactly clarified, neopterin is known as a biomarker of cell-mediated immunity. In this case, the highly elevated neopterin levels are parallel to the slightly elevated biopterin levels. On the other hand, the reduced form of biopterin-tetrahydrobiopterin is an essential cofactor of aromatic monoxygenases that leads to synthesis of tyrosine, tryptophan and dopamine neurotransmitters and its concentration in body fluids and tissues is maintained by the enzyme dihydropteridine reductase (DHPR). Increased numbers of activated lymphocytes can be found in peripheral blood, in the synovial fluid and synovial membranes or patients with rheumatoid arthritis (RA). Since the present study was undertaken to evaluate the role of the pteridine pathway in RA, we measured urine neopterin levels and dried blood DHPR activities in 36 patients with RA and in 20 healthy volunteers, in parallel with other clinical parameters. We found that neopterin excretion was significantly increased in RA patients compared with controls. The means were 433 +/- 216, 153 +/- 43 and 111 +/- 34 mumol/mol creatinine for patients in active stage, in remission and controls, respectively. Our results suggest that urine neopterin levels were strongly dependent on the stage and activity of RA. Either as an effect of the disease itself or of drug administration, slightly reduced DHPR activities were detected (3.484 +/- 0.304 for control, 2.974 +/- 0.255 in active stage RA, and 3.048 +/- 0.302 red cytochrome C/min/5 mm disc in remission).

Accumulation of 99mTc-Cysteine in experimental inflammatory lesions in comparison to 99mTc-glutamine and 99mTc-HIG.

AIM: The aim of this experimental work was to investigate the efficacy of 99mTc-L-Cysteine (Cys) in scintigraphic visualization of inflammatory lesions in comparison to 99mTc-L-glutamine (G), and 99mTc-HIG. METHODS: In mice abscesses were induced by intramuscular injection of turpentine. Six days later mice were injected with 3.7 MBq of each agent and sacrificed in groups of three at 1, 3, 6 and 24 h. Scintigrams were obtained with a gamma camera. The organs, some blood, abscesses, some muscle and urine were removed, weighed and counted in a gamma counter. Percentage of uptake by organs and per gram tissues and abscess/normal tissue concentration ratios were calculated. Experimental arthritis was produced in 6 New Zealand rabbits by intraarticular injection of ovalbumin. Four days later 37 MBq of 99mTc-Cys and 99mTc-HIG were each i.v. administered to 3 rabbits. Scintigrams obtained at 1, 3, 6, and 24 h demonstrated the arthritic joints very well. ROI's over arthritic joints were compared to contralateral normal joints (A/C). RESULTS: In mice the abscesses were well visualized on all scintigrams. The maximum abscess/muscle ratios were 5.21 +/- 1.09 (6 h), 3.73 +/- 0.81 (3 h) and 5.98 +/- 1.17 (24 h) and the maximum abscess/blood ratios were 3.46 +/- 1.33 (24 h), 1.81 +/- 0.10 (6 h) and 0.914 +/- 0.351 (24 h) for 99mTc-Cys, 99mTc-G, and 99mTc-HIG, respectively. In rabbits the maximum A/C ratios were 2.61 +/- 0.53 (3 h) and 2.92 +/- 0.99 (24 h) for 99mTc-Cys and 99mTc-HIG, respectively. CONCLUSION: Our results indicate that 99mTc-Cys is a promising agent for imaging inflammatory lesions. It is preferred to 99mTc-HIG, because of higher concentration ratios attained earlier, lower blood background, lower cost and a simpler in-house preparation method.

Evaluation of Tc-99m(V) DMSA for imaging inflammatory lesions: an experimental study.

The present study evaluated 99mTc(V) DMSA as an agent for the visualization of inflammatory lesions in comparison to 99mTc(III) DMSA and 99mTC-HIG. All three radiopharmaceuticals were prepared with commercial kits. 99mTc(V) DMSA was prepared at neutral pH by the addition of first bicarbonate and then pertechnetate to the kit contents. The labeling efficiency was 99% as determined by ITLC. Abscesses were induced by i.m. injection of 50 microliters turpentine into the right thighs of 36 Swiss albino mice. Six days later 3.7 MBq of each radiopharmaceutical was i.v. administered to 12 mice. The mice were sacrificed at 1, 3, 6 and 24 h later. Scintigrams were obtained with a gamma camera. The abscesses were better visualized on scintigrams with 99mTc(V) DMSA compared to 99mTc(III) DMSA, starting at 1 h. The animals were dissected and the organs were removed, weighed and the radioactivity determined with a gamma counter. The abscess to other tissue ratios were higher with 99mTc(V) DMSA than the other radiopharmaceuticals. The max. abscess/muscle ratios were 9.46 +/- 3.20 (24 h), 4.19 +/- 1.39 (6 h) and 5.98 +/- 1.17 (24 h) and max. abscess/blood ratios were 6.22 +/- 1.41, 4.09 +/- 0.84 and 0.914 +/- 0.351 all at 24 h for 99mTc(V) DMSA, 99mTc(III) DMSA and 99mTc-HIG, respectively. Experimental arthritis was produced in New Zealand white rabbits by intra-articular injection of ovalbumin. Four days later 37 MBq of 99mTc(V) DMSA and 99mTc-HIG were each i.v. administered to 3 rabbits. Scintigrams obtained at 1, 3, 6, and 24 h clearly demonstrated arthritic joints. ROI's over arthritic joints were compared to contralateral normal joints (A/C). The max. A/C ratios were 2.10 +/- 0.31 (3 h) and 2.92 +/- 0.99 (24 h) for 99mTc(V) DMSA and 99mTc-HIG, respectively. Our results indicated the feasibility of imaging inflammatory lesions with 99mTc(V) DMSA.

Early detection of neurological involvement in systemic lupus erythematosus patients.

In lupus the neurological abnormalities usually mimic many primary neurological diseases and often represent the only manifestation of SLE for several years before the onset of other features of the disease. The aim of this study was to investigate lupus patients to obtain electrophysiological data of possible neurological abnormalities even in the absence of neuropathy symptoms. Thirty-eight SLE patients, twenty healthy volunteers and 10 steroid-using control subjects were included. Eighteen were asymptomatic but 20 of them had neuropathy symptoms. Median, ulnar and peroneal nerve motor, median, ulnar and sural nerve sensory conduction velocities, median and tibial somatosensory evoked potentials (SEP) were recorded. 23.6% of all lupus patients had peripheral nerve conduction slowing and 39.5% had SEP abnormalities; almost half of them being asymptomatic. 44.7% of the total had carpal tunnel syndrome; again almost half of them (47%) were asymptomatic. There was no significant correlation between the electrophysiologic parameters and the clinical and laboratory parameters of the disease. In lupus patients, SEP abnormalities were more pronounced than peripheral findings, reflecting the CNS involvement more common than the peripheral neuropathy. Therefore, we suggest performing the electrophysiological studies in lupus patients, even in the asymptomatic ones, early in the course in order to detect the nervous system involvement.

Chitosan microspheres of diclofenac sodium, II: In vitro and in vivo evaluation.

A biodegradable diclofenac sodium (DS) microsphere system using chitosan has been characterized and evaluated in vitro and in vivo. The particle size distribution and drug content was determined. The release rate data were investigated by using zero-order, first-order, Hixson-Crowel and Higuchi kinetics. The optimum DS-Chitosan microsphere formulation, empty chitosan microspheres, sustained release commercial product and plain drug were evaluated for pharmacological activity. The ulcerogenic index in rabbits was also determined.

Effect of some anti-inflammatory drugs on human neutrophil chemotaxis.

The effects of piroxicam, tenoxicam, diclofenac sodium, acetylsalicylic acid and tiaprofenic acid on the chemotaxis and random migration of human polymorphonuclear leukocytes were investigated, using zymosan-activated serum as chemo-attractant, with a modified Boyden chamber technique. All five compounds significantly reduced chemotaxis. The random migration of polymorphonuclear leukocytes was inhibited by piroxicam, diclofenac sodium and tiaprofenic acid but not by tenoxicam or acetylsalicylic acid. The inhibitory effect of these non-steroidal anti-inflammatory drugs on polymorphonuclear leukocyte chemotaxis and on random migration was generally dose-dependent. The results suggest that the drugs studied may have a direct effect on polymorphonuclear leukocyte chemotaxis and that this activity may contribute to their anti-inflammatory properties.

Effects of tenoxicam on neutrophil chemotaxis in rheumatoid arthritis and healthy controls.

Using a modified Boyden chambers method, polymorphonuclear leucocyte (pmnl) random migration and chemotactic responsiveness were compared in 20 rheumatoid arthritis patients with that of 10 healthy controls receiving tenoxicam. Random migration and chemotaxis of neutrophils were examined before drug administration, following 2 hours and 7 days of drug administration and one week after the end of the 7-day-administration of this compound. There was no statistically significant difference between the chemotactic migration of neutrophils in healthy volunteers and patients with RA. The mean chemotactic value in patients with RA and healthy controls was significantly low at 2 hours after drug administration when compared with that before drug administration (p < 0.01). The comparison of the decreases in mean chemotactic values in patients with RA and healthy controls showed no statistical difference. At the end of 7-day-administration, neutrophil chemotaxis was significantly decreased in patients with RA (p < 0.01); however, in healthy controls it was decreased as well, but statistical difference could not be obtained. One week after drug withdrawal, neutrophil chemotaxis turned to baseline values in both groups. We suggest that tenoxicam is a potent inhibitor of neutrophil chemotaxis.

99mTc-citrate versus 67Ga-citrate for the scintigraphic visualization of inflammatory lesions.

Citric acid was labeled with 99mTc with an efficiency of > 99%. The biodistribution of 99mTc-citrate was studied in mice with turpentine-induced abscesses in comparison to 67Ga-citrate. The max. abscess/muscle concentration ratios were 4.61 +/- 1.92 (3 h) for 99mTc-citrate and 4.76 +/- 2.04 (4 h) for 67Ga-citrate. Arthritis was induced in 10 rabbits by intra-articular injection of ovalbumin Scintigrams obtained 4 days later and at 3 h post-injection of 99mTc-citrate showed increased activity involving the synovium. The max. arthritic/contralateral knee ratio was 3.19 +/- 1.29 (3 h) and 6.47 +/- 3.71 (24 h) for 99mTc- and 67Ga-citrate, respectively. The blood clearance curve of 99mTc-citrate in rabbits was biexponential with a fast (T1/2 = 36 min) and a slow (T1/2 = 18 h) component, compared to mono-exponential clearance of 67Ga-citrate (T1/2 = 23 h). In 10 patients with rheumatoid arthritis whole-body scintigrams and spot images of involved joints indicated localization of the tracer in inflamed tissues. The mean target-to-soft tissue ratios were 3.04 +/- 0.81 and 4.95 +/- 2.56 for 99mTc-citrate and 99mTc-MDP, respectively. Renal clearance of radioactivity was evident from the scintigrams. Our results demonstrated that 99mTc-citrate is effective as a radiopharmaceutical for the visualization of inflammatory lesions and may be preferred to 67Ga-citrate due to the ideal physical characteristics of the radionuclide, easy preparation, low cost, early accumulation and the preference for the renal route of excretion.

The effects of physical training on physical fitness tests and auditory and visual reaction times of volleyball players.

Twenty male volleyball players were taken for this study and during an 8-week-period they did physical conditioning exercises by weight training 5 days a week. Physical fitness tests, auditory and visual reaction times were measured at the beginning and at the end of training period. When results statistically analysed, it was observed that physical conditioning exercises affected their physical fitness positively and moreover auditory and visual reaction times were shortened.

Calcitonin and calcium combined therapy in osteoporosis: effects on vertebra trabecular bone density.

Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland. Like calcium salts, calcitonin acts by reducing bone resorption. In this study, 26 osteoporotic patients were given 100 IU salmon calcitonin for 10 days and, thereafter, 100 IU calcitonin every other day for 80 days combined with 1000 mg/day calcium salts. Prior to and after the combined therapy, the mean trabecular bone densities from the levels of thoracic 12 and lumbar 1 and 2 were obtained and routine thoracic and lumbar radiography performed. Combined calcitonin and calcium therapy for 3 months produced significant increases in vertebra trabecular bone density. The evaluation of the trabecular bone density and the number of non-traumatic compression fractures in 26 osteoporotic patients prior to the therapy did not indicate any close relationship between them. It is concluded that, in addition to other factors reported previously, microtraumas during daily activities have some effect on the incidence of fractures.