Is QUALIOST appropriate for the patients with orthotopic liver transplantation in measuring quality of life?

The quality of life questionnaire in osteoporosis (QUALIOST) measures the impact of this condition. The purpose of this study was to assess the psychometric properties of QUALIOST among 38 orthotopic liver transplantation (OLT) patients who had been diagnosed with osteoporosis or osteopenia versus 42 control subjects with osteoporosis or osteopenia associated with other conditions. Bone mineral density (gr/cm(2)) measurements were performed by dual-energy X-ray absorptiometry as well as thoracic and lumbar spine radiographs to assess fractures. Reliability studies evaluated by intraclass correlation coefficients (ICC) and internal consistency (Cronbach α). For the validity studies, correlation analysis was performed between this scale and Short Form-36 (SF-36) results. The questionnaire was filled out completely by all the patients with 0.9% and 1.3% of omitted answer rates for OLT and control patients. ICC and Cronbach's α values were good for all domains with values above .90. In both groups we observed significant negative high correlations between the domains of the questionnaire and all SF-36 dimensions (P < .001). At least one vertebral fracture was diagnosed in 17 (44.7%) and 20 (47.6%) patients with OLT and control respectively. The comparison analysis revealed that the scores of QUALIOST of patients with vertebral fracture were significantly higher than those without a fracture in both groups (P < .05). In conclusion, we evaluated the validity and reliability of a scale measuring quality of life in patients who had osteoporosis secondary to OLT. The results showed that the Turkish QUALIOST showed acceptable validity and reliability in these patients.

The prevention of bone fractures after liver transplantation: experience with alendronate treatment.

OBJECTIVE: The aim of this study was to prevent fractures in the first postoperative year. METHODS AND PATIENTS: We studied 59 patients (48 men, 11 women) aged 42.6+/-11.4 years, who underwent liver transplantation. All patients received oral alendronate 70 mg weekly and calcium 1 g and calcitriol 0.5 mug daily. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine and proximal femur at baseline as well as at 6 and 12 months after transplantation for comparison with an historical control group (n=31). Spinal radiographs were obtained to assess vertebral fractures at the same time. Additionally, serum osteocalcin, serum parathyroid hormone (PTH), urinary deoxypyridinoline (DPD), and biochemical parameters were determined every 3 months. RESULTS: At baseline, femoral total BMD of men was significantly greater than that of women (P<.05, .85+/-.1 vs .74+/-.1). A significant increase in BMD was observed at 12 months (P<.05), no patient developed a bone fracture. Comparison analysis of genders showed that there was a significant difference in favor of men (P<.05). The lumbar BMD, neck T-, and Z-scores were significantly higher among patients treated with alendronate than historical controls (P<.05). After 3 months, serum PTH was increased and serum osteocalcin and urinary DPD were reduced. No severe side effects from alendronate treatment were observed during the study. CONCLUSION: A direct sign of the success of our study was no fracture observed during the first postoperative year. Alendronate should be considered for patients with low bone mass after liver transplantation.

Effects of alendronate on bone mineral density and bone metabolic markers in patients with liver transplantation.

INTRODUCTION: The purpose of this study was to evaluate the effects of alendronate (ALN) on bone mineral density (BMD) and bone turnover markers in patients with orthotopic liver transplantation (OLT). METHODS: In the prospective, controlled, open study with 24 months of follow-up, 98 patients with OLT were randomised to receive ALN 70 mg weekly or no ALN; calcium (Ca) 1,000 mg daily and 0.5 mcg calcitriol daily were provided to all patients. Lumbar spine (LS) and hip BMDs were measured at 6-month intervals by dual-energy X-ray absorptiometry (DEXA). Spinal radiographs were obtained to assess vertebral fractures. Additionally, bone turnover markers, serum parathyroid hormone (PTH) and biochemical parameters were determined every 3 months. RESULTS: Compared with the control group, the ALN group showed significant increases in BMD of the LS (5.1+/-3.9% vs 0.4+/-4.2%, p<0.05 at 12 months, 8.9+/-5.7% vs 1.4+/-4.9%, p<0.05 at 24 months), femoral neck (4.3+/-3.8% vs -1.1+/-3.1%, p<0.05 at 12 months, 8.7+/-4.8% vs 0.6+/-4.5%, p<0.05 at 24 months) and total femur (3.6+/-3.8% vs -0.6+/-4.0%, p<0.05 at 12 months, 6.2+/-3.8% vs 0.3+/-4.6%, p<0.05 at 24 months). In the ALN group, osteocalcin and urinary deoxypyridinoline (DPD) decreased significantly at the sixth month, with no further change, by -35.6% and -63.0%, on average, respectively (p<0.05). In the control group, a significant increase in biochemical markers of bone turnover was observed in comparison to baseline values (p<0.05). PTH increased within reference levels without a difference between groups. Two nonvertebral fractures (4.2%) and nine vertebral fractures (18.8%) in the control group and three vertebral fractures (6.8%) in the ALN group occurred during the follow-up. The weekly ALN was well tolerated, and no severe side effects occurred. CONCLUSION: This is the first randomised study including a control group to demonstrate that weekly ALN was able to significantly increase BMD in patients with OLT when compared with Ca and calcitriol alone. However, ALN did not appear to offer protection against fractures.

Traumatic Nerve Root Avulsion and Pseudomeningocele Diagnosed by Three Dimensional MRI Technique (CISS Sequence). A Case Report.

This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.

Meralgia paresthetica after liver transplantation: a case report.

The focal neuropathies after orthotropic liver transplantation (OLTx) have been well documented to date. Most injuries to the peripheral nervous system involve the peroneal nerve and brachial plexus. We report the first case of lateral femoral cutaneous nerve (LFCN) injury after OLTx. The patient presented with pain and numbness on the lateral aspect of the right thigh that had progressively worsened since operation. Electrodiagnostic studies were indicative for right meralgia paresthetica (MP). The symptoms of MP improved progressively after physical therapy applications during the first 3 months. The etiology of MP in this case is unclear. However, it may be considered that ascites, surgical mechanisms, and immunosuppressive therapy were possible causative factors.

A comparison of muscle training methods in patients with knee osteoarthritis.

This study sought to compare the efficacy of isokinetic and progressive resistive exercise (PRE) programs in patients with knee osteoarthritis (OA). Forty-four patients with bilateral knee OA were included in the study. The patients in Group 1 ( n=21) performed isokinetic exercises and the patients in Group 2 ( n=18) performed a PRE program. Disease severity, pain, walking time, WOMAC, Lequesne index, AIMS2 and SF36 were compared before and after the treatments. All the patients were evaluated via a Cybex isokinetic device before and after treatment. Disease severity, pain, Lequesne, WOMAC and walking time improved with treatment in both groups. In SF36 and AIMS2 assessments, pain and social evaluation parameters in the PRE group showed better improvement. On isokinetic assessment flexor and extensor peak torque and peak torque body weight values improved significantly in both groups compared to pretreatment measurements. When the assessed parameters were taken into account no statistical significant difference was observed between the two groups. Our conclusions were that isokinetic and PRE programs are efficient in the treatment of knee OA; no statistically significant differences could be found between the two programs; and the PRE program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA.

The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint.

In this clinical trial, we examined the efficacy of intra-articular hyaluronic acid (HA) treatment in 38 patients with reducing displaced disc of the temporomandibular joint (TMJ). Subjects received two unilateral upper space injections of HA or physiological saline solution with 1 week apart. Efficacy was based on the following measurements: pain and sound intensity of the joint measured by visual analogue scale (VAS), modified Helkimo's clinical dysfunction index and the intensity of joint vibration during opening and closing the mouth measured by accelerometers. These measurements were performed before the first injection and 1 and 6 months after the last injection. In the treatment group (n=19), all measurements improved significantly at month 1 and at month 6 compared with the baseline (P < 0.01). The same measurements, in the placebo group (n=19), did not show any change, except for the pain intensity which improved at month 1 and month 6 (P < 0.05). The change in baseline measurements of all of the efficacy criteria at month 1 and at month 6 in the treatment group was significantly better compared with the change obtained with placebo at the same time intervals. This study demonstrates that intra-articular sodium hyaluronate (Orthovisc) injection into the TMJ is an effective treatment for a reducing displaced disc.

Local heat effect on sympathetic skin responses after pain of electrical stimulus.

OBJECTIVE: To investigate the analgesic effort of local superficial heating by studying sympathetic skin responses. DESIGN: Randomized trial. SETTING: Electromyography laboratory in the department of physical therapy and rehabilitation of a university hospital. SUBJECTS: Twenty healthy volunteers participated with informed consent. INTERVENTIONS: Sympathetic skin response (SSR) amplitudes following electrical stimulation of the right peroneal nerve and skin temperatures in both hands were recorded simultaneously. All of the recordings were repeated at 5-minute intervals during local heat application over the right palm and within 15 minutes after heat application was stopped. RESULTS: SSR amplitudes in both hands decreased significantly during local heating (p < .05) and did not return to their initial levels within 15 minutes of the recovery period; the reductions remained statistically significant (p < .05). Amplitude reductions were statistically more significant on the heated hand compared with those on the contralateral hand (p < .05). CONCLUSION: Therapeutic local heat application reduces the sudomotor response to a painful stimulus. This analgesic effect may be due to suppression of cortical pain sensation resulting from increased levels of endorphins, and may also be a result of local inhibition of both afferent and efferent C fibres.

Ulnar nerve lesion in the palm: report of an unusual case.

We report the case of a patient who had weakness of the fourth dorsal interosseous (DI) and third palmar interosseous (PI) muscles resulting in the abducted position of the little finger at rest. Electromyographic abnormalities were limited to only these muscles with partial denervation findings. The results of routine nerve conduction studies and imaging techniques were normal. Clinical and electrophysiological findings suggested that the lesion had occurred distal to the point where the very small motor branches to these muscles exit the deep palmar branch of the ulnar nerve.