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Öğe 99mTc-dextran scintigraphy to detect disease activity in patients with rheumatoid arthritis(Lippincott Williams & Wilkins, 2004) Kaya, M; Tuna, H; Firat, MF; Tuna, F; Seren, G; Yigitbasi, ÖNAim To test the applicability of Tc-99m-dextran joint scintigraphy in the assessment of disease activity in patients with rheumatoid arthritis (RA), and to compare it with the clinical disease activity scores and laboratory parameters. Methods Twenty-seven patients with RA were investigated using Tc-99m-dextran joint scintigraphy. The images were evaluated semi-quantitatively and the regional uptakes of the radiopharmaceutical were calculated for the knee, wrist and ankle joints. The clinical and laboratory parameters were collected and fully analysed. An articular Ritchie index (a tender joint score), the number of swollen joints (Sw), the number of tender joints, the morning stiffness h, the total Ritchie articular index (R), the visual analogue scale (VAS) and the Disease Activity Score (DAS) were determined for all patients. Results Compared with controls, patients with RA had significantly higher regional Tc-99m-dextran uptake in the knee, wrist and ankle joints (P=0.001). The regional 99mTc-dextran uptake showed no correlation with the patient's age, gender, duration of disease, number of swollen joints (Sw), number of tender joints, morning stiffness (h), VAS, total Ritchie articular index and DAS, or any laboratory parameters. There was a significant correlation between the regional Tc-99m-dextran uptake for individual joints and the articular Ritchie index of the right and left wrist (r=0.42, P=0.03; r=0.45, P=0.02), right and left knee (r=0.66, P<0.0001; r=0.80, P<0.0001) and right and left ankle (r=0.47, P=0.014; r=0.76, P<0.0001), respectively. Conclusions This study demonstrates that 99mTc-dextran scintigraphy is a sensitive method to detect active joint inflammation and could be useful in the management of patients with RA. (C) 2004 Lippincott Williams Wilkins.Öğe The evaluation of plantar pressure distribution in obese and non-obese adults(Elsevier Sci Ltd, 2004) Birtane, M; Tuna, HBackground. Although previous studies have generally reported increased plantar pressure values with obesity, none of these studies has classified the obesity. Our aim in this study was to compare the plantar pressure distribution in obese and control adults during standing and walking. Methods. This study was performed on 100 feet of 50 study participants. The subjects gathered in two groups, each containing 25 study participants, as non-obese and class I obese according to their body mass index values. Static and dynamic pedobarographic evaluations were performed during standing and walking. The findings were compared between the groups and also the correlation of body mass index with the pedobarographic parameters was assessed. Findings. The static pedobarographic evaluation revealed significantly higher values in terms of forefoot peak pressure, total plantar force and total contact area in the feet of class 1 obese subjects when only middle foot peak pressure was found to be higher in class 1 obese subjects than controls as a dynamic pedobarographic parameter. Among the static parameters body mass index was found to have positive correlation with total plantar force (r = 0.50, P = 0.000) and total contact area (r = 0.33, P = 0.019). Only middle foot peak pressure (r = 0.32, P = 0.025) among the dynamic pedobarographic parameters had positive correlation with body mass index. Interpretation. This study may be a first step to evaluate the effect of different obesity categories on the plantar pressure values. Further studies are needed to investigate the effect of different obesity grades. (C) 2004 Elsevier Ltd. All rights reserved.Öğe Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis(Springer Heidelberg, 2005) Tuna, H; Birtane, M; Tastekin, N; Kokino, SThe aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports.Öğe Pressure-induced pain on the tibia: an indicator of low bone mineral density?(Springer Tokyo, 2004) Birtane, M; Tuna, H; Ekuklu, G; Demirbag, D; Tuna, F; Kokino, SPrevious literature investigating bone pain in osteoporosis has prominently focused on painful conditions following osteoporotic fractures. Is osteoporosis really a silent disease without bone pain and tenderness unless a fracture occurs? Our aim in this study was to answer the question by assessing the questionable tenderness on tibia bones of fracture-free patients with low bone density and to compare the findings with a normal population. One-hundred-thirty-three consecutive postmenopausal female patients with the mean age of 56 years admitted to our clinic for bone mass measurement were included in the study. Bone mineral density (BMD) values of lumbar spine (L2-L4) and right proximal femur (neck, trochanter, Ward's triangle) were measured by dual-energy X-ray absorptiometry (DXA). Patients with T scores lower than -1 formed the osteopenic-osteoporotic group of patients (low BMD group) whereas those with T scores higher than -1 constituted the normal BMD group according to the osteoporosis definition regarding T score for DXA. Mechanical pressure was applied by a hand algometer on the middle points of three equally divided sections on the anterior part of tibia, and the pressure levels starting the pain sensation (POPL) were recorded. Although the patients in the normal BMD group reported consistently high POPL at all regions of tibia for all BMD measurement sites, this difference reached to a statistical significance level only for the femur neck region. Only mean POPL for the whole tibia had independent association with only femur neck BMD by multiple linear regression analysis. These results are encouraging for assessing the significance of pressure-induced tibial pain as an indicator of low BMD in the future.Öğe 'Quality of life of primary caregivers of children with cerebral palsy(Cambridge Univ Press, 2004) Tuna, H; Ünalan, H; Tuna, F; Kokino, S[Abstract Not Available]Öğe Quality of life of primary caregivers of spinal cord injury survivors living in the community(Nature Publishing Group, 2001) Ünalan, H; Gençosmanoglu, B; Akgün, K; Karamehmetoglu, S; Tuna, H; Önes, K; Rahimpenah, AObjective: To compare the quality of life scores of primary caregivers of spinal cord injury survivors living in the community with healthy age matched-population based controls and to determine the relationship between some severity parameters related with spinal cord injury and the quality of life scores of primary caregivers. Setting: University hospital, rehabilitation centre. Methods: Fifty primary caregivers of spinal cord injured patients living in the community and 40 healthy age-matched controls completed SF-36 (short form-36) questionnaire forms. Questionnaires were administered by interviewers who were physiatrists and the authors of the present study. All the patients were rehabilitated by the authors and data about the duration of injury, lesion levels, ASIA scores, degree of spasticity, presence of bladder and bowel incontinence and pressure sores were gathered from the hospital recordings and/or by physical examinations during control visits when the primary caregivers were administered the questionnaires. Results: Quality of life scores measured by SF-36 were significantly low in the primary caregivers group compared to age-matched healthy population based controls. No significant relation was demonstrated between the quality of life scores of primary caregivers and parameters such as the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively. Conclusion: According to the results of the present study, being a primary caregiver of a spinal cord injured victim significantly interferes with quality of life; some severity parameters related to the injury however do not seem to have an additional impact on the primary caregiver's life quality.
