No abstract

SummaryPlasma levels of f3-endorphin, vasopressin and cortisol during head-up tilt were measured in tetraplegic patients and in normal healthy subjects. In tetraplegic patients rapid tilt from the horizontal to 30° or 60° head-up induced orthostatic hypotension and increased plasma levels of cortisol, f3-endorphin and vasopressin. In control subjects head-up tilt failed to alter plasma levels of these hormones. These data show that the head-up position in tetraplegics causes various endocrine reactions.The normal mechanism by which blood pressure is maintained on the assumption of an upright posture (the orthostatic reflex) is absent in tetraplegic patients. In normal individuals, the orthostatic reflex comprises an afferent system involving baroreceptor input through the ninth and tenth cranial nerves and an efferent effector system that is primarily the peripheral sympathetic system. This orthostatic reflex arc is broken by spinal cord transection, so that tetraplegic subjects show marked hypotension in response to the upright posture. In these subjects this orthostatic hypotension stimulates emergency endocrine reactions (Stephen, 1984). Tilting and standing of the tetraplegic subjects usually results in increased levels of vaspressin (Sved et al., 1985), cortisol (Vallbano et al., 1966), aldosteron and plasma renin activity (Johnson and Park, 1973;Mathias et al., 1975Mathias et al., , 1980Kamelhar et al., 1978;Kooner et al., 1988).In the present study we have demonstrated that the increases in plasma levels of cortisol and vasopressin are associated with increase in levels of plasma 13-endorphin during the head-up position of tetraplegic subjects. Methods SubjectsWe studied 8 tetraplegic patients (4 men and 4 women) with spinal cord transection and 5 healthy volunteers, all having given informed consent. The ages of the

Aim: Our study aimed to evaluate the degree of response to intraarticular corticosteroid injection (IACSI) in patients with knee osteoarthritis using Tc-99m HIG scintigraphy and to investigate the relationship between changes in inflammatory activity and clinical and radiological findings. Methods: The study included 50 knees of 25 patients with symptomatic bilateral knee OA according to American College of Rheumatology (ACR) criteria. The knee with synovitis was the patient group (Group 1, n=25). The knee without synovitis was the control group (Group 2, n= 25). Synovial fluid aspiration was performed in the knee joint with synovitis. Subsequently, a suspension containing 1 ml of TCA (40 mg/ml) was injected into the synovial cavity. The clinical status was evaluated according to the WOMAC Osteoarthrosis Index. Knee radiographs were evaluated according to the Kellgren and Lawrence criteria. The patients were administered Tc-99m polyclonal human immunoglobulin G (HIG) intravenously. Evaluations were performed before and four weeks after treatment. Results: There was a significant difference between the two groups in all parameters except radiography when group 1 and group 2 were compared. There was a positive correlation between the Tc99m HIG scintigraphy score and all clinical parameters except the amount of effusion and radiography (p <0.001).The study was completed with 20 patients. After treatment, a significant improvement was observed in all parameters of the 20 patients (p<0.05). After treatment, all clinical parameters improved. The improvement in scintigraphy findings after treatment was variable. After the treatment, there was a positive correlation between the Tc99m HIG scintigraphy score and other clinical parameters except for joint swelling and radiography (p <0.05). Also, there was a positive correlation between the rate of change in scintigraphy score and the WOMAC total pain score and WOMAC physical function score. Conclusions: Our results showed that Tc99m-HIG scintigraphy was able to evaluate the response of IACSI to treatment in OA inflammation more effectively than clinical findings and did this independently of anatomic changes.