SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2007 Haziran; 14(2) A case of primary biliary... more SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2007 Haziran; 14(2) A case of primary biliary cirrhosis, CREST and Sjogren's syndrome overlap presented with severe esophageal variceal bleeding Mehmet Sahin*, Ulku Saritas**, Nurhayat Ozkan***, Sevket Ercan Tunc*, Nermin Karahan**** *Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey **Department of Internal Medicine, Division of Gastroenterology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey ***Department of Internal Medicine, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey ****Department of Pathology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey Ozet Ciddi Ozafagus Varis Kanamasi Ile Basvuran, CREST Ve Sjogren Sendromu Ile Cakisma Yapan Bir Primer Biliyer Siroz Vakasi Primer biliyer sirozda karaciger hasarinin mekanizmasi otoimmuniteye ait deliller olmasina ve cesitli otoimmun hastaliklarla cak...
The role of vitamin D in the etiopathogenesis of fibromyalgia and non-specific musculoskeletal pa... more The role of vitamin D in the etiopathogenesis of fibromyalgia and non-specific musculoskeletal pain is controversial. In our study, we aimed to investigate the effect of vitamin D therapy on quality of life in patients with fibromyalgia. Seventy patients diagnosed with fibromyalgia and 65 age- and sex-matched controls were included in the study. Patients were grouped as deficient (<20 ng/mL), inadequate (20-30 ng/mL), and sufficient (>30 ng/mL) according to the levels of vitamin D. Vitamin D replacement was performed for patients with deficiencies and inadequacies. Before and after vitamin D therapy, patients filled in the assessment tools, fibromyalgia impact questionnaire (FIQ), Arizona sexual experience scale (ASEX), Beck depression inventory (BDI), visual analog scale (VAS), and short form-36 (SF-36). Vitamin D deficiencies and inadequacies were observed in 60% of the patients (n=42). Among patients with low and normal levels of vitamin D, no statistically significant diff...
Ankylosing spondylitis (AS) is a chronic inflammatory disease. In many inflammatory diseases, inc... more Ankylosing spondylitis (AS) is a chronic inflammatory disease. In many inflammatory diseases, increased production of pro-inflammatory cytokines is associated with an increase in oxidative stress mediators. Thiol/disulfide homeostasis is a marker for oxidative stress. The aim of this study was to examine the dynamic thiol/disulfide homeostasis in AS. Sixty-nine patients with AS and 60 age- and sex-matched controls were included in the study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and visual analogue scale (VAS) were used to determine the disease activity. Native thiol, total thiol, and disulfide levels were measured with a novel automated method recently described by Erel and Neselioglu. The aforementioned method is also optionally manual spectrophotometric assay. The total thiol levels were significantly lower in the AS group compared with the control group (p = 0.03). When the patients were divided into active (n = 35) and inactive (n = 34) subgroups using...
Kaposi's sarcoma (KS) is a vascular malignant tumor, although it has previously been associat... more Kaposi's sarcoma (KS) is a vascular malignant tumor, although it has previously been associated with rheumatoid arthritis (RA) as well as other connective tissue diseases. 1 It may also occur in patients with lymphoid malignant disorders, 2 and corticosteroids, or ...
Behcet's disease BD may involve in any large or small artery, vein. We present a case of BD w... more Behcet's disease BD may involve in any large or small artery, vein. We present a case of BD with multiple venous thromboses, cardiac and pulmonary involvements, and renal failure. A 22-year-old man admitted with progressive dyspnea and edema on his face and neck. He had the history of recurrent oral and genital ulcers, and pustular skin lesions for 4 years. Doppler ultrasonography revealed right internal jugular vein thrombosis. Transthoracic echocardiography showed a pericardial effusion, decreased left ventricular ejection fraction. While his symptoms were regressing moderately with a pulse cyclophosphamide, prednisolone, and low molecular weight heparin treatment, new thromboses occurred in vena cava inferior, and bilateral renal veins after the third and 7th dosages of pulse cyclophosphamide. Creatinine levels increased progressively, which required hemodialysis. However, he died after the second session of hemodialysis. Patients with BD should be followed up for new develop...
We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting e... more We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with prostatic adenocarcinoma. One of the patients was positive for Helicobacter pylori and the other had secondary bone metastases. In the latter, the clinical picture of RS3PE developed after surgical intervention for the primary lesion. On physical examination, while the hands and feet were swollen in the first patient, pitting edema was present only at the feet of the other. All joints of the affected hands and feet were painful. Serological tests including rheumatoid factor, antinuclear antibody, and human leukocyte antigen B27 were all negative. Response to low-dose corticosteroid treatment was delayed in the first patient, but the symptoms were relieved better in the second one.
The aim of this study was to assess the esophageal motility by manometry in patients with primary... more The aim of this study was to assess the esophageal motility by manometry in patients with primary Sjögren&amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome. Esophageal manometry was carried out in 40 patients with primary Sjögren&amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome (SS), 15 with rheumatoid arthritis (RA), 15 with RA and secondary SS, and 21 healthy volunteers. We found that the mean lower esophageal sphincter (LES) pressures measured by station pull-through and rapid pull-through techniques were significantly higher in primary SS patients than with healthy controls and RA patients with or without SS (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Our study did not show any major differences when comparing the three patient groups (P&amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). However, peristaltic contraction velocity was lower and peristaltic contraction duration significantly higher at the middle and lower thirds of the esophagus in primary SS patients than in healthy controls (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The results of our study support the view that various esophageal motility disorders can be found in patients with primary SS which could be related to an increase in LES pressure. We also found no correlation of the esophageal abnormalities with other factors studied, suggesting that the cause of dysphagia is multifactorial in nature.
Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease is a systemic vasculitis in which studies have given conflicting results about ventricular diastolic functions. However, tissue Doppler echocardiography has never been used in any of these studies. Aortic stiffness, a cardiovascular risk factor, may also precede ventricular dysfunction. The aim of this study was to assess aortic stiffness and biventricular diastolic functions in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. A total of 26 patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (mean age; 33+/-10 years) and 20 age- and sex-matched controls (mean age; 33+/-7 years) were included. Aortic stiffness was evaluated by aortic strain and distensibility. Ventricular diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. Mitral E and A wave, E/A ratio of E wave, deceleration time, and isovolumic relaxation time were calculated. There was no significant difference in diastolic Doppler parameters between patients and controls. Similarly, there was no significant difference in mitral annular E and A velocities between these two groups. Aortic strain in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was found to be significantly less than in the controls (8.3+/-4.9% and 15.7+/-2.7% respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Aortic distensibility was also significantly low in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease when compared to controls (0.45+/-0.28 and 0.78+/-0.13 respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Beta index values were significantly high in…
Familial Mediterranean fever (FMF) is an autosomal recessively-inherited disorder typically manif... more Familial Mediterranean fever (FMF) is an autosomal recessively-inherited disorder typically manifested by recurrent attacks of fever and polyserositis. The articular disease occurs in 50-70% of patients. Bone scintigraphy is more sensitive in the diagnosis of arthritis than clinical examination or conventional radiological imaging, allowing earlier diagnosis through the visualization of disease in multiple sites. To assess joint involvements in FMF patients with or without joint symptoms, bone scintigraphy was performed in 36 patients with FMF and in 25 controls. There was arthritis in 72% of patients. Of these, 65% knee, 42% ankle, 50% sacroiliac, 8% elbow, 8% wrist, 4% sternoclavicular and 4% hip involvements were found. The sacroiliac joints with sacroiliac index higher than 1.34 were diagnosed as sacroiliitis, which was higher than 2 SD of normal. FMF is frequently associated with joint disease such as knee and ankle arthritis and sacroiliitis. This high incidence of sacroiliitis in our study has not been previously reported. This difference could be explained by the different methodology used for the screening of the joints. Thus, we recommend that bone scintigraphy can be used in patients with FMF to determine the presence of arthritis, especially in sacroiliac joints, even asymptomatic.
The aim of this study was to compare plasma Platelet-activating factor (PAF) and P-selectin (CD62... more The aim of this study was to compare plasma Platelet-activating factor (PAF) and P-selectin (CD62P) activities in Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease patients with and without thrombosis. In this cross-sectional and descriptive study, 30 consecutive Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients were included, 15 of them with venous thrombosis. All patients were also divided into two subgroups according to the presence or absence of clinical activity. Plasma PAF levels, basal and Ca++ ionophore (A23187)-induced leukocyte (cellular) PAF activities, and platelet-rich plasma DeltaCD62P activity (the mean fluorescent density difference between CD62P phycoerythrin-positive and -negative stains) were evaluated. In the thrombotic group, plasma PAF (P=0.001), basal leukocyte PAF (P=0.017), induced leukocyte PAF (P=0.024), and DeltaCD62P (P=0.023) levels were significantly higher than in the nonthrombotic group. In the whole group of Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients, there was a positive correlation between plasma PAF and DeltaCD62P levels (r=0.533, P=0.002). When we compared clinically active and inactive patients with respect to the above parameters, there was no significant difference, irrespective of thrombosis. Plasma PAF (P=0.001), basal leukocyte PAF (P=0.004), and DeltaCD62P (P=0.038) levels were significantly higher in the presence of both clinical activity and thrombosis than of clinical activity alone. Platelet-activating factor and CD62P may contribute to endothelial injury and thrombosis development in Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. These two parameters seem related to the presence of thrombosis rather than clinical activity.
Background Immune mediated diseases may be tissue specific such as insulin dependent diabetes mel... more Background Immune mediated diseases may be tissue specific such as insulin dependent diabetes mellitus (IDDM), or may be systemic such as rheumatoid arthritis (RA). Since impaired glucose tolerance have been reported in some connective tissue diseases.1,2 Objectives we investigated the frequency of autoantibodies targeting pancreas in RA patients with and without Sjögren’s syndrome (SjS). Methods 103 RA patients, 26 with secondary SjS were included in this study. Serum islet cell antibodies (ICA), anti-insulin antibodies (AIA) and insulin receptor antibodies (IRA) were measured. Standard oral glucose tolerance test was performed if fasting or postprandial plasma glucose levels were elevated, or if any of the above mentioned antibodies were positive. Results The frequencies of positive ICA, AIA and IRA in the whole group of patients with RA were 21.4%, 29.7% and 15.2%, respectively. There was no significant differences between the subgroups of RA patients with respect to OGTT results...
Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Sistemik lupus eritematozu... more Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Sistemik lupus eritematozus tanilibir olguda akciger, plevra ve bagirsak tuberkulozu: olgu sunumu Şule Kaya*, Necla Songur*, Onder Ozturk*, Metin I.Ciris**, Ercan Tunc***, Yildiran Songur****, M. Cem Kockar****, Ahmet Akkaya* Ozet Sistemik Lupus Eritematozus (SLE), bircok organ sistemlerinin tutulumu ile karakterize otoimmun bir hastaliktir. Son zamanlarda, SLE hastalarinda firsatci enfeksiyon riskinde, ozellikle de akciger tuberkulozu ve akciger disi organ tuberkulozunda artma olduguna dair bir cok yayin bulunmaktadir. Altiyildir SLE, diffuz proliferatif glomerulonefrit (DPGN) ve hipertansiyon tanilariile takip edilen 35 yasinda bayan hasta usume, titreme, ates, halsizlik ve kilo kaybiyakinmalariile klinigimize basvurdu. Akciger grafisinde, sol akciger orta ve alt zonda efuzyon ile uyumlu acikligiyukaribakan homojen dansite artisi izlendi. Hastanin oykusunden 1 ay once akut batin on tanisiyla sag hemikolektomi o...
BackgroundIleus is common after colorectal surgery and is associated with an increased risk of po... more BackgroundIleus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.MethodsA prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system.ResultsA total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return...
SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2007 Haziran; 14(2) A case of primary biliary... more SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2007 Haziran; 14(2) A case of primary biliary cirrhosis, CREST and Sjogren's syndrome overlap presented with severe esophageal variceal bleeding Mehmet Sahin*, Ulku Saritas**, Nurhayat Ozkan***, Sevket Ercan Tunc*, Nermin Karahan**** *Department of Internal Medicine, Division of Rheumatology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey **Department of Internal Medicine, Division of Gastroenterology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey ***Department of Internal Medicine, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey ****Department of Pathology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey Ozet Ciddi Ozafagus Varis Kanamasi Ile Basvuran, CREST Ve Sjogren Sendromu Ile Cakisma Yapan Bir Primer Biliyer Siroz Vakasi Primer biliyer sirozda karaciger hasarinin mekanizmasi otoimmuniteye ait deliller olmasina ve cesitli otoimmun hastaliklarla cak...
The role of vitamin D in the etiopathogenesis of fibromyalgia and non-specific musculoskeletal pa... more The role of vitamin D in the etiopathogenesis of fibromyalgia and non-specific musculoskeletal pain is controversial. In our study, we aimed to investigate the effect of vitamin D therapy on quality of life in patients with fibromyalgia. Seventy patients diagnosed with fibromyalgia and 65 age- and sex-matched controls were included in the study. Patients were grouped as deficient (<20 ng/mL), inadequate (20-30 ng/mL), and sufficient (>30 ng/mL) according to the levels of vitamin D. Vitamin D replacement was performed for patients with deficiencies and inadequacies. Before and after vitamin D therapy, patients filled in the assessment tools, fibromyalgia impact questionnaire (FIQ), Arizona sexual experience scale (ASEX), Beck depression inventory (BDI), visual analog scale (VAS), and short form-36 (SF-36). Vitamin D deficiencies and inadequacies were observed in 60% of the patients (n=42). Among patients with low and normal levels of vitamin D, no statistically significant diff...
Ankylosing spondylitis (AS) is a chronic inflammatory disease. In many inflammatory diseases, inc... more Ankylosing spondylitis (AS) is a chronic inflammatory disease. In many inflammatory diseases, increased production of pro-inflammatory cytokines is associated with an increase in oxidative stress mediators. Thiol/disulfide homeostasis is a marker for oxidative stress. The aim of this study was to examine the dynamic thiol/disulfide homeostasis in AS. Sixty-nine patients with AS and 60 age- and sex-matched controls were included in the study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and visual analogue scale (VAS) were used to determine the disease activity. Native thiol, total thiol, and disulfide levels were measured with a novel automated method recently described by Erel and Neselioglu. The aforementioned method is also optionally manual spectrophotometric assay. The total thiol levels were significantly lower in the AS group compared with the control group (p = 0.03). When the patients were divided into active (n = 35) and inactive (n = 34) subgroups using...
Kaposi's sarcoma (KS) is a vascular malignant tumor, although it has previously been associat... more Kaposi's sarcoma (KS) is a vascular malignant tumor, although it has previously been associated with rheumatoid arthritis (RA) as well as other connective tissue diseases. 1 It may also occur in patients with lymphoid malignant disorders, 2 and corticosteroids, or ...
Behcet's disease BD may involve in any large or small artery, vein. We present a case of BD w... more Behcet's disease BD may involve in any large or small artery, vein. We present a case of BD with multiple venous thromboses, cardiac and pulmonary involvements, and renal failure. A 22-year-old man admitted with progressive dyspnea and edema on his face and neck. He had the history of recurrent oral and genital ulcers, and pustular skin lesions for 4 years. Doppler ultrasonography revealed right internal jugular vein thrombosis. Transthoracic echocardiography showed a pericardial effusion, decreased left ventricular ejection fraction. While his symptoms were regressing moderately with a pulse cyclophosphamide, prednisolone, and low molecular weight heparin treatment, new thromboses occurred in vena cava inferior, and bilateral renal veins after the third and 7th dosages of pulse cyclophosphamide. Creatinine levels increased progressively, which required hemodialysis. However, he died after the second session of hemodialysis. Patients with BD should be followed up for new develop...
We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting e... more We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with prostatic adenocarcinoma. One of the patients was positive for Helicobacter pylori and the other had secondary bone metastases. In the latter, the clinical picture of RS3PE developed after surgical intervention for the primary lesion. On physical examination, while the hands and feet were swollen in the first patient, pitting edema was present only at the feet of the other. All joints of the affected hands and feet were painful. Serological tests including rheumatoid factor, antinuclear antibody, and human leukocyte antigen B27 were all negative. Response to low-dose corticosteroid treatment was delayed in the first patient, but the symptoms were relieved better in the second one.
The aim of this study was to assess the esophageal motility by manometry in patients with primary... more The aim of this study was to assess the esophageal motility by manometry in patients with primary Sjögren&amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome. Esophageal manometry was carried out in 40 patients with primary Sjögren&amp;amp;amp;amp;amp;amp;amp;amp;#39;s syndrome (SS), 15 with rheumatoid arthritis (RA), 15 with RA and secondary SS, and 21 healthy volunteers. We found that the mean lower esophageal sphincter (LES) pressures measured by station pull-through and rapid pull-through techniques were significantly higher in primary SS patients than with healthy controls and RA patients with or without SS (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Our study did not show any major differences when comparing the three patient groups (P&amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). However, peristaltic contraction velocity was lower and peristaltic contraction duration significantly higher at the middle and lower thirds of the esophagus in primary SS patients than in healthy controls (P&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The results of our study support the view that various esophageal motility disorders can be found in patients with primary SS which could be related to an increase in LES pressure. We also found no correlation of the esophageal abnormalities with other factors studied, suggesting that the cause of dysphagia is multifactorial in nature.
Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am... more Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease is a systemic vasculitis in which studies have given conflicting results about ventricular diastolic functions. However, tissue Doppler echocardiography has never been used in any of these studies. Aortic stiffness, a cardiovascular risk factor, may also precede ventricular dysfunction. The aim of this study was to assess aortic stiffness and biventricular diastolic functions in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. A total of 26 patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (mean age; 33+/-10 years) and 20 age- and sex-matched controls (mean age; 33+/-7 years) were included. Aortic stiffness was evaluated by aortic strain and distensibility. Ventricular diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. Mitral E and A wave, E/A ratio of E wave, deceleration time, and isovolumic relaxation time were calculated. There was no significant difference in diastolic Doppler parameters between patients and controls. Similarly, there was no significant difference in mitral annular E and A velocities between these two groups. Aortic strain in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was found to be significantly less than in the controls (8.3+/-4.9% and 15.7+/-2.7% respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Aortic distensibility was also significantly low in patients with Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease when compared to controls (0.45+/-0.28 and 0.78+/-0.13 respectively, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Beta index values were significantly high in…
Familial Mediterranean fever (FMF) is an autosomal recessively-inherited disorder typically manif... more Familial Mediterranean fever (FMF) is an autosomal recessively-inherited disorder typically manifested by recurrent attacks of fever and polyserositis. The articular disease occurs in 50-70% of patients. Bone scintigraphy is more sensitive in the diagnosis of arthritis than clinical examination or conventional radiological imaging, allowing earlier diagnosis through the visualization of disease in multiple sites. To assess joint involvements in FMF patients with or without joint symptoms, bone scintigraphy was performed in 36 patients with FMF and in 25 controls. There was arthritis in 72% of patients. Of these, 65% knee, 42% ankle, 50% sacroiliac, 8% elbow, 8% wrist, 4% sternoclavicular and 4% hip involvements were found. The sacroiliac joints with sacroiliac index higher than 1.34 were diagnosed as sacroiliitis, which was higher than 2 SD of normal. FMF is frequently associated with joint disease such as knee and ankle arthritis and sacroiliitis. This high incidence of sacroiliitis in our study has not been previously reported. This difference could be explained by the different methodology used for the screening of the joints. Thus, we recommend that bone scintigraphy can be used in patients with FMF to determine the presence of arthritis, especially in sacroiliac joints, even asymptomatic.
The aim of this study was to compare plasma Platelet-activating factor (PAF) and P-selectin (CD62... more The aim of this study was to compare plasma Platelet-activating factor (PAF) and P-selectin (CD62P) activities in Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease patients with and without thrombosis. In this cross-sectional and descriptive study, 30 consecutive Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients were included, 15 of them with venous thrombosis. All patients were also divided into two subgroups according to the presence or absence of clinical activity. Plasma PAF levels, basal and Ca++ ionophore (A23187)-induced leukocyte (cellular) PAF activities, and platelet-rich plasma DeltaCD62P activity (the mean fluorescent density difference between CD62P phycoerythrin-positive and -negative stains) were evaluated. In the thrombotic group, plasma PAF (P=0.001), basal leukocyte PAF (P=0.017), induced leukocyte PAF (P=0.024), and DeltaCD62P (P=0.023) levels were significantly higher than in the nonthrombotic group. In the whole group of Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s patients, there was a positive correlation between plasma PAF and DeltaCD62P levels (r=0.533, P=0.002). When we compared clinically active and inactive patients with respect to the above parameters, there was no significant difference, irrespective of thrombosis. Plasma PAF (P=0.001), basal leukocyte PAF (P=0.004), and DeltaCD62P (P=0.038) levels were significantly higher in the presence of both clinical activity and thrombosis than of clinical activity alone. Platelet-activating factor and CD62P may contribute to endothelial injury and thrombosis development in Behçet&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease. These two parameters seem related to the presence of thrombosis rather than clinical activity.
Background Immune mediated diseases may be tissue specific such as insulin dependent diabetes mel... more Background Immune mediated diseases may be tissue specific such as insulin dependent diabetes mellitus (IDDM), or may be systemic such as rheumatoid arthritis (RA). Since impaired glucose tolerance have been reported in some connective tissue diseases.1,2 Objectives we investigated the frequency of autoantibodies targeting pancreas in RA patients with and without Sjögren’s syndrome (SjS). Methods 103 RA patients, 26 with secondary SjS were included in this study. Serum islet cell antibodies (ICA), anti-insulin antibodies (AIA) and insulin receptor antibodies (IRA) were measured. Standard oral glucose tolerance test was performed if fasting or postprandial plasma glucose levels were elevated, or if any of the above mentioned antibodies were positive. Results The frequencies of positive ICA, AIA and IRA in the whole group of patients with RA were 21.4%, 29.7% and 15.2%, respectively. There was no significant differences between the subgroups of RA patients with respect to OGTT results...
Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Sistemik lupus eritematozu... more Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 2009 Mart; 16 (1) Sistemik lupus eritematozus tanilibir olguda akciger, plevra ve bagirsak tuberkulozu: olgu sunumu Şule Kaya*, Necla Songur*, Onder Ozturk*, Metin I.Ciris**, Ercan Tunc***, Yildiran Songur****, M. Cem Kockar****, Ahmet Akkaya* Ozet Sistemik Lupus Eritematozus (SLE), bircok organ sistemlerinin tutulumu ile karakterize otoimmun bir hastaliktir. Son zamanlarda, SLE hastalarinda firsatci enfeksiyon riskinde, ozellikle de akciger tuberkulozu ve akciger disi organ tuberkulozunda artma olduguna dair bir cok yayin bulunmaktadir. Altiyildir SLE, diffuz proliferatif glomerulonefrit (DPGN) ve hipertansiyon tanilariile takip edilen 35 yasinda bayan hasta usume, titreme, ates, halsizlik ve kilo kaybiyakinmalariile klinigimize basvurdu. Akciger grafisinde, sol akciger orta ve alt zonda efuzyon ile uyumlu acikligiyukaribakan homojen dansite artisi izlendi. Hastanin oykusunden 1 ay once akut batin on tanisiyla sag hemikolektomi o...
BackgroundIleus is common after colorectal surgery and is associated with an increased risk of po... more BackgroundIleus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.MethodsA prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system.ResultsA total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return...
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