Browsing by Author "Gul, A"

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Characteristics of Patients With Adult-Onset Familial Mediterranean Fever in Turkey: Analysis of 401 Cases
(Blackwell Publishing Ltd, 2005) Sayarlioglu, M; Cefle, A; Inanc, M; Kamali, S; Dalkilic, E; Gul, A; Konice, M
It has been generally accepted that the clinical onset of familial Mediterranean fever (FMF) begins before 20 years of age in most patients. In this study, we aimed to investigate the demographic and clinical characteristics of our FMF patients with an age of onset greater than or equal to20. Records of 401 patients (female/male: 204/197) that followed up between 1990 and 1999 were reviewed according to a pre-defined protocol. All patients fulfilled the diagnostic criteria of Livneh et al. The demographic and clinical features of adult-onset FMF patients were compared to those of patients with a disease onset before 20 years of age. There were 57 patients (14%) who experienced symptoms of FMF at greater than or equal to20 years of age; 34 of them (8.5%) reported their first attack between 20 and 29 years of age; 18 of them (4.5%) between 30 and 39 years of age and five patients (1.25%) had their first attack after 40 years of age. Arthritis (42 vs. 65%, p = 0.001) and erysipelas-like erythema (7 vs. 17%, p = 0.047) were significantly less frequent in patients with adult-onset FMF compared to patients with disease onset before 20 years of age. Arthritis and erysipelas-like erythema were less frequent in adult-onset patients compared to those with an earlier disease onset. Adult-onset FMF may be a form of disease with distinct clinical, demographic and molecular characteristics. Prospective clinical studies and investigation of genotypic features are needed to identify the characteristics of this phenotypic variant.
Characteristics of Patients With Late Onset Systemic Lupus Erythematosus in Turkey
(Wiley, 2005) Sayarlioglu, M; Cefle, A; Kamali, S; Gul, A; Inanc, M; Ocal, L; Konice, M
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder mainly affecting young women. In this study, we aimed at investigating the clinical, laboratory and management characteristics of our SLE patients with an age of onset greater than or equal to50. Twenty patients with late onset SLE (greater than or equal to50 years) were identified from the records, on the basis of their first SLE-related symptoms (Group I). A hundred consecutive SLE patients with initial symptoms before the age of 50 were also selected as controls (Group II). Clinical, laboratory and management characteristics of the patients were recorded according to pre-defined protocol and compared by chi(2), Student's t-test and Fisher's exact test. Comparison of the demographic findings between the Group I (F/M: 18/2) and the Group II (F/M: 90/10) were as follows: the mean age of disease onset was 53.9 +/- 4.5 years vs. 26.3 +/- 9.2 years, mean time of follow-up was 44.2 +/- 40.5 months vs. 50.1 +/- 47.4 months, mean damage index was 0.6 +/- 0.6 vs. 0.58 +/- 1.4. There was no significant difference between the two groups with regard to clinical, laboratory parameters, damage index and immunosuppressive treatment characteristics. SLE-related manifestations were similar in two groups except fever (10% in the Group I vs. 41% in the Group II; p = 0.01). The only two patients with pulmonary fibrosis were found in the Group I (p = 0.027). The clinical and laboratory characteristics and the disease outcome in SLE patients with an age of onset greater than or equal to50 years did not show significant differences from the control SLE patients with a younger age of onset.
Colchicine-Induced Myopathy in a Teenager With Familial Editerranean Fever
(Sage Publications inc, 2003) Sayarlioglu, M; Sayarlioglu, H; Ozen, S; Erkoc, R; Gul, A
OBJECTIVE: To report a case of colchicine-induced myopathy in a teenager with familial Mediterranean fever (FMF). CASE SUMMARY: A 15-year-old boy of Turkish origin, diagnosed as having FMF at the age of 14 years, was treated with colchicine 1.5 mg/d. He had experienced only 2 mild peritonitis attacks with fever within 1 year. The patient used the recommended dose regularly, and he described progressive proximal muscle weakness and generalized myalgias, which started 1 month before presentation. Physical examination showed proximal muscle weakness in his arms and legs. Laboratory tests revealed elevated serum creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. All other laboratory values were within normal range. Electromyographic investigation revealed a myopathic pattern in proximal muscles without any neuropathic changes. A biopsy of the deltoid muscle showed vacuolar degeneration of striated muscle fibers with no inflammatory findings. DISCUSSION: Colchicine, the most important drug in treatment of FMF, can cause myopathy in patients with impaired renal and hepatic function. In our patient, an objective causality scale showed that therapeutic doses of colchicine for FMF were the definite cause of myopathy, even though his renal and hepatic function were normal. The treatment of FMF attacks in patients who cannot use colchicine is an important problem. There are insufficient data about the use of immunosuppressive agents in the treatment of FMF attacks; however, we now successfully control the attacks with colchicine 0.5 mg/d and azathioprine 2 mg/kg/d. CONCLUSIONS: Colchicine-induced myopathy should be excluded in patients with FMF who present with generalized muscle weakness. Clinicians should be aware that myopathy can occur in patients with FMF who have normal renal and hepatic function.
Comparison of Argon Laser Photocoagulation Induced Cutaneous Inflammation and Skin Pathergy Test in Behcet's Disease
(B M J Publishing Group, 2003) Sayarlioglu, M; Calka, O; Cinal, A; Sayarlioglu, H; Akdeniz, N; Topcu, N; Gul, A
Hematological Malignancy and Pregnancy
(Blackwell Publishing, 2006) Dilek, I; Topcu, N; Demir, C; Bay, A; Uzun, K; Gul, A; Ugras, S
The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.
Morphological Quantitative Changes in the Number of Lymphocytes, Macrophages and Plasma Cells in the Uterus and Lymph Nodes of Rats Exposed To the Systemic Administration of Bcg
(Tohoku Univ Medical Press, 2003) Kanter, M; Gul, A; Meral, I; Koc, A; Ilhan, M; Erdogan, E
KANTER, M., GUL, A., MERAL, I., Koc, A., ILHAN, M. and ERDOGAN, E. Morphological Quantitative Changes in the Number of Lymphocytes, Macrophages and Plasma Cells in the Uterus and Lymph Nodes of Rats Exposed to the Systemic Administration of BCG. Tohoku J. Exp. Med., 2003, 199 (4), 219-228 - This study was designed to investigate the effect of systemic administration of BCG on the morphological quantitative changes in the number of lymphocytes, macrophages and plasma cells in the uterus and lymph nodes of rats. Thirty female virgin Wistar Albino rats, aging 6 months and weighing between 200-250 g, were assigned to the two experimental groups; BCG treated and controls (n = 15). BCG group received 0.1 ml BCG in tail skin and control group received 0.1 ml saline at the same place. Two weeks after injections, rats in both groups were anesthesized with a high dose of ether and decapitated. Uterus and ileocecal lymph nodes were processed to determine alpha napthyl acid esterase (ANAE)-positive T lymphocytes and macrophages. The plasma cells were stained with the methyl green-pyronin method. It was found that the numbers of T lymphocytes, macrophages and plasma cells in the uterus and the ileocecal lymph nodes of BCG treated group significantly increased indicating the presence of an immune response to the systemic BCG administration. It was concluded that the systemic administration of BCG increases humoral and cellular immunity in endometrium, myometrium and regional lymph nodes. The immune deficiency system plays an important role in the pathogenesis of endometriosis. Therefore, the endometriosis might be prevented by using periodical administration of BCG. However, further experimental and clinical studies associated with these issue are required.
A Note on Endoparasitic Fauna in Gulls Around Lake Van Region
(indian veterinary Journal, 2003) Senler, NG; Bicek, K; Gul, A; Deger, S
Outcome of Heterotopic Pregnancy Without Corpus Luteum
(Elsevier Science Bv, 2002) Sahin, HG; Sahin, HA; Gul, A; Ipeksoy, U; Kocar, M
The Prevalance and Distribution of Eimeria Species Found in Sheep in Van
(Tubitak Scientific & Technological Research Council Turkey, 2002) Gul, A; Deger, S
This study was performed to investigate the presence of Eimeria species in the sheep population of Van Stool samples were collected from 350 sheep in 10 geographically distinct locations (Van centre Saray Caldiran Ercek Edremit Gurpinar and Guvecli Bardakci Alakoy Kavuncu villages) in Van province Nine different Eimeria species were found in the examination of the stool samples These species were E parva (46 57%) E ovinoidalis (43 14%) E ahsata (39 42%) E ovina (39 14%) E crandalis (38 85%) E pallida (33 14%) E granulosa (16 57%) E faurei (15 42%) and E intricata (11 42%).
Prevalence of Endoparasites in Dogs and Their Importance on Human Health in and Around Van
(indian veterinary Journal, 2003) Senler, NG; Gul, A; Bicek, K; Deger, S
Prevalence of Toxocara Spp. Eggs in Soil. of Public Parks in Van, Turkey
(indian veterinary Journal, 2003) Ayaz, E; Yaman, M; Gul, A
Treatment of Recurrent Perforating Intestinal Ulcers With Thalidomide in Behcet's Disease
(Harvey Whitney Books Co, 2004) Sayarlioglu, M; Kotan, MC; Topcu, N; Bayram, I; Arslanturk, H; Gul, A
OBJECTIVE: To report the beneficial effects of thalidomide on recurrent perforating intestinal ulcers in a patient with Behcet's disease (BD). CASE SUMMARY: A 24-year-old Turkish woman with BD was admitted to our hospital because of severe abdominal pain and vomiting. She had been receiving colchicine 1.5 mg/day and azathioprine 150 mg/day for treatment of BD for 2 years. During emergency laparatomy, 2 perforating ulcers were detected in the anterior cecum, which were treated with debridement and primary repair. She experienced 2 more episodes of intestinal perforations during the second and fifth weeks despite intense immunosuppressive treatment with methylprednisolone and cyclophosphamide. New intestinal perforations were found in the posterolateral cecum and transverse colon during the second operation and in the terminal ileum during the third one. Thalidomide 100 mg/day was then started, and the symptoms disappeared within 2 weeks. The woman experienced no other intestinal perforation during the follow-up period of 4 months. DISCUSSION: The mode of action of thalidomide in BID is still unclear. In BID, various cytokines have been shown to be abnormally expressed and neutrophils are overactive. This is a possible mechanism of action with thalidomide reducing both tumor necrosis factor and the neutrophil migration. CONCLUSIONS: Thalidomide may be an effective alternative treatment for BID patients with recurrent and perforating intestinal ulcers despite intense immunosuppressive therapy.
Tuberculosis in Turkish Patients With Systemic Lupus Erythematosus: Increased Frequency of Extrapulmonary Localization
(Arnold, Hodder Headline Plc, 2004) Sayarlioglu, M; Inanc, M; Kamali, S; Cefle, A; Karaman, O; Gul, A; Konice, M
The objective was to investigate the frequency and characteristics of tuberculosis( TB) in patients with systemic lupus erythematosus (SLE). We reviewed the charts of 556 patients with SLE who were followed up between 1978 and 2001 in our lupus clinic. Patients who developed TB after the diagnosis of SLE were identified (SLE/TB). Ninety-six consecutive patients with SLE who did not develop TB during the follow-up were evaluated as a control group (SLE/TB+). Clinical, laboratory and management characteristics of these two groups of patients were recorded according to a predefined protocol, and compared. Of the 556 patients evaluated, 20 patients (3.6%) with TB were identified. Nine of the 20 patients (45%) had extrapulmonary TB ( vertebral involvement in three patients, meningeal in two, and joint and soft tissue in four). Arthritis and renal involvementwere significantly high in the SLE/TB+ group (P = 0.045, P = 0.009, respectively). The mean daily dose of prednisolone before the diagnosis of TB and the cumulative dose of prednisolone were significantly higher in the SLE/TB group compared to the SLE/TB- group (27 +/- 22 g versus 16 +/- 16 g, 24 +/- 45 mg versus 11 +/- 8.5 mg, respectively). In conclusion, we found an increased frequency of TB infection and a high prevalence of extrapulmonary TB in a large cohort of SLE patients. The mean daily dose of prednisolone before the diagnosis of TB and the cumulative dose of prednisolone, which possibly related to disease severity, were important determinants for the increased risk of TB in these patients with SLE.