Browsing by Author "Sayarlioglu, M"

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A Case of Antiphospholipid Syndrome Presenting With Pulmonary Truncus and Main Pulmonary Artery Thrombosis
(Springer, 2005) Sayarlioglu, M; Topcu, N; Harman, M; Guntekin, U; Erkoc, R
In patients with antiphospholipid syndrome (APS), thromboembolism and pulmonary hypertension are the most common pulmonary manifestations. Thrombotic obstruction at the level of the main and/or proximal pulmonary arteries is rare. We report a 40-year-old woman without any history of previous arterial and/or venous thrombosis who presented with severe dyspnea and was found to have pulmonary hypertension and positivity for anticardiolipin antibodies. Computed tomography revealed pulmonary truncus thrombosis extending to both right and left pulmonary arteries. The patient and her family refused surgical treatment. She had a prolonged hospital course, was unresponsive to thrombolytic, anticoagulant, antiplatelet, and immunosuppressive treatments, and died of right ventricle and respiratory failure 5 weeks later. This is the first reported case with thrombosis of pulmonary truncus and main pulmonary arteries concurrent with APS.
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
Duplex and Color Doppler Sonographic Findings in Active Sacroiliitis
(Amer Roentgen Ray Soc, 1999) Arslan, H; Sakarya, ME; Adak, B; Unal, O; Sayarlioglu, M
OBJECTIVE, The aim of this study was to describe the duplex and color Doppler sonographic findings in active sacroiliitis. SUBJECTS AND METHODS. Forty-one joints in 21 patients with active sacroiliitis, 20 sacroiliac joints in 10 patients with osteoarthritis, and 30 sacroiliac joints of 15 asymptomatic volunteers were investigated on duplex and color Doppler sonography. We investigated whether a vessel was present around the posterior portions of sacroiliac joints with color Doppler sonography. When an artery was detected the resistive index (RI) was measured using duplex Doppler sonography in all groups and also after treatment in the patients with active sacroiliitis. RESULTS. Vascularization around the posterior portions of sacroiliac joints was seen in 41 joints of the 21 patients with active sacroiliitis, nine joints of six patients with osteoarthritis, and 13 joints of eight volunteers. The mean RI values were 0.62 +/- 0.13, 0.91 +/- 0.09, and 0.97 +/- 0.03, respectively. In the patients with active sacroiliitis, the mean RT value was 0.91 +/- 0.07 after therapy. The RI values for the patients with active sacroiliitis were significantly different from those of the patients with osteoarthritis (p < .001) and of the volunteers (p < .001). In addition, the RI values were significantly different before and after treatment in the patients with active sacroiliitis (p < .001). CONCLUSION. Vascularization around the posterior portions of sacroiliac joints increased and RI values decreased in patients with active sacroiliitis. Color and duplex Doppler sonography were able to reveal these changes and can be used in the diagnosis of active sacroiliitis and follow-up after treatment. Thus, RI values may be a quantitative indicator for clinical symptoms in patients with active sacroiliitis.
The Effect of Colchicine on the Peritoneal Membrane
(Taylor & Francis inc, 2006) Sayarlioglu, H; Dogan, E; Erkoc, R; Ozbek, H; Bayram, I; Sayarlioglu, M; Bozkurt, H
Peritoneal dialysis (PD) is a treatment modality for patients with renal failure. Peritoneal fibrosis is one of the most serious complications after long-term continuous ambulatory peritoneal dialysis (CAPD). Histological studies in both humans and animals show that chronic peritoneal dialysis results in fibrosis of the peritoneal membrane. In our study, we investigated the effect of colchicine on peritoneal alterations induced by hypertonic PD solution in rats. Sprague-Dawley rats intraperitoneally received saline (control group) once daily, for 28 days, or 3.86% glucose (PDF group), or 3.86% glucose plus colchicine (colchicine group). Animals from each group were sacrificed after 28 days with anesthetized ketamine (60 mg/kg BW). For the PD fluid assessment, 1 h before the sacrifice of animals, 10 mL PD fluid of 2.27% glucose was given, and this fluid was obtained after the sacrifice. The levels of transforming endothelial growth factor ss (TGF-ss), tumor necrosis factor alpha (TNF-alpha) and albumin were investigated both in the peritoneal dialysate and blood, and the levels of malondialdehyde (MDA) were investigated only in peritoneal dialysate. The peritoneal membrane was evaluated histologically by light microscopy. When groups were compared in terms of body weight change, the colchicine group significantly lost weight compared to controls and PDF group (-4.7% 4.5, 3.5% 7.2, 3.0% 1.3, respectively, p = 0.018). Also, the blood albumin level was significantly lower for these in the colchicine group compared to those in the PDF group (2.7 0.35 versus 3.2 0.3 g/dL, respectively, p = 0.048). The blood TGF-ss level was significantly lower in the control group, and no difference was observed between the PDF and colchicine groups (294.4 67.5 versus 787.4 237.4 versus 615.3 235.1 pg/mL, respectively, p = 0.004). The mesothelial thickness found in groups was as follows: control group 102 18.9 mu m, PDF group 128.33 33.1 mu m, colchicine group 117 35.6 mu m ( p = 0.34). In conclusion, a rat model for peritoneal dialysis associated peritoneal derangement without fibrosis could be induced. Colchicine could not prevent peritoneal derangement in this model.
Effect of Glucose Concentration on Peritoneal Inflammatory Cytokines in Continuous Ambulatory Peritoneal Dialysis Patients
(Hindawi Ltd, 2004) Sayarlioglu, H; Topal, C; Sayarlioglu, M; Dulger, H; Dogan, E; Erkoc, R
OBJECTIVE : It is known that glucose concentrations of peritoneal dialysis solutions are detrimental to the peritoneal membrane. In order to determine the effect of glucose concentration on cytokine levels of peritoneal fluid of continuous ambulatory peritoneal dialysis (CAPD) patients, a cross-sectional study was performed. Methods: Nine non-diabetic CAPD patients participated in two 8-h dwell sessions of overnight exchanges in consecutive days, with 1.36% and 3.86% glucose containing peritoneal dialysis solutions (Baxter - Eczacibasi). Peritoneal dialysis fluid tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 levels were measured. Results: TNF-alpha levels after 1.36% and 3.86% glucose used dwells were 23 +/- 14 pg/ml and 28 +/- 4 pg/ml, respectively (p = 0.78). The IL-6 levels were 106 +/- 57 pg/ml and 115 +/- 63 pg/ ml ( p = 0.81), respectively. Conclusion: In our in vivo study we found that the glucose concentration of the conventional lactate-based CAPD solution has no effect on basal IL-6 and TNF-alpha levels of peritoneal fluid. Further in vivo studies with non-lactate-based CAPD solutions are needed in order to determine the effect of glucose concentration per se on cytokine release.
Effect of Hormone Replacement Therapy on Cd4+ and Cd8+ Numbers, Cd4+ Ratio, and Immunoglobulin Levels in Hemodialysis Patients
(Taylor & Francis Ltd, 2005) Dogan, E; Erkoc, R; Demir, C; Sayarlioglu, H; Dilek, I; Sayarlioglu, M
Uremia induces a suppression of the immune status. A large clinical literature suggests that estradiol (E-2) plays a critical role in immune function. A large proportion of women hemodialysis patients faced early menopause and inadequate estrogen levels. The aim of the present study is to evaluate the effect of hormone replacement therapy on immune function in terms of CD4(+) numbers (inducer/helper T cells), CD8(+) numbers (cytotoxic/ suppressor T cells), CD4(+)/CD8(+) ratio, and IgG, IgM, IgA levels in woman hemodialysis patients. In our study, 15 female hemodialysis patients (median age 32.6 range 24-45) were treated with triphasic estrogen/progesterone preparation (estradiol 2 mg for 10 days, and afterwards estradiol 2 mg+norethisterone 1 mg for another 10 days, and at the end estradiol 1 mg for 6 days) for 6 months. CD4(+) numbers, CD8(+) numbers, and IgG, IgA, and IgM levels were determined before and after HRT. The "paired-samples T" test was used for statistical analysis of pretreatment and posttreatment values. A significant increase was observed for CD4(+) numbers (582 +/- 435 versus 637 +/- 445, p=0.04) and CD4(+)/CD8(+) ratio (1.4 +/- 0.16 to 2.4 +/- 0.3, p<0.01) after hormone replacement therapy (HRT). Serum immunoglobulin levels were not changed significantly. In conclusion, in postmenopausal hemodialysis patients, HRT significantly increased CD4(+) numbers and CD4(+)/CD8(+) ratio, but no effect was observed in IgM, IgG, and IgA levels. Long-term clinical effects of HRT on immune system should be investigated in dialysis patients with further studies.
Effect of Infliximab on Refractory Uveitis in Behcet's Disease
(Harvey Whitney Books Co, 2004) Sayarlioglu, M; Cinal, A; Topcu, N; Demirok, A
Effects of Capd on Hepatosteatosis and Lipid Profile
(Oxford Univ Press, 2006) Sayarlioglu, H; Erkoc, R; Etlik, O; Sayarlioglu, M; Dogan, E; Kara, P
Fibrosing Mediastinitis and Thrombosis of Superior Vena Cava Associated With Behcet's Disease
(Elsevier Sci Ireland Ltd, 2003) Harman, M; Sayarlioglu, M; Arslan, H; Ayakta, H; Harman, E
We present CT, MRI and venography findings in 13-year boy with mediastinal fibrosis and superior vena cava (SVC) thrombosis associated with Behcet's disease. Fibrosing mediastinitis is an excessive fibrotic reaction that occurs in the mediastinum and may lead to compression of mediastinal structures (especially vascular). This condition is usually idiopathic, though many (and perhaps most) cases in the USA are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. SVC syndrome secondary to extrinsic compression by mediastinal fibrosis combined with Behcet's disease has rarely been described. Radiological investigations of this syndrome are necessary to avoid a useless anticoagulant therapy. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.
Mycophenolate Mofetil Use in Hepatitis B Associated-Membranous and Membranoproliferative Glomerulonephritis Induces Viral Replication
(Harvey Whitney Books Co, 2005) Sayarlioglu, H; Erkoc, R; Dogan, E; Sayarlioglu, M; Topal, C
Relation Between Left Ventricular And/Or Left Atrial Thrombus and Anticardiolipin Antibodies in Patients With Acute Myocardial Infarction
(Excerpta Medica inc-elsevier Science inc, 2000) Güler, N; Bilge, M; Eryonucu, B; Erkoç, R; Sayarlioglu, M
This study was designed to determine the relation between anticardiolipin antibodies and left atrial and/or left ventricular thrombus detected by transthoracic and/or transesophageal echocardiography in patients with acute myocardial infarction, Patients with acute myocardial infarction who had positive anticardiolipin immunoglobulin G and/or immunoglobulin M antibodies appeared to be at higher risk for thrombus formation in the left atrium and/or left ventricle.
Remitting Seronegative Symmetrical Synovitis With Pitting Edema Syndrome Associated With Non-hodgkin's Lymphoma: a Case Report
(Springer-verlag, 2004) Sayarlioglu, M; Bayram, I; Sayarlioglu, H; Erkoc, R
Sheehan Syndrome Presented With Acute Renal Failure Associated With Rhabdomyolysis and Hyponatraemia
(Oxford Univ Press, 2006) Sayarlioglu, H; Erkoc, R; Sayarlioglu, M; Dogan, E; Kara, PS; Begenik, H
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.