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Biomedical subjects

A Gürler

Publications and source records attributed to A Gürler.

At least 19 recordsLinked to original sources
PubMed2002

The prevalence of Behçet's disease above the age of 10 years. The results of a pilot study conducted at the Park Primary Health Care Center in Ankara, Turkey.

PURPOSE: The aim of this study was to determine the prevalence of Behçet's disease above the age of 10 years by means of a population-based study. METHODS: The epidemiological investigation (cross-sectional study) was made between May 1997 and May 1998 at the Park Primary Health Care Center, which is one of the education and research divisions of the Department of Public Health, Faculty of Medicine, Ankara University. The research aimed to cover all 17,256 (49.2% male, 50.8% female) inhabitants over 10 years of age living in this area. The screening team first surveyed and selected patients with recurrent aphthous stomatitis. These patients were further examined, free of charge, in the Preventive Ophthalmology Unit of the Public Health Center, at Ibni Sina Hospital's Behçet Center or in other clinics if necessary. In this study the International Study Group For Behçet's disease Criteria were used. RESULTS: As the final result of the screening, 11 female and 5 male patients with Behçet's disease were found (female/male = 2.2). These patients represented 9 already known and 7 newly diagnosed cases of Behçet's disease. The prevalence of Behçet's disease over 10 years of age is 0.11%. CONCLUSION: The existing regional prevalance studies conducted in Turkey have indicated that the real number of Behçet's patients in our country is markedly higher than the number of registered patients. Therefore the National Behçet's Disease Commity and Surveillance System was founded by our research group in December 1999.

Adolescent↗
PubMed2001

Comparison of effects of continuous combined transdermal with oral estrogen and oral progestogen replacement therapies on serum lipoproteins and compliance.

OBJECTIVE: To compare the effects of transdermal and oral hormone replacement therapy on compliance and serum lipoproteins. DESIGN: A total of 159 naturally menopausal women who received either 0.05 mg transdermal estradiol twice weekly or 0.625 mg oral conjugated estrogen daily, with 2.5 mg oral medroxyprogesterone acetate daily, were retrospectively studied. Continuation with or drop-out from treatment regimens, side-effects and bleeding patterns were recorded during a 2-year follow-up period. Baseline, first-year and second-year serum lipoprotein levels were compared between the two groups. RESULTS: Of the 100 women taking oral estrogen, 28 (28%) had dropped out whereas of the 59 women receiving transdermal estrogen, 17 (28.8%) had dropped out at the end of 2 years. The occurrence of bleeding episodes was the most common reason given for discontinuation in both treatment groups (52.9% in the transdermal group and 35.7% in the oral treatment group). The mean increase in high-density lipoprotein (HDL) level for the first year and second year was 10.2 +/- 3.2% and 31.4 +/- 2.8%, and 13.5 +/- 3.2% and 33.6 +/- 3.6% with oral treatment and transdermal therapy, respectively. The mean decrease in total cholesterol for the first year and second year was 2.9 +/- 1.9% and 14.7 +/- 1.6%, and 5.6 +/- 1.7% and 5.7 +/- 1.6% with oral and transdermal treatment, respectively. Likewise, the mean decrease in low-density lipoprotein (LDL) cholesterol for the first year and second year was 6.2 +/- 2.5% and 18 +/- 2.9%, and 7.9 +/- 3.0% and 15.9 +/- 5.2% with oral and transdermal treatment, respectively. There was no significant difference between groups in any of the lipid parameters. Transdermal treatment decreased triglyceride levels by 33.7 +/- 3.9%, whereas oral estrogen treatment increased triglycerides by 18.6 +/- 4.3% at the end of 2 years. This difference between the two groups was statistically significant (p < 0.0001). CONCLUSION: Continuation of treatment was similarly high at the end of 2 years with both transdermal and oral estrogen treatment. Both treatments changed serum lipids favorably. Nevertheless, triglycerides were increased by oral estrogen but decreased by transdermal treatment at 2 years; this difference between the groups was significant.

Administration, Cutaneous↗
PubMed2000

Comparison of coagulation parameters for healthy subjects and Behçet disease patients with and without vascular involvement.

Behçet disease (BD) is an inflammatory illness that may attack several systems. Vascular involvement with thrombosis is one of the basic characteristics of this disease. The etiology of thrombosis tendency in BD has not been understood well. In this study, the role of primary coagulation parameters in patients with BD who have thromboembolic events was evaluated. In addition, the relation between the clinical activity of the disease and these parameters was compared. A total of 96 patients with a diagnosis of BD were studied at Ankara University, Medical School, Department of General Surgery and Behçet Center. BD patients were separated into two groups with respect to vascular involvement. Group A contained 22 patients with vascular attacks, and group B contained 74 patients without vascular attacks. In addition, 25 healthy persons comprised the control group (group C). The coagulation parameters assessed included protein C, protein S, antithrombin III activity, fibrinogen level, prothrombin time (PT), and partial thromboplastin time (PTT). There were no differences among the three groups with respect to protein C, protein S, fibrinogen, PT, and PTT values (p > 0.05). The antithrombin III value was found to be high in BD patients compared to those in the control group (p = 0.011). There was no difference regarding the antithrombin III value between BD patients with or without vascular attacks (p = 0.954). There was no correlation between the activity of disease and coagulation parameters (p > 0.05), but a positive correlation was seen between the duration of illness and vascular involvement. Fifty percent of patients who had had BD more than 8 years had vascular involvement (p = 0.002). We could not determine a specific pathology in relation to coagulation parameters that could explain the etiology of thrombosis in patients with BD. The elevated antithrombin III levels in patients with BD (compared to controls) may be due to a compensatory defense mechanism against increased procoagulant activity. There was a correlation between the duration of illness and vascular involvement.

Adolescent↗
PubMed2000

Haemostasis in patients with Behçet's disease.

AIM: to determine whether Behçet's disease affects haemostatic function. SETTING: University Hospital, Turkey. PATIENTS: one hundred and twenty-seven consecutive patients with Behçet's disease, 34 of whom with a history of vascular involvement. METHODS: prothrombin fragment 1+2 tissue plasminogen activator, protein S and C, antithrombin, fibrinogen, von Willebrand factor, thrombomodulin and prothrombin time (PT) were measured in patient plasma. RESULTS: soluble thrombomodulin was significantly lower and von Willebrand factor (vWF) and tissue plasminogen activator (tPA) significantly higher in Behçet's patients. Patients with vascular involvement showed the highest levels of vWF and tPA. There was no activation of coagulation, not even in patients with an active disease at the time of sampling. CONCLUSION: there were indirect signs of endothelial activity or damage, particularly in patients with vascular involvement. Coagulation was not activated.

Adult↗
PubMed2000

Long-term effects of interferon alpha 2A treatment in Behçet's disease.

BACKGROUND: Between May 1995 and April 1996, 20 patients with Behçet's disease were successfully treated with interferon alpha(2a) (IFN-alpha(2a)) 9 million IU/day three times a week and 16 patients with colchicine 1.5 mg/day orally for 3 months. OBJECTIVE: To study the long-term effects of IFN treatment in Behçet's disease. METHODS: Between the years of 1996 and 1999, the patients were followed up every 3 months or whenever indicated. Retrospective evaluation was performed. RESULTS: In 56% of the patients with complete remission or partial remission at the end of IFN-alpha(2a) treatment, long-term remissions ranging from 36 to 48 months were observed. CONCLUSION: IFN-alpha(2a) treatment is an effective treatment modality in Behçet's disease with the advantage of inducing prolonged remissions.

Adult↗
PubMed2000

Effects of factor V gene G1691A, methylenetetrahydrofolate reductase gene C677T, and prothombin gene G20210A mutations on deep venous thrombogenesis in Behçet's disease.

OBJECTIVE: Behçet's disease (BD) is a multisystemic disease of unknown etiology, characterized by aphthous ulcerations and uveitis, that is common in the Turkish population. Venous involvement is observed in 25% of the cases. While superficial thrombophlebitis is the most common finding, deep venous thrombosis (DVT) follows it. Hyperactivity in the coagulation pathway, hypoactive anticoagulation mechanisms, or faulty fibrinolysis generate a tendency for thrombogenesis. Mutations of the genes involved in these pathways may cause predisposition to thrombosis. METHODS: Possible roles of methylenetetrahydrofolate reductase (MTHFR) gene C677T, factor V (FV) gene G1691A (Leiden), and prothrombin gene G20210A polymorphisms in venous thrombogenesis were evaluated in patients with BD; 100 healthy people, 30 BD patients without DVT, 30 BD patients with DVT, and 30 patients with idiopathic DVT were studied with the restriction fragment length polymorphism method for these 3 polymorphisms. The frequencies of these mutations for each group, separately and in combinations, are described. RESULTS: Among the 3 mutations, FV Leiden mutation was found to be a risk factor for DVT. An association between FV Leiden mutation and BD was likely, but FV Leiden mutation did not increase the risk for deep venous thrombogenesis in BD patients. MTHFR gene C677T mutation does not increase risk of DVT in BD either alone or combined with FV Leiden mutation. CONCLUSION: Although a thrombotic tendency is one of the major characteristics of BD, we found no association between these 3 thrombogenetic mutations and BD patients with thromboses.

Adolescent↗
PubMed1999

Evaluation of gastrointestinal involvement of Behçet's disease by nuclear medical techniques.

To evaluate the value of nuclear medicine procedures in the diagnosis of gastrointestinal involvement of Behcet's disease in asymptomatic patients, Tc-99m human immunoglobulin (HIG) and Tc-99m leucocyte (LC) whole body scintigraphies were performed on 30 patients with major symptoms of the disease. Comparison of the results with other diagnostic techniques showed that Tc-99m HIG whole body scanning can be a useful diagnostic aid before the disease becomes clinically active in the gastrointestinal system.

Adult↗
PubMed1998

Adhesion molecule expression in erythema nodosum-like lesions in Behçet's disease. A histopathological and immunohistochemical study.

Behçet's (BD) is a systemic inflammatory disease with histological evidence for vasculitis. Leucocyte-leucocyte and leucocyte-endothelial cell interactions are critical in inflammatory reactions that are influenced by the expression, activation and shedding of adhesion molecules. We investigated the expression of some adhesion molecules (E- and L-selectin, VLA-4, ICAM-1, PECAM-1, VCAM-1 and CD18 and CD11c chains of beta-2 integrins) on endothelial and inflammatory cells by immunohistochemistry on cryostat sections of erythema nodosum lesions taken from 15 patients with BD and 12 patients with erythema nodosum of unknown cause. Hematoxylin-eosin stained sections of all specimens were also assessed. The major histopathological findings were perivascular mononuclear cell infiltration and secondary vasculitic changes with no difference between the two groups (P > 0.05). However, the frequency of thrombophlebitis was higher in BD (P < 0.001). Endothelial and inflammatory cell adhesion molecule expression did not show any significant difference between groups (P > 0.05). Although VCAM-1 expression and intensity on endothelial cells of BD patients seemed to be lower, this did not reach statistical significance (P = 0.056). We concluded that subcutaneous thrombophlebitis is an important feature of erythema nodosum like lesions in BD, which is almost impossible to understand by physical examination alone. Colchicine, which is known to have some influence on adhesion molecules, might have affected our results, as these showed no significant difference regarding adhesion molecules between the two groups.

Adult↗
PubMed1998

Factor V Leiden mutation in patients with Behçet's disease.

OBJECTIVE: To determine the relation between factor V Leiden and Behçet's disease (BD), which is described as chronic relapsing vasculitis with pathogenetic mechanisms that seem to be related to anticoagulant pathways. METHODS: Using polymerase chain reaction, the factor V Leiden mutation was investigated in 44 patients with BD, of which 5 had thrombotic histories. RESULTS: Ten patients were found to have the factor V Leiden mutation. This frequency (22.7%) was higher than that of our general population (7.1 %) (p < 0.05). Of the 5 patients with BD with thrombotic histories, 3 (60%) had factor V Leiden mutation (one homozygote, 2 heterozygote), while 7 of 39 (17.9%) patients with no thrombotic history had the factor V Leiden mutation (2 homozygotes, 5 heterozygotes). There is no statistical difference in the frequency of the factor V mutation between patients with BD with no thrombosis and the control group. The frequency of thrombosis in BD with and without factor V Leiden mutation was (3/10) 30% and (2/34) 5.9%, respectively. CONCLUSION: These findings suggest that homozygosity or heterozygosity for factor V Leiden is not always associated with occurrence of venous thrombosis in BD, but it may be a contributing risk factor for venous thromboembolic events in these patients.

Adolescent↗
PubMed1998

Relationship between circulating estradiol levels, body mass index, and breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

OBJECTIVE: The purpose of this prospective study was to investigate the association of breakthrough bleeding with circulating estradiol levels and obesity in postmenopausal women receiving hormone replacement therapy. DESIGN: Fifty postmenopausal women receiving 0.625 mg conjugated estrogen with 2.5 mg medroxyprogesterone acetate were included in the study. Patients are recalled at 1st, 5th and 9th weeks for the measurements of the serum estradiol levels. RESULTS: Twenty women (40%) had a bleeding episode within 9 weeks of therapy. Of the 25 women who had a body mass index (BMI) of > 25, 13 (52%) had bleeding. Of the 25 women who had a BMI of < 25, 7 (28%) had bleeding. There was a trend toward a relation between BMI and breakthrough bleeding, although the relation did not achieve significance (p = 0.14). Serum estradiol levels of both bleeders and nonbleeders remained similar throughout the study. Endometrial histology revealed proliferative endometrium in two cases and secretory endometrium in one case at baseline; two cases of proliferative endometrium were found during bleeding. The remaining samples revealed atrophy. CONCLUSIONS: No relation was found between serum estradiol levels and breakthrough bleeding. Nevertheless, increased BMI may have an impact on breakthrough bleeding in postmenopausal women receiving hormone replacement therapy.

Atrophy↗
PubMed1997

Clinical manifestations of Behçet's disease: an analysis of 2147 patients.

To evaluate the prevalence of the clinical findings in Behçet's disease, we retrospectively analyzed the clinical data of 2147 Behçet patients from 9 to 87 years of age (mean age 38.3 years) followed up during the years 1976 through 1997. One thousand ninety three patients were male and 1054 patients were female. The male/female ratio was 1.03. The mean age at onset was 25.6 years. A family history of Behçet's disease was present in 7.3% of the patients. Positive pathergy was found in 1220 (56.8%) patients. All of the patients had mucocutaneous lesions. Out of the 2147 patients the disease manifested itself as only mucocutaneous involvement in 1168 patients. The prevalence of systemic manifestations was found as follows: 28.9% ocular involvement, 16.0% musculoskeletal involvement, 16.8% vascular involvement, 2.8% gastrointestinal involvement, 2.2% neurological involvement. Pulmonary involvement was seen in 20 (1.0%) patients, cardiac involvement was seen in 3 patients and renal involvement was observed in 2 patients. Male patients had vascular involvement 5.02, neurologic involvement 2.21 and ocular involvement 1.98 times more frequently than female patients.

Adolescent↗
PubMed1997

Systemic levels of the T cell regulatory cytokines IL-10 and IL-12 in Bechçet's disease; soluble TNFR-75 as a biological marker of disease activity.

OBJECTIVE: To analyze the levels of the T cell regulatory cytokines interleukin 10 (IL-10) and IL-12 in plasma of patients with Behçet's disease (BD), and to assess the value of cytokines and cytokine antagonists as biological markers of disease activity. METHODS: Sera/plasma of 66 consecutive outpatients with established diagnosis of BD were analyzed for the presence of IL-2R, IL-6, tumor necrosis factor-alpha (TNF-alpha), soluble (s) TNF receptor (R)-55, sTNFR-75, IL-10, and IL-12 using immunological methods. Additional laboratory measurements included erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Data from the history and clinical examination were recorded to correlate cytokine levels with clinical markers of disease activity. RESULTS: 18 patients had inactive (Group I), 36 had mildly active (Group II), and 12 patients had active BD (Group III). IL-10 was elevated in 42 plasma samples (64%). The percentage of samples containing IL-10 and the median levels of IL-10 of the 3 patient groups did not differ significantly. IL-12 was detectable in plasma of 9 patients: One from Group I (5%), 3 from Group II (8%), and 5 from Group III (41%). IL-12 correlated with disease activity (difference between Groups I and III, p = 0.02, between Groups II and III, p = 0.008). ESR in patients with active disease and mildly active disease was significantly higher than values in patients with inactive disease (p = 0.03, p = 0.02, respectively), while median CRP levels were significantly different between Group I and Group III only (p = 0.006). sTNFR-75 levels were significantly different between Groups II and III (p = 0.003) and between Groups I and III (p = 0.008). CONCLUSION: The elevation of plasma IL-10 in the majority of patients and the correlation of IL-12 plasma levels with disease activity suggest a pathogenic role of a TH1-type immune response in active disease. In addition, the correlation of sTNFR-75 levels with disease activity indicates that sTNFR-75 may serve as a biological marker of disease activity in BD.

Adolescent↗
PubMed1996

Fibronectin and circulating immune complexes in Behet's disease.

Being a high-molecular-weight adhesive glycoprotein, fibronectin (Fn) is suggested to be a component of immune complexes and may participate in the clearance of immune complexes. In Behçet's disease (BD), a multisystem disorder of unknown etiology, immune complexes have been shown to be deposited in affected tissue during disease activity, suggesting an immune mechanism. This study investigates the relationship between Fn and circulating immune complexes (CIC) and evaluates the changes in the levels of Fn and CIC along with disease activity. In 63 patients (31 active, 32 inactive) with BD, plasma Fn and serum CIC, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and the third and fourth components of the complement system (C3, C4) were studied. The mean ESR, CRP, C3 and C4 levels of active BD patients were found to be significantly higher than those of the inactive BD patient group. Although the mean Fn and CIC levels of BD patients were not significantly different from those of the healthy control group, Fn and CIC values of active BD patients were significantly lower than in the inactive group. Moreover, no significant correlation was observed among Fn levels and ESR, CRP, C3, C4 and CIC levels in BD patients. The result of this study suggest that the variation in Fn concentration is independent of the acute-phase response. The lack of relationship between the CIC and Fn concentrations indicates that IC deposition in the vessel wall is independent of the CIC levels. In order to determine the exact roles of Fn and IC, further studies in tissue specimens are required.

Adolescent↗
PubMed1996

Evaluation of peripheral vascular system disorders in vascular symptom--free Behçet's disease.

Vascular involvement in Behçet's disease has been reported in 7-40% of patients in the literature and nearly 8% of these will have serious vascular complications during follow-up. So far, little information is available on the extent of vascular involvement in patients with Behçet's disease who are free of vascular symptoms. The study comprised 34 individuals with Behçet's disease who were free of vascular symptoms and 47 healthy volunteers. Both groups underwent non-invasive peripheral vascular examination consisting of Doppler, photoplethysmography, and segmental pressure measurements and determination of ankle-brachial pressure and femoro-brachial pressure indices. Venous insufficiency was detected in 22 of 68 lower extremities examined in the Behçet's disease group and in ten of 94 in the controls (P < 0.001). The number of extremities with an ankle-brachial pressure index of less than 1.00 for both the anterior and posterior tibial arteries, was significantly higher in the Behçet's disease group (P < 0.001). The femoro-brachial pressure index was significantly higher in the controls than in the Behçet's disease group (1.32 versus 1.23 for the right leg, P < 0.05; 1.31 versus 1.22 for the left leg, P < 0.03). Vascular symptom-free patients with Behçet's disease seem to have a high incidence of peripheral vascular involvement compared with healthy controls.

Adult↗
PubMed1995

Elevated levels of soluble intercellular adhesion molecule-1 correlate with disease activity in Behçet's disease.

The objective of this study was to measure soluble intercellular adhesion molecule-1 (sICAM-1) in patients with Behçet's disease (BD) and to analyse the relationship of sICAM-1 levels with clinical and some laboratory measures of disease activity. Forty patients with BD fulfilling the International Study Group Criteria for the diagnosis of BD and 20 healthy controls were studied. Twenty patients had active, and 20 patients had inactive disease. Serum sICAM-1 was determined by a sandwich ELISA. The mean (+/- SD) sICAM-1 level was significantly higher in the whole BD group (297.3 +/- 86.6 ng/ml) than in the healthy controls (213 +/- 83.5 ng/ml; P < 0.05). The mean sICAM-1 levels in active and inactive BD patients were 315.7 +/- 76.3 ng/ml and 258.3 +/- 73.3 ng/ml, respectively. The mean sICAM-1 level in active patients was significantly higher than in inactive patients and healthy controls (P < 0.02 and P < 0.001, respectively). No statistically significant difference in mean sICAM-1 levels was found between inactive BD patients and healthy controls (P > 0.05). There was no statistically significant difference between the mean sICAM-1 levels of active patients with (351.3 +/- 77.2 ng/ml) or without vascular lesions (292 +/- 68.8; P > 0.05). In spite of a positive correlation between disease activity and both erythrocyte sedimentation rate and C-reactive protein (CRP; P < 0.01), we found no correlation between sICAM-1 and either of them (P > 0.05). The elevated levels of sICAM-1 may be due to endothelial cell activation and/or damage or may be the result of inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Urological evaluation of Behçet patients and the effect of colchicine on fertility.

Behçet's disease is a multisystem disorder in which urogenital involvement mainly consists of genital aphthous ulcers, epididymitis, urethritis and recurrent cystitis. Colchicine is commonly used in these patients for the prevention of arthritic episodes. In this prospective study, 62 male patients under colchicine therapy for Behçet's disease underwent a complete urogenital evaluation. 33 (53.2%) had no urologic complaints. Physical examination revealed genital aphthous ulcers in 42 patients (67.7%) and epididymitis in 5 (8.1%). Analysis of urine specimens demonstrated proteinuria in 54.8% and hematuria in 30.6%. To establish any possible adverse effects of colchicine administration on male fertility, sperm analysis was performed: 23 patients (37.1%) had oligonecrospermia, 2 patients (3.2%) had azoospermia. Penile color flow Doppler sonography revealed arterial insufficiency in 17 patients (27.4%). Other urological findings were interpreted as coincidental. Our results indicate that urologic manifestations of Behçet's disease, and especially the possible adverse effects of colchicine administration on the reproductive potential of the treated patients should be carefully monitored.

Adult↗