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S Kiraz

Publications and source records attributed to S Kiraz.

36 records · Page 2Linked to original sources
PubMed1996

Megakaryocyte-related interleukins in reactive thrombocytosis versus autonomous thrombocythemia.

The primary thrombocytosis (thrombocythemia) associated with myeloproliferative disorders is believed to be due to autonomous platelet production. Secondary or reactive thrombocytosis can be observed in a number of clinical circumstances, and may be related to persistent overproduction of some thrombocytopoietic factors acting on megakaryocytes. Several cytokines, including IL-6, IL-1 and IL-4 have been shown to act alone or in concert, to affect various cellular stages of megakaryocytopoiesis in humans. The aim of this study is to assess the serum concentrations of these cytokines in myeloproliferative disorders (MPD) with thrombocythemia and in rheumatoid arthritis (RA) with marked reactive thrombocytosis. Twenty-two patients (14 men, 8 women) with MPD and thrombocythemia (platelet counts > 500 x 10(9)/1; range 507-996 x 10(9)/1), 33 RA patients (28 women, 5 men) with marked thrombocytosis (platelet counts > 500 x 10(9)/1; range 500-745 x 10(9)/ 1), 27 RA patients (24 women, 3 men) with normal platelet counts (range 168-399 x 10(9)/1) and 15 healthy volunteers (8 women, 7 men) with normal platelet counts (range 161-385 x 10(9)/1) enrolled in the study. Serum IL-1 alpha, IL-1 beta, IL-4 and IL-6 concentrations were measured in these four groups. Of the 22 patients with MPD, 10 had chronic myelogenous leukemia, 5 had polycythemia vera, 6 had essential thrombocytosis and 1 had osteomyelofibrosis. Serum interleukin concentrations in patients with MPD and thrombocythemia were either suppressed or similar to those of normal subjects, whereas IL-6, IL-1 beta and IL-4 levels were increased in RA patients with reactive thrombocytosis. We conclude that thrombocythemia associated with MPD is an autonomous phenomenon, and is not regulated by cytokines which affect megakaryocytopoiesis.

Adolescent↗
PubMed1996

Effect of prophylactic benzathine penicillin on mucocutaneous symptoms of Behçet's disease.

BACKGROUND: Recent studies point out a probable role of streptococcal antigens in the pathogenesis of Behçet's disease (BD). This has led to the proposal of benzathine penicillin as a therapeutic modality in BD. OBJECTIVE: A prospective study was conducted to compare the efficacy of colchicine and colchicine + benzathine penicillin treatments on mucocutaneous manifestations of BD. METHODS: 60 patients (group I) were given colchicine alone and 94 (group II) were given colchicine + benzathine penicillin. Frequency, number, duration and severity of oral aphthous ulcers, genital ulcers and erythema nodosum were determined before and after treatment. RESULTS: In group I, all parameters of oral ulcers and the frequency and healing time of genital ulcers and erythema nodosum decreased significantly. In group II, all parameters of oral aphthous ulcers, genital ulcers and erythema nodosum were significantly improved. When treatment results in the two groups were compared, the decrements in the frequency and duration of oral ulcers and erythema nodosum and the frequency of genital ulcers were significantly greater in group II than in group I (p < 0.05). CONCLUSION: We conclude that prophylactic benzathine penicillin combined with colchicine is more effective in controlling mucocutaneous manifestations of BD than colchicine alone.

Adult↗
PubMed1996

Ifosfamide, mesna and epirubicin as second-line chemotherapy in advanced breast cancer.

The ifosfamide, mesna and epirubicin (IMEpi) combination is administered to 16 patients having advanced metastatic breast carcinoma as second-line chemotherapy. We observed complete response in 6%, partial response in 44% (total overall response rate of 50%), stable disease in 12% and progressive disease in the remaining 38% of the patients. The median remission duration in responders was calculated to be 9.6 months. IMEpi regimen had a tolerable toxicity profile including alopecia, nausea and vomiting, microscopic hematuria, leukopenia and neurotoxicity in which serious complications necessitating discontinuation of the chemotherapy were not encountered. It might be concluded that IMEpi chemotherapy combination is an effective alternative among schedules in the management of patients with stage IV breast carcinoma without serious side effects.

Adult↗
PubMed1992

Familial Behçet's disease.

OBJECTIVES: To highlight the frequency, clinical features and histocompatibility antigen types of the familial form of Behçet's disease. METHODS: Twenty-seven cases with familial Behçet's disease in 12 families were evaluated according to clinical features, sites of involvement, HLA-A and HLA-B typing. A review of the literature is presented. RESULTS: The frequency of familial form of Behçet's disease was found to be 8.7% among 137 patients studied. Vascular involvement was 7.4% (2/27) in the familial group while it was 28.8% (36/125) in patients without the familial form of the disease (p < 0.01). HLA-B51(5) and HLA-A2 were positive in 68% and 75% in 16 familial cases studied, respectively. CONCLUSIONS: Familial Behçet's disease, which constitutes a small group of patients with Behçet's disease, may represent a clinically heterogeneous subtype of this entity. Although lower frequency of vascular complications was observed in this study, it is not possible to indicate the precise frequency of vascular and ocular complications of the familial form of Behçet's disease. The frequencies of HLA-A2 and HLA-B51(5) positivity are higher than the previously reported non-Behçet's controls from Turkey.

Adolescent↗
PubMed1992

Vascular involvement in Behçet's disease.

Behçet's disease (BD) is a multisystem disorder characterized by recurrent oral and genital ulcerations with uveitis. At onset it may present with manifestations of vascular involvement instead of the classical triad. We analyzed 137 patients with BD and 38 had vascular involvement with a prevalence of 27.7%. Male to female ratio was 4.4 and associations of positive pathergy test (76.3%) and eye lesions (57.8%) were higher compared to patients without vascular involvement. Patients with subcutaneous thrombophlebitis were more likely to develop major venous occlusions (22.2%) in the lower extremities and inferior vena cava. Arterial lesions were less frequent features constituting 12.0% of vascular complications in BD.

Adult↗
PubMedDate not supplied

Ifosfamide and etoposide in previously treated patients with advanced breast cancer.

AIMS AND BACKGROUND: Ifosfamide is an active alkylating agent in the treatment of breast cancer, as a first-line therapy and in advanced disease. Since the combination of etoposide with an alkylating agent produces a synergistic and tolerable activity in various malignancies, in the present study, ifosfamide and etoposide were administered to patients with advanced breast cancer to evaluate the response characteristics and the toxicity profile. STUDY DESIGN: The combination of ifosfamide, mesna and etoposide was prospectively administered to 41 previously treated patients with stage IV breast carcinoma. The treatment schedule consisted of ifosfamide, 1500 mg/m2, infused over 24 hrs with 1500 mg/m2 mesna on days 1 to 5 and 120 mg/m2 etoposide, infused over 1 hr on days 1 to 3, to be repeated every 4th week. RESULTS: After a median follow-up of 10 months, an objective response rate of 23% (overall 2.5% complete remission and 20.5% partial remission) and a median response duration of 5.3 months were obtained in 39 assessable patients. The non-responder group consisted of 28.3% stable disease and 48.7% progressive disease. The prior status of chemotherapy was the only significant prognostic factor with an impact on the response rate. The overall toxicity was generally mild, with grade 3 myelotoxicity encountered in 25.7% of patients. CONCLUSIONS: The tolerable side effect profile of the ifosfamide and etoposide combination might be advantageous as regards the quality of life. To improve the rate and/or the duration of response and to clarify the precise role of the ifosfamide-etoposide combination in previously treated advanced breast cancer, further trials are warranted.

Adult↗
PubMedDate not supplied

Frequency of lymphadenopathy in rheumatoid arthritis and systemic lupus erythematosus.

This study aimed to assess the frequency of all palpable lymph nodes during active disease and remission in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Hospital records of 100 SLE patients, 100 RA patients, 100 spondyloarthropathy patients, and 150 osteoarthritis patients, treated in our rheumatology department, were evaluated retrospectively. Overall frequencies of enlarged lymph nodes in patients with active RA and SLE were 82% and 69%, respectively. Enlarged lymph nodes associated with RA were mostly located in the axillary region, and in SLE the nodes were smaller and lymphadenopathy was more generalized compared with RA. Palpable lymph nodes disappeared in the majority of patients during remission. Lymphadenopathy was significantly less frequent in patients treated with steroids before admission. Lymph node enlargement is an important physical finding associated with RA and SLE disease activity. Atypical locations and unusually large lymph nodes should raise clinical suspicion of another underlying disease.

Adult↗
PubMedDate not supplied

Combination therapy versus monotherapy for the treatment of patients with rheumatoid arthritis.

OBJECTIVE: The response to single disease modifying antirheumatic drug (DMARD) is often suboptimal in patients with rheumatoid arthritis (RA). Thus, despite the limited data on the therapeutic efficacy of combination therapies, many patients are currently treated with a combination of DMARDs. METHODS: We studied prospectively the efficacy of combination therapy with DMARDs. The study was designed as a randomized trial and a single DMARD or two or three DMARD combinations were administered to 180 consecutive, age- and sex-matched patients with active RA, each of whom was followed up for a period of 2 years under treatment. Patients were divided into 3 groups which did not differ with regard to demographic, clinical and laboratory parameters. Patients in group I were treated with a single DMARD [methotrexate (MTX) 7.5-15 mg/week or sulfasalazine (SSZ) 1-2 g/day or hydroxychloroquine (HCQ) 200 mg/day], group II with MTX + SSZ or MTX + HCQ, and group III with a combination of all three drugs. Patients were re-evaluated at regular intervals by means of clinical and biochemical tests designed to detect specific rheumatic activity. Radiological assessments were also performed and scored according to Larsen by the same radiologist who was blinded to the treatment groups. RESULTS: At the end of the trial there were significant improvements in the clinical and laboratory parameters in all 3 groups. However, improvements were greater and much more significant in the patients who were given combination therapies. The combination of MTX + SSZ + HCQ was more effective than both monotherapy and the two-drug combinations. CONCLUSION: In conclusion, we suggest that patients with RA should be treated with combinations of DMARDs.

Antirheumatic Agents↗
PubMedDate not supplied

Interactions of nitric oxide and superoxide dismutase in Behçet's disease.

OBJECTIVE: Nitric oxide (NO) is produced in increased amounts in inflammatory conditions and may cause tissue injury by reacting with superoxide to yield peroxynitrite, a powerful toxin. Superoxide dismutase (SOD) scavenges superoxide and inhibits the formation of peroxynitrite, thereby suppressing the resulting injury and regulating the bioavailability of NO. We conducted a study to assess serum NO and SOD in patients with Behçet's disease (BD) and correlate their levels with disease activity. METHODS: Serum NO concentrations and SOD activities were determined in 25 BD patients (mean age: 36 years; male/female: 13/12) and in 15 healthy controls. BD patients were allocated into two groups according to disease activity (active/inactive: 11/14). RESULTS: In patients with active disease, NO levels were found to be significantly elevated, while SOD activities were comparable to the control group. Conversely, patients with inactive disease exhibited markedly high SOD activities and normal NO levels. Moreover, there was a positive correlation between SOD activity and NO levels in patients with inactive BD (r = 0.562, p < 0.05). CONCLUSION: We propose that NO-associated injury of tissues, particularly the endothelium, may be important in the etiopathogenesis of vasculitis in BD, and SOD may play a protective role against inflammation.

Adolescent↗
PubMedDate not supplied

Synovial fluid cytokine levels in Behçet's disease.

OBJECTIVE: To investigate the synovial fluid levels of interleukin-1 beta (IL-1 beta), tumour necrosis factor-alpha (TNF-alpha), transforming growth factor-beta (TGF-beta), IL-1 receptor antagonist (IL-1ra), soluble IL-2 receptor (sIL-2r) and IL-8 in patients with Behçet's disease (BD) and to compare them to levels in rheumatoid arthritis (RA), and osteoarthritis (OA). METHODS: The cytokine levels of BD (n = 14), RA (n = 15) and OA (n = 15) patients were assessed by enzyme-linked immunosorbent method. RESULTS: Median synovial IL-1 beta and TNF-alpha levels were higher in RA compared to BD and OA patients. IL-1 beta levels were also higher in BD than OA whereas TNF levels were similar in these two groups. IL-1ra and TGF-beta activity in BD were higher than OA but lower than RA. sIL-2r and IL-8 levels were increased in BD and RA in comparison to OA patients. CONCLUSION: The arthritis of BD is non-erosive and accordingly, its synovial fluid contains lower levels of cytokines primarily involved in cartilage destruction, namely IL-1 beta and TNF-alpha, than RA. IL-1ra and TGF might serve as protective factors against erosion in the inflamed joints. High synovial fluid levels of sIL-2r and IL-8 probably reflect a non-specific inflammatory process.

Adult↗
PubMedDate not supplied

The contribution of underlying systemic rheumatic diseases to the mortality in patients admitted for intensive care: a matched cohort study.

OBJECTIVE: The aim of this study was to determine the outcome of patients with systemic rheumatic diseases admitted to our medical-intensive care unit (ICU) in comparison to the outcome of patients with non-rheumatic diseases in the same ICU. METHODS: The hospital files of 50 patients with systemic rheumatic diseases who were treated in the medical-ICU of Hacettepe University Hospital, Ankara between 1995 and 2001 were retrospectively evaluated. 50 patients without any underlying systemic rheumatic diseases admitted to the medical-ICU in the same time period and matched for age, gender and acute physiology and chronic health evaluation scores were included in the control group. ICU outcome was compared between the two groups. RESULTS: The acute physiology score of the study group was lower than that of the control group (13.4 +/- 5.7 [SD] vs. 17.3 +/- 7.2, p = 0.04). Moreover, the study group received more immunosuppressive treatment but less invasive procedures (i.e. mechanical ventilation and central venous catheterization). Mortality rates (56% vs. 54%, respectively, p = 0.5), lengths of stay in the ICU and in the hospital, the infection rates were similar between the rheumatic disease group and the control group. CONCLUSION: The presence of a systemic rheumatic disease seems to negatively affect the outcome in patients under intensive care.

Cause of Death↗
PubMedDate not supplied

The efficacy of continuous interferon alpha administration as an adjunctive agent to colchicine-resistant familial Mediterranean fever patients.

OBJECTIVE: About 10-20% of familial Mediterranean fever (FMF) patients are resistant to regular colchicine treatment and have painful recurrent attacks due to polyserositis. In clinical practice there is no alternative drug for such patients. In a previous pilot study on a small number of colchicine-resistant patients, interferon-alpha (IFN-alpha) was administered when painful attacks were about to occur. METHODS: In this study we gave IFN-alpha continuously to 8 colchicine-resistant FMF patients in a schedule while the colchicine therapy had been continued. All those patients were complicated with vasculitis or arthritis or together during the FMF course. Those complications were treated with the other immunosuppressive drugs. While they were under intense immunosuppressive therapy, the abdominal and the other serosal attacks remained to continue. RESULTS: After the administration of IFN-alpha therapy only one out of eight patients had abdominal painful attacks in twice, and one patient had arthritis in knees and ankles, the others responded well. Observed side effects were generally mild and acceptable. CONCLUSION: Continuous IFN administration in addition to the regular colchicine treatment may be useful for the colchicine-resistant attacks in FMF patients.

Adjuvants, Immunologic↗
PubMedDate not supplied

Serum interleukin 17 and interleukin 18 levels in familial Mediterranean fever.

OBJECTIVE: Familial Mediterranean fever (FMF) attacks are characterized by serosal inflammation rich in PMNL leukocytes and activation of a definite cytokine network. Moreover, there is sustained inflammation in attack-free FMF patients. Interleukin (IL)-17 and IL-18 are recently described proinflammatory cytokines, which can modulate certain neutrophil functions. In this study we measured serum levels of IL-17 and IL-18 in FMF patients. METHODS: The study groups comprised of 18 FMF patients in attack-free period (mean age: 30.2 +/- 9.5 years; male/female: 10/8), and 18 patients with an acute FMF attack (mean age: 25.4 +/- 4.9 years; male/female: 10/8). Twenty age-matched healthy subjects were included as a control group (male/female: 10/10). Levels of IL-17 and IL-18 were determined by commercial ELISA kits (Biosource International, USA). RESULTS: Serum IL-17 levels were 42.8 +/- 3.7, 42.7 +/- 3.2, and 39.9 +/- 2.3 pg/mL for FMF patients in attack-free period, FMF patients with acute attack, and healthy controls, respectively. Serum IL-18 levels were 878.8 +/- 315.0, 854.2 +/- 261.4, and 314.6 +/- 80.8 pg/mL for FMF patients in an attack-free period, FMF patients with acute attack, and healthy controls, respectively. Levels of both IL-17 and IL-18 were significantly higher in FMF patients with and without acute attack compared to control group (p < 0.05). Concentrations of those cytokines were comparable in FMF patients with acute attack and in attack-free period (p > 0.05). CONCLUSION: Our data suggest that IL-17 and IL-18 contribute to the cytokine network in the inflammatory cascade of FMF. However, their roles for the initiation of FMF attacks remain to be established.

Acute Disease↗
PubMedDate not supplied

Extra-articular manifestations of rheumatoid arthritis: results of a university hospital of 526 patients in Turkey.

OBJECTIVE: Presence of extra-articular manifestations (EAM) in rheumatoid arthritis (RA) is associated with more severe disease and increased mortality. Prevalence of EAM may vary in different geographic areas and in different ethnic populations. In this study we investigated the frequency of EAM in 526 RA patients from a single university hospital in Turkey. METHODS: The hospital records of patients who had been diagnosed as RA in Hacettepe University Department of Rheumatology between the years 1988 and 2003 were retrospectively evaluated. There were 73 males and 453 females, and mean age of the patients was 48.0 +/- 12.3 years. The mean follow-up period was 4.8 +/- 4.1 years. Three hundred and fifty-nine patients were rheumatoid factor (RF) positive (68.3%). RESULTS: The overall frequency of EAM was 38.4% (202 patients). The most common EAM was rheumatoid nodules (18.1%). Sicca symptoms, pulmonary findings, Raynaud's phenomenon, livedo reticularis, carpal tunnel syndrome, vasculitis, amyloidosis, and Felty syndrome were present in 11.4%, 4.8%, 3%, 4.8%, 2.8%, 1.3%, 1.1%, and 0.3% of the patients, respectively. Overall EAM and rheumatoid nodules were significantly more common in RF positive patients than RF negative patients. The frequency of rheumatoid nodules was significantly higher in males than in females. CONCLUSION: The prevalence of EAM in Turkey is higher than East Asia and Africa, and lower than UK and North America. Excluding secondary Sjögren's syndrome, our results are similar to other Mediterranean populations like Italy.

Adolescent↗
PubMedDate not supplied

Circulating thrombomodulin levels in familial Mediterranean fever.

Increments in circulating thrombomodulin levels reflect endothelial cell injury. Thrombomodulin can also be synthesized by several inflammatory cells including monocytes, neutrophils, and thrombomodulin itself can modulate the inflammatory response. In this study, we assessed circulating thrombomodulin concentrations in patients with familial Mediterranean fever (FMF). Twenty-five patients with FMF (F/M: 14/11) (mean age: 31.1 +/- 9.7 years) and 25 healthy controls (F/M: 13/12) (mean age: 34.6 +/- 7.0 years) were involved in the study. Thrombomodulin levels were measured by commercially available enzyme-linked immunosorbant assay (ELISA) (Immunoassay of thrombomodulin Diagnostica Stago, Asnieres-Sur-Seine, France). Twenty of the patients were in attack-free period and the remaining five had been during acute FMF attacks. Thrombomodulin levels were higher in the study group (20.9 +/- 12.1 ng/ml) than healthy controls (14.1 +/- 8.4 ng/ml) (p < 0.05). Circulating thrombomodulin levels were also higher in attack-free FMF patients (22.4 +/- 12.9 ng/ml) than controls. This study disclosed for the first time significantly higher increments in the circulating levels of thrombomodulin in FMF. This observation could be a consequence of injured endothelium and/or activated inflammatory cells.

Adult↗
PubMedDate not supplied

Parvovirus B19 infection in Behçet's disease.

OBJECTIVE: To investigate whether parvovirus B19 infection is associated with Behçet's disease (BD). METHODS: Serum samples from 41 patients with BD and from 40 age- and sex-matched controls were studied. An ELISA assay was used to detect antibodies against parvovirus B19. RESULTS: Six patients with BD (15.7%) had anti-B19 IgM antibodies in their serum samples indicating a recent infection, while no positivity for IgM antibodies was detected in the control group (p = 0.03). CONCLUSION: Although there have been several reports of B19 infection associated with vasculitis, our findings do not strongly support the involvement of B19 in the pathogenesis of BD. The serological evidence of acute infection in 6 BD patients may be purely coincidental. There was also no positive correlation with the articular and vascular manifestations of BD.

Adult↗
PubMedDate not supplied

Effects of colchicine on inflammatory cytokines and selectins in familial Mediterranean fever.

OBJECTIVE: To evaluate whether basal levels of circulating cytokines and selectins exhibit a distinct profile in attack-free, non-colchicine taking familial Mediterranean fever (FMF) patients compared to normal healthy controls, and to determine the effect of colchicine treatment on these parameters. METHODS: Serum levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-alpha, and soluble P-, E-, and L-selectin in attack-free, asymptomatic, non-colchicine using FMF patients (n = 11) and in normal controls (n = 10) were studied. Following 2 months of colchicine treatment the same parameters were evaluated again in the FMF patients. RESULTS: Before colchicine treatment the serum levels of all parameters except soluble P-selectin were significantly higher in FMF patients than in controls. After two months of treatment statistically significant decreases were observed in these parameters (p < 0.05). CONCLUSION: A distinct profile of IL-6, IL-8, TNF-alpha, and soluble E- and L-selectin levels was observed in FMF patients, which could reflect the presence of sustained inflammation in attack-free FMF patients. The effect of colchicine on these parameters suggests its therapeutic potential.

Adult↗