Biomedical subjects
Publications and source records attributed to S Unal.
HLA B27 and other clinical findings were investigated in 18 Turkish patients with Reiter's syndrome (mean age 35.8 +/- 8.09). Male/female ratio was 2/1. All 18 patients were seronegative, 12 (66.6%) presenting with an asymmetrical oligoarticular arthritis. Radiological sacroiliitis and enthesopathy was found in 9 (50%) and 7 (45.6%) patients respectively. HLA B27 was present in 11 (61.1%) patients.
A total of 448 episodes of bacteremia due to gram-negative organisms observed during the 7-year period between 1983 and 1989 at Hacettepe University Hospitals were studied for evaluating the factors influencing the prognosis. The overall mortality rate was 45.0%. The mortality rates were not significantly different in "rapidly fatal" and "ultimately fatal" disease groups (48.3% and 45.5%, respectively), whereas it was significantly less (34.8%) in the "nonfatal" disease group compared with the "rapidly fatal" category. There were great differences in the mortality rates among different diseases within the same disease category. Shock, multi-organ failure, source of infection, hospital service, appropriateness of antibiotic therapy, and place of acquisition of infection were found to affect prognosis significantly in multivariate analysis. In conclusion, the identification of prognostic factors is a further step for making necessary interventions in reducing the mortality rate associated with bacteremia due to gram-negative organisms. Underlying disease is still an important prognostic factor; however, a new approach is needed for classification of underlying diseases.
A polymerase chain reaction (PCR)-based test was developed for the detection of mecA in staphylococci. To facilitate this process, a rapid cell lysis procedure was established for the release of DNA from staphylococcal strains. Primers based on the DNA sequence of the mecA gene from Staphylococcus aureus were used in PCRs to screen for the presence of this gene in a total of 98 staphylococcal isolates. Fifty-one isolates were mecA positive (17 S. aureus strains and 34 coagulase-negative staphylococci including S. epidermidis, S. haemolyticus, and S. simulans). Results obtained with PCRs were generally consistent with those of standard microbiological assays. PCRs designed to detect the femA gene (factor essential for methicillin resistance) revealed the presence of the gene in all S. aureus strains examined regardless of the susceptibility profiles of the strains to methicillin. In contrast, femA could not be detected in coagulase-negative staphylococci by PCR with the same primers. Low-stringency hybridization suggested the presence of a gene structurally related to femA in S. epidermidis and other coagulase-negative staphylococci examined.
Prosthetic valve endocarditis caused by Pseudomonas aeruginosa is refractory to medical treatment alone and early valve replacement is necessary. We describe a 40-year-old patient in whom endocarditis developed in the early postoperative period, and reoperation was not considered feasible. Ciprofloxacin was administered orally in order to suppress bacteremia for 36 months. Long-term oral ciprofloxacin may provide an opportunity in the treatment of prosthetic valve endocarditis caused by Ps. aeruginosa in patients who are unfavorable candidates for reoperation.
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In this study the results of single-dose amoxicillin TMP-SMX, and ofloxacin therapy in ürinary tract infections have been presented. The study is held in Sağlik Sosyal Yardim Bakanliği - Hacettepe Universitesi Tip Fakültesi Cubuk Study Group Research and Training Hospital. The treatments were successful in 33% of 15 women treated with single-dose oral amoxicillin, in 60% of 15 women treated with 2 tablets DS single-dose TMP-SMX and 100% of 20 women treated with 400 mg oral single-dose ofloxacin.
This epidemiological Study is held in Sağlik Sosyal Yardim Bakanliği--Hacettepe Universitesi Tip Fakültesi Cubuk Research and Training area to find out the prevalence of urinary tract infections and to determine the antibiotic susceptibility of the causitive organisms. The prevalence of urinary tract infections in the area is 10%. E. coli is the most frequently isolated bacterium (40%). Amikacin, Cephotaxime, and Ofloxacine are the most effective antibiotics.
In this study we evaluated the susceptibility of 127 gram negative bacteria isolated from urine cultures, to TMP-SMX and Ofloxacin in vitro by disk diffusion technique. While 91 percent of bacteria were sensitive to Ofloxacin, only 50 percent were sensitive to TMP-SMX. This resistance to TMP-SMX is compared with similar results of other studies.
The relation between plasma trivalent chromium (Cr3+), glucose tolerance and insulin secretion was studied in healthy volunteers and in patients with juvenile- or adult-onset diabetes mellitus. Cr3+ levels before and during the oral glucose tolerance test were not significantly different in the three groups, whereas glucose tolerance and insulin secretion were impaired in the diabetics. Our results indicate that plasma Cr3+ behavior does not reflect impairment of glucose tolerance and insulin secretion in diabetes mellitus.
Transplantation of donor-derived stem cells can improve organ allograft survival in animal models. This study was designed to investigate the effect of different routes of bone marrow cell (BMC) transplantation on donor-specific tolerance induction across MHC barrier under short-term CsA monotherapy and alphabetaTCR/CsA treatment protocols. Forty-eight BMC transplantations were performed between BN(RT1(n)) donors and LEW(RT1(1)) recipients. Intraosseous and intravenous BMC transplantation was studied in six groups of eight animals each receiving 35 x 10(6) (n = 4) and 70 x 10(6) (n = 4) bone marrow cells. Groups I and II (controls) received BMC transplantation but no treatment, groups III and IV CsA monotherapy, and groups V, VI alphabetaTCR/CsA protocol for 7 days. Flow cytometry monitored immunodepletion and donor-specific chimerism for MHC class I RT1(n)/CD4, RT1(n)/CD8 and RT1(n)/CD45RA antigens. All animals survived without graft-versus-host disease. At day 63 under CsA monotherapy a low level of chimerism for RT1(n)/CD4 was induced after intraosseous (1.9%) and intravenous (0.8%) transplantation of (70 x 10(6)) BMC. Under alphabetaTCR/CsA protocol chimerism for RT1(n)/CD4 revealed 6.5% and 0.9% in intraosseous and intravenous (70 x 10(6)) BMC transplantation, respectively. The total number of chimerism in intraosseous and intravenous (70 x 10(6)) BMC transplantation groups was 9.9% and 3.4%, respectively. Following intraosseous BMC transplantation under alphabetaTCR/CsA protocol chimerism was 50% higher in a group receiving 70 x 10(6) (9.9%) vs 35 x 10(6) (4.9%) BMC. Intraosseous transplantation of donor BMC under alphabetaTCR/CsA protocol was 75% more efficient in induction of donor-specific chimerism compared to intravenous transplantation.
This study was conducted to evaluate and compare the total antioxidant capacity among fertile and infertile men. Thirty infertile patients and 20 fertility-proven healthy donors with normal sperm analysis were included in the study. Total antioxidant capacity, zinc and fructose levels of seminal plasma, and various sperm parameters were compared among fertile controls and idiopathic infertility patients prospectively. The mean antioxidant capacity of fertile controls (2.02 +/- 0.16 mmol/L) was significantly higher than that of the infertile patients group (1.78 +/- 0.23 mmol/L) (p < .01). Furthermore, asthenozoospermic and asthenoteratozoospermic groups had significantly lower mean antioxidant values (1.73 +/- 0.11 and 1.64 +/- 0.13, respectively) when compared to fertile control group (p < .01). The mean fructose level was significantly lower in the fertile control group and mean zinc level was significantly lower in the entire infertile group. On the other hand, antioxidant capacity is positively correlated to sperm motility (p = .001). Decreased antioxidant capacity was associated with impaired sperm function as a result of either increased ROS production or insufficient antioxidant capacity.
This study represents the clinical and laboratory features of 135 tuberculous peritonitis cases in whom peritoneoscopic investigation was used routinely. Disease was more common in women than men (1.5:1) and was most frequently encountered in the third and fourth decades in life. The most common presenting symptoms were abdominal distension (96%), abdominal pain (82%), weight loss (80%), weakness (76%), loss of appetite (73%) and fever (69%). The most common physical findings were ascites (96%), fever (75%) and abdominal tenderness (43%). One hundred and twenty-nine cases (95.5%) showed exudative type tuberculous peritonitis with variable amounts of ascites and filmy adhesions. In six patients (4.5%) the disease was of the plastic (dry) type. Peritoneoscopic investigations of 139 patients suggested tuberculous peritonitis but four cases showed histologically proven malignancy (3%). Laparoscopic diagnoses of the remaining cases were confirmed by histology (97%). The laparoscopic appearance of scattered yellowish-white nodules, approximately 1-5 mm in size, on the peritoneal surfaces, and filmy adhesions were suggestive of tuberculous peritonitis. A non-fatal colon perforation occurred as a major complication. After antituberculous therapy patients were followed for at least 1 year. Peritoneoscopy with simultaneous biopsy is the ideal and most accurate diagnostic modality in the diagnosis of tuberculous peritonitis.
PURPOSE: The purpose of this paper is to demonstrate a case of bilateral complete avulsion of the globes following maxillofacial trauma. METHODS: A 23-year-old man with bilateral complete globe avulsion following a maxillofacial trauma. Both globes were luxated out of the orbit and suspended on the skin of the upper lid below the brows. No direct or indirect light reflexes or any eye movements could be noted. Computerized tomography showed complete lacerations of both optic nerves at a level just anterior to the optic canal. There were also multiple fractures corresponding to Le Fort III fracture with Le Fort II components. The brain parenchyma was normal with an exception of brain edema. As the globes were unsuitable for repositioning, both were enucleated. The maxillofacial fractures were immobilized with plates and screws. Although the patient gained consciousness with normal vital signs in the early postoperative period, he died on the ninth day due to Pseudomonas aeruginosa infection, despite invasive antibiotic treatment. DISCUSSION: The optic nerve and the globes are very resistant to mild and moderate trauma. The avulsion of the nerve at the canalicular or more posterior level may demonstrate central nervous system complications resulting in life-threatening conditions. The most critical issue in complete globe avulsions with a transected optic nerve is to rescue the vision. In total transected optic nerves the final eyes could only have had cosmetic benefits. In spite of promising experimental research on optic nerve regeneration, there are unknowns, such as the methods to eliminate the risk of anterior segment ischemia and phthisis bulbi. CONCLUSIONS: Globe avulsions with a complete optic nerve cut remain a challenging problem. More research is required to better understand the pathophysiology of optic nerve repair.
Levosimendan is a calcium sensitizer that demonstrates enhanced myocardial contractility. There is little information concerning the effect of levosimendan on left ventricular tissue parameters and exercise capacity. We evaluated the effects of a 24-h course of levosimendan therapy on cardiac tissue parameters in 30 patients, aged 48 - 70 years, admitted to our hospital for the management of decompensated heart failure. All patients underwent echocardiographic examination using tissue Doppler imaging (TDI) and a 6-min walk test. Systolic myocardial velocity of the mitral annulus (Sm) was significantly increased in levosimendan-treated patients compared with placebo-treated patients. There was a positive correlation between Sm and exercise capacity. Levosimendan might be expected to increase cardiac contractile force, especially Sm velocity, in parallel with exercise tolerance. The study has also shown that the progress of ventricular function after levosimendan treatment in patients with exercise intolerance could be monitored effectively by Sm velocity measurements using TDI.
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BACKGROUND/AIMS: Primary achalasia is a premalignant disorder of the esophagus. The studies for esophageal cancer pathogenesis may reveal early diagnosis of esophageal cancer. DNA aneuploidy, p53 mutations and cellular proliferation are important factors in cancer development. As far as we know, we have not encountered any study on these factors in achalasia. METHODOLOGY: We studied DNA ploidy by flow cytometry and p53 and PCNA index by immunohistochemical technique and studied histopathology in the esophageal mucosa of primary achalasia and control patients. RESULTS: DNA analysis revealed aneuploidy in 2 of 20 achalasia patients but none of the 18 control patients. Sixty-five percent of achalasia and 22% of normal patients showed p53 positivity (P < 0.05). We have found normal mucosa, basal cell hyperplasia-esophagitis and dysplasia in 13, 22 and 3 patients and p53 positivity in 2, 12 and 3 of these patients, respectively (P < 0.05). PCNA labeling indexes (as % +/- SD) were 34.8 +/- 12.2, and 28.4 +/- 9.3 in achalasia and control groups, respectively (P > 0.05). PCNA labeling index was 28.0 +/- 8.2 in p53(-) and 36.0 +/- 12.9 in p53(+) patients (P < 0.05). PCNA indexes were found 29.3 +/- 9.6 in normal histopathologic group, 31.8 +/- 13.4 in basal cell hyperplasia-esophagitis, and 41.7 +/- 6.5 in dysplasia group (P > 0.05). CONCLUSIONS: DNA aneuploidy, p53 positivity, and higher cellular proliferation index may have important role in the pathogenesis of esophageal cancer in primary achalasia.
Dystrophic epidermolysis bullosa is an inherited disorder with frequent oesophageal stricture formation. There is no satisfactory medical treatment of dysphagia however; endoluminal balloon dilation is a novel method with satisfactory results. Intrafamilial cases of dystrophic epidermolysis bullosa manifest variable clinical presentations. We report two sisters with dystrophic epidermolysis bullosa simultaneously presenting with dysphagia. Fluoroscopically guided endoscopic balloon dilation revealed almost complete resolution of dysphagia in both patients. Our cases represented a striking similarity in their clinical picture and response to treatment. Balloon dilation in these cases is a safe and effective approach.
Endoscopic biliary drainage is an effective and harmless method for biliary obstructions of malign origin. Percutaneous biliary external drainage (PBED) could be attempted if endoscopic drainage is unsuccessful. The percutaneous route has some unwanted effect. We have PBED into internal endoprotheses in 8 malign patients successfully without any complications.