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Patients with end stage renal disease have a higher risk of mortality compared with the general population. The aim of the present study was to determine the value of neutrophil to lymphocyte ratio (NLR) in predicting mortality in hemodialysis patients. Fifty nine patients undergoing hemodialysis in our institution between January 2011 to June 2012 were analyzed. Baseline NLR, patient demographic, clinical, and biochemical parameters were obtained. The baseline median NLR value was 3.48. Patients were divided into two groups: Those with a NLR less than 3.48, and those greater than 3.48. The high NLR group had overall lower serum albumin levels (p=0.009) and higher C reactive protein levels (p=0.03). Seven (11.9%) patients died, and all were in the high NLR group (p=0.01). Hemodialysis patients with high NLR levels have increased risk of short term mortality. © 2013 OMU.

OBJECTIVE: Recently, despite the developments in diagnosis and treatment of diseases, herbal product use in patients with chronic diseases has become more frequent. The aim of our study was to investigate the frequency of herbal medicine use in patients with chronic kidney disease (CKD), used products, source of information, whether they were giving information to their clinicians about this subject and cost of used products. MATERIAL and METHODS: The investigation has been performed with 100 CKD patients. A questionnaire form has been used in collecting data about the patients. RESULTS: The herbal use rate in our study was 37%. The most used herbal products were ready products and stinging nettle. There was no relation between herbal product use and age, gender, educatin level, marital status (p>0.05). 87% of the patients indicated that monthly cost of the product was lower than 50 Turkish Liras. 78.4% of the patients defined that they didn't give information to their clinicians about the herbal product they used. CONCLUSION: A significant part of the patients with CKD use herbal products and do not give information to the clinicians about this subject. The physicians following the patients with CKD should examine the use of herbal products.

Despite recent developments in diagnosis and treatment of diseases, individuals with chronic disease use herbal products much more than others. Our study aims to examine the rates of herbal product use, the kinds of used products, source of information, whether the doctors are being informed and cost of the products used in patients with hypertension in our region. The study has been performed with 100 hypertension patients referred to our outpatient clinic. A questionnaire consisted of 9 questions has been used to gather the data about the patients. In our study, the herbal product use in hypertension patients was 53% . The most frequently used herbal products were lemon and garlic. Majority of the patients (83%) reported the source of information about the product as neighbours, relatives, friends or television and radio. While 28% of the patients were using the herbal product regularly everyday, 34% of them were only using these products if their blood pressure increased. Fourty six (87%) patients used these products did not give information to the clinician about the product. Eighty seven per cent of the patients told that the monthly cost of the product they used was less than 50 TL. A significant proportion of the patients with hypertension uses herbal product and they do not give information to the clinicians about the subject. The use of these kind of products without knowing the effects and side-effects may cause undesirable results. © 2012 OMU.

The Changes of Auditory Event-Related Potentials in the Uremic Patients Under Hemodialysis TreatmentWe have searched Ihe cognitive functions of chronic uremic patients under hemodialysis treatment by using event-related potential (P.300) recordings. The tests have been applied to he patients before and after hemodialysis reatment. P300 event-related potentials have been recorded according to oddball paradigm by using audiory stimulus. The tests of mini mental status have been applied as a neuropsychologic tests to evaluate cognitive functions. There was a significant correlation between the scores of mini mental status and the latencies of P300 wave both before and after hemodialysis treatment. The prolongations of P3()() wave latencies recorded in the period of pretreatment have been turned in the normal values in the period of posttreatment in the most of patients. These data have showed that event-related potential recording was a useful test in the evaluation of cognitive functions of ihe patients followed by the diagnosis of chronic renal failure.^/ Hemodializ tedavisi gören 25 kronik üremik hasta ve 25 sağlıklı bireyden oluşan kontrol grubunun bilişsel işlevleri P300 olaya bağlı endojen uyarılmış potansiyel incelemesi ile araştırıldı. Çalışmanın amacı, nörolojik semptomu bulunmayan üremik hastalarda dializ. öncesi ve sonrası, bilişsel işlevlerdeki değişiklikleri objektif olarak değerlendirmektir. Hastalara dializ tedavisi öncesi ve sonrası test uygulandı. P300 potansiyelleri işitsel uyaran ile ve 'oddball paradigması' yöntemi ile kayıt edildi. Bilişsel fonksiyonları değerlendirmek için nöropsikolojik test olarak Mini Mental Test uygulandı. Hem dializ öncesinde ve hem de dializ sonrasında mini mental durum skorları ile P300 dalga latansları arasında önemli korelasyonlar vardı. Dializ tedavisinden önce P30n dalga latanslarında uzamalar' tedavi ile önemli oranda normal değerlere dönüyordu. Tüm bu veriler, kronik böbrek yetmezliği tanısı ile izlenen hastalarda bilişsel işlevlerin değerlendirilmesinde işitsel olaya bağlı endojen uyarılmış potansiyel incelemelerinin yararlı bir yöntem olduğunu göstermiştir.

The Value of Bone Marrow Biopsy in the Diagnosis of AmyloidosisBiopsy of the involved organ is required for the diagnosis of amyloidosis and most common used tissues for biopsy are rectum and kidney. Bone marrow biopsy is an alternative diagnostic procedure for the diagnosis of amyloidosis. The value of bone marrow biopsy for the diagnosis of amyloidosis is discussed in this report. Amyloid was positive in 9 of 15 (60%) bone marrow biopsy in patients with amyloidosis. Bone marrow biopsy should be used initially for the diagnosis of amyloidosis in the patients with renal failure and respiratory distress.Amiloidoz tanısı için doku biyopsisi gereklidir ve biyopside en sık tercih edilen dokular böbrek ve rektumdur. Kemik iliği biyopsisi amiloidoz tanısında alternatif tanı işlemlerinden birisidir. Bu yazıda kemik iliği biyopsisinin amiloidoz tanısmdaki değeri tartışılmıştır. 15 amiloidozlu hastanın 9 (%60) tanesinde kemik iliği biyopsisinde amiloid pozitif olarak saptanmıştır. Böbrek yetmezliği ve solunum sıkıntısı olan hastalarda amiloidoz tanısı için başlangıçta kemik iliği biyopsisi kullanılmalıdır.

Behcet's Disease and Vena Cava Superior SyndromeVascular lesions are common in Behcet's disease. A patient with Behcet's disease and vena cava superior syndrome is presented. Magnetic resonance imaging findings of the patient are discussed.Behçet hastalığında vasküler lezyonlar sıkür. Behçet hastalığı ve vena kava superior sendromu olan bir hasta sunulmuştur. Bu hastadaki manyetik rezonans görüntüleme bulguları tartışılmıştır.

l Seminal Vesicle Cysts in Adult Polycystic Kidney DiseaseAdult polycystic kidney disease is associated with cyst formation in kidney, liver, pancreas, esophagus, ovary, uterus and brain. We describe the seminal vesicle cysts in a patient with adult polycystic kidney disease on transabdominal and transrectal ultrasonography in this report and discuss the literature about this association.Erişkin tip polikistik böbrek hastalığı otozomal dominant geçişli herediter bir hastalık olup başta böbrekler olmak üzere pek çok organda kistlerle karekterizedir. Bu hastalığın bir komponenti olarak seminal vezikül kistleri çok nadirdir ve bugüne kadar az sayıda olgu bildirilmiştir. Klinik şikayeti olmayan ve ultrasonografi incelemesi sırasında sap¬tanan böyle bir olgunun klinik ve radyolojik bulgulan sunulmuş ve literatür gözden geçirilmiştir

/ Prevalance of Anti-HCV Among Hemodialysis and CAPD PatientsHCV infection is the most common cause of liver disease among dialysis patients. Patients with end stage renal disease are at risk of acquiring HCV infection from blood product transfusions, intravenous access or other patients in dialysis units. Continuous ambulatory peritoneal dialysis is getting popular among dialysis patients in our country. The aim of this study is to demonstrate anti-HCV frequency, liver enzyme levels and blood transfusion numbers among hemodialysis and CAPD patients. 41 hemodialysis patients (19 male, 22 female, mean age 36.6 years, mean hemodialysis duration 55.2 months) and 24 CAPD patients (7 male, 17 female, mean age 46.4 years, mean CAPD duration 10.0 months) were included to the study.This study shows the prevalence of anti-HCV and number of blood transfusion is lower in CAPD patients than in hemodialysis patients.Diyaliz hastalarındaki karaciğer hastalıklarının en sık sebebi HCV enfeksiyonudur. Son dönem böbrek yetmezlikli hastalar, kan transfüzyonu, intravenöz girişim ve diyalizdeki diğer hastalarla temas nedeniyle HCV enfeksiyonu riski altındadırlar. Günümüzde sürekli ayaktan periton diyalizi (SAPD), diyaliz hastalan arasında ülkemizde giderek yaygınlaşmaktadır.Bu çalışmanın amacı hemodiyaliz ve SAPD hastalarında Anti-HCV sıklığını, karaciğer enzim yüksekliklerini ve kan transfüzyon sayılarını karşılaştırmaktır. Çalışmaya 41 he-modiyaliz hastası (19 erkek, 22 kadın, ortalama yaş 36.6 yıl, ortalama hemodiyaliz süresi 55.2 ay) ve 24 SAPD hastası (7 erkek, 17 kadın, ortalama yaş 46.4 yıl, ortalama SAPD süresi 10.0 ay) alındı. Çalışma sonucunda HCV enfeksiyonu prevalansı ve transfüzyon sayılan, SAPD has¬talarında, hemodiyaliz hastalarına göre düşük bulundu.

Continuous Ambulatory Peritoneal Dialysis (CAPD) in our CentreContinuous ambulatory peritoneal dialysis (CAPD) therapy has begun in 1976 in the world and in 1981 in our country. It has been done in our centre since October 1995. In this report, we evaluated the results of CAPD patients followed up in Ondokuz Mayıs University, School of Medicine Department of Nephrology.Sürekli Ayaktan Periton Diyalizi (SAPD) tedavisi dünyada ilk kez 1976, ülkemizde ise 1981 yılında uygulanmıştır. Merkezimizde 1995 yılı Ekim ayından beri uygulanmaktadır. Bu yazıda Ondokuz Mayıs Üniversitesi Tıp Fakültesi Nefroloji Ünitesinde izlenen SAPD hastalarının sonuçları değerlendirilmiştir

Tuberculosis, Renal Failure and Amyloidosis in the Bone Marrow (Case Report)Tuberculosis is a worldwide and chronic disease. Amyloidosis is a systemic disease and it is a well known complication of tuberculosis. Biopsy of the involved organ is required for the diagnosis of amyloidosis and most common used tissues for biopsy are rectum and kidney. In this paper, a patient with renal failure, tuberculosis and amyloidosis, which was shown in the bone marrow is presented. Renal and rectal biopsy could not been performed to the patient because of bleeding tendency and respiratory distress. Bone marrow biopsy showed amyloidosis by Congo Red stain and immunohistochemical study using monoclonal antibodies against AA type amyloid fibrils revealed AA type amyloidosis. Bone marrow biopsy should be used initially for the diagnosis of amyloidosis in the patients with renal failure and respiratory distress.Tüberküloz tüm dünyada yaygın ve kronik bir hastalıktır. Amiloidoz sistemik bir has¬talıktır ve tüberkülozun iyi bilinen bir komplikasyonudur. Amiloidoz tanısı için doku bi¬yopsi gereklidir ve biyopside en sık tercih edilen dokular böbrek ve rektumdur. Bu yazıda kemik iliğinde amiloidoz gösterilmiş böbrek yetmezliği olan tüberkülozlu bir hasta su¬nulmuştur. Hastaya kanama eğilimi ve solunum sıkıntısı nedeni ile böbrek ve rektal bi¬yopsi yapılamamıştır. Kemik iliği biyopsisinde yapılan Kongo kırmızısı boyası ile ami¬loidoz tanısı konmuş ve monoklonal antikor kullanılarak yapılan immünohistokimyasal çalışmada AA tip amiloid fibrilleri gösterilmiştir. Böbrek yetmezliği ve solunum sıkıntısı olan hastalarda amiloidoz tanısı için başlangıçta kemik iliği biyopsisi kullanılmalıdır

Laparoscopic Adrenalectomy in Primary Aldosteronism: Case ReportPrimary hyperaldosteronism secondary to a left adrenal adenoma was diagnosed in a 59 year old woman. She underwent laparoscopic adrenalectomy by lateral transabdominal approach. MR, norcholesterol scintigraphy and selective venous sampling were successful in localizing the adenoma. As new instruments and techniques are developed, laparoscopic adrenalectomy with its present advantages, may become the gold standard in adrenal surgery.Sol adrenal adenoma sekonder primer hiperaldosteronizm (Conn Syndrome) tesbit edilen 59 yaşındaki kadın hastaya lateral transabdominal yaklaşımla laparoskopik ad-renalektomi yapılmıştır. Lokallzasyon çalışmasında MR, norkolesterol sintigrafisi ve selektif venöz örnekleme başarılı olmuştur. Yeni malzeme ve teknikler geliştiğinde la-paroskopik adrenalektomi, mevcut avantajlannın da katkısıyla, açık cerrahi girişimin yerini alabilir.

PREVALANCE OF ANTİ-HCV ANTIBODIES IN HEMODIALYSIS PATIENTS FROMHEMODIALYSIS CENTERS IN BLACKSEA REGION§/ Hepatitis C virus (HCV) infection has become an important source of morbidity in hemo¬dialysis patients during the last few years. In this multicenter study, we investigated the prevalance of HCV infection among hemodialysis patients as well as the possible correla¬tion between HCV posilivily and duration of hemodialysis therapy, elevated serum liver enzymes, and number of blood transfusions. 144 of 273 patients from 13 hemodialysis centers in Blacksea Region were HCV antibody positive, our data also showed a positive correlation between HCV seroposilivity and duration on hemodialysis therapy elevated serum liver enzymes and number of blood transfusionsSon yıllarda hepatit C virusuna (HCV) bağlı infeksiyonların hemodiyaliz merkezlerinde önemli bir morbidite kaynağı olarak gündeme geldiği bilinmektedir. Bu çalışmada Karadeniz Bölgesi'ndeki 13 hemodiyaliz merkezinde kronik hemodiyaliz programında olan 273 kronik böbrek yetmezlikli hastada, anti-HCV pozitifliği ve anti-HCV pozitifliği ile diya¬lize giriş süresi, kan transfüzyon sayısı ve serum alanin amino transferaz (ALT) düzeyleri arasındaki ilişki araştırıldı. 273 hastanın 144'ünde (%52.74) anti-HCV(+) idi. Sonuç olarak diyalize giren hastalarda anti-HCV pozitifliği ile diyalize giriş süresi, kan transfüzyon sayısı ve serum ALT yüksekliği arasında istatistiksel olarak anlamlı bir ilişki bulundu.

OBJECTIVE: To report the novel finding of a significant improvement in Raynaud's I phenomenon symptoms with clonazepam in a patient with systemic sclerosis.

OBJECTIVE: To report the novel finding of a significant improvement in Raynaud's phenomenon symptoms with clonazepam in a patient with systemic sclerosis. CASE SUMMARY: A 45-year-old female with limited scleroderma and chronic renal failure was admitted to our hospital due to hyponatremia (sodium 103 mEq/L). Her hyponatremia was treated by intravenous infusion of NaCl 3%. Clonazepam, which had been prescribed previously for anxiety and insomnia, was discontinued. Three weeks after she was discharged from the hospital, the patient presented with the complaint of increased severity of Raynaud's phenomenon and digital ulcers. She told us that her fingertip ulcers had been healed while she was taking clonazepam and that episodes of Raynaud's phenomenon had increased after discontinuation of the drug. Clonazepam 1 mg twice daily was restarted, and Raynaud's phenomenon and fingertip ulcers resolved within a month. On 2 occasions after that time, we discontinued clonazepam and replaced it with alprazolam, as the patient believed alprazolam was more beneficial in alleviating anxiety. Episodes of Raynaud's phenomenon and new digital ulcers recurred on both of these occasions, and clonazepam was restarted. At the time of writing, no severe episodes of Raynaud's phenomenon or fingertip ulcers have occurred with clonazepam treatment. DISCUSSION: Raynaud's phenomenon and recurrent digital ulcers are a manifestation of vascular disease in patients with systemic sclerosis and lead to pain, impaired function, and tissue loss. Few drugs have previously been shown to affect digital ulcers in the setting of scleroderma. Our patient experienced a significant and sustained improvement in Raynaud's phenomenon and digital ulcers following the initiation of clonazepam. To our knowledge, as of March 2007, this is the first reported use of clonazepam in Raynaud's phenomenon and digital ulcer. While its therapeutic mechanism remains unclear, clonazepam may offer some advantages compared with current agents. CONCLUSIONS: We report a case of Raynaud's phenomenon and digital ulcers responding to clonazepam. Further research is warranted to test the robustness of this preliminary finding.

Annual European Congress of Rheumatology (EULAR 2006) -- JUN 21-24, 2006 -- Amsterdam, NETHERLANDS WOS: 000249372502481 …

PubMed: 16736418 Background: Amyloidosis, mainly AA type, is one of the common diseases in nepbrology clinics in Turkey. AA type amyloidosis is a complication of various chronic infections or inflammatory diseases such as familial Mediterranean fever (FMF), rheumatoid arthritis (RA), tuberculosis and bronchiectasis. A controversy exists in the literature regarding the relationship between SAA1 genotypes and AA type amyloidosis. This study aimed to investigate SAA1 gene polymorphism in different patient groups: 1) amyloidosis, 2) FMF and 3) healthy controls. Methods: Eighty-two patients from the three groups were included in the study: 1) amyloidosis, 2) FMF without amyloidosis, and 3) healthy controls. SAA1 genotypes were studied by the polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. Results: The homozygous ?/? genotype is the most common SAA1 genotype among patient groups with amyloidosis, and the ?/? genotype frequency is significantly higher than in healthy controls (68 vs. 38%, p

PubMedID: 15643295 Familial Mediterranean fever (FMF) is an autosomal recessive disease that is prevalent among eastern Mediterranean populations, mainly non-Ashkenazi Jews, Armenians, Turks, and Arabs. Since a large proportion of all the FMF patients in the world live in Turkey, the Turkish FMF Study Group (FMF-TR) was founded to develop a patient registry database and analyze demographic, clinical, and genetic features. The cohort was composed of 2838 patients (mean age, 23.0 ± 13.33 yr; range, 2-87 yr), with a male:female ratio of 1.2:1. There was a mean period of 6.9 ± 7.65 years from disease onset to diagnosis; the period was about 2 years shorter for each decade since 1981. Ninety-four percent of patients were living in the central-western parts of the country; however, their familial origins (70% from the central-eastern and Black Sea regions) reflected not only the ongoing east to west migration, but also the historical roots of FMF in Turkey. Patients' clinical features included peritonitis (93.7%), fever (92.5%), arthritis (47.4%), pleuritis (31.2%), myalgia (39.6%), and erysipelas-like erythema (20.9%). Arthritis, arthralgia, myalgia, and erysipelas-like erythema were significantly more frequent (p < 0.001) among patients with disease onset before the age of 18 years. Genetic analysis of 1090 patients revealed that M694V was the most frequent mutation (51.4%), followed by M680I (14.4%) and V726A (8.6%). Patients with the M694V/M694V genotype were found to have an earlier age of onset and higher frequencies of arthritis and arthralgia compared with the other groups (both p < 0.001). In contrast to other reported studies, there was no correlation between amyloidosis and M694V homozygosity in this cohort. However, amyloidosis was still remarkably frequent in our patients (12.9%), and it was prevalent (27.8%) even among the 18 patients with a disease onset after age 40 years. Twenty-two patients (0.8%) had nonamyloid glomerular diseases. The high prevalence of vasculitides (0.9% for polyarteritis nodosa and 2.7% for Henoch-Schönlein purpura) and high frequency of pericarditis (1.4%) were striking findings in the cohort. Phenotype II cases (those patients with amyloidosis as the presenting or only manifestation of disease) were rare (0.3% or less). There was a high rate of a past diagnosis of acute rheumatic fever, which suggested a possible misdiagnosis in children with FMF presenting with recurrent arthritis. To our knowledge, this is the largest series of patients with FMF reported from 1 country. We describe the features of the disease in the Turkish population and show that amyloidosis is still a substantial problem.

PubMed: 15895905 [No abstract available]

WOS: 000229767300056 PubMed: 15947344 Study objectives: The aims of this study were to investigate the frequency of pulmonary problems in Behcet disease (BD), and to discuss lesser-known features of pulmonary BD such as clinical characteristics, analysis of prognosis, and evaluation of treatment options with respect to the previously published cases. Design: We conducted a comprehensive review of the literature to analyze cumulated data about pulmonary involvement in BD. Setting: We found 159 articles regarding pulmonary disease associated with BD in May 2003. Patients: The evaluation of these articles demonstrated 598 pulmonary problems in 585 cases. Results: Pulmonary artery aneurysms (PAAs) are the most common pulmonary lesion in BD, and these are almost always associated with hemoptysis. Seventy-eight percent of patients with aneurysms have concomitant extrapulmonary venous thrombi or thrombophlebitis. Other pulmonary problems are reported in BD, and these are principally related to vascular lesions and radiologic abnormalities. Conclusions: Pulmonary vascular problems, either PAA or involvement of small-sized vessels, are the main pulmonary disorders in BD. Immunopathologic findings indicate that the underlying pathogenesis is pulmonary vasculitis, which may result in thrombosis, infarction, hemorrhage, and PAA formation. Patients with small nonspecific radiologic abnormalities should be followed up closely since early diagnosis of vascular lesions may be life-saving. Immunosuppression is the main therapy for the treatment of a vasculitis. It is important that pulmonary angiitis is not mistaken for pulmonary thromboembolic disease since fatalities have occurred in BD shortly after initiation of anticoagulation/thrombolytic treatment.

Measuring the free:total ratio of prostate-specific antigen (f/t-PSA) can improve the specificity of single-serum PSA values, distinguishing between benign prostatic hyperplasia (BPH) and prostatic carcinoma (PCa) in men over the age of 50. Additionally, clinical trials have shown that dihydroxyvitamin D3 can slow the rate of PSA rise in PCa patients. However, little is known regarding the applicability of those findings in men undergoing chronic peritoneal dialysis (CPD). In the present study, we investigated the prevalence of increased serum PSA levels among CPD patients and correlated those values with serum levels of vitamin D [25-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3]. We undertook a cross-sectional study of 71 male CPD patients without a known history of prostate cancer from 24 centers in Canada, Greece, and Turkey. All of the patients were more than 50 years of age. In these patients, we measured serum concentrations of PSA, free PSA (f-PSA), total PSA (t-PSA), prostate alkaline phosphatase (PAP), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and intact parathyroid hormone (iPTH). We recorded serum PSA levels < 4 ng/mL in 62 patients (87.3%, group A) and levels > 4 ng/mL in 9 patients (12.7%, group B). The f/t-PSA ratio was < 0.25 in 16 patients (22.5%). Group B patients were older than those in group A (median: 73 years vs. 65 years, p < 0.01) and had a lower body weight (median: 66.5 kg vs. 76.7 kg, p < 0.05). We observed no statistically significant difference between the two groups for serum 1,25-dihydroxyvitamin D3 (median: 9.8 ng/mL vs. 10.1 ng/mL) or 25-hydroxyvitamin D3 (8 ng/mL vs. 8.2 ng/mL) levels. Also, we observed no correlation between vitamin D levels and f/t-PSA, but iPTH levels were significantly higher in group A (200.5 pg/mL vs. 61.2 pg/mL, p < 0.04). Also, serum PAP levels correlated significantly with PSA (r = 0.49, p = 0.01) and with f-PSA (r = 0.56, p = 0.000). Our results showed no clear relationship between vitamin D and serum levels of PSA or-of f/t-PSA in PD patients. However, further studies are needed to better define the uses of these PSA markers in PD patients because, in such patients, other relevant factors might be implicated in their predictive value. Adv Perit Dial

WOS: 000181185200016 PubMed: 12653271 …

WOS: 000182505600004 It is common knowledge that quite a few patients with medical illness look for non-medical treatments. There are, however, very few articles in the literature regarding the reasons for these searches or the kinds of non-medical treatment these patients receive. In this research, we aimed to study the frequency of searches for non-medical treatment, the reasons for those searches, and the kinds of non-medical treatment methods used by hemodialysis (HD) patients with chronic renal failure. To that end, 199 HD patients filled out a questionnaire and an information form regarding these issues. Results showed that searches for non-medical treatment were infrequent among HD patients. Among those who did conduct searches, a feeling of helplessness was the most common reason for the search. Additionally, the level of education was found to be lower in patients who ultimately received non-medical treatment (p = 0.03). We conclude that if the non-medical treatment method settled upon has no harmful effect and does not drive the patient away from conventional medical treatment, it may, in fact, be somewhat beneficial for the patient.

PubMed: 12967895 Behçet's disease is a vasculitis disorder in which the etiopathogenetic pathway has not been clarified yet. Many organs and systems including the heart may be affected in BD. We affirm that pathological heart features are not so uncommon as previously reported in the literature and constant evaluation for the cardiovascular system in asymptomatic patients is needed. Therefore; management of BD may involve rheumatologists, gastroenterologists, neurologists, immunologists and cardiologists. Close liaison among these clinicians may be necessary to provide optimum care for the patient with BD. It is expected that clarification of the etiopathogenesis of BD will lead us to the better treatment options.

PubMed: 12653271 [No abstract available]

WOS: 000175218800005 PubMed: 11965596 Objective: To analyze cumulated data about renal involvement in Behcet's disease (1313) and to report on 6 patients with BD and renal problems. Methods: We found reports of 159 patients (including our patients) with BD and specific renal disease (amyloidosis 69, glomerulonephritis [GN] 51, renal vascular disease 35, and interstitial nephritis 4) in our survey. Results: The frequency of renal problems among BD patients has been reported to vary between 0% to 55%. Male gender is a risk factor for all types of renal BD. Nephrotic syndrome was present in 83% of patients with amyloidosis, and renal failure was common at the time of diagnosis. The mean interval between the initial manifestation of BD and diagnosis of amyloidosis was shorter in men than in women (P = .02). AA-type amyloid fibrils were shown in all cases studied. Vascular involvement was common in the patients with amyloidosis (60%). The renal findings in GN show a wide spectrum, from asymptomatic hematuria and/or proteinuria to rapidly progressive GN. Several types of glomerular lesions ranging from minor glomerular changes to crescentic glomerulonephritis are observed in BD. The common types of glomerular lesions among the reported cases are crescentic GN, proliferative GN, and immunoglobulin A (IgA) nephritis. Aneurysms may be located throughout the renal artery, from the orifice of the main artery to intrarenal microaneurysms. Another type of renal disease (amyloidosis or GN) and other major vascular involvement were present in all cases with renal vein thrombosis. Hypertension is common among patients with renal artery aneurysm or stenosis. Microscopic vascular disease was described in 4 patients. Conclusions: Based on data in the literature, we suggest that renal involvement in BID is more frequent than has been recognized, although it is most often mild in nature. Amyloidosis is one of the prognostic factors affecting survival. Patients with vascular involvement carry high risk for amyloidosis, and administration of colchicine to these patients may be beneficial. More evidence is needed to accept interstitial nephritis as a manifestation of BD. In spite of some difficulties, hemodialysis and renal transplantation are safe treatment options in BD-related uremia.

Background, material and methods: This study was performed in 20 patients with end-stage chronic renal failure (CRF) and 10 healthy volunteers, All of the patients were on regular hemodialysis treatment (RHD), 10 of whom were on recombinant human erythropoietin (rHuEPO) therapy. Hematocrit levels of the patients with CRF on rHuEPO were between 0.30 to 0.33 and not on rHuEPO were below 0.24. Baseline serum T-3, T-4, fr(3), fT(4) and TSH levels were measured and TRH stimulation test was performed in patients and control subjects. Serum TSH levels were measured hourly during the afternoon (2 to 5 p.m.) and at night (10 p.m. to 2 a.m.) to determine the nocturnal rhythm of TSH. Results: The mean T3 in rHuEPO, not rHuEPO and control groups were 98.01 +/- 5.54, 70.55 +/- 7.09, 98.29 +/- 4.2 ng/dl; T-4 6.47 +/- 0.68, 6.39 +/- 0.59, 8.35 +/- 0.46 ng/dl; fT(3) 2.24 +/- 0.19, 1.52 +/- 0.24, 2.29 +/- 0.17pg/ml and fT(4) 0.88 +/- 0.14, 0.75 +/- 0.14, 0.97 +/- 0.10 ng/dl, respectively. These values were significantly lower in patients not on rHuEPO compared to controls (p < 0.05). In patients on rHuEPO only T4 values were lower than in the controls (p < 0.05). In patients not on rHuEPO the T3, and fr3 were significantly lower than the values of patients on rHuEPO treatment (p < 0.05). Normal in 8 (80%), blunted in 1 (10%), no TSH response in I (10%) to TRH stimulation were obtained in rHuEPO group. TSH response was normal in 1 (10%), and delayed in 9 (90%) patients not on rHuEPO. The circadian nocturnal rhythm of TSH was abnormal in 8 (90%) patients not on rHuEPO, in 2 (20%) patients on rHuEPO. As a result, CRF and RHD distorts the circadian TSH rhythm and substantially change the thyroid hormone profile probably by affecting hypothalamic-pituitary-thyroid axis. Distortion of the circadian rhythm of TSH and TSH response to TRH points to a defect at the level of hypothalamus and pituitary gland. Conclusion: rHuEPO treatment has some beneficial effects on hypothalamo-pituitary-thyroid axis in the patients on RHD.

WOS: 000167127700006 PubMed: 11182028 Background: Familial Mediterranean fever (FMF) is caused by mutations in the gene encoding pyrin and is characterized by self-limited, recurrent attacks of fever and serositis. Vasculitis has been increasingly reported in FMF, A study evaluating the prognosis in FMF and polyarteritis nodosa (PAN) patients has not been reported previously. Objectives: To determine the special characteristics and the prognosis of PAN in FMF patients. Methods: A questionnaire was used for the present survey. The setting was 7 referral centers from Turkey and Israel. Seventeen patients who were diagnosed with FMF and who developed PAN were included. PAN was diagnosed in those who met the Chapel Hill consensus criteria for microscopic polyarteritis or classic PAN, The clinical features of these 17 patients and the outcomes of their vasculitis were analyzed. Results: The age at diagnosis of PAN in these FMF patients ranged from 3.5 to 37 years. All patients had constitutional symptoms, elevated acute phase reactants, and myalgia at the time PAM was diagnosed. The diagnosis of PAN was confirmed by renal angiography in 8 patients, by renal biopsy in 6 patients, and by muscle and/or nodule biopsies in 6 patients. A number of patients had definite features of both classic PAN and microscopic polyarteritis. Conclusions: When compared with other PAN patients, those with FMF tended to have a younger age at PAN onset, more frequent perirenal hemato mas, and an overall better prognosis. The cases with overlapping features of microscopic and classic PAN pose a problem for the current classification of vasculitis. We suggest that the clinical representation of PAN in FMF patients has certain characteristics and may be a feature of FMF per se. Semin Arthritis Rheum 30:281-287. Copyright (C) 2001 by W.B. Saunders Company.

Biopsy of the involved organ is required for the diagnosis of amyloidosis and most common used tissues for biopsy are rectum and kidney. Bone marrow biopsy is an alternative diagnostic procedure for the diagnosis of amyloidosis. The value of bone marrow biopsy for the diagnosis of amyloidosis is discussed in this report. Amyloid was positive in 9 of 15 (60%) bone marrow biopsy in patients with amyloidosis. Bone marrow biopsy should be used initially for the diagnosis of amyloidosis in the patients with renal failure and respiratory distress.

PubMed: 9776429 [No abstract available]

WOS: 000075830700014 PubMed: 9776429 …

WOS: 000072361500018 PubMed: 9599077 …

Vascular lesions are common in Behcet's disease. A patient with Behcet's disease and vena cava superior syndrome is presented. Magnetic resonance imaging findings of the patient are discussed.