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Öğe Adrenomedullin and nitrite levels in children with Bartter syndrome(Springer-Verlag, 2000) Balat, A; Çekmen, M; Yürekli, M; Kutlu, O; Islek, I; Sönmezgöz, E; Çakir, MChildren with Bartter syndrome have lower than normal vascular reactivity with normotension in spite of biochemical and hormonal abnormalities which are typical of hypertension. Nitric oxide (NO) is a potent endogenous vasodilator, and plays an important role in the control of vascular tone. Adrenomedullin (AM) is a novel hypotensive peptide originally isolated from human pheochromocytoma. The possible role of NO and PLM in maintaining this reduced vascular reactivity was examined by studying plasma and urinary nitrite, a stable metabolite of NO, and AM levels in ten children with Bartter syndrome, ten healthy controls, and five children with hypokalemia of causes other than Bartter syndrome (pseudo-Bartter). Urinary excretion of nitrite (mu mol/mg urinary creatinine) was 8.9.+/-1.2 in children with Bartter syndrome, 4.7.+/-0.9 in healthy controls, and 2.9.+/-0.8 in pseudo-Bartter (P<0.05). Plasma nitrite levels (mol/l) were 101.9+/-23.4, 59.9+/-14.7, and 65.0+/-29.7, respectively (P>0.05), in the three groups. Urinary excretion of AM (pmol/mg urinary creatinine) was 187+/-40, 65+/-10, and 160+/-50, respectively (P<0.05), in the three groups. Plasma AM levels were 47.4+/-1.8, 39.9+/-5.9, and 42.4+/-3.9, respectively (P>0.05), in the three groups. The same parameters were repeated in the two groups of controls and in the Bartter patients in the 6th month of therapy. Urinary nitrite and AM levels were still higher in the Bartter patients than in the other groups. We conclude that in Bartter syndrome the increased NO production may be responsible for the reduced vascular response of the disease. Initially, increased levels of AM in Bartter syndrome and pseudo-Bartter may be a compensatory response to acute hypokalemia; however, continuation of a high level of urinary excretion of AM in children with Bartter syndrome may suggest also the possible role of AM in the reduced vascular response of the disease.Öğe Adrenomedullin and nitrite levels in children with dilated cardiomyopathy(Springer-Verlag, 2003) Kilinç, M; Balat, A; Çekmen, M; Yürekli, M; Yilmaz, K; Sahinöz, SDilated cardiomyopathy (DCM) is an important cause of chronic congestive cardiac failure in children. In patients with idiopathic DCM, endothelium vasomotor function is disturbed. There are many studies on the roles of nitric oxide (NO) and adrenomedullin (AM) in adult patients with DCM. However, to our knowledge, no studies have investigated the level of AM and NO in children with idiopathic DCM. We determined plasma and urinary AM and total nitrite concentrations in children with idiopathic DCM and investigated the correlation between these and other clinical and laboratory findings. Eleven patients with DCM, ranging in age from 5 month to 14 years, were compared to 10 healthy age- and sex-matched controls. Plasma (pmol/ml) and urinary (pmol/mg creatinine) AM levels were significantly lower than in the healthy controls (19.55 +/- 2.36 vs 51.61 +/- 7.22 and 28.29 +/- 20.66 vs 68.87 +/- 40.23, respectively; p < 0.001). Plasma and urinary AM levels were negatively correlated with ejection fraction (EF) and fractional shortening (FS). The plasma (Mmol/L) and urinary nitrite levels (Mmol/mg creatinine) were not different between patients and controls [50.90 +/- 17.50 vs 53.40 +/- 26.05 (p > 0.05) and 1.98 +/- 1.24 vs 2.75 +/- 1.68 (p > 0.05), respectively]. In our study, the first to analyze AM and nitrite levels in children with DCM, plasma and urinary AM levels were found to be decreased. A possible explanation for this reduction could be depletion of the viable myocyte population. However, this hypothesis must be clarified by further studies.Öğe Adrenomedullin and nitrite levels in children with minimal change nephrotic syndrome(Springer-Verlag, 2000) Balat, A; Çekmen, M; Yürekli, M; Gülcan, H; Kutlu, O; Türköz, Y; Yologlu, SNitric oxide (NO) serves many functions within the kidney, and recent evidence suggests that NO contributes to glomerular injury. Adrenomedullin (AM) is a novel hypotensive peptide originally isolated from human pheochromocytoma. Recent studies showed that plasma AM concentrations correlated with the extent of proteinuria. We have examined the possible role of these two agents by studying plasma and urinary total nitrite (NO-(2) + NO-(3)) and AM levels in children with minimal change nephrotic syndrome (MCNS). In comparison with healthy controls, children with MCNS had increased urinary nitrite excretion (mu mol/mg urinary creatinine), irrespective of whether the disease was in relapse or remission (3.2+/-0.2 in relapse, n=13; 1.9+/-0.3 in remission, n=12; 1.0+/-0.2 in controls, n=10, P<0.05). Plasma nitrite levels (mol/l) were high in relapse compared with controls (53.2+/-8.7 vs 32+/-4.0, P<0.05). Plasma AM levels (pmol/ml) were decreased in relapse (27.6+/-1.4 in relapse, 43.3+/-1.2 in remission, 41.5+/-1.6 in controls, P<0.05). Urinary AM levels (pmol/mg urinary creatinine) were significantly higher in relapse than in remission and in controls (156+/-43 in relapse, 56+/-18 in remission, 36+/-16 in controls, P<0.05). Our data indicate that NO may play a role in mediating the clinical manifestations of MCNS in children. However, changes in AM levels may be the result of heavy proteinuria.Öğe Adrenomedullin and total nitrite levels in children with acute rheumatic fever(Pergamon-Elsevier Science Ltd, 2005) Balat, A; Kilinc, M; Cekmen, MB; Güler, E; Yürekli, M; Sahinöz, S; Coskun, YObjective: To investigate the levels of adrenomedullin (AM) and total nitrite, a stable product of nitric oxide (NO), in children with acute rheumatic fever (ARF). Design and methods: Eleven children with ARF were investigated in comparison with 14 healthy controls. Adrenomedullin was detected by HPLC, while total nitrite was quantitated by the Griess reaction. Results: Plasma urinary AM and total nitrite levels were significantly higher in children with ARE, irrespective of whether they were in the acute or convalescent phase of disease. Plasma AM (pmol/mL) levels were 49.19 +/- 3.23 in the acute phase, 44.52 +/- 4.26 in the convalescent phase, 35.49 +/- 3.43 in controls, and urinary AM excretion (pmol/mg creatinine) was 43.45 +/- 18.40 in the acute phase, 32.38 +/- 15.37 in the convalescent phase, and 24.84 +/- 11.38 in controls. Plasma total nitrite levels (mu mol/L) were 75.37 +/- 13.13 in the acute phase, 59.81 +/- 12.78 in the convalescent phase, and 41.09 +/- 10.27 in controls. Urinary total nitrite excretion (mu mol/mg creatinine) was 3.82 +/- 1.56 in the acute phase, 2.15 +/- 0.58 in the convalescent phase, and 1.33 +/- 0.61 in controls. The differences were statistically significant for all (P < 0.05). Conclusion: This study considered that AM and NO may have a role in the immunoinflammatory process of ARF. (c) 2005 The Canadian Society of Clinical Chemists. All rights reserved.Öğe Adrenomedullin and total nitrite levels in children with familial Mediterranean fever(Blackwell Publishing, 2006) Balat, A; Islek, I; Çekmen, M; Yürekli, M; Tekin, D; Muslu, A; Sahinöz, SAim: Familial Mediterranean fever (FMF) is the most frequent periodic syndrome characterised by recurrent attacks of polyserositis. However, recent studies revealed that there might be an ongoing subclinical inflammation between the attacks. As nitric oxide (NO) and adrenomedullin (AM) are both synthesised in the endothelium, and mediates many functions within immune system, we considered them to be an interesting target of investigation in FMF. Methods: Fifteen children with FMF receiving regular colchicine, ranging in age from 3 to 16 years, were investigated in comparison with 15 healthy age- and sex-matched controls. The mean age of the patients was 9.7 +/- 3.9 years. Total nitrite, a stable product of NO, was quantitated by means of the Griess reaction, while AM was measured by HPLC. Results: Plasma-urinary AM and total nitrite levels were significantly higher in children with FMF. Plasma AM levels (pmol/mL) in patients and controls were 40.95 +/- 5.99 vs. 34.86 +/- 5.24, P < 0.05, and urinary AM excretion (pmol/mg creatinine) was 51.16 +/- 28.15 vs. 37.5 +/- 24.26, P < 0.05 respectively. Plasma total nitrite levels (mu mol/L) in patients and controls were 44.80 +/- 10.36 vs. 32.13 +/- 9.28, P < 0.05, and urinary nitrite excretion (mu mol/mg creatinine) was 2.24 +/- 1.71 vs. 1.09 +/- 0.96, P < 0.05 respectively. Conclusion: This study considered that AM and NO may have a role in the immuno-inflammatory process of FMF, although, whether these act to preserve, or protect against, further inflammatory injury is not clear. Our results further supports the hypothesis that these patients have subclinical inflammation between attacks.Öğe Adrenomedullin and total nitrite levels in children with Henoch-Schonlein purpura(Springer, 2003) Islek, I; Balat, A; Çekmen, M; Yürekli, M; Muslu, A; Sahinöz, S; Sivasli, ENitric oxide (NO) is synthesized from endothelium and has an important role in the control of vascular tonus. Adrenomedullin (AM) is a potent vasodilator, and cytoprotective peptide is produced not only in adrenal medulla, but also in the vascular smooth muscle and endothelial cells. To investigate the endothelial synthesis of AM and NO, and endothelial injury in Henoch-Schonlein purpura (HSP), we measured their levels in 16 children with HSP, who were evaluated during the acute and remission phases, and compared with 12 healthy controls. Plasma AM levels (pmol/ml) were significantly higher in acute phase children (46.87+/-11.49) than in those in remission (35.59+/-12.39, p<0.01) and controls (30.70+/-9.12, p<0.001). Similarly, plasma total nitrite levels (mumol/l) were higher in acute phase patients (47.50+/-12.30) than in those in remission (35.94+/-10.08, p<0.005) and controls (34.56+/-11.51, p<0.05). Urinary excretion of AM (pmol/mg creatinine) was higher in acute phase patients (53.85+/-23.22) than in remission patients (29.97+/-9.33, p<0.01) and controls (37.43+/-15.78, p<0.05). Patients had increased urinary nitrite excretion (mumol/mg creatinine) in acute phase (2.39+/-1.18) compared to those in remission (1.53+/-0.90, p<0.05) and controls (1.05+/-0.61, p<0.005). There was no significant difference between remission phase and controls in AM and nitrite levels (p>0.05). This study concluded that AM and NO may have a role in the immunoinflammatory process of HSP, especially in the active stage, although whether this perpetuates, or protects against, further vascular injury is not clear. Further studies are needed to clearly establish the roles of AM and NO in the pathogenesis of HSP.Öğe Craniofacial anthropometry in a Turkish population(Alliance Communications Group Division Allen Press, 2002) Evereklioglu, C; Doganay, S; Er, H; Gunduz, A; Tercan, M; Balat, A; Cumurcu, TObjective: To present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects. Participants: Three thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study. Methods: Three age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age. Results: The fronto-occipital circumference and outer canthal distance of males was significantly (p < .001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p < .001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population. Conclusion: This study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.Öğe Decreased adrenomedullin and total nitrite levels in breast milk of preeclamptic women(Pergamon-Elsevier Science Ltd, 2004) Cekmen, MB; Balat, A; Balat, O; Aksoy, F; Yurekli, M; Erbagci, AB; Sahinoz, SObjective: To observe the adrenomedullin (AM) and total nitrite levels in the milk of preeclamptic and normal pregnant women. Design and methods: Fifteen women with preeclampsia and 15 normal pregnant women were included in the study. Total nitrite was quantitated by Griess reaction, while AM was measured by HPLC. Results: The levels of AM and total nitrite in colostrum and 30th-day breast milk were decreased in preeclamptics. Total. nitrite levels (mumol/l) were 56.09 +/- 11.18 vs. 82.20 +/- 12.01, P < 0.05, in colostrum of preeclamptics and controls, respectively. The level of total nitrite was 37.75 +/- 12.10 vs. 53.28 +/- 10.25, P < 0.05, in 30th-day milk of same patients. AM levels (pg/ml) were 11.18 +/- 1.11 vs. 16.59 +/- 1.24, P < 0.0001, in colostrum of preeclamptics and controls, respectively. In 30th-day milk of same patients, AM levels were 8.41 +/- 1.39 vs. 12.18 +/- 1.48, P < 0.005, respectively. Conclusion: This report shows for the first time that human milk has decreased levels of AM and total nitrite in preeclampsia. (C) 2003 The Canadian Society of Clinical Chemists. All rights reserved.Öğe Effects of shock wave lithotripsy on plasma and urinary levels of nitrite and adrenomedullin(Springer-Verlag, 2003) Sarica, K; Balat, A; Erbagci, A; Cekmen, M; Yurekli, M; Yagci, FPurpose: In this prospective clinical study, we aimed to determine whether shockwave lithotripsy (SWL) has any specific effect on plasma as well as urinary nitrite, a stabile metabolite of nitric oxide (NO) and adrenomedullin (AM) concentrations, and to investigate whether these variables can be used as a marker for detecting shockwave-induced impairment of renal tubular and glomerular cells. Material and Methods: A total of 20 patients with renal pelvic or caliceal stones less than or equal to2 cm undergoing anesthesia-free SWL without auxiliary measures and a control group of ten patients without any urological symptoms were included in this study. The plasma and urinary concentrations of nitrite and AM were measured before, 24 h, and 7 days after SWL. Nitrite levels were measured by Griess reaction. Reverse-phase high-performance liquid chromatography (HPLC) was used to determine AM levels. Results: Application of high-energy shock waves (HESW) in our study caused a statistically significant increase in plasma levels of both NO and AM, which reflected an organized response of the kidney to this type of trauma in an attempt to maintain normal renal hemodynamics. Mean plasma nitrite concentration before SWL application was 29.9+/-7.6 mumol/l and this value was found to be 39.02+/-8.45 mumol/l at 24-h follow-up. Comparative evaluation of the plasma concentrations of AM revealed a significant increase at the 24-h examination: 20.51+/-3.0 pmol/ml and 32.54+/-4.3 pmol/l, respectively. On the other hand, comparative evaluation of urinary levels of both nitrite and AM levels before as well as 24 h after SWL application revealed a statistically significant increase related to markers. Conclusion: This first clinical study on plasma-urinary nitrite and AM levels in patients undergoing the SWL procedure indicated that plasma and urine levels of both peptides were increased. Our findings in turn suggested that SWL application to kidneycan stimulate the NO-cGMP signalling pathway to increase NO production in the kidney. Our findings also indicated that the increased levels of NO and AM secretion during renal parenchymal ischemia may be protective enough for renal pathological alterations resulting from SWL-induced renal trauma. We suggest that this increase may be a compensatory response to SWL induced injury.Öğe Eosinophilic fasciitis - Progression to linear scleroderma - A case report(Turkish J Pediatrics, 1999) Balat, A; Akinci, A; Turgut, M; Mizrak, B; Aydin, AEosinophilic fasciitis is a rare disease in children. Although changes similar to linear scleroderma have been reported, the outcome is usually good. In this report, a 10-year-old boy who developed eosinophilic fasciitis without a good response to steroids is presented. He progressed to linear scleroderma within months. Our case reinforces the hypothesis that eosinophilic fasciitis may be an early manifestation or a variant of localized scleroderma similar to the other cases in the literature.Öğe Sympathetic skin response in patients with chronic renal failure(Wiley-Blackwell, 1996) Ozcan, AC; Boluk, A; Duranay, M; Ekmekci, H; Balat, A; Muftuoglu, MSympathetic skin response (SSR) was measured in 20 normal healthy subjects and in 22 patients with chronic renal failure on regular hemodialysis, and its correlation with abnormalities of sensorimotor nerve conduction study and clinical autonomic symptoms was investigated. Nerve conduction studies (NCS) were abnormal in 17 of 22 patients (77.3%), and SSR was absent in 14 of 22 patients (63.6%). Patients were divided into three groups based on their SSR response: patients with normal SSR (n:8, 36.4%), patients with absent SSR in the foot only (n:9, 40.9%), and patients with absent SSR in both hand and foot (n:5, 22.7%). Good correlation between abnormalities of NCS and absent SSR was observed. No correlation was noted between patient age, sex, duration of hemodialysis, duration of renal failure history, and absent SSR. However, statistically significant correlation was found between mean amplitude of the foot SSRs and sensorimotor nerve conduction velocities, and weekly frequency of hemodialysis.
