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Öğe Atlanto-odontoid osteoarthritis in rheumatoid arthritis: dynamic CT findings(Springer, 2004) Baysal, O; Baysal, T; Sigirci, A; Ersoy, Y; Altay, ZWe analyzed the CT appearances of degenerative change in the atlanto-odontoid joint (AOJ) in patients with rheumatoid arthritis (RA) and evaluated the effect of these changes on atlanto-axial joint (AAJ) rotation by dynamic CT. This revealed that 9 patients (24%) treated with methotrexate had degenerative features in the AOJ. The ratio of AAJ rotation to the total rotation of the cervical spine was significantly higher in normal subjects (54+/-3%) than in patients (38+/-12%). The degree of AAJ rotation was significantly lower in the patient group with degenerative features in the AOJ (20.9+/-8.4degrees) than in patients without degenerative features (28.5+/-7.4degrees). RA patients with a history of longstanding disease and treatment with antirheumatic drugs may develop AO OA. Although secondary OA was described as healing phenomena in the joints of RA patients, it can limit rotation in the AAJ and cause suboccipital neck pain. A regular check-up of the AAJ and AOJ by means of dynamic CT in all RA patients is proposed to avoid possible antirheumatic drug complications.Öğe Cerebral haemorrhage - Parenchymal intracranial haemorrhage(Karger, 2001) MacWalter, RS; Ersoy, Y; Wolfson, DRWhile there have been substantial improvements in the management of patients with cerebral infarction and there are likely to be further improvements over the next decade, the same may not be true for cerebral haemorrhage. Diagnostic facilities and neurosurgical techniques have improved but not all patients are benefiting from these, The current literature is reviewed, Further controlled trials of the utility of modern neurosurgical techniques are urgently required as at present no therapeutic intervention holds out hope for these patients other than optimum medical management. The main focus must be on prevention. Copyright (C) 2001 S.Karger AG, Basel.Öğe Cervical myositis ossificans traumatica: a rare location(Springer Verlag, 1999) Baysal, T; Baysal, O; Sarac, K; Elmali, N; Kutlu, R; Ersoy, YAn unusual case of myositis:ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.Öğe Clinical experience with three combination regimens for the treatment of high-risk febrile neutropenia(Acad Medicine Singapore, 2006) Serefhanoglu, K; Ersoy, Y; Serefhanoglu, S; Aydogdu, I; Kuku, I; Kaya, EIntroduction: The objective of this study was to compare the safety and efficacy of ceftazidime (2 g every 8 h), piperacillin/tazobactam (4 g/500 mg every 6 h), and meropenem (1 g every 8 h), when combined with amikacin (15 mg/kg once daily), in the empirical treatment of high-risk febrile neutropenic episodes in patients with haematological malignancy. Materials and Methods: A prospective, comparative study designed in the haematology unit of a university hospital in Turkey. Results: A total of 89 febrile episodes in 60 neutropenic patients were treated; 29 febrile episodes in 23 patients with ceftazidime plus amikacin (group 1), 30 episodes in 25 patients with piperacillin/tazobactam plus amikacin (group 2), and 30 episodes in 25 patients with meropenem plus amikacin (group 3). The 3 groups were comparable in terms of age, sex, underlying malignancy, pretherapy neutrophil counts, duration of neutropenia and types of infections. Neutropenia, since the start of fever, persisted for >= 10 days in all of the episodes in the 3 study groups. Nearly all of the episodes were seen in patients with acute leukaemia. In 25.8% (23/89) of the febrile neutropenia episodes, an aetiologic organism was isolated, with gram-negative bacteria being the most commonly isolated. The success without modification rates were 34.5%, 30% and 36.7% for groups 1, 2 and 3, respectively (P > 0.05). After modification with a different class of antimicrobial therapy, the response rates increased to 65.5%, 63.3% and 70% for groups 1, 2 and 3, respectively (P > 0.05). The mean duration of treatment and the time to defervescence were also comparable in all groups. In all arms, side effects were minimal. Conclusions: It is concluded that the 3 regimens were equally effective and safe in the empirical treatment of high-risk febrile neutropenic episodes.Öğe Comparison of three different combination therapies in the treatment of human brucellosis(Royal Soc Medicine Press Ltd, 2005) Ersoy, Y; Sonmez, E; Tevfik, MR; But, ADThe efficacy and tolerability of three different combination treatment regimens in human brucellosis were compared in 118 uncomplicated patients enrolled in a prospective study between May 1997 and December 2002. Brucellosis was diagnosed using standard clinical and microbiological findings. Patients with central nervous system involvement, spondylitis, endocarditis or children under 16 years of age were excluded from the study. Patients were randomly assigned to receive 400 mg of ofloxacin plus 600 mg of rifampicin (OR, n = 41),200 mg of doxycycline plus 600 mg of rifampicin (DR, n = 45) or 1 g intramuscularly streptomycin (administered for three weeks) plus 200 mg doxycycline (DS, n = 32) daily for 6 weeks. All patients were followed up at least 6 months after cessation of therapy. There was no statistical difference between the groups on relapse rates and clinical response to the treatment (P> 0.05). Five patients in OR (12.8%), six patients in DR (14.3%) and three patients in DS groups (9.7%) suffered relapse. The side-effects were seen in eight (19.5%), 21 (46.7%) and eight (25.0%) patients of OR, DR and DS groups, respectively. The use of combination therapy of ofloxacin plus rifampicin for 6 weeks was found to be as effective as DR and DS. The side-effects of therapy in OR and DS groups was less severe than in the DR group.Öğe Converting enzyme inhibitor or AT1-receptor blocker for decreasing long-term mortality in patients, with stroke history and renal dysfunction?: Response(Lippincott Williams & Wilkins, 2003) MacWalter, RS; Wong, KYK; Wong, SYS; Struthers, AD; Ersoy, Y[Abstract Not Available]Öğe Creatinine clearance calculated from demographic and serum variables is a long-term prognostic indicator in stroke patients(Lippincott Williams & Wilkins, 2003) Macwalter, RS; Wong, S; Wong, K; Fraser, C; Shirley, C; Porter, L; Ersoy, Y[Abstract Not Available]Öğe Cytokine profile and nitric oxide levels in sera from patients with brucellosis(Assoc Bras Divulg Cientifica, 2004) Refik, M; Mehmet, N; Durmaz, R; Ersoy, YThe aims of this study were to investigate the serum levels of some cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin 1beta (IL-1beta), IL-2R, IL-6, and IL-8] and nitric oxide (NO) levels in patients with untreated brucellosis and to test the correlation of these parameters with each other. The study was conducted on 67 subjects, 37 patients with brucellosis and 30 healthy individuals with no history of Brucella infection. Brucellosis was identified by a positive blood culture and/or increased Brucella antibodies in serological tests in addition to compatible clinical symptoms. Cytokine profile analysis was performed by the immulite chemiluminescent enzyme immunometric assay whose inter- and intra-assay coefficients of variance were 2.6-3.6 and 4.4-8.5%, respectively. The levels of nitrites/nitrates, which are representative of NO levels, were measured by the Griess method. Patients with brucellosis had significantly elevated serum levels of nitrites/nitrates, IL-2R, IL-6 and IL-8 (mean +/- SD, 102.8 +/- 23.8 mumol/l, 806.1 +/- 58.5 U/ml, 21.1 +/- 2.3 mug/ml, and 8.8 +/- 1.6 pg/ml, respectively) compared to healthy controls, whereas TNF-alpha and IL-1beta levels were unchanged. No statistically significant correlation was detected between any of the studied cytokine levels and nitrate/nitrite concentrations according to Pearson's linear correlation test. We conclude that only IL-6, IL-8 and IL-2R are elevated in brucellosis and the extent of elevation depends on the severity and clinical pattern of the disease. Moderate elevation in serum NO was comparable to that observed in previous studies. This explains the absence or very rare occurrence of septic shock in brucellosis.Öğe Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study(Lippincott Williams & Wilkins, 2002) MacWalter, RS; Wong, SYS; Wong, KYK; Stewart, G; Fraser, CG; Fraser, HW; Ersoy, YBackground and Purpose-The purpose of this study was to investigate renal function as a long-term predictor of mortality in patients hospitalized for acute stroke. Methods-This was a cohort study done in a Scottish tertiary teaching hospital. Participants included 2042 (993 male) unselected consecutive stroke patients (mean age, 73 years) admitted to hospital within 48 hours of stroke between 1988 and 1994. Follow-up was up to 7 years. Main outcome measure was all-cause mortality. Results-The total number of deaths at the end of follow-up was 1026. Most subjects (1512) had creatinine < 124 mumol/L. The mean calculated creatinine clearance was 54.8 mL/min (SD, 23 mL/min). Renal function indexes were analyzed by quartiles with Cox proportional-hazards model. Stroke survivors had higher calculated creatinine clearance and lower serum creatinine, urea, and ratios of urea to creatinine. Calculated creatinine clearance greater than or equal to51.27 mL/min significantly predicted better long-term survival in these stroke patients even after adjustment for confounders (age, neurological score, ischemic heart disease, hypertension, smoking, and diuretic use). Similarly, creatinine greater than or equal to119 mumol/L [relative risk (RR), 1.59; 95% confidence interval (CI), 1.32 to 1.92], urea 6.8 to 8.9 mmol/L (RR, 1.34; 95% CI, 1.09 to 1.65) or greater than or equal to9 mmol/L (RR, 1.74; 95% CI, 1.42 to 2.13), and ratio of urea to creatinine greater than or equal to0.08573 mmol/mumol (RR, 1.24; 95% CI, 1.03 to 1.50) remained significant predictors of mortality after adjustment for confounders. Conclusions-After acute stroke, patients with reduced admission calculated creatinine clearance, raised serum creatinine and urea concentrations (even within conventional reference intervals), and raised ratio of urea to creatinine had a higher mortality risk. This finding may be used to stratify risk and target interventions, eg, the use of angiotensin-converting enzyme inhibitors.Öğe Isolated intracranial hypertension(Elsevier Science Bv, 2004) Özisik, HI; Ersoy, Y; Tevfik, MR; Kizkin, S; Özcan, CBrucella melitensis infection is endemic in the eastern and south-eastern Anatolia regions of Turkey. We report an unusual case of brucella meningitis presenting with bilateral papilla stasis, diplopia and absence of other neurological involvement. Diagnosis was made by positive culture of Brucella spp. with a BACTEC 9120 system with inoculation of the patient's cerebrospinal fluid (CSF). This is the first report of isolation of Brucella spp. from CSF on a BACTEC 9120 system for diagnosis of meningitis. This case demonstrated that brucella meningitis may present with very slight symptoms, and inoculation of CSF into BACTEC bottle besides conventional cultures improves the detection of Brucella in endemic areas such as Turkey. (C) 2004 Elsevier SAS. All rights reserved.Öğe Isolated thrombocytopenia: the presenting finding of typhoid fever(Blackwell Publishing Ltd, 2003) Serefhanoglu, K; Kaya, E; Sevinc, A; Aydogdu, I; Kuku, I; Ersoy, YThrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed.Öğe The level of endothelin-1 and nitric oxide in patients with chronic viral hepatitis B and C and correlation with histopathological grading and staging(Wiley, 2006) Ersoy, Y; Bayraktar, NM; Mizrak, B; Ozerol, IH; Gunal, S; Aladag, M; Bayindir, YBackground and aim: The aim of this study was to estimate the serum levels of endothelin-1 (ET-1) and nitric oxide (NO) and to analyze the correlation of their levels with histopathological grading and staging of the liver in patients with chronic hepatitis B (CHB) and C (CHC). Methods: Eighty-nine patients who were either HBsAg positive (45 CHB patients, 34 inactive carriers (IQ) or had CHC (10 patients) and 36 healthy volunteers as a control group were included in this study. Fifty patients from the CHB (n = 43) or CHC (n = 7) groups with elevated serum alanine transaminase (ALT) levels underwent a liver biopsy. Histological activity was scored according to Ishak's activity and the fibrotic index. The ET-1 serum concentration was determined with a commercially available ELISA assay kit. Total nitrite was measured by the Griess reaction as an index for NO production. Results: Serum levels of ET-1 and NO were significantly increased in CHB patients (7.67 +/- 4.00 pg/ml and 172.44 +/- 50.30 mu mol/l, respectively) compared with the IC group (3.99 +/- 5.42 pg/ml and 114.68 +/- 32.22 mu mol/l, respectively) and the control group (3.05 +/- 0.65 pg/ml and 58.61 +/- 24.18 mu mol/l, respectively) (p < 0,000 1). The CHC patients also had significantly higher serum levels of ET- 1 (5.92 +/- 4.24 pg/ml) and NO (147.50 +/- 55.84 mu mol/l) compared to the control group (p < 0.0001 and < 0.001, respectively). Linear regression analysis identified that the level of ET- I was an independent variable that correlated significantly with the stage score (r(2) = 0.348, p < 0.0001) in CHB patients but there was no correlation in the CHC group. Conclusion: ET-1 and NO levels were increased in chronic hepatitis and there was a significant correlation between the ET-I level and the stage in CHB patients. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe Rhino-orbito-cerebral mucormycosis in transfusion-associated graft-versus-host disease: Case report(Karger, 2005) Bayindir, Y; Aydogdu, I; Bayindir, T; Kaya, E; Kuzucu, C; Alkan, A; Ersoy, YTransfusion-associated graft-versus-host disease (TA-GvHD) is in most cases refractory to immunosuppressive therapy and fatal because of severe bone marrow aplasia. Mucormycosis is a rare invasive fungal infection, but it has clinical importance because of its often delayed diagnosis and high mortality. Invasive mucomycosis is frequently associated with diabetes mellitus, neutropenia, severe immunodeficiencies following steroid therapy, organ transplantation, cytotoxic chemotherapy, and AIDS. We present a case of lethal rhino-orbito-cerebral mucormycosis after TA-GvHD in an initially healthy patient.Öğe Serum and gastric fluid levels of cytokines and nitrates in gastric diseases infected with Helicobacter pylori(Luigi Ponzio E Figlio, 2004) Mehmet, N; Refik, M; Harputluoglu, M; Ersoy, Y; Aydin, NE; Yildirim, BThis case control study presents data on the concentrations of nitrite and nitrate and a variety of pro-inflammatory cytokines such as interleukin-1beta (IL-1beta), interleukin-2R (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor TNF-alpha in gastric fluid and serum. Patients with gastritis, gastric ulcer and gastric cancer are studied and grouped according to infection by Helicobacter pylori. The 208 patients who underwent tipper gastrointestinal endoscopic examination were classified as follows; H. pylori-positive gastritis (n=32), H. pylori-negative gastritis (n=32), H. pylori-positive ulcers (n=34), H. pylori-negative ulcers (n=34), 43 patients with H. pylori-positive gastric cancer in addition to 33 H. pylori-negative healthy control individuals. Gastric fluids and blood samples were taken concomitantly. Cytokines and nitrite and nitrate determinations were attempted as soon as possible after collection of the samples. Nitrite and nitrate levels of serum and gastric fluids of H. pylori-positive gastritis and ulcers were higher than H. pylori-negative gastritis and ulcers. The concentrations of total nitrite and nitrate and cytokines (TNF-alpha IL-2R, IL-6, and IL-8) in gastric fluids and sera of H. pylori-positive gastric cancer patients were higher than H. pylori-negative control groups. IL-1beta level was significantly elevated in gastric fluid of infected cancer patients but not in serum. Taken together, the results suggest that an increase in cytokine-NO combination in gastric mucosa previously reported by many studies is not restricted to local infected gastric tissue but also detected in gastric fluid and sera of H. pylori-positive subjects and may have an important role in the pathogenesis and development of common gastric diseases.Öğe Serum nitrate and nitrite levels in patients with rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis(British Med Journal Publ Group, 2002) Ersoy, Y; Özerol, E; Baysal, Ö; Temel, I; MacWalter, RS; Meral, Ü; Altay, ZEObjective: To assess and compare serum nitrate and nitrite levels in patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA), and osteoarthritis (OA). Methods: Thirty five patients with RA, 32 patients with AS, and 36 patients with OA were entered into this study. In addition, 30 healthy volunteers acted as a control group. Concentrations of nitrate and nitrite in serum were determined by direct and indirect Griess reactions. C reactive protein and erythrocyte sedimentation rate levels were determined as markers of systemic activity of disease (SAD) in RA and AS groups. Results: Serum nitrate and nitrite levels were found to be higher in patients with AS and RA than in the OA group (p <0.01). In addition, serum nitrate and nitrite levels were higher in all three groups than in the control group (p <0.01). Moreover, serum nitrate and nitrite levels were higher in patients who had SAD than in those who had not in the RA and AS groups (p <0.01 and p <0.05, respectively), and there was a correlation between serum nitrate and nitrite concentrations and SAD variables in patients with RA (Spearman's r(s)=0.414, p <0.05 and r(s)=0.408, p <0.05, respectively) and AS (r(s)=0.421, p <0.05 and r(s)=0.412, p <0.05, respectively). Conclusion: The findings suggest that nitrate and nitrite production is enhanced in patients with inflammatory arthritis compared with OA. In addition, serum nitrate and nitrite levels are enhanced in patients with RA, AS, and OA compared with healthy subjects. Furthermore, there is a correlation between the SAD variables and serum nitrate and nitrite levels in patients with RA and AS.
