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Öğe Comparison of serum NO, TNF-?, IL-1?, sIL-2R, IL-6 and IL-8 levels with grades of retinopathy in patients with diabetes mellitus(Nature Publishing Group, 2002) Doganay, S; Evereklioglu, C; Er, H; Türköz, Y; Sevinç, A; Mehmet, N; Savli, HBackground Vitreal interleukin (IL)-1beta (IL-1beta), IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha) and nitric oxide (NO) levels have previously been determined in patients with proliferative diabetic retinopathy (PDR). However, at present there is no cohort study linking serum levels of NO and many inflammatory cytokines such as TNF-alpha, IL-1beta, soluble IL-2 receptor (sIL-2R), IL-6 and IL-8 to the grade of the microvascular complications. Purpose To determine the relation between the stages of DR and the levels of serum NO, TNF-alpha, IL-1beta, sIL-2R, IL-6 and chemokine IL-8 in patients with diabetes compared with healthy controls. Methods Fifty-three consecutive patients with diabetes (25 men, 28 women) with or without DR and 15 non-diabetic healthy subjects (seven men, eight women) as controls were included in this prospective study. As an indicator for NO, serum total nitrite (NO2- + NO3-) levels (end-product of NO) were measured by the Griess reaction. Serum TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 levels were determined by a spectrophotometric technique using an Immulite chemiluminescent immunometric assay. The patients with diabetes were classified into three groups according to the stage of DR: no DR (NDR; n = 16), non-proliferative DR (NPDR; n = 18) and PDR (n = 19). The data were analysed using a Mann-Whitney U-test and the results were expressed as mean +/- SE (range). Results The levels of IL-1beta and IL-6 were below the detection limits of the assay (for each, <5.0 pg/ml) in all patients with diabetes and controls. Soluble IL-2R levels ranged from 260 to 958 U/ml, with the highest values observed in the patients with PDR. In 47 of the 53 samples (89%) tested for diabetic patients, IL-8 levels were above the detection limits of the assay (5.0 pg/ml). IL-8 levels ranged from <5.0 to 25.0 pg/ml, with the highest mean values observed in PDR patients. TNF-alpha was detectable in 46 of 53 patients with diabetes (87%), ranging from <4.0 to 26.4 pg/ml, with again the highest values obtained in the patients with PDR. Serum NO levels ranged from 80 to 188 mumol/l, with the highest values obtained in patients with PDR. Taken together, the mean serum NO, sIL-2R, IL-8 and TNF-alpha levels increased with the stage of DR and the highest levels were found in patients with PDR. The PDR patients had significantly (for each, P < 0.001) higher serum NO (166.8 +/- 3.2 mumol/l), sIL-2R (807.9 +/- 33.3 U/ml), IL-8 (17.9 +/- 0.4 pg/ml) ;and TNF-alpha (15.0 +/- 0.8 pg/ml) levels compared with NPDR patients (149.5 +/- 2.1, 659.4 +/- 23.4, 12.9 +/- 1.1, 11.5 +/- 0.6, respectively), NDR patients (115.9 +/- 5.8, 373.8 +/- 15.0, 8.3 +/- 1.0, 6.6 +/- 0.9, respectively) and controls (116.6 +/- 2.3, 392.4 +/- 16.6, 7.2 +/- 0.3, 7.3 +/- 0.3, respectively). Serum levels of these parameters for NPDR patients were also significantly (for each, P < 0.01) higher compared with those of NDR patients and controls. On the other hand, serum NO, sIL-2R, IL-8 and TNF-alpha levels of patients with NDR were comparable with those of controls (for each, P > 0.05). Conclusion The results of the present study suggest that NO, sIL-2R, IL-8 and TNF-alpha may play important roles in the pathophysiology and progression of DR. We think that these potentially inflammatory cytokines and NO with their endothelial implications may act together during the course and progression of DR. These molecules may serve as therapeutic targets for the treatment and/or prevention of diabetes with its systemic and ocular microvascular complications.Öğe The effect of valproate on bone mineral density in adult epileptic patients(Academic Press Ltd Elsevier Science Ltd, 2004) Boluk, A; Guzelipek, M; Savli, H; Temel, I; Ozisik, HI; Kaygusuz, AThe effect of long-term valproate (VPA) treatment on bone mineral density (BMD) in adult epileptic patients is not clearly known, although several studies have been done in children. In adult epileptic patients (it = 50; 24 men, 26 women) treated with VPA, the bone mineral density at lumbar level (L I -L4) and neck, trochanter, and intertrochanter regions of left femur was studied by dual energy X-ray absorptiometry (DXA) at the beginning of the study and after 6 months, with the specific aim to evaluate the effect of long-term valproate monoteraphy on bone mineral density. Routine biochemical parameters were also evaluated. Sixty healthy control subjects were evaluated. Control subjects were similar to patient group with respect to age, race (all White), geographic area, and socioeconomic status. Lumbar and femural BMD values were significantly lower in patient group than control group (0.814 +/- 0.157 g/cm(2) versus 0.894 +/- 0.102 g/cm(2), P = 0.003) and (0.824 +/- 0.144 g/cm(2) versus 0.906 +/- 0.104 g/cm(2), p = 0.001), respectively. Osteopenia were detected in 13 of 60 control subjects (22%) and the others had no osteoporosis. In epileptic group, osteoporosis and osteopenia were detected in 8 subjects (16%), and in 26 subjects (52%), respectively. In epileptic group 16 subjects were normal (32%) at the lumbar regions, and 7 had osteoporosis (14%), 28 had osteopenia (56%), and 15 were normal (30%) at the femoral region. In the second measurements of the patients on valproate treatment, after 6 months, all of the DXA BMD values had worsened compared with the first measurements (P = 0.001 for lumbar BMD values and P = 0.004 for femural BMD values). In the patient group, a significant inverse cot-relation was observed between duration of valproate therapy and all DXA BMD values in the first and second measurements. Parathyroid hormone, alkaline phosphatase, and phosphor levels of patients were significantly higher than those of control group (52 +/- 11 pg/ml versus 46 +/- 13 pg/ml, P = 0.013), (113 +/- 32 U/l versus 95 +/- 36 U/l, P = 0.006), and (4.50 +/- 0.5 mg/dl versus 4.0 +/- 0.7 mg/dl, P = 0.0001), respectively. However, all of the parameters were within the normal reference ranges. It has been concluded that long-term (more than one year) valproate treatment induces a decrease in bone mineral density in epileptic adults. However, the multivariate analysis did show no association between BNID changes and parathyroid hormone, alkaline phosphatase or phosphorus levels. (C) 2003 Elsevier Ltd. All rights reserved.Öğe Giant mediastinal parathyroid adenoma presenting with a hyperparathyroid crisis and leading to postoperative hungry bone syndrome(Taylor & Francis As, 2002) Kuzucu, A; Soysal, O; Savli, H[Abstract Not Available]Öğe Hypothyroidism masquerading as depression: The role of noncompliance(Natl Med Assoc, 2004) Sevinc, A; Savli, HCompliance with prescribed medication is an important but complex issue which is incompletely understood, Depression is also a factor that can lead to noncompliance. A 30-year-old lady was seen in the outpatient clinic with complaints of palpitations and tremor. Her medical history revealed a subtotal thyroidectomy for multinodular goiter five years earlier. During a period of depression, she stopped taking levothyroxine for 45 days. Discontinuation of therapy worsened her depression. At her visit, the dosage of levothyroxine was increased, and the symptoms of depression improved. However, increasing the dosage of thyroid supplement resulted in a hyperthyroid state. The role of depression on noncompliance is also discussed.Öğe An interesting cause of pulmonary emboli: Acute carbon monoxide poisoning(Sage Publications Inc, 2005) Sevinc, A; Savli, H; Atmaca, HCarbon monoxide poisoning, a public health problem of considerable significance, is a relatively frequent event today, resulting in thousands of hospitalizations annually. A 70-year-old lady was seen in the emergency department with a provisional diagnosis of carbon monoxide poisoning. The previous night, she slept in a tightly closed room heated with coal ember. She was found unconscious in the morning with poor ventilation. She had a rare presentation of popliteal vein thrombosis, pulmonary emboli, and possible tissue necrosis with carbon monoxide poisoning. Oxygen treatment with low-molecular-weight heparin (nadroparine) and warfarin therapy resulted in an improvement in both popliteal and pulmonary circulations. in conclusion, the presence of pulmonary emboli should be sought in patients with carbon monoxide poisoning.Öğe Occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis(Editrice Kurtis S R L, 2001) Savli, H; Sevinc, A; Sari, R; Ozen, S; Buyukberber, S; Ertas, EA 47-year-old female patient with a previous history of right thyroid lobectomy was admitted to the hospital because of a 3 cm nodule in the thyroid gland. Hormonal evaluation showed subclinical hypothyroidism with serum levels of thyroid stimulating hormone slightly elevated to 4.4 mug/dl (normal: 0.4-4 mug/dl). Thyroid ultrasound showed diffuse irregularity of the gland and the presence of a solitary nodule (30x18 mm in diameter) localized in the left lobe. A fine needle aspiration biopsy was performed. Cytological analysis revealed papillary thyroid carcinoma and Hashimoto's thyroiditis. Total thyroidectomy was performed. During the operation, two of the parathyroid glands were detected to be hyperplastic. Histopathological examination of the thyroid and parathyroid glands revealed Hashimoto's thyroiditis with papillary thyroid carcinoma and synchronous carcinoma of the parathyroid gland. To our knowledge, this association of occult parathyroid carcinoma in a patient with papillary thyroid carcinoma and Hashimoto's thyroiditis has not been reported in the literature. Given the high prevalence of autoimmune diseases in elderly women, a random occurrence of this triad represents the most likely explanation. (C) 2001, Editrice Kurtis.Öğe Plasma lipid peroxidation products and antioxidant enzyme activities in patients with type 2 diabetes mellitus(Springer-Verlag Italia Srl, 2002) Turk, HM; Sevinc, A; Camci, C; Cigli, A; Buyukberber, S; Savli, H; Bayraktar, NDiabetes is associated with a significant increase in thiobarbituric acid reactive substances (TBARS) which are considered as an index of endogenous lipid peroxidation. The human body has a complex antioxidant defense system that prevents the initiation of free radical chain reactions. We measured plasma TBARS levels, superoxide dismutase (SOD) and catalase (CAT) activities and compared their relation to the metabolic control of diabetes and diabetic microangiopathy. Sixty-four patients (19 men), aged 52.35 +/- 9.31 years with type 2 diabetes mellitus were included in the study. Thirty-six healthy subjects (12 men), aged 51.02 +/- 7.01 years formed the control group. TBARS levels and SOD activity were elevated in the diabetic group when compared with the control group (p<0.001 and p<0.00001, respectively). However CAT activity was significantly decreased in the diabetic group when compared with the control group (p<0.00001). Patients with diabetic nephropathy and retinopathy. but not neuropathy, had elevated TBARS levels but there was no statistically significant difference when compared with diabetic patients without microangiopathy (p>0.05). There was a positive correlation between plasma TBARS levels and SOD activity (r=0.770, p=0.0001) and a negative correlation between plasma TBARS levels and CAT activity (r=-0.482, p=0.0001). There was also a negative correlation between SOD and CAT activities (r=-0.609, p=0.0001). We found significantly elevated TBARS levels in diabetic patients. We did not observe any correlation between TBARS levels and blood glucose and HbA(1c) levels. Elevated TBARS levels and SOD activity and decreased CAT activity may be due to a compensation mechanism of the body.Öğe The relation between plasma endothelin-1 levels and metabolic control, risk factors, treatment modalities, and diabetic microangiopathy in patients with Type 2 diabetes mellitus(Elsevier Science Inc, 2001) Ak, G; Buyukberber, S; Sevinc, A; Turk, HM; Ates, M; Sari, R; Savli, HWe evaluated the possible relation between plasma endothelin-1 (ET-I) levels and metabolic control, risk factors, treatment modalities, and diabetic microangiopathy, including nephropathy, neuropathy, and retinopathy in patients with Type 2 diabetes and healthy control group. Sixty-eight (39 females and 29 males) patients with Type 2 diabetes and 14 (6 females and 8 males) healthy subjects were included in the study. Plasma ET-I levels were found to be 10.46 +/- 1.24 pmol/l in the diabetic group, whereas 7.97 +/- 0.41 pmol/l in the control group, which was statistically significant (P < .01). We also found elevated plasma ET-I levels in patients with the least one microvascular complication when compared with the uncomplicated diabetes group (P=.02). Moreover, plasma ET-1 levels of the uncomplicated group was higher than the control group (P < .05). Plasma ET-1 levels were significantly elevated in hypertensive diabetics than normotensive diabetics (t=2.58, P=.012). It wets also found to be elevated in diabetic patients with diabetes duration of more than 10 years when compared with patients less than 10 years ( P=.02). These findings can be interpreted as the increased damage of microvascular complications in the disease process that may lead to elevated ET-I levels. Mean plasma ET-I levels in diabetic patients with a family history of diabetes was found to be higher than patients with no family history of diabetes. Genetical and environmental factors may have an effect on ET-1 level. We also studied the correlations of plasma ET-I levels on age, sex, fasting blood glucose levels, treatment modalities HbAlc, hyperlipidemia, C-peptide, Body Mass Index, and smoking, but did not find any statistically significant difference. In conclusion, plasma ET-1 levels are well correlated with microangiopathy, hypertension, increased disease duration, and family history of diabetes, but poorly correlated with metabolic control, treatment modalities, age, sex, hyperlipidemia, obesity, and smoking. (C) 2001 Elsevier Science Inc. All rights reserved.Öğe Relationship between plasma adrenomedullin levels and metabolic control, risk factors, and diabetic microangiopathy in patients with type 2 diabetes(Amer Diabetes Assoc, 2000) Turk, HM; Buyukberber, S; Sevinc, A; Ak, G; Ates, M; Sari, R; Savli, H[Abstract Not Available]
