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Öğe Anti-Saccharomyces cerevisiae antibodies in acute myocardial infarction(Bmj Publishing Group, 2007) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Kadakal, FigenBackground: Elevated anti-Saccharomyces cerevisiae antibody (ASCA) immunoglobulin (IgG) and IgA levels were first described in the serum of Crohn disease patients and have increasingly been reported in other inflammatory diseases. The role of in situ and remote inflammation in atherosclerosis is a major area of interest. In this study, we compared ASCA IgG and IgA levels in acute myocardial infarction (AMI) and controls to investigate the possible role of ASCA in AMI. Methods: Serum samples were obtained from 140 consecutive patients who presented to the emergency department with acute chest pain. AMI was diagnosed by electrocardiography and serial enzymes. Patients ruled out for acute coronary event were grouped as controls. ASCA IgA and IgG levels were determined using enzyme-linked immunosorbent assay. Groups were compared for statistically significant difference. Results:ASCA IgG titers ranged between 0.1 and 31.0 RIU/mL (mean 4.92) in the AMI group and 0.1 and 6.0 (mean 0.84) in the controls. The groups were found to differ very significantly (p = .001). ASCA IgA titers ranged between 2.0 and 200.0 RIU/mL (mean 13.73) in the AMI group and 2.0 and 11.5 RIU/mL, (mean 4.25) in controls. The groups differed significantly (p = .32). AMI and controls were also analyzed for ASCA IgA and IgG positivity. Both groups differed significantly from controls (p = .013). Conclusion: Elevated ASCA IgA and IgG levels as well as ASCA positivity in the AMI might suggest use of ASCA as a marker for atherosclerotic plaque instability. It might also provide a link between inflammatory processes and increased cardiovascular risk. Further studies are needed on a Saccharomyces cerevisiae-based diet, related intestinal colonization, and associated inflammation, autoimmune disorders, and cardiovascular events.Öğe Aplastic crisis due to Parvovirus B19 in an adult hereditary spherocytosis patient: Case report(Ortadogu Ad Pres & Publ Co, 2008) Güngör, Adem; Bilir, Cemil; Önder, Elif; Korkmaz, Uğur; Alçelik, Aytekin; Cinemre, HakanParvovirus B19 may cause transient aplastic crises in hereditary hemolytic anemia patients. A 29-year-old male presenting with fatigue, fever and diffuse joint and Muscle pain was admitted to the internal medicine service. He later developed leukopenia, thrombocytopenia and marked anemia with 0.8% reticulocytes. The bone marrow biopsy proved normocellular with increased proetrithroblasts and decreased mature erythroblasts. On day 6 of admission, his complete blood count (CBC) started to return to normal and the aplastic crisis was attributed to parvovirus B19 infection. Anti-IgM B19 antibody positivity supported the diagnosis and the clinical picture. This is the first reported Parvovirus B19-induced aplastic crisis in an adult hereditary spherocytosis patient in Turkey.Öğe A closed interatrial septal aneurysm mimicking a tumor in the left atrium(Texas Heart Inst, 2006) Akdemir, Ramazan; Duran, Sadık; Bulur, Serkan; Kaya, Ahmet; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir…Öğe Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study(Endocrine Soc, 2009) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Bahçebaşı, TalatContext: In patients with coexisting iron-deficiency anemia and subclinical hypothyroidism, anemia does not adequately respond to oral iron therapy. Objective: We studied whether iron-deficiency anemia might indicate treatment of subclinical hypothyroidism. Design: Patients were assigned to a control or experimental group: 240 mg/d oral iron alone (iron group) or 240 mg/d oral iron plus 75 mu g/d levothyroxine (iron/levothyroxine group). Levels of hemoglobin, hematocrit, red blood cell count, serum iron levels, ferritin, total iron-binding capacity, TSH, and free T-4 were measured before and after treatment. Setting: The study was conducted at a university hospital outpatient clinic. Patients: Fifty-one patients with coexisting iron-deficiency anemia and subclinical hypothyroidism participated in the study. Intervention: Patients were treated as described above in either the iron group or the iron/levothyroxine group. Main Outcome Measure: A clinically satisfactory increase in hemoglobin was regarded as successful. Results: Mean hemoglobin levels increased by 0.4 g/dl in the iron group [95% confidence interval (CI) 0.2-0.7, P = 0.001], whereas it increased by a mean of 1.9 g/dl in the iron/levothyroxine group (95% CI 1.5-2.3, P < 0.0001). The increase in serum iron was greater in the iron/levothyroxine group by a mean of 47.6 mu g/dl (95% CI 34.5-60.6, P < 0.0001). Increases in hemoglobin, red blood cells, hematocrit, and serum ferritin levels after treatment were statistically significantly greater in the iron/levothyroxine group (P < 0.0001). Starting hemoglobin and increase in hemoglobin were negatively correlated in the iron/levothyroxine group (r = -0.531, P = 0.006). Conclusions: Subclinical hypothyroidism should be treated in iron-deficiency anemia patients when both conditions coexist. This would provide a desired therapeutic response to oral iron replacement and prevent ineffective iron therapy. (J Clin Endocrinol Metab 94: 151-156, 2009)Öğe Images in Emergency Medicine: Acute severe coronary spasm associated with 5-fluorouracil chemotherapy(Bmj Publishing Group, 2006) Duran, Sadık; Bulur, Serkan; Sözen, Serhat Bahadır; Bilir, Cemil; Uyan, Cihangir; Akdemir, Ramazan…Öğe Increased P wave dispersion in hypothyroidism: a sign of risk of atrial fibrillation(Tubitak Scientific & Technical Research Council Turkey, 2009) Akdemir, Ramazan; Eryaşar, Neslihan Ebru; Çelik, Kudret; Güngüneş, Aşkın; Cinemre, Hakan; Bilir, Cemil; Kılıç, HarunAim: As in hyperthyroidism, cardiac arrhythmias can be seen in hypothyroidism. In this study, we measured P wave dispersion among hypothyroid patients to evaluate atrial fibrillation risk. Methods: 75 patients who received first time diagnosis of hypothyroidism and 40 normal control patients were included in this study. Each patient had echocardiographic and electrocardiographic studies were carried out. Groups were compared for statistically significant difference in P wave dispersion, minimum P wave duration and maximum P wave duration. Results: The groups were similar in echocardiographic and electrocardiograpic features. P wave dispersion was significantly higher in the hypothyroid group compared to normal controls (31.9 +/- 9.3 ms vs. 26.5 +/- 9.4 ms, p = 0.003). Minimum P wave duration was significantly shorter in the hypothyroid group compared to controls (63.8 +/- 9.2 ms vs 68 +/- 9.2ms, p = 0.026). Maximum P wave duration was not significantly different between groups (95.4 +/- 12.3 ms vs. 94.7 +/- 8.7 ms, p.0, 74). Conclusion: P wave dispersion was increased in the first time diagnosed clinical hypothyroid patients. This is the first study to evaluate P wave dispersion in clinical hypothyroid patients. We believe that our findings have clinically important implications and provide insight into possible mechanisms of this morbid condition.Öğe Increased Serum Asymmetric Dimethylarginine Levels in Primary Dysmenorrhea(Karger, 2010) Akdemir, Nermin; Cinemre, Hakan; Bilir, Cemil; Akın, Okhan; Akdemir, RamazanBackground: Primary dysmenorrhea is a common disorder among young women, and uterine ischemia plays an important role in pelvic pain. Asymmetric dimethylarginine (ADMA) is accepted as a strong marker of endothelial dysfunction. Objective: To investigate the role of ADMA in primary dysmenorrhea. Methods: Thirty-three patients with primary dysmenorrhea and 29 healthy controls were evaluated in a hospital outpatient clinic-based study. Secondary causes of dysmenorrhea had been ruled out in each patient. LDL cholesterol, triglycerides measured and body mass index were also calculated. Blood samples for determination of ADMA concentration were drawn on the 3rd day of menses in each woman. Groups were compared for statistically significant difference by Mann-Whitney U test. Results: Groups did not differ in age or hormone levels. ADMA level was higher in women with dysmenorrhea compared to healthy controls (Mann-Whitney U test, Z = -2.24, p = 0.025). ADMA levels showed positive correlation with age and erythrocyte sedimentation rate in the first group (Spearman's rho = 0.360, p = 0.040, and r = 0.379, p = 0.029, respectively). Although erythrocyte sedimentation rate and C-reactive protein (CRP) were positively correlated, no significant correlations were found between high-sensitivity CRP and ADMA level in the first group (Spearman's rho = 0.048, p = 0.749). Conclusion: ADMA concentrations are elevated in primary dysmenorrhea compared to healthy controls. This suggests that endothelial dysfunction plays a role in primary dysmenorrhea. Copyright (C) 2009 S. Karger AG, BaselÖğe Isolated Renal Vein Thrombosis Associated With MTHFR-1298 and PAI-1 4G Gene Mutations(Sage Publications Inc, 2010) Cinemre, Hakan; Bilir, Cemil; Akdemir, NerminIsolated renal vein thrombosis is very rare without the presence of nephrotic syndrome. It is more common in the newborns and infants. Whereas major risk factors in adults are the procoagulant states such as protein C or S deficiency, factor V Leiden mutation, primary or secondary antiphospholipid syndrome, severe hypothyroidism, and trauma. Here, we report a case of isolated renal vein thrombosis associated with MTHFR-1298 and PAI-1 4G gene mutations. It should be noted that the presence of MTHFR-1298 and PAI-1 4G gene mutations together might be one of the examples of genetic mutation combinations that increase the likelihood of a thrombotic event.Öğe Kimura disease's: A case report(2009) Cinemre, Hakan; Gökosmanoğlu, Feyzi; Bilir, CemilKimura is a chronic inflamatuary disease at oral mucosa which presents as large subcutaneous nodules or masses on the head or neck of adulthood males. The lesions characteristics are eosinophilia in lymphocytic infiltration, fibrosis and diffuse vascularity. Eosinophilia and elevated blood IgE can be peresent. A 62 years old female with inguinal mass and itching was presented.Öğe Kimura Disease's: A Case Report(Deri Zuhrevi Hastaliklar Dernegi, 2009) Cinemre, Hakan; Gökosmanoğlu, Feyzi; Bilir, CemilKimura is a chronic inflammatory disease at oral mucosa which presents as large subcutaneous nodules or masses on the head or neck of adulthood males The lesions characteristics are eosinophilia in lymphocytic infiltration, fibrosis and diffuse vascularity. Eosinophilia and elevated blood IgE can be present. A 62 years old female with inguinal mass and itching was presented (Turkderm 2009, 43 171-3)Öğe Kimura hastalığı: Olgu sunumu(2009) Cinemre, Hakan; Gökosmanoğlu, Hakan; Bilir, CemilKimura hastalığı; subkutan dokuda nodül veya kitleler şeklinde, özellikle genç ve orta yaşlı erkeklerde baş-boyun bölgesi, oral mukozada görülen kronik inflamatuvar bir hastalıktır. Lezyonlar, lenfositik infiltrasyonların içinde yer alan eozinofiller, fibrozis ve zengin vasküler ağ yapısının varlığıyla karakterizedir. Periferik kanda eozinofili ve serum Ig E artışı olabilir. Olgumuz 62 yaşında kadın olup inguinal bölgede şişlik ve bütün vucudda yaygın kaşıntı yakınması ile başvurdu.Öğe Multiple myeloma bağlı maksiller tutulum sonrası gelişen akut lösemi(2007) Gökosmanoğlu, Feyzi; Cinemre, Hakan; Bilir, CemilMultiple myelom, immünglobulin sekrete eden plazma hücrelerinin malign bir klonunu meydana getiren, transformasyona uğramış B-lenfoid progenitor hücrelerinin proliferasyonunun neden olduğu, kemik iliğini infiltre eden plazma hücrelerinden kaynaklanan, yaşlı popülasyonun neoplastik bir hastalığıdır. Multiple myelom (MM) tüm kemik tümörlerinin %27'sini oluşturur ve bu oran ile kemiğin en sık görülen malign tümörüdür. Lokalize ya da yaygın iskelet sistemi ağrılarının eşlik ettiği kemik tutulumları karakteristiktir. Multiple myelom, genellikle kafatası, klavikula, vertebra, pelvis gibi yassı kemikleri tutar. MM 'da oral bulguların ortaya çıkması, hastalığın ileri dönemde olduğuna işaret eder. Bu nedenle multiple myelom tanılı olguların dikkatli değerlendirilmesi ve bu olgulara multidisipliner yaklaşılmalıdır. Biz, kliniğimizde multiple myelom tanısı alan 60 yaşında kadın bir hastanın takipleri sırasında ikinci molar diş bölgesi lokalizasyonunda myelomatoz maksiUer tutulum sonrası gelişen akut plazma hücreli lösemili bir olgu rapor ettik.Öğe Oral ulcers caused by alendronate use(2008) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Aytuğ, Necip Ö.Bisphosphonates are the drugs which modulate bone turnover and reduce bone reabsorbsion. Hence, they are used in postmenopausal osteoporosis, multiple myeloma or osteolisis associated with malign cancer. The rare complications are appearing more often now because of their wide use in treatments. Most important possible adverse effects belong to gastrointestinal systems; esophagitis, gastric ulcers, dyspepsia, heartburn and rarely oral ulcers, osteonecrosis on jaws and esophagial stricturs are illustrated.Öğe Oral ulcers caused by Alendronate use(Aves Yayincilik, Ibrahim Kara, 2008) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Aytuğ, Necip Ö.Bisphosphonates are the drugs which modulate bone turnover and reduce bone reabsorbsion. Hence, they are used in postmenopausal osteoporosis, multiple myeloma or osteolisis associated with malign cancer. The rare complications are appearing more often now because of their wide use in treatments. Most important possible adverse effects belong to gastrointestinal systems; esophagitis, gastric ulcers, dyspepsia, heartburn and rarely oral ulcers, osteonecrosis on jaws and esophagial stricturs are illustrated.Öğe Plevra sıvısıyla seyreden multipl miyelom (vaka sunumu)(2009) Gökosmanoğlu, Feyzi; Cinemre, Hakan; Bilir, CemilPlevra hastalıkları, farklı akciğer hastalıklarının yanında çok çeşitli sistemik hastalıkların tutulumunun sonucu olarak da ortaya çıkabilmektedir. Akciğer ya da akciğer dışı hastalıkların plevrayı etkilemeleri ile ortaya çıkan en sık görünüm, plevrada sıvı birikimidir. Hematolojik maligniteler nadiren plevra sıvısıyla prezente olabilir. Multipl miyelomda plevra sıvısı nadir bulgudur, malign plazma hücreleri infiltrasyonuna bağlı plevra sıvısı ise çok daha nadirdir. Multipl miyelomda plevra sıvısı genellikle benign karakterdedir, hipoalbüminemi, enfeksiyon, amiloidoza bağlı kalp yetmezliği veya böbrek yetmezliği gibi nedenlere bağlı olarak gelişebileceği akılda tutulmalıdır. Biz, kliniğimize multipl miyeloma bağlı bilateral plevra sıvısı ile gelen 70 yaşında bir erkek hastayı rapor ettik.Öğe Predictors of time to remission and treatment failure in patients with Graves' disease treated with propylthiouracil(Canadian Soc Clinical Investigation, 2009) Cinemre, Hakan; Bilir, Cemil; Gökosmanoğlu, Feyzi; Akdemir, Nermin; Erdoğmuş, Beşir; Büyükkaya, RamazanPurpose: Propylthiouracil is one of the thionamides used in the treatment of Graves' disease. The drug has serious side effects and long-term treatment might be needed to achieve remission. We designed this study to evaluate the clinical and thyroid Doppler characteristics that might predict time to remission and treatment failure in propylthiouracil treated Graves' patients. Methods: 26 patients, among 134 presenting to our university hospital outpatient clinic between Feb -July 2007 and with first time diagnosis of clinical thyroid dysfunction, were clinically and ultasonographically diagnosed with Graves' disease. Doppler parameters, serum thyrotropin, free thyroxine and free triiodothyronine were measured at the beginning of the study and thyroid studies were repeated every 4 weeks until remission. Propylthiouracil 300 mg/day was started for each patient at the time of diagnosis and doses were titrated according to repeat thyroid studies. Patients were treated and followed up for 18 months. Results: Treatment failure was associated with smoking (P = 0.001) and male gender (P= 0.037). Stepwise multiple regression analysis revealed that age, free thyroxine and superior thyroid artery flow rate were predictors of time to remission (P= 0.001, 0.002 and 0.003, respectively). Conclusion: The time to remission in Graves patients treated with propylthiouracil can be predicted using age, serum free thyroxine and superior thyroid artery flow rate. This may help early consideration of alternative treatment for the patients requiring prolonged treatment for remission or for those who fail medical treatment. This would decrease unnecessary, long-term propylthiouracil exposure with its serious side effects.Öğe Regression of the Carotid Intima Media Thickness by Propylthiouracil Therapy in Graves' Hyperthyroidism(Elsevier Science Inc, 2012) Bilir, Cemil; Gökosmanoğlu, Feyzi; Çalışkan, Mustafa; Cinemre, Hakan; Akdemir, RamazanIntroduction: One of the cardiovascular effects of hyperthyroidism is increased carotid intima media thickness (CIMT). The aim of this study is to investigate the CIMT in patients with Graves' hyperthyroidism and the effect of propylthiouracil (PTU) therapy on CIMT. Method: Twenty-six patients with Graves' hyperthyroidism and 33 healthy controls were included in the study. CIMT was measured at the right and left external carotid arteries in every patient in both groups. CIMT was measured before and after the PTU therapy in patients with Graves' hyperthyroidism. Results: There was a significant difference in CIMT between the group of Graves' hyperthyroid patients and the control group (0.72 versus 0.55 mm, P < 0.0001) at baseline. Twenty-five of 26 patients with Graves' disease were followed up for 18 months prospectively. Euthyroidism has been achieved in 21 patients. After 18 months of treatment, CIMT decreased significantly compared with the baseline values [0.84 (0.54-1.3) to 0.72 (0.50-1.2), change 0.12 mm, P < 0.001]. Conclusion: Graves' hyperthyroidism is associated with atherosclerosis as assessed by CIMT. Treatment of Graves' hyperthyroidism with PTU decreases the CIMT.Öğe Relationship of Bone Densitometry and Bone Resorption Markers With Menopausal Type and Duration(Turkish League Against Rheumatism, 2010) Akdemir, Nermin; Bilir, Cemil; Cinemre, Hakan; Pekuz, Muhittin; Gökosmanoğlu, FeyziObjective: Menopause age and bone mineral density are positively related and there is a rapid bone loss in the early postmenopausal period. A ratio of 30% of post-menopausal women are affected from osteoporosis developing due to bone loss and this causes 40% risk of fracture in a 50-year old woman. Materials and Methods: In this sudy, serum osteocalcin and urine deoxypridinoline levels were analyzed in 102 postmenapausal and 48 healthy premenopausal controls who presented to gynecology outpatient clinic. Bone densitometry was obtained from all postmenopausal women. Postmenopausal patients were further divided into four groups according to time since menopause: <5 years, 5-9 years, 10-19 years and > 20 years. Results: Mean (SD) age in 48 premenopausal women was 47.7 (3.7) while it was 56.5 (6.8) in 102 post-menopausal women. 34 out of 102 post-menopausal women had surgical menopause due to bilateral oopheroctomy+hysterectomy while the remaining had natural menopause. No significant difference was found in bone-turnover markers between women with surgical and natural menopause. Conclusion: Although there was not a statistically significant difference between bone-turnover markers, bone mineral density stays lower in surgical menopausal patients and this difference disappear only after about 20 years. Also bone turnover markers are usually high up to five years after surgical menopause and return to normal levels after then. Thus, our study suggested that oopheroctomy does not cause additional risk to hysterectomy. We also suggest that there is not a longterm relationship between serum bone turnover markers or bone density and the etiology of menopause. (Turk J Rheumatol 2010; 25: 29-33)Öğe Tiroid fonksiyon bozuklukları ile mevsimler arasındaki ilişki(Düzce Üniversitesi, 2009) Bilir, Cemil; Cinemre, HakanAmaç: Klinik gözlemleriz doğrultusunda tiroid fonksiyon bozuklukları ile mevsimler arasındaki ilişkiyi araştırdık.Yöntem: Düzce Üniversitesi Tıp Fakültesi İç Hastalıkları kliniğinde, 2006 Şubat -2007 Ocak döneminde polikliniğimize ilk defa başvuran ve daha önce hastalıkları bilinmeyen 2133 hasta dosyası retrospektif olarak incelendi. Tüm hastalar başvuru zamanlarına göre ayrılarak tiroid disfonksiyonu olanların tanı zamanları tespit edildi.Bulgular: Tüm tiroid difonksiyonları değerlendirildiğinde eylül-şubat arası 6 aylık soğuk mevsim periyodunda tüm tiroid fonksiyon bozuklukları yaklaşık %50 (151/96, P =0.04) daha fazladır. Hipotiroid hastalarda sıcak mevsim (Mart-Ağustos) döneminde 34, soğuk mevsim (Eylül-Şubat) döneminde 65 hasta (P =0.022), hipertiroid hastalarda ise (Mart-Ağustos) döneminde 62, soğuk mevsim (Eylül-Şubat) döneminde 86 hasta olup (P >0.1) istatiksel olarak anlam yoktu.Sonuç: Endemik guatr ve uzun yıllar iyot replasmanı yapılan yerlerde diyetsel faktörler her türlü tiroid hastalığını tetikleyebilir ve değişik prevalans ve insidansların oluşmasına sebep olabilir.
