Makale Arama

Familial Mediterranean Fever (FMF) is characterized by attacks and inflammation of serous membranes. After discovery of MEVF mutations, several studies have been carried out about the effect of genotype to phenotype, a number of them showed relationship between genotype and phenotype, but some of them not. The aim of our study was to investigate the relationship between genotype and clinical features in children with FMF. This study was performed with 131 patients who have FMF diagnosis. The demographic data, clinical findings, mutations were investigated retrospectively. 52.7% of our patients were boys, 47.3% were girls. Distribution of the age of diagnosed was different from age of onset of symptoms (p=0.00). The most frequent symptom was abdominal pain (94.7%) and it is followed by fever (91.6%), arthralgia (65.6%) and chest pain (27.5%). Infection, stress, menstruation and physical training triggered the attack in some patients. Respectively, the most common mutations were M694V (50.4%), M680I (26.7%) and 148Q (11.5%). No mutation was detected in 14.5% of our patients. Nausea and vomiting were less in M694V homozygous patients, and arthralgia was higher in E148Q heterozygous patients (p<0.05). We had 3 patients with colchicine-resistant who were siblings. In our study, a significant relationship between phenotype and genotype was not observed. It is difficult to recognize the disease in infancy period, FMF should be considered in patients with frequently admitted to hospital in order to avoid complications.

Familial Mediterranean fever (FMF) is an auto inflammatory disorder characterized by recurrent febrile polyserositis and arthritis attacks. Coexistence of FMF and rheumatoid arthritis (RA) is very rare in the literature. Here, we present a case with FMF and RA. Clinicians should there fore consider the possibility of RA development in FMF patients exhibiting morning stiffness and erosive polyarthritis.

Large vessel vasculitis, although a part of the primary vasculitides, more branches of the aorta and is characterized by chronic granulomatous inflammation, and obliterative changes. Abdominal pain is rarely described as a clinical manifestation of Takayasu arteritis, although abdominal vascular involvement is common in this disease. Until now, at the medical literature, which is the first symptom of acute or chronic abdominal pain have been reported in thirteen cases with Takayasu’s arteritis. In our case, we aimed to present that the diagnosis of the large vessel vasculitis (Takayasu’s arteritis) at the 45 years old woman admitted to the emergency room with acute abdominal pain and her abdominal imaging method showed that organ infarction and widespread thrombosis with branches of the aorta.

Aim: To identify the effects of sex hormones on inflammation and fibrosis on and around gall bladder. Material and method: In this study 48 rabbit (24 male, 24 female) was used. Acute cholecysstitis was achived by cystic canal ligature (SCL) except control groups. Female (DI, DII, DIII, DIV) and male (EI, EII, EIII, EIV) groups had 4 subgroups, each consist of 6 members. Macroscopic findings of acute cholecystitis were evoluated. Adhesive bands around gall bladder and biopsies from gall bladder were protected in deep freezer. Fibrotic bands and gall bladder were analyzed for hidroxyprolin (HP) and collagen. Results: Acute cholecystitis was developed in all subjects macroscopically. On male subjects adhesions around gall bladder were seen more intensively. Result of subjects with ooferectomy were close to male subjects. On castrated male subjects adhesions were similar to female subjects. The adhessons were less at female subjects with ooferectomy with external estrogen use. The lesions were more at castrated male subjects with external testosteron use. These findings were relevant with quantitative values of HP. Collagen were found more in male subjects compored to female subjects. Conclusion: The results is castrated males were similar to those in females and with usage of external testosteron male type results were achieved. And the similarity of results in female subjects with ooferectomy to males achivement of female type results with usage of external estrogens clearly shows us inflammation and fibrosis increasing effect of male sex hormones in acute cholecystitis.

Aim: Sarcoidosis is a multifactorial disease with unknown aetiology and characterized by non-caseous granulomatous inflammation. The pathogenesis of sarcoidosis is defined as inflammation and autoimmune activation. Here, we aimed to evaluate plasma clusterin (CLU) and α-klotho levels in those with sarcoidosis.                                        

Patients and methods: Forty patients with sarcoidosis (mean age: 52.10±12.60 years; 12 males, 28 females) and 40 healthy volunteers (mean age: 37.40±18.20 years; 12 males, 28 females) were enrolled into the study. Blood samples were drawn from both groups, and plasma CLU and α-klotho levels were investigated by enzyme-linked immunosorbent assay (ELISA) technique.                                                               

Results: Patients with sarcoidosis had significantly higher plasma CLU levels (309.73±40.68 ng/mL), compared with healthy controls (117.86±102.03 ng/mL) (p=0.005). The plasma levels of α-klotho were measured as 5.34±7.30 in the sarcoidosis patients and 7.21±9.84 ng/mL in the controls. A minimal decrease was observed, but there was no statistically significant difference (p=0.338). The hemoglobin levels of sarcoidosis patients were decreased, when compared with the control group (12.93±1.02 g/dL vs 14.06±1.50 g/dL) (p=0.012).                                                                    

Conclusion: We concluded that sarcoidosis is associated with high levels of CLU. Plasma CLU may be a potential biomarker of sarcoidosis. Based on literature and to the best of our knowledge, this is the first study to provide insight in the determination of plasma levels of CLU and α-klotho in sarcoidosis. Further and comprehensive investigations are needed to clarify the entity.

Purpose: In this study, contrubitions of computed tomography (CT) and magnetic resonance imaging (MRI) were researched in the diagnosis of benign paranasal sinüs (PNS) lesions. Materials and methods: According to the clinical findings, between January 2001 – February 2004, 30 cases have been studied who were thought to have benign lesions belonging to nasal cavity, PNS or neighboring structures. CT and MRI studies are made to the all case. Inner structure characteristics, locations and radiological apperarances coursing pathological diagnosis of lesions in CT and MRI have been assessed. Results: The histopathological diagnoses of lesions were mucocele (8), odontogenic cysts (4), fibrous dysplasia (3), inverted papilloma (2), hemangioma (2), menengioma (2), schwannoma, osteoma, osteochondroma, paget disease, ameloblastom, giant cell tumor, central giant cell granuloma. Whwn assessed according to pathological results, sensitivity of CT and MRI were found to be 86.6% and 83.3% respectively. In 3 cases showing radiological malign feature (1 giant cell tumor, 2 inverted papillomas) the correct diagnosis was made histopathologically. Canclusion: CT is an effective method to show bone expansion and destructions, tumors originated from bone and intratumoral calcifications. MRI offers better the inner structures of cystic lesions, intratumoral hemorhages and differentiation of tumor from inflammation. Therefore, CT and MRI should be used jointly in the evaluation of the PNS lesions.

Mesenteric panniculitis is a situation which effects adipose tissue of the mesentery with inflammation and fibrosis. There may be symptoms like stomachache, nausea, vomiting or asymptomatic. Trauma, abdominal surgery, infection are the main causes and recently its association with the malignancy has been increased. We reported asymptomatic mesenteric panniculitis in a patient with chronic lymphocytic leukemia that hasn’t been experienced before in the literature.

Abdominal actinomycosis is a rare infectious disease caused by an anaerobic bacterium actinomyces israeli. Pelvic actinomycosis is generally associated with the use of intrauterin devices (IUD). This chronic suppurative infection can mimic pelvic malignancy. The diagnosis of the disease is frequently miss preoperatively. The surgeons must be aware of this rare complication in order to avoid an extensive surgical procedure. Case: We present the case of a 31 year old premenoposal woman with an abdominal pain and a history of IUD us efor 6 years. On physical examination the patient had tenderness on right lower abdomen and a palpable cystic mass 8x10 cm in size on pelvic bimanual examination. A preoperative transvaginal USG showed a 9x9 cm cystic mass originated from right ovary. The patient was taken to the emergency operating suite with the diagnosis of torsion of the right cystic ovary by gynaecologist. During the exploratory laparotomy we observed an extensive diffusely infiltrating process involving right adnexa, sigmoid colon sacrum and right pelvic Wall. A loop of jejunum was adherent to this infiltrating process and a mass 5x6 cm in size was palpated in sigmoid colon. These findings were highly suggestive of a colonic carcinoma and the patient was consulted with a general surgeon intraoperatively. Right salpingo -ooferectomy + sigmoid resection + segmental jejunal resection was performed. Pathologic findings showed chronic inflammatory tissue with evidence of actinomycosis. Conclusion: The case described here underlines that surgeons must be aware of this unusual infectious disease in the differential diagnosis of pelvic mass.

Aim: Bullous pemphigoid (BP) is a bullous dermatosis frequently seen in advanced age that is caused by antibodies reacting to antigens in the dermoepidermal junction. It has been reported that as a result of autoantibody-induced inflammation, inflammatory mediators are increased in patient sera and bullae, and that these increased mediators might be related to disease severity. Neutrophil lymphocyte ratio (NLR) is determined by dividing the number of neutrophils by the number of lymphocytes; it is a parameter that has been previously studied in inflammatory diseases such as urticaria, psoriasis, pemphigus vulgaris and cutaneous vasculitis and has been associated with the disease. The present study investigated the utility of NLR, the marker of systemic inflammation, as a marker in patients with BP. Patients and Methods: Medical records of patients diagnosed with BP between January 2013 and December 2017 were reviewed. By evaluating the laboratory results in their files, the mean platelet volume (MPV), neutrophil count, lymphocyte count, and neutrophil lymphocyte ratio calculated by dividing the number of neutrophils by the number of lymphocytes were recorded. Results: The study included 26 patients with BP and 25 control patients. Neutrophil count (P = 0.005) and NLR (P = 0.04) were found to be higher in patients with BP compared with the control group. No difference was found in lymphocyte count and MPV between the groups. Conclusion: To our knowledge, this is the first study to investigate NLR in patients with BP in the etiopathogenesis of which inflammation takes a part. We believe that NLR, a parameter that can be easily calculated by a whole blood count for systemic inflammation, can be a marker that can be used in the diagnosis of BP.

Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. 

Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments.

Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001).

Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

Thyroid ectopy is caused by failure of the descent of thyroid tissue through thyroglossal duct during embryological development. Base of the tongue is the most common ectopic localisation of thyroid gland. It is usually asympthomatic. Adenoma, hyperplasia, inflammation, malignancy similarly can be seen in ectopic thyroid tissue, as may occur in normal thyroid tissue. In this report, we present the case who has no thyroid tissue on normal localisation, searched for ectopic localisation with scintigraphycally; treated for hypothyroidism and followed.

With the understanding that adipose tissue is not only a passive energy store, but also an endocrine organ, interest in bioactive factors secreted from adipose tissue has increased. Adipose tissue, consisting of pre-adipocytes, macrophages, endothelial cells, fibroblasts and leukocytes, as well as adipocytes, has an important role in systemic metabolic regulation. Chemerin, called tazarotene-induced gene 2 (TIG2) or retinoic acid receptor responder 2 (RARRES2), was first discovered in 1997 in psoriatic skin lesions as a retinoic acid-sensitive gene. It was later determined that chemerin regulates adipogenesis and adipocyte metabolism, with data showing that it alters adipocyte differentiation, expression of important genes in glucose and lipid metabolism, and is classified as a new adipokine. The effects of chemerin in circulating and inflammatory fluids are mediated through receptor G protein-bound receptor chemokine-like receptor 1 (CMKLR1). The increase in the number of clinical trials associated with increased levels of local and / or circulating chemerin in various diseases, from obesity, metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome (PCOS) to inflammatory diseases, supports the important roles of chemerin in the pathogenesis of these diseases. Although it is clear that serum chemerin levels increase in these diseases, the mechanisms regulating the expression of the chemerin are not fully understood. More randomized controlled studies are needed to understand the mechanisms of action of chemerin.

Sydenham’s Chorea (SC) is a neurological movement disorder that results from antistreptocpccal antibodies cross-reacting with brain tissues, especially basal ganglia and causing to an inflamatory reaction. According to the 1992 modified Jones criteria, acute rheumatic fever is a major criterion and is sufficient evidence on which to base a diagnosis. SC is frequently seen in the 5-15 years of age. It appears approximately 6 months later from the attack of ARF. SC usually continues 4-6 weeks, it may be permanent. Carditis accompanies SC much more frequently than the other signs of ARF. SC is a neuropsychiatric disorder that may present with anxiety, emotional lability, obsessive compulsive symptoms, attention deficit and hyperactivity symptoms or tics. Most of the cases improve spontanously and many treatment are available. Recurence is common. Penisilin prophylaxis should continued to avoid carditis and recurrence. SC is considered to be the most common cause of acquired chorea in devoloping countries. Even though it has been recognized for centuries, it has kept up its importance by periodic exacerbations. SC and ARF are still declining in recent years in our country, together with which is a significant cause of morbidity as a public health problem.

Aim: Multiple sclerosis (MS) is an immune- mediated disease of the central nervous system. We will emphasize in this article; very different mechanisms, and complex interactions have important role in immunopathology of multiple sclerosis. Main Findings: The pathogenesis of MS is best viewed as a complex interaction between genetically predetermined susceptibility markers and environmental stimuli. MS is charecterized by inflammation, demyelination, apoptosis in oligodendrocytes, remyelination, and axon loss. Immune reaction against different components of the central nervous system (particularly myelin structures) are thought to play an important role in the initiation of the destructive process. The inflammation in MS appears to be caused by an overactive pro-inflammatory TH1 profile in T cells. Demyelination can result as a consequence of direct damage to myelin by inflammatory cells or indirectly because of the enviroment produced by inflammation. Axon loss occurs in MS lesions starting early in the disease. Conclusion: MS occurs with different immünopathological mechanisms.

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

Chronic otitis media and mastoiditis are the result of infection by an organism of low virulence or of acute infection with incomplete resolution. Mastoid inflammation produces thickening of some trabeculae secondary to reactive new bone formation and at the same time mineralization of other trabeculae. A cholesteatoma is an epidermoid cyst that consists histologicaly of an iner layer of stratified squamous epithelium. The lumen of the cyst is filled with desquamated epithelial debris. As the cyst enlarges and comes into contact with contigious bony structures of the middle ear, mastoid and petrous pyramid, erosion of these structures occurs owing to pressure necrosis and enzymatic lysis of bone. Ossicular erosion is seen %70 ratio. Ossicular erosion is seen later and the long crus of incus is eroded the most frequently. But the bigger lesions may make erosion whole ossicles. Cholesteatomas may make tegmen erosion, mastoid cortex irregularity, fasial nevre contour irregularity and semisircular canal defect according to bigness and period. Tympanosclerosis develops in the result of collecting hyalin and calsific deposits in tympanic membran and the submucosa of middle ear. These are tympanosclerotic plugs. It appears in the result of otitis media or trauma.

Aim: Studies of paediatric acute pancreatitis have remained in the shadow of adult literature for many
years, and have only increased following the recent acceptance of the severity classification. There is now
a need to determine inflammatory biomarkers which will be able to rapidly predict in the early stage which
patients will develop severe disease. This study's purpose was to research the efficacy as early predictors
and determine cutoff values for inflammatory biomarkers including the systemic immune-inflammation
index (SII), and the neutrophil-lymphocyte ratio (NLR).
Patients and Methods: A retrospective evaluation was made of the clinical characteristics, laboratory
test results, and imaging findings of 53 children diagnosed with acute pancreatitis between 2019-2022.
The study population were separated into groups as ‘mild’ and ‘moderately severe-severe’ according
to severity. The groups were compared in respect of inflammatory markers. Factors predicting disease
severity were evaluated with ROC curve analysis. For the significant cutoff values, positive predictive
value (PPV), negative predictive value (NPV), sensitivity and s pecificity were calculated.
Results: The NLR, and SII values were found to be statistically significantly higher in the “moderately
severe-severe” group than in th “mild” group (p<0.001 for all). The cutoff values of NLR≥3.33 (AUC:0.894,
95% CI:0.81-0.979, PPV 89.7%, NPV 83.3%), and SII≥1225.57 (AUC:0.912, 95% CI:0.831-0.992, PPV
90.0%, NPV 87.0%) were determined to be able to predict disease severity with high sensitivity and
specificity.
Conclusion: The NLR, and SII are inflammatory biomarkers that can make an early prediction of a poor
outcome in paediatric acute pancreatitis. To the best of our knowledge, this is the first study to have
evaluated the prognostic importance of these biomarkers, in pae diatric acute pancreatitis.

Wound healing is a physiological process consisting of hemostasis, inflammation, proliferation, and
maturation phases. The disruption that occurs at any stage of these intertwined phases is presented to the
clinician as a chronic wound. The stromal vascular fraction, isolated as a part of the aqueous fraction after
enzymatic or mechanical digestion of lipoaspirate, is an important mesenchymal stem cell reserve, as
well as. It is considered a heterogeneous tissue cocktail due to the preadipocytes, endothelial precursors,
immune cells, hematopoietic cells, fibroblasts and pericytes it contains. Because of its proangiogenic,
antiapoptotic, antifibrotic, immunomodulatory, and anti-inflammatory activities, as well as its advantages
in isolation, stromal vascular fraction has lately acquired prominence in current wound therapy. Although
SVF alone is not effective for wound healing, it is a new and effective technology that provides adequate
cell count and viability for proper wound care and wound bed preparation prior to reconstruction and to
minimize surgical failure.

Introduction: Circulating stem cells (CSCs) are released from bone marrow in to the circulation after myocardial injury to improve tissue repair. Radiofrequency ablation (RFA) of cardiac arrhythmias, particularly for atrial fibrillation, has been shown to trigger the release of CSCs through inflammatory mediators. We aimed to investigate whether CSCs are increased in the circulation following non-extensive ablation procedures such as slow pathway or accessory pathway ablations.

Methods: Twenty-six patients [13 females, 54 (18-74) years old] who underwent slow pathway ablation for atrioventricular nodal reentrant tachycardia (n=18) and accessory pathway ablation for atrioventricular reentrant tachycardia (n=8) were included. Peripheral blood CD34+ cell count and multiple serologic markers [troponin I (Tn-I), C-reactive protein (CRP), interleukin-6 (IL-6), stromal cell derived factor (SDF) 1 alpha] were evaluated before the ablation procedure and 7 and 30 days after the procedure.

Results: The CD34+ cell count was significantly increased on the 7^th day after the procedure when compared to baseline [33 (15-133) vs. 22,5 (5-79) cells per microliter respectively, P<0.001]. The CD34+ cell count was similar to baseline on the 30^th day following the procedure. Levels of Tn-I, CRP, IL-6 and SDF1-α did not change significantly following ablation. The amount of energy applied during RFA (watts) was significantly correlated with the 30^th day CD34+ cell count (r: 0.460; p= 0.018).

Conclusions: Peripheral blood CSCs are increased after slow pathway or accessory pathway ablations which are less extensive ablations compared to atrial fibrillation ablation. The levels return to baseline by the 30^th day following the procedure. The increase in CSCs was positively correlated with the amount of energy delivered during the procedure.

Asthma is one ofthe commonest diseases in children and adults İn many countries. The prevalence of asthma has dramatically increased in recent years. The development of asthma depend on an interaction between genetic factors, environmental exposure to allergens, and nonspesific adjuvant factors such as tobacco smoke, air pollu- tion, and vira! infections. These factors initiates a series of immunological changes, resulting in airvvay inflamma- tion. The airvvay inflammatory process is characterized by chronic eosinophilic and Th2 type lymphocytic infiltra- tion. Although the knovvledge about asthma pathogenesis has increased, the prevalence of asthma has not decreased. Therefore, the asthma stili is a threat for the society’s health at the beginning of the 21 st century.

Aim: Lateral elbow tendinopathy is primarily associated with an extensor dysfunction of extensor digitorum
communis, extensor carpi radialis brevis and extensor carpi ulnaris muscles. The secondary functions
of extensor carpi radialis brevis and extensor carpi ulnaris are radial and ulnar deviation movement
of the wrist, respectively. We hypothesized that common extensor tendon cannot fully rest, due to this
antagonistic strength of wrist (radio-ulnar) as a vicious circle. We aimed to explain the chronic persistent
pathophysiological mechanism that prevented complete recovery and to present results of this novel
exercise method in the study .
Patients and Methods: 47 LET patients (exercise: 27; control: 20) were included in the case-control
study between 2015 and 2016. The exercise consisted of ulnar to radial deviation for the exercise group.
The patient-rated tennis elbow evaluation (PRTEE) test was used for measurements at baseline, 1st , 6th,
and 12th months. Mixed models were used to compare these score s of the two groups.
Results: There was no difference between the PRTEE baseline scores of the exercise and control groups
(t:-0.22, p:0.830). The PRTEE scores in the 1st ,6th, and 12th months were significantly lower in the
exercise group than in the controls ( t: -3.71, p: 0.0003; t: -3.88, p:0.0002; t: -2.28, p:0.024, respectively).
Conclusion: Common extensor tendon cannot fully rest, due to this antagonistic strength. The exercise
method, which aims to decrease the antagonistic tension on the tendon, was found to be effective, which
may contribute to understand the prolonged inflammation and/or tendinosis mechanism.

Acute pancreatitis is an important cause of acute abdominal pain in children and requires prompt treatment because it may become life-threatening. The incidence of acute pediatric pancreatitis is increasing. Although epidemiology of acute pancreatitis, clinical manifestations and acute pancreatitis course in children are generally different than in adults, information about etiology, management and results are obtained on the basis of adult studies. In most cases, inflammation may limit itself, but in some cases acute pancreatitis, acute recurrent pancreatitis or chronic pancreatitis may progress. It is necessary to provide optimal management in the acute period of pancreatitis in children, as this may prevent secondary conplications. In this review we summarise the epidemiology of acute pancreatitis, role of imaging and imaging findings in the diagnosis of acute pancreatitis, treatment methods and management and complications of acute pancreatitis.