Browsing by Author "Bayindir, P"
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Item The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritisTikiz, H; Arslan, Ö; Pirildar, T; Tikiz, C; Bayindir, PObjective: To investigate the effects of tumor necrosis factor (INF)-alpha antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0 +/- 10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0 +/- 6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2 +/- 0.8% to 7.9 +/- 1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6 +/- 1.1% to 7.0 +/- 1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2 +/- 6.8 to 9.2 +/- 5.1 mm/h, p=0.003 and from 14.68 +/- 3.4 to 9.25 +/- 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-alpha blockers in patients with active RA may reduce the high incidence of cardiovascular complications. (Anadolu Kardiyol Derg 2010; 10: 98-103)Item Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweightAkinci, G; Akinci, B; Coskun, S; Bayindir, P; Hekimsoy, Z; Özmen, BOBJECTIVE: Childhood obesity is associated with impaired endothelial function, insulin resistance and inflammation. Being at risk for overweight has been defined as having a body mass index (BMI) between the 85(th) and 94(th) percentile for age and sex. In this study, we looked for features linked to cardiovascular, risk in children who are at risk for overweight. DESIGN: Twenty-one children who were at risk for overweight (study group) and 20 children with a BMI between the 25(th)-74(th) percentiles (controls) were studied. Fasting blood levels of glucose, insulin, total cholesterol, HDL cholesterol, triglycerides, uric acid, fibrinogen and high sensitive C-reactive protein (CRP) were assessed in both groups. LDL-cholesterol, HOMA-IR and QUICKI indices were calculated. Flow-Mediated Vasodilatation (FMD) was determined for the evaluation of endothelial function. RESULTS: Increased HOMA-IR was observed in children who were at risk for overweight. Waist circumference was the main predictor of insulin resistance in these children. Higher levels of CRP were found in the study group compared to controls, while plasma fibrinogen died not differ in the two groups. The children who were at risk for overweight had lower FMD values and slightly elevated lipids compared to controls; however, these differences were not statistically significant. CONCLUSION: Insulin resistance and inflammation indices were higher in children who were at risk for overweight as has been shown for obese children. The data suggest that appropriate treatment strategies for weight control are essential not only for obese children but also for those at risk for overweight.Item Diagnosis of Bronchiolitis Obliterans with Computed Tomography in ChildrenSmith, KJ; Dishop, MK; Fan, LL; Moonnumakal, SP; Smith, EO; Bayindir, P; Guillerman, RPHistopathology has been considered the gold standard for diagnosis of bronchiolitis obliterans (BO). Although chest computed tomography (CT) has gained acceptance as an alternative tool for diagnosis, no systematic studies validating the diagnostic accuracy of chest CT have been performed in children with BO unrelated to transplantation. A study was undertaken to provide estimates of the strength of association between CT findings and the presence or absence of BO, and to determine if chest CT is predictive of lung biopsy results. In a single-center, retrospective, case control study, 120 children who had both a chest CT and lung biopsy and no history of lung, heart lung, or bone marrow transplant were included in this study. Chest CTs were scored for the presence or absence of 24 individual CT findings by a blinded subspecialty-trained pediatric radiologist. Lung biopsies were reviewed by a pediatric lung pathologist for the presence of airway fibrosis, which was classified as mild, moderate, or severe. Ten children had moderate-to-severe BO by lung biopsy. The presence of parenchymal hypoattenuation (P = 0.003) and bronchiectasis (P = 0.001) distinguished these patients from the remaining 110 patients who formed the control group. Combinations of findings improved specificity, and the combination of parenchymal hypoattenuation and vascular attenuation was highly specific (specificity 99.1%; positive likelihood ratio 22.2 and 44.4 for moderate and severe disease, respectively). However, the sensitivity of individual and combination findings was modest. In children with moderate or severe BO, a confident diagnosis can be made with a chest CT that has characteristic radiographic findings, thus avoiding the need for open lung biopsy. However, CT is not an effective screening tool for excluding BO.Item Atherosclerosis risk factors in children of parents with the metabolic syndromeAkinci, G; Coskun, S; Akinci, B; Hekimsoy, Z; Bayindir, P; Onur, E; Ozmen, BBackground: Metabolic syndrome is a constellation of disorders that produces a high risk of atherosclerosis. Endothelial dysfunction is the key event in atherosclerosis and already present even in the childhood. The aim of the present study is to investigate inflammatory and radiological signs of atherosclerosis in children who have parents with the metabolic syndrome. Design and methods: Fifty children of parents with the metabolic syndrome and 38 age- and sex-matched controls were studied. Anthropometric measurements, blood pressure assessment, echocardiography, flow-mediated vasodilatation (FMD) which is a non-invasive test for the evaluation of endothelial function and fasting blood measurements including blood glucose, insulin, total cholesterol, HDL cholesterol, triglyceride, hsCRP and soluble CD40 ligand were performed. Results: Serum sCD40L and hsCRP levels were significantly higher in the study group compared to the controls. FMD values did not differ between the study and control groups. Increased serum sCD40L levels were positively correlated with body mass index, waist hip ratio, LDL/HDL cholesterol ratio, and the number of metabolic syndrome components in parents, whereas showed negative correlation with the serum HDL cholesterol levels. High hsCRP levels were positively correlated with body mass index and the number of metabolic syndrome components. Multiple regression analysis demonstrated that the number of metabolic syndrome components in parents presented as being a significant predictor of the serum sCD40L and hsCRP levels of their children. Conclusion: Our results suggest that children of patients with metabolic syndrome have higher values of the serum markers of inflammation, which may be associated with increased risk for development of cardiovascular disease. (C) 2007 Elsevier Ireland Ltd. All rights reserved.Item CT study on morphometry of frontal sinusTatlisumak, E; Ovali, GY; Asirdizer, M; Aslan, A; Ozyurt, B; Bayindir, P; Tarhan, SThe aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.Item Elongated Styloid Process and Cervical SpondylosisUnlu, Z; Orguc, S; Eskiizmir, G; Aslan, A; Bayindir, PBackground: Dysphagia, is a significant sign of many different lesions in upper digestive system especially in proximal esophagus. Tumors, gastroesophageal reflux, achalasia and extrinsic compressions are the most common causes that may lead to dysphagia in geriatric population. Cervical osteophyte induced dysphagia, is one of the uncommon reasons of dysphagia, therefore other causes of dysphagia must be excluded to establish the exact diagnosis. Eagle syndrome is one of the considerable reason which may lead to misdiagnosis in patients with cervical osteophytes. In this case report, we represent four patients who had dysphagia due to anteriorly located cervical osteophytes and evaluate the patients with special reference to Eagle syndrome. Material and methods: After a detailed anamnesis and ENT examination, cervical plain radiographs in four projections and Towne radiographs were obtained for every patient. After that, magnetic resonance imaging (MRI) of cervical spine and barium swallowing studies were performed to evaluate the presence of esophageal compression. Results: Eagle syndrome was excluded due to absence of other symptoms and physical signs, eventhough unilateral or bilateral elongation of styloid processes was found in all of the patients. Conclusion: Cervical osteophytes induced dysphagia is a rare clinical entity, diagnosis should be done by a careful examination, intensive radiologic evaluation. Moreover, all the other causes like Eagle syndrome should be excluded during the diagnosis of cervical osteophyte induced dysphagia.Item Radiologic features of lumbar spine in ochronosis in late stagesBayindir, P; Ovali, GY; Pabusçu, Y; Temiz, C; Duruoz, TOchronosis is a rare hereditary disorder of tyrosine metabolism. Severe degenerative arthritis and spondylosis occur in the later stages of this disease. Radiologic examinations may reveal changes considered almost pathognomonic for ochronosis. We present the radiologic features of the lumbar spine in two ochronotic patients who were diagnosed after radiologic examinations in the late stages of the disease.Item CT and MRI examinations left behind in the radiology departmentGöktan, C; Pekindil, G; Örgüc, S; Tunçyürek, Ö; Bayindir, P; Öner, MPURPOSE To retrospectively document the reported computerized tomography (CT) and magnetic resonance imaging (MRI) examinations that were left behind in our radiology department, to calculate their cost, and to determine possible sources of waste in order to draw attention to this subject. MATERIALS AND METHODS The reported and billed CT and MRI examinations for 2003 that were not taken from the radiology department were documented, and the percentage they represented of all CT and MRI performed that year were determined. The total cost of the examinations, including contrast media, was calculated. RESULTS In all, 200 CTs out of 4390 and 95 MRIs out of 7003 were left behind in the radiology department during 2003. Total cost of the examinations, including the contrast media, was 31,320 YTL. CONCLUSION The percentages of CT and MRI examinations left behind in the radiology department were evaluated in this preliminary report. Since we did not find any similar study in the literature, we could not comment on the limits of acceptability of the results; however, we think other radiology departments should determine the percentages CTs and MRIs that are left behind and take the necessary precautions to minimize waste and reduce expenses.Item Co-occurrence of internal carotid artery agenesiswith multicystic dysplastic kidneyOvali, GY; Tarhan, S; Bayindir, P; Polat, M; Akil, ICongenital absence of Internal Carotid Artery (ICA) is a rare disorder. This anomaly may be an isolated entity or may be associated with other organ, or system anomalies (1). Multicystic Dysplastic Kidney (MCDK) is a congenital mal-development in which the renal cortex is replaced by numerous cysts of multiple sizes. Urologic and non-urologic anomalies may accompany MCDK (2). In this paper, we detail a case of congenital agenesis of ICA and the existence of MCDK. To our knowledge, this is the first of such a case to be reported regarding the co-occurrence of ICA agenesis and MCDK.Item Effects of angiotensin-converting enzyme inhibition and statin treatment on inflammatory markers and endothelial functions in patients with longterm rheumatoid arthritisTikiz, C; Utuk, O; Pirildar, T; Bayturan, O; Bayindir, P; Taneli, F; Tikiz, H; Tuzun, CObjective. To investigate the effects of angiotensin-converting enzyme (ACE) inhibitors and statins (hydroxy-methyl-glutaryl-CoA reductase inhibitors) on inflammatory markers and endothelial functions in patients with rheumatoid arthritis (RA). Methods. A total of 45 patients with longterm RA were randomized into 3 groups to receive 8 weeks of treatment with placebo (n = 15), simvastatin (20 mg/day, n = 15), or quinapril (10 mg/day, n = 15) as an adjunct to existing antirheumatic drug treatment. Factors with a role in the development of endothelial dysfunction, such as C-reactive protein (CRP), fibrinogen, nitric oxide (NO), and serum cytokine concentrations including interleukin 1 beta (IL-1 beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) were measured at baseline and in the posttreatment period. Brachial artery vasodilator responses were assessed by high resolution ultrasound to evaluate endothelial functions. Results. Simvastatin treatment significantly decreased serum CRP and TNF-alpha [from 14 6 to 7 3 mg/l (p = 0.025) and 30 +/- 5 to 16 +/- 4 pg/ml (p = 0.012), respectively], while quinapril had no significant changes in these 2 measures. IL-1 beta and IL-6 showed insignificant changes in patients in the 2 drug groups. Endothelium-dependent vasodilatation was improved significantly in the simvastatin group [from 5.3 +/- 1.1% to 8.9 +/- 1.4% (p = 0.025)], while there was no difference in endothelium-independent vasodilatation [9.0 +/- 1.8% to 11.2 +/- 2.5% (p = 0.17)]. The quinapril group showed no significant changes in both types of vasodilation although there was a tendency to an increase in endothelium-dependent vasodilatation [from 6.1 +/- 0.8% to 7.8 +/- 0.7% (p = 0.06)]. Treatment with the 2 drugs had no significant effects on resting arterial diameter. Conclusion. We show that simvastatin 20 mg daily improves endothelial function in patients with RA. Its beneficial effect may be attributed to lowering CRP and TNF-a concentrations. ACE inhibition with daily 10 mg quinapril was found to have no significant effects on inflammatory markers and endothelial vasodilator response.Item Unusual long bone and metacarpo-carpal abnormalities in a case of pseudo-pseudohypoparathyroidismUnlu, Z; Orguc, S; Ovali, GY; Bayindir, PA case of pseudo-pseudohypoparathyroidism (PPH) with shortening of the left femur and tibia and coalition of the base of the fourth metacarpals with capitatum and hamatum in bilateral wrist joints was presented. Involvement of the fourth digits both in hands and feet were more prominent on the left side, with shortening of the left leg.Item The value of ultrasonography alone in screening surveys of cystic echinococcosis in children in TurkeyKilimcioglu, AA; Özkol, M; Bayindir, P; Girginkardesler, N; Östan, I; Ok, ÜZA total of 1205 primary school children were examined for cystic echinococcosis in five villages of Manisa, Turkey, to evaluate the efficacy of diagnostic methods of this infection in community-based screening surveys. Six hundred and thirty children from three villages, examined by a portable ultrasound scanner, chest microfilm and serological methods (ELISA, indirect hemagglutination) in our previous study, were designated as Study Group 1; and 575 children, from two adjacent villages, examined by ultrasonography alone in the present study, were designated as Study Group 2. In Study Group 1, hepatic cystic echinococcosis was detected in two cases (0.3%) by ultrasonography, while 43 (8.9%) and 49 (10.1%) cases were found to be positive for cystic echinococcosis by ELISA and indirect hemagglutination, respectively. Three of 575 children (0.5%) were diagnosed with cystic echinococcosis (two hepatic and one renal involvement) by ultrasonography alone in Study Group 2; and lung lesions were later detected in both cases with liver involvement by chest radiography. Our results suggested that serological tests may be beneficial in suspected cases for confirmation and differential diagnosis, but have some drawbacks, such as discrepancy in results and high false seropositivity rates. Chest microfilm is not easy in field studies and exposure to X-ray is undesirable. As a reliable, simple, inexpensive and rapid technique, ultrasonography alone is recommended to be used in community-based screening surveys for cystic echinococcosis with confirmatory tests for suspected cases found during the screening program. (c) 2006 Elsevier Ireland Ltd. All rights reserved.Item Radiation safety in invasive pain medicineYentür, EA; Bayindir, P; Pabuscu, YInvasive procedures have been an inseparable part of contemporary pain medicine. As a result, flouroscope has been an indispensable equipment in our daily practice but this development brings some questions into mind like how much knowledge do we have about the operation of flouroscope, ionizing radiation and radiation safety? We aimed to give basic information about radiation physics, ionizing radiation. Besides, important points about radiation safety will be specially emphasized.Item A rare disorder: idiopathic tumoral calcinosisOvali, GY; Tarhan, S; Serter, S; Bayindir, P; Okcu, G; Demireli, P; Pabuscu, YItem Selective COX-2 inhibition with different doses of rofecoxib does not impair endothelial function in patients with coronary artery diseaseTikiz, C; Ütük, O; Bayturan, O; Bayindir, P; Ekmekçi, C; Tikiz, HIn this study, we investigated the effects of both 25 and 50 mg daily doses of rofecoxib on the endothelial functions of patients with coronary artery disease (CAD). For this purpose, 34 patients with documented severe CAD and who were under aspirin treatment (300 mg/day) were randomized to receive 4 weeks of treatment with a placebo (n = 10, group I), rofecoxib 25 mg/day (n = 12, group II), and rofecoxib 50 mg/day (n = 12, group III). Brachial artery vasodilator responses were measured in order to evaluate endothelial function. The percentage of change in endothelial-dependent vasodilation in groups I, II, and III were similar at the baseline level and showed no significant change after treatment (6.2 +/- 3.9% vs. 5.9 +/- 3.1% and 5.8 +/- 3.3% vs. 5.6 +/- 3.8% and 6.1 +/- 4.5% vs. 5.8 +/- 4.1%, respectively; P > 0.05). Compared with the baseline, endothelium-independent vasodilatation, as assessed by nitroglycerine (NTG), remained unchanged after the treatment period (11.2 +/- 6.9% vs. 10.3 +/- 7.1% and 11.2 +/- 6.3% vs. 9.9 +/- 5.1% and 9.5 +/- 4.9% and 8.8 +/- 4.6 %, respectively; P > 0.05). Treatment with both doses also showed no significant effects on high-sensitivity C-reactive protein (hs-CRP) levels and resting arterial diameters (P > 0.05). In conclusion, 4 weeks of treatment with standard and high doses of rofecoxib showed no significant effects on either endothelial-dependent or independent vasodilator response or plasma hs-CRP levels in patients with severe CAD taking concomitant aspirin.Item Is Helicobacter pylori related to endothelial dysfunction during childhood?Coskun, S; Kasirga, E; Yilmaz, O; Bayindir, P; Akil, I; Yuksel, H; Polat, M; Sanlidag, TBackground: Helicobacter pylori infection has been proposed to have a role in the development of atherosclerosis preceded by endothelial dysfunction. The aim of the present study was to determine if a relationship exists between H. pylori infection in childhood and endothelial dysfunction and level of high-sensitivity C-reactive protein (hsCRP). Methods: Between October 2003 and November 2004, 28 subjects who were anti-H. pylori IgG-positive and 25 who were anti-H. pylori IgG-negative were included in the study. Mean ages of the H. pylori-positive and negative groups were not significantly different. Endothelial functions were evaluated on Doppler ultrasonography of the brachial artery. Percent ratio of the change in systolic diameter during hyperemic phase to the basal diameter was evaluated. Each subject's serum was tested for hsCRP, homocysteine and lipids. Results: Percent ratio of the change in systolic diameters during hyperemic phase to the basal diameter was not significantly different between the H. pylori-negative and -positive groups (P > 0.29). Mean levels of hsCRP were also not significantly different (1.48 +/- 1.8 g/dL vs 2.35 +/- 3.33 g/dL; P > 0.24). Similarly, serum levels of lipids and homocysteine were not significantly different (P > 0.05 for all lipids). Conclusions: Non-invasive techniques used in the present study were not indicative of early findings of atherosclerosis in H. pylori infection during childhood. Further studies are required to evaluate the relationship between early endothelial dysfunction and H. pylori infection in children with cardiovascular risk factors.Item The radiological evaluation of anatomical variations of frontal recess in normal population and cases with frontal rhinosinusitisKüçükgünay, B; Eskiizmir, G; Ünlü, HH; Aslan, A; Bayindir, P; Ovali, GY; Özyurt, BObjective: In this study, we aimed to evaluate the anatomical variations around frontal recess and the influence of variations on frontal rhinosinusitis (FR) in healthy individuals and in cases with frontal rhinosinusitis (FR). Methods: A total of 61 cases that applied to our outpatient center were grouped according to: cases with ear complaints (Group I, control group), cases with sinonasal symptoms but FR findings (Group II), and cases with both sinonasal and FR findings (Group III). All cases underwent paranasal computerized tomography (CT) with parasagittal reconstruction. All scans were assessed for the presence of fronto-ethmoidal cells, anatomical variations, osteomeatal complex diseases and sinus opacifications. Results: In all sides of study, the rate of fronto-ethmoidal cell was 20.9%. When cases with sinonasal signs (Groups II and III) and control group (Group I) were compared, intersinus septum (p=0.01) and agger nasi cells (p=0.001) were statistically significant. In sides with frontal recess disease (+) and/or frontal sinus opacification (+), Kuhn type III (p=0.03) fronto-ethmoidal cells and bulla frontalis (p=0.02) were significantly increased, and Kuhn type IV fronto-ethmoidal cell (both sides) was present only in cases with frontal recess disease (+) and/or frontal sinus opacification (+). When the role of fronto-ethmoidal cells on frontal recess disease and/or frontal sinus opacification were assessed, Kuhn Type III cell was 4.55 times (% 95 GS: 0.560-12.196) more effective. Conclusion: Kuhn type III and IV fronto-ethmoidal cells and bulla frontalis may have a role in FR. The radiological evaluation of anatomical variations around frontal recess with parasagittal sections was useful.Item A province-based study using sampling method to investigate the prevalence of cystic echinococcosis among primary school children in Manisa, TurkeyOk, UZ; Özkol, M; Kilimcioglu, AA; Dinç, G; Bayindir, P; Östan, I; Pabusçu, Y; Özcan, C; Korkmaz, M; Coskun, S; Yüksel, H; Girginkardesler, NA province-based field study using a portable ultrasound scanner (US) was performed for the first time using sampling method to investigate the prevalence of cystic echinococcosis (CE) in primary school children in Manisa, Turkey. A total of 6093 children from 37 primary schools was selected as the representative sample of the total number of 166,766 primary school children, and examined by the US. Prevalence was found to be 0.15%, as nine children were diagnosed with CE, seven new and two previously operated. A questionnaire applied to the children revealed no significant relationship between the risk factors and the infection (P > 0.05). In conclusion, it would be advisable to repeat the study at the same schools in eight years' time, in order to evaluate the efficacy of the control programs, since nearly all students involved in this study will have graduated by then. Besides, it is recommended to choose a sampling group to find the prevalence of an infection in a defined region. (c) 2007 Elsevier B.V. All rights reserved.