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Öğe Association of secondary amyloidosis with common variable immune deficiency and tuberculosis(Yonsei Univ Coll Medicine, 2005) Çelik, AF; Altiparmak, MR; Pamuk, GE; Pamuk, ÖN; Tabak, FThis paper describes the first case of common variable immunodeficiency (CVID) and AA amyloidosis. A recently treated tuberculosis, and chronic inflammation induced by frequent respiratory tract infections, were thought to be responsible for the amyloidosis. No other reason for this condition could be detected. Although T cell dysfunction in some CVID patients has been reported, pulmonary tuberculosis is quite rare with this condition. Bacterial or viral agents or evidence in favour of intestinal tuberculosis, which would explain this patient's recurrent diarrhea, were not found. In this case, the response of the attacks of diarrhea to metranidazole and the histologic observation of extensive intestinal amyloid deposition, which is known to decrease intestinal motility, made us conclude that the diarrhea was associated with bacterial overgrowth. In this report, we discuss the association of CVID and tuberculosis to secondary amyloidosis and recurrent diarrhea.Öğe Bone cysts in sarcoidosis(Springer Heidelberg, 2004) Yanardag, H; Pamuk, ÖNThe incidence of bone cysts in sarcoidosis, a multisystemic disease, varies in different series, and these cysts are generally asymptomatic. We evaluated bone cysts in 516 sarcoidosis patients with available hand X-rays and in 200 patients with foot X-rays. Bone cysts were present in 21 cases (19 females, two males). The cysts were localized in phalanges of the hand in all cases, in feet in five cases, and in nasal bone in one. Six patients with bone cysts also had lupus pernio. Among those with cystic bone lesions, females were more frequent; extrapulmonary and skin involvement and lupus pernio were significantly more common. We diagnosed cystic bone lesions in 3.6% of our sarcoidosis patients and conclude that cysts were more frequent in females and in patients with lupus pernio.Öğe Continuous ambulatory peritoneal dialysis in familial Mediterranean fever amyloidosis patients with end-stage renal failure(Karger, 2004) Altiparmak, MR; Pamuk, ÖN; Ataman, R; Serdengeçti, KBackground/Aims: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterised by recurrent fever attacks and polyserositis which may lead to the development of AA amyloidosis and end-stage renal disease ( ESRD). In this study, we aimed to evaluate the efficacy of continuous ambulatory peritoneal dialysis (CAPD) in FMF-amyloidosis patients with ESRD. Methods: Forty age- and sex-matched patients undergoing CAPD at our centre between 1996 and 2002 were included in the study. Of these, 10 had FMF-amyloidosis, 10 had diabetes mellitus (DM), 10 had chronic glomerulonephritis (CGN) and 10 had chronic interstitial nephritis (CIN). Efficiency of CAPD, development of complications, presence of other diseases and survival were compared. Results: With the onset of ESRD, the frequency of FMF peritonitis attacks decreased, with less attacks occurring during CAPD in FMF-amyloidosis patients (p < 0.05). There was no significant difference between the FMF-amyloidosis group and other groups in terms of efficiency of CAPD, peritoneal function, complications and survival. DM patients had a shorter survival period compared with CGN and CIN patients (p < 0.05), but there was no survival difference between FMF-amyloidosis patients and other groups (p > 0.05). Conclusions: We conclude that CAPD is an effective and safe renal replacement therapy for FMF-amyloidosis patients with ESRD. Copyright (C) 2004 S. Karger AG, Basel.Öğe Cutaneous involvement in sarcoidosis(W B Saunders Co Ltd, 2003) Yanardag, H; Pamuk, ÖN; Karayel, TIn our study, we retrospectively evaluated the clinical features of patients diagnosed as sarcoidosis at our center within the Last 36 years and who had skin involvement. Cutaneous involvement was observed in 170 patients (32.9%, 136 females, 34 mates). The most frequent skin lesion was erythema nodosum (EN) (106 subjects, 20.5%). In addition, skin plaques and subcutaneous nodules were observed in 22 cases (4.3%), maculopapular eruptions in 19 cases (3.7%), scar lesions in 15 cases (2.9%), lupus pernio (LP) in 14 cases (2.7%) and psoriasiform plaques in five cases (0.9%). Among patients with LP (64.3%) and scar lesions (40%), pulmonary parenchymal involvement was more frequent than patients with other skin lesions. Parenchymal. involvement present in 10.4% of patients with EN was significantly less than in patients with LP and scar lesions (P values, respectively, <0.001, 0.002). When patients with skin involvement were compared to other sarcoidosis patients, it was seen that the frequency of females among those with skin involvement was significantly higher than the frequency among other sarcoidosis patients (P<0.001). Parenchymal involvement in sarcoidosis patients without skin involvement was less frequent than in patients with LP; however, more frequent than in patients with EN (both P values=0.002). As a conclusion, skin involvement was diagnosed in approximately one-third of our sarcoidosis patients with a generally female predominance. EN was the most frequent skin lesion encountered. Parenchymal involvement was more frequent in patients with LP and scar lesions and less frequent in patients with EN. (C) 2003 Elsevier Science Ltd. All rights reserved.Öğe The factors which affect the number of tender points in fibromyalgia and chronic widespread pain patients who did not meet the ACR 1990 criteria for fibromyalgia(Bmj Publishing Group, 2004) Pamuk, ÖN; Çakir, N[Abstract Not Available]Öğe Findings of pulmonary involvement on HRCT in turkish rheumatoid arthritis patients and contributory factors(Bmj Publishing Group, 2005) Koker, IH; Pamuk, ÖN; Tuncbilek, N; Karlikaya, C; Çakir, N[Abstract Not Available]Öğe The frequency of thyroid antibodies in fibromyalgia patients and their relationship with symptoms [Meeting Abstract](Bmj Publishing Group, 2005) Pamuk, ÖN; Seyhan, S; Çakyr, N[Abstract Not Available]Öğe Henoch-Schonlein purpura in two brothers imprisoned in the same jail(Clinical & Exper Rheumatology, 2004) Çakir, N; Pamuk, ÖN; Dönmez, SWe Present two brothers who came to us with similar complaints within a two-month interval and who were diagnosed is having Henoch-Schonlein purpura. Interestingly, the two brothers were prisoners in the same jail. In addition, we shall review, the small number of familial Henoch-Schonlein purpura cases that have been reported in the literature to date. Our two Patients exhibited arthritis and/or arthralgia, purpuric skin lesions, abdominal pain and hematuria, and were treated with steroids. We did not detect the presence of any inciting agent and hypothesize that an undefined factor present in the shared environment might have triggered the disease in two subjects with a similar genetic background.Öğe Lacrimal gland involvement in sarcoidosis -: The clinical features of 9 patients(E M H Swiss Medical Publishers Ltd, 2003) Yanardag, H; Pamuk, ÖNPatients and Methods: Ocular disease is relatively common in sarcoidosis and can be the initial clinical manifestation in some instances. In this study, we retrospectively evaluated the clinical and demographic features of 9 (1.74%) patients with lacrimal gland (LG) involvement out of 516 sarcoidosis patients who were followed up at our centre over the preceding 36-years. In addition, the characteristics of patients with LG involvement were compared to those of other cases with eye involvement and to other sarcoidosis patients. Results: In 5 subjects with LG involvement, the chest X-ray was normal. The number of stage 0 subjects among other sarcoidosis patients was significantly lower than among patients with LG involvement (p <0.001). In 2 of these cases, the diagnosis of sarcoidosis was reached by LG biopsy. The mean age of patients with LG involvement was significantly lower than that of other sarcoidosis patients (p <0.001). Also, sarcoidosis-related organ involvement - other than of the LG - was more frequent than in other sarcoidosis patients (p <0.001). Conclusions: It should be borne in mind that LG involvement might be the initial manifestation of sarcoidosis and the chest X-ray in these patients might be completely normal.Öğe Lofgren syndrome in Turkey(Blackwell Publishing Asia, 2003) Yanardag, H; Pamuk, ÖN; Karayel, TIn the 36-year period between 1966 and 2002, 514 patients were diagnosed with sarcoidosis at Cerrahpala Medical Faculty, Gstanbul, Turkey, and of these 98 (19.1%) had Lofgren syndrome. The frequency of female patients with Lofgren was higher than the frequency among other sarcoidosis patients (female : male ratio 4.8 vs. 1.64; P < 0.001). Erythema nodosum was diagnosed in 72.4% of the subjects and arthritis or arthralgia was diagnosed in 51%. Erythema nodosum and arthritis or arthralgia were more frequent in Lofgren; however, pulmonary parenchymal involvement was more frequent in other sarcoidosis patients (all P-values < 0.001).Öğe Lupus pernio in sarcoidosis -: Clinical features and treatment outcomes of 14 patients(Lippincott Williams & Wilkins, 2003) Yanardag, H; Pamuk, ÖN; Pamuk, GELupus perio, (LP) is the most characteristic skin lesion of sarcoidosis. In this study, we retrospectively evaluated the clinical features of sarcoidosis patients with diagnosed LP at our center. Of 516 sarcoidosis patients diagnosed within a 36-year period, 14 (2.7%) had skin lesions that were clinically and histologically diagnosed as LP. Thirteen of our LP patients were females, and one was a male (mean age: 46.3, range: 24-67). In 2 sarcoidosis patients, the initial presentation of the disease was LP. When the LP patients were compared with other sarcoidosis patients, there were more fe- males, and the frequency of extrapidnionary involvement and the number of patients with advanced stage disease were higher (P <0.001). Oral and/or intralesional steroid therapy was the preferred treatment modality in all our patients and led to either recovery or regression in most patients with IP. As our study was an uncontrolled, retrospective one with few patients, it is difficult to say whether steroids are effective. LP runs a chronic course and spontaneous remission of lesions of more than 2 years' duration is quite rare. Because of the unwanted side effects of steroids, the efficacy of new treatment modalities should be tested especially in sarcoidosis patients with only skin involvement.Öğe Massive hematuria in rheumatoid arthritis(Clinical & Exper Rheumatology, 2003) Altiparmak, MR; Pamuk, ÖN; Fresko, I[Abstract Not Available]Öğe Mitral valve vegetation and cerebral emboli in a primary antiphospholipid syndrome patient who had hepatitis C virus infection(Springer-Verlag, 2003) Pamuk, ÖN; Çakir, N; Soy, M; Aktoz, M; Çelik, Y; Akdemir, OWe report the case of 36-year-old woman who came to us with a history of recurrent miscarriages and who was later diagnosed as having primary antiphospholipid syndrome (PAPS) and chronic hepatitis C virus (HCV) infection. The patient was referred to us with generalised seizures; cranial MRI revealed multiple embolic infarcts in both frontal lobes and a focal cortical infarct in the left frontoparietal lobe. Her echocardiography showed mitral valve vegetation and insufficiency. The patient was put on oral anticoagulant therapy and during her 8-month follow-up period no thrombotic events occurred. We report this case because it was the first in which PAPS, valvular disease, a cerebral embolic event and HCV infection were coexistent in the same patient. We also review other cases in which there was valvular vegetation and a cerebral ischaemic event associated with PAPS.Öğe Older sarcoidosis patients(Lippincott Williams & Wilkins, 2004) Yanardag, H; Pamuk, ÖNObjectives: Although sarcoidosis is classically defined to be a disease of young adults, it might also be seen at older ages. There are very few clinical studies which focus on the features of patients diagnosed at older ages. In this study, we tried to determine the frequency of patients diagnosed at or above 50 years of age and to compare the clinical and demographic features of these subjects with other sarcoidosis patients. Methods: We evaluated the general clinical features of sarcoidosis patients more than 50 years of age who were diagnosed at our center within a 36-year period. We also compared the clinical features of older sarcoidosis patients with the features of other patients. Results: Of 579 sarcoidosis patients being followed up at our center, 102 (17.7%) were older than 50 years of age at the time of initial diagnosis. The female to male ratio in this group was higher than the ratio in other sarcoidosis patients (3.43 versus 1.85, P = 0.015). When the features of older patients were compared with other sarcoidosis patients, extrapulmonary involvement was observed to be more common in this group (P < 0.001). By contrast, arthritis or arthralgia (P < 0.001), clinical presentation in the form of Lofgren syndrome (P < 0.001), erythema nodosum (P < 0.001), and uveitis (P = 0.006) were less frequent. Conclusions: Although generally presenting as a disease of the young, in many subjects sarcoidosis is diagnosed at older ages, and this study indicates that the clinical features of sarcoidosis in older subjects differ from those found among younger patients.Öğe A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis -: Report on one case and review of the literature(Springer London Ltd, 2005) Pamuk, ÖN; Harmandar, O; Tosun, B; Yörük, Y; Çakir, NUpper lobe fibrobullous disease is a well-known finding in advanced stages of ankylosing spondylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe segmentectomy and an aspergilloma was detected. Histologic findings were in favour of necrotising Aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising Aspergillus pneumonia. In the literature, there are recently published series of pulmonary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnormalities are quite frequent. Although the clinical significance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflammation. Here, we review the series of pulmonary HRCT in AS patients.Öğe A patient with Behcet's disease who presented with simultaneous cardiac tamponade and central nervous system involvement(Springer-Verlag, 2004) Çakir, N; Pamuk, ÖN; Pekindil, G; Dogutan, H[Abstract Not Available]Öğe The prevalance of rheumatologic diseases in Havsa(Bmj Publishing Group, 2005) Çakir, N; Pamuk, ÖN; Dervis, E; Imeryuz, N; Uslu, H; Benian, Ö; Senocak, M[Abstract Not Available]Öğe A primary Sjogren's syndrome patient with distal renal tubular acidosis, who presented with symptoms of hypokalemic periodic paralysis(Springer Heidelberg, 2005) Soy, M; Pamuk, ÖN; Gerenli, M; Çelik, YAlthough renal tubular acidosis (RTA), secondary to autoimmune interstitial nephritis, develops in a large proportion of patients with Sjogren's syndrome (SS), most of the subjects are asymptomatic. Here, we shall present a 39-year-old female patient who came to us with hypokalemic periodic paralysis (HPP), and who was later diagnosed with distal RTA. The patient, who had xerostomia and xerophthalmia for a long period of time, was diagnosed with primary SS from serologic and histologic findings. The patient recovered by being prescribed potassium replacement therapy. Although renal biopsy was not performed, corticosteroids were administered because HPP indicated severe interstitial nephritis. HPP did not reoccur during a 2-year follow-up period. We also review cases with SS-related distal RTA and HPP.Öğe The renal effects of the addition of low-dose aspirin to COX-2 selective and nonselective antiinflammatory drugs(Springer London Ltd, 2006) Pamuk, ÖN; Çakir, NObjective: We aimed to evaluate the effect on renal functions and blood pressure of the addition of low dose aspirin (LDA) to cyclooxygenase-2 (COX-2) inhibitors or nonselective NSAIDs. Methods: Two groups each containing 14 patients with one group using celecoxib and the other indomethacin regularly for at least 1 week were included into the study. Both groups were initially administered 100 mg/day (week 1), and later 300 mg/day (week 2) aspirin. Baseline and weekly serum creatinine, uric acid, electrolytes, creatinine clearance (CrCl) and blood pressure were obtained. Results: Contrary to the celecoxib group, in the indomethacin group, both after the first and the second weeks the mean serum creatinine increased and CrCl decreased when compared to baseline values (p values < 0.05). In the indomethacin group, when compared to baseline values systolic blood pressure was significantly higher after week 1 and uric acid level after week 2 (p values=0.01). The frequency of patients with a >= 20% decrease in CrCl at the end of week 2 was higher in the indomethacin group than in the celecoxib group (42.9% vs. 0%, p=0.016). The difference between the mean creatinine (p=0.017) and CrCl values (p=0.007) from baseline until after week 2 was more significant in the indomethacin group than in the celecoxib group. Conclusions: The addition of LDA to patients using indomethacin led to significant renal dysfunction. Subjects using celecoxib seem to have been protected from the renal side effects of LDA.Öğe Revalidation of description of constipation in terms of recall bias and visual scale analog questionnaire(Blackwell Publishing Asia, 2003) Pamuk, ÖN; Pamuk, GE; Çelik, AFBackground and Aim: The present study was designed to identify a cut-off value to define subjective and relatively objective criteria of constipation using the visual scale analog questionnaire (VSAQ) in healthy subjects. In addition, the importance of recall bias when evaluating constipation was investigated by repeating the questionnaire and ensuring the subjects maintained diaries. Methods: Seven hundred and sixty healthy hospital personnel were questioned by means of a standard questionnaire. Subjects were initially asked if they were constipated (self-reported) and their daily defecation frequencies. Severity of the parameters of constipation, the consistency of defecation in the form of hard stools, straining and incomplete evacuation were also investigated using a VSAQ (0-10). Subjects were asked to complete a standard form about their daily bowel habits in the subsequent 7 days (diary). At the end of this series, the questionnaire forms completed at the beginning were readministered. Using the criteria of functional constipation, the prevalence of self-reported, symptom-based (greater than or equal to2 criteria) and diary-based (greater than or equal to2 criteria in the diary) were defined. Results: Of the subjects, 48.5% (369/760) completed diaries regarding their bowel habits and completed the questionnaire for the second time (198 female, 171 male; mean age 31.6 +/- 7.1 years). According to only interrogation, 29.8% of subjects reported that they were constipated; however, this number increased to 39.6% when symptom-based constipation (greater than or equal to2 criteria) was considered. Significant agreement was observed between the results of self-reported constipation in form I and II, and symptom-based and diary-based constipation (concordance = 77.7-98.6%, k = 0.47-0.97). Furthermore, 98.1% of the subjects who reported that they were not constipated scored 3 on the VSAQ; conversely, 91.8% who accepted being constipated scored >3 for the same question. A total of 76.1% subjects who had symptom-based constipation scored 3 on the VSAQ, 97.3% of those who had <2 criteria scored 3. When asked 'Are you constipated?' 1.2% of subjects with none of the criteria for diary-based constipation, and 10.7% of subjects who had one criteria scored >3 on the VSAQ. Also, 91.8% of those with three criteria and 100% of those with four criteria had a score >3 on the VSAQ for the same question. Conclusions: The prevalence of constipation in the questionnaire form based on self-reported, symptom-based and diary-based criteria were highly compatible with the result obtained on readministration. Recall bias was negligibly low. Also, the present results suggest that the diagnosis of constipation is more accurate when >2 criteria are present. In addition, the VSAQ seems to be sensitive enough to differentiate subjects with constipation from those without, when a score of 3 has been chosen as the cut-off value for discrimination. However, this sensitivity was less in the group who stated they were constipated. (C) 2003 Blackwell Publishing Asia Pty Ltd.
