Biomedical subjects
Publications and source records attributed to S Yurdakul.
We investigated the frequency of amyloidosis in 99 consecutive patients (65 men and 34 women) with Behçet's syndrome. Rectal biopsies performed on all patients showed no amyloidosis by polarizing microscopy. The results of urinalyses were normal in all patients. Among 1,130 patients registered in our Behçet's syndrome outpatient clinic, 5 were found to have systemic amyloidosis, all of the AA type.
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1550 conjunctival cultures taken between 1985-1988 were evaluated retrospectively. Among 455 cultures with positive growth, bacterial agents seen in their order of occurrence were Staphylococcus epidermidis (35.82%), Streptococcus pneumonia (19.34%) and Staphylococcus aureus (18.46%), respectively. Moreover, the distribution of agents in 185 cases with complete clinical records were discussed in the light of data found in the literature.
We investigated the prevalence and type of neurologic involvement in Behçet's syndrome in a prospective protocol. Of 323 consecutive patients with Behçet's syndrome seen during a 12-month period, 46 underwent neurologic evaluation because of headaches and/or neurologic symptoms and signs. Only 17 (5.3%) were found to have involvement of the nervous system. Hemispheric lesions were as common as brain-stem involvement. Headaches were of no clinical importance unless accompanied by other neurologic findings. Computed tomographic scans were of little diagnostic help. After 12 +/- 4 (SD) months of follow-up, only three patients showed worsening of their neurologic findings.
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We conducted a field survey to establish the prevalence of Behçet's syndrome among all the inhabitants aged 10 years or older in a village in northern Turkey. The prevalence of Behçet's syndrome was 19/5,131. There were 13 females and 6 males. None had eye involvement. Pathergy test was positive in 6/18 (33%) and 5/19 carried HLA-B5 (26%), suggesting that the previously established association of HLA-B5 in Behçet's syndrome is mainly true for hospital based populations. Moreover, the pathergy test was less commonly positive in milder disease.
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Radiological sacroiliitis in Behçet's syndrome (BS) has been a subject of controversy. We have examined pelvic radiographs of 38 patients with BS and 28 age and sex matched controls which we reported previously, and also 17 with ankylosing spondylitis (AS), 27 with non-renal familial Mediterranean fever (FMF), and 33 with primary osteoarthrosis (OA). Initially, five observers assessed radiographs on two different occasions according to the New York criteria for sacroiliitis in a blind protocol. Later, three of them examined the various possible abnormalities of the sacroiliac (SI) joints after training sessions. Although the inter- and intraobserver variation was quite high, all observers found the expected changes in patients with AS. The abnormalities detected in the other diseases were either mild, inconsistent, or both. Erosions were confined to patients with AS, and osteophytes and glenoid sulci to patients with OA. We conclude that high observer variation in interpreting a film of the anteroposterior (AP) view of the pelvis for sacroiliitis may be a major cause of reported 'sacroiliitis' in BS and FMF.
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Eleven separate three-month courses of cyclosporin A, an oral solution 10 mg/kg/day, were administered to eight patients with Behçet's disease with sight-threatening posterior uveitis. It was found to be effective in arresting the inflammatory activity in the eye as well as the mucocutaneous lesions of Behçet's disease. Improvement in visual acuity was observed within one week of starting therapy. Severe exacerbations in the ocular and mucocutaneous lesions occurred on withdrawal of the drug. At this dosage side effects included hirsutism in all women, and a slight rise of serum bilirubins in two patients and of blood urea in one patient. The latter two conditions responded rapidly to dose adjustment.
Plasma von Willebrand factor F VIII related antigen levels were elevated in 13 patients with Behçet's syndrome and vascular disease compared to 17 with Behçet's syndrome without vascular involvement and 23 healthy controls. As expected 12 diseased controls, 9 of whom had systemic sclerosis, had still higher levels of F VIII related antigen.
In a prospective study of 150 patients with Behçet's disease, significant associations were shown between CRP positivity and the presence of erythema nodosum (p less than 0.02) and acute thrombophlebitis (p less than 0.05) and between ESR and erythema nodosum (p less than 0.01), acute thrombophlebitis (p less than 0.001), and acute arthritis (p less than 0.01). Mucocutaneous, ocular, or central nervous system activities did not show significant associations with these indices of inflammation. In 50 patients in whom quantitative CRP determinations were performed, clinical disease activity was accompanied by slight to moderate increases in CRP and ESR.
Sulphasalazine was administered to 18 patients with juvenile rheumatoid arthritis (JRA). The mean duration of therapy was 7.8 +/- 2.6 months. There was significant improvement in all clinical variables and erythrocyte sedimentation rate. Five children developed minor and transient side effects. Medication was discontinued in 3 patients: one because of leukopenia, 2 for lack of effect. These results suggest that sulphasalazine is an effective and relatively safe drug which may prove to be a useful second line agent in the management of JRA.
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Serum samples from 57 Turkish patients with Behçet's syndrome (BS) were analysed for C-reactive protein, histidine, total sulphydryl concentration and gamma glutamyl transpeptidase. Clinical subgroups did not exhibit biochemical differences, including BS with and without arthritis. When compared with normal controls and with patients with active rheumatoid arthritis (RA), those with BS were shown to be biochemically abnormal in a manner quantitatively similar to RA, but to a lesser degree. Gamma-glutamyl transpeptidase concentrations were found to be normal in BS.
Forty-eight Turkish and 12 British patients along with 24 Turkish and 7 British healthy controls were assessed for the presence of the pathergy phenomenon. A photographic method with 'blind' reading was utilised. The pathergy phenomenon was present only among the Turkish patients.
Eye disease, arthritis, folliculitis, and thrombophlebitis were more common among males, and erythema nodosum among females, in 297 patients with Behćet syndrome (BS) at their first visit despite an identical disease duration. Younger males and females (age of onset 24 years or less) had a higher prevalence of eye disease and total clinical activity than did the older patients (age of onset 25 years or more). Among the 51 patients followed up for 52 months (SD 7 months) the total clinical activity became significantly less (p less than 0.05) in the whole group at the end of this period. This was particularly true for older females. While male sex and a younger age of onset are associated with more severe disease in BS, overall, the syndrome ran an improving or stable course over 4 1/2 years.