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Öğe AB0311 Evaluating of atherosclerosis in rheumatoid arthritis patients with carotid intima media thİckness and lipoprotein phospholipase A2 activity(Bmj Publishing Group, 2014) Bes, Cemal; Gürel, Safiye; Buğdaycı, Güler; Dikbaş, Oğuz; Soy, MehmetÖğe Amyloidosis and its related factors in patients with familial mediterranean fever: A nationwide multicenter study(Wiley-Blackwell, 2013) Kaşifoğlu, Timuçin; Yaşar, Şule; Sarı, İsmail; Solmaz, Dilek; Şenel, Soner; Emmungil, Hakan; Kılıç, Levent; Bes, CemalFamilial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease that occurs worldwide and predominantly affects the populations arising from the Mediterranean origin. Secondary (AA) amyloidosis still remains the most devastating complication of FMF especially in untreated and noncompliant patients. However, pathogenesis and risk factors of amyloidosis still remains only partially understood in FMF. The primary aim of this study was to investigate the prevalence of amyloidosis and its related factors in a large number of FMF patients.Öğe Amyloidosis and its related factors in Turkish patients with familial Mediterranean fever: a multicentre study(Oxford Univ Press, 2014) Kaşifoğlu, Timuçin; Bilge, Şule Yaşar; Sarı, İsmail; Solmaz, Dilek; Şenel, Soner; Bes, CemalMethods. Fifteen centres from the different geographical regions of Turkey were included in the study. Detailed demographic and medical data based on a structured questionnaire and medical records were collected. The diagnosis of amyloidosis was based on histological proof of congophilic fibrillar deposits in tissue biopsy specimens. Results. There were 2246 FMF patients. The male/female ratio was 0.87 (1049/1197). The mean age of the patients was 34.5 years (s.d. 11.9). Peritonitis was the most frequent clinical finding and it was present in 94.6% of patients. Genetic testing was available in 1719 patients (76.5%). The most frequently observed genotype was homozygous M694V mutation, which was present in 413 (24%) patients. Amyloidosis was present in 193 patients (8.6%). Male sex, arthritis, delay in diagnosis, M694V genotype, patients with end-stage renal disease (ESRD) and family history of amyloidosis and ESRD were significantly more prevalent in patients with amyloidosis compared with the amyloidosis-negative subjects. Patients with homozygous M694V mutations had a 6-fold higher risk of amyloidosis compared with the other genotypes (95% CI 4.29, 8.7, P < 0.001). Conclusion. In this nationwide study we found that 8.6% of our FMF patients had amyloidosis and homozygosity for M694V was the most common mutation in these patients. The latter finding confirms the association of homozygous M694V mutation with amyloidosis in Turkish FMF patients.Öğe Atherosclerosis assessment and rheumatoid arthritis(Springer Heidelberg, 2018) Bes, Cemal; Gürel, Safiye; Buğdaycı, Güler; Dikbaş, Oğuz; Soy, MehmetRheumatoid arthritis is associated with increased morbidity and mortality due to atherosclerotic cardiovascular diseases. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme of phospholipase A2; it plays an important role in inflammation and atherosclerosis. Herein we aimed to investigate whether Lp-PLA2 activity is associated with atherosclerosis in patients with rheumatoid arthritis and compare the Lp-PLA2 activity with carotid intima media thickness (CIMT). 25 patients with rheumatoid arthritis and 40 controls (20 patients with type 2 diabetes mellitus [DM] and 20 healthy controls) were included in the study. Frozen serum samples were used for analyzing Lp-PLA2 activity. Disease activity was calculated with DAS28 (Disease Activity Score 28) in the rheumatoid arthritis group. The mean CIMT was calculated in all participants. Lp-PLA2 activity was significantly higher in the DM group (p = 0.006) and LDL (Low density cholesterol levels) were lower in rheumatoid arthritis and healthy control groups compared with diabetics (p = 0.001 and p = 0.029, respectively). The mean CIMT was significantly higher in patients with type 2 DM (p = 0.047). Lp-PLA2 activity was not increased in the rheumatoid arthritis group when compared with healthy controls and the DM group. This result may be associated with low disease activity scores in patients with rheumatoid arthritis.Öğe Can bone quality be predicted accurately by Singh Index in patients with rheumatoid arthritis?(Springer London Ltd, 2012) Bes, Cemal; Güven, Melih; Akman, Budak; Atay, Evren Fehmi; Ceviz, Emrah; Soy, MehmetThe aim of this study was to evaluate Singh index as a simple and inexpensive means of estimation of bone quality in patients with rheumatoid arthritis. Singh index evaluation was made on digital pelvis radiographs in 50 consecutive patients by three observers. Bone mineral density T scores of the spine and left proximal femur were assessed using dual energy X-ray absorptiometry. Singh index was correlated with densitometry measurements after grouping the patients as normal, osteopenia and osteoporosis. Intra-and interobserver agreements were evaluated by kappa correlations. Sensitivity, specificity, positive and negative predictive values and likelihood ratio's of Singh index were calculated. Both intra-and interobserver agreements were 0.71 (range, 0.69 to 0.72) on average. Singh index proved highly sensitive for the diagnosis of osteopenia at the proximal femur (91%) and spine (90%), whereas the specificity of Singh index for identifying of osteoporosis at the femoral neck (93%) and spine (91%) was higher than sensitivity. Predictive values for osteoporosis at the proximal femur and spine were acceptable and positive likelihood ratios of Singh index for osteopenia and osteoporosis at the proximal femur were 2.4 and 10.1, respectively. Singh index can identify osteoporosis with a high specificity in patients with rheumatoid arthritis. However, the patients who are graded as osteopenia by the Singh index should undergo further evaluation with dual energy X-ray absorptiometry.Öğe A case of propylthiouracil-induced antineutrophilic cytoplasmic antibody-positive vasculitis successfully treated with radioactive iodine(2013) Bes, Cemal; Dikbaş, Oğuz; Keskin, Fatma Ela; Kaptanoğulları, Nazmiye Özlem; Soy, MehmetAntineutrophilic cytoplasmic antibody (ANCA) associated vasculitis is one of the rare complications of propyl-thiouracil treatment. Having a variable clinical spectrum, it may be presented with both skin limited vasculitis and life-threatening systemic vasculitis. In this study, we present a case that developed ANCA-positive vascu-litis with skin and kidney involvement (hematuria and proteinuria) six months after propylthiouracil treatment was initiated for toxic nodular goiter. Proteinuria recovered dramatically subsequent to radioactive iodine treat-ment following ceasing the drug.Öğe Comparison of early versus late onset familial mediterranean fever(Wiley, 2018) Bilge, Nazife Şule Yaşar; Sarı, İsmail; Solmaz, Dilek; Şenel, Soner; Emmungil, Hakan; Kılıç, Levent; Yılmaz Öner, Sibel; Bes, CemalAimFamilial Mediterranean fever (FMF) is the most common autoinflammatory disease. One of the common characteristics of this disease is its young age predominance. Nearly 90% of patients experience disease flares during early adult age periods. Currently there are limited data for the comparison of early versus late onset FMF and therefore the primary aim of this study was to investigate these two subsets with regard to their certain demographic, clinical and genetic differences. MethodsEarly (20years, Group 1) and late (>20years, Group 2) onset FMF patients were identified from the national FMF registry that involves 2246 patients from 15 adult rheumatology clinics located in different geographical areas of Turkey. ResultsOf the 2246 patients, 1633 (72.7%) were aged 20years old (Group 1) and the remaining 613 were older than 20years (Group 2). Delay in diagnosis was longer in Group 1 and fever, peritonitis, pleuritis, erysipelas-like erythema (ELE), arthritis, family history of FMF and amyloidosis were more common in Group 1. On the other hand, sex distribution, rates of amyloidosis, vasculitis and kidney failure were not different between the groups. Among patients with available genotypes, homozygous and heterozygous M694V mutations weresignificantly higher and heterozygous E148Q mutation was significantly lower in Group 1 compared to Group 2. ConclusionPatients with FMF whose symptoms start before 20years of age seem to have severe symptoms and M694V mutation may be responsible for the early expression of the disease.Öğe Corrected Qt interval in patients with metabolic syndrome(2011) Paksoy, Fatma; Ulaş, Turgay; Bes, Cemal; Dal, Mehmet Sinan; Borlu, FatihObjectives: Metabolic syndrome may be associated with increased cardiovascular mortality and morbidity. However, prolongation of QT intervals due to metabolic syndrome is still unclear. The purpose of this study was to investigate the incidence prolonged QT intervals in pa tients with metabolic syndrome and also demonstrate the relationship between them. Therefore, we aimed to inves tigate the relationship between metabolic syndrome and the QT prolongation in a large patient group. Materials and methods: A total of 1009 individuals were enrolled in this study. Metabolic syndrome was defined according to the IDF criteria and the QTc intervals were measured by using Bazett Formula. QT ≤ 0.44 second was accepted as normal. Results: Totally, 278 male and 731 female individuals of 1009 cases were enrolled in this study. The average dura tion of corrected QT of men according to the Bazzett formula were found as 0,448±0,04 second and QT interval of women were 0,449±0,05 second. QT intervals of both women and men with metabolic syndrome were significantly higher than normal limits of QT interval (p<0,01). Conclusion: Metabolic syndrome found as associated with a prolonged QTc. Results of our study suggest that QTc interval length was increased in patients with metabolic syndrome.Öğe Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features(Springer Heidelberg, 2017) Kabasakal, Yasemin; Kitapçıoğlu, Gül; Karabulut, Gonca; Tezcan, Mehmet; Balkarlı, Ayşe; Bes, CemalPatients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 +/- 2.3 vs 4.3 +/- 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features.Öğe Current antiviral practice and course of Hepatitis B virus infection in inflammatory arthritis: a multicentric observational study (A(Aves, 2015) Kalyoncu, Umut; Emmungil, Hakan; Onat, Ahmet Mesut; Yılmaz, Sedat; Kaşifoğlu, Timuçin; Bes, Cemal; Soy, MehmetObjective: The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis. Material and Methods: Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection. Results: In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44 +/- 12 years, and the mean follow-up duration was 31 +/- 22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment). Conclusion: HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.Öğe Diagnostic dilemma of paraneoplastic arthritis: case series(Blackwell Publishing, 2014) Kısacık, Bünyamin; Onat, Ahmet M.; Kaşifoğlu, Timuçin; Pehlivan, Yavuz; Bes, CemalObjectives: Paraneoplastic arthritis (PA) may mimic rheumatic diseases. While presenting the demographic and laboratory features of the patients diagnosed with PA, this study also aims to provide possible appropriate tools to differentiate the PA cases from early rheumatoid arthritis (ERA). Methods: Sixty-five patients with PA (male/female: 43/22) from 15 different rheumatology clinics and 50 consecutive patients with ERA (male/female: 13/37) fulfilling the 2010 American College of Rheumatology (ACR) criteria for the diagnosis if the RA from Gaziantep Rheumatology Early Arthritis Trial (GREAT) as controls who were diagnosed at least 12 months before, were enrolled into study. Results: Mean ages of the patients with PA and ERA were 50.2 ± 15.3, and 42.7 ± 12.3, respectively, and the mean ages of the patients with PA were significantly higher than the ERA. Unlike the ERA patients, in our case series PA was predominantly observed among males. Oligoarthritis was significantly higher in solid tumors in contrast to ERA (P = 0.001). Polyarthritis and symmetric arthritis were significantly higher in the ERA group in contrast to all malignancies (P = 0.001). Rheumatoid factor (RF) and anticyclic citrullinated peptide antibody (anti-CCP) positivity were significantly higher in the ERA group (each P = 0.001). Lactic dehydrogenase levels of hematologic malignancies were significantly higher than other groups (each, P = 0.001). Conclusions: ERA patients had more symmetric joint involvement than PA; laboratory markers could be also an alternative where there is high RF and anti-CCP positivity with antibody levels among the ERA patients. Finally, the demographic features can be used as differentiating factors; ERA was seen predominantly among females aged 40-59 years which refers to young adults.Öğe The distribution of MEFV mutations in Turkish FMF patients: Multicenter study representing results of Anatolia(2019) Bilge, N. Şule Yaşar; Sarı, İsmail; Solmaz, Dilek; Şenel, Soner; Emmungil, Hakan; Bes, CemalBackground/aim: The distribution of Mediterranean fever (MEFV) gene mutations in Turkish familial Mediterranean fever (FMF) patients varies according to geographic area of Turkey. There is a need for highly representative data for Turkish FMF patients. The aim of our study was to investigate the distribution of the common MEFV mutations in Turkish FMF patients in a nationwide, multicenter study. Materials and methods: Data of the 2246 FMF patients, from 15 adult rheumatology clinics located in different parts of the country, were evaluated retrospectively. The following mutations have been tested in all patients: M694V, M680I, M694I, V726A, and E148Q. Results: There were 1719 FMF patients with available genetic testing. According to the genotyping, homozygous M694V, present in 413 patients (24%), was the most common mutation . One hundred and fifty-four (9%) of patients had no detectable mutations. Allele frequencies of common mutations were: M694V (n = 1529, 44.5%), M680I (n = 423, 12.3%), V726A (n = 315, 9.2%), E148Q (n = 214, 1%), and M694I (n = 12, <1%). Conclusion: In this large-scale multicenter study, we provided information about the frequencies of common MEFV gene mutations obtained from adult Turkish FMF patients. Nearly half of the patients were carrying at least one M694V mutations in their alleles.Öğe The effect of TNF-alpha blockers on psychometric measures in ankylosing spondylitis patients: a preliminary observation(Springer Heidelberg, 2013) Arısoy, Özden; Bes, Cemal; Çifçi, Çiğdem; Sercan, Mustafa; Soy, MehmetThere is a high co-morbidity between chronic inflammatory disorders and depression. Proinflammatory cytokines like TNF-alpha seem to play a central role in the pathogenesis of these disorders, and its neutralization provides a potent treatment for inflammatory disorders. Few studies showed that TNF-alpha blockers also caused an improvement in depressive symptoms associated with these chronic inflammatory disorders. To evaluate the effectiveness of TNF-alpha blockers on symptoms of ankylosing spondylitis (AS), depression, anxiety and quality of life, 9 AS patients resistant to classical therapy were enrolled and followed-up at 2nd and 6th weeks after a TNF-alpha blocker was started. Hamilton Depression and Anxiety Scales (HAM-D, HAM-A), Hospital Depression and Anxiety Questionnaire (HAD), Quality of Life Scale (SF36) and AS severity index (BASDAI) were applied to the patients at weeks 0, 2 and 6. ESR and CRP were evaluated to monitor biological disease activity. There was a significant reduction in HAM-D (p = 0.00), HAM-A (p = 0.00), HAD anxiety scores (p = 0.02) and a significant improvement in SF36 physical function (p = 0.00), physical role limitations (p = 0.00), bodily pain (p = 0.05), general health (p = 0.01), vitality (p = 0.03) and emotional role limitations (p = 0.00) subscales, BASDAI scores (p = 0.00), ESR (p = 0.00) and CRP (p = 0.00). Change in clinical disease activity (BASDAI) was not correlated with change in depression-anxiety scores, while change in biological disease activity (CRP) was correlated with change in depression-anxiety scores. TNF alpha blockers may have a potential antidepressant effect besides its anti-inflammatory effect that seems to be independent of its clinical effect.Öğe Familial mediterranean fever without cardinal symptoms and role of genetic screening(Page Press Publications, 2012) Ulaş, Turgay; Büyükhatipoğlu, Hakan; Bes, Cemal; Dal, Mehmet Sinan; Hacıbekiroğlu, İlhan; Apucu, Hacı Gökhan; Borlu, FatihFamilial Mediterranean fever is an autosomal recessive disorder characterized by paroxysmal episodes of fever and serosal inflammation. The classical presentation is fever and severe recurrent abdominal pain due to serositis that lasts for one to three days and the resolves spontaneously. Between the episodes patients are asymptomatic. Ninety-five percent of patients with familial mediterranean fever have painful episodes localized to the abdomen, which is usually the dominant manifestation of the disease. Herein, we present a case of a 34-year-old man with incomplete abdominal pain episode of familial mediterranean fever limited to the epigastrum and had no cardinals symptoms of this disease. The diagnosis was made by genetic screening. Successful treatment response was achieved by colchicine.Öğe Impact of rheumatoid arthritis in Turkey: a questionnaire study(Clinical & Exper Rheumatology, 2014) Direşkeneli, Haner; Akkoç, Nurullah; Bes, Cemal; Çakır, Necati; Çefle, AyşeObjective Unmet needs of rheumatoid arthritis (RA) patients regarding physician/patient communication, treatment preferences and quality of life issues were investigated in a Turkish survey study. Methods The study was conducted with the contribution of 33 rheumatologists, and included 519 RA patients. The study population included patients who had been on biologic therapy for >6 months and were still receiving biologic therapy (BT group), and those who were biologic naive, but found eligible for biologic treatment (NBT group). Of the RA patients, 35.5% initially had a visit to an internal disease specialist, 25.5% to a physical therapy and rehabilitation specialist, and 12.2% to a rheumatology specialist for their RA complaints. The diagnosis of RA was made by a rheumatologist in 48.2% of patients. Results The majority of RA patients (86.3%) visit their doctor within 15-week intervals. Most of the physician-patient communication focused on disease symptoms (99.0%) and impact of the disease on quality of life (61.8%). The proportion of RA patients who perceived their health status as good/very good/excellent was higher in the BT group than in the NBT group (74.3% vs. 51.5%, p<0.001). However, of those RA patients in the NBT group, only 24.8% have been recommended to start a biologic treatment by their doctors. With respect to dose frequency options, once-monthly injections were preferred (80%) to a bi-weekly injection schedule (8%). Conclusion In conclusion, RA patients receiving biologic therapy reported higher rates of improved symptoms and better quality of life and seemed to be more satisfied with their treatment in our study.Öğe Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis(Springer Wien, 2013) Kurt, Özlem Kar; Kurt, Bahar; Talay, Fahrettin; Tuğ, Tuncer; Soy, Mehmet; Bes, Cemal; Hayran, MutluThe use of anti-TNF drugs for rheumatic diseases has increased in recent years. Several studies have reported an increased risk of reactivation of tuberculosis (TB) with anti-TNF agents. The aim of this study was to present the follow-up results of a single center from Turkey, a country with a high rate of active and latent tuberculosis infection (LTBI), for INH chemoprophylaxis in patients receiving anti-TNF-alpha therapy for rheumatic diseases infection. In this prospective observational study, consenting patients who were to be administered an anti-TNF agent for a rheumatic disease were evaluated for the presence of active infection or LTBI by a chest X-ray and a tuberculin skin test. Patients with LTBI were given chemoprophylaxis 1 month prior to commencement of anti-TNF treatment. All patients were followed-up bimonthly for any signs of pulmonary or extrapulmonary TB. A total of 73 patients, 23 female (31.5 %) and 50 male (68.5 %), with a mean age of 41.0 +/- A 13.1 years (18-78) were enrolled in the study. Overall, 44 patients (60.3 %) had ankylosing spondylitis, 18 (24.7 %) had rheumatoid arthritis, 7 (9.6 %) had juvenile rheumatoid arthritis, and 3 (4.1 %) had psoriatic arthritis. LTBI was identified in 58 patients all of whom received chemoprophylaxis for 9 months. None of the patients in the study developed any signs of tuberculosis reactivation during follow-up. TST is a reliable and cost-effective method for the diagnosis of LTBI in patients prior to anti-TNF therapy. Moreover, chemoprophylaxis with INH seems to be effective for the prevention of TB reactivation in individuals with LTBI.Öğe Items of Yamaguchi criteria might be associated with diseases severity and prognosis in adult-onset still's disease(Wiley-Blackwell, 2015) Kalyoncu, Umut; Solmaz, Dilek; Emmungil, Hakan; Yazıcı, Ayten; Kaşifoğlu, Timuçin; Bes, Cemal; Soy, MehmetÖğe Lack of an effect of CYP3A4 and MDR1 gene polymorphisms on colchicine pharmacogenetics in the treatment of familial Mediterranean fever(Funpec-Editora, 2013) Doğruer, D.; Tuğ, Esra; Bes, Cemal; Soy, MehmetThe P-gp/MDR1 multidrug transporter mediates detoxification of numerous drugs, including colchicine, and CYP3A4 is key to the biotransformation of colchicine. We investigated the effects of CYP3A4 and P-gp/MDR1 polymorphisms on bioavailability of colchicine in patients with Familial Mediterranean fever (FMF). Forty-eight Turkish patients with FMF treated with colchicine were genotyped for 3435C>T, (-)1A>G, 61A>G, 1199G>A, 1236C>T, 2677G>A, 2677G>T polymorphisms in the P-gp/MDR1 gene and 3435C>T, *1B(-392A>G), *2(15713T>C), *3(23171T>C), *12(21896C>T), *17(15615T>C) polymorphisms in the CYP3A4 gene. Doses of colchicine administered to patients did not differ with respect to P-gp/MDR1 or CYP3A4 gene polymorphism. We also determined the genotype distributions of CYP3A4 and P-gp/MDR1 genes among FMF patients. There was no significant gender difference in the P-gp/MDR1 polymorphism, whereas there were significant gender differences in the frequencies of 15713T>C and 15615T>C polymorphisms in the CYP3A4 gene. No significant relationship was found between colchicine doses that would introduce optimal clinical response and affect the therapeutic dose and CYP3A4 and P-gp/MDR1 gene polymorphisms in these FMF patients.Öğe Massive lower gastrointestinal bleeding associated with solitary rectal ulcer in a patient with Behcet's disease(Pagepress Publ, 2015) Bes, Cemal; Dağlı, Ülkü; Yılmaz, Fahri; Soy, MehmetSolitary rectal ulcer syndrome is a rare benign disorder that has a wide range of clinical presentations and variable endoscopic findings which makes it difficult to diagnose and treat. The clinical and endoscopic picture in this condition can also mimic malign ulceration, malignancy or Crohn's disease. Behcet's disease can affect the gastrointestinal tract. However to the best of our knowledge, no case with solitary rectal ulceration has been reported so far in literature. We herein present a patient diagnosed with Behcet's disease admitted to our clinic with rectal bleeding due to solitary rectal ulceration.Öğe Non-sirotik portal hipertansiyonun nadir bir nedeni: Primer antifosfolipid sendromu(2011) Ulaş, Turgay; Bes, Cemal; Gültürk, Emine; Namal, Esat; Paksoy, Fatma; Gökçen, Didem Gürbüz; Borlu, FatihAntifosfolipid sendrom, serumda uzun süre antifosfolipid antikorların varlığı, venöz ya da arteriyel trombozlar, tekrarlayıcı gebelik kayıpları veya trombositopeniyle karakterize sistemik otoimmün bir hastalıktır. İki formu tanımlanmıştır: başka hiç bir hastalığın eşlik etmediği birincil antifosfolipid sendrom ve genellikle sistemik lupus eritematozus gibi başka bir hastalığa eşlik eden ikincil antifosfolipid sendrom. Klasik özellikleri livedo retikularis, splinter hemorajiler, yüzeysel tromboflebit ve bacak ülserleri gibi deri bulguları; serebral, retinal ven trombozu gibi venöz trombotik olaylar; geçici iskemik atak ya da iskemik infarktlar gibi arteriyel trombotik olaylar, tekrarlayıcı erken-term spontan düşükler ve trombositopenidir. Budd-Chiari sendromu, hepatik veno-okluzif hastalık, küçük hepatik venlerin oklüzyonu, nodüler rejeneratif hiperplazi ve portal hipertansiyon gibi çeşitli karaciğer hastalıkları da antifosfolipid sendromu birlikteliğiyle literatürde bildirilmiştir. Biz de burada literatürde oldukça nadir görülen bir birliktelik olan primer antifosfolipid sendromuyla ilişkili non-sirotik portal hipertansiyon olgusu sunuyoruz.
