Halil Kiyici

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.

Purpose: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin. Methods: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire. Results: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment. Conclusions: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.

Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo-controlled environmental trial.

Purpose:  We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC).

Effects of Intravitreal Moxifloxacin and Dexamethasone in Experimental Staphylococcus aureus Endophthalmitis

Purpose: To evaluate the effects of intravitreal moxifloxacin and moxifloxacin and dexamethasone combination in an experimental rabbit model of Staphylococcus aureus endophthalmitis. Methods: The right eyes of 24 rabbits weighing 2 to 3 kg were used. Ten thousand colony-forming units (CFU) of S. aureus in 0.1 ml saline solution were inoculated into the vitreous cavity. The eyes were randomly assigned to one of the four groups equally. Twenty-four hours after the inoculation of S. aureus, group 1 received 50 μ g moxifloxacin, group 2 received 50 μ g moxifloxacin plus 400 μ g dexamethasone, and group 3 received 1mg vancomycin intravitreally. No treatment was given to group 4. Clinical examination scores were recorded. Vitreous aspirates were obtained for microbiological analysis just before sacrifice, and the eyes were enucleated for histopathologic examination. Statistical analysis was performed using Kruskal-Wallis and Mann-Whitney U tests. Results: In all treatment groups, mean number of CFU and histopathologic score were significantly lower compared with control group (p < 0.05), and the difference between treatment groups was not statistically significant (p > 0.05). The clinical score was not significantly different between groups (p > 0.05). Conclusions: Intravitreal injection of 50 μg moxifloxacin was effective in the treatment of S. aureus endophthalmitis. Bacteriological, histopathologic, and clinical outcomes after treatment using moxifloxacin, moxifloxacin and dexamethasone combination, and vancomycin were comparable. Intravitreal moxifloxacin may be an option in the treatment of S. aureus endophthalmitis.

Conjunctival impression cytology and tear-film changes in patients with familial Mediterranean fever

Purpose:  To evaluate the ocular surface changes and tear‐film functions in patients with familial Mediterranean fever (FMF).

Penile Kaposi's sarcomas in a circumcised and HIV-seronegative patient

Abstract  Kaposis sarcoma (KS) limited to penis is rare and usually observed in AIDS patients. However, in circumcised and HIV‐seronegative patients, KS confined to the penis is extremely rare. We present the case of an HIV‐seronegative and circumcised 55‐year‐old man, who presented with two reddish papules, one 5 mm in diameter on the coronal sulcus near the frenulum, and the other 2 mm in diameter on the glans penis, which were reported as a Kaposis sarcoma after excision of the lesion.

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

Background A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. Methods Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. Results Immunopositivity scores in epithelial cells in NP (median, 2; range, 1–3) were significantly higher than those of controls (median, 1.5; range, 1–2; p < 0.001). ADAM–33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1–3) compared with control tissues (median, 1.5; range, 1–2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1–3), there was no statistical significance when compared with controls (median 2; range, 1–3; p = 0.228). ADAM–33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM–33 and the stages of polyp or computerized tomography scores (p > 0.05). Conclusion This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

Ultrastructural Examination of Glomerular and Tubular Changes in Renal Allografts with Cyclosporine Toxicity

The introduction of cyclosporine (CsA) has improved the clinical results of renal transplantation significantly; however, these improvements were closely associated with an increased incidence of renal dysfunction. The present study sought to examine the ultrastructural changes in renal allografts with CsA nephrotoxicity. Nine patients who underwent renal transplantation at the Baskent University Faculty of Medicine between 2001 and 2002 were examined; 26 biopsies of these nine patients who had received their first renal allograft were included in this study. All patients with CsA toxicity showed some form of glomerular endothelial cell injury. The swelling of mitochondria was present in three of nine renal allografts with CsA toxicity, and podocyte changes were found significantly more frequently among patients with CsA toxicity. In addition, focal segmental thickening and the duplication of glomerular basement membrane were observed statistically more frequently. In conclusion, these findings could help differentiate CsA toxicity from other conditions and develop better treatment strategies.

Probable Sulbactam/Ampicillin–Associated Prolonged Cholestasis

OBJECTIVE To present a single case of sulbactam/ampicillin–induced chronic cholestasis and a literature review of antibiotic-associated chronic cholestasis. CASE SUMMARY A 74-year-old man with Hodgkins disease in remission developed severe and prolonged cholestasis after treatment with sulbactam/ampicillin 750 mg twice daily for 7 days. All other etiologies, including Hodgkins disease, were appropriately ruled out and the cholestasis was ascribed to sulbactam/ampicillin treatment. The patient improved gradually and became asymptomatic 7 months after the last dose of sulbactam/ampicillin. According to the Naranjo probability scale, sulbactam/ampicillin was the probable cause of the cholestasis. DISCUSSION Ampicillin, a semisynthetic penicillin, has rarely been associated with hepatic injury when used alone. Hepatocellular and acute cholestatic injury due to ampicillin have been described. Cholestasis secondary to sulbactam/ampicillin use has not been previously reported. CONCLUSIONS Sulbactam/ampicillin, one of the most widely used antibiotics, may cause chronic cholestatic hepatitis. Clinicians should be aware of this adverse affect and consider it during diagnostic workup of liver injury.

Expression of metalloproteinases MMP-2 and MMP-9 in antrochoanal polyps.

Background Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP). Methods We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohisto-chemistry for MMP-2 and MMP-9 expression. Results Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05). Conclusion MMP-9–expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

Globular amyloid deposits in the wall of the gastrointestinal tract: report of six cases

Amyloid deposition in the gastrointestinal tract basement membrane, lamina propria, and blood vessel walls has been well documented. This article describes six cases that exhibited the unusual globular pattern of deposition on light microscopy, yet exhibited the classic histochemical and immunohistochemical properties of deposited amyloid. This deposition pattern is a novel finding in the gastrointestinal system. Endoscopic examination of five patients revealed mild nodularity of the gastric mucosa and diffuse gastritis. In the other case, macroscopic examination of resected small intestine showed focal mucosal depressions. In all six cases, light microscopy study revealed round to oval-shaped globules in the lamina propria, with globule diameters of 3 to 40 μm. When stained with Congo red, the deposited material refracted polarised light, and immunohistochemical testing showed a positive reaction to AA antibody. The deposits did not react with antibodies to β2, microglobulin, transthyretin, or lambda and kappa light-chain immuno-globulins. None of the laboratory or clinical findings in the six cases was compatible with monoclonal gammopathy or multiple myeloma. The literature contains a few case reports of globular amyloid deposition in the liver, but this is the first description of a globular pattern in the gastrointestinal tract. The pathogenesis and significance of this finding are not clear, and will require further study.