Hamdi Er

Serum levels of TNF-alpha, sIL-2R, IL-6, and IL-8 are increased and associated with elevated lipid peroxidation in patients with Behçet's disease.

AIM: Behçets disease (BD) is asystemic immunoinflammatory disorder and the aetiopathogenesis is to be specified. Cytokines play a role in immune response and in many inflammatory diseases. The aim of this case-control study is to investigate serum pro-inflammatory cytokine tumour necrosis factor (TNF)-alpha, interleukin-1beta (IL-1beta), soluble IL-2 receptor (sIL-2R), IL-6, and chemokine IL-8 levels in patients with BD. We also determined the end product of lipid peroxidation (malondialdehyde (MDA)) in BD patients as an index for oxidative stress. METHODS: A total of 37 patients (19 men, 18 women) with BD (active, n = 17; inactive, n = 20) and 20 age-matched and sex-matched healthy control subjects (11 men, nine women) included in this cross-sectional, blinded study. Serum TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 levels were determined by a spectrophotometer technique using the immulite chemiluminescent immunometric assay. Lipid peroxidation was evaluated by Wasowicz et aL The levels of cytokines and lipid peroxidation in the active period were compared with the inactive period of the disease. Results are expressed as mean +/- standard error. RESULTS: IL-1beta levels were below the detection limits of the assay (< 5 pg/ml) in all samples. Mean levels of MDA (8.1+/-0.7 micromol/l), sIL-2R (800+/-38 U/ml), IL-6 (12.6+/-1.1 pg/ml), IL-8 (7.2+/-0.4 pg/ml), and TNF-alpha (7.9+/-0.5 pg/ml) in active BD patients were significantly higher than those in inactive patients (4.3+/-0.5 micromol/l, p < 0.01; 447+/-16 U/ml, p < 0.001; 8.3+/-0.6 pg/ml, p = 0.006; 5.3+/-0.1 pg/ml, p < 0.001; and 5.1 0.2 pg/ml, p < 0.001; respectively) or control subjects (2.1+/-0.2 micromol/l, p < 0.001; 446+/-20 U/ml, p < 0.001; 6.4+/-0.2 pg/ml, p < 0.001; 5.4+/-0.1 pg/ml, p < 0.001; and 4.7+/-0.1 pg/ml, p < 0.001, respectively). On the contrary, only the mean IL-6 level was significantly different between inactive BD and control subjects (p = 0.02). All acute phase reactants were significantly higher in active BD than in inactive period (for each, p < 0.01). Conclusions: High levels of sIL-2R, IL-6, IL-8 and TNF-alpha indicate the activation of immune system in BD. Serum sIL-2R, IL-6, IL-8 and TNF-alpha seem to be related to disease activity. Increased lipid peroxidation suggests oxidative stress in BD and therefore tissue damage in such patients. Amelioration of clinical manifestations would be envisaged by targeting these cytokines, chemokines and lipid peroxidation with pharmacological agents.

Increased Plasma Adrenomedullin Levels in Patients with Behçet’s Disease

Background: Behçet’s disease (BD) is a chronic systemic inflammatory disorder affecting multiple organs with a generalized vasculitis of arteries and veins. Endothelial dysfunction is one of the prominent features of BD. Adrenomedullin (AM) is a peptide produced not only in normal adrenal medulla but also in the vascular smooth muscle cells and endothelial cells, and its role in the course of BD has not been previously described. Objective: To detect changes of plasma AM concentrations in patients with BD compared with age- and sex-matched healthy subjects by using high-performance liquid chromatography (HPCL). We also investigated if disease activity or the duration of BD correlates with AM levels. Methods: Forty-two consecutive patients with BD (38.5 ± 11.1 years, 19 male and 23 female) and 20 healthy age- and sex-matched control subjects (39.5 ± 10.9 years, 8 male and 12 female) were included in this study. We measured plasma AM levels by HPCL, and acute-phase reactants including α1-antitrypsin and α2-macroglobulin, neutrophil count and the erythrocyte sedimentation rate. Results: Mean ± SD plasma AM levels in patients with BD (73.22 ± 25.55 pmol/l) were significantly higher (p < 0.001) than in healthy control volunteers (21.35 ± 12.37 pmol/l). Patients with active BD had similar plasma AM concentrations (79.32 ± 21.89 pmol/l) with patients with inactive disease (67.44 ± 29.92 pmol/l). On the other hand, patients with longer duration of the disease (mean duration, 13.9 ± 3.8 years) had significantly higher plasma AM levels (83.99 ± 19.71 pmol/l; p = 0.005) than patients (62.45 ± 26.57 pmol/l) with shorter duration of the disease (mean duration, 5.5 ± 2.3 years). All acute-phase reaction parameters were found to be significantly increased in the active disease. Conclusion: Considering its endothelial cell implications, AM may be involved in reparatory vessel endothelium mechanisms, especially in the chronic disease.

Craniofacial Anthropometry in a Turkish Population

OBJECTIVEnTo present norms and demonstrate the anthropometric variations in fronto-occipital circumference, inner and outer canthal distances, near and distant [far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects.nnnPARTICIPANTSnThree thousand four hundred forty-eight subjects (1852 male, 1596 female) aged 7 to 40 years were included in this study.nnnMETHODSnThree age groups were studied: children aged 7 to 15 years, young adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each parameter with advancing age.nnnRESULTSnThe fronto-occipital circumference and outer canthal distance of males was significantly (p <.001) wider than females in all age groups. The near and distant interpupillary distances of male subjects were, on average, wider than the female subjects with greater differences with advancing age. Across all subjects aged 7 to 40 years, the mean of all measured parameters and calculated indexes of men and boys was significantly different from girls and women (p <.001). The mean for interpupillary distances in our study in both sexes were found to be similar to Arabian, Hong Kong, and British children; larger than those of Chinese, Black, Indian, and Caucasians; and smaller than those of Mexican children and a mixed European population.nnnCONCLUSIONnThis study clearly shows the anthropometric variation for fronto-occipital circumference, inner canthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital or posttraumatic telecanthus and of planning surgical intervention. We suggest that the comparison of craniofacial dimensions of a patient must be performed with normal standards specific for age as well as sex and race.

Computerized videokeratography and keratometry in determining intraocular lens calculations.

Purpose: To compare the accuracy of standard keratometry and computerized videokeratography (CVK) in determining intraocular lens (IOL) power calculations. Methods: Using the EyeSys Corneal Analysis SystemTM, we prospectively obtained CVK maps on 75 eyes of 69 patients scheduled to have phacoemulsification with implantation of a posterior chamber intraocular lens. Using manifest refraction obtained at 6 weeks postoperatively, we optimized the calculations for the Hoffer Q, Holladay, and SRK/T formulas for standard keratometric and the following six CVK values: average curvatures at the 1 mm, 2 mm, and 3 mm zones, the keratometric equivalent at the 3 mm zone, and the Stiles‐Crawford weighted averages over the 3 mm and 6 mm zones. The accuracy of these parameters was determined by calculating the mean absolute error and percentage of patients with accuracy within ≤ 0.5 diopter (D), ≤ 1.0 D, and ≤ 2.0 D. Results: Keratometrically derived data were slightly more accurate than the CVK‐derived values. The average difference in mean absolute error between the keratometric and CVK values was 0.13 D for the Hoffer Q formula, 0.11 D for the Holladay, and 0.08 D for the SRK/T. Conclusions: In this population of patients, we found the CVK‐derived corneal curvature values to be slightly less accurate than standard keratometry in predicting IOL power. However, CVK provides important corneal curvature data for IOL calculations in patients with abnormal or surgically altered corneal surfaces.

The levels of cytokines and nitric oxide in rabbit vitreous humor after retinal laser photocoagulation

OBJECTIVEnTo determine the levels of nitric oxide (NO) and cytokines such as interleukin 1-beta (IL-1beta), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor-alpha (TNF-alpha) on vitreous humor following retinal laser photocoagulation.nnnMATERIALS AND METHODSnThe rabbits were divided into 3 groups of 4 animals (8 eyes) each. Twelve pigmented rabbit eyes underwent modified grid pattern photocoagulation with a power of 240 mW (group I); 300 mW (group II); and 360 mW (group III). The eyes received 200 burns using a spot size of 200 micro, and duration of 0.2 s. Vitreous humor samples were collected from each eye preoperatively and at 24 and 72 hours after the laser.nnnRESULTSnWhen compared to preoperative levels, IL-6 levels were increased in all groups; IL-1beta levels were increased significantly only in group III. IL-8 levels were high in groups II and III only at 72 hours (P <0.05). TNFalpha levels were elevated significantly in group II and III only at 24 hours (P <0.05). NO levels were significantly higher than preoperative values in all groups at all times.nnnCONCLUSIONnOur results support that especially IL-6, IL-8, and NO levels increase significantly following laser photocoagulation. This preliminary study suggests that IL-6, IL-8, and NO might be dominant contributing factors in the occurrence of the inflammation postoperatively.

Adrenomedullin and Leptin Levels in Diabetic Retinopathy and Retinal Diseases

Purpose: Proliferative and vascular retinal diseases are important cause of irreversible blindness. Consistent features of these diseases are endothelial dysfunction and angiogenesis. Adrenomedullin (ADM) is a multifunctional vasorelaxant peptide. Leptin is a recently discovered metabolic peptide that regulates energy metabolism in human. In the present study, we aimed to investigate the possible roles of adrenomedullin and leptin in the pathophysiology of diabetic and proliferative diseases. Methods: Ten patients with proliferative diabetic retinopathy (57.1 years, 5 female and 5 male) and 8 patients (51 years, 5 female and 3 male) with other retinal diseases including macular hole and epiretinal membrane were included in this study. All the patients had undergone pars plana vitrectomy for complications of the diseases. Vitreous samples were collected by vitreous tap during the vitrectomy. Adrenomedullin analysis was made by using reverse-phase high-performance liquid chromatography (HPLC). Leptin was measured by enzyme-linked immunosorbent assay (ELISA). Body mass index (BMI) [weight (kg)/height (m2)] was calculated for each group. The Mann-Whitney U test was used for statistics. Results: The age, gender ratio and BMI were not substantially different between the two groups. The mean vitreous adrenomedullin levels (63.9 ± 7.1 pmol/l) were significantly higher (p < 0.05) in group I than in group II (34.25 ± 3.0 pmol/l). Leptin levels in vitreous (4.54 ±1.6 ng/ml) were also significantly higher (p < 0.05) in patients with diabetic retinopathy than in those without diabetes (1.83 ± 0.5 ng/ml). Conclusion: Increased adrenomedullin and leptin levels in vitreous humor might be a possible newly associated factor in the course of vascular and proliferative retinal diseases.

Urinary adrenomedullin levels are increased and correlated with plasma concentrations in patients with Behçet's syndrome

Background: The objective was to measure urinary adrenomedullin (AM) levels in patients with active or inactive Behçets syndrome and compare them to levels in healthy control subjects.

Effects of NG-nitro L-arginine and corticosteroids on aqueous humor levels of nitric oxide and cytokines after cataract surgery

PURPOSEnTo assess the efficacy of nitric oxide synthesis (NOS) inhibitor, topical steroids, and nonsteroidal anti-inflammatory drugs on aqueous levels of nitric oxide (NO) and cytokines after cataract surgery.nnnSETTINGnResearch Laboratory, Inonu University Turgut Ozal Medical Center, Malatya, Turkey.nnnMETHODSnFifteen rabbits had intercapsular phacoemulsification and were randomly divided into 3 treatment groups: Group 1 was treated with topical prednisolone acetate 1% drops 5 times a day for 1 week; Group 2, flurbiprofen 0.03% drops 5 times a day for 1 week; Group 3, a 0.1 cc subconjunctival injection of NG-nitro L-arginine (L-NAME) (150 mg/kg) 1 day and 3 days after surgery. Three rabbits serving as controls received a subconjunctival injection of an equal volume of balanced salt solution (BSS) at the same times as the L-NAME injections. Aqueous humor specimens were collected from each eye to determine NO and cytokine levels including interleukin-1-beta (IL-1 beta), interleukin-2R (IL-2R), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha).nnnRESULTSnThe levels of IL-1 beta and IL-6 were higher in Group 2 and the control group than in Groups 1 and 3 at all times. The differences were not statistically significant (P < .05). Nitric oxide and TNF-alpha levels in Groups 1 and 3 were significantly lower than in Groups 2 and the controls 1, 3, and 7 days postoperatively (P < .05).nnnCONCLUSIONnThese findings suggest a strong inhibitory effect of NOS inhibitors and corticosteroids on aqueous levels of TNF-alpha and NO and no inhibitory effect on IL-1 beta and IL-6 levels after cataract surgery.

Primary Heavy Silicone Oil Usage in Inferior Rhegmatogenous Retinal Detachment

Purpose: To evaluate the efficacy and complications of heavy silicone oil (Densiron 68) in primary inferiorly located retinal detachment. Methods: Sixty-seven eyes of patients aged 24–79 years with inferior primary rhegmatogenous retinal detachment with/without proliferative vitreoretinopathy grades C and lower were included in the study. The mean duration of the Densiron endotamponade was 87 days (range, 60–180 days), with a mean follow-up after removal of 110 ± 41 days. Results: Anatomical success was achieved in 64 of 67 eyes with completed follow-up. The mean visual acuity was changed significantly (p < 0.05). Partial superior redetachment occurred in 3 cases during endotamponade. No redetachment occurred after removal of the silicone oil. Postoperative best corrected visual acuity was better than 20/40 in 43 of cases at the end of follow-up. The mean intraocular pressure was 19.2 mm Hg during endotamponade follow-up. Mild to moderate intraocular inflammation was detected in 7 eyes. In 6 cases, adherence of residual bubble or bubbles was present after removal of the heavy silicone oil. Other complications, like elevated intraocular pressure (n = 6), emulsification (n = 8), temporary lens opacities (n = 14) or early cataract (n = 9), were detected after the operation. Conclusion: Long-term endotamponade with Densiron in inferior retinal detachment appears to be a safe and useful option.

Inhibition of Experimental Proliferative Vitreoretinopathy with Protein Kinase C Inhibitor (Chelerythrine Chloride) and Melatonin

Purpose: To investigate whether a protein kinase C (PKC) inhibitor and melatonin prevent proliferative vitreoretinopathy (PVR). Methods: Twentypigmented rabbits were used in this study. All rabbits except controls received an intravitreal injection of 0.15 ml (75,000 units) of platelet-rich plasma into their left eye. The animals were divided into four groups: group I was treated with intravitreal injection of 0.1 ml (100 µmol/ml) of PKC inhibitor (chelerythrine chloride), group II received 1 ml (4 mg/kg) of intraperitoneal melatonin for 3 days, group III received nothing (blank group), and group IV (control group) received only 0.5 ml of 1% ethanol intraperitoneally for 3 days. Proliferative changes were graded in a masked fashion by indirect ophthalmoscopy for a 15-day follow-up period. The malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite levels were measured in the vitreous humor. Results: The grades of PVR were A and B in group I and II, treated with PKC inhibitor and melatonin, respectively. The PVR grade in the blank group was C-D. The mean MDA level in group I (4.2 ± 0.9 µmol/l) was significantly lower than in the blank group (6.0 ± 1.0 µmol/l; p < 0.05). The mean GSH level in group I (66.3 ± 8.8 µmol/l) was not significantly different from that in the blank group (p > 0.05). The MDA and GSH levels in group II were 3.2 ± 0.7 and 70.1 ± 13.3 µmol/l, respectively. Both these levels were significantly different from those of the blank group (p < 0.05). The NO levels in both treatment groups were significantly lower than in the blank group (p < 0.001). Conclusion: These findings suggest an inhibitory effect of PKC inhibitor and melatonin on PVR. The inhibition of PVR development was associated with lower MDA and NO levels with higher GSH levels in the treatment groups.