Sema Yilmaz

Impaired coronary microvascular function and increased intima-media thickness in rheumatoid arthritis

BACKGROUND Rheumatoid arthritis (RA) is associated with excessive cardiovascular mortality. Recently, some studies have shown endothelial dysfunction in RA patients with high inflammatory activity. In addition, it has been suggested that the chronic inflammatory state of RA contributes to accelerated atherosclerosis. Therefore, we aimed to evaluate whether coronary microvascular dysfunction and increased carotid artery intima-media thickness exist in patients with a long history and well controlled disease activity of RA lacking traditional cardiovascular risk factors. METHODS Thirty RA patients (22 women; mean age 43.7+/-9.0) and 52 healthy volunteers (38 women; mean age 45.3+/-5.4) were included into the study. Using transthoracic echocardiography, each subject underwent echocardiographic examination including coronary flow reserve (CFR) and carotid intima-media thickness (IMT) measurement. RESULTS CFR values were statistically reduced for RA patients as compared to controls (2.4+/-0.5 vs. 2.7+/-0.4, P=0.002) whereas IMT values were significantly increased (0.6+/-0.1 vs. 0.5+/-0.1, P=0.001). In RA patients, CFR positively correlated with lateral Em/Am ratio (r=0.399, P=0.029), and negatively correlated with lateral isovolumic relaxation time (IVRT) (r=-0.744, P=0.005), IMT (r=-0.542, P=0.002) and RA disease duration (r=-0.495, P=0.005). Reflecting LV diastolic function, mitral E-wave deceleration time and isovolumic relaxation time were borderline significant between the groups, however lateral Em/Am ratio and lateral IVRT were statistically different. CONCLUSIONS Patients with RA had impaired CFR and increased carotid IMT, and these injurious effects correlated significantly with disease duration.

Cochleovestibular dysfunction in ankylosing spondylitis.

Ankylosing spondylitis (AS) is a rheumatic disease characterized by chronic inflammation. The aim of this study was to evaluate the functions of the cochlea and the vestibular system in patients with AS. The study group consisted of 32 patients with AS and 30 healthy volunteers as a control group. Otorhinolaryngologic examinations were performed in all patients together with pure-tone audiometry, speech tests, impedancemetry, transient evoked otoacoustic emission (TEOAE) and electronystagmography (ENG). A significant difference was found between the 2 groups with regard to pure-tone averages at high frequencies in each ear (p < 0.05). The rates of reproducibility in TEOAE testing were significantly lower in patients with AS (p = 0.03). The signal-to-noise rates of the response values were lower at all frequencies in patients with AS, but a statistically significant difference was only observed at 2, 3 and 4 Hz (p < 0.05). ENG revealed pathologies in 11 patients with AS (34%), 8 of which were central (25%) and 3 of which were peripheral (9%). No correlation was found between cochleovestibular dysfunction and age, sex, disease duration, activity and medication taken. This study demonstrated that there is an association between AS and cochleovestibular dysfunction.

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).

Coronary flow reserve and coronary microvascular functions are strongly related to serum uric acid concentrations in healthy adults.

BackgroundUric acid is a well known antioxidant; however, the relationship between serum uric acid levels and oxidative stress-caused disorders including cardiovascular diseases is not clear yet. Transthoracic Doppler echocardiographic measurement of coronary flow reserve is a useful tool to investigate coronary flow reserve and coronary microvascular functions. In this study, we investigated the possible association between serum uric acid concentrations and coronary flow reserve in healthy adults. MethodsOne hundred healthy volunteers with normal uric acid levels, between 18 and 55 years of age, were included in this study. The study group was divided into two with regard to the serum uric acid levels. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion (0.56 mg/kg over 4 min) using echocardiography. ResultsCoronary flow reserve and hyperemic mean peak flow velocity were significantly greater in participants with lower serum uric acid concentrations (≤234 μmol/l for women, ≤302 μmol/l for men) than in those with higher serum uric acid concentrations (>234 μmol/l for women, >302 μmol/l for men) (2.91±0.5 vs. 2.47±0.5, P<0.001; 66.8±11.4 vs. 61.1±16.5, P=0.04). The baseline mean peak flow velocity was significantly greater in participants with higher serum uric acid concentrations than in those with lower serum uric acid concentrations (24.7±4.1 vs. 23.1±2.4, P=0.02). ConclusionLower serum uric acid concentrations might be regarded as indicative of coronary microvascular and conductance vessel functionality.

Vestibular evoked myogenic potentials in Behcet's disease.

The aim of this study was to investigate vestibular evoked myogenic potentials (VEMPs) and their clinical significance in Behcet’s disease. Twenty-six patients with Behcet’s disease and 25 healthy volunteers were evaluated for pure tone audiometry, caloric response, and VEMPs. Sensorineural hearing loss was found in 53.8% of patients with Behcet’s disease, which was significantly higher than controls. Four patients had canal paresis, but no controls; this difference was not significant. Although VEMP recordings were elicited in all study subjects, mean p13 and n23 latencies were prolonged in Behcet’s patients compared with controls. Seven patients had delayed VEMP responses. There were no correlations regarding p13 values and age, duration or activity of disease, vertigo, or sensorineural hearing loss. The results of this preliminary study suggest an association between delayed VEMP responses and Behcet’s disease. Further research with large samples is needed to confirm that VEMP testing is useful to diagnose and follow vestibular dysfunction in Behcet’s disease.

Patients with Behcet's disease carry a higher risk for microvascular involvement in active disease period

Background. Behcets disease (BD) is characterized with remissions and exacerbations. However, to date, there is no study to investigate a possible association of disease activity (active versus inactive disease period) with cardiovascular complications. Methods. Forty patients with BD were evaluated in both active and in inactive disease period. For the control group 45 healthy volunteers, age and sex matched, were registered. Subjects with at least a 15‐day lesion‐free period were regarded in inactive disease period, and subjects with any oral, skin, and/or genital lesion was regarded as in active disease period. In each subject coronary diastolic peak flow velocities (DPFV) were measured at baseline and after dipyridamole infusion (0.84 mg/kg over 6 minutes) using an Acuson Sequoia C256® echocardiography system. Coronary flow reserve (CFR) was defined as the ratio of hyperemic to baseline DPFV. Results. CFR values were significantly lower in BD patients compared to the controls (2.57±0.50 versus 2.87±0.53, P = 0.006). In active disease period, basal DPFV (24.6±7.5 versus 27.3±6.6, P = 0.019) was significantly higher than in the inactive disease period. In the active disease period hyperemic DPFV (61.7±14.9 versus 56.8±16.7, P = 0.015) values decreased significantly. Therefore, in the active disease period CFR significantly decreased from 2.57±0.50 to 2.09±0.46, P<0.001. The only independent predictor of CFR within the active disease period was the disease duration (β = −0.384, P = 0.012). Conclusion. Within the active disease period, coronary microvascular function is more prominently impaired in BD patients. Therefore, BD patients are possibly more vulnerable to cardiovascular manifestations when they are in an active disease period.

Ciprofloxacin-induced generalized bullous fixed drug eruption

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The clinical value and histopathological correlation of lacrimal scintigraphy in patients with primary Sjögren's syndrome.

PurposeTo evaluate the lacrimal gland function in patients with primary Sjögren’s syndrome (SS) using lacrimal scintigraphy (LS) and to determine the relationship between clinicopathological stage of primary SS and LS findings. MethodsSeventy eyes from 35 patients with primary SS and 20 eyes from 10 healthy age-matched and sex-matched individuals who served as the control group were included in this study. The patients with primary SS were divided into two groups – early stage and advanced stage – according to the labial biopsy scores (23 patients in early stage and 12 in advanced stage). LS, the Schirmer-1 test, determination of break-up time (BUT), Rose bengal ocular surface vital staining and assessment of functional parameters including ocular surface disease index (OSDI) scores were performed for all cases. LS was used to evaluate tear clearance. Lacrimal scintigrams were evaluated for the presence and severity of delayed tear clearance. Delay in clearance was also subclassified according to the severity of delay (mild, moderate, severe and very severe). LS findings and ophthalmological test results of patients in early stage of disease were compared with the results of those in advanced stage and with those of normal individuals. ResultThe Schirmer-1 test and BUT values of patients in advanced stage of primary SS decreased significantly, whereas the Rose bengal and OSDI values increased significantly when compared with the values of patients in early stage of primary SS and with those of normal individuals (P<0.05 and P<0.001, respectively). Tear clearance of patients in advanced-stage disease was delayed significantly, compared with the tear delay in patients in early stage of disease and that of normal individuals (P<0.001). An inverse correlation existed between tear clearance and both the Schirmer-1 test and BUT value in all patients (P<0.001). However, there was a positive correlation between both the Rose bengal ocular surface staining values and OSDI scores and tear clearance in all cases (P<0.001). LS findings and ophthalmologic test results were significantly different between early-stage and advanced-stage primary SS. ConclusionThe results indicate that LS, which is correlated closely with ophthalmological test results, may be a useful method for the assessment of the lacrimal gland function in patients with primary SS. LS findings and ophthalmological tests may be used for determining disease severity in primary SS.

Conjunctival impression cytology and tear-film changes in patients with familial Mediterranean fever: authors’ reply

Editor, W e would like to thank Drs Lazar & Rothkoff (2009) for their interest in our recent article, which evaluated ocular surface changes in patients with familial Mediterranean fever (FMF) (Karalezli et al. 2009). We found that despite normal tear production, the ocular surface and tear-film functions of FMF patients differ from those of healthy individuals. We concluded that these changes might be related to the chronic inflammatory nature of FMF. Drs Lazar & Rothkoff stated that ocular surface changes in FMF patients might have resulted from the colchicine treament that they received. There are few case reports in the literature that report the delay of corneal wound healing in patients with FMF who are under colchicine treatment (Biedner et al. 1977; Alster et al. 1997; Leibovitch et al. 2003a, 2003b). However, there is no prospective randomized clinical study that evaluates the effect of colchicine on the ocular surface. Leibovitch et al. (2003a, 2003b) reported that very small quantities of colchicine were secreted in tears but they could not state whether the levels that were measured were in a toxic range. Further prospective randomized control-group studies are needed to confirm the effect of colchicine on the ocular surface and its correlation with the amount and duration of colchicine treatment.