Tekin Akpolat

Pulmonary Involvement in Behçet’s Disease

Background: Behçet’s disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate poor prognosis and high mortality. Objectives: The aims of this study were to report on patients with pulmonary involvement and to discuss pulmonary artery thrombus and small-sized vasculitis associated with BD, with respect to previously published cases. Methods: Fifteen patients with BD and pulmonary involvement were included in this study. Massive hemoptysis was observed in all patients having pulmonary artery aneurysm (PAA). Results: Eleven patients had macroscopic pulmonary vascular disease (2 PAA, 3 PAA and thrombi and 6 only thrombi) and 3 patients had microscopic pulmonary vascular disease. The remaining patient had pulmonary cryptococcosis. Conclusions: Data regarding treatment and outcomes of patients having BD-related pulmonary emboli/infarct and small-sized vasculitis are limited. Pulmonary vasculitis affects different levels of the pulmonary artery in BD and should be classified as macroscopic and microscopic vascular disease. ‘Pulmonary artery thrombosis’ should be used instead of ‘pulmonary emboli’. Spiral CT angiography is the best radiological tool for evaluation of pulmonary problems in BD. Treatment of vasculitis should be based on the type of vascular disease and may vary among different types of vascular disease. Anticoagulation can be used in patients with microscopic vascular disease and nonaneurysmal macroscopic vascular disease. More studies are needed to clarify this issue.

Behçet’s Disease and AA-Type Amyloidosis

Behçet’s disease (BD) is a multisystem disorder characterized by vasculitis. To our knowledge, 52 patients with BD and amyloidosis have previously been described in the literature. Nephrotic syndrome was the most common type of presentation of amyloidosis in these patients. The prognosis of patients with BD and amyloidosis has not been reported before. In this report, we present a patient with BD and AA-type amyloidosis and analyze the prognosis in these patients. Follow-up and prognosis have been reported in 23 patients. Ten of these 23 patients died and most of these deaths occurred within 3 months after the diagnosis of amyloidosis. End-stage renal disease developed shortly in 4 patients. BD should be considered in the differential diagnosis of AA amyloidosis. In conclusion, the cases with BD and amyloidosis carry poor prognosis.

Iliac Artery Aneurysm in Behçet's Disease: A Case Report

Today, Behçets disease is known as a multisystem disorder.1-4 Eye lesions, mouth and genital aphthous lesions, and skin lesions are accepted as major lesions. The disease also attacks the locomotor system, central nervous system, gastrointestinal system and also arteries and veins. According to available data, some 30% of the patients have vascular lesions; mostly thrombosis of the veins. Arterial thromboses have been rarely reported; and only a few number of arte rial aneurysms are noted.5-13 Here we present an iliac artery aneurysm in a case of Behçets disease.

SAA1 α/α alleles in Behçet’s disease related amyloidosis

Behçet’s disease (BD) related amyloidosis is relatively rare. Serum amyloid A protein (SAA) protein gene polymorphism is one of the factors implicated in the pathogenesis of AA type amyloidosis. The aim of this study is to investigate SAA1 gene polymorphism in different patient groups: (1) BD related amyloidosis, (2) BD without amyloidosis, and (3) healthy controls. One hundred eleven patients from three main groups were included in the study: (1) BD related amyloidosis (n = 9), (2) BD without amyloidosis (n = 39), and (3) healthy controls (n = 63). Homozygous α/α is present in 78% of patients with BD and amyloidosis. The SAA1 α/α genotype is significantly more common among patients with BD and amyloidosis. This study demonstrated increased frequency of α/α genotype in BD related amyloidosis. To our knowledge, the relationship between α/α genotype and BD related amyloidosis was not studied previously. In conclusion, the SAA1 α/α genotype is a risk factor for amyloidosis in BD.

Sudden Hearing Loss in a Cyclosporin-Treated Renal Transplantation Patient

Turgay Arinsoy, Nephrology and Otolaryngology Departments, Hacettepe University Medical School, T-06100 Ankara (Turkey) Sir, Thromboembolic complications constitute an important risk in the postoperative course after renal transplantation. The incidence has been reported to be as high as 24% [1]. We present a case of sudden hearing loss due to a thromboembolic event in a renal transplant recipient on triple immunosup-pressive treatment consisting of cyclosporin A (CsA), azathioprine (Aza) and predniso-lone (Pred). A 22-year-old Caucasian male with end-stage renal disease secondary to membrano-proliferative glomerulonephritis underwent a living-related donor renal transplantation. The patient had been maintained on a hemo-dialysis program for 3 months prior to renal transplantation. Initial laboratory results showed that serum creatinine level and blood urea nitrogen were 397 μmol/l and 18.3 mmol/l, respectively. The remainder of his laboratory results including prothrombin time (FT), partial thromboplastin time (PTT), chest X-ray and electrocardiogram were within normal limits. Before the operation, CsA was given in a single dose of 4 mg/kg orally. Methylpredni-solone 1,000 mg and Aza 150 mg were given intravenously during surgery. On the operation day, Pred 100 mg was given orally and tapered by 10 mg daily until the dose of 20 mg per day. He received CsA (4 mg/kg) b.i.d. and Aza (1.5 mg/kg/day) in a single oral dose. He tolerated the operation well and had good urine output postoperatively. On the 7th postoperative day, the patient complained of right sudden hearing loss. On the same day, his blood CsA level was measured as 200 ng/ml, and serum creatinine level was 106 μmol/l. PT and PTT were within normal limits. Because of right sudden hearing loss, the patient was referred to the Otolaryngology Department. He had not any vestibular symptoms, otolaryngologic examination revealed no abnormality except for tuning fork tests. With the tuning fork at 512 cps, there was no response on the right ear. The patient localized the sound in the left ear on the Weber test. Investigations included a full range of

Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012.

Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.

Effect of Vitamin E and Pentoxifylline on Glycerol-Induced Acute Renal Failure

The pathogenesis of acute renal failure may involve, among other causes, ischemia, vascular congestion, arachidonic acid pathways, and reactive oxygen metabolites. The aim of this study is to evaluate the effects of pentoxifylline and vitamin E on the prevention of experimental acute renal failure induced by glycerol. Eighty-five Sprague-Dawley rats weighing 170–230 g were included in the study. The rats were randomly divided into four groups: group 1 was given 1 ml saline; group 2, glycerol; group 3, glycerol plus vitamin E, and group 4, glycerol plus pentoxifylline. Extent of histological renal tubular necrosis and regeneration in each animal were graded. Blood urea nitrogen, serum creatinine, and creatine kinase concentrations were measured. Mean blood urea nitrogen and serum creatinine concentrations and tubular injury scores were significantly lower in group 1 than in groups 2–4 (p < 0.001), but there were no significant differences among groups 2–4. We conclude that postinsult administration of vitamin E and pentoxifylline does not have a beneficial effect on prevention and severity of acute renal failure and that controlled, multicenter studies involving a large number of patients are needed to clarify this subject.

Inaccuracy of home sphygmomanometers: a perspective from clinical practice.

ObjectiveHome blood pressure monitoring requires a precise blood pressure measurement technique and an accurate sphygmomanometer. The oscillometric sphygmomanometers have some drawbacks including inaccuracy. The aims of this study were to assess the inaccuracy of home sphygmomanometers using a method first proposed in 2009 and to compare validated devices with other devices. Materials and methodsThree hundred and eighty-two home sphygmomanometers that had been brought by individuals to the University Hospital were included in this study. This method has three stages (general evaluation, quick screening, final assessment) and sequential measurement of blood pressure is used for assessment. The devices were categorized into two groups for comparisons: validated and ‘others’. ResultsOne hundred and fourteen (30%) of the 382 devices were validated. Final assessment showed 91 (24%) of the 382 devices to be inaccurate. Inaccuracy among the ‘others’ and wrist devices were more common than for the validated and upper arm devices (P<0.0001 for both comparisons). The categorization of upper arm devices into validated and ‘others’ showed that the validated devices were more accurate than the ‘others’ (94 vs. 79%) (P=0.002). The frequency of inaccurate and very inaccurate devices was 3% (three of 114) and 4% (four of 114) for the validated devices, respectively. ConclusionValidated and upper arm devices were more accurate than the ‘others’ and wrist devices. Validation did not guarantee individual accuracy. Active involvement of hypertension centers is required to improve the quality and reliability of home blood pressure monitoring.

Transplantation tourism: high risk for the recipients.

Yakupoglu YK, Ozden E, Dilek M, Demirbas A, Adibelli Z, Sarikaya S, Akpolat T. Transplantation tourism: high risk for the recipients. 
Clin Transplant 2010: 24: 835–838.

Home sphygmomanometers: validation versus accuracy.

ObjectiveThe validation and accuracy of sphygmomanometers are important issues in the home sphygmomanometer market and in clinical practice. The aims of this study are to assess the frequency of validated home sphygmomanometers and to evaluate the relationship between the validation and accuracy of the devices. MethodsEight hundred and ninety-six home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic for this study, and 870 (97%) of the devices were in adequate working condition and suitable for analysis. The relationship between accuracy and validation was investigated only in automated sphygmomanometers (n = 554). ResultsBoth the manufacturer and model were known in 500 devices (90%), and these devices were eligible for evaluation of validation. We found 74 devices listed in the dabl Educational Trust website. Twenty-two of the 74 (30%) devices were validated. Four hundred (72%) of the 554 automated sphygmomanometers were inaccurate. The frequency of accuracy was higher among validated devices compared with nonvalidated devices (68 vs. 15%) (P<0.01). ConclusionOur study showed that the frequency of accurate devices was higher among validated sphygmomanometers compared with nonvalidated sphygmomanometers. To our knowledge, our study is the first to demonstrate the relationship between accuracy and validation of home sphygmomanometers. The frequency of device-related errors can be decreased by training patients and supervising the blood pressure device market. Nonprofit organizations can help patients to overcome some of the problems in the blood pressure device market.