Serdal Ugurlu

Istanbul University, İstanbul, Istanbul, Turkey

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Publications (66)247.67 Total impact

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    ABSTRACT: Many clinicians believe hypercortisolism is ulcerogenic. However, data from clinical studies show that prophylaxis for peptic ulcer disease is no longer recommended in patients receiving corticosteroid treatment. This has not yet been verified in endogenous hypercortisolism by controlled clinical studies. The purpose of the current study was to evaluate the relationship between endogenous Cushing’s syndrome (CS) and peptic ulcer disease and Helicobacter pylori infection. The study group contained 20 cases with CS resulting from ACTH-dependent endogenous hypercortisolism. The control groups consisted of 14 age- and gender-matched cases receiving exogenous corticosteroid therapy and 100 cases of dyspepsia with noncushingoid features. Upper gastrointestinal endoscopy was performed on all cases. Biopsies were taken from five different points: two samples from the antrum, two samples from the corpus, and one sample from the fundus. A histological diagnosis of Helicobacter pylori infection was also obtained from evaluation of biopsy specimens. The frequency of stomach and duodenal ulcers did not vary between the groups (p = 0.5 and p = 0.7). Antral gastritis was less frequent and pangastritis was more common in cases with CS compared to the healthy controls (p = 0.001 and p\0.001). The incidence of Candida esophagitis was more frequent in cases with CS compared to cases with corticosteroid treatment and healthy controls (p = 0.03). Histopathological findings and frequency of Helicobacter pylori based on pathology results did not vary between the three groups. It is possible that neither exogenous nor endogenous corticosteroid excess directly causes peptic ulcer or Helicobacter pylori infection. Prophylactic use of proton pump inhibitors is not compulsory for hypercortisolism of any type.
    Endocrine 04/2015; DOI:10.1007/s12020-015-0608-8
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    ABSTRACT: We have previously shown that venous claudication is significantly more common among patients with Behçet's disease (BD) and had proposed that this was a "venous claudication" because it was specifically more common among men with lower extremity venous thrombosis (LEVT). With this study, we reassessed the presence of claudication prospectively by a questionnaire and a treadmill exercise. We studied all men: 61 BD patients with LEVT, 40 BD patients without vascular involvement, and 56 healthy controls. Venous claudication was assessed by a standardized questionnaire. In addition, patients were asked to walk on a treadmill for 10 minutes. Patients who experienced symptoms consistent with venous claudication but still able to walk and those who had to give up the treadmill exercise were noted. Ankle-brachial pressure indices measured before and after the treadmill test did not indicate any peripheral arterial disease. Twenty-one BD patients with LEVT (34%), two BD patients without vascular involvement (5%), and none of the healthy controls described venous claudication when assessed with the questionnaire (P < .001). There were significantly more patients who described claudication during the treadmill exercise among patients with LEVT (21%) compared with those with no vascular disease (8%) and healthy controls (2%) (P = .002). Finally, only those with LEVT (6 of 61) had to stop the treadmill challenge because of claudication. Venous claudication is a severe and frequent symptom, being present in up to one third of BD patients with LEVT. It impairs walking capacity in 10% of these patients. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 04/2015; DOI:10.1016/j.jvs.2015.02.060
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    ABSTRACT: Impaired physical performance is a disturbing complication of acromegaly. We aimed to evaluate the role of regular exercise in amelioration of the impaired physical performance in acromegaly. Patients with acromegaly were divided into two groups according to their participation in a prescheduled program of exercise. Participants in the study group exercised 3 days a week for 3 consecutive months. Exercise tolerance was evaluated by maximal oxygen consumption (VO2 max) and time (T) taken to complete the Bruce protocol, muscle flexibility by the sit and reach test (SRT) and muscle strength by the hand grip strength test (HGST). Concomitantly, anthropometric assessment was done using body mass index (BMI), waist to hip ratio (WHR), skinfold measurements from 8 points, percentage body fat (PBF), fat mass (FM) and lean body mass (LBM). After 3 months of exercise VO2 max and T were higher in cases that exercised than in cases that did not (p=0.004 and p=0.001). Over 3 months, within the exercise group, VO2 max and T of the Bruce protocol increased (p=0.003 and p=0.004) and heart rate during warming decreased (p=0.04). SRT increased within the exercise group after 3 months (p=0.004). HGSRT did not change significantly (right p=0.06 and left p=0.2). The sum of skinfolds, BMI, WHR and LBM remained stable over the study period (p=0.1, p=0.08, p=0.3 and p=0.09). PBF decreased slightly and FM decreased significantly over 3 months (p=0.05 and p=0.03). Even short-term exercise may improve impaired physical performance, muscle activity and disturbed body fat composition in acromegaly. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 12/2014; DOI:10.1111/cen.12708
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    ABSTRACT: BACKGROUND: Behçet's syndrome (BS) is a well-recognized cause of Budd-Chiari syndrome (BCS); however, information about its clinical characteristics and outcome is limited. METHODS: We reviewed the records of about 9000 patients with BS registered at the multidisciplinary Behçet's syndrome outpatient clinic at Cerrahpasa Medical Faculty between July 1977 and October 2013. We identified 43 (40 M/3 F) patients who were diagnosed as having BCS. Their outcome was evaluated between September 2012 and October 2013. RESULTS: In total, 33 patients (77%) had presented with liver-related symptoms (Group I), while 10 (23%) were asymptomatic for liver disease (Group II). This latter group had presented with symptoms related to the presence of major vessel disease such as fever, leg swelling, or dyspnea. The site of venous obstruction determined in 41 patients was inferior vena cava (IVC) and hepatic veins combined in 25 (61%), IVC alone in 12 (29%), and only hepatic veins in 4 patients (10%). The number of patients with concurrent obstruction in the hepatic veins and the IVC was less in Group II than in Group I (3/10 vs 22/31, p = 0.06). A total of 20 (19 M/1 F) patients (47%) had died at a median of 10 months after diagnosis. Mortality was significantly lower in Group II (10%) than in Group I (58%), (p = 0.011). By the end of the survey, 23 patients were alive, of whom 21 could be re-evaluated at the clinic. CONCLUSIONS: BCS associated with BS is usually due to IVC thrombosis with or without hepatic vein thrombosis. Silent cases exist and have a better prognosis. The mortality rate among the patients symptomatic for liver disease remains high.
    Seminars in Arthritis and Rheumatism 12/2014; 44(5). DOI:10.1016/j.semarthrit.2014.10.014.
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    ABSTRACT: Parvovirus B19 infection is often asymptomatic, but clinical expressions may include transient aplastic crisis, erythema infectiosum, non-immune hydrops fetalis, and chronic red cell aplasia. This virus has also been associated with rheumatoid arthritis and other autoimmune connective tissue diseases; however, we could not identify any acute adult myositis case developed after a Parvovirus B19 infection in the literature. For this reason, we would like to present a rare case of acute myositis developed after Parvovirus B19 infection. In patients presenting with symptoms of fever, rash on the legs and myositis, viral infections such as Parvovirus B19 should be kept in mind. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
    11/2014; 55(2). DOI:10.1016/j.rbre.2014.10.001
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    ABSTRACT: Parvovirus B19 infection is often asymptomatic, but clinical expressions may include transient aplastic crisis, erythema infectiosum, non‐immune hydrops fetalis, and chronic red cell aplasia. This virus has also been associated with rheumatoid arthritis and other autoimmune connective tissue diseases; however, we could not identify any acute adult myositis case developed after a Parvovirus B19 infection in the literature. For this reason, we would like to present a rare case of acute myositis developed after Parvovirus B19 infection. In patients presenting with symptoms of fever, rash on the legs and myositis, viral infections such as Parvovirus B19 should be kept in mind.
    Revista Brasileira de Reumatologia 10/2014; 55(2). DOI:10.1016/j.rbr.2013.06.005
  • Clinical and experimental rheumatology 09/2014; 32 Suppl 84(4):175.
  • Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):313-313. DOI:10.1136/annrheumdis-2014-eular.5626
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    ABSTRACT: Objective. Some features of Behcet's syndrome (BS) tend to go together. We aimed to explore the association and timing of various vascular events in both the venous and the arterial vascular tree. Methods. We conducted a chart survey on the type and time of vascular involvement of BS. The cross-relationships of involvement were assessed by phi correlation coefficients. Multiple correspondence analysis was used to identify patterns of vascular involvement. The risk of vascular recurrence was also estimated. Results. We identified 882 patients with vascular involvement among 5970 BS patients (14.7%). Deep vein thrombosis (DVT), almost always in the legs, was the most frequent single vascular event (592/882; 67.1%). The cumulative risk of a recurrent vascular event was 38.4% at 5 years. Patients with extrapulmonary artery involvement (EPAI) were significantly older than those with venous and pulmonary artery involvement (PAI). There were significant correlations between dural sinus thrombosis (DST) and PAI, Budd-Chiari syndrome (BCS) and inferior vena cava syndrome (IVCS) and between IVCS and superior vena cava syndrome (SVCS). Multiple correspondence analysis further indicated clustering of PAI, DST, BCS, IVCS and SVCS. However, EPAI and DVT clustered separately from forms of vascular disease, the separate clustering of the DVT being attributed to its propensity to occur solo. Conclusion. The most common type of vascular involvement in BS is solo DVT, almost always occurring in the legs. Various forms of venous disease in BS segregate together and PAI is included in this group. EPAI segregates separately.
    Rheumatology (Oxford, England) 06/2014; 53(11). DOI:10.1093/rheumatology/keu233
  • Caner Saygin, Didem Uzunaslan, Serdal Ugurlu
    Laboratory hematology: official publication of the International Society for Laboratory Hematology 06/2014; 20(2):7-8. DOI:10.1532/LH96.13001
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    ABSTRACT: The introduction of TNF inhibitors into clinical practice has revolutionalised the treatment of most inflammatory diseases. However, these drugs are associated with various and potentially serious side effects. Despite being rare, demyelinating neuroinflammatory disordes including multiple sclerosis, optic neuritis, transverse myelitis, polyradiculoneuropathy, and Guillain-Barre Syndrome (GBS) have been reported after using anti-TNF drugs, particularly with infliximab. Adalimumab is a newer fully humanised monoclonal anti-TNF antibody and to date, transverse myelitis during the course of adalimumab treatment has never been reported. Herein, we describe a patient who received adalimumab for management of his ankylosing spondylitis (AS) and developed synchronous transverse myelitis and GBS after therapy. A 69-year old male with a 30-year history of AS, was admitted to neurology clinic with lower extremity weakness. Physical examination revealed bilateral 5/5 and 0/5 motor strengths in upper and lower extremities, respectively. He did not have sphincteric or sensorial deficits, cerebellar symptoms, or aphasia. He had received adalimumab treatment for 8 months (40 mg subcutaneously every 2 weeks) which controlled his refractory AS symptoms, but the patient had stopped taking the drug 3 months before the onset of his symptoms. MRI showed increased signal intensity at distal spinal cord which supported the diagnosis of myelitis. After one week course of pulse steroids, the patient responded well and gained full strength. One month later, he presented again with bilateral lower extremity weakness and falls, and physical examination showed full strength in upper extremity and muscle strength was 2/5 on right and 0/5 on left lower extremity. He had hypotonia and hyporeflexia on the right and areflexia on the left lower extremity. Repeated MRI scan showed regressed spinal lesion, lumbar puncture revealed elevated protein levels (107 mg/dL) and EMG was compatible with GBS. The patient received intravenous immunoglobulin and showed gradual improvement in lower extremity muscle strength. Central and peripheral progressive demyelinating neuroinflammatory lesions might occur during anti-TNF treatment, with the latter being more common than central nervous system involvement. There are a few reports indicating an association between adalimumab and GBS in patients with rheumatoid arthritis, but synchronous occurence of transverse myelitis and GBS is so unusual, and both diseases responded well to standard measures.
    Annals of the rheumatic diseases 03/2014; 73 Suppl 1:A40-1. DOI:10.1136/annrheumdis-2013-205124.92
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    ABSTRACT: To test the hypothesis that colchicine use during early disease decreases immunosuppressive use in Behçet syndrome (BS) in the long term. Patients with BS who participated in a double-blind, placebo-controlled trial of colchicine 16.6 ± 1.1 years ago were evaluated for immunosuppressive use during the posttrial period. We could contact 90/116 patients; 28 (31%) received immunosuppressives during the posttrial period, 14 being from the colchicine arm. Posttrial colchicine use and cumulative duration were similar between patients who received immunosuppressives and those who did not. Continuous use of colchicine, even when initiated at an early disease stage, does not seem to decrease the use of immunosuppressives in the long term.
    The Journal of Rheumatology 02/2014; 41(4). DOI:10.3899/jrheum.130847
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):716-716. DOI:10.1136/annrheumdis-2012-eular.1362
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):707-707. DOI:10.1136/annrheumdis-2012-eular.1220
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A488-A488. DOI:10.1136/annrheumdis-2013-eular.1464
  • Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A541-A541. DOI:10.1136/annrheumdis-2013-eular.1620
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):395-395. DOI:10.1136/annrheumdis-2012-eular.2697
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):708-708. DOI:10.1136/annrheumdis-2012-eular.1227
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):225-225. DOI:10.1136/annrheumdis-2012-eular.2173
  • Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):714-714. DOI:10.1136/annrheumdis-2012-eular.1327

Publication Stats

324 Citations
247.67 Total Impact Points

Institutions

  • 2006–2015
    • Istanbul University
      • Department of Family Medicine (Cerrahpasa Faculty of Medicine)
      İstanbul, Istanbul, Turkey
  • 2014
    • Istanbul Medical University
      İstanbul, Istanbul, Turkey
  • 2009–2010
    • Fatih Sultan Mehmet Training and Research Hospital
      İstanbul, Istanbul, Turkey
  • 2007–2009
    • Cumhuriyet University
      • Faculty of Medicine
      Sivas, Sivas, Turkey