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    A rare cause of spinal dysraphism: lipomeningomyelocele
    (Elsevier Science Inc, 2016) Resorlu, Hatice; Gokmen, Ferhat; Resorlu, Mustafa; Akbal, Ayla; Bozkurt, Emre
    [Anstract Not Available]
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    Aggravated neuromuscular symptoms of mercury exposure from dental amalgam fillings
    (Elsevier Gmbh, Urban & Fischer Verlag, 2014) Akbal, Ayla; Yilmaz, Hinc; Tutkun, Engin; Kos, Durdu Mehmet
    Dental amalgam fillings are widely used all over the world. However, their mercury content can lead to various side effects and clinical problems. Acute or chronic mercury exposure can cause several side effects on the central nerve system, renal and hepatic functions, immune system, fetal development and it can play a role on exacerbation of neuromuscular diseases. In this case, we will present a patient with vacuolar myopathy whose symptoms were started and aggravated with her dental amalgam fillings. (C) 2013 Elsevier GmbH. All rights reserved.
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    Ağır metallerin kemik doku üzerine toksik etkileri
    (2015) Akbal, Ayla; Reşorlu, Hatice; Yılmaz, Savaş
    Ağır metaller doğada yaygın olarak bulunur. Çevresel ve mesleki nedenlerle ağır metallere maruz kalındığı zaman çeşitli sistemlerde toksiketkiler ortaya çıkabilir. Ağır metallere akut ve kronik maruziyette farklı klinik bulgular ortaya çıkar. Birçok ağır metalin primer doku organıkemiktir ve kronik maruziyette kemik dokuda toksik etkiler oluşturur. Bu makalede maruziyetine sık rastlanan ağır metallerin kemik üzerinetoksik etkilerinin gözden geçirilmesi amaçlandı. (Türk Osteoporoz Dergisi 2015;21: 30-3)
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    Angioedema - an unusual serious side effect of risperidone injection
    (Informa Healthcare, 2013) Gunes, Fahri; Batgi, Hikmetullah; Akbal, Ayla; Canatan, Tugba
    [Anstract Not Available]
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    Are inflammatory bowel disease patients aware of Achilles tendonitis?
    (Oxford Univ Press, 2014) Akbal, Ayla; Gokmen, Ferhat; Doner, Davut; Uysal, Fatma
    [Anstract Not Available]
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    Arsenic exposure associated with decreased bone mineralization in male
    (Informa Healthcare, 2014) Akbal, Ayla; Yilmaz, Hinc; Tutkun, Engin
    Objective: Arsenic (As) exposure may cause several medical problems. There were a few studies investigated whether it has affected bone tissue in women. However, there was no study in men. The aim of this study was to evaluate associations between bone mineral density (BMD) and As exposure in men subjects. Material and methods: We enrolled in this study 254 subjects who due to chronic As exposure suspected and 82 subjects as a control group. Hair As levels were detected by a hair analysis (Varian AA240Z Zeeman Atomic Absorption Spectrometer, USA). BMD measurements were obtained using dual-energy X-ray absorptiometry instrumentation. We investigated associations between the hair As levels and BMD measurements. Results: The frequency of osteoporosis and osteopenia was found to be 0.8% and 54.5%, respectively, in the As exposure group. The frequency of osteoporosis was found to be 1% and osteopenia was 32.4% in control subjects. There was significant difference between two groups (p<0.001). Hair As level has a median 1.01 (min: 0.06 and max: 25.71). There were no significant correlation between hair As levels and BMD measurements. Conclusion: According to our observations, As exposure was associated with bone metabolism. Possible cause of osteopenia may be exposure to As. Further investigations are needed to estimate the relationship between As and bone metabolism.
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    Assessment of BMP-6 polymorphism and relationship with disease activity in Ankylosing Spondylitis patients
    (Elsevier Science Bv, 2016) Oztopuz, R. Ozlem; Sılan, Fatma; Akbal, Ayla; Coskun, Ozlem; Özdemir, Öztürk
    [Anstract Not Available]
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    Association between apparent diffusion coefficient and intervertebral disc degeneration in patients with ankylosing spondylitis
    (E-Century Publishing Corp, 2015) Resorlu, Mustafa; Gokmen, Ferhat; Resorlu, Hatice; Adam, Gurhan; Akbal, Ayla; Cevizci, Sibel; Sariyildirim, Abdullah
    Purpose: To assess the relation between ankylosing spondylitis (AS) and degenerative disc disease emerging in association with various intrinsic and extrinsic factors and to evaluate the correlation between degree of degeneration in intervertebral discs and apparent diffusion coefficient (ADC) values. Methods: Thirty-five patients with AS and a control group of 35 patients were included in the study. Three hundred fifty intervertebral discs were assessed in terms of degeneration by analyzing signal intensities and morphologies on T2 weighted series of a 1.5 Tesla magnetic resonance scanner. ADC values were determined in diffusion weighted images (DWI) using a b value of 500 s/mm(2). Patients in the AS and control groups were compared in terms of intervertebral disc degeneration, and association between degree of degeneration and ADC values was analyzed. Results: The mean of total degeneration degrees for five lumbar intervertebral discs was significantly higher in the patients with AS compared to the control group (16.77 +/- 4.67 vs 13.00 +/- 4.08, respectively; P=0.001). When intervertebral discs were analyzed separately, disc degeneration was again significantly higher in patients with AS compared to the control group, with the exception of L5-S1. Age, cholesterol level, triglyceride level, duration of disease and BASFI index were significantly associated with degree of degeneration in patients with AS. A negative correlation was determined between disc degeneration and ADC value. Conclusion: AS is a risk factor for degenerative disc disease due to its systemic effects, the fact it leads to posture impairment and its inflammatory effects on the vertebrae. A decrease in ADC values is observed as degeneration worsens in degenerative disc disease.
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    Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging
    (Soc Physical Therapy Science, 2015) Resorlu, Hatice; Resorlu, Mustafa; Gokmen, Ferhat; Akbal, Ayla; Adam, Gurhan; Komurcu, Erkam; Goksel, Ferdi
    [Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3 +/- 7.0 years, while it was 16.7 +/- 12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.
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    Association between mean platelet volume and disease severity in patients with psoriasis and psoriatic arthritis
    (Termedia Publishing House Ltd, 2017) Kilic, Sevilay; Resorlu, Hatice; Isik, Selda; Oymak, Sibel; Akbal, Ayla; Hiz, Meliha Merve; Ogretmen, Zerrin
    Introduction: Mean platelet volume (MPV) is an important marker that shows the activation and function of the platelets, which is effective in the inflammatory diseases. Aim: To show the relationship between MPV and the development of psoriatic arthritis (PA) in patients with psoriasis vulgaris (PV) and the correlation between MPV and psoriasis severity score (PASI). Material and methods: Our study included 116 patients with psoriatic arthritis (68 female, 48 male) and 41 patients in the psoriasis group (19 female, 22 male) and 90 subjects in the control group (55 female, 35 male). The demographic data of the patients, duration of disease, PAS', the nature of the disease were evaluated retrospectively. Results: Mean platelet volume levels of both the PV group (8.79 +/- 0.86 fl) and the PA group (9.18 +/- 1.26 fl) were significantly higher compared to the control group (8.42 +/- 0.74 fl). There was a weak statistically positive correlation between the PASI and the MPV according to the correlation analysis (r = 0.165; p = 0.046). Conclusions: Our results show that MPV may be helpful as an indicator of the clinical course of PV and PA. In this regard, that study should be supported by prospective studies to find strong correlations.
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    Bilateral Upper Extremity Edema in the Psoriatic Arthritis Case
    (Aves, 2015) Gokmen, Ferhat; Akbal, Ayla; Savas, Yilmaz; Zateri, Coskun; Karaca, Adem; Tan, Yusuf Ziya
    Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by peripheral arthritis, enthesis, spondylitis, and psoriasis. Lymphedema arises from the slowing of lymphatic flow because of inflammatory or noninflammatory diseases such as tumors, infections, bursitis, rheumatoid arthritis, and polymyalgia rheumatica. It is commonly encountered in one or more regions of distal extremities. Lymphedema is a rare complication of PsA, and it is commonly seen asymmetrically and in lower extremities. We aimed to report a case, who followed-up with diagnosis with PsA and with complaints of upper extremity swelling and bilateral upper extremity lymphedema diagnosed as a result of the review.
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    C-reactive protein gene and Toll-like receptor 4 gene polymorphisms can relate to the development of psoriatic arthritis
    (Springer London Ltd, 2015) Akbal, Ayla; Oguz, Sevilay; Gokmen, Ferhat; Bilim, Serhat; Resorlu, Hatice; Sılan, Fatma; Uludağ, Ahmet
    We aimed to determine in psoriatic arthritis (PsA) patients the Toll-like receptor (TLR) 4 and C-reactive gene (CRP) polymorphisms and allele frequency and to investigate the relationship between clinical parameters and gene polymorphisms. We enrolled in this study 31 PsA and 41 healthy control subjects. PsA diagnosis was according to CASPAR criteria. Bath ankylosing spondylitis diseases activity index, Maastricht ankylosing spondylitis enthesitis score, and Bath ankylosing spondylitis functional index were measured. C, A, and T alleles of CRP and A and G alleles of TLR 4 were determined using the analysis of melting curves after real-time PCR. CRP A, C, and T allele frequency in controls was 26.8, 73.2, and 36.6 %, respectively. In the PsA patient group, A, C, and T allele frequency was 9.7, 87.1, and 12.9 %, respectively. Between control and PsA groups, there was a significant difference in A, C, and T allele frequency (P = 0.008, 0.038, and 0.001, respectively). The frequency of CRP gene polymorphisms (CA, AA, CT, TA, and TT alleles) in the control group was 56.1 % and in the PsA group was 22.6 %. There was a significant difference between the two groups (P = 0.004). The absence of a CRP gene polymorphism was a risk factor for PsA (odds ratio 4.3, 95 % CI; 1.5-12.4, P = 0.005). TLR gene haploid frequency was investigated, and all control subjects had the wild-type AA allele. PsA patient GA allele frequency was 6.5 %. There was no significant difference between the two groups (P = 0.182). GA mutant allele frequency was related to PsA (odds ratio 7.03, 95 % CI; 0.32-151.9, P = 0.214). We have shown that CRP gene polymorphisms are higher in control subjects than PsA patients, and TLR 4 gene polymorphisms were found to be related to PsA.
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    Cubital tunnel syndrome secondary to gouty tophi: A case report
    (Pakistan Medical Assoc, 2017) Resorlu, Hatice; Zateri, Coskun; Akbal, Ayla; Gokmen, Ferhat; Adam, Gurhan; Bilim, Serhad; Bozkurt, Emre
    Gout is a chronic rheumatic disease resulting from accumulation of monosodium urate crystals in tissues. The most important risk factor for the disease is hyperuricaemia. Precipitation of uric acid in the joint in the form of monosodium urate crystals is the main factor responsible for triggering attacks of arthritis. Tophi occur as a result of urate crystals that precipitate into joints and surrounding tissues. Tophi can erode the bone where they are located and cause compression in soft tissue due to a mass effect. The following case report describes a case of cubital tunnel syndrome developed in association with tophaceous compression and resolved with surgical decompression in a patient with chronic gouty arthritis.
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    Dose of Methotrexate the Association with Methotrexate Induced Rheumatoid Nodulosis
    (Çanakkale Onsekiz Mart Üniversitesi, 2013) Akbal, Ayla; Gökmen, Ferhat; Sargın, Betül; Oğuz, Sevilay
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    Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study
    (Springer, 2014) Komurcu, Erkam; Yuksel, Halil Yalcin; Ersoz, Murat; Aktekin, Cem Nuri; Hapa, Onur; Celebi, Levent; Akbal, Ayla
    The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90A degrees. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60A degrees and 180A degrees/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180A degrees/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2 %) than in Group 1 (-23.1 %). For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. II.
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    Effect of Systemically Used Anti-Tumor Necrosis Factor- Medication on the Corneal Epithelium and Stroma of Patients with Ankylosing Spondylitis
    (Taylor & Francis Inc, 2017) Arikan, Sedat; Gokmen, Ferhat; Ersan, Ismail; Akbal, Ayla; Resorlu, Hatice; Gencer, Baran; Ali Tufan, Hasan
    Purpose: To evaluate the effect of systemically used anti-tumor necrosis factor alpha (TNF-alpha) medication on the thickness of corneal epithelium and stroma in patients with ankylosing spondylitis (AS). Methods: A total of 125 eyes of 69 participants were included in this retrospective study of three groups: healthy participants (Group 1), AS patients receiving anti-TNF-alpha medication (Group 2), and AS patients receiving a nonsteroidal anti-inflammatory medication (Group 3). Results: According to anterior segment optical coherence tomography, the mean thickness of the corneal epithelium was significantly thicker in Group 2 than in Group 3 (51.6 +/- 3.2 mu m versus 50.4 +/- 3 mu m, p = 0.01), as was that of the stroma (475 +/- 33 mu m versus 443 +/- 29 mu m, p = 0.002). Conclusions: Anti-TNF-alpha medication and/or avoidance of nonsteroidal anti-inflammatory drugs could improve the thickness of both the corneal epithelium and stroma in AS patients.
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    Effect of Using High-Speed Drill in Anterior Cervical Discectomy and Fusion
    (Turkish Neurosurgical Soc, 2016) Guven, Mustafa; Ceylan, Davut; Aras, Adem Bozkurt; Akbal, Ayla; Gokmen, Ferhat; Resorlu, Hatice; Alkan, Bahadir
    AIM: The objective of this study was to investigate the effect of using 2 different surgical techniques (curette or high-speed drill) in anterior cervical discectomy surgery on the healing of cases. MATERIAL and METHODS: Fifty-four operated cervical disc hernia cases were retrospectively examined in 2 groups. Discectomy and osteophytectomy were carried out in Group A by using a high-speed drill, while a curette was used for group B. Preoperative and postoperative computerized tomography and direct radiography were performed. Cervical disc height, cervical and segmental lordotic angles were calculated. The visual analogue scale and Odom's criteria were used in the assessment of pain and clinical healing. The fusion ratio of both groups was compared. The Mann-Whitney U test was used to compare data from the groups. RESULTS: Satisfactory results were obtained in the groups where high-speed drill and curette were used. Independently from the surgical technique, pain scores were significantly reduced in both groups after surgery. No radiologically significant differences were identified between the two groups within the postoperative period. CONCLUSION: Either high-speed drill or curette can be chosen for the osteophytectomy and discectomy stages of anterior cervical discectomy operations.
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    Epicardial Adipose Tissue Is Increased in Patients With Inflammatory Bowel Disease
    (Amer Inst Ultrasound Medicine, 2016) Uysal, Fatma; Akbal, Erdem; Akbal, Ayla; Cevizci, Sibel; Arik, Kasim; Gazi, Emine
    Objectives-Patients with inflammatory bowel disease (IBD) have high cardiovascular morbidity, and, in general, epicardial adipose tissue thickness is related to atherosclerotic vascular disease. This study aimed to investigate the association between epicardial adipose tissue thickness and carotid intima-media thickness as markers of early atherosclerosis in patients with IBD. Methods-The study comprised 47 patients with IBD (25 with Crohn disease and 22 with ulcerative colitis) and 35 control participants. In all individuals, epicardial adipose tissue and carotid intima-media thickness values were measured by sonography. Results-The mean age +/- SD of the 47 patients with IBD was 42.3 +/- 11.2 years, versus 41.4 +/- 10.1 years for the control group. The epicardial adipose tissue thickness was higher in both the Crohn disease and ulcerative colitis groups compared to the control group (P < .001), but not the carotid intima-media thickness (P = .695 and .917, respectively). There was a strong positive correlation between the carotid intima-media and epicardial adipose tissue thickness values in the Crohn disease and ulcerative colitis groups (r = 0.757; 95% confidence interval, 0.711-0.901; r = 0.786; 95% confidence interval, 0.364-0.615; both P < .001). However, there was no significant difference between the patients who were in the active and inactive disease periods in both groups in terms of carotid intima-media and epicardial adipose tissue thickness values. Conclusions-Our findings suggest that epicardial adipose tissue thickness might be a marker for detection of early atherosclerosis in patients with IBD. There was a strong positive correlation between carotid intima-media thickness and epicardial adipose tissue thickness values in the patients with IBD. However, there was no correlation between IBD activity and carotid intima-media or epicardial adipose tissue thickness.
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    Epicardial adipose tissue thickness in patients with ankylosing spondylitis
    (Springer London Ltd, 2015) Resorlu, Hatice; Akbal, Ayla; Resorlu, Mustafa; Gokmen, Ferhat; Ates, Can; Uysal, Fatma; Adam, Gurhan
    The purpose of our study was to measure epicardial adipose tissue (EAT) thickness as a novel indicator of atherosclerosis and cardiovascular risk factor in ankylosing spondylitis (AS) patients and to show the relationship with clinical parameters and inflammatory markers. Forty AS patients (42.75 +/- 12.43 years) and 40 healthy individuals with no cardiovascular risk factor as the control group (43.02 +/- 14.78 years) were included in the study. Carotid intima-media thickness (CIMT) and EAT thickness were measured in AS patients and the control group. Total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, erythrocyte sedimentation rate, urea, and blood pressure were investigated in both groups. In addition, the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used to evaluate the association between clinical findings and CIMT and EAT in the patient group. CIMT and EAT thickness were higher in the AS patients compared to the control group. CIMT was 0.76 +/- 0.19 and 0.57 +/- 0.12 mm (p < 0.001) and EAT thickness was 4.35 +/- 1.56 and 3.03 +/- 0.94 mm (p < 0.001) in the AS and control groups, respectively. A correlation was determined between EAT thickness and CIMT. Triglyceride level, patient age, blood pressure, and duration of disease were correlated with both CIMT and EAT thickness. Increased CIMT and EAT thickness in AS patients compared to the control group shows a risk for subclinical atherosclerosis and cardiovascular disease.
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    Evaluation of possible factors affecting contrast sensitivity function in patients with primary Sjogren's syndrome
    (Consel Brasil Oftalmologia, 2015) Arikan, Sedat; Gokmen, Ferhat; Comez, Arzu Taskiran; Gencer, Baran; Kara, Selcuk; Akbal, Ayla
    Purpose: The contrast sensitivity (CS) function in patients with primary Sjogren's syndrome (pSS) may be impaired either frequently as a result of dry eye diseases or rarely as a result of optic neuropathy. In this study, we aimed to evaluate the CS function in pSS patients as well as to assess corneal aberrations and thickness of the peripapillary retinal nerve fiber layer (pRNFL). Methods: Fourteen eyes of 14 pSS patients (pSS group) and 14 eyes of 14 healthy participants (control group) were subjected to assessment of CS at the spatial frequencies of 1.5, 3.0, 6.0, 12, and 18 cycles/degree (cpd) using a functional visual acuity contrast test (FACT); measurement of corneal high-order aberrations (HOAs) in terms of coma-like, spherical-like, and total HOAs using Scheimpflug corneal topography; and measurement of the thickness of both the macular ganglion cell-inner plexiform layer (mGCIPL) and pRNFL in all quadrants using optical coherence tomography. None of the participants were under treatment with artificial tears. Results: The results of the CS test did not differ between the 2 groups at all spatial frequencies (p>0.05). In addition, there were no statistically significant differences between the 2 groups in terms of corneal HOAs (p>0.05) and thickness of mGCIPL (p>0.05). However, among all quadrants, only the inferior quadrant of pRNFL in pSS patients was statistically significantly thinner than that in the healthy participants (p=0.04). Conclusions: The CS function in pSS patients can be maintained with normal thickness of both pRNFL and mGCIPL and with lack of increased corneal HOAs, which may be present even in the absence of artificial tear usage.