[Show abstract][Hide abstract] ABSTRACT: Aim: Increasing healtcare costs reveal to consider the costs of present diagnostic
and treatment modalities. In this study we analysed the costs of
hospitalized patients with upper gastrointestinal hemorrhage (UGIB) who
admitted to Sisli Hamidiye Etfal Education and Research Hospital. Material
and Method: In this retrospective study, 524 UGIB patients who admitted
to emergency department in 3 years were enrolled. Patients records that
include gender, age, complaint at admission, history of medical drug use,
presence of comorbidity, blood type, cost of hospitalization, mortality, endoscopic
findings, endoscopic forrest’s classification, duration of hospitalization,
number of blood transfusion were recorded. Obtained data were evaluated
to determine their impact on cost of hospitalization. Results: This study
was consisted of 362 male (69,1%) and 162 female (30,9%) patients. Mean
duration of hospitalization was 6.35 ± 4.94 days, mean age was 54.70 ±
20.4 years, and mean number of transfused blood was 2.19 ± 2.25. Mortality
rate was 4,2% (n = 22). Mean cost of hospitalization was 827.97 ± 747.11
Turkish Liras (TL). A statistical significance was determined between cost
of hospitalization and age (p=0,001), duration of hospitalization (p=0,001),
comorbidity (p<0,05), number of transfused blood (p=0,001), and hemoglobine
levels at admission (p<0,05). Discussion: Predisposing drug use, presence
of comorbidity, age, duration of hospitalization, number of transfused
blood were determined as factors that have impact on mortality. Presence of
comorbidity, number of comorbid diseases, age, number of transfused blood
and hemoglobine levels at admission were determined as factors that have
impact on cost of treatment. More studies are needed about duration of
hospitalization and number of transfused blood in UGIB patients.
[Show abstract][Hide abstract] ABSTRACT: Insulinoma is a rare neuroendocrine tumor of the pancreas and is the most common cause of endogenous hyperinsulinemic hypoglycemia. Although 90% of insulinomas are benign tumors, recurrent episodes of hypoglycemia may lead to life threatening consequences. Because surgery is the only curative method for patients with insulinomas, the preoperative localization of these tumors by appropriate imaging methods is important. In this case series, 5 cases of endogenous hyperinsulinemic hypoglycemia, including one patient with MEN-1 syndrome, who were diagnosed as insulinoma according to the prolonged fasting test, were reported. All of the cases had normal pancreas on upper abdominal MRI, therefore, they underwent endoscopic ultrasonography (EUS) for localization of insulinomas and were operated according to the EUS results. EUS demonstrated well-demarcated tumors in the tail of pancreas in 4 cases and in the head of pancreas in one case. However, in contrast to EUS results, one patient with MEN-1 syndrome had a glucagonoma and two insulinomas and one other patient hadn’t any tumor on histopathological evaluation of the distal pancreas after surgery. In this case series, we aimed to present the diagnostic performance of EUS and the treatment outcomes in a cluster of patients with insulinomas who hadn’t a pancreatic lesion on upper abdominal MRI and to briefly review the currently available imaging methods for localization of insulinomas.
Turkish Journal of Endocrinology and Metabolism 04/2015; 19(3). DOI:10.4274/tjem.3007
[Show abstract][Hide abstract] ABSTRACT: Amaç: 25-hidroksi vitamin D [25(OH)D] düzeyleri ile serum paratiroid hormon (PTH), kalsiyum (Ca) ve fosfor (P) arasındaki ilişkinin değerlendirilmesi ve vitamin D eksikliğinin tanımlanmasında serum iPTH, Cave P değerlerinin prediktif bir rolünün olup olmadığının araştırılmasıdır. Gereç ve Yöntemler: Yedi yüz erişkinde serum iPTH, Ca, P değerleri geriye dönük (retrospektif) olarak analiz edildi. Çalışmaya 619 (%88,4) kadın ve 81 (%11,6) erkek birey dâhil edildi. Ortalama yaş 47,44±16,58 yıl idi. Vitamin D eksikliğinin tanımlanmasında
bireyler dört gruba ayrıldı. 25(OH)D düzeyleri <25 nmol/L olan grup ciddi vitamin D eksikliği, 25-49,9 nmol/L vitamin D eksikliği, 50-74,9 nmol/L arasındaki değerler vitamin D yetersizliği ve ≥75 nmol/L üzerindeki değerler ise vitamin D’nin yeterli bulunduğu grubu göstermektedir. Bulgular: Ortalama 25(OH)D, iPTH, Ca ve P düzeyleri sırasıyla 39,42±29,43 nmol/L; 66,15±34,59 pg/mL, 9,64±0,48 mg/dL ve 3,35±0,52 mg/dL olarak bulundu. Bireylerin 271 (%38,7)’i ciddi 25(OH)D eksikliği grubunda, ve 237 (%33,9)’si 25(OH)D eksikliği grubunda, 91 (%13,0)’i 25(OH)D yetersizliği grubunda ve son olarak 101 (%14,4)’i ise 25(OH)D’nin yeterli olduğu gruba uygun olarak sınıflandırıldı. Sekonder hiperparatiroidi 277 (%46,24) bireyde gözlenirken, bu grupta 25(OH)D düzeyleri sırasıyla ciddi eksiklik, eksiklik ve 25(OH)D’nin yetersizliğinin olduğu gruplarda sınıflandı [167 (%61,6); 81 (%34,2) ve 29 (%31,9). iPTH ve 25(OH)D arasında anlamlı ilişki gözlenirken
(r=-0,264), 25(OH)D ile Ca, P, yaş ve cinsiyet arasında anlamlı bir korelasyon gözlenmedi (sırasıyla r=0,099; 0,065; 0,003 ve 0,012). “Post-hoc” analizde iPTH düzeyleri ciddi eksiklik grubunda diğer üç gruba oranla (eksiklik,yetersizlik, 25(OH)D yeterli) anlamlı olarak daha yüksek gözlendi (p<0,05). iPTH değeri 25(OH)D eksiklik grubunda yetersizlik ve 25(OH)D’nin yeterli olduğu gruplarla karşılaştırıldığında anlamlı farklılık gözlenmemiştir (p>0,05). ROC analizi eğrisinde PTH “cut-off” en iyi değeri (62,5 pg/mL) için bile sensitivite
ve spesifisite sırasıyla %65,3 ve %64,8 olarak bulundu. Sonuç: 25(OH)D ciddi eksikliği olan bireylerde PTH değeri anlamlı yüksek olarak bulunmakla beraber, Ca, P ve PTH değerlerinin hiçbiri vitamin D eksikliğini göstermede yeterli sensitivite ve spesifisiteye sahip değildir.
[Show abstract][Hide abstract] ABSTRACT: Plasmapheresis is an alternative way of removing excess thyroid hormones from circulation to control the signs and symptoms of hyperthyroidism. The purpose of this report was to determine the effectiveness of plasmapheresis in rapid preparation of toxic multinodular goiter for thyroid surgery. The indications for plasmapheresis were propylthiouracil related ANCA(+) panniculitis and ineffective control of hyperthyroidism with methimazole. Thyroid hormone levels only moderately decreased after 7 sessions of plasmapheresis. She underwent surgery with β-blocker and dexamethasone treatment to avoid thyroid storm in the perioperative period. Surgery was performed uneventfully. Plasmapheresis can be considered a safe and effective method to prepare patients with thyrotoxicosis for surgery when treatment is contraindicated or failed.
Turkish Journal of Endocrinology and Metabolism 03/2014; 18/(1):23-25. DOI:10.4274/tjem.2302
[Show abstract][Hide abstract] ABSTRACT: The etiopathogenesis of thyroid cancer has not been clearly elucidated although the role of chronical inflammation and the imbalance between pro- and anti-inflammatory cytokines may play a role in the etiology. The aim of the present study was to investigate whether cytokine gene polymorphisms are associated with papillary thyroid cancer (PTC), and to evaluate the relationship between genotypes and clinical/laboratory manifestation of PTC. Tumor necrosis factorα (TNFα) G-308A (rs 1800629), interleukin-6 (IL-6) G-174C (rs 1800795) and IL-10 A-1082G (rs 1800896) single nucleotide polymorphisms in DNA from peripheral blood leukocytes of 190 patients with thyroid cancer and 216 healthy controls were investigated by real-time PCR combined with melting curve analysis. There was no notable risk for PTC afflicted by TNFα-308 and IL-6-174 alone. However, IL-10-1082 G allele frequency were higher among PTC patients than healthy controls (p = 0.009). The patients with IL-10-1082 GG geotype have twofold increased risk of developing thyroid cancer according to AA genotype (OR 2.07, 95 % CI 1.21-3.55). In addition, the concomitant presence of IL-10-1082 G allele (GG + AG genotypes) together with IL-6 -174 GG genotype has a nearly twofold increased risk for thyroid cancer (OR 1.75 with 95 % CI 1.00-3.05, p = 0.049). We suggest that IL-10-1082 G allele is associated with an increased risk of PTC. The polymorphism of IL-10 gene can improve our knowledge about the pathogenesis of PTC, and could provide to estimate people at the increased risk for PTC.
[Show abstract][Hide abstract] ABSTRACT: To determine the role of peak systolic velocity, end-diastolic velocity and resistance indices of both the right and left inferior thyroid arteries measured by color-flow Doppler ultrasonography for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.
The right and left inferior thyroid artery-peak systolic velocity, end-diastolic velocity and resistance indices of 96 patients with thyrotoxicosis (41 with gestational transient thyrotoxicosis, 31 age-matched pregnant patients with Graves' disease and 24 age- and sex-matched non-pregnant patients with Graves' disease) and 25 age and sex-matched healthy euthyroid subjects were assessed with color-flow Doppler ultrasonography.
The right and left inferior thyroid artery-peak systolic and end-diastolic velocities in patients with gestational transient thyrotoxicosis were found to be significantly lower than those of pregnant patients with Graves' disease and higher than those of healthy euthyroid subjects. However, the right and left inferior thyroid artery peak systolic and end-diastolic velocities in pregnant patients with Graves' disease were significantly lower than those of non-pregnant patients with Graves' disease. The right and left inferior thyroid artery peak systolic and end-diastolic velocities were positively correlated with TSH-receptor antibody levels. We found an overlap between the inferior thyroid artery-blood flow velocities in a considerable number of patients with gestational transient thyrotoxicosis and pregnant patients with Graves' disease.
This study suggests that the measurement of inferior thyroid artery-blood flow velocities with color-flow Doppler ultrasonography does not have sufficient sensitivity and specificity to be recommended as an initial diagnostic test for a differential diagnosis between gestational transient thyrotoxicosis and Graves' disease during pregnancy.
[Show abstract][Hide abstract] ABSTRACT: At present, no effective medical treatment exists for recurrent and aggressive craniopharyngiomas that are resistant to conventional
therapies, including surgery and adjuvant radiotherapy. Temozolomide is an alkylating chemotherapeutic agent used routinely
in the management of high grade gliomas. The response to temozolomide is suggested to be dependent on the tumoral expression
of O-6 methylguanine DNA methyltransferase (MGMT). Evidence supports that low MGMT immunoexpression correlates with positive response
to temozolomide. Therefore, we aimed to assess MGMT immunoexpression in adamantinomatous craniopharyngiomas, in an effort
to predict the likelihood of response to temozolomide. The MGMT immunostaining was performed on 23 adamantinomatous craniofaryngiomas
operated at the Sisli Etfal Training and Research Hospital and identified by histological analysis. Paraffin embedded tissue
sections were immunostained for MGMT and were evaluated semi-quantitatively. Of the 23 cases evaluated, 22 (96%) demonstrated
negative (<10%) and 1 (4%) demonstrated low (10%) MGMT immunoexpression. Data from this study suggest a high proportion of
adamantinomatous craniopharyngiomas exhibit negative/low MGMT immunoreactivity and could be treated with temozolomide, if
conventional therapy fails.
[Show abstract][Hide abstract] ABSTRACT: Acute pancreatitis (AP) is a common systemic inflammatory disorder of the pancreas. The data related to the lipid changes in patients with AP were insufficient. In this study, we aimed to investigate the relation between high-density lipoprotein (HDL) and the other lipid parameters and the severity of the disease in AP cases.
Seventy-five cases admitted to the Gastroenterohepatology Clinic with diagnosis of AP were included in the study. Ranson scores and Glasgow scores were used for prognosis. Lipid parameters were evaluated for the first 24 hours and after clinic and laboratory remission.
The causes of the disease among patients included in the study were as follows: 44 biliary origin (58.7%), 14 alcohol dependent (18.7%), 10 idiopathic (13.3%), 6 hyperlipidemic (8%), and 1 endoscopic retrograde cholangiopancreatography dependent (1.3%). Triglyceride (TG) levels of the patients included in the study measured in the first 2 days were significantly higher than TG levels measured after clinic and laboratory remission (P = 0.013). High-density lipoprotein was significantly lower in alcoholic and hypertriglyceridemic AP cases. There was a statistical correlation between HDL and Ranson (P = 0.023).
The low levels of HDL in AP cases during acute attack are associated with severity of the disease.
[Show abstract][Hide abstract] ABSTRACT: Recent publications suggest the utility of temozolomide (TMZ) in the management of aggressive pituitary adenomas and carcinomas, resistant to conventional treatments. The response to TMZ is inversely correlated with tumoral expression of O-6 methylguanine DNA methyl transferase (MGMT). Therefore, we aimed to assess MGMT immunoexpression in pure GH-secreting pituitary adenomas, in an effort to predict the likelihood of response to TMZ, and to correlate MGMT immunoexpression with Ki-67 LI and cytokeratin (CK) distribution pattern. Our material consisted of 36 GH-secreting pituitary adenomas (21 female,15 male, mean age 42.5 ± 10.5), operated at our center between 2003 and 2010. Immunostaining for MGMT, Ki-67, and CK was performed using avidin–biotin-peroxidase complex method. Immunoreactivity for MGMT and Ki-67 was evaluated microscopically and recorded as percentages of positive nuclear immunostaining. CK distribution pattern was also evaluated microscopically and assoreted into dot-like and
nondot-like pattern subtypes. MGMT immunoexpression scored as 0 = none, 1 = <10%, 2 = <25%, 3 = <50%, and 4 = >50%. Staining for MGMT was <10% (score 1) in 30 (83.3%), 10–25% (score 2) in 3 (8.3%), 25–50% (score 3) in 2 (5.6%) and >50% (score 4) in 1 (2.8%) of the tumors, respectively. There was no correlation between Ki-67 LI and CK distribution pattern with MGMT immunoreactivity (P > 0.05). Data from the current study suggest a large proportion of GH-secreting adenomas, including those with dot-like CK distribution pattern and high Ki-67 LI, demonstrate negative/low MGMT immunoreactivity and could be treated with TMZ, if conventional treatment fails.
[Show abstract][Hide abstract] ABSTRACT: Helicobacter pylori infection is a most frequent cause of chronic gastritis. H. pylori may decrease absorption of oral thyroxine by decreasing gastric acid secretion in the stomach. In this study, we aimed to investigate the change in thyroid function tests of the cases after H. pylori eradication who were not responding to high doses of thyroxine treatment before H. pylori eradication.
Hypothyroid cases who were not responding to high doses of thyroxine among the ones presented to Endocrinology and Gastroenterohepatology Clinics of Sisli Etfal Training and Research Hospital between 2009 and 2010 were included in the study. Thyroid function tests were performed two times in all cases before and after H. pylori eradication. Duodenal, antral and corporal biopsies, and jejunal aspirates and biopsies were taken during upper gastrointestinal system endoscopies performed in all patients. Cases without intestinal pathology were included in the study.
Serum thyrotropin (TSH), free T3, and free T4 values before H. pylori eradication were 30.5 ± 28.8 IU/mL, 2.64 ± 0.56 pg/mL, and 0.92 ± 0.32 ng/mL, respectively, and after eradication were found to be 4.2 ± 10.6 IU/mL, 3.02 ± 0.61 pg/mL, and 1.3 ± 0.34 ng/mL, respectively (p values <.001, .002, and <.001, respectively). After H. pylori eradication treatment, TSH decreased in all of the cases, factitious thyrotoxicosis developed in % 21 of these cases.
In hypothyroid cases, H. pylori gastritis may be responsible for an inadequate response to the treatment. H. pylori eradication in the cases receiving high doses of thyroxine has a risk for thyrotoxicosis.
[Show abstract][Hide abstract] ABSTRACT: Introduction: In this study, we aimed to determine the relationship between metabolic syndrome and cognitive decline in patients
over 60 years of age, cross-sectionally.
Materials and Methods: The age of participants ranged between 60-89 (71.71 ± 6.58) years, and according to NCEP ATP III
criteria, 93 had metabolic syndrome and 47 did not. Cognitive performance was determined with the use of standardized minimental
test, and the mini-mental scores of the two groups were compared. Apart from metabolic syndrome, we investigated the
relationship between mini-mental score and age, gender, educational status, tobacco and alcohol use, history of acute myocardial
infarction and stroke, drug use (antihypertensive, insulin, oral antidiabetic, statin), and body mass index. Depression, which is
a cause of pseudodementia, was also assessed with the use of the geriatric depression scale.
Results: The mini-mental score was low in 25 (26.9%) patients in the metabolic syndrome group and in 7 (14.9%) patients in
the control group; there was no statistically significant difference between the two groups in mini-mental scores. In this study, the
mini-mental score was low in patients with high fasting glucose level, tobacco use, insulin use, advanced age, and depression.
The geriatric depression scale scores of the two groups were similar. No statistically significant differences in the mini-mental scores
were determined between patients with high blood pressure, high triglyceride level, low high-density lipoprotein (HDL) cholesterol
level, history of acute myocardial infarction and stroke, low educational status, or high body mass index when compared
to those without these parameters. No difference could be determined in mini-mental scores of the patients who used antihypertensives,
oral antidiabetics or statins and those who do not.
Conclusion: As in other parts of the world, the number of the elderly is increasing in Turkey, and in accordance with this, cognitive
decline related to diseases also increases. There are few studies dealing with the effects of metabolic syndrome and its risk
factors on cognitive function and cognitive decline. The establishment of the risk factors in the elderly and their prevention could
help to prevent cognitive decline, one of the most important causes of mortality and morbidity in today’s world.
Key Words: Metabolic syndrome, cognitive function, elderly.