Ayse Sertkaya Cikim

Evaluation of Endothelial Function in Subclinical Hypothyroidism and Subclinical Hyperthyroidism

Subclinical hypothyroidism and subclinical hyperthyroidism are two frequently occurring conditions for which exact therapeutic approaches have not yet been established. The aim of this study was to compare the endothelial function and carotid artery intimae-media thickness (IMT) of these two groups of patients to euthyroid subjects and to assess the effects of these conditions on endothelial function. Study groups comprised of 25 subclinical hypothyroid patients (mean age, 32.28 +/- 9.67 years), 13 subclinical hyperthyroid patients (mean age, 35.69 +/- 9.67 years), and 23 euthyroid subjects (mean age, 35.87 +/- 7.93 years). They were evaluated for flow-mediated dilatation (FMD), and carotid artery IMT. The groups were matched strictly for atherosclerotic risk factors. The subclinical hypothyroid group was found to have significantly lower FMD values. No significant differences were observed between the groups with respect to other vascular parameters. The only discriminative factor between the groups was the state of their thyroid function. Therefore, subclinical hypothyroidism may have adverse effects on endothelial function independent from other well-known atherosclerotic risk factors.

Evaluation of in vivo cerebral metabolism on proton magnetic resonance spectroscopy in patients with impaired glucose tolerance and type 2 diabetes mellitus

The aim of this study was to investigate possible metabolic alterations in cerebral tissues on magnetic resonance spectroscopy (MRS) in patients with impaired glucose tolerance (IGT) and with type 2 diabetes mellitus (T2-DM). Twenty-five patients with T2-DM, 13 patients with IGT, and 14 healthy volunteers were included. Single-voxel spectroscopy (TR: 2000 ms, TE: 31 ms) was performed in all subjects. Voxels were placed in the frontal cortex, thalamus, and parietal white matter. N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, and myo-inositol (MI)/Cr ratios were calculated. Frontal cortical Cho/Cr ratios were increased in patients with IGT compared to control subjects. Parietal white matter Cho/Cr ratios were significantly higher in patients with IGT when compared to patients with T2-DM. In the diabetic group, frontal cortical MI/Cr ratios were increased, and parietal white matter Cho/Cr ratios were decreased when compared to the control group. Frontal cortical NAA/Cr and Cho/Cr ratios and parietal white matter Cho/Cr ratios were decreased in diabetic patients with poor glycemic control (A1C>10%). A1C levels were inversely correlated with frontal cortical NAA/Cr and Cho/Cr ratios and with parietal white matter Cho/Cr ratios. T2-DM and IGT may cause subtle cerebral metabolic changes, and these changes may be shown with MRS. Increased Cho/Cr ratios may suggest dynamic change in membrane turnover in patients with IGT. Diabetic patients with poor glycemic control may be associated with neuronal dysfunction/damage in brain in accordance with A1C levels and, in some, extend with insulin resistance.

The effect of moxonidine on endothelial dysfunction in metabolic syndrome

BackgroundEndothelial dysfunction has been reported in patients with type 2 diabetes mellitus and even in healthy obese individuals with a normal metabolic profile. Sympathetic activity commonly is increased in obese hypertensive patients, and moxonidine is effective in lowering BP and improving insulin sensitivity.ObjectiveTo evaluate the effect of moxonidine on endothelial dysfunction in patients with metabolic syndrome.MethodsTwenty-six patients with mild hypertension were treated with moxonidine and a hypocaloric diet for 3 months, while a second normotensive group (n = 26) were followed-up with calorie restriction alone. Anthropometric (body mass index, waist and hip circumferences, and waist-to-hip ratio) and metabolic features (fasting plasma glucose and insulin, aminotransferases, γ-glutamyl transpeptidase, triglycerides, and cholesterol levels) and flow-mediated dilatation (FMD) were evaluated. Insulin resistance was calculated by using the homeostasis model assessment formula. Insulin sensitivity was calculated according to the quantitative insulin-sensitivity check index (QUICKI).ResultsSBP and DBP (both p < 0.001) and waist circumference (p = 0.02) were higher, and QUICKI (p = 0.043) and FMD (p = 0.01) were lower in the hypertensive group at baseline. After 3 months, nearly all the study parameters improved in both treatment groups. The decrease in BP, increase in FMD, and improvements in metabolic and anthropometric parameters were significantly greater in the moxonidine-treated group than in those treated with diet alone.ConclusionMoxonidine is proposed as a valuable option for treating mild-to-moderate hypertension in obese and insulin-resistant patients with metabolic syndrome as it appears to improve endothelial dysfunction in these patients.

Relationship between Cardiovascular Risk Indicators and Types of Obesity in Overweight and Obese Women

We aimed to evaluate the relationship between different types of obesity and cardiovascular risk indicators. A total of 623 overweight (body mass index [BMI] > 25 kg/m2), and 2559 obese (BMI > 30 kg/m2) women were divided into four groups according to their BMI and waist-to-hip ratio (WHR): simple overweight (BMI 25-30 kg/m2 and WHR < 0.8, n = 371), abdominal adiposity (BMI 25-30 kg/m2 and WHR > 0.8, n = 252), peripheral (pure) obesity (BMI > 30 kg/m2 and WHR < 0.8, n = 918) and central obesity (BMI > 30 kg/m2 and WHR > 0.8, n = 1641). The levels of the risk indicators measured (clinical, anthropometric and laboratory) were significantly higher in the central obesity group. Total body fat and abdominal fat accumulation seems to result in more serious hyperinsulinaemia and insulin resistance in central obesity. Measuring BMI and WHR in obese patients may reveal their risk for coronary heart disease.

NON-RECURRENT INFERIOR LARYNGEAL NERVES: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Although the non-recurrent inferior laryngeal nerve (NRILN) is a rare occurrence, it may become damaged inadvertently during cervicotomy and causes permanent ipsilateral vocal cord paralysis. Several published reports have described an incidence of NRILN of 0.21–1.6%, with most occurring on the right side.1–3 However, it is difficult to establish the exact incidence of this anomaly. To date, three anatomical variants have been recognized: In type 1, NRILN arises from cervical vagus directly and descends into the larynx at the level of the upper thyroid pole. In type 2A, NRILN follows a transverse path parallel to and over the trunk of inferior thyroid artery, at the level of isthmus. In type 2B, NRILN follows a transverse path parallel to and under the trunk of inferior thyroid artery, making a downward curve.1,2 The most common is type 2A. Herein, we present findings of two cases in which one of them showed previously unrecognized anatomical variant of a NRILN. Two female patients of age 42 and 47 years presented with swelling of their thyroids. Physical, radiological and laboratory examinations showed multinodulary goitre. During thyroidectomies, when the right inferior laryngeal nerves (ILN) could not be identified in a normal anatomic position, we continued to dissect further laterally and found NRILN. In the first patient the NRILN arose from vagus nerve, passed over carotid artery and descended into the larynx at the level of the upper thyroid pole (type 1) (Fig. 1). In the second patient the NRILN followed a transverse path parallel to and over the trunk of inferior thyroid artery, making a slightly downward curve (type 2A). The nerves were carefully traced and preserved. The patient’s postoperative courses were uneventful. Although an NRILN was observed in a cadaver by Stedman 1823, it was not introduced in the surgical published work until 1932. Since then, numerous reports of NRILN have appeared with

Pathologic hepatic Tc-99m-MDP uptake in polyostotic fibrous dysplasia

Fibrous dysplasia of bone is a congenital, sporadic developmental disorder characterized by immature fibrous connective tissue and bone deformities. Hepatic Tc-99m-MDP uptake is a rare, serendipitous finding during bone scanning studies. The present patient was a 25-year-old male who had severe polyostotic fibrous dysplasia. On Tc-99m-MDP (methylene diphosphonate) bone scintigraphy, increased activity accumulations were seen on multiple ribs, vertebrae and base of the cranium. In addition, diffuse increased pathologic uptake of Tc-99m-MDP in the liver was shown. Intravenous pamidronate was administered monthly for two months. In the third week of the last administration Tc-99m-MDP bone scintigraphy was performed again, but despite sustained bone involvement, pathologic hepatic uptake was not seen on the scan. We thought that pathologic hepatic Tc-99m-MDP accumulation, may be related to the formation and aggregation of calcium oxalate and phosphate crystals which improved with pamidromat treatment.