Gökhan Özdemir

Tuberculosis of the Thyroid Gland: Review of the Literature

ObjectiveThyroid tuberculosis (TTB) is a very rare condition, even in countries with a high prevalence of tuberculosis. The aim of this article is to review and retrieve data about thyroid tuberculosis from the English-language literature in order to gain a better understanding of the clinical characteristics of TTB.Study DesignWe performed Medline, PubMed, and library searches using the key words “thyroid tuberculosis,” “throid disease,” “tuberculosis and thyroid.” Reference lists of the articles obtained and previous reviews were also examined.ResultsWe retrieved 76 cases matching our selection criteria from the search. Review of the cases with TTB revealed a slight female preponderance. The patients reported in the literature ranged in age from 9 to 83 years, with a median age of 40 ± 16 years for men and 44 ± 17 years for women. In the articles surveyed, TTB presented with a broad spectrum of manifestations, ranging from an isolated nodule to thyrotoxicosis. It seems that diagnosis of thyroid tuberculosis has recently been increasing, perhaps because of the growing incidence of tuberculosis and the diagnostic use of fine-needle aspiration cytology in the diagnosis. Although, in the past, the diagnosis was genarally made by the examination of the specimens, at present, fine-needle aspiration cytology seems to be a useful method in diagnosis tuberculous thyroiditis.The role of surgery is limited after the diagnosis. The choice of treatment should be medical antituberculous therapy.ConclusiıonsPreoperative diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery. This condition should be kept in mind in evaluating patients with a thyroid nodule, in communities where the prevalence of tuberculosis is high.

Ocular surface disorders and tear function changes in patients with chronic renal failure

BACKGROUND Ocular surface changes, mainly squamous metaplasia of the conjunctival epithelium and corneoconjunctival calcification of unknown etiology, may develop in patients with chronic renal failure undergoing hemodialysis. An association between squamous metaplasia and corneoconjunctival calcification has been suggested. The purpose of this study was to investigate the relation between ocular surface disorders and tear function changes in patients with chronic renal failure undergoing hemodialysis. METHODS In this prospective case-control study, 42 patients with chronic renal failure and 20 age- and sex-matched control subjects underwent full ophthalmologic examination, tear function tests (including Schirmers test, tear film break-up time [BUT] test and rose bengal staining) and impression cytology to determine the degree of conjunctival squamous metaplasia. They also responded to a questionnaire regarding subjective ocular complaints. Corneoconjunctival calcification was graded on a scale of 0 to 5 according to the system proposed by Porter and Crombie. Impression cytology samples were graded on scale of 0 to 3 according to the Nelson classification. The relation between ocular surface disorders and tear function changes was evaluated. RESULTS Of the 42 patients, 12 (28%) had grade 0 calcification, 10 (24%) had grade 1, 14 (33%) had grade 2, and 6 (14%) had grade 3 or higher. Four patients (10%) had grade 0 squamous metaplasia, 22 (52%) had grade 1, 12 (28%) had grade 2, and 4 (10%) had grade 3. The difference between the patient and control subjects in squamous metaplasia grades and corneoconjunctival calcification grades was statistically significant (p < 0.001 and p = 0.022 respectively). Abnormal tear film BUT (p = 0.002) and abnormal rose bengal staining (p = 0.023) were significantly more frequent in the patient group than in the control group. The grade of conjunctival squamous metaplasia was correlated with abnormal rose bengal staining (tau = 0.79, p < 0.001) and with the existence of subjective ocular complaints (tau = 0.32, p = 0.026). There was no correlation between corneoconjunctival calcification and tear function changes. INTERPRETATION Abnormal rose bengal staining and the presence of subjective ocular complaints may be used as follow-up criteria for ocular surface disorders in patients with chronic renal failure regularly undergoing hemodialysis.

Ocular findings in children with thalassemia major in Eastern Mediterranean.

AIM To investigate ophthalmologic findings in children with thalassemia major (TM) and compare the findings with healthy controls. METHODS In a cross-sectional study, 43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination, tear function tests including the Schirmer test, fluorescein tear break-up time (BUT), ultrasound pachymetry, and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. RESULTS The mean best corrected visual acuity was 1.34±0.75 in TM and 1.08±0.28 in controls. It was found lower than 0.1 logMAR unit in 10 (23.2%) children with TM and 2 (4.2%) in controls, and the difference was statistically significant (P<0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98±20.45µm in controls (P>0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group (P<0.01). The mean BUT score was 9.62±1.28 in TM and 9.73±0.6s in the control group (P>0.05). CONCLUSION In TM, while corneal thickness, axial length, and BUT are close to controls, the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSE To measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome. METHODS This prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed. RESULTS A total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 μm, the mean TP was 487 ± 49 μm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 μm, the mean TP was 538.0 ± 40.8 μm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 μm in 16 subjects (59.2%) and <450 μm in 5 (18.5%). In the control group, the CCT was <500 μm in 14 subjects (37.8%) and <450 μm in 2 (5.4%). CONCLUSIONS In this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

Comparison of the Intraocular Pressure Lowering Effect of Latanoprost and Carteolol-pilocarpine Combination in Newly Diagnosed Glaucoma

PURPOSE To evaluate the comparative efficacy of latanoprost monotherapy versus combined carteolol and pilocarpine therapy in patients with newly diagnosed glaucoma. METHODS Masked randomized prospective trial. This study included 51 patients (64 eyes) with newly diagnosed glaucoma or ocular hypertension. The cases were randomly divided into two treatment groups for administration of latanoprost 0.005% once daily, or of carteolol 2% twice daily and pilocarpine 2% twice daily. Mean diurnal intraocular pressure (IOP) was measured at baseline, week 2, week 4, and month 3 after the beginning of treatment. Changes in mean IOP from baseline to the 3-month visit were determined by an analysis of variance. RESULTS Mean diurnal IOP values were 25.1 +/- 3.1 mm Hg and 25.5 +/- 2.5 mm Hg at baseline in the latanoprost monotherapy group and in the carteolol-plus-pilocarpine group, respectively. Diurnal IOP was significantly decreased from baseline to 3 months in both groups (P <.001). At this time point, latanoprost monotherapy had reduced mean diurnal IOP by 7.2 +/- 2.5 mm Hg (28.7%) and carteolol plus pilocarpine had reduced mean diurnal IOP by 7.4 +/- 2.7 mm Hg (29%). There was no difference between the groups in terms of their IOP reduction effect (P =.51). Decreased visual acuity and twilight vision, blurred vision, and headache were more frequent in the carteolol-plus-pilocarpine group than in the latanoprost group (P <.05). CONCLUSIONS We concluded that latanoprost monotherapy was at least as effective as the carteolol-pilocarpine combination therapy in reducing mean diurnal IOP in newly diagnosed glaucoma or ocular hypertension.

Karpal tünel sendromunda Novel metoduyla yapılan steroid enjeksiyonunun ağrı şiddeti ve elektrofizyolojik bulgular üzerine etkisi

Objective: The aim of the present study is to investigate the effects of local steroid injection therapy with the Novel method on subjective patient complaints and electrophysiological investigations at the end of 3 months. Methods: 101 hands of 59 subjects (5 men and 54 women) with mild carpal tunnel syndrome received steroid injection with the Novel technique. Visual Analogue Scale (VAS) was used to determine the severity of pain. Nerve conduction findings obtained prior to and 3 months after the injection were compared using the VAS. Results: According to the VAS, mean pain severity for the right hand (n:56) was 7.79±1.4 before the injection, and 3.29±1.9 at 3 months. Mean pain severity for the left hand (n=45) was 7.71±1.2 before the injection, and 3.16±2.0 at 3 months. Median motor nerve distal latency was statistically significant for both hands after the injec tion (p<0.001). Median motor velocity was statistically non-significant in both hands after the injection. After the injection, median sensory distal latency, amplitude and velocity were statistically significant for both hands. Conclusion: The present study showed the efficacy of local steroid injection therapy on subjective complaints and electrophysiological findings in mild carpal tunnel syndrome. Because the improvement is greater in the non-dominant hand compared to the other, splints should be used to keep the hand in neutral position and hand rest should be employed in addition to the local injection.

Prevalence of Tension-Type Headache in Individuals Aged between 18-65 Years in the Eastern Parts of Turkey

OBJECTIVE Although tension-type headache (TTHA) is one of the most frequently encountered diseases in the general population, relatively few studies have been conducted on this health condition. The published data are limited on the frequency of TTHA in Turkey, and no studies to date have been initiated on the prevalence of TTHA in the city of Erzurum or the Eastern Anatolian Region. MATERIALS AND METHODS The study was conducted using in-depth interviews from 1972 individuals from city of Erzurum. TTHA was queried in patients with a history of headache, according to the International Classification of Headache Disorders diagnostic criteria, and the frequency of TTHA was investigated. RESULTS A total of 1972 patients were enrolled in this study. The frequency reached a peak between the ages of 40-49 years (35%), and it significantly declined after the age of 49. During an examination (palpation), cranial muscle sensitivity was detected in 33% of the patients. CONCLUSION The frequency of TTHA has been identified as 22.3% in patients between the ages of 18-65. The frequency of tension type headache in the city of Erzurum was lower than that in the general population of Turkey.

Latanoprost therapy in patients with glaucoma and ocular hypertension inadequately controlled with carteolol.

Long-term use of drugs on a regular basis may be inconvenient in glaucoma patients. Latanoprost has several advantages, including once-a-day dosage, few adverse effects, and high efficiency. In this study, we compare the effects of latanoprost monotherapy with the addition of latanoprost to carteolol in patients with open-angle glaucoma (OAG) or ocular hypertension (OH) inadequately controlled with carteolol.