Hatice Nursun Ozcan

Evaluation of Ovarian Reserve Based on Hormonal Parameters, Ovarian Volume, and Antral Follicle Count in Women with Type 2 Diabetes Mellitus

OBJECTIVE The aim of this study was to evaluate ovarian reserve of women with type 2 diabetes mellitus (T2DM). METHODOLOGY Eighty-nine women with T2DM and 73 healthy controls were enrolled and divided into three age groups [group 1 (20-29 yr), seven diabetics and 18 healthy controls; group 2 (30-39 yr): 35 diabetics and 35 healthy controls; and group 3 (40-49 yr): 47 diabetics and 20 healthy controls]. All participants were subjected to transvaginal ultrasonographic examination on the third day of their menstrual periods for the determination of ovarian volume and total antral follicle count (AFC). RESULTS A significant difference in mean FSH levels (international units per liter) was observed between women with diabetes and healthy controls in all age groups (group 1, 7.8 ± 0.9 vs. 5.0 ± 1.0; group 2, 8.2 ± 1.1 vs. 7.2 ± 1.8; group 3, 9.5 ± 3.2 vs. 6.4 ± 2.4; P < 0.001 for all). Similarly, mean AFC was significantly lower in patients with T2DM than in healthy controls in all age groups (group 1, 21.1 ± 4.8 vs. 25.0 ± 9.1; group 2, 10.4 ± 5.2 vs. 23.0 ± 9.5; group 3, 6.0 ± 3.5 vs. 21.7 ± 2.1; P < 0.001 for all). A statistically significant difference in total ovarian volume was only observed in group 1 (9.7 ± 3.0 in T2DM patients vs. 6.8 ± 2.7 in healthy controls; P = 0.002). AFC was found to be negatively correlated with FSH (r = -0.406, P < 0.001), age (r = -0.618, P < 0.001), glycolized hemoglobin (r = -0.505, P < 0.001), and fasting blood glucose (r = -0.687, P < 0.001). CONCLUSION In this pioneer study, the first to evaluate ovarian reserve in T2DM patients, we managed to demonstrate lower ovarian reserves in women with diabetes compared with healthy controls.

Imaging Findings of Fetal-Neonatal Ovarian Cysts Complicated With Ovarian Torsion and Autoamputation

OBJECTIVE Large nonresolving neonatal ovarian cysts may be a risk factor for complications such as torsion, mass effect, rupture, intracystic hemorrhage, and autoamputation. Torsed cysts and autoamputated cysts can cause a diagnostic dilemma. The objective of our study was to correlate the imaging findings of intrauterine ovarian torsion and autoamputated ovaries with their pathologic findings. MATERIALS AND METHODS We retrospectively analyzed the pre- and postnatal medical records, sonographic findings, operation notes, and pathologic reports of 15 patients with ovarian torsion. All patients had complex cysts noted on postnatal sonographic examination. A complex heterogeneous ovarian cyst was defined by the presence of a fluid-debris level indicating hemorrhage within the cyst, a retracting clot, septations with or without internal echoes, calcification, and a solid component. RESULTS On ultrasound examination, four cysts had solid components, and 11 were heterogeneous and had a fluid-debris level. Calcifications were seen in two patients. The mean patient age at the time of surgery was 3.9 months. Exploratory laparotomy was performed on all patients. Torsed ovaries were identified in five patients. Ten patients had ovaries that were floating free in the peritoneal cavity at the time of surgery. Histopathologic evaluation revealed that 11 of the cysts consisted of extensive hemorrhagic, necrotic autolytic tissue with dystrophic calcification. None of the cysts contained any ovarian tissue. CONCLUSION A complex heterogeneous ovarian cyst with a fluid-debris level indicating hemorrhage is a significant sonographic hallmark for the diagnosis of ovarian torsion. A calcified abdominal mass, with or without wandering, can be an autoamputated ovary.

Dynamic Doppler evaluation of the radial and ulnar arteries in patients with carpal tunnel syndrome.

OBJECTIVE The objective of our study was to evaluate the blood flow characteristics of the radial and ulnar arteries of the hands of patients with carpal tunnel syndrome (CTS) either in the neutral position or in provocative positions using color Doppler imaging. SUBJECTS AND METHODS Subjects with relevant complaints of CTS and positive Tinel sign and/or Phalen maneuver were recruited. Nerve conduction studies were performed to confirm the diagnosis of CTS. Forty-four hands of 22 patients with CTS (bilateral involvement) and 24 hands of 12 healthy volunteers were included in the study. Pulsed and color Doppler evaluations with the hands in the neutral, Phalen, and reverse Phalen positions were performed of the radial and ulnar arteries using a 5-13-MHZ linear-array transducer (Logiq 9). RESULTS All of the CTS patients and control subjects were women; their mean ages were 50.77 ± 7.69 (SD) and 46.42 ± 4.32 years, respectively. When hands were evaluated in the neutral position, the flow volume, peak systolic velocity, end-diastolic velocity, and diameter values of both the radial and ulnar arteries were significantly greater in patients with CTS than in control subjects (all p < 0.05). When compared with the measurements obtained with hands at the neutral position, the decreases in the amount of blood flow during the Phalen and reverse Phalen maneuvers were significantly greater in the CTS group than the control group. The amount of blood flow decrease was not correlated with the disease duration. CONCLUSION Blood flow in the hands of CTS patients differs from that of healthy individuals both at rest and during certain hand movements. Future studies, also with simultaneous monitoring of sympathetic innervation, could be beneficial to confirm the association between blood flow and the sympathetic nerves of the hand.

Ischiofemoral impingement revisited: what physiatrists need to know in short.

A 53-yr-old female patient was seen because of low back, right hip, and buttock pain radiating to the right lower extremity for the last 2 yrs. On detailed questioning, she declared that her pain got worse during walking or other daily activities and that she was better during rest. She denied any trauma, and her medical history was unremarkable except for diabetes mellitus (for 3 yrs) and total colectomy due to ulcerative colitis (7 yrs ago). With the same complaints, she had visited another center where she had been diagnosed with enteropathic spondyloarthropathy and started on a combination treatment of sulphasalazine and acemetacin for 2 mos. On physical examination, low back and hip range of motion were normal. However, she experienced pain during resistive right hip adduction and external rotation. Neurologic evaluation of the lower limbs was otherwise noncontributory. Complete blood count, erythrocyte sedimentation rate, C-reactive protein, and liver/renal/thyroid function tests were unremarkable. Because the aforementioned diagnosis of spondyloarthropathy was considered to be unlikely, pelvic magnetic resonance imaging was performed and revealed bilateral ischiofemoral impingement (Fig. 1). Accordingly, she was treated with a 3-wk physical therapy program, which was composed of moist heat, ultrasound, transcutaneous electrical nerve stimulation, and hip stretching exercises. On the control visit, her complaints were found to have improved significantly. Ischiofemoral impingement is described as one of the uncommon sources of hip pain that ensues because of entrapment of the quadratus femoris muscle between the lesser trochanter and the ischium. Although its etiology remains unclear, several congenital or acquired conditions (e.g., intertrochanteric fractures/osteotomy, hip osteoarthritis, hamstring insertion problems) have been speculated to cause this clinical scenario. Eventually, the pertinent complaints of the patients occur secondary to the narrowing of the ischiofemoral space (compressing the quadratus femoris muscle) and, in case of radiating pain, as a result of irritation of the ipsilateral sciatic nerve. Presenting this case report, we aimed to draw the attention of physiatrists to this potentially underestimated syndrome whereby prompt physical examination as well as radiologic imaging and initial conservative treatment are crucial for its management.

Radiological manifestations of abdominopelvic nerve tumours seen in neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is the most common of the phakomatoses, which is inherited in an autosomal dominant pattern. Neurofibromas arise from Schwann cells and fibroblasts and plexiform neurofibromas are pathognomonic for NF1, which may arise in any peripheral nerve. The clinical expression of NF1 is extremely variable and gastrointestinal manifestations of NF1 are relatively uncommon. The purpose of this article is to illustrate the abdominal ultrasound, computed tomography, and magnetic resonance imaging findings of abdominopelvic nerve tumours seen in NF1 in both paediatric and adult patients.

Diagnosis and treatment of pulmonary alveolar microlithiasis

Pulmonary alveolar microlithiasis (PAM) is a rare genetic disease caused by mutations in sodium–phosphate co‐transporter (SLC34A2), which encodes a type 2b sodium phosphate co‐transporter. Disease is characterized by intra‐alveolar microlith formation of phosphate. Turkey has a high prevalence of PAM. Herein, we report the clinical and radiological findings of three patients diagnosed with PAM and treated with disodium etidronate.

Relationship between thyroid nodules and non-functioning adrenal incidentalomas and their association with insulin resistance

Abstract Objective: The relationship between insulin resistance and thyroid nodules in patients with non-functional adrenal incidentalomas (AI) is not clearly understood. The aim of this study was to determine the frequency of thyroid nodules in AI patients, as well as to evaluate any possible associations with disorders of insulin resistance. Methods: Patients diagnosed with a non-functional AI were approached for inclusion in the study. Insulin resistance was evaluated using homeostasis model assessment (HOMA-IR). All participants were screened for the presence of thyroid nodule by ultrasonography, and fine needle aspiration biopsies were obtained from consenting subjects. Results: One-hundred-thirteen patients with AI and 152 age-, BMI- and gender-matched healthy controls were enrolled. AI patients had higher waist circumference and waist/hip ratio than the control group. Metabolic syndrome, hypertension and type 2 diabetes mellitus rates were significantly higher in AI patients. HOMA-IR was similar between the groups. At least one thyroid nodule was observed in 42 (27.6%) of the controls compared to 55 (48.7%) of AI patients (p < 0.001). The mean number of thyroid nodules in AI patients was significantly higher than the control subjects (2.4 ± 0.9 versus 1.7 ± 1.0, p = 0.008). Mean nodule volume was similar between AI patients and the controls. A correlation could not be established between adrenal tumor/thyroid nodule volumes and the number of thyroid nodules, HOMA-IR, waist circumference, waist/hip ratio, BMI and thyroid function tests. Conclusion: A higher prevalence of thyroid nodule and a higher number of thyroid nodules were determined in patients with AI compared to healthy controls.

Doppler ultrasonographic evaluation of the radial and ulnar arteries in hemiparetic patients after stroke

To evaluate blood flow of hand arteries (using Doppler ultrasonography) and sympathetic skin response (SSR) in patients with hemiparesis.

Unusual splenic hemangioma of a pediatric patient: hypointense on T2-weighted image

Splenic hemangioma is a very rare neoplasm in children. On magnetic resonance imaging, splenic hemangioma shows high signal intensity on T2-weighted images. In this report, we present the first pediatric case of a splenic hemangioma, which was significantly hypointense on T2-weighted images.

Chronic necrotizing pulmonary aspergillosis in an immunocompetent patient after the surgery of hydatid cyst

Chronic necrotizing pulmonary aspergillosis (CNPA) is a condition caused by the ubiquitous fungus Aspergillus fumigatus in non-immunocompromised individuals. Numerous underlying conditions have been associated with CNPA. Tuberculosis, non-tuberculous mycobacterial infection and allergic bronchopulmonary aspergillosis (ABPA) remain the predominant risk factors for development of CNPA. Development of CNPA in echinococcal cyst cavities is very rare and the optimal therapeutic regimen and treatment duration have not been established. Here, we present a case of CNPA developed six years after the cystectomy operation of hydatid cyst and treated with voriconazole successfully.