Mehmet Aşık

Mean platelet volume in patients with polycystic ovary disease

Polycystic ovary syndrome (PCOS) is a frequently encountered clinical condition characterized by chronic anovulation and hyperandrogenism. There are many reports pointing to the causal links between PCOS and cardiovascular disease (CVD). Although the level of risk for CVD remains uncertain in PCOS, there is substantial evidence that insulin resistance, obesity, dyslipidemia, hypertension, hypercoagulable state, and markers of abnormal vascular function possibly contribute to increased CVD risk [1, 2]. Platelets play a crucial role in the pathogenesis of thrombotic diseases. Circulating platelets are heterogeneous in size, density, and reactivity. The mean platelet volume (MPV), the accurate measure of platelet size, is considered a marker and determinant of platelet function since larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis [3]. Elevated MPV levels have been shown to be an independent risk factor for CVD [4, 5]. We investigated MPV in patients with PCOS alongside a comparable group of healthy control subjects. Eighty-five newly diagnosed PCOS patients who have no propensity to thrombotic or bleeding disorder and 81 ageand BMI (body mass index)matched regularly menstruating healthy non-hirsute women as the controls participated in this study. Demographic details of subjects are presented in Table I. All MPV measurements were performed on automated blood counter Cell-Dyn 4000 (Abbott Diagnostics, Santa Clara, CA, USA). The other parameters measured in fasting blood sample were glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, free testosterone and total testosterone, and estrogen. Glucose values obtained at 0, 30, 60, 90, and 120 minutes after a 75 g oral glucose tolerance test was also measured. Each subject’s level of insulin resistance was estimated based on the homeostasis model assessment insulin resistance (HOMA-IR) index. Clinical and laboratory features of patients with PCOS and control subjects are depicted in Table I. The MPV was significantly higher in patients with PCOS (8.5 1.4 fl) than control subjects (7.8 0.9 fl) (p1⁄4 0.002). There was no statistically significant difference regarding platelet absolute count in patients with PCOS (264 51 10/L) and control subjects (257 48 10/L). HOMA-IR index was significantly higher in patients with PCOS than control subjects (3.0 3.1 vs. 2.0 0.8, p1⁄4 0.02). We did not observe any significant correlation between MPV and age, BMI, HOMAIR, lipid parameters, and levels of estrogen, free and total testosterone in patients with PCOS. There was also no correlation between MPV and glucose values obtained at 0, 30, 60, 90, and 120 minutes after a 75 g oral glucose tolerance test. Although direct evidence for increased thrombotic risk is still lacking in patients with PCOS, increased propensity to thrombosis is suggested

Aromatase inhibitor treatment for breast cancer: short-term effect on bone health

Aim of this study Aim of this study was to examine the effects of aromatase inhibitors (AIs), which are used in every phase of breast cancer treatment, on the bone mineral density (BMD) of patients with early-stage breast cancer. Material and methods Menopausal female patients who were diagnosed with stages 1–3 breast cancer and who were planned for anastrazole or letrozole as adjuvant therapy were examined. After the patients’ BMD was measured, 45 patients without osteoporosis were included in the study. Six months after AI therapy started, the patients’ BMD was measured again. Results In this study, we tried to show that there was a statistical difference in the BMD of 45 patients before and 6 months after treatment. Among all measurements (femur and lumbar T-scores), the femur Z-score (p = 0.52) was the only score that was not statistically significant. Statistical significance (p < 0.01) was detected in comparative analysis of the other measurements. According to this analysis, a significant loss of BMD was seen even in the first six months after AI treatment was introduced. Conclusions Female patients with breast cancer are at higher risk for bone loss and fractures than healthy women. In this study, we showed the negative effects on BMD of aromatase inhibitor therapy, one of the main contributions to osteoporosis in women with breast cancer. This study is the first to quantify the short-term effect of AI treatment on BMD in postmenopausal women with breast cancer.

Less aggressive disease in patients with primary squamous cell carcinomas of the thyroid gland and coexisting lymphocytic thyroiditis

Aim of the study Primary squamous cell carcinoma (SCC) of the thyroid gland is extremely rare. Infrequently, primary SCC of the thyroid gland is accompanied by other thyroid diseases such as Hashimotos thyroiditis (HT). Recently, studies have demonstrated that differentiated thyroid cancer with coexisting HT has a better prognosis. However, the prognosis of patients with primary SCC of the thyroid gland and coexistent HT has not been clearly identified. We compared the clinical characteristics and disease stages of patients with primary SCC with and without lymphocytic thyroiditis (LT). Material and methods We reviewed reports of primary SCC of the thyroid gland published in the English literature. Results and conclusions We identified 46 papers that included 17 cases of primary SCC of the thyroid gland with LT and 77 cases of primary SCC of the thyroid gland without LT. Lymph node metastasis and local invasion rates did not differ between these two groups. Distant metastases were absent in patients with LT, and were observed in 13 (16.9%) patients without LT. A greater proportion of patients without LT had advanced stage disease (stage IV A-B-C) than patients with LT (p < 0.05). Patients with primary SCC of the thyroid gland and coexisting LT had lower tumour-node-metastasis stage and frequency of distant metastasis than those without LT. Lymphocytic infiltration in patients with SCC appears to limit tumour growth and distant metastases.

Does Retinal Neurodegeneration Seen in Diabetic Patients Begin in the Insulin Resistance Stage

Objectives: To investigate whether retinal neurodegeneration and impairment in contrast sensitivity (CS), which have been demonstrated to begin in diabetic patients before the presence of signs of diabetic retinal vasculopathy, also occur in the stage of insulin resistance. Materials and Methods: The average, minimum and sectoral (inferior, superior, inferonasal, superonasal, inferotemporal and superotemporal) thicknesses of the ganglion cell-inner plexiform layer (GCIPL) measured using optical coherence tomography were compared between an insulin-resistant group and control group in order to evaluate the presence of retinal neurodegeneration. The CS of the two groups was also compared according to the logarithmic values measured at spatial frequencies of 1.5, 3, 6, 12 and 18 cycles per degree in photopic light using functional acuity contrast test (FACT). Results: Twenty-five eyes of 25 patients with insulin resistance (insulin resistant group) and 25 eyes of 25 healthy subjects (control group) were included in this study. There were no statistically significant differences between the two groups in any of the spatial frequencies in the FACT. The mean average GCIPL thickness and mean GCIPL thickness in the inferotemporal sector were significantly less in the insulin-resistant group when compared with the control group (mean average GCIPL thicknesses in the insulin-resistant and control groups were 83.6±4.7 µm and 86.7±3.7 µm respectively, p=0.01; mean inferotemporal GCIPL thicknesses in the insulin-resistant and control groups were 83±6.0 µm and 86.7±4.6 µm respectively, p=0.02). Conclusion: Although it may not lead to functional visual impairment such as CS loss, the retinal neurodegeneration seen in diabetic patients may begin in the insulin resistance stage.

Primer Hiperparatiroidi Nedeniyle Opere Edilen Vakalarda Eşlik Eden Tiroid Patolojilerinin Değerlendirilmesi

Purpose: In this study we aimed to evaluate thyroid pathologies in patients with primaryhyperparathyroidism who underwent surgery for parathyroidectomy.Methods: Patients who underwent parathyroidectomy for primary hyperparathyroidism betweenthe years of 2006-2012 were included in this retrospective study. Before and after surgery,hormonal and biochemical examinations of the patients and results of preoperative imagingstudies were recorded.Results: Of the patients included in the study, 86 were female and 12 were male. Preoperativemean serum calcium level was 12.25 ± 1.48 mg/dL (normal range 8.5-10.1 mg/dL), meanparathyroid hormone (PTH) level was 425.09 ± 440.47 pg/mL (normal range 11-65 pg/mL).The thyroid ultrasound records of 93 patients were available. Of these patients, 26 (28%) hadnormal ultrasound, 18 (19.4%) had solitary nodule, 43 (46.2%) had multinodular goiter and 4(4.3%) had thyroiditis (without nodule) and 2 (% 2.2) had solitary nodule with thyroiditis.Adenoma was detected by ultrasonography in 45.2 % of patients, and by scintigraphy in 72.7of patients. Parathyroidectomy and thyroidectomy were performed at the same time in 54 of 98patients (65.1%). Of these patients Seven (7.1%) had papillary thyroid cancer, 30 (30.6%) hadbenign multinodular goiter, 8 patients (8.2%) had benign solitary nodule, 2 patients (2%) hadlymphocytic thyroiditis, and 7 (7.1%) had normal thyroid tissue.Conclusion: Thyroid diseases are frequently encountered with primary hyperparathyroidism.Therefore, before performing parathyroidectomy with minimally invasive procedure, patientsmust be evaluated for thyroid disorders

Significant improvement of hyperglycemia after treatment in a patient with primary aldosteronism

Primer aldosteronizm, surrenal korteksten asiri miktarda aldosteronun sentez ve saliniminin oldugu, genellikle tek tarafli adenom veya iki tarafli hiperplaziden kaynaklanan bir sendromdur (1). Primer aldosteronizme en sik neden olan adrenokortikal adenom (aldosteronoma), Conn sendromu olarak da bilinir (2). Primer aldosteronizmin klasik bir bulgusu olan hipertansiyon, orta siddette veya yuksek olarak saptanir ve genellikle antihipertansif tedaviye direnclidir. Adrenalektomi sonrasi kan basinci belirgin olarak duzelir ya da normale doner. Primer aldosteronizm, insulin direnci ile iliskilendirilmistir. Deneysel kanitlar mineralokortikoid hormonlarin ve insulin arasindaki islevsel etkilesimi gostermektedir (3) . Buna bagli olarak hastalarda, ek olarak glukoz metabolizma bozukluklari gorulebilmektedir. Adrenalektomi sonrasi, hiperglisemisi duzelen hastayi literatur esliginde tartismayi amacladik.