Mehmet Gumus

Platelet activity indices in patients with deep vein thrombosis.

Background: Extensive research has been performed regarding the association between platelet activity indices and various cardiovascular disorders. Less clear data, however, are present between these indices and deep vein thrombosis (DVT). Aim: The aim of this study was to investigate the association between platelet activity indices and DVT in a relatively large population. Methods: Mean platelet volume (MPV), mean platelet mass (MPM), and mean platelet component (MPC) were measured by an autoanalyzer in a total of 203 patients with DVT and the results were compared with 210 age- and sex-matched controls without DVT. Results: There were significant differences between the study and control groups in MPV (8.6 ± 1.3 fL vs 7.9 ± 0.5 fL [95% CI −0.82 to −0.44], P < .001, respectively), MPM (2.2 ± 0.3 pg vs 2.0 ± 0.1 pg [95% CI −0.20 to −0.11], P < .001, respectively), and MPC (24.9 ± 3.2 g/dL vs 26.3 ± 1.6 g/dL [95% CI 0.91 to 1.89], P < .001, respectively). These 3 platelet activity indices were also found to be significant predictors of the presence of DVT (all Ps < .001). Conclusion: In patients with DVT, the presence of DVT was closely associated with increased platelet activation. The MPV, MPM, and MPC may identify patients requiring aggressive antiplatelet treatment.

CA 19-9 level in patients with type 2 diabetes mellitus and its relation to the metabolic control and microvascular complications.

Introduction:The aim of this study is to compare CA 19-9 levels in patients with type 2 diabetes mellitus (DM) and healthy control group. The relation of CA 19-9 levels to metabolic control and microvascular complications in patients with diabetes was also investigated. Methods:Three hundred forty patients with type 2 DM and age-, sex- and body mass index-matched 214 healthy controls group were included in the study. HbA1c, duration of DM and microvascular complications of DM were reviewed. CA 19-9 levels (normal range, 0–35 U/mL) were measured in all participants. Results:Median CA 19-9 level was significantly higher in patients with diabetes compared with control group [19.5 U/mL (0–214.8 U/mL) versus 7.4 U/mL (0.4–47.0 U/mL)] (P < 0.001). Prevalence of high CA 19-9 levels in patients with diabetes was 31.2%, and CA 19-9 level was positively correlated with age, duration of diabetes, HbA1c and number of complications. Effects of duration of diabetes, HbA1c and diabetic nephropathy were still continuing in multiple linear regression analysis. Using regression coefficients of all variables in multiple regression analysis, this study tried to determine a new cutoff value for CA 19-9 level in patients with diabetes. The cutoff value at 97th percentile was 57.14 U/mL. Conclusions:High CA 19-9 value in patients with diabetes may indicate the need for a careful evaluation of blood glucose regulation and investigation of complications. Defining a new cutoff value in these patients would prevent unnecessary laboratory or imaging procedures.

Percutaneous laser ablation of an autonomous thyroid nodule: effects on nodule size and histopathology of the nodule 2 years after the procedure.

Ultrasound (US)–guided percutaneous laser ablation (PLA) is a new procedure for decreasing the size of thyroid nodules (1–5). It has been used to treat compressive symptoms in benign solitary cold thyroid nodules (1–5) and to reduce thyroid hormone production in autonomous functioning thyroid nodules (6–9). In two cases of anaplastic thyroid carcinoma, it was used for palliative purposes (7,10). Pacella et al. (11) first described thermal injury of thyroid tissue by PLA. We previously studied the effects of PLA on the cytology of hypofunctioning thyroid nodules, nodule volume, and thyroid function, but did not report data on histopathologic changes produced by US-guided PLA in thyroid nodules (4). We now describe the histopathology of an autonomously functioning thyroid nodule 2 years after PLA. A 25-year-old woman presented with swelling of the neck and difficulty breathing. On physical examination, a nontender, mobile, moderately firm nodule of about 3 cm was noted in the right lobe of the thyroid. Serum thyrotropin (thyroid-stimulating hormone, TSH) was 0.55 mIU=mL (normal range: 0.4–4 mIU=mL), serum free thyroxine level was 1.21 ng=dL (normal range: 0.85–1.78 ng=dL), and serum free triiodothyronine level was 3.85 pg=mL (normal range: 1.57– 4.71 pg=mL), all within normal limits. Serum antithyroid peroxidase antibody was 5 IU=mL (normal range: 0–35 IU=mL), anti-thyroglobulin antibody (anti-TgAb) was 10 IU=mL (normal range: 0–40 IU=mL), serum Tg level was 10 ng=mL (normal range: 0–55 ng=mL), and serum calcitonin level was 1 pg=mL (normal range: 5.0–11.5 pg=mL). US was performed using a Pro 200 Scanner (GE Medical Systems Kyunggido, Korea), and a 13.50 mL solid nodule was detected in the right lobe of the thyroid. Echogenity was normal in the remaining thyroid tissue. Technetium-99m (Tc) scintigraphy showed a hot nodule in the right lobe, with slight suppression of 99m Tc uptake in the remainder of the thyroid (Fig. 1). US-guided fine-needle aspiration biopsy of the nodule showed benignappearing thyrocytes, which formed occasional follicles. The patient refused surgery or radioiodine treatment. PLA of the thyroid nodule was advised, and she accepted and gave informed consent to the procedure. The approval of the local ethics committee was obtained (Ataturk Education and Research Hospital, Ankara; date: 09.11.2004; record no.: 2004=10=009). A 16-mm-long, 21-gauge (0.8 mm) needle was custommanufactured for the nodule. Sedation was obtained with 7.5 mg diazepam (SABA Pharmaceuticals, Istanbul, Turkey) 1 hour prior to the procedure. The skin above the nodule was sterilized with 95% ethanol, and 2 mL of 2% Lidocaine was injected subcutaneously. The custom-produced needle was inserted under US guidance into the proper position within the nodule along its long axis. Then, a bare flat-end fiber, 400mm in diameter, was inserted through needle lumen. The fiber tip was aligned with the needle tip, and then advanced 5 mm to provide direct contact with thyroid tissue. Two-plane US imaging was used to confirm that the fiber tip was at least 2 cm from surrounding vital organs. A total of 3000 J of energy was transferred through the fiber tip within 600 seconds with 5 W power by an electronic infrared diode laser at 810 nm wavelength using a gallium-aluminumarsenide power source (model 15 plus; Diomed, Cambridge, UK) (1,2,4,6,9,10). The patient experienced neck discomfort and pain extending toward the chin. The pain ceased after power transfer was stopped, and no complications were encountered after the procedure. Indirect laryngoscopic examinations before and after the procedure were normal. The thyroid nodule volume, which was 13.50 mL before the procedure, decreased to 8.40 mL 3 months later and to 4.20 mL 6 months after PLA. The patient’s compression symptoms (difficulty in breathing and difficulty in swallowing) decreased from 7 points to 2 points when evaluated by visual analog scale (min, 0; max, 10) (1,2,4). Nine months after PLA, however, the volume of the nodule had increased to 5.5 mL; at 1 year it was 6.6 mL; at 2 years it was 10 mL. Serum TSH, triiodothyronine, and thyroxine remained normal, but serum anti-TgAb level, which was 10 IU=mL before the procedure, increased to 150 IU=mL at the 6th month and regressed to 60 IU=mL at the 24th month. US-guided fine-needle aspiration biopsy was performed 1 year after PLA and showed no evidence of malignancy. Scintigraphies performed at 12th and 24th months by Tc showed that the hot nodule was still present, but serum TSH was normal (0.72mIU=mL) at 24 months. The patient felt that the size of the nodule was increasing, and the visual analog scale was increased to 7 points. Therefore, thyroidectomy was advised, and the patient agreed to this. The patient underwent complete resection of the right lobe, which contained the nodule, isthmusectomy, and near-total resection of the left lobe. Macroscopic examination showed a white-gray lesion in the region of the nodule, surrounded by hemorrhagic areas (Fig. 2). Rare old and new hemorrhagic regions, minimal fibrosis, and multiple microfollicles with colloid in their lumen were observed (Fig. 3) on histopathological examination. In the thyroid tissue surrounding the nodule, lymphoid cells with occasional germinal centers were observed (Fig. 4). Also, lymphocytic infiltration was observed in the opposite lobe. PLA-induced thermal injury in human thyroid tissue was first described by Pacella et al. (11). They reported the histopathology of single nodules in two patients whose THYROID Volume 18, Number 7, 2008 a Mary Ann Liebert, Inc. DOI: 10.1089=thy.2007.0316

Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules.

PURPOSE To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis. MATERIALS AND METHODS One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods. RESULTS There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05). CONCLUSION The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

Short Saphenous Vein Incompetence and Chronic Lower Extremity Venous Disease

We performed this prospective study on patients with signs and symptoms of chronic venous disease to emphasize short saphenous vein (SSV) insufficiency, which is not routinely evaluated with Doppler ultrasonography in every center.

Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players

Elastography is a new sonographic technique that evaluates the elasticity of different tissues such as the Achilles tendon. In this study, we aimed to investigate the elastographic findings of Achilles tendons in professional athletes in comparison with healthy volunteers.

The relationship between diurnal variation of TSH and thyroid blood flow with Doppler ultrasonography in healthy adults

Abstract Aim. To determine the presence of a correlation between the Doppler parameters of thyroid blood flow and diurnal variation of TSH. Method. Thirty healthy adults were included. FT3, FT4, and TSH measurements were made at 08.00, 16.00, and 24.00. Thyroid volumes were calculated followed by peak systolic velocity (PSV) and resistance index (RI) from the inferior thyroid artery by Doppler ultrasonography. Results. The difference between diurnal measurements of TSH was found to be significant (1.29 ± 0.55 vs 3.09 ± 1.52; p < 0.001). PSV was detected to be higher at 24.00 compared to values measured at 08.00 and 16.00 (27.75 ± 9.54 vs 24.9 ± 8.51; p < 0.01 and 27.75 ± 9.54 vs 25.88 ± 9.82; p < 0.05). Mean RI values were lower at 24.00 compared to those at 08.00 and 16.00 (0.53 ± 0.07 vs 0.57 ± 0.07; p < 0.001 and 0.53 ± 0.08 vs 0.56 ± 0.05; p < 0.05). Conclusion. Thyroid blood flow should be evaluated diurnally by Doppler ultrasonography in thyroid pathologies.

Real-Time Ultrasound Elastographic Features of Primary Open Angle Glaucoma.

Objective To investigate the significance of ultrasound elastography for evaluating the optic nerve in patients with primary open angle glaucoma (POAG). Methods This prospective, comparative case series included 40 eyes of 40 patients. Twenty eyes with POAG comprised the POAG group, and 20 eyes of 20 patients without glaucoma who admitted to general eye clinic for near vision glasses comprised the control group. All real-time sonographicelastographic examinations were performed by the same physician. The ratio of orbital fat to optic nerve head (ROFON) and lateral rectus to optic nerve head (RLRON) were determined. Statistical analyses were performed using Student t test, Kolmogorov-Smirnov test, and &khgr;2 test. Results The mean ages of the patients in the study and the control groups were 65.10 ± 7.88 years (range, 48–80 years), and 69.15 ± 7.92 years (range, 55–89 years), respectively (P = 0.113). Mean ROFONs were 1.85 and 6.42 (P < 0.05), and mean RLRONs were 0.65 and 1.07 (P < 0.05) in the control and POAG groups, respectively. Conclusions Real-time elastography showed increased ROFON and RLRON in POAG patients. This can help to understand optic nerve head biomechanics and clarify glaucoma damage in early glaucoma cases.

Hypertrophic columns of bertin: imaging findings.

Hypertrophic column of Bertin (HCB) may mimic renal mass and may lead to unnecessary nephrectomy in some conditions. In this case report we present a patient with HCB, which mimics renal mass in ultrasonography (US) examination with its US, Doppler US and magnetic resonance imaging (MRI) findings. In contrast to the US, excretory urography (EU) and computed tomography (CT) findings of HCB, MRI findings of this entity could not take part in the literature sufficiently. We suggest that this case report could be useful in preventing the unnecessary biopsy and surgical procedures. In conclusion, however, US is often sufficient in the diagnosis of HCB, unusual lesions could be seen. In the final diagnosis of these lesions, MRI is very useful and more responsive technique. Understanding the imaging characteristics of HCB could prevent unnecessary interventional or surgical procedures.

Effects of menstrual cycle showing infradian rhythm on thyroid blood flow and thyroid volume in healthy women

The aim of the present study was to determine alterations in thyroid blood flow parameters and thyroid volume (TV), measured at inferior thyroid artery (ITA), due to changes in sex hormones and thyroid stimulating hormone (TSH) at four different periods of menstrual cycle (MC) showing infradian rhythm in healthy women. Twenty-two women with regular MC were recruited. Individuals were assessed with hormone levels, and Doppler ultrasound (US) findings at days 3, 7, 14, and 21 of MC. Mean TSH, peak systolic velocity (PSV), resistance index (RI), pulsatile index (PI), and TV were statistically analyzed. Compared to days 3 and 7, significant increases were detected in TSH, TV, and PSV at day 14 (p = 0.005, p = 0.000, p = 0.014; and p = 0.021, p = 0.002, p = 0.021, respectively). No significant differences were found for PI at different periods of MC (p > 0.05). RI significantly decreased at days 14 and 21 when compared to day 3 (p = 0.020 and p = 0.015, respectively). Alterations occur in ITA blood flow parameters and TV along with TSH levels throughout the MC.