Özlem Yönem

Characteristic features of 20 patients with Sheehan's syndrome

Sheehans syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The aim of the present study was to determine the clinical characteristics of Sheehans syndrome in 20 patients (mean age 60.15 ± 3.41 years) with typical obstetric history. The mean duration between time of diagnosis and date of the last delivery was 26.82 ± 2.52 years (range 2–40 years). All patients had a history of massive hemorrhage at delivery and physical signs of Sheehans syndrome. Fourteen patients (70.0%) lacked postpartum milk production and did not menstruate following delivery. Baseline and stimulated anterior pituitary hormone levels were measured in all patients. According to the hormonal values, 18 (90.0%) patients had secondary hypothyroidism, 11 (55.0%) had adrenal failure and all of them had hypogonadism, prolactin and growth hormone deficiency. Hyponatremia was present in seven patients (35.0%). Total or partially empty sella was revealed in all patients by magnetic resonance imaging. Diabetes insipidus was not found in any patient. We found that lack of lactation in the postpartum period and early menopause seemed the most important clues for diagnosis of Sheehans syndrome, and inadequate prolactin and gonadotropin responses to stimulation tests were the most sensitive diagnostic signs in patients with severe postpartum hemorrhage.

The relation between serum leptin levels and body fat mass in patients with active lung tuberculosis.

The relationship of leptin to diminished appetite and weight loss has been investigated in many diseases. Diminished appetite and weight loss are the most apparent characteristics of patients with active lung tuberculosis and in this study the relation of leptin to such diminished appetite and weight loss has been investigated in patients with active lung tuberculosis before and after treatment. Twenty‐five patients (7 female, 18 male) with active tuberculosis having an age range of 18–70 years (mean 47.48 ± 15.36 y) and 25 normal individuals (9 female, 16 male) having an age range of 25–71 years (mean 44.60 ± 13.80 y) were included in this study. Leptin levels, body mass index (BMI), body fat ratio (BFR), and waist hip ratio (WHR) were measured before and after 6 months of antituberculosis treatment. The same measurements were also made in the control group and the results were compared. While the pretreatment BMI (22.02 ± 4.31 kg/m2) and BFR (16.60% ± 9.30%) values in the patient group were significantly lower than in the control group, we found no difference in their pretreatment WHR values. Pretreatment leptin levels (3.49 ± 3.34 µg/L) were significantly higher in patients with tuberculosis than in the control group (2.33 ± 1.10 µg/L). Leptin levels were found to be significantly increased at the 6th month of antituberculosis treatment (5.65 ± 5.41 µg/L) than the pretreatment values (p < 0.05). We observed an evident increase in BMI (24.10 ± 4.87 kg/m2) and BFR (17.51% ± 9.25%) due to antituberculosis treatment (p < 0.05). This study suggests that leptin has a role in the diminished appetite and weight loss symptoms in patients with active lung tuberculosis.

Serum zinc level and its effect on anthropometric measurements in 7-11 year-old children with different socioeconomic backgrounds.

This study was performed in order to determine the serum zinc (Zn) level of primary school students, to show the effect of socioeconomic status (SES) on the zinc level, and finally to show the effect of zinc deficiency on the anthropometric parameters. Ten different primary schools were included in the study according to SES. Four-mL venous blood samples were obtained under fasting conditions using disposable plastic syringes. Four hundred thirty-two randomly chosen students between 7 and 11 years of age were investigated. All the children were living in Sivas, a city located in the middle eastern part of Turkey. Serum Zn level was measured by atomic absorption spectrophotometry (Hitachi 2-800). The weight and height of each child was recorded. The SES of children included in this study was as follows: 43.1% low (n = 186), 34.3% middle (n = 148), and 22.7% high (n = 98). Mean serum Zn levels of low and middle SES subjects were 56.3 +/- 17.50 micrograms/dL and 86.6 +/- 26.8 micrograms/dL respectively, while in children with high SES the mean serum Zn was 110.7 +/- 24.50 micrograms/dL. The difference between the groups was found to be statistically significant (F = 19.545, p < 0.05). When height-for-age z-scores were calculated according to SES, 105 of 186 children (56.4%) with low SES were found to have a z-score of -2 or lower and 14 of 147 children with middle SES had a z-score of -2 or lower. None of the children in the high SES group had a z-score of -2 or lower.

Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage

Background: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively. Results: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner. Conclusions: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

Umbilical Serum Insulin-like growth Factor 1 (IGF-1) in Newborns: Effects of Gestational Age, Postnatal Age, and Nutrition

AIM The aim of this study was to determine the relationship between nutrition, gestational age, and birth weight, and serum insulin-like growth factor 1 (IGF-1) levels in newborns. METHOD The first study group consisted of sixty newborns: thirty were fed with human breast milk and the others were fed with infant formula. Serum samples were obtained from all the newborns on days one and seven of life. Seventy-two pregnant women and their neonatal cord blood serum samples were obtained in a labor ward in the study group. All the serum samples were analyzed for IGF-1 by immunoassay. RESULT Newborns fed with human milk had higher serum IGF-1 concentrations compared to formula-fed controls (p < 0.05). Cord IGF-1 levels showed a negative correlation with birthweight (p < 0.05) and a positive correlation with gestational age (p < 0.05). CONCLUSION These findings suggest that IGF-1 levels during the neonatal period are influenced by gestational age, birth weight, and nutrition.

The relationship between red cell distribution width and homozygous M694V mutation in familial Mediterranean fever patients.

BACKGROUND AND OBJECTIVE Familial Mediterranean fever (FMF) is characterized by recurrent and self-limiting attacks with peritonitis, pleuritis, arthritis, and erysipelas-like erythema. We aimed to investigate the red cell distribution width (RDW) level as an inflammatory marker in FMF patients compared with normal subjects. DESIGN AND SETTINGS A retrospective study of FMF patients at the Department of Gastroenterology, Cumhuriyet University, between November 2011-February 2013. METHODS A total of 249 FMF patients and 131 age- and sex-matched control participants were included in the currrent study. RDW levels were also analyzed by standard methods. Each patient was given 2 mL of blood sample to obtain genomic DNA. RESULTS Statistically significant differences were observed in RDW values between the FMF patients and the control group. Also, RDW levels were higher in the FMF patients with the homozygous M94V mutation compared with those with other mutations. The receiver-operating characteristic curve analysis suggested that the optimum RDW cutoff point for the FMF patients was 13.95, with a sensitivity, specificity, negative predictive value, and positive predictive value of 70%, 64%, 68%, and 66%, respectively (area under the curve: 0.711, 95% confidence interval 0.627–0.795, P<.0001). CONCLUSION We suggest that RDW may show subclinical inflammation in FMF patients. RDW may be a promising marker in predicting the homozygous M694V mutation in FMF patients.

The Relationship Between Mean Platelet Volume Levels and the Inflammation in Helicobacter Pylori Gastritis

Helicobacter pylori is a cause of chronic gastritis. Mean platelet volume (MPV) has been started to be used as a simple inflammatory indicator in some diseases. We have aimed especially to investigate the usability of MPV as a simple indicator that may reflect severity of inflammation in gastric mucosa. Included in the study were a total of 114 patients who visited the outpatient clinic of gastroenterology with complaint of dyspepsia. Blood MPV levels in hemogram results were evaluated. Esophagogastroduodenoscopy was performed on patients included in the study, and histological analysis was performed by obtaining 2 specimens from each of antrum, corpus, and incisura angularis. All specimens were evaluated according to the updated Sydney System. No statistically significant result was found among blood MPV levels, the intensity of H pylori, and the severity of inflammation of gastric mucosa. However, it is interesting that mean MPV levels in cases with lymphoid follicle were lower. We suggest that MPV level cannot be used as a simple marker to reflect H pylori intensity and severity of inflammation in gastric endoscopic biopsies.

Steatohepatitis and liver cirrhosis in Chanarin-Dorfman syndrome with a new ABDH5 mutation.

Chanarin-Dorfman syndrome (CDS) is an autosomal recessive neutral lipid storage disease. It is very rare and characterized by ichtiosis, intracellular fat droplets in leucocytes (Jordan anomaly) and involvement of multiple tissues (skeletal muscle, central nervous system, bone marrow, eye and ear) mainly the liver. Our patients were diagnosed as CDS because they had ichtiosis, Jordon anomaly of leucocytes in peripheral blood smear, liver involvement and presence of homozygous 88 insertion C frame shift mutation on exon 4 of ABHD5/CGI-58 gene in genetic analysis. Our cases were two sisters. One of them developed severe steatohepatitis on age 19 and the other one was diagnosed as decompensated cirrhosis when she was 26 years old. We report here a new mutation in comparative gene identification-58 (CGI-58) gene causing syndactyly and steatohepatitis induced early cirrhosis.

A new variant of bile duct duplication with coexistence of distal cholangiocarcinoma

Background. A 72-year-old hypertensive woman presented with a 2-month history of right upper quadrant abdominal pain. She had a 15-day history of jaundice, fever with chills and shivering, nausea, vomiting, weight loss and generalized pruritus.Investigations. Physical examination, laboratory evaluation, transabdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, brush cytology, laparotomy and histopathology.Diagnosis. Bile duct duplication with coexistence of distal cholangiocarcinoma.Management. En bloc resection (including the duodenum, pancreatic head and adjacent lymph nodes), hepaticojejunostomy and pylorus-saving Whipple operation.

A Behçet Case with Renal Amyloidosis

Behçets disease is a chronic systemic vasculitis with unknown etiology characterized by recurrent oral and genital ulcerations, ocular inflammation, having manifestations related to the skin and joints. Neurologic, pulmonary and gastrointestinal findings can also be observed during the course of the disease. In this report a case of Behçets disease that had amyloidosis due to renal parenchymal involvement of the disease showing itself by nephrotic syndrome is presented.