Successful localisation of recurrent thyroid cancer using preoperative patent blue dye injection.

PURPOSE: In the follow-up of patients with thyroid cancer, recurrences are often detected, posing challenges in locating and removing these lesions in a reoperative setting. This study aimed to assess the effectiveness of preoperative ultrasound (US)-guided injection of patent blue (PB) dye into the recurrences to aid in their safe and efficient removal. METHODS: In this retrospective analysis, we reviewed the records of the patients in a tertiary care centre between February 2019 and March 2023 who underwent US-guided PB injection in the endocrinology outpatient clinic before reoperative neck surgery. The duration between the injection of PB and the initiation of surgery was recorded. The complications and effectiveness of the procedure were evaluated using ultrasonographic, laboratory, surgical, and pathologic records. RESULTS: We reached 23 consecutive patients with 28 lesions. The recurrences averaged 8.8 mm (4.1-15.6) in size and were successfully stained in all cases. The median time between the PB injection and the incision was 90 (35-210) min. There were no complications related to the dye injection. The blue recurrences were conveniently identified and removed in all cases. CONCLUSIONS: A preoperative US-guided injection of PB is a safe, readily available and highly effective technique for localising recurrent tumours, even in small lesions within scarred reoperative neck surgeries.

Are neutrophil-to-lymphocyte ratios and large unstained cells different in hospitalized COVID-19 PCR-positive patients with and without diabetes mellitus?

OBJECTIVE: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought. MATERIALS AND METHODS: In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records. RESULTS: When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs.  5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs.  64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively). CONCLUSIONS: We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

EMPTY SELLA IN A PATIENT WITH CLINICAL AND BIOCHEMICAL DIAGNOSIS OF ACROMEGALY.

Background: Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Empty sella (ES) is an anatomical condition of sella turcica that is partially or completely filled with cerebrospinal fluid mainly due to intrasellar herniation of subarachnoid space. Here, we describe a patient who presented with clinical and biochemical features of acromegaly and who had an ES on pituitary magnetic resonance imaging (MRI). Case report: A 73-year-old male patient was consulted in our clinic because of the acromegalic phenotype while planning for colorectal adenocarcinoma surgery. The patient noticed gradual enlarging of his hands, feet and nose for 30 years, but never consulted to any clinician for this reason. Serum GH was 20.6 ng/mL (normal <3 ng/mL) and IGF-1 was 531 ng/mL (normal, 69-200 ng/ml). An oral glucose tolerance test showed no suppression of GH values. T1-weighted MRI revealed an ES. 18F-FDG PET/CT and Ga-DOTATADE PET/CT did not show any finding consistent with ectopic GH secretion. Growth hormone releasing hormone (GHRH) was within the normal range (<100mg/dL). He was treated with long-acting octreotide 20 mg per 28 days. At the 6th month of treatment, serum GH and IGF-1 levels were decreased to 5.45 ng/mL and 274 ng/mL, respectively. Conclusion: The mechanism underlying the association of acromegaly and ES remains unclear. Apoplexy on existing pituitary adenoma and then formation of necrosis can proceed to ES. Since our patient did not have a history of pituitary apoplexy and we could not find any reason for secondary ES, we considered primary ES.

Comparison of thyroid fine needle aspiration biopsy results before and after implementation of Bethesda classification.

OBJECTIVE: The Bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology (FNAC). We compared the diagnostic value of pre-Bethesda and Bethesda classification systems in the differentiation of benign and malignant thyroid nodules. METHODS: Medical records of patients who underwent a thyroidectomy between June 2007 and June 2014 were reviewed retrospectively. Nodules evaluated with FNAC before March 2010 were classified as pre-Bethesda (non-diagnostic, benign, indeterminate, suspicious for malignancy and malignant), and those evaluated after March 2010 were considered Bethesda (non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two classification systems were calculated. RESULTS: There were 1810 nodules in the pre-Bethesda and 5115 nodules in the Bethesda group. The non-diagnostic rate was significantly higher, and benign and suspicious for malignancy rates were lower in Bethesda compared with the pre-Bethesda group (P<.001 for each). When benign cytology was considered negative, and indeterminate, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant cytologies were considered positive, results for pre-Bethesda and Bethesda were as follows: sensitivity, 78.9% and 78.5%; specificity, 86.6% and 97.0%; PPV, 42.8% and 72.6%; NPV, 97% and 97.8%; and accuracy, 85.7% and 95.3%, respectively. CONCLUSIONS: Among operated nodules, percentages of benign and suspicious for malignancy cytologies decreased, and percentages of non-diagnostic and uncertain cytologies increased with the implementation of Bethesda. The diagnostic value of FNAC seems to have increased with the use of Bethesda classification.

Bethesda classification is a valuable guide for fine needle aspiration reports and highly predictive especially for diagnosing aggressive variants of papillary thyroid carcinoma.

BACKGROUND: A fine needle aspiration biopsy (FNAB) is the most valuable diagnostic procedure for pre-operative discrimination of benign and malignant nodules. The Bethesda System for Reporting Thyroid Cytopathology provides standardised reporting and cytomorphological criteria in aspiration smears. The aim of the present study was to determine malignancy rates in nodules with different cytology results and evaluate the diagnostic value of Bethesda for variants of papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: A retrospective analysis of 2534 cases with 5784 thyroid nodules, who underwent FNAB followed by surgery, were included in this study. FNAB was performed with ultrasonography guidance. Cytological diagnoses were classified as: non-diagnostic (ND), benign, atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy (SUS) and malignant. Histopathological diagnoses were classified into four groups: benign, PTC, follicular thyroid cancer and other types of thyroid cancer (including medullary thyroid cancer, undifferentiated thyroid cancer and thyroid tumours of uncertain malignant potential). Cases with PTC were further divided into four categories: conventional variant, follicular variant, aggressive variants (tall cell, diffuse sclerosing and columnar variant) and other variants (oncocytic, solid/trabecular and warthin-like variants). FNAB results were compared with histopathological results. RESULTS: Malignancy rates were 6.3%, 3.2%, 20.7%, 33.3%, 74.2% and 95.6% in the nodules with ND, benign, AUS/FLUS, FN/SFN, SUS and malignant cytology results, respectively. Pre-operative cytology was malignant or SUS in 56.6% of conventional, 24.3% of follicular, 92% of aggressive and 41.7% of other variants of histopathologically confirmed PTC. The difference between the groups was significant (P < 0.001). CONCLUSION: The Bethesda classification is a reliable indicator of malignancy in nodules with different cytology results and seems to be very effective in predicting the malignancy for the nodules diagnosed with aggressive variant PTC on the final histological examination.

Clinicopathological features of thyroid cancer in the elderly compared to younger counterparts: single-center experience.

PURPOSE: The incidence of thyroid cancer is increased in elderly patients. It tends to be larger and have more aggressive characteristics in these patients. Our aim was to compare features of thyroid carcinoma in geriatric and non-geriatric patients. METHODS: In total, 933 patients with thyroid cancer were retrospectively reviewed. Thyroid functions, ultrasonography features of malignant nodules, cytological and histopathological findings and the rates of recurrence and persistence were compared in patients ≥65 and <65 years old. RESULTS: There were 153 malignant foci in 109 (11.7%) patients ≥65 and 1185 malignant foci in 824 (88.3%) patients <65 years old. Mean nodule diameter was significantly higher in geriatric patients (p = 0.008). Most of the ultrasonographical features of malignant nodules were similar in two groups. Hypoechoic halo was observed in 16.4 and 28.6% of malignant nodules in geriatric and non-geriatric group, respectively (p = 0.034). There was no significant difference in cytological diagnosis. Histopathologically, tumor diameter, rates of microcarcinomas and incidentality were similar. Of all cancer types, 88.8% in geriatric and 93.9% in non-geriatric group were papillary thyroid cancer (p = 0.028). Hurthle cell cancer constituted 3.9 and 1.1% of carcinomas in geriatric and non-geriatric patients, respectively (p = 0.015); 2.0 and 0.2% of tumors in geriatric and non-geriatric group were anaplastic, respectively (p = 0.012). Capsular and vascular invasion, extrathyroidal extension, persistence and recurrence rates were similar. CONCLUSIONS: Rates of anaplastic cancer and Hurthle cell cancer which is known to have worser prognosis among other differentiated thyroid cancers are increased in geriatric ages. Cytological evaluation of thyroid nodules should strongly be considered due to increased tendency for aggressive tumor types in these patients.

A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma.

AIM: The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors. METHODS: In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted. RESULTS: Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extra-thyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size>5 mm (P<0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cut-off value≥7.98 ngmL(-1)) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median follow-up of 2 years (range:0.3-11 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence. CONCLUSION: Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.

Postpartum osteoporosis and vertebral fractures in two patients treated with enoxaparin during pregnancy.

Postpartum osteoporosis (PPO) is a rare disease associated with pregnancy and lactation period. Here, we report severe PPO and multiple vertebral compression fractures in two patients treated with enoxaparin--low-molecular-weight heparin (LMWH)--throughout their pregnancy. A 34-year-old woman who has delivered her second baby 3 months ago presented with severe low-back pain. She was treated with enoxaparin 40 mg/day for 8 months during her pregnancy. Dual-energy X-ray absorptiometry (DEXA) showed low T- and Z-scores in lumbar (L) vertebras. In magnetic resonance imaging (MRI), severe height losses in thoracic (T) 12, L1, and L2 vertebras were detected. She was diagnosed to have severe PPO and multiple vertebral compression fractures and was prescribed risedronate 35 mg/week, calcium, and vitamin D. The other patient was a 36-year-old woman diagnosed with PPO and vertebral fractures at the third week postpartum. She was also treated with enoxaparin 60 mg/day during her pregnancy. Severe osteoporosis in L vertebras and height losses indicative for compression fractures in T5-8, T11-12, and L2-5 vertebras were detected by DEXA and MRI, respectively. She was treated with calcitonin 200 U/day, calcium, and vitamin D. These findings suggest that vertebral compression fractures and PPO may be one of the causes of severe back pain in postpartum patients. Treatment with LMWH during pregnancy might be considered as a new risk factor for this rare condition.

Sheehan's syndrome co-existing with Graves' disease.

Sheehan's syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Graves' disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a 22-year-old female patient in our clinic presented symptoms of amenorrhea, lack of lactation, palpitations and sweating. Her physical examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec 99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co-existing with SS. GD with concomitant hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

The relationship between acute coronary syndrome and stress hyperglycemia.

BACKGROUND AND OBJECTIVE: Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events. METHOD: 89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months. RESULTS: In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed. CONCLUSION: Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.

Elastosonographic strain index in thyroid nodules with atypia of undetermined significance.

AIM: In this study, we aimed to evaluate the diagnostic accuracy of elastosonography (ESG) scoring and strain ratio in patients who had atypia of undetermined significance (AUS) cytology and underwent surgery for thyroid nodules. MATERIALS AND METHODS: 250 patients were included in this study. They had at least one nodule in thyroid USG, underwent USG-guided FNAC according to the current guidelines and had AUS cytology according to the Bethesda system. Both elastosonographic color scoring and strain index were evaluated. RESULTS: A total of 270 nodules in 250 patients were evaluated. Histopathologically, 81 (30 %) nodules were malignant and 189 (70 %) were benign. According to the ESG, 10 (3.7 %) nodules were assigned a score of 1, while 13 (4.8 %) nodules were assigned a score of 5. All of the nodules with an ESG score of 1 were histopathologically benign and 92.3 % of the patients with ESG score 5 were in the malignant group. Median SI in the benign histopathologic group was significantly lower compared to malignant group [(2.58 (IQR = 2.35) vs. 14.54 (IQR = 10.71)]. The optimal SI cut-off value to distinguish between the benign and malignant nodules was 6.66, with a sensitivity of 98.77 % and specificity of 96.30 %. CONCLUSION: Our study is one of the first studies evaluating the role of SI for discriminating malignant and benign nodules with AUS cytology. Malignant nodules had a significantly higher stiffness compared to benign ones and SI had high sensitivity, specificity, positive predictive value, negative predictive value and accuracy for these nodules. We think SI may be helpful for the presurgical selection of nodules with AUS cytology.

Hürthle cell presence alters the distribution and outcome of categories in the Bethesda system for reporting thyroid cytopathology.

OBJECTIVES: We aimed to determine whether the presence of Hürthle cells altered the distribution of categories in the Bethesda system for reporting thyroid cytopathology, or the expected neoplastic and malignant outcome. METHODS: Fine needle aspiration (FNA) cytology reports of Hürthle cells in a 2-year period were evaluated. The distribution of Bethesda system categories and the outcome at partial or complete thyroidectomy were compared for FNAs with and without Hürthle cells. RESULTS: Of 895 adequate FNAs with Hürthle cells, 764 (85.4%) were classified as benign, 86 (9.6%) as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 32 (3.6%) as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 12 (1.3%) as suspicious for malignancy (SFM) and one (0.1%) as malignant. Of 10 359 adequate FNAs without Hürthle cells, 9707 (93.7%) were classified as benign, 412 (4.0%) as AUS/FLUS, 77 (0.7%) as FN/SFN, 93 (0.9%) as SFM and 70 (0.7%) as malignant. The distribution of categories in FNAs with and without Hürthle cells was significantly different (P < 0.001) as a result of a decrease in benign and an increase in AUS/FLUS and FN/SFN categories. Among 128 patients with and 582 without Hürthle cells undergoing surgery, the overall neoplastic and malignancy rates were higher in the former than in the latter group (27.3% versus 14.9%, P < 0.001; 21.1% versus 11.7%, P = 0.003; respectively). Although neoplastic and malignant rates were higher in the group with than without Hürthle cells in all categories, the differences were only significant for a neoplastic outcome of benign cytology (15.1% versus 6.0%, P = 0.0013) and a malignant outcome of FN/SFN cytology (63.6% versus 21.9%, P = 0.0108). CONCLUSIONS: We found that the rates of AUS/FLUS and FN/SFN categories in the Bethesda system were higher when Hürthle cells were present. After surgery, neoplastic and malignant outcomes were significantly higher in the Hürthle cell group.

Follow-up of atypia and follicular lesions of undetermined significance in thyroid fine needle aspiration cytology.

OBJECTIVE: To report our experience of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) rate and outcome. METHODS: Among 7658 patients with 19 569 nodules, 524 (2.7%) nodules were diagnosed as AUS/FLUS on fine needle aspiration (FNA). After exclusion of patients with simultaneous nodules that were suspicious for follicular neoplasm or malignancy or that were malignant, 368 (4.8%) patients were diagnosed as AUS/FLUS. The outcome of 146 patients who had undergone surgery or repeated fine needle aspirate at the time of preparation of this study was evaluated. The original FNAs were matched to repeated FNAs and thyroidectomy or diagnostic lobectomy specimens. RESULTS: Seventy-two (19.6%) of the 368 patients had directly undergone surgery, either a lobectomy or a thyroidectomy: of these, 27 (37.5%) had neoplastic nodules (21 were malignant). Seventy-four (20.1%) of the 368 patients had repeat FNA. On second FNA, 47 of 74 (63.5%) were benign, three were suspicious for follicular neoplasm, one was malignant and 23 (31.1%) were non-diagnostic. Four patients had a third FNA: two were AUS/FLUS, one was malignant and one non-diagnostic. One patient had a fourth FNA, which was diagnosed as AUS/FLUS. Sixteen (21.6%) of 74 patients with repeat FNA had surgery: three of these had neoplastic nodules (two were malignant). Overall, 88 of the 368 (23.9%) patients had a thyroidectomy of which 30 (34.1%) were neoplastic and 23 (26.1%) malignant. The neoplastic rate for patients who were once diagnosed with AUS/FLUS was 8.2% and the malignancy rate 6.3%. The malignancy rate for patients on follow-up at the time we prepared the study was 15.7% (23/146); 222 remained on follow-up without surgery or repeat FNA or were managed elsewhere. CONCLUSIONS: Although in this category repeat FNA is expected rather than excision, we suggest evaluation of all AUS/FLUS patients in multidisciplinary meetings to decide management and recommend follow-up of all patients with this diagnosis.

Association of polymorphisms in the IL-18 and IL-12 genes with susceptibility to Type 1 diabetes in Turkish patients.

BACKGROUND: Recent studies have indicated that polymorphisms of the interleukin-18 (IL-18) and interleukin- 12 (IL-12) genes are associated with the development of Type 1 diabetes mellitus (T1DM) in some populations, but not all. AIM: The present study was designed to examine the roles of polymorphisms in the IL-18 promoter and IL-12p40 with respect to susceptibility to T1DM in Turkish patients. SUBJECTS AND METHODS: Ninety-one patients with T1DM and 87 unrelated healthy subjects were included in the study. The IL-18 polymorphisms at positions -607 and -137 were detected by a sequence-specific PCR method. The single nucleotide polymorphism in the IL-12p40 3' untranslated region (3'-UTR) at position +1188 was analyzed by the PCR-restriction fragment length polymorphism (RFPL) method. RESULTS: The allelic and genotypic frequencies of the IL-18 and IL-12p40 polymorphisms did not differ significantly between subjects with T1DM and the controls (p>0.05). However, diabetic patients with the -137 (CC) genotype showed a younger onset age compared to patients with the -137 (GG) genotype (p=0.02). In addition, patients with the -607 (CC) genotype had higher levels of glycated hemoglobin (HbA1c) than patients with the -607 (AC) genotype (p=0.004). Furthermore, patients with the IL-12p40 (AC) genotype had higher HbA(1c) levels than patients with the IL-12p40 (AA) genotype (p=0.01). CONCLUSIONS: The results of the present study show that the IL- 18 and IL-12p40 polymorphisms may have some effect on the onset age and deterioration of glycemic control in Turkish patients with T1DM.

Plasma visfatin concentrations in subjects with type 1 diabetes mellitus.

BACKGROUND/AIMS: Visfatin is a recently discovered adipokine, and its circulating concentrations have not been adequately studied in type 1 diabetes mellitus (DM). Therefore, this study was designed to examine plasma visfatin levels in type 1 diabetic patients and to determine the relationships between visfatin and duration of diabetes, body mass index, glycemic control, insulin dosage and lipid profile. METHODS: Forty-eight patients with type 1 DM and 26 healthy controls were investigated. RESULTS: Type 1 diabetic patients had significantly low visfatin levels compared with controls (18.8 +/- 1.7 vs. 20.2 +/- 0.3 ng/ml; p < 0.0001). Visfatin levels were comparable between patients with a short duration of diabetes (<10 years) and patients with a long duration of diabetes (>or=10 years) (18.9 +/- 1.7 vs. 18.2 +/- 2.0 ng/ml; p > 0.05). There was a significant correlation between visfatin and hemoglobin A1c (HbA1c) even after the adjustment for age, sex, body mass index and duration of diabetes (r = -0.48, p = 0.005) in the patient group. Multivariate analysis showed that significant determinants of visfatin concentrations were HbA1c and duration of diabetes (r(2) = 0.27). CONCLUSION: These data emphasize that plasma visfatin concentrations are lower in patients with type 1 DM and related to glycemic control reflected by HbA1c.

Assessment of left ventricular functions by tissue Doppler echocardiography in patients with Cushing's disease.

OBJECTIVE: To verify whether tissue Doppler imaging (TDI) could contribute to a better understanding of the natural history of cardiomyopathy in active Cushing's disease (CD), through its enhanced sensitivity to diastolic dysfunction, and identifying preliminary regional signs of systolic dysfunction before the appearance of clinical symptoms of cardiac pathologies. METHODS: Eleven women with newly diagnosed CD and 32 control cases, purposely matched for gender, age, body mass index and co-incidental diseases were enrolled in this study. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S'm), early diastolic myocardial peak velocity (E'm), late diastolic myocardial peak velocity (A'm), isovolumic acceleration (IVA), myocardial pre-contraction time (PCT'm), myocardial contraction time (CT'm) and myocardial relaxation time (RT'm) were measured at septal and lateral mitral anulus. RESULTS: In TDI, E'm and, E'm/A'm ratio were significantly lower, and PCT'm/CT'm ratio was higher, S'm, A'm, peak early diastole/E'm ratio, PCT'm, and isovolumetric myocardial relaxation time values were similar at lateral and septal anulus in patients with CD than controls (p>0.05). Lateral and septal anulus IVA were significantly lower in patients with CD than the control group (p<0.05). Correlation analysis showed that IVA time at lateral anulus correlated positively with S'm at lateral anulus (r=0.58; p=0.002) and IVA time at septal anulus correlated positively with S'm at septal anulus (r=0.51; p=0.008). CONCLUSION: Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDI. We recommend using TDI in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with Cushing' syndrome.

Calpain 10 gene single-nucleotide 44 polymorphism may have an influence on clinical and metabolic features in patients with polycystic ovary syndrome.

AIM: This study was designed in order to examine the relationship between Calpain 10 [single-nucleotide polymorphism (SNP) 19,43,44,63] gene polymorphisms and clinical and hormonal characteristics in women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: One hundred and seven patients with PCOS and 114 healthy subjects were included in this study. Serum levels of sex steroids were measured for each individual. Insulin resistance (IR) was evaluated by the homeostasis model assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI) methods. Insulin and glucose responses to the oral glucose tolerance test (OGTT) were analyzed by calculating the areas under the curve for insulin (AUCI) and glucose by the trapezoidal methods.We used PCR and restriction fragment length polymorphism technique to examine Calpain 10 SNP 19, 43, 44, and 63 polymorphisms. RESULTS: Allele distribution of Calpain 10 SNP 44 gene polymorphism was observed as significantly different between the groups. Calpain 10 SNP 44 TC genotype was found to be increased in PCOS subjects (69.15%) compared to the control subjects (50%). However, when compared to control subjects, patients with PCOS had similar Calpain 10 SNP 19, Calpain 10 SNP 43, and SNP 63 gene polymorphisms. When compared with normal Calpain 10 gene SNP 44 allele in PCOS subjects, subjects with PCOS having Calpain 10 gene SNP 44 allele polymorphism had higher free testosterone, androstenedione, DHEA-S, and fasting insulin levels. Also, PCOS women with Calpain 10 gene SNP 44 allele polymorphism had high Ferriman-Gallwey (F-G) score, acne, prevalence of menstrual disturbances, waist-hip ratio, HOMA-IR, AUCI levels and low QUICKI levels. CONCLUSION: The findings show that Calpain 10 gene SNP 44 allele polymorphism may have a role in PCOS pathogenesis. However, larger-scale studies are needed in this field.

The importance of nasal provocation test in the diagnosis of natural rubber latex allergy.

BACKGROUND: Most studies regarding natural rubber latex (NRL) allergy have concentrated on the prevalence using skin prick test (SPT) and specific IgE assay. The objective of this study is to examine the target organ (skin, nasal mucosa) responses in patients with positive SPT to NRL using the nasal provocation test (NPT) and glove use test (GUT). METHODS: Four thousand four hundred and twenty patients presented to our polyclinic between July 2003 and January 2007 were evaluated. One thousand six hundred and ninety-nine patients had positive SPT to one or more allergens (NRL and other inhaler allergens). Twenty-nine patients with positive SPT to NRL comprised the NRL sensitive group (group 1). Thirty-five randomized patients with positive SPT to an inhaler allergen other than NRL and negative NRL-specific IgE comprised atopic control group (group 2). Thirty healthy individuals who had no allergic diseases and had negative SPT and NRL-specific IgE comprised the healthy control group (group 3). RESULTS: The lowest NRL allergen concentration leading to NPT positiveness was 0.05 microg/mL. NPT was negative in groups 2 and 3. NPT was found to have a sensitivity of 96%, specificity of 100%, negative predictive value of 98% and positive predictive value of 100%. GUT was found to have a sensitivity of 81%, specificity of 90%, negative predictive value of 75% and positive predictive value of 93%. CONCLUSIONS: Nasal provocation test was successfully used for the first time in the diagnosis of NRL allergy. NPT is a more sensitive method as compared to GUT.

Food allergy due to olive.

We report the case of a 28-year-old man who presented palatal itching and genaralized urticaria following ingestion of olive 3 years after being diagnosed with olive pollinosis. The patient did not have a history of food allergy or urticaria. The results of skin prick tests with aeroallergens including latex were positive for house dust mite and olive pollen. The results of prick tests and prick-to-prick tests for olive fruit were positive, as were those of specific immunoglobulin E tests to olive pollen and fruit. The results of prick tests to peach, pear, kiwi, melon, and nut were negative. Nasal provocation with olive pollen gave positive results. An open oral provocation test with olive oil did not cause symptoms. This case is unique in that the patient developed olive fruit allergy in the presence of olive pollinosis, and he did not experience allergic symptoms to fruits other than olive, thus enabling us to define a new pollen-food (olive-olive) syndrome.

Thyroid carcinoma risk in patients with hyperthyroidism and role of preoperative cytology in diagnosis.

AIM: The aim of this study was to determine the frequency of thyroid carcinoma in patients with hyperthyroidism and evaluate the role of preoperative ultrasonography (US) guided thyroid fine needle aspiration biopsy (FNAB) in diagnosis of thyroid carcinoma in these patients. METHODS: Three hundred twenty-five hyperthyroid patients--119 with toxic multinodular goiter (TMNG), 47 with autonomous functioning toxic nodule (AFTN) and 159 with Graves Disease (GD)--were included in this study. All patients were evaluated with US and in all patients with nodules, US guided FNAB was carried out. RESULTS: Among 159 patients with GD, 62 were without nodules. Totally, 583 nodules in 263 patients were sampled by FNAB. Cytologic results of nodules were as follows: 87.7% benign, 6.2% inadequate, 4.3% suspicious and 1.9% malignant. Postoperatively, 42 (12.9%) patients were diagnosed as thyroid carcinoma histopathologically. Thyroid carcinoma was detected postoperatively in all patients with malignant cytology, in 47.8% of patients with suspicious cytology and in 44.4% of patients with inadequate cytology. Moreover, in 13 patients with benign cytology and in 3 Graves patients without any nodule ultrasonographically, incidental thyroid carcinoma was found (5.7%). Consequently, thyroid malignancy rates were 16% in TMNG, 6.4% in AFTN and 12.6% in GD. CONCLUSION: Thyroid carcinoma is common in hyperthyroidism and FNAB is a reliable method in diagnosis of thyroid malignancy in these patients. Additionally, incidental thyroid carcinoma prevalence is also high in patients with hyperthyroidism. We suggest that it is reasonable to evaluate nodules with FNAB in hyperthyroid patients prior to radioactive iodine treatment or surgical intervention.