Evaluation of ovarian reserves in women suffering from an autoimmune disease vitiligo.

OBJECTIVE: In this study, we aimed to investigate whether vitiligo, an autoimmune disease, affects the ovarian reserves of women suffering from this disease. PATIENTS AND METHODS: This case-control study included 27 vitiligo patients and 44 healthy participants with regular menstrual cycles. The total number of participants was 71. We conducted the study in a tertiary hospital between June 2022 and November 2022. We carried out the study after receiving the Ethics Committee Approval of the same institute, numbered KAEK/2022.04.88. Before the study, we obtained informed consent from all the participants included in our study. We complied with the Declaration of Helsinki at all stages of the study. We compared the study groups' demographic information, hormonal parameters, ovarian volumes, and antral follicle numbers. We performed an independent t-test to compare group means. We used SPSS for Windows 24.0 (IBM Corp., Armonk, NY, USA) for the analyses. We considered the p-value lower than 0.05 to be statistically significant. RESULTS: AMH values were 2.66±1.76 pmol/L in the control group and 1.61±0.86 pmol/L in the patient group. The total number of antral follicles was 10.25±2.13 (n) in the control group and 9.26±2.97 (n) in the study group. Ovarian volume was 11.57±1.37 ml in the control group and 10.63±1.96 ml in the study group. These results were statistically significantly different. We detected one premature ovarian failure (POI) in the study group. Although there was only one case, this difference between the groups was statistically significant. CONCLUSIONS: Our study has proven that the ovaries of women of reproductive age suffering from any disease with an autoimmune etiology are affected by this autoimmune process. Therefore, ovarian reserves should be evaluated in all fertile women with autoimmune diseases. Due to the evaluation, appropriate treatment and follow-up plans should be made in patients with infertility or premature ovarian failure (POF) risk.

Management of ectopic pregnancy in a tertiary hospital: a retrospective cohort study.

OBJECTIVE: The goal of this study was to manage the treatment modalities of ectopic pregnancy. PATIENTS AND METHODS: This retrospective study included 1,103 women diagnosed and treated for ectopic pregnancy at Kanuni Sultan Suleyman Training and Research Hospital between January 1, 2017, and December 31, 2020. Serial beta-human chorionic gonadotropin (ß-Hcg) measurements and transvaginal ultrasound (TV USG) findings were used to establish the diagnosis of an ectopic pregnancy. They were divided into four groups: expectant treatment, single-dose methotrexate, multidose methotrexate, and surgical treatment. All data analyses were performed using SPSS version 24.0. A receiver operating characteristic (ROC) analysis was used to determine the cut-off for change in beta-human chorionic gonadotropin (ß-hCG) levels between the first and fourth day. RESULTS: There were significant differences between groups in terms of gestational age and ß-hCG changes (p < 0.001). In patients receiving expectant treatment, the decrease in ß-hCG values on the fourth day was 35.19%, while patients receiving single-dose methotrexate treatment showed a decrease of 24%. The most common risk factor for ectopic pregnancy was the absence of risk factors. Comparison of the surgical treatment group with the other groups revealed significant differences in terms of the presence of free fluid in the abdomen, the average diameter of the ectopic pregnancy mass, and the presence of fetal cardiac activity. A single dose of methotrexate was effective in patients with ß-hCG levels lower than 1,227.5 mIU/ml, with a 68.5% sensitivity and 69.1% specificity. CONCLUSIONS: An increase in gestational age also leads to an increase in ß-hCG values and the diameter of the ectopic focus. As the diagnosis period progresses, the need for surgical intervention increases.

Diffusion restriction associated with bevacizumab treatment in recurrent glial tumors, evaluation of survival with ADC measurement analysis.

OBJECTIVE: Recurrent glial tumors treated with bevacizumab often develop diffusion restriction. In this study, we investigated the diffusion restriction pattern after bevacizumab treatment along with the relationship between apparent diffusion coefficient (ADC) values of regions with diffusion restriction and survival period as there are conflicting results on this relationship. PATIENTS AND METHODS: We retrospectively identified 24 patients treated with bevacizumab for recurrent glial tumor who had low ADC values after the onset of the treatment. Magnetic resonance imaging (MRI) findings were analyzed for the presence of restricted diffusion, time to onset, location, duration of restriction, and persistence of restriction after cessation of bevacizumab treatment. A retrospective study was performed to investigate the relationship between ADC values obtained at first post-bevacizumab scan and survival periods. RESULTS: Diffusion restriction appeared 2 to 6 months after the onset of bevacizumab therapy and persisted up to 24 months while on bevacizumab. The restricted diffusion persisted up to 6 months after cessation of bevacizumab. Our results showed that there is a negative correlation between ADC values and progression free survival as well as overall survival. Patients having diffusion restriction areas with lower ADC values after the initiation of bevacizumab treatment, are found to have increased overall and progression free survival (p<0.05). CONCLUSIONS: In patients with recurrent glial tumor treated with bevacizumab, diffusion restriction can be observed and the ADC values obtained from these areas at first post-bevacizumab MRI scan correlate with progression free and overall survival with the worst survival seen in patients with higher ADC values which therefore can be considered as an imaging marker that can predict the prognosis.

The effects of resveratrol and melatonin on cardiac dysfunction in diabetic elderly female rats.

We aimed to investigate the effects of melatonin and resveratrol on diabetes-related papillary muscle dysfunction and structural heart disorders. The protective effect of resveratrol and melatonin supplementation on cardiac functions was investigated in a diabetic elderly female rat model. 16-month-old rats (n=48) were allocated into 8 groups. Group1: Control, Group2: Resveratrol Control, Group3: Melatonin Control, Group4: Resveratrol and Melatonin Control, Group5: Diabetes, Group6: Diabetes Resveratrol, Group7: Diabetes Melatonin, Group8: Diabetes Resveratrol and Melatonin. Streptozotocin was injected intraperitoneally to the rats for experimental diabetes induction. Thereafter, resveratrol (intraperitoneal) and melatonin (subcutaneous) were administered for 4 weeks. Resveratrol and melatonin had a protective effect on the contractile parameters and structural properties of the papillary muscle, which was impaired by diabetes. it has been presented that diabetes impairs the contractile function of the papillary muscle for each stimulus frequency tested and the responses obtained as a result of Ca+2 uptake and release mechanisms from the Sarcoplasmic reticulum, and it has been observed that these effects are improved with resveratrol and melatonin injection. The decrease in myocardial papillary muscle strength in the diabetic elderly female rat can be reversed with the combination of resveratrol, melatonin and resveratrol+melatonin. Melatonin+resveratrol supplementation is no different from melatonin and/or resveratrol supplementation. Resveratrol and melatonin supplementation may have a protective effect on cardiac functions in a diabetic elderly female rat model.

Treatment of abnormal uterine bleeding using levonorgestrel-releasing intrauterine devices: experience from a Turkish tertiary hospital.

OBJECTIVE: We evaluated the efficacy of the levonorgestrel-releasing intrauterine device in treating menorrhagia using a pictorial blood assessment chart. PATIENTS AND METHODS: We retrospectively examined 822 patients treated with a levonorgestrel-releasing intrauterine device for abnormal uterine bleeding between January 1, 2017, and December 31, 2020, at a Turkish tertiary hospital. A pictorial blood assessment chart was used to determine each patient's blood loss amount, which involves the use of an objective scoring system to determine the amount of bleeding in towels, pads, or tampons. Descriptive statistical values were presented as mean and standard deviation, and paired sample t-tests were used for within-group comparisons of normally distributed parameters. Moreover, in the part of the descriptive statistical analysis, the mean and median values for the non-normally distributed tests were not close to each other, indicating that the data obtained and analyzed in this study had a non-normal distribution. RESULTS: Of 822 patients, 751 (91.4%) exhibited a significant reduction in menstrual bleeding after device insertion. Moreover, a significant decrease was observed in the pictorial blood assessment chart scores 6 months postoperatively (p < 0.05). CONCLUSIONS: This study revealed that the levonorgestrel-releasing intrauterine device is an easy-to-insert, safe, and effective treatment option for abnormal uterine bleeding (AUB). Furthermore, the pictorial blood assessment chart is a simple and reliable tool for evaluating menstrual blood loss in women before and after the insertion of levonorgestrel-releasing intrauterine devices.

The Effects of Proximal Fibular Osteotomy on the Knee and Ankle Joints: a Finite Element Analysis.

PURPOSE OF THE STUDY In this study, our aim is to examine the effect of proximal fibular osteotomy on knee and ankle kinematics with finite element analysis method. MATERIAL AND METHODS One 62-year-old, female volunteer's radiologic images were used for creating lower limb model. Osteotomized model (OM) which was created according to definition of PFO and non-osteotomized model (NOM) were created. To obtain a stress distribution comparison between the two models, 350 N of axial force was applied to the femoral heads of the models. RESULTS After PFO, the average contact pressure decreased 26.1% at the medial tibial cartilage and increased 42.4% at the lateral tibial cartilage. The Von Mises stresses decreased 57.1% at the femoral cartilage and decreased 79.1% at tibial cartilage. The stress on the tibial cartilage increased 44.6%, and stress on the talar cartilage increased 7.1% at the ankle joint. CONCLUSIONS FEA revealed that main loading at the knee joint shifted from medial tibial cartilage to the lateral tibial cartilage after PFO. Additionally, the stresses on each cartilage were redistributed across a wider and more peripheral area. FEA also demonstrated that the Von Mises stresses of the tibial and talar cartilages of the ankle joint increased after PFO. Key words: knee pain, osteoarthritis, osteotomy, finite element analysis, axial loadings.

GUse of provisional K wires instead of Poller screws for treatment of diametaphyseal fractures of the distal femur and proximal and distal tibia.

There are several important technical points that need to be observed when using an intramedullary nail to fix diametaphyseal fractures of femur and tibia. We aimed to describe a technique using 3.0-mm K wires, which act like Poller screws, in conjunction with intramedullary nails to obtain alignment of diametaphyseal fractures of the femur and tibia, and present our results. 7 distal femoral, 2 proximal tibial, and 4 distal tibial diametaphyseal fractures who were treated with this technique were identified. There was no case of nonunion at the last follow-up. In all, 12 of the 13 patients had postoperative fracture angulation that was less than 5° degrees in the coronal and sagittal planes. K wires function essentially as a Poller screw for centralization of the nail and help to ensure reduction. Locking the nail in different directions, appropriate reduction can be maintained until the bone heals and there is no need for additional fixation material.

Differentiation between endometrial carcinoma and atypical endometrial hyperplasia with transvaginal sonographic elastography.

PURPOSE: To assess the value of transvaginal sonographic elastography (TSE) in discriminating between endometrial hyperplasia and endometrial carcinoma. MATERIALS AND METHODS: A total of 61 women with post-menopausal hemorrhage and/or normal TSE were included. There were 32 women (mean age: 53.1±14.1 years) with endometrial hyperplasia, 14 women (mean age: 60.0±14.0 years) with endometrial carcinoma and 15 women (mean age: 51.9±7.8 years) with no endometrial disease who served as a control group. The strain index (SI) values obtained during TSE in each group were compared using Mann-Whitney U test and Kruskal-Wallis analysis of variance test. RESULTS: The mean SI values were 0.80 (range: 0.30-1.30) in the endometrial hyperplasia group, 1.80 (range: 0.80-3.20) in the endometrial carcinoma group and 1.00 (range: 0.50-4.00) in the control group. No significant differences were found between endometrial hyperplasia group and control group, but significant differences were found between endometrial carcinoma and hyperplasia groups and between endometrial carcinoma and control groups (P<0.0001). TSE had a sensitivity of 81.3%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 70% in differentiating endometrial carcinoma from endometrial hyperplasia. The area under ROC curve (AUC) to distinguish between endometrial carcinoma and endometrial hyperplasia was 0.933 (95% CI, 0.853-1.000) using a threshold SI value of 1.05. The AUC to distinguish between endometrial carcinoma and control was 0.881 (95% CI, 0.735-1.000) using a threshold SI value of 1.15. CONCLUSION: Our results indicate that TSE can provide important information that help discriminate between endometrial carcinoma and endometrial hyperplasia.

Serum irisin levels in patients with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is clinically heterogeneous endocrine disorders. Insulin resistance-related proteins play a role in the etiopathogenesis of PCOS. Irisin is a newly identified myokine which act like adipokines. Irisin has been shown to be associated with the insulin resistance and metabolic syndrome. The purpose of this study was to determine the serum levels of irisin in PCOS patients and evaluate the correlations with other metabolic and hormonal parameters. PATIENTS AND METHODS: Thirty-five PCOS patients and 35 matched healthy controls were enrolled to study. Serum irisin levels, anthropometric, hormonal and metabolic parameters including HOMA-IR were measured. Linear regression analysis was employed to study the relationship between irisin and hormonal and metabolic parameters. RESULTS: Serum irisin level in PCOS patients (mean value; 0.491±0.145 µg/mL) was significantly elevated when compared to control group (mean value 0.281±0.138 µg/mL) (p < 0.001). Linear regression analysis showed that serum irisin was positively associated with body mass index, luteinizing hormone, fasting insulin and total cholesterol in the overall patient population but not for PCOS group alone (p < 0.05). CONCLUSIONS: Serum irisin level of PCOS patients was high compared to that of healthy control subjects. In patients with PCOS, this situation may be due to insulin resistance, when there is leptin resistance or metabolic syndrome.

Endovenous laser ablation treatment with 980 nm diode laser for saphenous vein insufficiency: 6 months follow up results.

OBJECTIVE: Superficial venous insufficiency is a common problem associated with varicose veins which, if untreated, may progress to venous ulceration. Endovenous laser ablation (EVLA) is a new, minimally invasive method for management of superficial venous insufficiency and varicose veins. The aim of this study was to demonstrate the effectiveness of 980 nm EVLA for treatment of symptomatic saphenous venous insufficiency and to present its early outcomes. METHODS: Thirty-eight great saphenous veins and 5 small saphenous veins in 40 patients with saphenofemoral reflux were treated with 980 nm diode endovenous laser equipment. The diameter and length of the vein treated, total laser energy and energy density (Joules/cm) delivered were recorded. To determine the severity of the venous disease Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were used. Patients were followed up for 6 months after the procedure. Complications were recorded prospectively. RESULTS: Forty-three saphenous veins in 40 patients were treated. The mean age of the patients was 39.9 (range 21-72) years. The mean diameter and length of the veins were 4.9 mm (range, 3.5 to 8.5 mm) and 30.2 cm (range, 16 to 50 cm), respectively. At 6 months follow-up, total occlusion rate was 95.4% (41/43), and recanalization rate was 4.6%. Significant decrease was observed for VCSS and VAS scores after the procedure. No major complication was detected. CONCLUSION: EVLA treatment for superficial venous insufficiency is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates.

Paracetamol vs dexketoprofen for perineal pain relief after episiotomy or perineal tear.

A randomised controlled trial was conducted to investigate efficacy of paracetamol and dexketoprofen trometamol for perineal pain relief after perineal repair. Subjects were randomly assigned to receive two doses of either 50 mg of intravenous dexketoprofen trometamol via slow i.v. infusion (Group I, n = 49) or 1,000 mg of paracetamol via intravenous infusion (Group II, n = 46). The main outcome measure was a VAS (visual analogue scale) for pain recorded at 1 h (VAS 1). A total of 82 patients were included in the final analysis (Group I, n = 41; Group II, n = 41). There was no difference among groups in terms of pain scores at the beginning (VAS 0). The pain was decreased in 70% of the patients in Group I and in 62% of the patients in Group II (p = 0.502). Both paracetamol and dexketoprofen are effective in perineal pain relief after episiotomy or perineal tear repair.

Bilateral internal laryngoceles mimicking asthma.

Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients.

Endocrine therapy alone vs. chemotherapy plus endocrine therapies for the treatment of elderly patients with endocrine-responsive and node positive breast cancer: a retrospective analysis of a multicenter study (Anatolian Society of Medical Oncology).

PURPOSE: The extra benefit of adding chemotherapy to effective endocrine therapy (ET) has not been clearly or consistently identified in patients older than 70 years with estrogen receptor (ER) positive and node positive breast cancer. The aim of this study was to evaluate the efficacy of adjuvant ET vs. chemotherapy plus endocrine therapies (Chemo/ET) in such patients. METHODS: In this retrospective multicenter study 191 patients ≥ 70 years with operated hormone receptor breast cancer, who were administered adjuvant ET or Chemo/ET were assessed. RESULTS: The median patient follow-up time was 29.0 months (range 1-252). Therefore disease free survival (DFS) and overall survival (OS) analysis was limited, due to the rather short median follow-up, and only 30-month cumulative percentages are reported herein. The 30-month DFS rates were 50.0% in the ET arm and 49.0% in the Chemo/ET arm (p=0.79). The 30-month OS rates were 86% in the ET arm and 96.0% in the Chemo/ET arm (p=0.08). Cox proportional hazard model showed that only surgery was independent prognostic factor for survival (p=0.047), while tumor size showed a strong trend for statistical significance (p=0.051). CONCLUSION: The addition of chemotherapy to endocrine therapy in older patients has no significant impact on DFS and OS.

Conservative treatment of arterial pseudoaneurism in patients with behcet disease.

Behcet's Disease (BD) is a rare disease, of unknown origin that generally causes an inflammation in the subcutaneous tissue, eyes and brain vessels, and related with the immune system, predominantly seen in male patients and the mean age at onset is mainly in the third decade. The aim of the study was to present our experiences with the cases of arterial pseudoaneurysms that we treated conservatively without surgical or radiological intervention. Eleven patients with Behcet's disease who developed arterial pseudoaneuryms and responsed to the medical treatment are included in the study. The operation requirement, the complication rates, and factors that influence morbidity and mortality are evaluated. The mean age of the patients was 29,5 (18-35) years. Nine of the patients were male and 2 were female. The mean period of hospitalization was 18 (11-34) days. Six patients redeveloped aneurysm during their follow-up. Three of these patients were treated with surgery. Five patients had no complication during an average of 20 months of follow-up period. Arterial pseudoaneurysm is a rare complication of Behcet's disease. Despite the good response to conservative treatment at the beginning period, the patients should be closely followed up and redevelopment of the aneurysm should be kept in mind.

The role of diffusion-weighted MR imaging and ADC values in the diagnosis of gastric tumors.

BACKGROUND: The aim of this study was to investigate the role of diffusion-weighted MR imaging (DWI) in the diagnosis of gastric tumors by means of measuring the apparent diffusion coefficient (ADC) values of these lesions, and making a comparison with the endoscopic biopsy results. SUBJECTS AND METHODS: Seventy patients having gastric tumor constituted the case group. For the control group 30 healthy individuals were included. Abdominal MRI examinations were performed with a 1,5 Tesla unit. DWI examinations were obtained by single shot spin echoplanar imaging. The ADC was measured based on the tissue of the gastric tumoral entities and normal gastric mucosa in the control group. RESULTS: Mean ADC values were 0,84 +/- 0,17 x 10(-3) mm2/s and 1,79 +/- 0,08 x 10 mm2/s in gastric tumor group and in control group, respectively, being statistically significant (p<0.05).There was no significance among ADC values of adenocarcinoma subgroups. The comparison of the ADC values in the adenocarcinoma and lymphoma cases were also found to be statistically significant. CONCLUSIONS: DWI is beneficial in the diagnosis of malignant gastric lesions by the aid of ADC measurements. Although ADC quantification seems to be invaluable in the evaluation of histopathologic subgroups of adenocarcinoma, it can help in the diagnosis of gastric lymphoma.

Secondary hemophagocytosis in 3 patients with organic acidemia involving propionate metabolism.

Hemophagocytic lymphohistiocytosis (HLH) may develop secondary to infections, malignancies, immune deficiency syndromes, and rheumatologic and metabolic disorders. Associations between HLH and inborn errors of metabolism, including lysinuric protein intolerance, multiple sulfatase deficiency, galactosemia, Gaucher disease, Pearson syndrome, and galactosialidosis, have previously been reported in the literature. In this report the authors present 3 children with disorders of propionate metabolism--1 with methylmalonic acidemia and 2 with propionic acidemia--who developed secondary HLH during their metabolic attacks. All patients fulfilled the 5 HLH criteria of the Histiocyte Society. Familial HLH was ruled out by molecular analysis. Plasma exchange was performed for 2 of them. Unfortunately 1 died of multiorgan failure despite intensive therapy. This is the first report of such an association.

Vacuum assisted closure improves the quality of life in patients with diabetic foot.

BACKGROUND: Diabetes Mellitus (DM) is the most common endocrine disease worldwide. One of the most important chronic complications of this disease is the development of diabetic foot. The management of diabetic foot wounds is quite important with respect to public health. AIMS: To determine the effect of Vacuum Assisted Closure (VAC) therapy on the quality of life in the treatment of diabetic foot ulcers and compare it with standart wound care. METHODS: Between May 2007 to December 2008, 67 consecutive patients with diabetic foot ulcers were randomly assigned to VAC therapy (Group 1, n : 30) or standart wound care (Group 2, n : 37). The SF-36 questionnaire was administered the day before and in the month following wound healing. Global analyses of the 8 domains and 2 comprehensive indexes of SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) were performed. Clinical measures included standard antidiabetic treatment, daily wound care including antiseptic bath, debridement, toe removal for gangrene when necessary, and wound care with conventional methods or VAC. Healing time was calculated as the time from hospital admission to the time of re-epithelization. RESULTS: There were no differences in the mean age, ulcer size and pulse status of the patients in both groups. Healing time in the VAC group was significantly reduced (p < 0.05). All 8 domains of SF-36 and MCS and PCS scores improved remarkably after VAC therapy. CONCLUSION: Vacuum Assisted Closure therapy was found to be effective in the treatment of chronic diabetic ulcers. The improvement of quality of life demonstrates a clear-cut indication in this particular group of patients.

A retrospective analysis of women's chances to become pregnant after completion of chemotherapy: a single center experience.

PURPOSE: With the improvement in anticancer therapies, the survival of women with malignancies has increased and infertility may affect the quality of life of premenopausal women, who experience temporary or permanent amenorrhea due to chemotherapy. The aim of this study was to review the rate of pregnancies among women with malignancy previously treated with chemotherapy. METHODS: We retrospectively recorded 317 women younger than 40 years of age who were treated with chemotherapy (and a number of them with additional radiotherapy/RT) due to several malignancies between 2007-2010. The patients who got pregnant after stopping chemotherapy and during followup were analyzed. RESULTS: Among women with breast cancer (n=116), malignant lymphoma (n=85), ovarian cancer (n=26) and colon cancer (n=90), 20 got pregnant after a median 22.9 months (range 10.7-96.5) from the end of chemotherapy. Childbearing was uneventful and newborns were healthy. CONCLUSION: Women who had previously received chemotherapy for malignancy can get pregnant and deliver healthy newborns.

The involvement of distinct neural systems in patients with obsessive-compulsive disorder with autogenous and reactive obsessions.

OBJECTIVE: To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. METHOD: We assessed right anterior cingulate cortex (ACC) and amygdala-hippocampal region (Am + Hpp) N-acetyl-aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single-voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD-A), 15 patients with reactive obsessions (OCD-R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. RESULTS: Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD-A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD-A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. CONCLUSION: While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.

Preoperative parathyroid hormone levels are correlated with parathyroid adenoma volume and bone mineral density but not serum calcium levels.

AIM: The aim of this study was to determine the relationship between biochemical parameters, parathyroid adenoma volume, and bone mineral density with respect to intact parathyroid hormone (iPTH) levels in patients with primary hyperparathyroidism. METHODS: Data were collected retrospectively from patients with primary hyperparathyroidism who were diagnosed and followed in our clinic between 2005 and 2008. Forty-eight (female/male=42/6) patients with a mean age of 52.8±13.1 years were enrolled into the study. RESULTS: Bone pain was the most common presenting feature, seen in 41.7% of patients, while 29.1% of patients were asymptomatic. The mean serum calcium and iPTH concentrations were 2.9±0.6 mmol/L and 657.1±682 ng/L, respectively. The mean total Z/T scores of dual-energy X-ray absorptiometry (DEXA) scan at the femur and lumbar spine were -0.4±1.6/-1.0±1.7 and -1.4±1.6/-2.2±1.5, respectively. Preoperative iPTH levels were correlated with serum phosphate (r=-0.412, P=0.005), alkaline phosphatase (r=0.698, P=0.0001), and femur (r=-0.402, P=0.020) and lumbar spine total Z scores (r=-0.441, P=0.013), whereas parathyroid adenoma volume was correlated with iPTH (r=0.367, P=0.036) and alkaline phosphatase (r=0.570, P=0.001). There was no correlation between iPTH, serum calcium levels and total T scores at the femur and lumbar spine. After excluding patients with 25-OHD insufficiency, there was still no correlation between serum iPTH and calcium levels. Parathyroid adenoma volume, serum iPTH and calcium levels were also not different between patients with and without 25-OHD insufficiency. CONCLUSION: These results suggest that serum iPTH level may be useful in predicting parathyroid adenoma volume and it is also well correlated with femur and lumbar spine Z scores.