Royal jelly protection on flunixin meglumine-induced spermiotoxicity and testicular degeneration in mice.

Current study was designed to investigate the protective effects of royal jelly on Flunixin me- glumine (FM)-induced spermiotoxicity related to sperm concentration, abnormal spermatozoa count and histopathological changes in mice testis. The subjects were divided into five groups according to FM and/or royal jelly intake: Control group; group 1, FM alone (25 mg/kg, im); group 2, combination of FM (25 mg/kg, im) and royal jelly (200 mg/kg, oral); group 3, FM alone (50 mg/kg, im); and group 4, combination of FM (50 mg/kg, im) and royal jelly (200 mg/kg, oral). The animals were fed once daily for 15 days and they were sacrificed last day. Epididymal sperm concentration and abnormal spermatozoa count were noted. Testicular histological findings were evaluated. On purpose, organization of each animal was graded according to Johnsen's scoring to assess the spermatogenesis relying on seminiferous tubule cross-section scores. Comparing to controls, FM administration caused a decrease in sperm concentration (p⟨0.05), an increase in total abnormal spermatozoa rates (p⟨0.05) and more degenerative changes in testes in mice. Royal jelly supplementation ameliorated both sperm concentration and abnormal spermato- zoa (p⟨0.05) comparing to the control group. In conclusion, we suggested that royal jelly might have protective effects in the FM-induced reductions in epididymal sperm concentration and in- crease in abnormal spermatozoa rate.

Utility of baseline serum phosphorus levels for predicting remission in acromegaly patients.

PURPOSE: High GH and IGF I levels increase tubular phosphate reabsorption in patients with acromegaly. We aimed to investigate the utility of serum phosphorus levels as an indicator for predicting chance of remission in acromegaly patients. DESIGN: Fifty-one patients (n: 51; F: 24, M: 27) with diagnosis of acromegaly were included in the study. Plasma IGF-1, Phosphorus (P) and nadir GH levels on oral glucose tolerance test (OGTT) at the time of diagnosis were analysed retrospectively. Patients were classified into two groups according to their plasma P levels; P ≤ 4.5 mg/dl (Group-1, n: 23, 45.1%), P > 4.5 mg/dl (Group-2, n: 28, 54.9%). Two groups were compared according to remission status; remission (n: 27) and non-remission (n: 24). Remission was defined with absence of clinical symptoms, normal plasma IGF-1 (adjusted for age and gender) and GH levels (<1 mcg/dl) at least 3 months after initial treatment. RESULTS: Serum P levels decreased significantly after treatment in both groups (p < 0.001). There was a significant correlation between baseline phosphorus levels and remission rates, nadir GH in OGTT, pituitary adenoma size and Ki-67 scores (p = 0.001, r: -0.51; p = 0.01, r: 0.44; p = 0.001, r: 0.52; p = 0.02, r: 0.71, respectively). Mean baseline P levels were significantly higher in patients with non-remission (4.8 vs 4.2, P < 0.001). Logistic regression analysis did not reveal an independent effect on remission with any of these risk factors. CONCLUSION: High serum P levels may be an indicator for a low likelihood of onset of remission in acromegaly patients. Further studies with wider spectrum are needed to make specific suggestions.

Effects of melatonin on testis histology, oxidative stress and spermatogenesis after experimental testis ischemia-reperfusion in rats.

BACKGROUND: Testicular torsion due to oxidative stress results in infertility and testicular damage which can be preventable an important health problem worldwide. AIM: The purpose of the present study was to investigate the changes of malondialdehyde (MDA), total antioxidant status (TAS), total oxidant status (TOS) levels; histopathological alterations; morphology, concentration and motilities of the sperm in post ischemic reperfused (I/R) testis tissue. MATERIALS AND METHODS: Forty adult male Wistar rats were carried out and were randomized to five groups; (1) Control group, (2) Ipsilateral left testis ischemia, (3) Melatonin plus ipsilateral left testis ischemia, (4) Contralateral right testis ischemia, 5. Melatonin plus contralateral right testis ischemia. After 1 h ischemia and 24 h perfusion; MDA, TAS and TOS levels were measured, histopathological alterations were determined using by Johnsen's score (JS) and sperm morphology, concentration, motility were examined. RESULTS: MDA, TAS and TOS levels of the testis tissue did not change in all groups (p > 0.05 for all). JS was decreased in I/R group and melatonin treatment reversed histopathological changes and increased JS both in ipsilateral and contralateral testis. Abnormal sperm rate significantly increased in I/R group and melatonin administration changed abnormal sperm rate to normal. CONCLUSIONS: As a result, the present study demonstrated that testicular damage occurs following I/R without an increase of MDA, TAS and TOS levels. Our results also suggested that melatonin is a potent antioxidant agent in preventing testicular I/R injury, as shown by increased JS and changed abnormal sperm rate.

Malignant phaeochromocytoma with cavoatrial extension: transcaval removal of tumor without cardiopulmonary bypass A case report.

Adrenal carcinoma is a rare tumor and with metastasis usually in lungs, lymph nodes, liver, and bones. However, intracaval invasion extending into the right atrium is very rare. The surgical approach to adrenal tumor extending into the vena cava is challenging. The optimal surgical approach of tumor with inferior vena cava extension depends on the level of vena cava involvement. This article reports a case of malignant pheochromocytoma extending into the cavoatrial junction in a young man.

Investigation of early atherosclerotic changes in acromegalic patients.

BACKGROUND: Functional and morphological changes of endothelium were risk factors for mortality attributed to atherosclerosis. Studies investigating early atherosclerotic alterations and the effect of the treatment of acromegaly on these alterations gave conflicting results. OBJECTIVE: Surrogate markers of early atherosclerotic changes, i.e. brachial artery flow-mediated dilation (FMD) and carotid artery intima-media-thickness (IMT) in active and inactive acromegalic patients were compared with control subjects matched to patients for age, sex and cardiovascular risk factors to find out the direct effects of growth hormone (GH)/insulin-like growth factor-1 excess. METHODS: In 14 active acromegalics and their 14 matched controls, 14 inactive acromegalics and their 14 matched controls, carotid artery IMT and FMD of brachial artery were measured. Inactive acromegalics were in remission for at least 1 year. RESULTS: Active acromegalics had higher IMT than matched controls and inactive acromegalics (0.85 +/- 0.20 mm, 0.64 +/- 1.77 mm, 0.66 +/- 0.20 mm respectively; p < 0.005, p < 0.05) and IMT of inactive acromegalics was not different from their matched controls (0.61 +/- 0.12 mm). FMD was significantly lower in active acromegalics than in matched controls and inactive acromegalics (2.910 +/- 2.00 mm, 6.5 +/- 2.81 mm, 5.68 +/- 2.9 mm respectively; p < 0.005, p < 0.05). FMD of inactive acromegalics was not significantly different from their matched controls (7.96 +/- 3.12 mm). A significant inverse relationship was found between GH and FMD in active acromegalics (r = -0.659, p = 0.010). CONCLUSION: In active acromegalics, early atherosclerotic changes are not only attributed to the high prevalence of risk factors, but also to the abnormal GH secretion itself.

Changes in Mesopotamian spiny eel, Mastacembelus mastacembelus (Bank & Solender in Russell, 1794) (Mastacembelidae) milt quality during a spawning period.

This study was carried out to determine the milt quality in male Mesopotamian spiny eel (Mastacembelus mastacembelus; Bank & Solender in Russell, 1794) during spawning season. Review was performed using 58 M. mastecembulus males captured from Atatürk Dam Lake in Turkey. Milt samples were collected and evaluated daily during sampling period. In collected milt, volume of milt, sperm motility percentage, the duration of forward motility, sperm concentration, milt production and milt pH were evaluated. On June 10, 2005, 72% of the males were spermiating, which increased to 100% in the middle of June and dropped to 72% by late June. Sperm motility percentage showed a significant improvement after beginning of spermiation (P<0.001). Sperm concentration changed significantly (P<0.001) in milt collected during sampling period. Duration of sperm motility increased significantly (P<0.001) from beginning (8.22 min) through end (37.33 min) of spermiation. Milt production was maximal on June 15th, decreasing from a mean value of 3.12-0.46 x 10(9)/ml. The high pH in milt was observed during the week of spermiation (P<0.001). In conclusion, the results show that season has a significant influence on semen quality in male M. mastecembulus corresponding to spawning season in hot arid. Milt of good quality was especially collected in the middle of June. Spawning season in this fish species was found to be short.

Clinical laboratory findings and results of therapy in 55 patients with Cushing's syndrome.

In this study, 55 patients with Cushing's syndrome (CS) (50 female, 5 male; mean age 34 +/- 12.3 yr) who attended our clinics between the years 1983 and 2000 were retrospectively evaluated for clinical and laboratory features and modalities and results of therapy, due to a few similar studies over the last ten years. Cushing's disease was diagnosed in 39 patients (71%), adrenal adenoma in 13 patients (23.6%) and adrenal carcinoma in 3 patients (5.5%). Centripedal obesity, moon face, hypertension, hirsutism and purplish stria were the most frequent findings. Loss of normal serum F circadian rhythm was found in all patients with CS. The overnight 1 mg oral dexamethasone suppression test and low-dose dexamethasone suppression test (LDDST) yielded 100% and 100% diagnostic sensitivity for CS, respectively. Sensitivity and specivity of the high-dose dexamethasone suppression test (HDDST) in distinguishing Cushing's disease was found to be 82% and 100%, respectively. All of the patients with adrenal CS were not suppressed with HDDST. Sellar CT and/or MRI accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (11%) of the 28 patients with Cushing's disease, treated by transsphenoidal adenomectomy. Recurrence was diagnosed 1.5, 3 and 6 yr after the operation in these 3 patients. One patient had residue tumor. In our case series, bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing's disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one of the patients with Cushing's disease. All of the patients with adrenal CS, the tumor was accurately localized with imaging methods before the operation. The appropriate operative procedure resulted in complete remission in patients with adrenal adenoma. Consequently, Cushing's disease was the most common form of CS. The overnight 1 mg oral DST and 24-h urine free F excretion (UFC) as screening tests, 2-day LDDST as diagnostic test and 2-day HDDST as differential diagnostic test were good studies. More successful outcomes have been achieved in treatment of Cushing's disease with the development of pituitary surgery in the recent years, as well as in our case series. Surgery is also curative for adrenal adenoma patients. Survival remains poor among carcinoma patients.

Changes in bone turnover on deoxypyridinoline levels in diabetic patients.

In this study, we evaluated bone turnover in 35 patients with non- insulin-dependent diabetes mellitus with no complications and in 35 healthy volunteers who formed the control group and whose ages matched those of the patients. We determined serum osteocalcin (OC) and total alkaline phosphatase levels as markers of bone formation, and urinary deoxypyridinoline (DPD) and urinary calcium levels as markers of bone resorption. Statistical comparison of the levels of these markers between sexes in diabetic and control groups revealed that the OC levels were significantly decreased in males and females in the diabetic group compared with those of the control group. No significant difference was observed for other markers. It was found that the OC levels of diabetic subjects were not affected by the type of therapy. No statistically significant difference was found in serum calcium, phosphorus and magnesium levels between the diabetic and the control groups. In our study, the finding that, in spite of the decrease in the OC levels in the diabetic group no difference was observed in DPD levels, was attributed to the fact that only the formation phase was affected in diabetes, while the resorption phase remained unaltered.

Relationship between adrenal cortex pathology in Cushing's syndrome and its response to the dexamethasone suppression test.

Cushing's syndrome is a severely disabling condition which can cause death if left untreated. Endogenous Cushing's syndrome can be ACTH-dependent or ACTH-independent. The ACTH-dependent type is more common and is usually caused by diffuse hyperplasia on the adrenal cortex. This study investigated the response to low- and high-dose dexamethasone suppression testing of 30 adrenalectomized patients with Cushing's syndrome, average age 37.3 +/- 9.7 years. Twenty-four (79.3%) patients were female, and six (20.7%) were male. Bilateral adrenalectomy was performed in 14 (48.2%) patients and unilateral adrenalectomy (nine and seven right adrenalectomy) in 16 (51.8%). Two of the bilateral adrenalectomies were applied via endoscopic surgical approach. In the histopathological evaluation, diffuse hyperplasia was diagnosed in 13 (44.8%) patients and nodular hyperplasia in eight (26.6%), three macronodular and five micronodular hyperplasia. Adrenal cell adenoma was diagnosed in nine (28.6%) patients. Classic dexamethasone suppression testing was performed on all patients. Plasma levels of cortisol were not significantly decreased after low-dose testing, but plasma levels of cortisol were significantly decreased after high-dose testing in the diffuse hyperplasia group. In summary, due to the pathological changes of the adrenal cortex, dexamethasone suppression testing can differentiate between the two types of Cushing's syndrome.

Pituitary macroadenoma in Addison's disease.

Long-standing primary failure of pituitary-dependent endocrine glands may lead to hyperplasia of the pituitary cells. These changes in the pituitary gland may be correlated with the severity and duration of target-endocrine gland insufficiency. Production of adrenocorticotrophic hormone by the pituitary tumour and modest hyperprolactinaemia may develop due to adrenocortical insufficiency, but production of prolactin by the pituitary tumour due to primary adrenal insufficiency is rare. A case study is presented, with primary adrenal insufficiency associated with hyperprolactinaemia and pituitary macroadenoma (most probably prolactinoma). Plasma levels of prolactin were found to decrease after glucocorticoid, mineralocorticoid and bromocriptine therapy.

Clinical and laboratory evaluation of 40 patients with Sheehan's syndrome.

Forty patients with typical obstetric history of Sheehan's syndrome were reviewed retrospectively. Together with baseline laboratory values, insulin hypoglycemia test was evaluated in 15 patients, thyrotropin-releasing hormone (TRH) in 27 and luteinizing hormone-releasing hormone (LH-RH) in 7 patients. Baseline hormone values suggested secondary hypothyroidism, hypogonadotropic hypogonadism and hypocortisolemia. According to the results of the anterior pituitary stimulation tests, one patient (6.6%) showed normal cortisol response and one patient (6.6%) showed normal growth hormone response to hypoglycemia. Nine patients (33.3%) who were clinically and biochemically hypothyroid demonstrated adequate TSH response to TRH. None of the patients showed normal prolactin response to TRH. Four out of seven amenorrheic patients (57.1%) had adequate follicle-stimulating hormone and/or LH responses to LH-RH. It has been concluded that isolated anterior pituitary hormone deficiencies may occur in patients with Sheehan's syndrome. Prolactin response to TRH seems the most sensitive screening test for detecting Sheehan's syndrome in patients with typical obstetric history.

Bromocriptine-induced cerebrospinal fluid fistula in patients with macroprolactinomas: report of three cases and a review of the literature.

Bromocriptine therapy for macroprolactinoma induced cerebrospinal fluid (CSF) rhinorrhea in three patients. The tumor had extended well beyond the sella turcica and caused bony erosion in all the cases. All three patients responded to bromocriptine therapy rapidly. CSF fistula occurred concomitantly with the reduction of tumor size and caused meningitis in two of the patients. Withdrawal of bromocriptine resulted in cessation of the leakage. One of the patients underwent transsphenoidal repair. Two patients refused surgery. This potentially lethal complication encountered in these three cases demonstrates the need for close supervision of macroprolactinoma patients with skull base erosion placed under bromocriptine therapy.

Human lymphocyte antigens (HLA) and Graves' disease in Turkey.

To evaluate the association of HLA types with Turkish patients with Graves' disease, HLA typing, clinical findings, and thyroid antibodies were correlated. The HLA types, clinical findings (ophthalmopathy and age at onset), and thyroid stimulating hormone (TSH) receptor (TRAb) and antithyroid microsomal antibodies (MAb) were analyzed. Seventy Turkish patients with Graves' disease and 306 control subjects were assessed. Serological HLA typing was performed in HLA A, B, C, DR, and DQ loci. There was a significantly increased prevalence of HLA B8, B49, DR3, DR4, and DR10 in Graves' disease. The association of Graves' disease with HLA DR3 was found to be less strong than previously described. The HLA DR4 antigen may contribute to the predisposition of Graves' disease in Turkey. The results suggest that HLA B7, B13, DR7, DQw2, and DQw3 may confer a protective effect for Graves' disease in Turkey. Patients carrying HLA B12, B18, and B44 haplotypes had a tendency to develop the disease at a later age. The difference from the other studies may be the result of the selection of the controls; in part, of the variability in serological typing reagents; and, also, of the rather weak HLA associations with the disease.