Performance of glucose dehydrogenase (GDH) based and glucose oxidase (GOX) based blood glucose meter systems at moderately high altitude.

OBJECTIVE: Self-monitoring of blood glucose (SMBG) is a fairly efficient method of preventing hypoglycaemia in diabetic patients. Blood glucose meters (BGMs) are influenced by factors such as altitude, temperature, blood oxygen concentration, low atmospheric pressure or humidity. In this study we aimed at evaluating the performance of glucose dehydrogenase (GDH) or glucose oxidase (GOX) based glucometers at moderately high altitude. METHOD: A total of 286 female or male patients, most of whom had type 2 diabetes, were included in this study. The simultaneous readings made by two different glucometers were compared with the readings made at the reference laboratory. RESULTS: Blood glucose levels measured by a GDH based glucometer at moderately high altitude were significantly (p=0.007) higher compared to those measured at the reference laboratory. Although blood glucose levels measured by a GOX based glucometer were lower compared to those measured at the reference laboratory, the difference was not significant (p=0.54). The difference between GOX and GDH readings with regard to blood glucose levels was also significant (p=0.001). Blood glucometers were influenced by moderately high altitude. CONCLUSION: The use of a GOX based glucometer at moderately high altitude may be useful in detecting hypoglycaemia at these conditions, since significantly higher blood glucose levels were measured with a GDH based glucometer compared to reference readings.

The effect of short-term treatment with atorvastatin on E-selectin levels in severely burned patients.

Cellular adhesion molecules are expressed by activated endothelial cells in severe bum. The release of these molecules can lead to organ damage. We measured E-selectin levels in the blood of 20 severe-burn patients. Then the patients were divided into two groups of 10 patients each. In the study group, atorvastatin 20 mg/day was administered orally for 14 days. In the control group, an equal volume of placebo was administered orally for 14 days. In both groups, following the last dose of the agents, serum E-selectin levels were measured again. Mean burn size and the percentage of third-degree bums of total burned area were not significantly different between the groups. Serum E-selectin level obtained at the beginning of the treatment was 23.69 +/- 2.71 ng/ml in the atorvastatin group and 18.08 +/- 0.97 ng/ml in the control group. Serum E-selectin level obtained at the end of the treatment was 10.86 +/- 1.36 ng/ml in the atorvastatin group and 21.69 +/- 2.11 ng/ml in the control group. The difference between the two groups was statistically significant (p < 0.05). In the comparison of early and late serum E-selectin levels in the atorvastatin group, a significant decrease was obtained (p < 0.05). In the control group, serum E-selectin levels were found to be increased in the late period. However, the difference between the early and late values was nonsignificant (p > 0.05). We concluded that atorvastatin is effective in the prevention of E-selectin release in severely burned patients.

Relationship between electroneurographic changes and serum ubiquitin levels in patients with type 2 diabetes.

OBJECTIVE: The aim of the present study was to investigate any relationship between serum ubiquitin levels and electroneurographic changes in peripheral nerves for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: The study involved 34 patients (19 men, 15 women; mean age 46 +/- 13 years) with type 2 diabetes. Serum ubiquitin values were measured by sandwich enzyme-linked immunosorbent assay Measurement of nerve conduction velocity (NCV) was performed on three motor (median, tibial, and peroneal) and three sensory (median, ulnar, and sural) nerves. The value of motor compound muscle action potential (CMAP) was obtained from the sum of median, tibial, and peroneal motor nerve amplitudes, and sensory compound nerve action potential (CNAP) was computed as the sum of median and ulnar sensory nerve amplitudes. RESULTS: Patients with diabetes were divided into three groups: group 1 (n = 8) had normal electroneurography results, group 2 (n = 8) had slowed NCV, and group 3 (n = 18) had low values of motor CMAP and/or sensory CNAP as well as slowed NCV. Mean ubiquitin level in group 3 (20.4 +/- 2.9 ng/dl) was significantly higher than that in group 1 (11.2 +/- 1.1 ng/dl, t = 11.5, P < 0.0001) and group 2 (13.2 +/- 2.7 ng/dl, t = 5.9, P < 0.0001). Serum ubiquitin levels were inversely correlated with motor CMAP (r = -0.68) and sensory CNAP (r = -0.61) values. CONCLUSIONS: The results of this study indicate that there could be a relationship between the diminished amplitudes of axons of the peripheral nerve and the increase in serum ubiquitin levels in patients with type 2 diabetes. Further studies are required to confirm this relationship.

The effect of growth hormone on 24-h urinary creatinine levels in burned patients.

Catabolism is increased in burned patients. Creatinine excreted in urine is accepted as an indicator of catabolism of muscle mass. Growth hormone (GH) is one of the most potent anabolic agents. We investigated the effect of GH on 24-h urinary creatinine levels as an indicator of catabolism of muscle mass in burned patients. In 20 patients with severe burns, 24-h urinary creatinine levels were investigated for 3 days following hospitalisation. Then the patients were divided into two groups of 10. In the study group, following investigation of 24-h urinary creatinine levels for 3 days, GH 0.1 mg/kg was injected subcutaneously three times in a week. Following the last dose of GH, 24-h urinary creatinine levels were investigated for 3 days again. In the control group, an equal volume of isotonic saline solution was injected at the same times instead of GH, and 24-h urinary creatinine levels were investigated for 3 days again. Mean burn size and age were not significantly different between the groups. 24-h urinary creatinine level obtained in the early period was 48.5+/-16.6 mg/day in the study group and 49.9+/-11.3 mg/day in the control group. There was no statistical difference between these two values (p>0.5). 24-h average urinary creatinine level obtained in the late period was 36.6+/-16.4 mg/day in the study group and 50.6+/-9.9 mg/day in the control group, and the difference was statistically significant (p<0.05). In the comparison of early and late 24-h urinary creatinine levels in the study group, there was a statistically significant difference between these two values (p<0.05). In the control group, there was no difference between early and late 24-h urinary creatinine levels (p>0.5). We concluded that GH is effective in decreasing urinary creatinine excretion. This decrease in urinary creatinine excretion may be associated with diminished muscle catabolism.

Serum paraoxonase levels in pancreatic cancer.

BACKGROUND/AIMS: Serum paraoxonase (PON) is a calcium-dependent esterase that is known to contribute to the antioxidant protection conferred by high-density lipoprotein (HDL) on low-density lipoprotein (LDL) oxidation. Serum PON activity was shown to be reduced in patients with diseases such as myocardial infarction, diabetes mellitus, etc in comparison to healthy subjects. However, the relation of serum PON levels to cancer is still not known. So, we intended to measure serum PON, HDL, LDL and very low-density lipoprotein (VLDL) levels and to investigate the relation of serum PON to plasma lipoproteins in the patients with pancreatic cancer. METHODOLOGY: We measured serum PON, HDL, LDL, and VLDL levels in 20 patients with pancreatic cancer and in 20 age-and gender-matched healthy controls. We investigated the relationship between PON and HDL, PON and LDL, and PON and VLDL. RESULTS: Serum HDL levels were lower in the patients than in controls (40.21 +/- 13.82 mg/dL, and 47.30 +/- 6.65 mg/dL, respectively) (p<0.05). Serum LDL and VLDL levels measured in the patient group were not significantly different from those of the control group. Serum PON levels were lower in the patients than in controls (61.57 +/- 22.44 U/L, and 87.50 +/- 23.39 U/L, respectively) (p<0.005). There was a positive correlation between serum PON and HDL levels (r: 0.69, p<0.05). CONCLUSIONS: We concluded that the patients with pancreatic cancer had low PON and HDL levels compared to healthy controls. The importance of PON as a predictive risk factor for cancer should be assessed in future studies.

Serum paraoxonase levels in gastric cancer.

BACKGROUND/AIMS: Serum paraoxonase (PON) is a calcium-dependent esterase that is known to contribute to the antioxidant protection conferred by high-density lipoprotein (HDL) on low-density lipoprotein (LDL) oxidation. Serum PON activity was shown to be reduced in patients with diseases such as myocardial infarction, diabetes mellitus, etc in comparison to healthy subjects. However, the relation of serum PON levels to cancer is still not known. So, we intended to measure serum PON, HDL, LDL and very low-density lipoprotein (VLDL) levels and to investigate the relation of serum PON to plasma lipoproteins in the patients with gastric cancer. METHODOLOGY: We measured serum PON, HDL, LDL and VLDL levels in 20 patients with gastric cancer and in 20 age-and gender-matched healthy controls. We investigated the relationship between PON and HDL, PON and LDL, and PON and VLDL. RESULTS: Serum HDL levels were lower in the patients than in controls (33.10 +/- 7.75 mg/dL, and 47.30 +/- 6.65 mg/dL, respectively) (p<0.0001). Serum VLDL levels were lower in the patients than in controls (21.65 +/- 6.92 mg/dL, and 33.10 +/- 6.09 mg/dL, respectively) (p<0.0001). Serum LDL levels measured in the patients were not significantly different from those of the controls. Serum PON levels were lower in the patients than in controls (67.10 +/- 17.92 U/L, and 87.50 +/- 23.39 U/L, respectively) and there was a positive correlation between serum PON and HDL levels (r: 0.52, p<0.05). CONCLUSIONS: We concluded that the patients with gastric cancer had low serum PON, HDL, and VLDL levels compared to healthy controls. The importance of PON as a predictive risk factor for cancer should be assessed in future studies.

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.

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.

Addisonian crisis due to adrenal gland metastasis in Hodgkin's disease.

Adrenal insufficiency or Addison's disease is a rare illness associated with multiple pathology. We describe the case of a 61-year-old male with Hodgkin's disease and metastases in both adrenal glands who was diagnosed with adrenal insufficiency as a result of an acute addisonian crisis.

Assessment of thyroid nodules by technetium-99m-tetrofosmin scintigraphy.

Thyroid nodularity is a common finding. The incidence of thyroid cancer in the general population is estimated at 0.1%. Thyroid nodules are evaluated by palpation, ultrasonography, radionuclide scintigraphy and fine-needle aspiration cytology. Routine thyroid scintigraphy is made by using Tc-99m-pertechnetate or the I-131 and I-123 scintigraphic method. Tc-99m-tetrofosmin accumulates in the myocardium, skeletal muscle, liver, spleen breast tissue, kidney and normal and pathological thyroid tissue. We investigated 36 patients (28 females and 8 males) with solitary and/or multiple thyroid nodules. All the patients were euthyroid, and their thyroid nodules were diagnosed by palpation and ultrasound examination. Thyroid scintigraphy was applied by Tc-99m-pertechnetate, then thyroid fine-needle aspiration biopsy was performed. Finally, Tc-99m-tetrofosmin scintigraphy was carried out. Five patients (14.8%) had differential thyroid carcinoma, 23 (63.8%) had thyroid adenoma, 1 (0.02%) had Riedel's thyroiditis and 7 (19.4%) had follicular cyst. We detected 80% uptake in the early phase and 100% in the late phase by Tc-99m-tetrofosmin scintigraphy in the differentiated thyroid carcinoma group. In summary, we claim that Tc-99m-tetrofosmin may be an important scintigraphic method to identify thyroid malignancy from benign thyroid pathologies.

Spontaneous bilateral rupture of kidneys in a patient with polyarteritis nodosa. A case report.

A previously well 42-year-old man presented with a three-hour history of pain in the right flank of acute onset. At laparotomy he was found to have a ruptured right kidney which was treated by nephrectomy. Eight days later he developed similar symptoms on the left: at operation 21 of blood were drained and nephrostomy and catheterisation carried out. He recovered after a complicated postoperative course, and histological examination of the removed kidney, and biopsy specimens, showed classic polyarteritis nodosa. This is a rare cause of spontaneous rupture of the kidney but must be considered whenever a patient presents with renal haemorrhage of unknown cause.

Effect of nitric oxide synthase inhibitor on experimentally induced burn wounds.

BACKGROUND: Nitric oxide (NO) may have an important role in the healing of burn wounds. This study investigated the effect of NO on experimentally induced burn wounds by preventing NO synthesis. METHODS: A total of 40 mice weighing 25 to 30 g were used in this study. The shaved skin on the back of the mice was immersed in 100 degrees C water for 10 seconds to achieve a partial-thickness scald burn. The mice were divided into two groups of 20. In group I (control group), 17.5 mg/kg of serum physiologic (placebo) was injected intraperitoneally two times a day for 15 days. In group II (study group), 17.5 mg/kg of aminoguanidine (NO synthase inhibitor) was injected intraperitoneally two times a day for 15 days. On day 15 of the burn, the animals were killed and the burn areas were investigated histologically. Histologic changes such as epithelial proliferation, abscess, collagen, and granulation tissue were evaluated. RESULTS: Epithelial proliferation, formation of collagen, and granulation tissue with rich capillaries observed in the control group were statically significantly higher than those observed in the study group (z = -2.022, p < 0.05; z = -2.02, p < 0.05; and z = -2.022, p < 0.05; respectively). CONCLUSION: We concluded that healing of the burn wound is delayed by preventing NO synthesis.