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This study aimed to evaluate the effects of physiotherapy methods combined with respiratory and relaxation exercises on patients with major depression. This randomized, controlled trial included 42 patients with a sedentary lifestyle, comprising 21 males and 21 females with a mean age of 37.78±11.67 years (range, 20-60 years). The experimental (n:22)and control groups (n:20) were evaluated using the Beck Depression and Anxiety Score, Visual Analog Score, Patient Health Questionnaire-15, Generalized Anxiety Disorder 7-Items, and Patient Health Questionnaire-9. In both the experimental group and control group, a statistically significant difference was found in all parameters over time, with greater improvements made in the experimental group than in the control group in all the parameters. A rehabilitation program combined with respiratory and relaxation exercises applied in addition to standard treatment, can obtain more successful outcomes in major depression treatment. [Med-Science 2020; 9(4.000): 837-43]

In today’s automation driven manufacturing environments, emerging technologies like cobots (collaborative robots) and augmented reality interfaces can help integrating humans into the production workflow to benefit from their adaptability and cognitive skills. In such settings, humans are expected to work with robots side by side and physically interact with them. However, the trade-off between stability and transparency is a core challenge in the presence of physical human robot interaction (pHRI). While stability is of utmost importance for safety, transparency is required for fully exploiting the precision and ability of robots in handling labor intensive tasks. In this work, we propose a new variable admittance controller based on fractional order control to handle this trade-off more effectively. We compared the performance of fractional order variable admittance controller with a classical admittance controller with fixed parameters as a baseline and an integer order variable admittance controller during a realistic drilling task. Our comparisons indicate that the proposed controller led to a more transparent interaction compared to the other controllers without sacrificing the stability. We also demonstrate a use case for an augmented reality (AR) headset which can augment human sensory capabilities for reaching a certain drilling depth otherwise not possible without changing the role of the robot as the decision maker.

In the near future, collaborative robots (cobots) are expected to play a vital role in the manufacturing and automation sectors. It is predicted that workers will work side by side in collaboration with cobots to surpass fully automated factories. In this regard, physical human-robot interaction (pHRI) aims to develop natural communication between the partners to bring speed, flexibility, and ergonomics to the execution of complex manufacturing tasks. One challenge in pHRI is to design an optimal interaction controller to balance the limitations introduced by the contradicting nature of transparency and stability requirements. In this paper, a general methodology to design an admittance controller for a pHRI system is developed by considering the stability and transparency objectives. In our approach, collaborative robot constrains the movement of human operator to help with a pHRI task while an augmented reality (AR) interface informs the operator about its phases. To this end, dynamical characterization of the collaborative robot (LBR IIWA 7 R800, KUKA Inc.) is presented first. Then, the stability and transparency analyses for our pHRI task involving collaborative drilling with this robot are reported. A range of allowable parameters for the admittance controller is determined by superimposing the stability and transparency graphs. Finally, three different sets of parameters are selected from the allowable range and the effect of admittance controllers utilizing these parameter sets on the task performance is investigated., Comment: 13 figures, published in Transactions of the Institute of Measurement and Control, July 27, 2020

WOS: 000423949600009 Pregnancy is a rare occurrence in acromegalic patients because of impaired fertility due to the disease. There are limited data available regarding pregnancy in acromegalic patients; although, it appears that the patients are usually able to carry their pregnancies to full term. In addition, certain metabolic effects of acromegaly need to be considered as they can be harmful to both mother and fetus. The discontinuation of the medical treatment is usually recommended as the effects of medical treatment are unclear. Herein, we report five new cases of pregnancies in acromegalic patients who had undergone surgery and medical treatment for macroadenoma, before the onset of pregnancy, from different centers. Two of them had received radiotherapy after the surgery. None of the patients in our study were treated for pregnancy; however, two of them were receiving octreotide when the diagnosis of pregnancy was established. The medical treatment of these two patients was discontinued at the beginning of pregnancy. Four patients delivered healthy babies, and therapeutic abortion was performed at the sixth week of pregnancy to one of the patients who was being treated with octreotide before the pregnancy. Out of the five patients in our study, two had pregestational diabetes and one had hypertension. As a conclusion, it can be said that pregnancy in acromegalic patients is usually uneventful without any treatment throughout the pregnancy.

WOS: 000424952600002 PubMed: 29141453 Nodular thyroid diseases are common in Turkey. Insulin resistance (IR) is considered as the most important component of metabolic syndrome (MetS), and it is thought to directly affect thyroid diseases, together with other components of MetS. The aim of this study was to evaluate potential factors associated with thyroid nodularity. This study was part of the prospective MELEN study. In total, randomly selected 2233 subjects were evaluated. A euthyroid subgroup of participants (n=1432) was selected and 421 of them had MetS. Both goitres and multinodular goitres (MNGs) were significantly more common in the MetS (+) group (p

OBJECTIVE: We aimed to investigate the possible risk factors which could effect the mortality of infected patients in Intensive Care Unit ICU like age, concomitant diseases, Procalcitonin PCT , C-reactive protein CRP , vitamin D levels and APACHE II score. These parameters were also investigated for mortality during hospitalization period and thirty and ninety-day mortality after discharge from hospital.METHODS: Fifty-two infected patients who were admitted to ICU of Duzce University School of Medicine, Department of Internal Medicine between 01 September 2011 to 30 August 2012 were evaluated prospectively.RESULTS: Sepsis increased mortality rate in ICU significantly. Concomitant diseases except hypertension were not associated with discharge status, 30 and 90 daily life expectancy. In the first hospitalization day CRP and PCT were found to be high while 25-OH vitamin D was found to be low. 25-0H vitamin D and PCT levels and APACHE II score were not associated with discharge status from ICU. CRP has been associated with increased risk of death, while APACHE II score was associated with thirty and ninety days life expectancy. It was found that life expectancy is higher with longer duration of hospitalization after ICU.CONCLUSION: Sepsis may increase ICU mortality as well as advanced age with septicemia may increase 30th and 90th days mortality after discharge. APACHE II score can be used to predict long-term survival after discharge. PCT, CRP and 25-OH vitamin D were not considered as an ideal method alone for follow up and prognosis of ICU patients., AMAÇ: Yoğun Bakım Ünitesindeki YBÜ enfeksiyöz hastalarda mortalite üzerinde etkili olabilecek risk faktörleri olan yaş, eşlik eden hastalıklar, prokalsitonin PCT , C-reaktif protein CRP , 25-OH vitamin D düzeyi ve APACHE II skoru ile; bu parametrelerin yoğun bakımda ve hastane sonrası otuz ile doksan günlük mortalite arasındaki ilişkisini değerlendirmeyi amaçladık. YÖNTEMLER: Düzce Üniversitesi Tıp Fakültesi İç Hastalıları YBÜ’ye 1 Eylül 2011–30 Ağustos 2012 tarihleri arasında enfeksiyon tanısı ile kabul edilen 52 hasta prospektif olarak değerlendirilmiştir. BULGULAR: Sepsis, YBÜ’de mortaliteyi belirgin artırmıştır. Eşlik eden hastalıklardan; hipertansiyon dışındakilerin taburculuk durumuna, 30 ve 90 günlük yaşam süresine ulaşmayla ilişkisi saptanmadı. Yatış laboratuar değerlerinde; CRP ve PCT yüksek, 25-OH vitamin D ise düşük saptanmıştır. YBÜ’den taburculukta; yaş, 25-OH vitamin D, PCT, APACHE II’nin etkili olmadıkları, CRP artışının ölüm riski ile ilişkili olduğu görüldü. APACHE II skoru, otuz günlük yaşamla; yaş ise, otuz ve doksan günlük yaşamla ilişkili bulunmuştur. YBÜ sonrası devredilen serviste yatış süresi uzun olanlarda, hastane sonrası yaşam süresinin yüksek olduğu saptanmıştırSONUÇ: Sepsis, YBÜ mortalitesini, sepsisle beraber ileri yaş ta taburculuk sonrası 30 ve 90 günlük mortaliteyi artırabilir. APACHE II skoru, taburculuk sonrası uzun dönem sağkalım tahmininde kullanılabilir. PCT, CRP ve 25-OH vitamin D’nin, YBÜ hastalarının takibi ve prognozunu belirlemede tek başlarına ideal yöntemler olarak kullanılmasının uygun olmadığı düşünülmektedir.

In physical human-robot interaction (pHRI), the cognitive skill of a human is combined with the accuracy, repeatability and strength of a robot. While the promises and potential outcomes of pHRI are glamorous, the control of such coupled systems is challenging in many aspects. In this paper, we propose a new controller, fractional order admittance controller, for pHRI systems. The stability analysis of the new control system with human in-the-loop is performed and the interaction performance is investigated experimentally with 10 subjects during a task imitating a contact with a stiff environment. The results show that the fractional order controller is more robust than the standard admittance controller and helps to reduce the human effort in task execution., NA, IEEE; IEEE Robotics Automation Soc; Euro Haptics; Haptics Tech Committee; DFG; TUM; Force Dimension; Ultra Haptics; Polytec; Gotouchyr; Hap2U; Disney Res; Immersion; Tanvas; Haption; Actronika; Tactile Labs; Lofelt; Oculus; Alto; Springer

Purpose: Radioactive 131Iodine therapy (RAIT) plays a major role in the treatment of hyperthyroidism. In addition to the thyroid gland, significant amounts of radioactive iodine are maintained in the stomach. The aim of this study was to determine if RAIT has any effect on Helicobacter pylori infection, based on the 14C urea breath test (UBT). Materials and Methods: The study included 85 patients with hyperthyroidism scheduled to undergo RAIT and 69 hyperthyroid subjects in whom methimazole treatment was planned. All subjects had pretreatment-positive UBT results, and the test was repeated on the first and third months after RAIT and methimazole treatment. Results: After a mean RAIT dose of 15 mCi (range, 10Y20 mCi), UBT became negative in 13 (15.3%) of 85 patients on the first month and 18 (21.2%) of 85 patients on the third month. All subjects treated with methimazole remained UBT positive on the first and third months of methimazole treatment (100%). Reduction in the number of UBT-positive patients on both the first and the third months after RAITwas statistically significant (P G 0.001). Distribution of hyperthyroidism etiologies and thyroid autoantibody levels in subjects with UBT that became negative and in subjects with UBT that remained positive were similar in the RAIT group (P 9 0.05). Urea breath test negativity rates did not differ according to the radioiodine dose. Conclusions: Our findings indirectly showed that RAIT might have an antimicrobial effect on H. pylori. Clinical applications of this beneficial effect of RAITon H. pylori should be further evaluated. Copyright © 2014 by Lippincott Williams & Wilkins.

WOS: 000335393000004 PubMed: 24791840 Objective: The aim of the study was to investigate thyroid diseases and the prevalence of goiter by ultrasonography (US) in a moderately iodine deficient area. Material-Methods: The MELEN Study is a prospective cohort study on the prevalence of thyroid diseases in Turkish adults. A total of 2233 subjects with a mean age of 50 (age range 18 to 92) were submitted to study. Thyroid US was performed and interpreted by the same experienced physician. Goiter prevalence was defined according to Gutekunst's criteria. Results: The most common thyroid disease was multinodular goiter (MNG) (42%), followed by nodular goiter (NG) (14.6%). The crude prevalence of nodular disease in the region was 56.6%. In the study cohort, thyrotoxicosis (TSH < 0.35 mu IU/ml) prevalence was 12 % and subclinical and overt hypothyroidism (TSH > 4.5 mu IU/ml) prevalence was 6.5 %. Conclusion: We found that thyrotoxicosis and nodular thyroidal diseases are more important public health issues in moderate iodine deficient geographical areas. We recommend the increased rates of US screening especially in the endemic regions in order to detect thyroidal nodules earlier. Duzce University Scientific Research ProgrammeDuzce University This work was supported by the Duzce University Scientific Research Programme.

WOS: 000337254200001 PubMed: 24869934 Background: Metabolic syndrome (MS) has become a pandemic in Turkey, as is the case globally. Increase in carotid artery intima-media thickness (CIMT) and erectile dysfunction (ED) may be evident before the clinical signs of cardiovascular disease appear. We aimed to investigate the prevalence of increased CIMT and ED as markers of atherosclerotic disease in patients with MS. Material/Methods: Thirty-two patients with MS and 29 healthy controls were included. Anthropometric and biochemical parameters, along with total testosterone (TT), high sensitive C-reactive protein (hs-CRP), were recorded. Carotid artery intima-media thickness was measured. Erectile dysfunction was assessed with International Index of Erectile Function. Results: Patients with MS had higher BMI, fasting plasma glucose, post-prandial plasma glucose, insulin, HOMA-IR, total cholesterol, triglycerides, hs-CRP, and CIMT, whereas TT levels were lower (p

Purpose: Main diagnostic method of thyroid nodules is fine needle aspiration biopsy (FNAB), but sensitivity of this method in the evaluation of follicular lesions is low. We reevaluated patients who underwent operation with FNAB reports of follicular neoplasm, Hurthle cell neoplasm and oncocytic changes. Postoperative histopathological examination and thyroid ultrasound (TUS) results, scintigraphic features of nodules were reevaluated. Material and Method: One hundred and three patients who were diagnosed with FNAB as follicular neoplasm, Hurthle cell neoplasm, oncocytic changes and who underwent thyroidectomy were reevaluated, retrospectively. FNAB and postoperative histopathological thyroidectomy specimen results were compared. Results: Comparison results of FNAB cytologic evaluation and postoperative histopathological examination of those nodules were as follows. Eight patients who were diagnosed as follicular lesion in FNAB were papillary carcinoma, 6 were follicular carcinoma. One patients who were diagnosed as Hurthle cell neoplasm in FNAB was papillary carcinoma. Six patients who were diagnosed as oncocytic changes in FNAB were papillary carcinoma. According to postoperative histopathology results, all patients’ diagnoses were as follows: 21 patients (20.4%) were diagnosed with thyroid malignancy in which 15 patients (14.6%) were papillary carcinoma, 6 patients (5.8%) were follicular carcinoma. Hypoechoic appearance of nodule in TUS was found to be the only independent risk factor in prediction of malignancy. Discussion: One fifth of the patients who were reported as follicular neoplasm, Hurthle cell neoplasm and oncocytic changes in FNAB were consistent with malignancy. Hypoechoic appearance of these nodules in TUS was found to be an independent risk factor in prediction of malignancy. Turk Jem 2014; 1: 5-12

Struma ovarii, which is classified as benign or malignant, is a mature ovarian teratoma consisting mainly of the thyroid tissue. Here, we present the case of malign struma ovarii in a patient with right adnexal mass. In a 53-year-old female, who was referred to our hospital with pelvic pain, abdominopelvic imaging revealed a cystic lesion measuring 15x14 cm in diameter in the right adnexa. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Microscopic evaluation revealed a 1.5x1x0.5 cm papillary carcinoma focus in frozen sections of the mural nodule which was observed inside the cyst. Following the surgical procedure, the patient’s TSH levels were kept low by thyroxine treatment, and it was decided to follow the patient by annual measurement of thyroglobulin levels and pelvic imaging. There is not a common consensus on optimal treatment of malignant struma ovarii. Treatment options depend on cases or case series. Turk Jem 2015; 19: 112-114

WOS: 000353553700074 PubMed: 25910343 Bone metastasis is common in patients with lung, prostate, and breast cancers but it isn't common in stomach cancer. Gastric carcinoma infrequently metastasizes to the bone and rarely in an osteoblastic form. Herein we presented a rare case of signet ring cell gastric adenocarcinoma in early stage with osteoblastic metastasis. To our knowledge our case was the youngest signet cell gastric cancer patient with osteoblastic bone metastasis reported in literature.

WOS: 000298836300011 PubMed: 22299387 Objective Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before. Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. Methods and results The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC =0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (>88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (>0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (Cl) = 1.663-4.53; P value

Aim: The aim of the Melen Study was to investigate the cardiovascular risk profile of Turkish adults by utilizing newest techniques. Besides prevalence and types of endemic goiter will be established which was an important health problem in the Black sea region Method: The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of carotid intima media thickness, echocardiographic examination, ECG recording, bioempedance meter analysis of body composition, pulmonary function test and various biochemical analysis. Result: Twenty nine percent of the population had hypertension, 12% had diabetes mellitus and 17% were smokers. Thyroid ultrasonography revealed that 29% of the cohort had goiter. Echocardiographic measurements showed that 39% of the participants had diastolic dysfunction. Comparison of males with females showed that men had significantly higher visceral fat, triglyceride, hemoglobin and CIMT whereas women had higher mean diastolic blood pressure, HDL and total cholesterol. Conclusion: According to the histories of patients, hypertension, diabetes mellitus and smoking were very frequent among Turkish adults. Among the objectively measured variables, diastolic dysfunction, visceral adiposity and goiter were strikingly high.

Hearing loss has commonly been reported in association with thyroid disorders and during treatment with propylthiouracil. The relationship between hyperthyroidism and the auditory system has not been previously investigated. The aim of this cross-sectional, case–control study was to investigate hearing loss in patients with Graves’ disease (GD). The study population consisted of patients with newly diagnosed GD and healthy controls. Pure tone audiometry at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz, along with immittance measures including tympanometry and acoustic reflex tests, were performed in all participants. Twenty-two GD patients and 22 healthy controls consented to inclusion in the study. The differences between groups with regards to age and gender distribution were statistically insignificant (P = 0.567 and P = 0.757, respectively). The hearing thresholds of right and left ears were also similar in both groups (P > 0.05). When single-ear evaluations were taken into account (total of 44 ears for both groups), hearing thresholds in the GD group were significantly higher than healthy controls at all frequencies (P < 0.05). Following testing at the designated frequencies, the only significant effect of thyrotoxicosis was observed with frequencies of 4000 and 8000 Hz. The odds ratio for having hearing loss at a frequency of 8000 HZ associated with GD was 14.97 (95% confidence interval 4.03–55.64). In patients with GD, right and left pure tone audiometric findings at a frequency of 8000 Hz correlated positively with FT3, FT4 and negatively with TSH. Our results are highly suggestive of a decrease in hearing ability in patients with GD, particularly at high frequencies. Further studies are needed to help elucidate the mechanisms behind hearing loss which develops in association with GD.

Objectives: Standard triple therapy composed of a proton pump inhibitor, clarithromycin and amoxicillin has been widely preferred for H. pylori eradication in Turkey and World. Alternative therapies are currently under investiga­tion because of an increase in clarithromycin resistance. The aim of this study was to evaluate the efficacy of a levoflox-acin-containing triple therapy. Materials and methods: The study was carried out in 81 H. pylori-infected patients (52 female, 29 male) with nonul-cer dyspepsia. The mean age was found 46.3 ± 13.9. Treatment was indicated with lansoprazol 30 mg b.d., amoxicil-lin 1 g b.d., and levofloxacin 500 mg daily for 7 days. H. pylori status was rechecked by (14)C urea breath test 6-8 weeks after the end of therapy. Results: Totally 81 patients could complete the treat­ment and follow-up protocol. Effectiveness was 68%. The distrib-tions of age, gender and smoking were similar be­tween eradicated and non-eradicated groups (p > 0.05). Conclusion: Seven-day levofloxacin based triple therapy is not very effective in the first-line treatment of H. pylori in-fection. The new treatment modalities should be inves­tigated., Amaç: İlk basamak H.pilori eradikasyonunda Türkiye\'de ve Dünya\'da en çok tercih edilen tedavi protokolü pro­ton pompa inhibitörü, klaritromisin ve amoksisilin içeren standart tedavi rejimidir. Ancak artan klaritromisin direnci sebe-biyle alternatif tedavi rejimleri araştırılmaktadır. Ça­lışmamızda standart üçlü tedavi rejimindeki klaritromisin yerine le-vofloksasin getirilmesiyle oluşturulan kombinas­yonun etkinliğini araştırdık. Gereç ve yöntem: Çalışma, H.pilori ile enfekte 52 kadın, 29 erkek, toplam 81 nonülser dispepsi hastasında tamam-landı (yaş ortalaması 46,3 ± 13,9). Tedavide “lansoprazol 30mg 2x1, levofloksasin 500 mg 1x1, amoksisilin 1 gr 2x1” 7 gün verildi. Tedavi bitiminden 6-8 hafta sonra C14 üre-nefes testiyle tedavinin etkinliği kontrol edildi. Bulgular: Hastaların % 68\'inde H.pilori negatifliği sağlan­dı. Eradikasyon sağlanan ve sağlanmayan hasta grupları yaş, sigara ve cinsiyet dağılımı yönünden benzer bulundu (p > 0,05). Sonuç: İlk basamak H.pilori eradikasyonunda 7 gün sü­reyle verilen levofloksasin temelli üçlü tedavi yeterince etkin değildir. Yeni tedavi protokollerine ihtiyaç duyulmak­tadır.

BACKGROUND AND OBJECTIVES: Different nutritional and environmental factors are responsible for the pathogenesis of goiter, but iodine deficiency is the most important factor. However, little is known about the natural course of benign thyroid nodules in euthyroid patients over time. Few studies have used ultrasonographic evaluation to address this issue, especially in iodine-deficient areas. In this study, we present the long-term follow-up of benign thyroid nodules in a iodine-deficient area. DESIGN AND SETTING: Cross-sectional study at a tertiary referral center. PATIENTS AND METHODS: This study included 62 randomly selected patients with benign euthyroid nodule. Thyroid volume and nodules were measured with sonography. Iodine intake was estimated by patient diet history and by measuring iodine excretion in spot urine samples. Patients were followed one year. RESULTS: Patients were divided into three groups according to level of urine iodine excretion: Group 1: 100 g/L (iodine sufficient group). The presence of additional disease (hypertension, diabetes mellitus, coronary heart disease, chronic renal failure and a history of any medication for chronic disorder) and smoking rates were significantly higher in first group compared to the second and third group. Among groups, no significant difference was observed in either right or left thyroid lobe volume after one year. A clinically significant increase in nodule volume was observed in the first group, while there was a significant decrease in the second and third group. CONCLUSION: In this study, iodine deficiency was associated with an increase in thyroid nodule volumes. Smoking rates were higher in iodine deficient groups. It is thought that smoking impairs iodine intake or absorption consistent with a previous report.

In patients, who undergo surgery for hyperthyroidism, many cases of incidental thyroid cancer (ITC) have been detected. In the literature, there is no study about ITC in subcentimeter nodules in these patients. We performed this study to determine the frequency of ITC in subcentimeter nodules and ultrasonographic features that can predict malignancy in the patients with hyperthyroidism. We retrospectively reviewed our database about 3114 patients, who underwent thyroidectomy in our hospital. Among 869 patients (27.9%), who were operated because of hyperthyroidism, we enrolled 337 patients, who underwent total thyroidectomy and had subcentimeter nodule [59 Graves’ disease (GD) 98 subcentimeter nodule; 278 toxic multinodular goitre (TMNG), 359 subcentimeter nodule], in this study. Twenty-five nodules with ITC and 432 benign nodules have been detected and compared for ultrasonographic (US) features. Incidental thyroid cancer detection ratio was 5.4% [10.2% (10/98) in subcentimeter thyroid nodules in individuals with GD, and 4.1% (15/359) in individuals with TMNG, P = 0.018)]. Significant differences have been observed between the groups in terms of microcalcification in US examination of malign and benign subcentimeter thyroid nodules and the ratio of anterioposterior diameter to transverse diameter (A/T) ≥1 [(OR = 5.172; 95% CI: 1.495–17.886, P = 0.015), and (OR = 5.930; 95% CI: 1.531–22.971, P = 0.007), respectively]. We detected a higher incidence of ITC in subcentimeter thyroid nodules in GD compared to TMNG. US examination of subcentimeter nodules in hyperthyroid individuals has indicated that microcalcification and ratio of A/T ≥1 are the parameters that predict malignancy.

Acromegaly is associated with an increased prevalence of colonic polyps. The aim of this study was to evaluate the prevalence and recurrence rate of colonic polyps in acromegalic patients. Ninety-six acromegalic patients and 100 irritable bowel syndrome patients (IBS) were enrolled in the study. Twenty patients who were cured exclusively by surgery, and 20 patients that could not be hormonally controlled were re-examined colonoscopically after 36 months. Twenty-nine of 96 acromegalic patients (30.2%) had colonic polyps. In the IBS group, 10 (10.0%) had colonic polyps. The prevalence of colonic polyps was significantly higher in acromegaly. The group of acromegalic patients with and without polyps did not differ significantly with regard to plasma GH, IGF-I, fasting insulin levels and glycemic status. The presence of colonic polyps was correlated with increased patient age and male gender. We did not observe a difference in terms of polyp recurrence frequencies in the patients cured by surgery compared to uncontrolled patients. Acromegalic patients have a higher prevalence of colonic polyps than that of control subjects. We could not identify any factors that could predict polyps within the acromegalic patients - but age and male sex.

OBJECTIVE Atherosclerosis is the major cause of the morbidity and mortality in type 1 diabetes mellitus (DM). Carotid intima-media thickness (CIMT) is the early sign of atherosclerosis and thereby, also the sign of macrovascular diseases. In this study, we aimed to evaluate the CIMT in patients with type 1 DM, and its association with diabetic microvascular complications (nephropathy-retinopathy). METHODS One hundred and thirteen consecutive patients with type 1 DM without macrovascular disease were enrolled into this cross-sectional study. Age, gender, and body mass index matched 59 healthy subjects, were taken as the control group. Microvascular complications in diabetic patients were scanned. Ultrasonographic analysis of the carotid artery was performed with a high-resolution ultrasound scanner. Student's t, Mann Whitney U, Chi-square and Kruskal-Wallis tests, as well as multiple linear regression analysis were used for the statistical analysis. RESULTS Patients with type 1 DM had significantly higher CIMT compared to control group (p

Oral sodium phosphate (NaP) is increasingly being used for bowel preparation. There are several reports of significant serum electrolyte changes after the administration of oral NaP solution in renal failure. We report a case of postoperative hypoparathyroidism who developed severe hyperphosphatemia and associated hypocalcemia after bowel preparation with oral NaP. A 39-year old woman was admitted to the hospital because of multiple bone fractures. The diagnosis of primary hyperparathyroidism was confirmed. Further assays suggested Cushing’s disease and MRI disclosed a pituitary microadenoma. Considering the diagnostic suspect of multiple endocrine neoplasia type 1, computed tomography of abdomen was performed, showing a mass in the right adrenal. The patient underwent transsphenoidal surgery and then total parathyroidectomy. Despite total removal of the microadenoma by transsphenoidal surgery, there was no suppression in serum cortisol levels. So, an operation was scheduled for the adrenal tumor. The patient was administered 45 mL oral NaP solution for bowel cleansing before the surgery. Although her calcium and phosphorus levels were normal before NaP administration, four hours later she developed respiratory distress and tetany. Laboratory studies revealed severe hyperphosphatemia and hypocalcemia. We conclude that the use of NaP for bowel preparation should be avoided in patients with hypoparathyroidism.

The aim of the study was to determine the frequency and titers of anti-thyroid peroxidase (Anti-TPO), anti-thyroglobulin (Anti-TG), and anti-glutamic acid decarboxylase (Anti-GAD) antibodies in Turkish patients with type 1 diabetes mellitus (DM), and to compare the frequency of anti-TPO and anti-TG titers in the presence or absence of anti-GAD. A total of 104 patients including 56 males and 48 females with type 1 DM and their age-, gender-, and body mass index-matched control group, including 31 males and 27 females, 58 cases in total with an age range of 15-50 years, were recruited into this study. In patients with type 1 DM, positive anti-GAD was detected in 30.8% (n=32). In patients with positive anti-GAD, rate of positive anti-TPO was 37.5%; however, in patients with negative anti-GAD, the rate of positive anti-TPO was 9.7% and the difference was statistically significant (p=0.001). In patients with positive anti-GAD, the rate of positive anti-TG was 18.8%. In patients with negative anti-GAD, the rate of positive anti-TG was 2.8%, and the difference between them was statistically significant (p=0.005). In patients with positive and negative anti-GAD, rates of both positive anti-TPO and anti-TG were 15.6% and 1.4%, respectively, with the difference showing statistical significance (p=0.004). Thyroid autoimmunity in type 1 DM patients with positive anti-GAD was apparently higher; therefore, these patients should be followed more frequently and carefully.

Aim To determine the rate of major congenital anomalies and complications retrospectively in offspring of women with diabetes mellitus treated insulin lispro. Material and methods Twenty-seven patients had used insulin lispro (ILYS) and 59 patients had used regular human insulin (RHI) during the pregnancy period were evaluated. We also evaluated and analyzed the results of 53 of the 86 women who had gestational diabetes mellitus only. They were not using insulin aspart or insulin glarjine. We evaluated the birth weight, congenital anamolies, mode of delivery, abortus and stillbirth rates. Results Mean HbA1c level was 6.27 + 2.23 for ILYS group and 7.07 + 2.09 for RHI group ( p : 0.067). The duration of diabetes, gestational age, mode of delivery, type of diabetes, number of liveborn, stillbirth and miscarriages were not stastically different between all groups ( p > 0.05). Nine (15.25%) of 59 infants treated with RHI had congenital anomalies and one stillborn. The infants in ILYS-receiving group had no congenital anomalies but one pregnant (3.70%) had a stillborn. The difference in incidence of congenital anomalies between those using ILYS and RHI was not statistically significant ( p : 0.157). There was also no difference in respect to congenital anomalies of gestational diabetic groups which used either ILYS or RHI. Conclusion Major congenital anomalies for offspring of mothers treated with ILYS are similar with RHI group. Although HbA1c levels were lower in ILYS group, all outcomes are similar with RHI. So ILYS is an alternative choice in treatment of pregnant women with DM.

* Correspondence: elifonder61@yahoo.com To the Editor, We read the article entitled “Herbal self-medication use in patients with diabetes mellitus type 2” by Damnjanovic et al. in a recent issue of the Turkish Journal of Medical Science with great interest (1). We thank Dr Damnjanovic and colleagues for their interesting and also important investigation on herbal self-medication use in type 2 diabetics. They reported that type 2 diabetics have used different types of herbal product in daily life. Especially they found 5 important herbal products usage: ginseng, garlic, aloe, cinnamon, and St. John’s wort. We published a similar article about herbal therapy in type 2 diabetics in a Turkish diabetic population 2 years ago (2). Therefore, we wanted to make some comments on the article and this subject. Prevalence of herbal treatment use is very high in Turkish diabetic patients. Approximately 1/3 of diabetic patients have used different types of herbal products. Damnjanovic et al. reported 5 different types of herbal products. We detected approximately 20 different types of herbal products in our diabetic patients. They have most commonly used cinnamon, pepino, Prunus laurocerasus leaf, chamomile tea, cabbage juice, pomegranate flower, mulberry leaves, garlic etc. (2). We did not detect any favorable effect on control of diabetes because HbA1c levels were similar in both the herbal treatment and nonherbal group. We also investigated the factors influencing the use of herbal treatment. Patients were dissatisfied with the current medical treatment due to ineffectiveness, side effects, and hypoglycemia. Therefore, they tended to use herbal treatment. Dr Damnjanovic also reported that recommendations for herbal treatment arose from different sources. They reported that influencing decisions about herbal dietary supplements were media, friends, pharmacists, and physicians. We also detected similar findings. Advisers recommending herbal treatment in addition to medical therapy were as follows: neighbors or friends 45%, media 30%, health care workers (physicians and pharmacists) 13%, and herbalists 9%. In Turkey, one third of type 2 diabetic patients have used many different forms and types of herbal treatments regularly. The most important factors influencing herbal treatment use were dissatisfaction with current diabetic medicine and its side effects. In addition, other important factors leading to patients’ using herbal treatment were former users (friends, neighbors, and other patients) and the media. In conclusion, although various herbal treatments could be used as adjunctive therapy in addition to the current medical treatment, due to lack of evidence-based data in this field, potential severe adverse effects can result in death, depending on improper use. Moreover, to prevent misuse of herbal treatments for diabetic patients, we also recommend more educational programs on television or in the press about diabetes treatment. Received: 13.07.2015 Accepted/Published Online: 01.12.2015 Final Version: 23.06.2016 Letter to the Editor

Objective: The increase in the mean age of the general population is reflected in the patient populations who are in need of intensive care. Increasing number of comorbidities with age is also an important issue to be considered in the management of these patients. We evaluated clinical and laboratory features of the elderly (65-79 years) and very elderly (≥80 years) patients in our medical intensive care unit (ICU). Methods: The clinical and laboratory data of intensive care patients aged 65 and over were retrospectively analyzed. Comorbidities were commented with 19 disease-weighted Charlson Comorbidity Index (CCI). Results: 231 elderly and 216 very elderly patients were included in this study. Pulmonary diseases were the most prevalent primary cause of admission to ICU in both groups. The most common comorbidities were hypertension and heart failure in both groups. Number of patients whose CCI scores>3 were higher in very elderly patients group than in elderly patients group. While there was no difference in terms of median ICU-survival between two groups in general, when 30 days and longer intensive care follow-ups were evaluated, it was found 81.0 (95% CI: 48.8-113.2) days and 41.0 (95% CI: 36.6- 45.4) days in the elderly and very elderly patients respectively (p = 0.009). Conclusion: We concluded that, age is not the main factor affecting the ICU-survival in patient over 65 years old in intensive care unit. However, increasing age may be associated with short survival at prolonged hospitalizations in ICU. J Clin Exp Invest 2015; 6 (2): 144-149

Introduction: Pituitary apoplexy results from haemorrhagic infarction of a pre-existing pituitary adenoma or within physiologically enlarged gland. Pituitary apoplexy during pregnancy is rare but serious event with significant morbidity and mortality if not recognised in time. Pituitary apoplexy is characterized by sudden onset of headache, nausea, vomiting, visual disturbances, eye movements restricted and varying degrees of pituitary insufficiency and accompanied by change of consciousness may be clinically overt or as subclinical. Our case report describes a woman who presented with pituitary apoplexy in the 27 weeks of pregnancy.

This case is presented with a pulmonary parenchymal destruction due to acquired multiple myeloma who has a history of pulmonary tuberculosis. A 55 year old male patient attempted to emergency department with complaints of shortness of breath. The final diagnose with the existing clinical and laboratory outputs were right pulmonary parenchymal destruction and pleural involvements secondary to multiple myeloma. Our prediagnose was confirmed by the overt plasma cell increase and Russell bodies in cytopathologic examination of the pleural fluid. Even though multiple myeloma leads to destruction in the pulmonary parenchyma rarely, patients should be scrutinized enough to elicit true diagnose., Multipl myeloma bağlı, pulmoner parankimal destrüksiyon gelişen, daha önceden geçirilmiş pulmoner tüberküloz öyküsü olan vaka sunulmuştur. 55 yaşında erkek hasta acil servise nefes darlığı şikayeti ile başvurdu. Hasta klinik bulguları ve labaratuar tetkikleri ile değerlendirildikten sonra, mutipl myeloma sekonder sağ pulmoner parankimal destrüksiyon ve plevral tutulum tanısı konuldu. Ön tanımız, plevral sıvının sitopatolojik incelemesinde artmış plazma hücresi ve Russell body hücreleri görülmesi ile doğrulandı. Multipl myelom nadiren pulmoner parankimal destrüksiyone yol açmasına rağmen, hastalarda ayırıcı tanı için ayrıntılı incelemek gerekmektedir

The effectiveness of hormone replacement therapy for patients with cardiovascular disease and for postmenopausal women with associated cardiovascular risks is currently under wide investigation. Among the cardiovascular risks are those related to body fat percentage and distribution. The present study undertook to investigate the effects of combined hormone replacement therapy on body fat percentage and distribution in postmenopausal women. Data for the present study were collected via retrospective analyses of 287 healthy postmenopausal women (146 as a study group, 141 as controls). Participants in the study group received 0.625 mg conjugated equine estrogen combined with 2.5 mg medroxyprogesterone acetate per day for 18 months. Body fat percentage and fat distribution were evaluated through the electrical impedance method and measurements of skinfold thickness, respectively. Two indices of centripetal fat distribution were defined: ratio of trunk-to-extremity skinfold thickness (T/E index), and ratio of upper-to-lower body skinfold thickness (U/L index). Investigators found that a daily dose of 0.625 mg of conjugated equine estrogen combined with 2.5 mg of medroxyprogesterone acetate taken for 18 months increased body fat percentage by decreasing lean body mass and by affecting upper-to-lower body fat distribution, without producing significant changes in overall weight. A slight decrease in the trunk-to-extremity body fat ratio was noted at 18 months of treatment, but this decrease did not reach statistical significance. Data related to the effects of hormone replacement therapy on body fat percentage and distribution in postmenopausal women are scarce. Additional research is needed to clarify the possible health benefits of hormone replacement therapy.

This study covers the long-term measurements and applications done between 15 January 2015 and 21 October 2016 in the Kozlu Colliery, one of the five collieries of Turkish Hardcoal Enterprise (TTK), Zonguldak, Turkey. It intends to address the practical problems encountered with the gas and air velocity sensors used in underground coal mines, and attempts to justify the accuracy of sensors. It also aims at determining the correct locations of the gas and air velocity sensors within cross-section of mine entries. Moreover, air densities were calculated to interpret the positions of individual gases within the mine air. The results showed that the infrared CH4 sensors used in the mine do not accurately measure CH4 concentrations at their current locations. Moreover, they are affected by relative humidity and thus necessitate more frequent calibration at places having high relative humidity. The air velocity sensors used in the mine are completely ineffective in their current state. Changing their locations led to better yet ineffective results. It was found that a correction factor of 1.25 is needed to correct air velocity sensor readings. It was concluded that air velocity, CH4 and CO sensors must be installed to points where air flow is higher, considering the Amagat's law. [Received: October 17, 2017; Accepted: April 4, 2018]

WOS: 000351702500009 PubMed: 25421155 Introduction Patients with hyperprolactinemia who require medical therapy are typically treated with dopamine agonists (DAs). In most cases, DAs normalize prolactin levels, control symptoms, and substantially decrease tumor size. Here, we aimed to compare the efficacy of cabergoline (CAB) and bromocriptine (BRC) in patients with hyperprolactinemia at a single center. Methods Retrospective analysis of the clinical records of 498 patients with hyperprolactinemia [mean age 33.3 +/- 10.8 years (range 16-66), 450 women, and 48 men] who had received either CAB (n = 450) or BRC (n = 48) was performed. Results The mean age, gender distribution, and treatment duration were similar between the CAB and BRC groups (33.2 +/- 11 vs. 34.1 +/- 9.6 years, male/female 44/406 vs. 4/44, 18.7 +/- 12.1 vs. 17.8 +/- 6.0 months, respectively; p > 0.05 for all). Mean dosage was 1.5 +/- 1.6 mg/week for CAB and 3.8 +/- 2.7 mg/day for BRC. Baseline prolactin levels, frequency of galactorrhea, amenorrhea, oligomenorrhea, erectile dysfunction, infertility, and visual impairment were similar between the two groups, whereas the baseline tumor volume was higher in the CAB group. The prolactin normalization rate (87.4 vs. 41.4 %, p = 0.029) and tumor volume shrinkage (79.8 +/- 39.1 vs. 54.1 +/- 55.3 %, p = 0.015) were significantly higher in the CAB-treated patients than in the BRC-treated patients, while the tumor cure rates were similar. Symptom relief was higher in the CAB group than in the BRC group. More side effects were recorded in patients who took BRC (29.1 vs. 5.3 %, p < 0.001). Conclusion Our data revealed that CAB was more effective than BRC in controlling symptoms associated with hormone excess, normalizing serum prolactin levels, and shrinking prolactinomas.

Akut pankreatitin (AP) en önemli nedenleri benign safra yolu hastalıkları, metabolik hastalıklar ve alkolizmdir. Bazı ilaçlar (sülfonamidler, tiazidler, lizinopril, kaptopril, östrojen ve tetrasiklinler) da APyi indükleyebilirler. Burada farklı ilaçlar kullanmış olan hastalara ait dört AP olgusu sunulmuştur. İlk olgu 4 haftadır zofenopril kullanan 73 yaşındaki bir erkek hasta, ikinci olgu ise gebelik sonrası furosemid kullanan 24 yaşındaki bir kadın hastaydı. Üçüncü olgu bir ay valsartan kulanmıştı. Dördüncü hasta altı hafta süresince liziopril kullanmış ve AP olmuştu. Hastalardan hiçbiri pankreatit için bilinen risk faktörlerine sahip değildi. İlaçların kesilmesinin ardından dört hasta birkaç gün içinde herhangi bir komplikasyon olmadan iyileşti. Zofenoprile bağlı AP literatürde ilk kez bu çalışma ile sunulmuştur. The most important reasons of acute pancreatitis (AP) are benign biliary tract diseases, metabolic diseases and alcoholism. Some drugs also (sulfonamides, thiazides, lysinopril, captopril, estrogens and tetracyclines) can induce AP. We herein report four cases of AP patients who were using different drugs. The first case was 73 years old male patient who has been using zofenopril for 4 weeks and the second patient was 24 years old female who was using furosemide after her pregnancy. Third one was using valsartan for one month. Fourth patient was using lysinopril for six weeks and resulted in AP. All patients had no known risk factors for pancreatitis. After cessation of the drugs, four patients recovered in a few days without any complications. AP due to zofenopril was firstly reported in our manuscript in the literature.

YILMAZ, Engin/0000-0001-8873-7645 WOS: 000331638200020 PubMed: 23673869 Von Hippel Lindau (VHL) syndrome is an autosomal dominant disorder characterized by benign and malignant tumors. This study presents the clinical and genetic features of VHL syndrome in a Turkish family. For the diagnosis of pheochromocytoma-related diseases, 49 family members from three generations were evaluated between March 2008 and January 2013. Family members were examined to identify components of pheochromocytoma- related genetic syndromes through physical examination, laboratory tests, and imaging methods. For the causative mutation, sequence analysis of VHL gene was performed. Nine patients were diagnosed with pheochromocytoma. Lumbal spinal hemangioblastoma and pancreatic neuroendocrine tumor without pheochromocytoma were detected in one patient. In patients with pheochromocytoma, additional tumors, such as retinal angioma, renal cell carcinoma, pancreatic serous cystadenoma, and pancreatic neuroendocrine tumors were detected. All patients were diagnosed as VHL syndrome type 2B. Sequence analysis of VHL gene revealed heterozygous p.A149S mutation in all symptomatic patients and in seven of the asymptomatic family members. This is the first study that identified VHL p.A149S mutation in a Turkish family with VHL syndrome. However, VHL p.A149S mutation was identified in an American family by Atuk et al. (J Clin Endocrinol Metab, 83:117-120, 14) and the family was defined as VHL type 2A. In our study, the family was identified as VHL type 2B. This variability in the phenotypic features suggests that further studies are required to beter assess the genotype-phenotype correlation in such cases.

WOS: 000308111400048 PubMed: 20369240 Acromegaly is a chronic endocrinopathy characterized by hypersecretion of growth hormone (GH) and consequently of insulin-like growth factor-1 (IGF-1). The arthropathy in acromegaly is the most frequent and important cause of morbidity and functional disability in acromegaly. Rheumatoid arthritis (RA) is a rarely reported clinical situation in patients with acromegalic. We herein report 57- and 45-year-old two women, who complained bilateral, symmetric pain, swelling and morning stiffness in the joints of hands after optimal acromegaly treatment resembling acromegaly arthropathy. There was not arthralgia in other joints of the patients. Laboratory and radiological evaluations were carried out. After excluding the acromegaly activation and arthropathy by GH and IGF-1 measurement, according to clinical presentation, laboratory and radiological assessments, patients were diagnosed as RA.

Resistance to thyroid hormone (RTH) is a rare disease characterized by non-suppressed TSH in spite of high free thyroid hormone levels. Up to date, in the literature, there are more than 600 RTH cases, but co-incidental hypophyseal adenoma was reported in only 1 case. In the literature, despite reported cases with thyrotropinoma accompanying RTH, we could not find a case with somatotropinoma accompanying RTH. Here, we report a 34-yr-old male patient, who was admitted to the hospital with complaints of dyspnea, chest pain, and palpitation in 2003. His alpha- subunit value was normal and the alpha-subunit/TSH molar ratio was1. His response to TRH stimulation test was normal. His TSH level was suppressed in the T3 suppression test. Hypophyseal magnetic resonance imaging showed a 6-mm hypophyseal microadenoma. Levels of all anterior hypophyseal hormones, including GH and IGF-I, were normal. Oral glucose tolerance test (OGTT)-GH suppression test was normal. The patient was followed with the diagnosis of RTH and incidental hypophyseal adenoma. After 3 yr, because of high levels of IGF-I: 901 ng/ml (68-324), the OGTT-GH suppression test was reported and no suppression was detected. Thus, the patient was referred to surgery with the pre-diagnosis of RTH and acromegaly. Immunohistochemistry was showed as strong GH staining with low Ki 67 index while TSH and other anterior hypophyseal hormones stainings were negative. Post-operative thyroid hormones were still high.

WOS: 000318664500005 PubMed: 23705556 Objective Patients with diabetes mellitus (DM) are at an increased risk of sudden cardiac death (SCD) partly explained by cardiac autonomic neuropathy (CAN). There have been fewer studies to evaluate CAN using heart rate variability (HRV) and heart rate recovery (HRR) in patients with type 2 DM. To our knowledge, there has been no study to investigate the association between HRR, HRV and type 1 DM. The purpose of this study was to examine the changes in HRR and HRV measurements in type 1 diabetic patients. Methods The study population consisted of 35 consecutive patients with type 1 diabetes and 35 sex- and age-matched non-diabetic controls. We performed electrocardiography, echocardiography, Holter analysis, exercise stress test, routine biochemical tests including haemoglobin A1c, high-sensitivity C-reactive protein and evaluated the clinical characteristics. HRR was calculated by subtracting the heart rate values at the first minute of the recovery phase from the peak heart rate. Abnormal HRR was defined as HRR

et al. The effects of gonadotropin treatment on the immu- nological features of male patients with idiopathic hypogo- nadotropic hypogonadism. J Clin Endocrinol Metab 2000;85: 66-70. [CrossRef]

BACKGROUND Potassium permanganate is used clinically as an antiseptic and antifungal agent. Ingestion of potassium permanganate may result in damage to the upper gastrointestinal tract. Burns and ulceration of the mouth, esophagus and stomach occur due to its action. Emergency endoscopy is useful to assess the severity of damage and also to guide management. METHODS We reported a patient presenting to the emergency department after suicidal ingestion of potassium permanganate. RESULTS After treatment, the patient was discharged home on the 7th day after admission. CONCLUSION Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department.

Aim. This study compares the effectiveness of Michigan Neuropathy Screening Instrument (MNSI), neurothesiometer, and electromyography (EMG) in detecting diabetic peripheral neuropathy in patients with diabetes type 2.Materials and Methods. 106 patients with diabetes type 2 treated at the outpatient clinic of Ankara Numune Education and Research Hospital Department of Endocrinology between September 2008 and May 2009 were included in this study. Patients were evaluated by glycemic regulation tests, MNSI (questionnaire and physical examination), EMG (for detecting sensorial and motor defects in right median, ulnar, posterior tibial, and bilateral sural nerves), and neurothesiometer (for detecting alterations in cold and warm sensations as well as vibratory sensations).Results. According to the MNSI score, there was diabetic peripheral neuropathy in 34 (32.1%) patients (score ≥2.5). However, when the patients were evaluated by EMG and neurothesiometer, neurological impairments were detected in 49 (46.2%) and 79 (74.5%) patients, respectively.Conclusion. According to our findings, questionnaires and physical examination often present lower diabetic peripheral neuropathy prevalence. Hence, we recommend that in the evaluation of diabetic patients neurological tests should be used for more accurate results and thus early treatment options to prevent neuropathic complications.

WOS: 000331638200007 PubMed: 23504651 Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were >= 1 cm, 82.9 % of the benign nodules were >= 1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients.