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The aim of the study was to assess the prevalence of female sexual function and related factors in Turkish women with type 2 diabetes mellitus (T2DM). A total of 93 female patients diagnosed with T2DM (age 48.0 +/- 7.2 years (Mean +/- SD) were included. Data on age, diabetes age, HbA1c level, educational level, diabetes treatment, diabetes-related complications, co-morbid disorders and concomitant medications were recorded, as were the scores obtained using a Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was noted in 55.9% of patients including problems related to desire (60.2%), arousal (52.7%), lubrication (55.9%), orgasm (51.6%) and satisfaction (58.1%) as well as pain during sexual intercourse (54.8%). Total scores were correlated negatively to age (r = -0.329, p = 0.001) and duration of diabetes (r = -0.246, p = 0.018), while significantly higher in patients with than without hypertension (19.6 vs. 22.4, p = 0.012) and with than without insulin therapy (20.0 vs. 23.7, p = 0.050). Our findings indicate the adverse effects of T2DM on sexual function in 55.9% of women in all domains of sexual response cycle, although this seems to be associated with older age, longer duration of diabetes, insulin and antidepressant therapy, presence of hypertension as well as end-organ complications of neuropathy and coronary artery disease (CAD).

Although the effects of hypothyroidism or hyperthyroidism on weight have clearly been demonstrated, data regarding the effects of relatively minor defects in thyroid function are limited. In the present study, the relationship between body mass index (BMI) and alterations in thyroid function within the normal range was investigated in obese patients. Three hundred fifty-seven euthyroid, obese patients (309 female and 48 male; mean age, 42 years) were included in the study. The patients were divided into 2 groups based on a BMI threshold value of 40 kg/m(2). Thyroid function, BMI, and the epidemiologic characteristics of the patients were retrospectively evaluated. No statistically significant difference was detected between the groups with respect to gender, place of birth, place of residence, smoking habits, and family history. Severely obese patients with a BMI >= 40 kg/m(2) were older and had a lower serum-free thyroxine level (fT4) than obese patients with a BMI < 40 kg/m(2) (P < 0.01). In patients with normal thyroid function, a negative correlation between fT4 and BMI existed. No statistically significant association was detected between BMI and epidemiologic characteristics in euthyroid, obese patients.

Objective: To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules. Materials and Methods: We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values. Results: A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05). Conclusion: Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.

Background. Monocyte chemoattractant protein (MCP)-1 is suggested to be implicated in the pathogenesis of diabetic nephropathy by activating and recruiting monocytes to the glomerulus via regulation of adhesion molecule expressions. The aim of this study was to test potential associations between serum concentrations of MCP-1, monocyte expression of Mac-1 and LFA-1 and nephropathy in type 1 diabetes mellitus. Methods. Serum MCP-1 levels and expression of monocyte adhesion molecules in 51 type 1 diabetic patients with and without diabetic nephropathy were compared with matched 15 healthy control subjects. Concentrations of serum MCP-1 were determined by enzyme-linked immunosorbent assays whereas monocyte expression of adhesion molecules Mac-1 and LFA-1 was measured by flow cytometry. Results. Serum MCP-1 levels and expression of Mac-1, but not LFA-1, were significantly higher in diabetic patients compared with controls. The mean serum MCP-1 level was 137.2 +/- 71.4 pg/mL in control patients, whereas it was 246.2 +/- 114.9 pg/ml in diabetic patients (p = 0.002). Serum MCP-1 levels were positively correlated with HbA1c and plasma fasting glucose levels. There was no difference in serum levels of MCP-1 and expression of monocyte adhesion molecules between type 1 diabetic patients with and without diabetic nephropathy. Conclusions. In type 1 diabetic patients, the levels of circulating MCP-1 concentration and expression of Mac-1 is mostly influenced by glycemic control rather than the existence of diabetic nephropathy.

Fine needle aspiration biopsy is of little value in distinguishing benign and malignant thyroid follicular neoplasms. In this study, we investigated clinical and histopathologic characteristics of cytologically indeterminate thyroid follicular lesions (ITFL) in attempt to predict malignancy as determined by histopathologic examination. Fifty-seven patients diagnosed with ITFL underwent thyroidectomy. The mean patient age was 50.4 +/- 13.4 years. Based on the histopathologic findings, cases were classified into 3 categories: nonfollicular lesion (NF), follicular adenoma (FA), and follicular carcinoma (FC). The NF group contained 19 subjects with nodular colloidal goiter (NCG), 3 with Hashimoto thyroiditis. and one with granulomatous thyroiditis. The FA group contained 7 classic follicular and 8 Hurtle cell adenomas. The FC group contained 6 classic follicular, 8 Hurtle cell, and one insular carcinoma. The mean nodule size was significantly larger in the FC group than in the FA and NF groups (4.2 +/- 2.4 cm vs 2.2 +/- 0.9 cm and 2.5 +/- 1.3 cm, respectively, P < 0.05). Using a value of nodule size of 3 cm, the sensitivity and specificity for solvent malignant histology are 66.7% and 83.3%, respectively. These data show that nodule size of ITFL is predictive of malignancy. A nodule size greater than 3 cm is associated with a higher probability of malignancy and suggests total thyroidectomy as an initial therapeutic intervention.

Bu çalışma, 26 Nisan 2003 tarihinde Lyon[Fransa]'da düzenlenen 6. European Congress of Endocrinology'de bildiri olarak sunulmuştur. To examine serum leptin concentrations in obese and lean patients with polycystic ovary syndrome (PCOS) to assess whether the changes in leptin levels are due to obesity or hormonal alterations. Controlled clinical study. Academic research environment. Obese and lean women with PCOS. Blood samples were collected before and after food consumption. Serum leptin and insulin levels. Serum leptin concentrations were significantly correlated with body mass index (r = 0.649) and also with HOMA (r = 0.535). However, after controlling for body mass index in a partial correlation analysis, no significant correlation was found between serum leptin levels and HOMA or hyperinsulinemia. While lean patients with PCOS had a significant correlation between leptin concentrations and obesity parameters, they did not show any significant correlation with insulin resistance parameters. Although leptin concentrations in women with PCOS correlate with insulin resistance/hyperinsulinemia, this is related only to obesity.

OBJECTIVE. The purpose of this study was to evaluate the long-term efficacy of polyurethane stent placement in adults with nasolacrimal duct obstruction. SUBJECTS AND METHODS. Polyurethane stents were placed under fluoroscopic guidance in 52 eyes of 49 patients (mean age, 43 years) with severe epiphora due to idiopathic nasolacrimal duct obstruction. The obstruction was complete in 44 eyes and partial in eight. Clinical success was defined as complete resolution of or great improvement in the symptoms of epiphora and the patency of the lacrimal system to irrigation. Mean follow-up was 23 months (range, 14-44 months). RESULTS. Stent placement was technically successful in 50 eyes (96%). The mean fluoroscopy screening time was 2.2 min (range, 0.2-5.8 min). Two patients were lost to follow-up. Clinical success was obtained in 33 (69%) of 48 eyes. Lacrimal symptoms developed in 23 (70%) of these 33 eyes at least once during the follow-up, but these patients responded well to topical drug treatment and lacrimal irrigation. External dacryocystorhinostomy was performed in 13 eyes after failure of the stents. At surgery, lacrimal sacs were shrunken, hyperemic, and fragile in all eyes, making it difficult to anastomose with nasal mucosa. Histologic examination showed granulation tissue and chronic inflammation of the sac epithelium. CONCLUSION. The success rate of the nasolacrimal stent decreases as follow-up lengthens. After stent treatment, lacrimal symptoms frequently develop, even if the stent remains patent, and require multiple office visits and therapy. The polyurethane stent may induce a chronic inflammatory response in the lacrimal sac, which can interfere with subsequent dacryocystorhinostomy.

This cross-sectional, observational pilot. study was designed to investigate the frequency of different endpoints of genotoxicity (sister-chromatid exchange, total chromosome aberrations, and micronucleus formation) and cytotoxicity (mitotic index, replication index, and nuclear division index) in the peripheral lymphocytes of patients with type-2 diabetes treated with different oral anti-diabetic agents for 6 months. A total of 104 patients who met the American Diabetes Association criteria for type-2 diabetes were enrolled in the study. Of the 104 patients, 33 were being treated with sitagliptin (100 mg/day), 25 with pioglitazone (30 mg/day), 22 with rosiglitazone (4 mg/day), and 24 with medical nutrition therapy (control group). The results for all the genotoxicity endpoints were significantly different across the four study groups. Post hoc analysis revealed that the genotoxicity observed in the sitagliptin group was significantly higher than that observed in the medical nutrition therapy group, but lower than that occurring in subjects who received thiazolidinediones. All of the three cytotoxicity endpoints were significantly lower in patients treated by oral anti-diabetic agents compared with those who received medical nutrition therapy. However, the three indexes did not differ significantly in the sitagliptin, rosiglitazone, and pioglitazone groups. Taken together, these pilot data indicate that sitagliptin and thiazolidinediones may exert genotoxic and cytotoxic effects in patients with type-2 diabetes. Further investigations are necessary to clarify the possible long-term differences between oral anti-diabetic drugs in terms of genotoxicity and cytotoxicity, and how these can modulate the risk of developing diabetic complications in general and cancer in particular.

The objective of this study was to investigate the effect of G870A gene polymorphism of CCND1 on the formation and behavioral features of prolactinomas. One hundred and thirteen patients with prolactinoma and 108 age and gender matched control were included in the study. The patients were divided into two groups as noninvasive and invasive tumors. CCND1 G870A gene polymorphism was compared in patients/control and invasive/noninvasive groups. A and G allele frequencies were found as 41.7% and 58.3% in the controls, and 61.1% and 38.9% in the patients (p

Previous studies have suggested an influence of vitamin D receptor alleles on bone metabolism and on susceptibility to type 1 diabetes mellitus in different ethnic populations. We aimed to investigate the distribution of vitamin D receptor (VDR) alleles in relation to biochemical bone turnover parameters and bone densitometry measurements in a group of Turkish type 1 diabetic patients. One hundred and seventeen patients (M/F 57/60, 27.6 +/- A 7.3 y duration of diabetes 8.1 +/- A 6.3 y) and 134 healthy controls (M/F 61/73, 26.2 +/- A 5.3 y) were included in the study. Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry (DEXA). The vitamin D receptor gene (VDR) polymorphisms FokI, Bsm1, Apa1, and Taq1 were examined using a PCR-based restriction analysis. Serum levels of calcium, phosphor osteocalcin, intact parathyroid hormone, and C telopeptide were measured. Vitamin D receptor Bsm1 Fok1, Apa1, and Taq1 genotype distributions were not different between patient with diabetes and control groups. BMD was 0.77 +/- A 0.2 g/cm(2) vs. 0.97 +/- A 0.2 g/cm(2) (P = 0.0001) for the femur, 1.0 +/- A 0.1 g/cm(2) vs. 1.13 +/- A 0.1 g/cm(2) (P = 0.001) for type 1 diabetic patients and controls. Bone turnover markers were significantly lower in type 1 diabetic group. BMD measurements and bone metabolic markers were not different between the genotypes in either the patient with diabetes or the controls. The VDR gene polymorphisms, Bsm1, Fok 1, Apa1, and Taq1 showed no influence on bone metabolism in our group of type 1 diabetic patients. Turkish Diabetes Foundation

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

Aim Sitagliptin is not associated with weight gain and has neutral effects on body weight. It is unclear whether sitagliptin treatment alters serum ghrelin levels in people with type 2 diabetes. Methods Forty-four subjects with type 2 diabetes were randomly assigned to receive sitagliptin or medical nutrition therapy (MNT) for 12 weeks. Changes in anthropometric variables, glycemic control, insulin resistance, lipid parameters, and total ghrelin levels were evaluated at baseline and following 12 weeks of treatment. Results Significant decreases in body weight and body mass index were observed over the entire study period in both treatment groups. Glycosylated hemoglobin and postprandial plasma glucose levels were statistically significant decreased in the groups receiving sitagliptin compared with baseline values ( p = 0.021 and p = 0.021, respectively), while they were unchanged in the groups receiving MNT. There was a significant decrease in total ghrelin in the groups receiving sitagliptin ( p = 0.04) compared with baseline values but not in the groups receiving MNT ( p = 0.46) at the end of the 12 weeks. Conclusions In this study of patients with type 2 diabetes, treatment with sitagliptin was associated with a significant decrease in serum ghrelin levels. These results suggest that the neutral effect of sitagliptin on weight might be associated with the suppression of fasting serum ghrelin levels.

Low levels of soluble receptor for advanced glycation end products (sRAGE) have been associated with the occurrence of vascular complications in patients with type 2 diabetes mellitus. Preliminary evidence has suggested that thiazolidinediones have the ability to modulate circulating levels of this molecule in the hyperglycemic milieu. The aim of this pilot study was to assess the differential effect of 2 different thiazolidinediones—pioglitazone and rosiglitazone—on plasma levels of sRAGE in type 2 diabetes mellitus patients. Sixty type 2 diabetes mellitus subjects were randomly assigned to receive pioglitazone (30 mg/d, n = 19), rosiglitazone (4 mg/d, n = 20), or placebo (medical nutrition therapy, n = 21) for 12 weeks. Changes in plasma glucose, glycosylated hemoglobin, insulin resistance (homeostasis model assessment), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and sRAGE were evaluated at baseline and after 12 weeks. At 12 weeks, the pioglitazone (P < .001) group had a significant increase from baseline in sRAGE values that was not seen in the medical nutrition therapy and rosiglitazone groups. We conclude that, in type 2 diabetes mellitus patients, pioglitazone—but not rosiglitazone—significantly raised sRAGE, which may contribute to its antiatherogenic effects.

Insulin resistance (IR) is one of the common features of the polycystic ovary syndrome (PCOS), and recent studies indicate the possible role of vitamin D in the pathogenesis of IR and glucose metabolism. Aim of this study was aimed to determine the effect of vitamin D replacement therapy on glucose metabolism, insulin, and androgen levels in obese, insulin-resistant women with PCOS. Eleven women with PCOS were included in the study. Mean age of the patients was 23.6+/-5.7 yr, body mass index 33.9+/-5.1 kg/m(2). Six patients (54.5%) had acantosis nigricans and 10 (90.9%) oligoamenorrhea. The mean Ferriman Gallwey score was 14.1+/-4.6. Only 2 women were within the normal limits of vitamin D levels as >20 ng/ml. Three weeks after the administration of the single dose of 300,000 units of vitamin D3 orally, 25-hydroxyvitamin D3 significantly increased from 16.9+/-16 ng/ml to 37.1+/-14.6 ng/ml (p: 0.027) and only 2 women were detected to have vitamin D3 levels

Apart from fasting blood glucose (FBG) and insulin (FBI), oral glucose tolerance test (OGTT) is also used in calculating insulin sensitivity. During OGTT, insulin secretion may not reflect normal physiological insulin secretion. Based on this idea, hepatic and whole body insulin sensitivity rates were tested during OGTT and mixed meal test (MMT) in obese subjects. Thirty-one women with Quantitative Insulin Sensitivity Check Index (QUICKI) values below 0.350 and body mass index (BMI) a parts per thousand yen30 were included into the study. OGTT with 75-g glucose and MMT 300 kcal were applied to all cases. Data obtained from OGTT and MMT were used in the assessment of insulin sensitivity with Hemostasis of Model Assessment-Insulin Resistance (HOMA-IR) and Matsuda's Composite Whole Body Insulin Sensitivity Index (Matsuda's ISI). Mean BMI, FBG, and FBI were 36.8 +/- A 3.9 kg/m(2), 100.5 +/- A 0.10 mg/dl, 16.2 +/- A 5.3 mu g/ml, respectively. QUICKI was 0.31 +/- A 0.01 and HOMA-IR was 3.71 +/- A 0.88. Matsuda's ISI derived from OGTT was 6.96 +/- A 3.35 and from MMT was 11.32 +/- A 6.61. In analysis, it was demonstrated that there was a correlation between HOMA-IR, QUICKI, and Matsuda's ISIs derived from OGTT and MMT. Comparing the time periods separately, it was detected that despite similar increment in insulin levels, glucose levels were higher in OGTT than MMT at 15 and 30 min. Consequently, Matsuda's ISI was demonstrated to be effectively used with the data of MMT, as used with OGTT. Moreover, MMT was shown to be in parallel to physiologic insulin secretion and reflect pancreatic functions better compared to OGTT.

Ghrelin, a potent gut-brain orexigenic peptide, has a role in stimulation of food intake and long-term regulation of body weight. Metformin and pioglitazone treatment have different effects on body weight. This discrepancy might be related with the effect of these two drugs on plasma ghrelin levels. We investigated the effect of these two drugs on post-prandial acylated and total ghrelin levels in patients with type 2 diabetes. Eleven patients treated with diet, 12 patients treated with 850 mg/day metformin monotherapy and 12 patients treated with 30 mg/day pioglitazone monotherapy for at least 6 months were enrolled in the study. Plasma acylated and total ghrelin levels were investigated at baseline and at the 60 th , 120 th , 180 th , 240 th minutes after a mixed meal test. There were no differences between groups in any of baseline metabolic and anthropometric parameters, including acylated and total ghrelin levels. Acylated and total ghrelin concentrations were suppressed similarly after food consumption, and we could not determine any significant difference between the groups at any time interval. A prolonged postprandial suppression of acylated ghrelin concentrations was observed in the pioglitazone treatment group compared with baseline values. In conclusion, total and acylated ghrelin levels after a mixed meal test were similar in type 2 diabetic patients treated with metformin, pioglitazone or diet therapy alone. These results suggest that changes in body weight during metformin and pioglitazone treatment are not associated with plasma ghrelin levels.

Oxidative stress-induced DNA damage seems to play a role in the pathogenesis of type-1 diabetes mellitus and its complications. Several in vitro assays have been used to measure the DNA damage produced by oxidative stress. In the present study, we aimed to investigate the frequency of sister chromatid exchange (SCE), chromosomal aberrations (CA) and micronuclei (MN) in type-1 diabetes mellitus patients compared with healthy controls. SCE. CA and MN tests were carried out with the blood-cell cultures from 35 type-1 diabetic patients and 15 healthy, age- and sex-matched control subjects. The mean age of the type-1 diabetic patients was 31.89 +/- 10.01 years, with a mean duration of the diabetes of 7.8 +/- 6.02 years. The mean level of HbA1c of the type-1 diabetic patients was 8.37 +/- 1.36%. Only three (8.5%) patients with type-1 diabetes mellitus had an HbA1c level below 7%. Patients with type-1 diabetes mellitus showed a higher frequency of SCE compared with controls (5.44 +/- 1.47 and 2.54 +/- 0.82, respectively, p < 0.001). but there was no significant correlation between the duration of diabetes, HbA1c and SCE. No significant difference was found in CA or MN frequency in type-1 diabetic patients compared with controls. In conclusion, these results suggest that type-1 diabetes mellitus is a condition with genomic instability characterized by an increased level of SCE. Hyperglycemia-induced oxidative stress may be the underlying factor of the increased SCE frequency.

Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >= mmol/l and hemoglobin glycated (A1C) >= 9% under maximal CAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty Patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9 +/- 1.4% to 7.7 +/- 1.1% in group 1 and 11.0 +/- 1.4% to 8.1 +/- 1.4% in group 2. FBG levels were significantly decreased from 11.9 +/- 2.7 to 7.1 +/- 2.3 mmol/l in group 1 and 11.1 +/- 2.5 to 6.8 +/- 1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3 +/- 3.8 to 10.3 +/- 3.0 mmol/l in group 1 and 14.0 +/- 3.1 to 8.9 +/- 2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Syptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulance incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.

Purpose To evaluate morphologic changes occurring in the retrobulbar region after optic nerve sheath decompression (ONSD) in patients with idiopathic intracranial hypertension using magnetic resonance (MR) imaging. Design Prospective observational study. Methods This study included 26 eyes of 17 patients (age range, nine to 57 years) with idiopathic intracranial hypertension who underwent ONSD. The surgery was performed through transconjunctival medial orbitotomy and by a dural window excision. After ONSD, the optic nerves were examined with MR imaging by means of 3-dimensional “constructive interference in steady state” (CISS) sequence. Results After ONSD, papilledema resolved in all eyes and visual functions improved in all except one. Early postoperative MR imaging (two to eight weeks after surgery) demonstrated a cyst-like fluid collection adjacent to the dural window site in nine (75%) of 12 eyes and a fibrous tissue formation in three eyes (25%). Late postoperative MR imaging (six to 15 months after surgery) demonstrated a fibrous tissue formation at the decompression site in 25 eyes (96%) and perioptic fluid collection in one eye (4%). Conclusions In early postoperative period after ONSD, a fluid collection adjacent to the decompression site occurs in most eyes; this finding disappears in late period. Early postoperative MR findings support the idea that ONSD functions through the cerebrospinal fluid (CSF) filtration.

A rare case of thoracoabdominal duplication is reported. Radiological workup including US, CT and MR provided the correct diagnosis. The US revealed the cystic nature of the lesions, whereas CT and MR showed their relationship with the diaphragm and each other. Coronal- and sagittal-plane MR images were helpful in demonstrating the extension of the lesions. The patient was discharged after an uneventful surgery and recovery. The histological evaluation revealed the cyst lined with single-layered columnar epithelium and the cyst wall contained submucosal mucous glands with underlying smooth muscle and also some mature chondroid elements with bronchogenic origin. Radiological findings and differential diagnosis are discussed.

OBJECTIVE. ne purpose of this study was to assess the advantages of the image subtraction technique in chemical shift MRI for the differentiation of adrenal adenomas from nonadenomas. SUBJECTS AND METHODS. Thirty-five patients with 42 adrenal masses (eight metastases and 34 nonfunctioning adenomas) underwent chemical shift MRI using a double-echo fast low-angle shot sequence. Subsequently, opposed-phase chemical shift MR images were subtracted from in-phase images, The subtraction images were assessed quantitatively and qualitatively. For quantitative assessment, the signal intensity values of the adrenal masses were measured by one investigator with manually defined regions of interest. Qualitative assessment of the subtraction images was performed independently by two investigators, who reported their confidence in diagnosing adenomas versus nonadenomas based on signal intensity of the adrenal masses on subtraction images. RESULTS. The mean signal intensities were significantly different between adenomas and metastases on subtraction images (213 vs 18: p < 0.0001). There was no overlap in signal intensities between adenomas and metastatic tumors, The accuracy in distinguishing adenomas from metastatic tumors was 100% if the cutoff value of the signal intensity selected was 36-106. Quantitative results corresponding to 100% specificity were also observed, with similar sensitivity. No difference in interpretation between the two investigators occurred. CONCLUSION. Chemical shift subtraction MRI provides a high confidence level in distinguishing adrenal adenomas from adrenal metastases. The image subtraction technique also facilitates quantitative and qualitative evaluation of adrenal masses in chemical shift MRI.

Background. To evaluate the obesity status, factors and comorbidities related to it in three district municipalities (DM) that compose city center of Bursa with inhabitants of different socioeconomic status. Methods. A total of 1632 inhabitants greater than or equal to 18 years of age were interviewed. The number of sample in each DM was obtained proportional to their populations by stratified sampling method. Among 1632, a total of 1543 subjects were included by random sampling and a questionnaire was filled in including demographic, social and behavioral features. Results. The participants living in DM with the highest socioeconomical status (SES) score and level of education had the lowest body mass index (BMI) and body fat percentage (%BF) compared to other DMs. The lowest obesity prevalence (30.8% vs. 36.4% and 39.3%) in that DM was possibly due to younger age, lower female ratio, more active professional, higher percentage of smoking, more consumption of vegetables, olive or corn oil, and less carbohydrate. For the evaluation of the factors that may influence obesity risk, we investigated the effects of these factors in men and women separately with logistic regression model. Sedentary life style and dyslipidemia (DL) in men, being unemployed, having lower level of education and having hypertension (HT) in women and familial obesity in both gender were found to be related to increased obesity risk. Conclusions. The prevalence of obesity in Bursa is increasing although inhabitants are taking some precautions parallel to their socioeconomical and educational levels. Obesity is becoming a more alarming public health problem in Bursa and Turkey like in most other parts of the world, which forces us to invent new prevention policies. Besides, the results of our study highlight the fact that especially female education requires more attention for decreasing obesity prevalence in coming generations.

Brown tumor is an important but rare complication of primary hyperparathyroidism. It is seen in approximately 1% of the cases. Common involvement areas are long bones, ribs, hand, skull, pelvic bones, and mandible. The maxillary sinus is a rare involvement site. Patellar bone involvement has not been reported. Because brown tumor and giant cell tumor have similar histopathologic findings, the differential diagnosis is important. We present a patient with ectopic parathyroid adenoma with multiple brown tumors located in uncommon areas such as the maxillary sinus and patella. A 54-year-old female patient was operated on 3 times for the suspicion of osteal giant cell tumor. After admission, the diagnosis of primary hyperparathyroidism was suggested by the clinical history. This was confirmed by biochemical, radiologic, and histopathologic determinations. Excision of an ectopic parathyroid adenoma normalized the metabolic status. The unusual brown tumor localizations were important in the differential diagnosis of lytic skeletal lesions.

Background & objectives: Tumour necrosis factor-alpha (TNF-α) has been suggested to play a key role in insulin resistance (IR) in obesity and may contribute to the development of type 2 diabetes mellitus. Recently, studies are focused on the effect of antihypertensive drugs on insulin sensitivity and cytokines. We undertook this study to evaluate the effect of amlodipine, a long-acting dihydropyridine calcium channel blocker treatment on TNF-α, homeostasis model assessment (HOMA) IR and leptin levels in obese hypertensive type 2 diabetic patients. Methods: Amlodipine 5-10 mg for 12 wk was given to type 2 diabetic patients in the amiodipine group. Pre- and post-treatment values of laboratory parameters in the amlodipine group were compared with those of normotensive nondiabetic obese controls. At baseline blood pressures (BP) and metabolic parameters were measured in all patients and repeated after 12 wk in the amlodipine group. Results: Basal waist-to-hip ratio, systolic and diastolic BPs, fasting glucose, TNF-α and HOMA-IR values of the amlodipine group were higher than the control group. No difference was detected in body mass index, fasting insulin, hemoglobin Alc and leptin values between groups. The systolic and diastolic BPs, fasting glucose, HOMA-IR and TNF-α values decreased significantly after the treatment. But, there was no correlation between percentage change in TNF-α and HOMA-IR. Interpretation & conclusion: Besides reducing BP, amlodipine seemed to improve IR and decrease TNF-α levels. In this context, these properties may provide additional benefits of antihypertensive drug regimens chosen for this population, but larger group interventions are needed.

A prospective study was undertaken to assess the value of both T2-weighted spin-echo (SE) and contrast-enhanced dynamic gradient-echo (GRE) sequences using MR imaging in differentiating the deep myometrial invasion from lower stages produced by endometrial carcinoma. For the correlation of MR findings with the histopathologic findings, patients who had no myometrial invasion (stage 1 a) and patients in whom tumors were confined to the superficial myometrium (stage 1 b) at pathologic examination were combined as lower stages. Twenty patients with endometrial carcinoma were studied using both techniques. The absence of any detectable tumor (stage 1 a) or the presence of a tumor confined to inner half of myometrium (stage 1 b) and extention of tumor to the outer half of myometrium (stage 1 c) were used as the diagnostic criteria. In pathologic examination of excised specimens, deep myometrial invasion was detected in 9 of 20 patients. The sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of T2-weighted SE in differentiating deep myometrial invasion from combined lower stages were 88, 91, 90, 88, and 91 %, respectively, whereas corresponding values for contrast-enhanced dynamic GRE sequences were 78, 100, 90, 100, and 85 %. Statistical difference between two sequences did not reach a significant level. We conclude that in cases of absence of visible junctional zone with SE sequence, contrast-enhanced dynamic GRE MR imaging may be helpful.