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This experiment was carried out in order to determine the best almond cultivars for irrigated areas in Gaziantep, Turkey. The experimental orchard was established at 3 × 5 m in spacing in 1998. Twenty almond cultivars and types were used as material based on tree growth, bearing, yield and some quality characteristics. The best diameter growth of trunk was occurred on Yaltinski cultivar. The highest yield per decare (0.1 ha.) was obtained from Ferraduel (572.6 kg), Cristomorto (516.7 kg), Yaltinski (504.9 kg) and 101-23 (500.9 kg) in 2003.

This study was carried out on Uzun and Siirt pistachio cultivars present at the Pistachio Research Institute orchards. After the most suitable pruning, fertilization and irrigation practices, different plant growth regulators were sprayed on entire trees at the different doses, and effects of plant growth regulators on alternate bearing were investigated.In the study, 10, 25 and 50 ppm 1-Naphthaleneacetic acid (NAA), 25 ppm N-benzyl-9-(2-tetra-hydropyranyl) adenine (BA) and 0.25% urea were used, and 0.25% urea was added to all plant growth regulators’ doses. Plant growth regulators were sprayed to the fruits, buds and leaves to the point of drip. Applications were done two times in year. First application was done at starting kernel development, and second application was done 20 days after the first application.According to the results, the highest yield was obtained from 25 ppm benzyladenine + 0.25% urea in Uzun (4.98 kg per tree) and 47.29% of inflorescence buds retained in this application. The lowest yield was obtained from control as 4.05 kg per tree and 47.56% of inflorescence buds retained in control.At the Siirt, the highest yield (8.26 kg per tree) was obtained from 0.25% urea application and 51.58% of inflorescence buds retained in this application. The lowest yield was obtained from 50 ppm naphthalene acetic acid application (5.16 kg per tree) and 58.49% of inflorescence buds retained in this application. At the Siirt , 5.53 kg yield per tree was obtained from control and 6.01 kg per tree obtained from 25 ppm benzyladenine + 0.25% urea.

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: 000351184700008 The present study aimed to measure the distribution of water loss via evapotranspiration (ET) in a pistachio tree orchard under drip irrigation and non-irrigation conditions at the experimental orchard of the Pistachio Research Institute, Gaziantep, Turkey. The experimental design consisted of a 10 x 10 m(2) grid system constructed of PVC pipes spaced 2 in apart (horizontally and vertically) that was placed around each tree for the drip irrigation condition (water applied every 7 days) and the non-irrigated condition. Moisture content was measured using the neutron scattering method for both treatments. Water loss via ET was estimated based on the soil water balance method, which included measurement of soil moisture, precipitation, and irrigation. Total water loss via ET under drip irrigation conditions was 518 mm vs 220 mm under non-irrigated conditions. Water loss via ET for the total soil profile and individual layers under non-irrigated conditions was higher at the four outer corners of each 10 x 10 m(2) grid than under irrigated conditions. Moreover, water loss via ET was the highest at the grid system pipes closest to the two laterals under irrigation conditions. In addition, the total percentage of water loss via ET was the highest at the 60-80-cm and 20-40-cm soil layers under drip irrigation and non-irrigation conditions, respectively, and the total percentage of water loss via ET was the lowest at the 40-60-cm and 0-20-cm soil layers under drip irrigation and non-irrigation conditions, respectively. Lastly, it could be considered that root density increased as water loss via ET increased. TUBITAK (Turkish Scientific and Technological Research Council)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) The authors thank TUBITAK (Turkish Scientific and Technological Research Council) for financial support of this study. Furthermore, the authors thank Dr. E. Uz of the University of Uludag, Bursa, Turkey, and Dr. T. SHAPLAND of the University of California, Davis, USA, for their help in preparing this manuscript.

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.

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.

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.

Karabulut, Ismail/0000-0002-1339-5385 WOS: 000327592600026 PubMed: 25558576 Aim: This study was designed to investigate the function of outer hair cells and medial olivocochlear efferents in type II diabetes mellitus (DM). Materials and methods: There were 50 patients with type II DM and 51 age-and sex-matched healthy controls included in the study. Both groups were compared in terms of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and contralateral suppression of TEOAE. Results: Pure tone thresholds of the patients with type II DM were significantly higher than in the controls (P < 0.05). The TEOAE amplitudes at 1 kHz and at 1.5, 2, 3, 4, and 6 kHz signal-to-noise ratio amplitudes on DPOAE testing were significantly lower in the patients than controls (P < 0.05). There was no significant difference between the type II DM and control groups regarding contralateral suppression test results of TEOAEs. Conclusion: Type II DM seems to impact the auditory system at the cochlear level by affecting the functions of outer hair cells, and it results in elevation of the thresholds on audiometry and a decrease in the amplitudes of otoacoustic emissions.

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.

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.

To compare the urine iodine, fluoride, and to measure thyroid volumes in 10-15-year-old children using ultrasonography, a gold standard in evaluating thyroid volume.A total of 261 children were enrolled into the study group from the 4-8th grades of 3 different primary schools, which were in the zone with high fluoride levels. The control group was formed by enrolling 298 children from the 4-8th grades of only one primary school. Age, gender, height, and weight values were recorded for the children. The urine iodine, fluoride, and thyroid volumes were measured with ultrasonography in 10-15-year-old children with fluorosis and controls and compared between two groups.The mean urine fluoride level was 0.48±0.24 mg/L in the study group and 0.22±0.17 mg/L in the control group (p0.001). The mean urine iodine level did not differ between two groups. The mean total thyroid volume was 8.60±3.11 mL and 8.73± 2.75 mL in the study and control group, respectively. The groups were also compared according to the echobody index, and the score was 6.94±2.14 ml/m² in the study group and 6.48±1.53 ml/m² in the control group (p=0.003). Mean thyroid volumes did not differ between two groups. However, the echobody index in the study group was higher than in the control group.A relation between fluoride concentration and thyroid gland with ultrasonographic examination was firstly evaluated, and it was concluded that fluoride affected thyroid gland although it was weakly significant. After puberty, echobody index in subjects with fluorosis was markedly high. Based on our results, we thought that fluorosis increases thyroid volume in children with fluorosis after puberty.

WOS: 000306131300022 PubMed: 22771654 In 2009 winter, Influenza A (H1N1) monovalent split virus vaccine was used prevalently in the whole world as a result of the pandemic caused by Influenza (H1N1) virus. The vaccine's adverse effects were observed closely and vaccination has been found as safe in most studies. But some reports about immune response related diseases after influenza vaccinations are remarkable. The close relationship between membranous glomerulonephritis and antigens is known, particularly in seconder forms which occur after viral infections and vaccinations. So this case report is about a 56-year-old man, who developed membranous glomerulonephritis 23 days after the vaccination against Influenza A (H1N1) virus.

Diabetes mellitus (DM) is a chronic disease requiring continuous monitoring and treatment. Self-monitoring of blood glucose (SMBG) is frequently recommended. The purpose of the study was to evaluate effectiveness of SMBG on metabolic control in Turkish patients with type 2 DM.The cross-sectional study enrolled type 2 diabetic patients without insulin regimen. The participants were assigned to three groups according to status of SMBG: group 1- regular, group 2 - irregular and group 3 - never SMBG implementation.A total of 349 patients were enrolled. There was no significant difference in mean fasting and post-prandial blood glucose, lipid profile values between the groups. The number of patients with high education level in group 1 was higher than groups 2 and 3 (p = 0.001). HbA1c level was higher in groups 2 and 3 than group 1, but not significantly (p = 0.285). Mean spot urinary albumin- creatinine ratio (ACR) in group 1 is significantly lower than in groups 2 and 3 (p = 0.008 and p = 0.044, respectively), but no significant difference was observed between group 2 and 3 (p = 0.473).The study indicated that regular use of SMBG was not superior to irregular/never use of SMBG on glycemic control, but it seemed to be good intervention for prevention of diabetic nephropathy. We suggestively offered that SMBG should be recommended for patients with a high education level to meet the goal of its use, and it should be incorporated into self-management with effective educational intervention.

Background: Metabolic syndrome is a systemic atherosclerotic cascade terminating with multi-organ failures. Methods: Consecutive patients with Coronary Heart Disease (CHD) were studied. Results: Study included 1,620 females and 1,240 males. Prevalences of CHD were similar in both sexes (3.8% versus 4.4%, respectively, p>0.05). Mean ages of CHD cases were 61.5 versus 63.5 years in both sexes, respectively (p>0.05). Smoking and Chronic Obstructive Pulmonary Disease (COPD) were higher in males with CHD (54.5% versus 9.6%, p 0.05 for both) probably due to small sample sizes of the groups. Whereas low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were higher in females with CHD, significantly (132.6 versus 115.6 mg/dL, p=0.008 and 250.3 versus 150.1 mg/dL, p=0.002, respectively). Similarly, hypertension (HT) and diabetes mellitus (DM) were also higher in females with CHD, significantly (58.0% versus 30.9%, p

WOS: 000298148800028 PubMed: 22153539 Background: Transforming growth factor-beta 1 (TGF-beta 1) contributes to tissue repair by promoting tissue fibrosis, and elevations have been reported in patients with bone marrow fibrosis. The aim of this study was to evaluate the relationship between TGF-beta 1 levels and vitamin D deficiency. Methods: All patients presenting to the outpatient Endocrinology and Metabolic Diseases clinic between June and September of 2008 were approached, and consenting patients who were deemed suitable candidates were enrolled. Hematological parameters were measured, along with serum levels of total and ionized calcium, phosphorus, parathyroid hormone, iron, folic acid vitamin B12 levels, 25 OH vitamin D3 (25OHD(3)) and TGF-beta 1. Results: A total of 132 patients were included in the study. Patients were divided into 4 groups based on levels of 25OHD(3) [group 1 (< 5 ng/ml), 20 patients; group 2 (5-15 ng/ml), 38 patients; group 3 (16-30 ng/ml); and group 4 (> 30 ng/ml), 28 patients]. TGF-beta 1 levels were higher in patients in group 1 compared to the other groups. Transforming growth factor-beta levels correlated negatively with vitamin D3 and positively with leukocyte count, platelet count, of MCV and MCH. Multiple regression analyses revealed TGF-beta 1 levels to be associated with 25OHD(3) as well as with platelet count. Conclusions: Results of this study are suggestive of the presence of a significant relationship between TGF-beta and vitamin D deficiency. Increased TGF-beta 1 and platelet count may be an early indicator of bone marrow fibrosis in patients with vitamin D deficiency. Crown Copyright (C) 2011 Published by Elsevier B. V. on behalf of European Federation of Internal Medicine. All rights reserved.

Lymphatic mapping and sentinel lymphadenectomy on a rare malignant blue nevus of the eyelid are reported. The treatment was wide excision and reconstruction. A 72-year-old male was referred with a progressively growing right lower eyelid mass on a blue flat lesion. Incisional biopsy confirmed malignancy. After wide tumor excision the resulting defect was reconstructed with Mustarde's cheek flap and a chondromucosal graft. A submandibular lymph node was found with intraoperative lymphatic mapping and sentinel lymphadenectomy technique. Histopathologic examination revealed a malignant blue nevus with sentinel lymph node involvement. Additional surgery or chemotherapy was not possible because of the patient's unfavorable general health. He was followed for 1 year without local or distant metastasis. Sentinel lymphadenectomy should be in the armamentarium of surgeons. This method provides important information about regional lymph node status and staging of patients as in malignant melanoma.

WOS: 000303584800021 PubMed: 22187359 Hyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8 +/- 10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0 +/- 10.1 vs. 30.7 +/- 9.8, P = 0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 +/- 347.0 vs. 238.8 +/- 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels.

WOS: 000308817000016 PubMed: 21863263 Long-acting somatostatin analogs are frequently used as adjuvant treatment of acromegaly patients after noncurative surgery. This sudy aims to compare the efficacy of octreotide long-acting release (OCT) and lanreotide Autogel (LAN) in acromegaly patients. Sixty-eight patients not cured by transsphenoidal endoscopic or microscopic pituitary surgery between 2003 and 2009 were retrospectively analyzed (25 men; 43 women; mean age 41.1 +/- A 10.9 years [range 18-65 years]). The patients were assigned randomly to OCT (n = 36) and LAN (n = 32) groups. Evaluations included insulin-like growth factor I (IGF-I) and growth hormone (GH) after oral glucose tolerance test (OGTT) 3, 6, 12 and 18 months after starting medical treatment; pituitary magnetic resonance imaging was performed before treatment and after 3 and 12 months. Patients achieving IGF-I levels within the age and gender normal range and GH level < 1 mu g/l following OGTT were considered a 'biochemical cure'. Mean IGF-I and GH values and tumor volumes (cm(3)) in the LAN and OCT groups were similar in the post-operative period before initiation of medical treatment. A statistically significant decrease in GH and IGF-I levels was obtained for both treatment groups at each follow-up visit compared to the previous value. Tumor shrinkage after 12 months of treatment was statistically significant in both groups but the percentage tumor shrinkage (28.5% vs. 34.9%, P = 0.166) and rate of patients achieving biochemical cure (63.9 and 78.1%, P = 0.454) were similar between OCT and LAN groups, respectively. OCT and LAN treatment options have similar efficacy for ensuring biochemical cure and tumor shrinkage in acromegaly patients who had noncurative surgery. Ipsen (Paris, France) Editorial assistance was provided by Martin Gilmour at ESP Bioscience (Crowthorne, UK) and funded by Ipsen (Paris, France). We have not received any funding support for the study.

Thyroid stimulating hormone (TSH) secreting pituitary adenomas are rare tumors manifested as hyperthyroidism with goiter in the presence of elevated TSH. We present a case with pituitary adenoma secreting both TSH and growth hormone (GH) with the prominent clinical findings of hyperthyroidism but without clinical findings of acromegaly. Pituitary magnetic resonance imaging revealed a macroadenoma. Transsphenoidal surgery was performed twice. The immunohistochemical staining showed that tumor cells were strongly reactive to GH and relatively mildly reactive to TSH. Control pituitary imaging revealed a residual macroadenoma, and long acting octreotide treatment was administered. After two years of the treatment, tumor size remained the same while thyroid function tests and insulin-like growth factor 1 (IGF-I) values returned to normal ranges. In conclusion, we always recommend hormonal examinations for all patients who have pituitary adenoma without signs and symptoms of acromegaly.

WOS: 000300805400004 PubMed: 21742606 Objective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P

WOS: 000295101200010 PubMed: 21949584 Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.

This experimental study was carried out between the years of 1997 and 2008 to determine the best pistachio rootstock-cultivar combinations for irrigated conditions in Sanliurfa in Turkey. Four different Pistacia species (Pistacia khinjuk Stocks, Pistacia atlantica Desf., Pistacia vera L. and Pistacia terebinthus L.) were used as rootstocks and five standard pistachio cultivars (Siirt, Ohadi, Kellekoci, Kerman and Selection 14) were grafted on them. Experimental orchard was established by 4x6 m in spacing in 1997. According to selected criteria, such as, tree vigor, bearing, yield and some quality characteristics, the best highlighted combinations were determined. P. khinjuk × Siirt cultivar and P. atlantica × Siirt combinations gave the best results for irrigated conditions in Sanliurfa.

Address for Correspondence/Yaz›flma Adresi: Dr. Talha Dumlu, Duzce Universitesi T›p Fakultesi, Go¤us Hastal›klar› Anabilim Dal›, Duzce, Turkiye Gsm: +90 505 312 82 72 E-mail: talhadumlu@yahoo.com Received/Gelifl tarihi: 09.06.2010 Accepted/Kabul tarihi: 23.09.2010 © Archives of Neuropsychiatry, published by Galenos Publishing. / © Noropsikiyatri Arflivi Dergisi, Galenos Yay›nevi taraf›ndan bas›lm›flt›r. OZET Mirtazapin, major depresyon tedavisinde onay alm›fl, noradrenerjik ve spesifik serotonerjik bir antidepresand›r. Sersemlik, afl›r› sedasyon, ifltahta artma, kilo al›m› ve a¤›z kurulu¤u gibi yan etkileri olabilmesine karfl›n genellikle iyi tolere edilir. Burada, 23 yafl›nda depresif kad›n hastada, mirtazapin tedavisi s›ras›nda geliflen kar›n a¤r›s› ve karaci¤er enzimlerinde yukselme olmas› ve mirtazapin kullan›m› durdurulduktan sonra bulgular›n normale donmesi tart›fl›lm›flt›r. (Noropsikiyatri Arflivi 2011; 48: 162-3) Anahtar kelimeler: Hepatotoksisite, major depresyon, mirtazapin ABSTRACT Mirtazapine is a noradrenergic and specific serotonergic antidepressant that is approved for use in the treatment of major depression. It is generally well tolerated with some mild side effects such as drowsiness, excessive sedation, increased appetite, weight gain, and dry mouth. We present a case of 23 years old female depressive patient who developed abdominal pain and elevation of liver enzymes during treatment with mirtazapine and returned to normal after stopping the mirtazapine use. (Archives of Neuropsychiatry 2011; 48: 162-3)

Obesity, particularly visceral obesity, is associated with increased risk of cardiovascular morbidity and mortality. Therefore, cardiovascular risk should be determined by evaluating visceral fat tissue not only in obese individuals but also in non-obese individuals. We aimed to evaluate the comparison of visceral fat tissue measurement methods with computed tomography (CT).One hundred four participants, 19 to 58 years of age (21 males, 83 females) were enrolled in this study. Participants underwent anthropometric evaluation, bioelectrical impedance analysis (BIA), ultrasonography (US), and CT examinations on the same day.The mean body mass index (BMI) was 31.2 +/- 8.7 kg/m2 (73 individuals [70.2%] had BMIor =30, and 31 individuals [29.8%] had BMI30). The non-obese group (BMI30) that showed the best correlation coefficient values were for visceral fat area (VFA) by BIA in all participants, males and women (r = 0.902, P0.001; r = 0.994, P0.001; r = 0.645, P = 0.01, respectively); in case of BMIor =30 the best correlation coefficient values were for VFA by BIA (r = 0.774, P0.001) for all participants, and visceral fat thickness by US for males (r = 0.851, P0.001), and BMI (r = 0.786, P0.001) for females. Using multiple stepwise regression analysis, the methods best reflecting VFA by CT were as follows: In subjects with BMI25, BIA correlated best with CT measures of VFA; while in subjects with BMI30 waist-to-hip ratio showed the best correlation with CT measures of VFA. The method best reflecting VFA by CT was visceral thickness by US in males; and the method best reflecting VFA by CT in females was visceral thickness by US, BMI and waist circumference.Anthropometric measurements and visceral fat tissue measurement methods such as US and BIA exhibit differences with respect to compliance with CT results in visceral fat tissue measurements by gender and BMI levels.

� Objective: To investigate whether serum matrix metalloproteinase-9 (MMP-9) levels can be used as a diagnostic tool in determining the functioning status of benign adrenal tumors. � Methods: In this case-control study, medical records of patients with adrenal tumors who consecutively presented to an endocrinology clinic between August 2005 and October 2008 were evaluated. Operation was recommended when the incidentaloma was larger than 4 cm or when a hypersecreting tumor was suspected. A control group of healthy persons matched for age, body mass index, and sex was also enrolled. Patients underwent routine endocrinologic examinations. MMP-9 levels were compared preoperatively and postoperatively. Findings were compared among patients with functioning adrenal tumors, patients with nonfunctioning adrenal tumors, and control participants. � Results: Of 370 patients with adrenal tumors, 50 with adrenal incidentaloma met the inclusion criteria. Twentyfive healthy individuals were enrolled as controls. Group 1 included 20 patients with functioning adrenal tumors (14 with Cushing syndrome and 6 with pheochromocytoma), and Group 2 included 30 patients with nonfunctioning adrenal tumors. MMP-9 levels were higher in patients with nonfunctioning adrenal tumors and functioning adrenal tumors than in control participants (P

Thyroid hemiagenesis (TH) is a rare congenital abnormality of the thyroid gland, characterised by the absence of one lobe. The true prevalence of this congenital abnormality is not known because the absence of one thyroid lobe usually does not cause clinical symptoms by itself. This study aims to identify the frequency of TH and associated diseases in outpatients referred to our clinic for the first time.6242 outpatients, who were referred to our thyroid clinic between January 2008 and March 2009 and underwent thyroid ultrasonography, were retrospectively analysed. For patients with TH, demographic data, family history of thyroid disorders, drugs administered, thyroid function parameters, thyroid autoantibodies were examined and thyroid sonography was carried out. Tc99m pertechnetate scintigraphy was performed to confirm the diagnosis of hemiagenesis and to rule out coexisting ectopic thyroid tissue.We identified 10 cases of TH in 6242 outpatients with various thyroid disorders, 8 women and 2 men (ratio 4:1), age 21-63 years, indicating a prevalence of 0.16%. Associated thyroid disease in these patients included: 1 patient with nodular Graves' disease, 1 with Hashimoto's thyroiditis, 4 with euthyroid nodular goiters and 2 with euthyroid multinodular goiters. Nine patients were clinically asymptomatic. However, the patient with nodular Graves' disease presented thyrotoxicosis.TH is a rare congenital anomaly and prevalence of TH in thyroid patients is 0.16%. In our study, the most frequently seen thyroid disease accompanying thyroid hemiagenesis was nodular goiter.

Some precursor P wave changes on electrocardiogram (ECG) before the atrial fibrillation (AF) episodes occur in the hyperthyroidism. Our aim was to compare the effect of two antithyroid drugs (ATD) on P wave duration and dispersion (PWD) in patients with hyperthyroidism.Fifty patients (13 men, 37 women; mean age 39.2+/-13.2 years) with newly diagnosed overt hyperthyroid patients with Graves' disease (GD) were enrolled in the prospective, randomized study. The maximum P wave duration (Pmax) and the minimum P wave duration (Pmin) were measured in all 12-lead surface ECGs. The patients were consecutively randomized to propylthiouracil (PTU) (n=24) and methimazole (MMZ) (n=26) groups. Electrocardiogram was repeated within euthyroid state after the 18-month ATD treatment. Student t-test, Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The differences between pre- and post-treatment measurements within groups were evaluated by Wilcoxon Sign Rank test. The correlation of data was tested by using Spearman correlation analysis.The maximum P wave duration (Pmax) was 90 (80-110) and 90 (90-110) msec, (p=0.586), and PWD was 35 (22.5-48.7) and 40 (30-40) msec, respectively (p=0.952) in PTU and MMZ groups. After euthyroidism was achieved, Pmax was 80 (80-90) and 87.5 (80-90) msec (p=0.676), and PWD was 27.5 (20-35) and 27.5 (20-30) msec in PTU and MMZ groups, respectively (p=0.540). After ATD treatment PWD decreased (p=0.009 and p0.001, respectively) in both of PTU and MMZ groups. However effects of ATD on PWD change were similar (p=0.486).P wave duration and PWD are found to be prolonged in hyperthyroid patients with GD. Both propylthiouracil and methimazole reduce the P wave duration and dispersion. Thus, we can conclude that improvements in atrial conduction properties are not associated with the type of ATD but with only achievement of euthyroidism.

Type 2 diabetes mellitus (DM) is a common disease affecting people in the world and its incidence is increasing rapidly. Cardiovascular disease (CVD) is the most important cause of mortality and morbidity among patients with type 2 DM. Patients with diabetes have a poorer prognosis than patients without diabetes. It is well known that other cardiovascular risk factors such as hyperlipidemia, hypertension and obesity that usually accompany to diabetes mellitus or impaired glucose tolerance as a metabolic syndrome component or not, can contribute to accelerated atherosclerosis and increased risk of cardiovascular event in diabetes mellitus. The management of patient with type 2 DM is not only glucocentric but focuses on multiple risk factor intervention.

A primary effusion lymphoma is a rare type of non-Hodgkin's lymphoma where serous cavities are involved. That-cause peritoneal, pleural and pericardial effusions without any lymphadenopathy. They affect immunosuppressive patients with human herpes virus-8 being the suspected etiological agent. The prognosis is usually poor despite treatment. Herein, the case of an immunocompetent patient with ascites and pleural effusion diagnosed as primary effusion lymphoma is presented and discuss the case in the light of the current literature.

Objective To describe the first case of syndrome of inappropriate antidiuretic hormone secretion with lifethreatening hyponatremia due to rosiglitazone therapy. Methods We describe the clinical, laboratory, and imaging findings of the study patient. Results An 89-year-old woman with a 5-year history of type 2 diabetes mellitus was admitted to the emergency department because of unconsciousness. She had reported generalized weakness for 15 days and nausea and vomiting for 3 days. Findings from laboratory analysis showed severe hyponatremia (sodium, 110 mEq/L). She had normal renal, cardiac, and adrenal function, and she did not have edema or volume depletion. The cause of hyponatremia was syndrome of inappropriate antidiuretic hormone secretion. We did not find any cause for her condition other than rosiglitazone, an antihyperglycemic drug that is increasingly being used in patients with type 2 diabetes mellitus. According to her medical history, rosiglitazone was prescribed 1 month previously after withdrawal of gliclazide. We stopped the rosiglitazone and administered hypertonic saline infusion to treat the hyponatremia. Saline infusion was stopped and blood sodium levels were stabilized in the normal range after 2 days. The patient’s plasma sodium concentration has remained in the reference range at follow-up visits. Conclusions This is the first reported case of syndrome of inappropriate antidiuretic hormone secretion as an adverse effect of rosiglitazone, and this drug should possibly be considered for addition to the list of drugs that cause this condition. (Endocr Pract. 2008;14:1017-1019)

The need to perform fine-needle aspiration biopsy (TFNAB) on subcentimeter thyroid nodules is less clear than for larger nodules. We compared the ultrasonographic features of thyroid nodules less than and greater than one centimeter and correlated this information with the cytological results for TFNAB and the final histopathological diagnosis in selected patients.We evaluated 520 thyroid nodules (247 subcentimeter [group 1], 273 supracentimeter [group 2]) in 426 patients. Ultrasonography-guided fine-needle aspiration biopsy was performed on all nodules. Surgery was recommended for patients with TFNAB results that were read as malignant or suspicious. The results of ultrasonography, TFNAB, and histopathology were compared between the groups.Out of 426 patients, 337 had one nodule, 84 had two, and five had three. There was indeterminate cytology in 20 cases, 10 from each group. Inadequate cytology was obtained in 41/247 (16.6%) nodules in group 1 and 61/273 (22.3%) nodules in group 2, and the difference in rate was not significant (p = 0.067). The malignancy rate as determined by TFNAB was 4.9% in group 1 and 1.5% in group 2 (p0.025). In patients who underwent surgery for thyroid nodules the malignancy rate was 6% in group 1 and 2.9% in group 2 (p = 0.08). Hypoechoic pattern, microcalcification, and a long axis/short axis ratio (LA/SA) of1.5 were associated with malignancy in subcentimeter thyroid nodules (group 1), while only a hypoechoic pattern was associated with malignancy in supracentimeter thyroid nodules (group 2).The incidence of cancer in thyroid nodules1 cm does not appear to be lower than in larger nodules and may even be higher. Physicians should consider obtaining biopsy samples from subcentimeter hypoechoic nodules that contain microcalcification and have a relatively round shape (LA/SA1.5).

The dominant trend today, in all countries, is to integrate the training of teachers into higher education. Turkey completed this integration in 1982. The transfer of the whole teacher education system into the university sector was not difficult since the Turkish educational system is centrally controlled. Turkey has two sources of mathematics teachers, namely Education and Science Faculties. Science Faculty graduates obtain their teaching certificate from Education Faculties. At present, Turkey needs to apply a new model for student assessment, and selection to detect and attract more capable and committed individuals into teaching.

Cushing's syndrome occurs rarely in pregnancy because of ovulatory disturbances including anovulation which is caused by hypercortisolism, but it can cause maternal complications such as hypertension, gestational diabetes, spontaneous abortion, premature birth, pre-eclampsia and stillbirth. Herein we present the case of a 22-year-old patient in the 11th week of pregnancy who was admitted to our hospital with Cushing's syndrome complicated by early pre-eclampsia. Severe pre-eclampsia has high maternal and perinatal morbidities, and therefore the possibility of this complication requires that Cushing's syndrome, although rare in pregnancy, be given a high clinical suspicion. Medical therapy and/or surgical therapy should be considered promptly to influence outcome favorably.

To assess the risk factors for deaths and injuries caused by earthquakes in a high-risk earthquake zone.A cross-sectional study was carried out in Eber town, Cay County, following the earthquake of February 3, 2002 in Afyon, Turkey. This area was particularly affected by the earthquake, with high number of casualties, including many fatalities. The study included 812 persons living in Eber at the time of the earthquake. The study population was interviewed at their homes to obtain information on the deaths and non-fatal injuries, along with potential risk factors for death and injuries. These included the type and degree of the damage to the building, precise location and the initial actions of victims at the moment of the earthquake, and socio-demographic data.Earthquake-related mortality rate was 16 per 1,000 people, injury rate was 22 per 1,000 people, and death/injury ratio was 1:1.4. During the earthquake, 60% of the buildings collapsed or were heavily damaged. Risk factors for death and injury were higher among those who lived in collapsed or heavily damaged buildings, wooden type buildings, or those who were near the outer walls during the earthquake.The most important risk factor for earthquake-induced mortality and morbidity was the degree of damage to the building. Another important risk factor was the location of the individual inside the room at the time of the quake.

Data were collected on disabilities from a sample population in order to estimate the prevalence of orthopedic disabilities in the general population.A two-stage field study was conducted in Cay, a district of Afyon, Turkey. In the first stage, a list of all individuals with orthopedic disabilities was derived. Then, medical histories were elicited and examinations were made by a team of specialists of orthopedics and traumatology. Radiographic studies were made when necessary. Orthopedic disabilities were defined as any muscle or skeletal abnormality that was associated with a permanent functional loss and were classified as congenital, traumatic, cerebral palsy, poliomyelitis, and other causes.The overall population was 35,571, of whom 189 had orthopedic disabilities (53/10,000). The male-to-female ratio was 1.8. The most common cause was congenital diseases (25.9%; 13.7/10,000), followed by trauma (23.8%; 12.6/10,000), cerebral palsy (21.7%; 11.5/10,000), poliomyelitis (10.1%; 5.3/10,000), and others (18.5%; 9.8/10,000). The lowest mean age (19+/-5 years) was found in those with cerebral palsy, which was associated with the highest degree of functional loss. The mean age in patients with poliomyelitis was 29+/-7 years. It was found that 37% of the disabled could benefit from either a limited or extensive surgical intervention, and 9% could have significant improvement both in functional ability and life quality through physical therapy or the use of a prosthesis/orthosis. Only 18% were under the coverage of a health insurance, though.The data of this study may throw some new light on the prevalence and implications of orthopedic disabilities in Turkey.

Intravenous (IV) calcium is usually given to temporarily treat the effects of hyperkalaemia on muscle and heart. When extravasation of a calcium gluconate infusion occurs, there may be rapid and marked swelling and erythema, with signs of soft-tissue necrosis or infection, and ensuing extensive local calcification, called calcinosis cutis. We report a 26-year-old woman who was hospitalized for exacerbation of acute intermittent porphyria. She had a history of hypertension and chronic renal failure. On the second day of her hospitalization, she developed hyperpotassaemia (6.7 mEq/L potassium; normal range 3.5-5 mEq/L). She was given an IV infusion of 10 mL calcium gluconate into the left dorsal pedal vein. Bullous skin reactions occurred in the infusion area nearly 2 h after administration. The patient's leg was elevated and the lesions cleaned with 0.9% saline. By day 9 of hospitalization, the lesions had markedly regressed. Several drugs have been associated with dermoepidermal blistering as an adverse drug reaction, but there is only one existing report in the literature about this side-effect associated with calcium gluconate. Clinicians should be alert to the possibility of bullous skin reactions, which may be a predictor of extravasation and necrosis, when treating patients with IV calcium gluconate.

According to TURDEP-II study, the prevalence of diabetes has reached 13.7% in Turkey. Diabetes mellitus is rapidly increasing, and diabetic patients are likely to undergo surgical procedures more than non-diabetic patients. Observational and prospective studies have demonstrated that hyperglycemia correlates with increased morbidity and mortality associated with surgery. Stress hormones such as epinephrine, norepinephrine, cortisol, glucagon, and growth hormone are mostly augmented, and insulin resistance develops during surgery. All diabetic patients undergoing surgery should have comprehensive preoperative evaluation due to the risk of both hypoglycemia and hyperglycemia during surgical procedures. In this article we aimed to review the diabetes treatment protocols for preoperative and postoperative assessment of adult diabetic patients undergoing surgery.