Search

Purpose Loss of vision is an extremely rare and unexpected complication following a routine uncomplicated nasal surgery. In majority of patients, visual loss has attributed to retinal emboli which occur with retrograde flow of the intra-arterially injected agents into the nasal cavity or direct trauma to the optic nerve. In this report, the authors present a patient with unilateral decreased vision due to branch retinal artery occlusion soon after a routine nasal surgery. Methods Clinical report. Result A 32-year-old female patient admitted to the author' clinic with the complaints of decreased visual acuity in the left eye. She stated that she had undergone rhinoplasty operation 1 week ago and vision loss started immediately after the surgery.In the ophthalmological examination, the best corrected visual acuity with Snellen chart was 1.0 in the right eye and 0.3 in the left eye. In the fundoscopic examination of left eye there was a pale area in the inferior part of the macula. Fundus fluorescein angiography showed no evidence of nonperfusion in the right and left eyes and vascular structure was normal. On the optic coherence tomography, hyperreflectivity and increased thickness were observed in the inner retinal layers of the left eye. In the visual field test, there was a loss of the visual field which corresponds to the pale area on the left eye. Hyperbaric oxygen therapy was recommended. The ophthalmologic examination carried out 2 months later revealed a best corrected visual acuity of the left eye 0.9. In the fundoscopy pale area was regressed in the left eye. Fundus fluorescein angiography showed a good perfusion. There was a little progression in the visual field test. Conclusion Direct mechanical trauma and vasoplastic/embolic vascular events are thought to be possible mechanisms. The authors think in this case, there was a retrograde flow of agents used during the surgery through ophthalmic artery to retinal arteries and vasospasm by epinephrin worsened the situation. Although rare retinal artery occlusion may develop after rhinoplasty, vision loss as a result of a surgery, if done for aesthetic purposes is not acceptable.

Middle East Technical University – Defocusing Beam Line (METU-DBL) project is an irradiation facility providing 15 MeV to 30 MeV kinetic energy protons for testing various high radiation level applications, ranging from Hi-Lumi LHC upgrade, space electronic components to nuclear material research. The project located inside the premises of the TAEA (Turkish Atomic Energy Agency) SANAEM (Saraykoy Nuclear Education and Research Center) close to Ankara, provides users a wide selectable flux menu (105–1010 p/cm2/s). The facility is now being commissioned and the facility will be providing a large test area (20 cm x 15 cm) for material, detector and electronics tests. The proton beam is monitored along the beamline using aluminum oxide screens and the flux and uniformity is measured using three detectors attached to the robotic system for cross- checks. A fiber scintillator detector scans the large irradiation area while small area diamond detector and Timepix3 detector are used for spot checks for calibration. Several samples can be radiated simultaneously inside the irradiation area and the robotic system provides 5 separate holders for samples which can be moved in or out, providing users flexibility for the desired fluence. This talk will first introduce METU- DBL as a radiation test facility, then discuss the radiation monitoring of the beam area and the radiation room, while highlighting how this facility can be used for future testing of materials for radiation tolerance.

METU Defocusing Beamline (DBL)is being installed at TAEA SANAEM Proton Accelerator Facility [1] for radiation tests of electronic devices to be used in satellites and spacecrafts which are exposed to a high radiation dose in space or at the Hi-Lumi LHC [2]. 15 − 30 MeV protons from the accelerator are spread out over an area of 15.40 × 21.55 cm to provide large irradiation in accordance to ESA/ESCC No. 25100 standard with METU-DBL. A wide selectable flux menu ranging from 105 − 1010p/cm2/s will be available to users starting in summer 2019. The final design has been updated with the experience gained from the pre-test setup installation [3] and the ensuing irradiation campaign with different users [4]. In this paper, magnetic measurement results of a custom design quadrupole magnet, as well as updates to the mechanical, robotic and control subsystems are presented.

Field studies were carried out in April, October, and November 2013 and March and October 2014 in Tokat Province of Turkey. Gall specimens of Diplolepis fructuum (Rübsaamen, 1895) (Hymenoptera: Cynipidae) on host plants from the genus Rosa were collected. Thirteen species from six families were reared. Among them, Eurytoma caninae Lotfalizadeh and Delvare, 2007 and Aximopsis collina (Zerova, 1984) are new records for Turkey. The most common parasitoids are Eupelmus urozonus Dalman, 1820 and Stepanovia eurytomae (Nees, 1834), respectively.

We conducted an experiment to investigate the effectiveness of bacterial cellulose, a new graft material, in correcting and preventing dorsal nasal disorder in rhinoplasty. The experiment was performed on 20 Wistar albino rats. The rats were evenly divided into two groups: a fascia group and a cellulose group. In the fascia group, grafts from the conchal cartilage were removed, shredded, and then wrapped in temporal muscle fascia. In the cellulose group, shredded cartilage was wrapped in the bacterial cellulose. These shredded gristle grafts, which were also placed in a subcutaneous area at the back of the rats, were excised after 60 days. We then performed histopathology to compare the health and integrity of the cartilage and the degree of vascularization, fibrosis, and chronic inflammation in the two groups. We found a significantly greater degree of vascularization (p = 0.004) and fibrosis (p = 0.005) in the fascia group and a significantly greater degree of chronic inflammation (p = 0.023) in the cellulose group. We found no statistically significant difference between the two groups in terms of cartilage health and integrity. Our results suggest that bacterial cellulose grafting may play a role as an alternative to fascia grafting for the wrapping of shredded cartilages in Turkish delight grafting, but further investigation is needed.

Rose gall wasps (Hymenoptera: Cynipidae: Diplolepidini) are well-known gall-inducing insects on Rosa species, and their galls support species-rich communities. During this investigation, gall samples of Diplolepis fructuum and D. rosae, which are the two most common rose gall wasps in Turkey, were collected in Gümüşhane, Tokat, Sivas, and Erzincan provinces. Fifteen species associated with D. fructuum and 12 species associated with D. rosae were reared. These community members are mostly primary and secondary parasitoids, along with seed- and gall-tissue?feeders. The association between Aximopsis collina and D. rosae was determined here for the first time. In D. fructuum galls, Pteromalus bedeguaris, Eupelmus urozonus, and Torymus bedeguaris, and in D. rosae galls, P. bedeguaris and Periclistus brandtii were the most common inhabitants among the community members excluding the gall wasps. Additionally, approximate emergence dates of the community members are given.

Objective: We evaluated the incidence of psychiatric disorders in patients with allergic rhinitis (AR) and assessed the effects of the use of antidepressants on symptoms when they are included in the treatment regimen of patients with AR who are resistant to AR treatment.Methods: A total of 49 patients who were resistant to the treatment for AR and who did not accept the option of immunotherapy were included in the study. Thirty-eight of the 40 patients were advised to take the antidepressant sertraline; however, only 21 of them agreed to use the medication while 17 of them refused. The 21 patients who agreed to begin the antidepressant were also advised to undergo AR treatment with desloratadine once per day and intranasal mometasone furoate once per day (Group 1). The patients who refused to use the antidepressant were advised to begin the AR treatment (Group 2). Symptom scoring for AR was again performed for all patients 6 weeks after treatment. The Psychological Symptom Checklist-90 (SCL-90), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI TX I and TXII) were performed on the patients in the company of a psychiatrist.Results: The post-treatment nasal and non-nasal symptom scores in Group 1 were significantly better than the pretreatment scores for any of the seven symptoms (p=0.000). No significant correlation was found between the AR symptom scores and the average SCL-90 general symptom score, the SCL-90 subscale scores, the total BDI scores, and the STAI scores (p>0.05).Conclusion: This study suggests that the use of antidepressants diminishes the allergic symptoms in patients with treatment-resistant AR since psychosomatic factor is of great importance in the patient population of AR.

Methods: The length of stay, complication rates, decannulation time, time to initiate oral nutrition, costs of examination, medication costs and total cost were assessed by investigating the records and bills of 26 patients with larynx squamous-cell carcinoma treated with frontolateral, supraglottic and supracricoid laryngectomy surgery in the Ear-Nose-Throat Clinic of the Sisli Etfal Research and Training Hospital between January 2007 and December 2011.

WOS: 000330078200047, PubMed: 23715004, Objective: This study aimed to compare the effectiveness of radio-frequency ablation (RFA) and intranasal steroid (INS) treatments on respiratory and olfactory functions in patients with inferior concha hypertrophy and chronic nasal obstruction. Study Design and Setting: This was a prospective clinical trial performed at a tertiary referral center. Methods: We assessed patients with nasal obstruction between July 2011 and February 2012. The severity of the nasal obstruction in both groups was determined before treatment and 3 months after using a visual analog scale. For the purpose of an objective test, assessment was performed by the acoustic rhinometry. Using Sniffin' Sticks for test odor identification, the discrimination and thresholds were assessed in both groups. Results: The visual analog scale score after treatment was significantly lower in each group. Radiofrequency ablation treatment significantly improved the right minimal cross-sectional area 1 (MCA1), mean MCA1, and volume 1, as well as the right MCA2, mean MCA2, volume 2, and total volume. In the INS group, improvement was detected for the left MCA1, mean MCA1, and volume 1. Minimal cross-sectional area 2, volume 2, and total volume improved significantly after RFA treatment, but not after INS treatment. Conclusions: Although RFA may be more effective in the posterior region of the nasal cavity, INS and RFA used in the treatment of inferior concha hypertrophy both had favorable effects on respiratory function. Intranasal steroid treatment provided improved discrimination and total score values, whereas RFA treatment improved only odor identification.

The aim of this study was to evaluate whether insulin sensitivity, inflammatory response, and plasma lipid profile are associated with circulating adiponectin levels in nondiabetic healthy women. The authors also assessed whether adiponectin has any effect on high-density lipoprotein cholesterol-linked paraoxonase 1 (PON-1) activity and on the susceptibility of low-density lipoproteins to oxidation. Plasma adiponectin was measured in 91 nondiabetic premenopausal women, and the patients were then divided into quartiles. Circulating adiponectin was found to be associated with body mass index (r=.55, P

Summary Objective To determine ‘alarm and action levels' of waist circumference (WC) in overweight and obese Turkish women and investigate the relationship with cardiovascular risk factors. Research subjects and methods Four thousand three hundred and seventy-five women aged 18–81 years selected from Istanbul Faculty of Medicine Obesity outpatient clinic. WC, waist-to-hip ratio (WHR), body mass index [(BMI) (weight (kg)/height (m 2 ))], blood pressure, and biochemical parameters were analyzed. Results There was strong correlation between BMI and WC levels ( r : 0.852). The regression equation which describes this correlation [WC=1.68×BMI (kg/m 2 )+39.2±1.6] was applied to 500 random samples in order to define alarm and action levels for WC. Our results indicated that alarm level of WC at BMI 25kg/m 2 is 81cm and action level of WC at BMI 30kg/m 2 is 90cm. Validating samples were divided into three groups: group I (WC levels below 81cm, n : 421), group II (WC levels between 81 and 90cm, n : 718), group III (WC levels above 90cm, n : 2736) and further correlative analyses were performed. Strong differences within alarm and action groups in terms of cardiovascular risk factors were identified. The prevalence and mean values of cardiovascular risk factors significantly increased with WC. In group 1 one or more risk factor prevalence was 64.8%, whereas in groups 2 and 3 prevalence was increased to 76.8 and 89%, respectively. Conclusion Turkish women with WC greater than 81cm should gain no further weight and those greater than 90cm should reduce their weight.

Patients with hyperthyroidism occasionally need rapid restoration to the euthyroid state. In view of the increased enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) in thyrotoxicosis, and metabolic effects of konjac glucomannan in gastrointestinal system, we aimed to determine the activity of glucomannan in treatment of hyperthyroidism.A prospective, randomized, placebo-controlled, one-blind study design was used with newly diagnosed 48 hyperthyroid patients (30 patients with Graves' disease and 12 with multinodulary goitre). They were assigned to one of the following treatment groups: I) methimazole 2 x 10 mg, propranolol 2 x 20 mg, and glucomannan (Propol) 2 x 1.3 gr daily for two months; II) methimazole 2 x 10 mg, propranolol 2 x 20 mg, and placebo powder daily for two months.No differences were detected from the point of view of the baseline thyroid hormone levels between groups (p0.05). Further analyses revealed that the patients receiving glucomannan at the end of the second, fourth and sixth weeks of the study had significantly lower serum T3, T4, FT3 and FT4 levels than the patients who received placebo (p0.05). TSH was not different between the two groups at any specific time (p0.05). At week 8, thyroid hormone levels were not shown any differences. The glucomannan-treated group had a more rapid decline in all four serum thyroid hormone levels than the placebo-treated group.We believe our preliminary results indicate that glucomannan may be a safe and easily tolerated adjunctive therapeutic agent in the treatment of thyrotoxicosis. This combination therapy seems most effect during first weeks of treatment of a hyperthyroid patient.

OBJECTIVE Numerous clinical manifestations have been described in association with Cushing's syndrome. There are no eligible data on pulmonary function tests in Cushing's disease (CD). We aimed to asses pulmonary function tests including spirometry in a series of patients with active CD. MATERIALS AND METHODS This cross-sectional study comprised 10 patients with Cushing's disease (F/M, 9/1). The forced expiratory volume in 1st second (FEV1), the forced vital capacity (FVC), the FEV1/FVC ratio and the forced expiratory flow over the middle half of the FVC (FEF 25-75%) values and predicted values were determined by spirometry. RESULTS Mean age, height, weight, body mass index were 36.7+/-12.6 yrs (range 22-63 years), 156.9+/-8.4 cm, 74.1+/-10.7 kg, 29.6+/-3.8 kg/m(2), respectively. Spirometric abnormalities (impairment of FEV1, FVC, FEV1/FVC and FEF 25-75 values) were not detected, and there were no significant differences compared to reference values. Disease duration and cortisol concentrations by HDDSTs were negatively correlated with predicted FEV1/FVC values and the percentage of predicted FEV1 ratios, respectively. DISCUSSION The lung volume and ventilatory performance by spirometry were not disturbed in patients with endogenous hypercostisolism due to Cushing's disease.

A 19-year-old female patient with hypercalciuria and recurrent nephrolithiasis/urinary tract infection unresponsive to thiazide type diuretics is presented. The patient first experienced nephrolithiasis at the age of 4 years. Afterwards, recurrent passages of stones and urinary tract infection occurred. On diagnostic evaluation at the age of 19 years, she also had hypocitraturia and hypomagnesemia. Her serum calcium concentrations were near the lower limit of normal (8.5–8.8 mg/dl; normal range: 8.5–10.5), her serum magnesium concentrations were 1.15–1.24 mg/dl (normal range: 1.4–2.5) and urinary calcium excretion was 900 mg/24 h. PTH concentrations were increased (110–156 pg/ml; normal range: 10–65). We tried to treat the patient with hydrochlorothiazide at a dose of 50 mg/day. During treatment with thiazide diuretics, PTH concentration remained high and the patient had recurrent urinary tract infections and passages of stones. Serum magnesium concentration did not normalize even under the parenteral magnesium infusion. Her mother had a history of nephrolithiasis 20 years ago. Severe hypomagnesemia in association with hypercalciuria/urinary stones is reported as a rare autosomal recessive disorder caused by impaired reabsorption of magnesium and calcium in the thick assending limp of Henle’s loop. Recent studies showed that mutations in the CLDN16 gene encoding paracellin-1 cause the disorder. In exon 4, a homozygous nucleotide exchange (G679C) was identified for the patient. This results in a point mutation at position Glycine227, which is replaced by an Arginine residue (G227R). The mother was heterozygous for this mutation. G227 is located in the fourth transmembrane domain and is highly conserved in the claudin gene family. This case indicates the pathogenetic role of paracellin-1 mutation in familial hypomagnesemia with hypercalciuria and nephrocalcinosis and further underlines the risk of stone formation in heterozygous mutation carriers.

Endogenous malondialdehyde and diene conjugate levels, the susceptibility of apolipoprotein B-containing lipoproteins to copper-induced lipid peroxidation, and antibody titer against oxidized low-density lipoproteins were increased, but serum antioxidant activity was unchanged in obese women. Serum cholesterol, low-density lipoproteincholesterol, and trigliceride levels were also elevated, but high-density lipoprotein-cholesterol levels remained unchanged in obese women. In vitro, oxidation of apolipoprotein B-containing lipoproteins and levels of antibody against oxidized low-density lipoprotein correlated with body mass index, serum total cholesterol, and low-density lipoproteincholesterol levels in obese women. These results indicate that obesity is associated with increases in endogenous lipid peroxides, oxidation of low-density lipoproteins, and lipids in serum.

The aim of this study was to evaluate cardiac performance, in particular diastolic function, in adult patients with adulthood onset GH deficiency. The study group was composed of 19 GH deficient adult hypopituitary patients with at-least 3 additional pituitary hormone deficits and 19 age, sex and BMI matched healthy controls. Mean duration of hypopituitarism was 108.6 +/- 77.0 months. None of the patients and controls presented with or had previous diagnosis of concomitant diseases that could affect cardiac function. All hormone deficiencies, except for GH, were appropriately replaced in the patients. Left ventricular function and geometry were evaluated by two-dimensional, M-mode and Doppler echocardiography. Body composition was evaluated by bioelectrical impedance analysis. Not significant differences were observed with respect to left heart dimensions and left ventricular systolic function between patients and controls. Nevertheless 2 of the left ventricular diastolic function parameters, deceleration time and isovolumetric relaxation time, were significantly prolonged in the patients compared with controls (247.88 +/- 70.65 vs 143.26 +/- 31.70 milliseconds (ms) and 122.31 +/- 18.24 vs 89.47 +/- 12.12 ms respectively, p0.001). Duration of hypopituitarism was significantly correlated with percent body fat mass (r=0.6119, p0.01) and percent lean body mass (r=-0.5949, p0.01). It is concluded that in adults affected by hypopituitarism, GH deficiency predominantly impairs diastolic function while systolic function at rest is spared. This observation might indicate a preclinical stage of a cardiomyopathy.

The aim of this study is to determine the body fat distribution and cardiovascular disease risk factors in pre- and postmenopausal obese women matched for weight, height and body mass index (BMI). Study group consisted of 405 premenopausal overweight/obese (BMI27 kg/m2, mean 37.83 +/- 6.91 kg/m2) and 405 postmenopausal overweight/obese (BMI27 kg/m2), BMI-matched (mean 37.77 +/- 6.84 kg/m2) women. None of the women were on hormone replacement therapy. Insulin resistance was evaluated by "homeostasis model assessment" (HOMA) formula. Intraabdominal fat volume was calculated according to the following formula: IAF (L) = [(0.370 x abdominal sagittal diameter) - 4.85]. Age, waist circumference, waist to hip ratio (WHR) and intraabdominal fat volume were significantly higher in postmenopausals compared with BMI-matched premenopausal women (p0.001). Systolic and diastolic blood pressure, glucose, uric acid, cholesterol and triglyceride were significantly higher (p0.001) and HDL-cholesterol was significantly lower (p0.05) in postmenopausals. No significant differences were observed with respect to insulin and HOMA. When age-matched pre- and postmenopausal women were compared, only total cholesterol was significantly higher in the postmenopausal group. However, older postmenopausal women (50 years) had significantly higher systolic blood pressure, waist circumference, WHR, glucose and uric acid concentrations compared with younger (or = 50 years) postmenopausals. It is concluded that an increase in abdominal fat accumulation and unfavorable alterations in risk factors disturb postmenopausal obese women even if total body weight and BMI do not change during menopause transition. Ageing, particularly throughout the postmenopausal years, has important effects on the detrimental changes associated with menopause.

WOS: 000340257800017, PubMed: 25006938, Objective: Allergic rhinitis (AR), a chronic inflammatory disorder of the nasal mucosa, affects approximately 20% of the world's population and often causes olfactory dysfunction. Conventional treatments cannot cure it, but only alleviate and control the symptoms. Systemic immunotherapy (SIT) is the only curative treatment for AR, but its positive effect on olfactory function has not been quantitatively demonstrated. We measured the olfactory function in patients using a "Sniffin' Sticks'' test and analyzed the effects of subcutaneous SIT. Methods: The study included 12 patients (aged 13-44 years) who were eligible to receive subcutaneous SIT to treat AR between 2010 and 2012 in the Department of Otolaryngology, Sisli Etfal Training and Research Hospital. A 3-step Sniffin' Sticks test was performed before and 18 months after subcutaneous SIT. The data collected before and after treatment were compared for each patient. Results: The average scores for smell test parameters increased after treatment. Although improvements in the mean threshold, mean discrimination, and mean total scores were not significant, the mean identification score was significantly improved after treatment (P < 0.05). Age, sex, and smoking were not significantly related to the changes in the parameters. Conclusions: Subcutaneous SIT improved the olfactory performance in AR patients. Additional studies with larger patient populations and longer follow-up periods are needed to establish subcutaneous SIT as an effective treatment for olfactory disorders in these patients.

Multiple peripheral pulmonary carcinoid tumors or their smaller counterparts (tumorlets of carcinoid type) are the most unusual form of carcinoids as a cause of ectopic corticotropin syndrome. Only three case reports were found in the literature. We describe a 35 year-old female patient with ectopic corticotropin secretion due to multiple peripheral pulmonary carcinoid tumors and tumorlets. A high-dose dexamethasone suppression test result led to the diagnosis of Cushing's disease in our case. But no tumor was identified on sella imaging and bilateral inferior petrosal sinus sampling was non-diagnostic. Computed tomography of the lungs revealed multiple acinar-nodular parenchymal infiltrations confined to the left lung. Corticotropin-dependent hypercortisolism persisted after bilateral adrenalectomy. A second operation was necessary to remove the hyperplastic adrenal remnants. Meanwhile, computed tomography findings of the thorax were unchanged. We decided to explore these nodules by open lung biopsy. During the procedure multiple nodules ranging 12 to 3 mm in diameter scattered throughout the left lung were observed and left pneumonectomy was performed. Histopathological diagnosis was multiple peripheral carcinoid tumors and tumorlets of carcinoid type showing positive immunostaining with corticotropin. This observation emphasizes a rare form of carcinoids as a cause of ectopic corticotropin secretion and its unusual response to high dose dexamethasone suppression test.

OBJECTIVE: To investigate the effects of growth hormone (GH) deficiency on serum lipid and leptin concentrations in hypopituitary patients taking conventional replacement therapy and to determine the relations between leptin and gender and anthropometric and metabolic variables. SUBJECTS: Twenty-one GH deficient adult hypopituitary patients (15 women, six men) and 21 (14 women, seven men) age, sex and body mass index (BMI) matched healthy controls. MEASUREMENTS: After an overnight fast, anthropometric parameters were measured and body composition was determined by a bioelectrical impedance analyser. Venous blood samples were obtained for the measurements of glucose, total cholesterol, high density lipoprotein (HDL) cholesterol, triglyceride, intact insulin, insulin-like growth factor 1 (IGF-1) and leptin concentrations. Serum leptin and hormones were analysed by radioimmunoassay. RESULTS: Hypopituitary patients with GH deficiency showed significantly higher triglyceride, total and low density lipoprotein (LDL) cholesterol and lower HDL cholesterol concentrations on conventional replacement therapy. The unfavourable lipid profile was particularly evident in women. Significantly higher leptin concentrations were found in patients compared with healthy controls with similar body fat content (23.5±11.8 ng/ml vs 11.7±6.9 ng/ml, P=0.01). This difference remained significant even when leptin values were expressed in relation to fat mass percentage (0.79±0.40 vs 0.42±0.17 ng/ml%, P

In this study, we evaluated protein oxidation in 84 patients with Type 2 diabetes with no complications and in 61 healthy volunteers who formed the control group, whose ages matched those of the patients. We determined plasma carbonyl and plasma thiol levels as markers of oxidative protein damage and erythrocyte glutathione, plasma ceruloplasmin and transferrin as markers of free radical scavengers. The concentrations (mean +/- SD) of both of plasma carbonyl (1.24 +/- 0.46 vs. 0.72 +/- 0.17 nmole/mg protein; p < 0.0001) and lipid hydroperoxides (1.8 +/- 0.63 vs. 1.3 +/- 0.21 micromole/l; p < 0.0001) were increased, and the concentration of plasma transferrin (3.85 +/- 0.65 vs. 4.59 +/- 0.79 g/l; p < 0.05) was decreased, respectively, in Type 2 diabetic patients compared with those of the controls. There were no significant differences in the concentrations of plasma thiol (0.0064 +/- 0.001 vs. 0.0068 +/- 0.001 micromole/mg protein), erythrocyte glutathione (2.54 +/- 0.57 vs. 2.65 +/- 0.56 mg/g Hb), plasma ceruloplasmin (548 +/- 107.30 vs. 609 +/- 93.34 mg/l) between the patients and the controls. These changes observed in diabetic patients contribute to the imbalance in the redox status of the plasma. We attribute this imbalance to oxidative protein damage in Type 2 diabetic patients clinically free of complications.

Our objective was to evaluate the relationship between subjective pulsatile tinnitus and petrous bone pneumatization. Twenty-five patients admitted between January 2012 and March 2012 were assessed. The control group data were obtained by assessment of petrous bone images of 25 cases in which paranasal sinus computed tomography (CT) was performed because of chronic sinusitis and in which no ear pathology was present. Temporal bone CT images of patients with subjective pulsatile tinnitus were compared with those of patients with no ear complaints. The presence of petrous bone pneumatization was evaluated by CT. Subjective pulsatile tinnitus complaints were present for 32 of 50 ears. Pneumatization was detected in the petrous bone of 22 (68.8%) of 32 ears with subjective pulsatile tinnitus. In the control group, 25 patients (50 ears) with no ear complaints were assessed. Petrous bone pneumatization was detected in 12 (24%) of 50 ears comprising the control group. There was a statistically significant difference between the 2 groups (P = 0.000 < 0.001). Petrous bone pneumatization might be the cause of the subjective pulsatile tinnitus.

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

The use of cartilage grafts in tympanoplasties is recommended in cases with a higher probability of failure. Many grafting techniques have been reported, including palisade, cartilage island, and cartilage shield grafts. Cartilage minimizes the inflammatory tissue reaction, ensures resistance against infection during the recovery process, and provides good support against the retraction by virtue of its rigidity.This study compared the anatomic and functional results of conchal cartilage, tragal cartilage, and temporal muscle fascia grafts in primary type 1 tympanoplasty. Between January 2007 and January 2011, 79 patients with subtotal dry tympanic membrane perforation and an intact ossicular chain underwent primary type 1 tympanoplasty in our clinic. The postoperative perforation closure ratios, air and bone pure tone averages, and mean air-bone gap (ABG) in the 3 groups were compared with the preoperative values. The improvement in the mean ABG was assessed.The perforation closure ratio was 80.6%, 100%, and 88.5% in the muscle fascia, conchal cartilage, and tragal cartilage groups, respectively, and the mean increase in the ABG was 5.7, 8.9, and 9.7 dB, respectively.The island graft with cartilage perichondrium, which has recently become popular, can be also used in type 1 tympanoplasty. Because it does not require a second incision, conchal cartilage can be used routinely in tympanoplasties performed via a postauricular approach.

This study aims to evaluate patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) and to discuss the advantages and disadvantages of this technique in the light of literature data.Between May 2008 and February 2009, 20 patients (18 females, 2 males; mean age 44.5±13.6 years; range 23 to 68 years) who underwent MIVAT using a 4 mm and 30° rigid endoscope and ultrasonic scalpel for dissected the main thyroid vessels were included in the study. Inclusion criteria were benign thyroid nodules of30 mm and ultrasonographically thyroid volume of20 ml.The mean length of incision was 2.6±0.5 cm, the mean operation time was 111.7±39.7 min and the mean amount of bleeding was 82.8±84.1 cc. A statistically significantly positive relationship was found between the operation time and the nodule size and the amount of bleeding and also between the length of the incision and cosmetic satisfaction scale scores (p0.05). However, no statistically significant correlation was found between the operation time and postoperative pain and between the length of incision and postoperative pain (p0.05). Although 30% of the patients had mild to moderate pain, 50% had moderate pain and 20% had severe pain in the early postoperative period, no patient had pain in the postoperative third day. No postoperative persistent vocal cord paralysis was observed in the patients.Minimally invasive video-assisted thyroidectomy is a safe and useful approach in the treatment of the patients with benign thyroid nodules.

A 19-year-old female patient with hypercalciuria and recurrent nephrolithiasis/urinary tract infection unresponsive to thiazide type diuretics is presented. The patient first experienced nephrolithiasis at the age of 4 years. Afterwards, recurrent passages of stones and urinary tract infection occurred. On diagnostic evaluation at the age of 19 years, she also had hypocitraturia and hypomagnesemia. Her serum calcium concentrations were near the lower limit of normal (8.5-8.8 mg/dl; normal range: 8.5-10.5), her serum magnesium concentrations were 1.15-1.24 mg/dl (normal range: 1.4-2.5) and urinary calcium excretion was 900 mg/24 h. PTH concentrations were increased (110-156 pg/ml; normal range: 10-65). We tried to treat the patient with hydrochlorothiazide at a dose of 50 mg/day. During treatment with thiazide diuretics, PTH concentration remained high and the patient had recurrent urinary tract infections and passages of stones. Serum magnesium concentration did not normalize even under the parenteral magnesium infusion. Her mother had a history of nephrolithiasis 20 years ago. Severe hypomagnesemia in association with hypercalciuria/urinary stones is reported as a rare autosomal recessive disorder caused by impaired reabsorption of magnesium and calcium in the thick assending limp of Henle's loop. Recent studies showed that mutations in the CLDN16 gene encoding paracellin-1 cause the disorder. In exon 4, a homozygous nucleotide exchange (G679C) was identified for the patient. This results in a point mutation at position Glycine227, which is replaced by an Arginine residue (G227R). The mother was heterozygous for this mutation. G227 is located in the fourth transmembrane domain and is highly conserved in the claudin gene family. This case indicates the pathogenetic role of paracellin-1 mutation in familial hypomagnesemia with hypercalciuria and nephrocalcinosis and further underlines the risk of stone formation in heterozygous mutation carriers.

We aimed to evaluate the relationship between different types of obesity and cardiovascular risk indicators. A total of 623 overweight (body mass index [BMI] > 25 kg/m2), and 2559 obese (BMI > 30 kg/m2) women were divided into four groups according to their BMI and waist-to-hip ratio (WHR): simple overweight (BMI 25-30 kg/m2and WHR < 0.8, n = 371), abdominal adiposity (BMI 25-30 kg/m2and WHR > 0.8, n = 252), peripheral (pure) obesity (BMI > 30 kg/m2and WHR < 0.8, n = 918) and central obesity (BMI > 30 kg/m2and WHR > 0.8, n = 1641). The levels of the risk indicators measured (clinical, anthropometric and laboratory) were significantly higher in the central obesity group. Total body fat and abdominal fat accumulation seems to result in more serious hyperinsulinaemia and insulin resistance in central obesity. Measuring BMI and WHR in obese patients may reveal their risk for coronary heart disease.

In this study, 55 patients with Cushing's syndrome (CS) (50 female, 5 male; mean age 34+/-12.3 yr) who attended our clinics between the years 1983 and 2000 were retrospectively evaluated for clinical and laboratory features and modalities and results of therapy, due to a few similar studies over the last ten years. Cushing's disease was diagnosed in 39 patients (71%), adrenal adenoma in 13 patients (23.6%) and adrenal carcinoma in 3 patients (5.5%). Centripedal obesity, moon face, hypertension, hirsutism and purplish stria were the most frequent findings. Loss of normal serum F circadian rhythm was found in all patients with CS. The overnight 1 mg oral dexamethasone suppression test and low-dose dexamethasone suppression test (LDDST) yielded 100% and 100% diagnostic sensitivity for CS, respectively. Sensitivity and specivity of the high-dose dexamethasone suppression test (HDDST) in distinguishing Cushing's disease was found to be 82% and 100%, respectively. All of the patients with adrenal CS were not suppressed with HDDST. Sellir CT and/or MRI accurately identified the tumor in 58% of these patients. Recurrence was observed in 3 (11%) of the 28 patients with Cushing's disease, treated by transsphenoidal adenomectomy. Recurrence was diagnosed 1.5, 3 and 6 yr after the operation in these 3 patients. One patient had residue tumor. In our case series, bilateral adrenalectomy plus pituitary irradiation achieved the highest remission rate (100%) in Cushing's disease. In 2 out of 4 patients (50%) treated by left adrenalectomy associated with pituitary irradiation, recurrence was observed. Panhypopituitarism due to tumor apoplexy was observed in one of the patients with Cushing's disease. All of the patients with adrenal CS, the tumor was accurately localized with imaging methods before the operation. The appropriate operative procedure resulted in complete remission in patients with adrenal adenoma. Consequently, Cushing's disease was the most common form of CS. The overnight 1 mg oral DST and 24-h urine free IF excretion (UFC) as screening tests, 2-day LDDST as diagnostic test and 2-day HDDST as differential diagnostic test were good studies. More successful outcomes have been achieved in treatment of Cushing's disease with the development of pituitary surgery in the recent years, as well as in our case series. Surgery is also curative for adrenal adenoma patients. Survival remains poor among carcinoma patients. ((C))2003, Editrice Kurtis.

This study was performed to test whether plasma asymmetric dimethylarginine (ADMA) concentrations are related to obesity and obesity complications including decrement in insulin sensitivity and adiponectin levels, dyslipidemia and low-grade inflammation. Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) concentrations were analyzed by HPLC in 17 overweight (BMIor = 25 kg/m2) and 40 obese (BMIor = 30 kg/m2) premenopausal women. Age-matched healthy women were studied as controls. Obesity did not give rise to a significant change in circulating ADMA levels but reduced in SDMA levels. As compared with control subjects (0.441 +/- 0.102 microM), ADMA values in overweight and obese subjects were found to be as 0.412 +/- 0.102 and 0.436 +/- 0.093, respectively. No Pearson's association of ADMA with relevant risk variables for cardiovascular disease, including blood pressure, insulin sensitivity, inflammatory markers, lipid and adiponectin levels. However, in linear regression analysis, BMI, diastolic blood pressure, glucose, insulin, and IL-8 emerged as significant predictors of ADMA. In spite of obese women have elevated hs-CRP, triglyceride levels and decreased insulin sensitivity, adiponectin and HDL-cholesterol levels, all of which is closely linked risk factors for cardiovascular disease, circulating ADMA levels remained unchanged in obese individuals as compared with controls.

To determine the correlations between signal-averaged electrocardiography (SAECG) indices and various anthropometric parameters in obese women.Twenty-seven healthy obese women (mean age 29.7 +/- 9.6 y, mean body mass index 35.2 +/- 6.0 kg/m2).SAECG was performed using a Marquette, MAC 12/15 system. Bidirectional filtering, low-pass filtering 250 Hz and 25, 40 and 80 Hz high-pass filter settings were employed on the same averaged beats. At least 200 beats were averaged to achieve a noise level1 microV. Body mass index, waist to hip circumference ratio, neck circumference, arm circumference and conicity index were determined for all subjects. Skinfold thicknesses were measured in triceps, biceps, subscapular, supra-iliac and para-umbilical regions.Significant correlations were observed between the root mean square (RMS) voltage of the terminal 40 ms of the filtered ORS complex at 25 and 40 Hz and skinfold thicknesses measured at different sites. Significant correlations were obtained between the noise level at 25 and 40 Hz and skinfold thicknesses measured at subscapular, biceps and triceps regions also. The only SAECG parameter correlated significantly with the noise level was the RMS voltage at 25 and 40 Hz high-pass filter settings.In obese women SAECG must be performed with 80 Hz high-pass filter setting which eliminates the random noise originating from the subcutaneous adipose tissue. In addition RMS voltage which shows positive linear correlations with the noise level of 25 and 40 Hz high-pass filter settings might be inappropriate for the definition of abnormal SAECG criteria in obese women.

It is recently shown that the majority of acromegalic patients without concomitant heart disease have diastolic dysfunction at rest. The aim of this study is to evaluate left ventricular diastolic function in normotensive acromegalic patients without any evidence of heart disease. Eleven acromegalic patients and 16 normal subjects of comparable age and sex distribution were studied by echocardiography. Left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume and stroke volume were found to be significantly higher in acromegalic patients. Left ventricular mass and left ventricular mass index increased significantly in acromegalics in comparison with controls (229.16 +/- 46.11 g versus 167.17 +/- 24.57 g and 124.99 +/- 26.91 g/m2 versus 95.09 +/- 13.29 g/m2 respectively, p < 0.001). Mitral A wave desceleration rate and isovolumetric relaxation time (IVRT)-two of the studied parameters of left ventricular diastolic filling- were significantly prolonged in patients as compared with controls (p = 0.03 and p < 0.001 respectively). Four (36%) of the acromegalic patients had peak early/late diastolic mitral velocity ratio lower than 1, indicating diastolic dysfunction. All of the patients had IVRT longer than 90 ms (mean + 2 standart deviations of normals). It is concluded that in acromegalic patients without any other evidence of heart disease left ventricular diastolic function is impaired. This indicates a specific cardiomyopathy exists in the subclinical stage. IVRT is found to be more sensitive than other studied parameters for detecting diastolic dysfunction at this stage.

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