Charakter wzrostu gruczolaków przysadki typu prolactinoma zależy od stężenia prolaktyny i płci pacjentów, ale nie od wartości wskaźnika Ki-67

Introduction: The objective of this study was to investigate the effects of some clinical and pathological features of prolactinomas on tumour behaviour.Material and methods: The study included 113 patients with prolactinoma (27 male, 86 female), with a mean age at diagnosis of 34.4 ± 10.0 years (40.3 ± 12.6 in males, 32.6 ± 8.3 in females). Patients were grouped as invasive or non-invasive according to radiological imaging findings. Ki-67 levels were evaluated if possible.Results: The mean adenoma size (longest dimension) was 38.6 ± 21.6 mm and 10.8 ± 9.4 mm in male and female patients. Pre-treatment serum levels of prolactin were defined as mean 1,926 ± 6,662 ng/mL in all, 124.8 ± 63.4 and 4,675 ± 10,049 ng/mL in the noninvasive and invasive groups (p < 0.05). A positive correlation was found between the serum levels of prolactin and tumour size. The rate of patients with Ki-67 ≥ 0.03 was 37.5% and 47.8% in the noninvasive and invasive groups. The reduction rates were 60.8% and 80.4% in tumour sizes and 81.1% and 93.8% in prolactin level in the noninvasive and invasive groups, respectively, (p < 0.05).Conclusions: We found a strong correlation between prolactin levels and invasiveness in male patients compared to females. Ki-67 index was not found to have a place in defining the prognosis.Wstęp: Celem badania była analiza zależności pomiędzy wybranymi danymi klinicznymi i cechami patomorfologicznymi a przebiegiem klinicznym u pacjentów z gruczolakiem przysadki wydzielającym prolaktynę (prolactinoma)/lub z gruczolakiem prolaktynowym przysadki.Materiał i metody: Do badania włączono 113 pacjentów, u których rozpoznano guzy typu prolactinoma (27 mężczyzn, 86 kobiet). Średni wiek pacjentów w momencie rozpoznania wynosił 34,4 ± 10,0 lat (40,3 ± 12,6 u mężczyzn, 32,6 ± 8,3 u kobiet). Na podstawie badań obrazowych/badań radiologicznych guzów pacjentów podzielono na dwie grupy — z gruczolakami inwazyjnymi i gruczolakami nieinwazyjnymi. Wskaźnik Ki-67 oceniono w tych preparatch, gdzie było to możliwe.Wyniki: Średni wymiar gruczolaka (mierzony według najdłuższej osi) wyniósł 38,6 ± 21,6 mm u mężczyzn i 10,8 ± 9,4 mm u kobiet. Średnie stężenie prolaktyny w surowicy przed leczeniem wynosiło 1926 ± 6662 ng/ml w całej grupie badanej, 124,8 ± 63,4 w grupie guzów nienaciekających i 4675 ± 10049 ng/ml w przypadku guzów naciekających (p < 0,05). Stwierdzono istnienie dodatniej zależności pomiędzy stężeniem prolaktyny w surowicy i wymiarem guza. Odsetki pacjentów, u których wartość wskaźnika Ki-67 była duża (≥ 0,03) wyniosły odpowiednio 37,5% w grupie guzów nienaciekających i 47,8% w grupie guzów naciekających. W grupie nowotworów nienaciekających zmniejszenie wymiarów gruczolaka nastąpiło u 60,8% a zmniejszenie stężenia prolaktyny u 81,1% pacjentów, natomiast w grupie guzów naciekających odpowiednie wartości wyniosły 80,4% i 93,8% (p < 0,05).Wnioski: U mężczyzn stwierdzono istnienie wyraźnej zależności pomiędzy stężeniem prolaktyny w surowicy a charakterem naciekającym guza, czego nie wykazano u kobiet. Wskaźnik Ki-67 nie miał związku z charakterem wzrostu guza

Relationship vitamin D levels and microalbuminuria in type 2 diabetic patients

Bu çalışma, 24-27 Mayıs 2012 tarihleri arasında Paris[Fransa]’da düzenlenen 49th Congress of the European-Renal-Association/European-Dialysis-and-Transplant-Association (ERA-EDTA)’da bildiri olarak sunulmuştur.European Renal AssocEuropean Dialysis & Transplant Asso

A retrospective comparison of medical and surgical treatment in patients with prolactinoma

Prolaktinomalı hastaların tedavisi sıklıkla sadece medikal olmakla birlikte cerrahi tedavi veya nadiren radyoterapi de seçilmiş olgularda uygulanabilen tedavi şekillerindendir. Bölgesel bir referans merkezi olan kliniğimize başvuran prolaktinoma olgularının tedavi sonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Değerlendirmeye alınan 170 olguya uygulanan tedavi şekilleri, başarı oranları ve uzun dönem sonuçları irdelendi. Olguların %37,6 sına cerrahi tedavi uygulanmış idi. Mikroadenomlu hastalarda operasyon oranı %8,8, makroadenomlarda ise bu oran %87,9 idi. Sadece medikal tedavi ile prolaktin seviyeleri %95,3 oranında kontrol altına alınırken, cerrahi tedavi sonrası bu oran %28,6 idi. Mikroadenomlu hastalarda cerrahi ile başarı oranı %66,7, makroadenomlularda ise bu oran %21,6 idi. Cerrahi tedavi sonrası kontrol altına alınamayan olgularda uygulanan medikal tedavi sonrası tedaviye yanıt oranı %95,6 idi. Prolaktinoma serimizin literatürde yayınlanan prolaktinoma serilerinden temel farklılıkları operasyon yüzdesinin yüksekliği ve operasyon ile elde edilen başarılı sonuç oranının düşüklüğüdür. Serimizde özellikle makroadenomu olan prolaktinomalı hastaların cerrahi tedavi yaklaşımı ile tedavi edildikleri saptandı. Bu bulgularla prolaktinomalı hastaların tedavisine bu konuda çalışan farklı branşlardaki uzmanların koordineli çalışmaları ile ortak karar vermeleri gerektiği ve günlük pratikte bu hastalarla karşılaşma olasılığı olan tüm hekimlerin prolaktinoma tedavi yaklaşımları konusundaki bilgilerinin güncellenmesi gerektiği sonucuna varıldı.Although medical therapy is the most commonly applied therapy for prolactinomas, occasionally surgical therapy or radiotherapy can be performed in selected patients. We aimed to evaluate retrospectively the results of the management of prolactinoma patients examined in our reference center. One-hundred seventy patients were evaluated for the treatment modalities in terms of type and success rate. Thirty-seven percent of patients were undertaken surgical therapy. Operation ratio was 8,8 %in patients with microadenoma while this ratio was 87,9 %in macroadenoma patients. In patients that were treated only with dopamin agonist medical therapy, normalisation of serum prolactin levels was achieved in 95,3 %of patients. Normalization of serum prolactin levels after surgery was 29%of patients which were undertaken surgery. Success rate after surgery was 66,7 %in patients that had microadenoma and, 21,6 %in patients with macroadenoma. In patients that normalization of serum prolactin levels after surgery was not achieved, the success rate of medical therapy after surgery was 95,6%. Our results significantly differs from the series in the literature in terms of high operation rate and low success rate by surgical treatment. It is stated that, in our series themanagement of prolactinoma was judged in priority with surgical therapy especially in patients with macroadenoma. It is concluded that management of patients with prolactinoma should be decided by the multidisciplinary approach and physicians encountering with these patients should be updated about the contemporary treatment modalities

Investigation of glutathione-S-transferases (GSTT1 and GSTM1) gene polymorphisms in turkish patients with type 1 diabetes(T1D)

Oksidatif stres, tip 1 diyabet (T1D) ve komplikasyonlarının gelişiminde önemli bir rol oynamaktadır Oksidatif stresin zararlı etkilerine karşı savunma sistemlerinden biri de Glutatyon-S-Transferaz (GST)’dır. Çalışmamızda, GSTT1 ve GSTM1 gen polimorfizmleri ile T1D’li Türk hastalar arasındaki ilişkiyi araştırmayı amaçladık. Çalışmamıza, T1D tanısı konmuş 71 hasta ile 62 kontrol birey dahil edildi. GSTM1 ve GSTT1 gen polimorfizmini değerlendirmek için multiplex PCR yöntemi kullanıldı. İstatistiksel analizde anlamlılık düzeyi p 0.05). Bu sonuçlar GSTT1 ve GSTM1 negatif(null) genotiplerinin T1D ve komplikasyonların gelişimi için katkısının olmadığını göstermektedir fakat daha geniş olgu sayılı çalışmalara ihtiyaç vardır.Oxidative stress plays an important role in the development of type 1 diabetes(T1D) and its complications. Glutathione-S-Transferases (GST) is one of the defense systems against the harmful effects of oxidative stress. In our study, we aimed to investigate the relationship between GSTT1 and GSTM1 gene polymorphisms and Turkish patients with T1D. In our study, 71 patients were diagnosed with T1D and 62 control subjects were included. GSTM1 and GSTT1 gene polymorphisms were used to evaluate the multiplex PCR method.In statistical analysis, the level of significance was set at p0.05). These results show that GSTT1 and GSTM1-negative (null) genotypes may not contribute to the development of T1D and its complications but more studies with larger sample size are needed

Türkiye’de insülin-naiv tıp 2 diyabet hastalarında insülin glarjin ile intensif insülin titrasyonu: Lantit çalışması

WOS: 000362601700003Purpose: This open-label, single-arm, phase 4 study was designed to evaluate the efficacy of intensive insulin glargine titration in type 2 diabetes mellitus (T2DM) patients for 6 months to reach good glycaemic control. Material and Method: Two hundred-forty one insulin-naive T2DM patients were included. The primary efficacy variable was the glycaemic control (HbA1c level of <= 7%). The secondary variables were a fasting blood glucose (FBG) level of <100 mg/dL, the final dose of basal insulin, number of dose adjustments, time to dose titration in reaching target HbA1c level of <= 7%, weight gain and treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Hypoglycemia, severe hypoglycemia and adverse events were also assessed. Results: The mean (+/-SD) HbA1c level of 8.8+/-0.6% at baseline decreased to 7.4+/-0.9% on day-90 (p<0.001) and to 7.3+/-0.9% on day-180 (p<0.001). The percentage of patients with HbA1c <=%7 was 36.9% on day-90 and 40% on day-180. The mean FBG of 186.3+/-52.5 mg/dL at baseline decreased to 111.5+/-36.6 mg/dL on day-90 (p<0.001) and to 114.1+/-34.8 mg/dL on day-180 (p<0.001). The mean insulin glargine dose on the last day of FBG measurement (day-89) was 32.7+/-15.5 IU and the mean number of titrations was 12.7+/-6.6. These values on day-179 were 36.8+/-19.4 IU and 5.8+/-5.7, respectively. The total DTSQ score (20.3+/-7.7) and scores for each item at baseline showed improvement on day-180 (p<0.001). The most frequently reported adverse reactions were hypoglycaemia (49.7%) and weight gain (9.5%). Serious hypoglycaemia cases reported during the first and the second 3-month periods were 11.2% and 13.3%, respectively. Discussion: In conclusion, the use of insulin glargine with intensive dose titration is effective and safe in T2DM patients.Amaç: Bu açık-etiketli, tek-kollu faz 4 çalışma, insulin glarjin ile tedavi edilen tip 2 diabetus mellitus (T2DM) hastalarında iyi glisemik kontrol için etkili dozlara ulaşmada yoğunlaştırılmış insülin titrasyonunu değerlendirmek amacıyla tasarlanmıştır. Gereç ve Yöntem: Önceden insülin kullanmamış 241 T2DM hastası çalışmaya alınmıştır. Birincil değerlendirme kriteri glisemik kontrol (HbA1c seviyesi ≤%7), ikincil kriterler ise açlık kan şekeri (AKŞ) <100 mg/dL, son bazal insülin dozu, doz ayarlama sayısı, hedef HbA1c seviyesine ulaşıldığı an doz titrasyonuna kadar geçen zaman, kilo alımı ve tedavi memnuniyetinin Diyabet Tedavi Memnuniyet Anketi (DTSQ) ile değerlendirilmesi olmuş, ayrıca hipoglisemi, ciddi hipoglisemi ve advers olaylar da değerlendirilmiştir. Bulgular: Başlangıçtaki ortalama ± SD HbA1c seviyesi %8,8±0,6, 90. günde %7,4±0,9 seviyesine (p<0,001), 180. günde ise %7,3±0,9 seviyesine (p<0,001) düşmüştür. HbA1c seviyesi ≤%7 olan hastaların oranı 90. günde %36,9 iken 180. günde %40 olmuştur. Ortalama AKŞ başlangıçta 186,3±52,5 mg/dL iken 90. günde 111,5±36,6 mg/dL’ye (p<0,001), 180. günde ise 114,1± 34,8 mg/dL’ye düşmüştür (p<0,001). Son AKŞ ölçümü sırasında (89. gün) ortalama insülin glarjin dozu 32,7±15,5 IU ve ortalama titrasyon sayısı ise 12,7±6,6 idi. Bu değerler 169. gün 36,8±19,4 IU ve 5,8±5,7 idi. Total DTSQ skoru (20,3±7,7) ve her bir madde için 180. günde başlangıç vizitine göre bir iyileşme izlendi (p<0,001). En sık bildirilen advers olay hipoglisemi (%49,7) ve kilo alımı (%9,5) idi. İlk ve ikinci 3 aylık dönemlerde bildirilen ciddi hipoglisemi olayları sırasıyla %11,2 ve %13,3 idi. Tartışma: Sonuç olarak yoğunlaştırılmış doz titrasyonu ile insülin glarjin kullanımı T2DM hastalarında etkili ve güvenli bir tedavi seçeneğidir

An Uncommon Reason of Osteoporosis: Spondyloepiphyseal Dysplasia Congenita

Skeletal dysplasia is a complex and rare disease group that presents with clinical and radiological findings that differ from classical metabolic bone diseases in which bone and cartilage tissue are affected together. Spondyloepiphyseal dysplasia conjenita with involvement of the spine and long bone epiphyses is seen with short stature and short body from birth. Although bone deformities such as shortness of neck and vertebrae, kyphosis, scoliosis, pectus carinatum, genu varum or valgum are frequent, association with osteopenia/osteoporosis has been rarely reported. Although spondyloepiphyseal dysplasia tarda and osteopenia are coexisting in the literature, there is no evidence of the association of spondyloepiphyseal dysplasia tarda and conjunctiva with osteoporosis. In our case report, we presented a patient who was applied to our center with short stature, diagnosed with osteoporosis and spondyloepiphyseal dysplasia congenita by detecting femur head aplasia in radiological imaging