A case of mediastinitis accompanied with hyperosmolar nonketotic coma

AbstractMediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling

Nieinwazyjny pomiar ilości tkanki tłuszczowej trzewnej metodą ultrasonograficzną — potencjalne zastosowanie w ocenie zaawansowania subklinicznej miażdżycy u mężczyzn z niedoczynnością przysadki i niedoborem hormonu wzrostu

Introduction: Growth hormone (GH) deficiency, either isolated or combined with other pituitary hormone deficiencies, is associated with increased mortality and abnormal body composition, particularly visceral adiposity. We aimed to investigate the effects of GH deficiency with or without sex steroid deficiencies on ultrasonographic visceral fat (VF) and cardiovascular risk markers in patients with hypopituitarism on conventional hormone replacement therapy.Material and methods: Forty hypopituitarism patients (24 women, 16 men; mean age 48 ± 16.1 years) with GH deficiency and 15 age- and sex-matched healthy controls were included in this cross-sectional study. The patients were stable on conventional hormone replacement but they were not on GH therapy. Patients who had sex steroid replacement were classified as Group 1 (n = 19), and patients who did not use sex steroids were classified as Group 2 (n = 21). Anthropometric measurements were performed. VF in three regions, subcutaneous fat, and carotid intima-media thickness (CIMT) were measured. VF volume was calculated by using a formula.Results: Visceral fat volume and mean CIMT were significantly higher in patients than healthy controls (p = 0.001 and 0.019 respectively). Homocysteine and hs-CRP were higher in patients (p < 0.05). In males, VF volume and VF thickness measured between abdominal muscle and splenic vein were significantly correlated with CIMT (r = 0.54, p = 0.047 and r = 0.66, p = 0.010 respectively). Furthermore, there was a strong positive correlation between VF thickness in pararenal region and homocysteine (r = 0.74, p = 0.001) in males.Conclusions: VF volume evaluated by ultrasound can be accepted as a cause of subclinical atherosclerosis in GH deficient hypopituitary patients, particularly males.Wstęp: Niedobór hormonu wzrostu (GH, growth hormone) może występować jako zaburzenie izolowane lub współistnieć z niedoborami innych hormonów przysadki. Wszyscy pacjenci z niedoborem GH są jednak obarczeni większym ryzykiem zgonu i mają nieprawidłowy skład tkanek ciała, z tendencją do otyłości brzusznej. Celem pracy była ocena zależności pomiędzy niedoborem GH, niezależnie od ewentualnego współistnienia niedoborów hormonów płciowych a grubością tkanki tłuszczowej trzewnej (VF, visceral fat) mierzoną metodą ultrasonograficzną oraz czynnikami ryzyka sercowo-naczyniowego u pacjentów z niedoczynnością przysadki, leczonych konwencjonalnymi preparatami hormonalnymi.Materiał i metody: Badanie miało charakter przekrojowy i zakwalifikowano do niego 40 pacjentów z niedoczynnością przysadki i niedoborem GH, w tym 24 kobiety, 16 mężczyzn; średni wiek badanych wynosił 48 ± 16,1 lat. Do badania włączono też 15 osób w grupie kontrolnej, dobranych pod względem płci i wieku do osób z grupy badanej. Pacjenci w grupie badanej leczeni byli konwencjonalnie preparatami hormonalnymi, ale nie otrzymywali hormonu wzrostu. Pacjenci leczeni hormonami płciowymi zostali włączeni do grupy 1 (n = 19), a pacjenci nie otrzymujący takich preparatów do grupy 2 (n = 21). U wszystkich wykonano badania antropometryczne. Wykonywano pomiar grubości VF w trzech miejscach, badano grubość podskórnej tkanki tłuszczowej oraz grubość warstwy wewnętrznej i środkowej ściany tętnicy szyjnej (CIMT, carotid intima-media thickness). Objętość VF wyliczano według wzoru.Wyniki: U pacjentów w grupie badanej stwierdzono znamiennie większą objętość trzewnej tkanki tłuszczowej i średnią wartość CIMT w porównaniu z osobami zdrowymi (odpowiednio p = 0,001 i p = 0,019). Stężenie homocysteiny i hs-CRP były również większe w grupie badanej (p < 0,05). U mężczyzn stwierdzono istotną korelację pomiędzy objętością VF i grubością VF mierzoną pomiędzy mięśniami brzucha a żyłą śledzionową a wartością CIMT (odpowiednio r = 0,54 i p = 0,047 oraz r = 0,66 i p = 0,010). Ponadto, u mężczyzn stwierdzono wyraźną zależność pomiędzy grubością VF w okolicy nerek a stężeniem homocysteiny (r = 0,74 i p = 0,001).Wnioski: Objętość VF mierzona ultrasonograficznie może być wykładnikiem subklinicznie toczącej się miażdżycy u pacjentów z niedoborem hormonu wzrostu na skutek niedoczynności przysadki, w szczególności u mężczyzn

A Case Report of Allgrove Syndrome with Neurological Involvement

Allgrove syndrome is a very rare seen disorder with an autosomal recessive trait. The three characteristics of disease are alacrima, achalasia and adrenal failure. Alacrimia is the first manifestation in most cases. Achalasia and adrenal failure are seen later. Neurological involvement is rare and usually occurs in older age. A women 22 years old admitted to our hospital with adrenal failure crisis. She had alacrimia and used teardrop for many years. Achalasia was diagnosed after evaluation of her dysphagia. Thus, diagnosis of Allgrove syndrome, was done. Autonomic cardiac dysfunction and peripheral motor neuropathy were detected. In conclusion, Allgrove syndrome is rare and has life threatening potential due to adrenal failure. Early diagnosis and appropriate treatment may improve life quality and expectancy. Patients with relevant symptoms should be evaluated for autonomic neuropathy. [Med-Science 2015; 4(3.000): 2570-4

Clinical and Demographic Characteristics of 78 Patients with Adrenal Incidentaloma [Adrenal Insidentalomali 78 Hastanin Demografik ve Klinik Ozellikleri]

Adrenal incidentalomas (AIs) are adrenal lesions detected on abdominal imaging procedures or abdominal laparotomy that had been performed for unrelated reasons. AIs have become a common clinical concern as a result of widespread use of abdominal ultrasound, CT and MR imaging in clinical practice. The aim of this study was to evaluate the demographical and clinical data our patients with AI. This study included data from 78 patients (53 female 25 male) with AI those followed at Dicle University School of Medicine, Department of Endocrinology and Metabolism, between 2007 and 2013. Data collected from the records were physical and hormonal evaluation, diameter of the lesion, and the features of the lesion on radiological imaging. Also the results of serum cortisol, aldosterone, renin and 24 hour urinary metanephrine and normetanephrine were recorded. The average age of patients were 48.6 ±14.9 years. There was no significant difference in terms of localization of adenomas. Body mass index of patients were 28.54 ± 5.82. Of the patients, 45 (57.7%) were diagnosed as non-functional AI, 10 (12.8%) as subclinical Cushings syndrome, 11 (14,1%) as pheochromocytoma, 2(2.6%) as primary hyperaldosteronism, and 3(3.8%) as adrenal carcinoma. Ganglioneuroma was stated in 2 patients (2.6%), myelolipoma was stated in 1 patient (1.3%), adrenal adenoma was stated in 1 patient, adrenal cyst was stated in 1 patient, schwannoma was stated in 1 patient and neoplasia with small circular cells was stated in 1 patients. AIs are currently more frequently detected in clinical practice due to increased use of imaging techniques. Although the vast majority of AIs are benign and non-functioning, appropriate hormonal evaluation and imaging procedures must be performed. [Med-Science 2015; 4(2.000): 2181-95

Idiopathic Spontaneous Adrenal Hemorrhage in the Third Trimester of Pregnancy

Spontaneous adrenal hemorrhage (SAH) is seen in the absence of trauma or adrenal tumor in adrenal glands. The incidence of SAH has been reported from 0.14% to 1.1% and it usually involves the right gland. During pregnancy, idiopathic unilateral SAH has been reported rarely. We present a case which comes to emergency department with an acute abdominal pain and the test results showed spontaneous left SAH

Increased Lipid Levels Improves after Treatment with Cabergolin in Patients with Prolactinoma

It has been suggested that hyperprolactinemia may be associated with obesity and dyslipidemia. However it is not fully understood that dyslipidemia is occurs independently or due to obesity. The study was aimed to investigate lipid abnormalities and androgen hormone levels before and after cabergolin (CAB) treatment in non- obese premenauposal patients with prolactinoma. This study was a single-centre, prospective, casecontrol study, consisted of 53 patients with symptomatic prolactinoma (group 1) and 57 healty women (group 3). All subjects underwent a physical examination, anthropometric measurement and a 12 hour fasting blood sample for fasting blood glucose and lipid levels. 49 patients with prolactinoma were reevaluated for metabolic parameters after one year of cabergolin treatment (group 2). The median age was 34 (24-38) in group 1, and 33 (27-41) in group 3 (p=0.522). The initially higher body mass index (BMI) in patients with prolactinoma became similar after one year of treatment those with control group (p=0.475). While LDL-C was significanly higher in group 1 than in controls, HDL was significanly lower in group 1. Also post- treatment values of LDL-C (p=0.440) and HDL-C (p=0.612) were not different from the control group. No correlation was found between baseline prolactin levels and FSH, LH, LDL-C, HDL-C (p=0.129, p=0.658, p=0.817, p=0.760 respectively). In conclusion, beneficial metabolic changes were seen in patients with prolactinoma after treatment with cabergoline. Thus considering the metabolic profile and an appropriate treatment goal is important in the clinical management of patients with prolactinoma. [Med-Science 2015; 4(1.000): 1985-92

Thyroid Gland Hemiagenesis with Multinodular Graves' Disease: A Case Report [Multinoduler Graves' Hastaliginin Eslik Ettigi Tiroid Hemiagenezili Olgu]

Thyroid hemiagenesis (THA) is a rare congenital anomaly. It occurs more frequently in the left lobe and predominantly in women. Most of the cases are asymptomatic. The most frequent associated thyroid disorders with THA are nontoxic nodular goiter and Hashimoto's thyroiditis whereas association of Graves' disease with THA is very rare. We present a man patient with THA and multinodular Graves' disease. A 47-year-old male was admitted with palpitation, hand tremor, and weight loss, and was found to have overt thyrotoxicosis and high TSH receptor antibody (TRAB) levels in laboratory analysis (TSH=0.04 µIU/ml sT4=1.3 ng/dl sT3=4.5 pg/ml TRAB=35 IU/l ). Thyroid ultrasonography revealed multiple thyroid nodules (largest one 6x11x17 mm in diameter) in the right lobe; the left lobe was not visualized. Tc-99m thyroid scan showed increased uptake of radioisotope in the right lobe, and there was no uptake in the left lobe. Based on these findings, the patient was diagnosed with THA and multinodular Graves' disease, and started on metimazole treatment. Although very rare, Graves' disease may occur in patients with THA, and it should be considered in the differential diagnosis of patients presenting with hyperthyroidism. [Med-Science 2015; 4(3.000): 2575-83

Hearing impairment in middle-aged patients with diabetes

Most studies focus on elderly patients with type 2 diabetes mellitus (T2DM). There is little known about the hearing of middle-aged subjects with T2DM. The objective of this study is to evaluate hearing impairment in patients aged 40–50 years with T2DM using pure-tone audiometry and high-frequency audiometry. Forty patients with T2DM (19 males, 21 females) and 40 (20 males, 20 females) age and sex similar controls were included. All subjects completed clinical, laboratory and auditory assessments. Pure-tone audiometry auditory tests and high-frequency audiometry tests were performed in a soundproof room for each ear using the AC-40 audiometer from Interacoustics with a special earphone appropriate for high frequency. In the T2DM group, the duration of T2DM was between 5 and 15 years (7.7 ± 2.4 years). At all frequencies, the thresholds of the T2DM group were higher than the control group for both right and left ears and also significant. However, the thresholds at standard frequencies (125–8000 Hz) for both group's average were lower than 20 dB-HL and were considered to be normal, and at high frequencies (9000–16,000 Hz) the T2DM group's average thresholds were higher than 20 dB-HL and considered to be a hearing loss. A Spearman's correlation test was done between the duration of T2DM and hearing thresholds. There was a mild correlation between the duration of T2DM and hearing thresholds in all frequencies. In conclusion, patients with type 2 diabetes have a high prevalence of subclinical sensorineural hearing loss. High-frequency audiometry can be used in hearing assessment screening of diabetic patients

Predictive Factors of Malignancy in Residual Thyroid Tissue after Partial Thyroidectomy in Patients with Differentiated Thyroid Cancer

Although partial thyroidectomy has lower operative risk, it potentially caries the risk of leaving residual malignancy. The aim of this study was to establish malignancy rate in residual thyroid tissue in patients with differentiated thyroid cancer (DTC) who underwent partial thyroid surgery and subsequently had completion thyroidectomy. We also investigated a number of clinical and biochemical factors that may anticipate the presence of malignancy in the thyroid remnant. Data of 58 patients with DTC who underwent completion thyroidectomy were retrospectively analyzed. Patients were divided into 2 groups based on the residual tissue pathology after completion thyroidectomy; the first group consisted of patients with malignant residual tissue, and the second group consisted of patients with benign residual tissue. Tumor histopathology type and serum thyroglobulin levels before completion thyroidectomy were compared between the two groups. Among 58 patients, 13 (22.4%) patients were found to have malignant residual tissue after completion thyroidectomy. No significant differences were found between the groups with respect to age, serum thyroglobulin level before completion thyroidectomy, primary tumor type, tumor size, bilateralism, multifocality, arterial invasion, thyroid capsular invasion, and extrathyroidal invasion. Residual thyroid volume was higher in patients with malignant residual tissue. In binary logistic regression analysis, residual thyroid volume was the only predictor factor for the presence of malignancy in the thyroid remnant. Malignancy in residual thyroid tissue is not uncommon. Thyroid remnant volume may be predictive of malignancy in residual thyroid tissue. [Med-Science 2015; 4(3.000): 2498-506

Comparison of echocardiographic findings in patients with nonfunctioning adrenal incidentalomas

Adrenal incidentalomas (AIs) are usually discovered incidentally after imaging unrelated to adrenal glands. We aimed to evaluate standard risk factors for systemic atherosclerosis and echocardiographic changes in patients with nonfunctioning AIs and compare them with normal subjects. We evaluated 70 patients diagnosed with AIs and 51 healthy controls. Mean levels were determined for HbA1c, LDL, uric acid, fasting plasma insulin, HOMA, and neutrophil-to-lymphocyte ratio (NLR), and these values were found to be significantly higher in the patients than the controls. The mean left atrial diameter, interventricular septum thickness, posterior wall thickness, left ventricular mass, E-wave deceleration time, isovolumetric relaxation time, and the median ratio of the early transmittal flow velocity to the early diastolic tissue velocity (E/Em) were higher in patients with AIs compared to controls. The mitral annular early diastolic velocity was lower in patients with AIs. The mean aortic diastolic diameter, stiffness index (SI), and aortic strain were higher, and aortic distensibility was lower in the patients. The mean right ventricular diameter, right atrial major-axis diameter, and right atrial minor-axis diameter were statistically higher in the patient group than the controls. A negative correlation was found between the NLR and aortic strain and aortic distensibility, while a positive correction was found between the NLR and SI. We found altered left ventricular (LV) and right ventricular (RV) echocardiographic findings in patients with AIs without known cardiovascular disease. Aortic stiffness was also increased. These changes may be related to an increase in cardiovascular risk factors in AI patients