Wpływ dystrybucji tkanki tłuszczowej oraz wybranych adipokin na insulinooporność w stanie przedcukrzycowym

  Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p < 0.001) and visfatin (p < 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p < 0.01) and fat mass (p < 0.01) and low adiponectin (p < 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277–282)    Wstęp: Ryzyko rozwoju insulinooporności i zespołu metabolicznego zwiększa się zwłaszcza u osób z otyłością centralną. W niniejszym badaniu oceniono wpływ dystrybucji tkanki tłuszczowej i wybranych adipokin na insulinooporność u osób ze stanem przedcukrzycowym. Materiał i metody: Osiemdziesięciu siedmiu chorych dobranych pod względem wieku I płci podzielono na 3 grupy w zależności od wyniku testu doustnego obciążenia 75 g glukozy: osoby z nieprawidłową glikemią na czczo, osoby z nieprawidłową tolerancją glukozy i osoby z prawidłową tolerancją glukozy. Zmierzono stężenie insulin na czczo. Do oszacowania insulinooporności zastosowano model homeostazy. Masę tkanki tłuszczowej oceniono za pomocą analizatora bioimpedancji elektrycznej, a grubość brzusznej tkanki tłuszczowej (podskórnej, trzewnej i przedotrzewnowej) zmierzono metodą ultrasonograficzną. Stężenie na czczo w surowicy kilku adipokin (adiponektyna, leptyna, rezystyna, waspina, wisfatyna, białko wiążące retinol-4 [RBP-4], czynnik martwicy nowotworów alfa [TNF-alfa]) zmierzono, stosując metodę ELISA. Wyniki: Średni wskaźnik masy ciała, masa tkanki tłuszczowej I grubość brzusznej tkanki tłuszczowej były podobne we wszystkich grupach. Nie stwierdzono różnic między grupami pod względem średniego stężenia insuliny na czczo ani stężeń waspiny, RBP-4, leptyny, rezystyny i TNF-alfa. W porównaniu grup ze stanem cukrzycowym i grupy z prawidłową tolerancją glukozy wykazano, że stężenia adiponektyny (p < 0,001) i wisfatyny (p < 0,001) były niższe u osób ze stanem przedcukrzycowym. Ponadto stwierdzono, że wysoki wskaźnik masy ciała (p < 0,01) i duża masa tkanki tłuszczowej (p < 0,01) oraz niskie stężenie adiponektyny (p < 0,05) przyczyniają się do rozwoju insulinooporności u osób ze stanem przedcukrzycowym. Wnioski: Autorzy sugerują, że nie tylko otyłość, ale również obniżenie stężenia adiponektyny odgrywają pewną rolę w patogenezie insulinooporności w okresie przedcukrzycowym. (Endokrynol Pol 2016; 67 (3): 277–282)

Evaluation of the Compatibility of Atrium and Ventricular Measurements in Thoracic Computerized Tomography and Coronary Computerized Tomography Angiography

Aim: We aimed to evaluate the consistency of the measurements of diameter and area of cardiac chambers in coronary computed tomography angiography (CTA) and contrast-enhanced thoracic computed tomography (CT) images.Materials and Methods: 30 patients who underwent thoracic CT and coronary CTA over a 6-month period between August 2016 and August 2019 were included in the study. Maximum left atrium area, anteroposterior and transverse left atrium diameter, right atrium transverse diameter, right and left ventricular transverse diameters were measured by two observers. Inter-observer and intra-observer Contrast-enhanced thoracic CT and coronary CTA measurements of the cardiac chambers were found to be perfectly compatible. Both left atrial axial area and AP diameter were evaluated on coronary CTA images and contrast-enhanced thoracic CT with excellent reproducibility.Conclusion: To our knowledge, this is the first study that shows the measurement of diameter and area of the cardiac chambers in thoracic CT and coronary CTA and comparing them with each other. Thoracic CT, with its high reproducibility, could be a useful tool in evaluation of cardiac chambers

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

Correlation Between Digital X-Ray Radiogrammetry Findings and Bone Mineral Density in Postmenopausal Women

The relation between bone mineral density (BMD) determined by dual energy X ray absorptiometry (DEXA) and radiogrammetric measurements on digital radiographies was investigated in this study. Fifty-seven postmenopausal women who had applied for DEXA measurement were included in the study. External diameter (ED) and internal diameter (ID) measurements were performed on the mid-points of the longitudinal axis of the non-dominant second metacarpal bone on digital radiographic images. By using these two measurement values, the combined cortical thickness (CCT), cortical area (CA), medullary area (MA), metacarpal index (MI) and cortical ratio (CR) values were determined by simple geometrical calculations. The osteoporosis group had 28 women and the control group 29 women after DEXA evaluations. ID and MA were found to be significantly higher (p<0.001); and CCT, CR and MI significantly lower (p<0.001) in women with osteoporosis. BMD of lumbar spine (vertebrae L2-L4) positively correlated with CCT (p<0.05). Positive correlations were found between BMD of femur neck and CCT (p<0.001), MI, CR (p<0.05). BMD of femur Ward’s triangle correlated with CCT, MI and CR positively while it correlated negatively with ID and MA (p<0.001). Similarly BMD of femur trochanter showed positive correlations with CCR, CA, MI, CR (p<0.001), and negative correlations with ID and MA (p<0.05). No significant threshold value could be provided in the ROC curves in order to discriminate patients with osteoporosis from normal. The concordant relations found between bone geometry measurements and DEXA seemed to be encouraging to prove probably the value of digital radiogrammetry for the discrimination of osteoporotic patients from normal, in studies with larger patient population

Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19). Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4). Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80) months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients

Spontaneous Cure of an Apoplectic Somatotropinoma in the Setting of Coronary Angiography

Pituitary apoplexy, which results from spontaneous hemorrhage into a pituitary adenoma, may be associated with a number of clinical settings including head trauma, hypertension, diabetes mellitus, acute hypovolemic shock, contrast media usage, and anticoagulation therapy. Clinical manifestations are due to the mechanical compression of the optic apparatus and cavernous sinus content, and pituitary insufficiency. Pituitary insufficiency does not recover in most of the cases. Ophthalmoplegia may resolve spontaneously over time or after surgery. Rarely, pituitary apoplexy may be followed by an endocrinologic cure. We present an apoplectic somatotropinoma in the setting of coronary angiography and unstable angina pectoris, which was spontaneously cured after pituitary apoplexy. This is one of few reports of pituitary apoplexy in association with contrast medium and anticoagulant-antiaggregant drug administration. Turk Jem 2008; 12:35-

İntervertebral disk yüksekliklerinin radyografik ve cerrahi ölçümleri arasındaki uyum: Bir kadavra çalışması

Amaç: Disk yüksekliği ölçümünün birçok klinik anlamı vardır. Disk yüksekliğinin radyolojik ölçümü doğru sonuç vermeyebilir ve bu ölçümün direkt “cerrahi” olarak doğrulanması çalışılmamıştır. Bu çalışmada C2-C3'ten L5-S1'e kadar insan intervertebral disk yüksekliklerinin radyografik ve diskektomi sonrası cerrahi ölçümleri arasındaki uyumu değerlendirilmiştir. Gereç ve Yöntemler: Onbir kadavra omurgasında (243 intervertebral disk) çalışıldı. Diskektomi öncesi, tüm intervertebral disk yükseklikleri Frobin ve ark.'nın lumbal seviyeler için kullandığı yöntemle radyolojik olarak ölçüldü. Daha sonra diskektomiler gerçekleştirildi ve cerrahi disk spacer'leri kullanılarak disk yükseklikleri doğrudan ölçüldü. Bulgular: Disk yüksekliklerinin radyolojik ve doğrudan ölçümlerinin ortalama ve standart sapma değerleri sırasıyla, servikal seviyeler için 4.7±0.6 mm ve 4.5±0.6 mm, torasik seviyeler için 5.1±0.7 mm ve 4.9±0.7 mm ve lumbal seviyeler için 11.3±2.5 mm ve 10.9±1.8 mm idi. Radyolojik ve doğrudan ölçüm değerleri uyumlu bulundu. Sonuç: Bu çalışmanın sonuçları cerrahi öncesi büyütmesiz Lateral X-Ray ile Frobin ve ark.'nın tarif ettiği yöntem kullanılarak, diskektomi sonrası cerrahi intervertebral disk yüksekliklerini tüm omurga bölgeleri için doğru olarak tahmin etmenin mümkün olduğunu desteklemektedir.Objective: Measurement of disc height has various clinical implications. Radiographic measurement of disc height may present inaccurate results and its direct &amp;#8220;surgical&amp;#8221; confirmation has not been studied. This study aimed to evaluate the agreement between the radiographic and post-discectomy surgical measurements of human intervertebral discs' height C2-C3 thru L5-S1. Material and Methods: Eleven cadaver spines (243 discs) were studied. Before discectomies, the heights of all intervertebral discs were measured radiologically, using the method proposed by Frobin et al., which had been originally used for lumbar levels. Then, discectomies were performed and the discs were measured directly, using surgical disc spacers. Results: Mean values and standard deviations for radiographic and direct measurements of disc heights were, respectively, 4.7&plusmn;0.6 mm and 4.5&plusmn;0.6 mm for cervical, 5.1&plusmn;0.7 mm and 4.9&plusmn;0.7 mm for thoracic, and 11.3&plusmn;2.5 mm and 10.9&plusmn;1.8 mm for lumbar regions. The agreement between radiographic and direct measurements was good. Conclusion: The results from this study suggest that it is possible to estimate correctly the post-discectomy surgical heights of intervertebral discs for all spine regions by using non-magnified preoperative lateral X-rays and the method described by Frobin et al