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

Mogu li hemocitometrijski parametri poslužiti kao biološki biljezi u razlikovanju adrenalnih adenoma i karcinoma te u prognozi adrenokortikalnih karcinoma?

Recently, studies have reported that inflammatory response and elevated platelet counts are associated with several cancers. In the present study, we aimed to evaluate hemocytometer parameters in differentiating adrenal adenoma and carcinoma, and the prognostic utility of hemocytometer parameters in adrenocortical carcinoma (ACC). We included 30 patients with nonfunctional adrenal adenoma and 13 patients with ACC having undergone surgery between 2005 and 2017 and followed up postoperatively at our centre. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) and plateletcrit (PCT) were evaluated preoperatively in all patients included in the study. There was a significant difference between the adrenal adenoma and ACC groups in terms of neutrophil and lymphocyte counts, NLR and PLR. There was no significant difference between the two groups in terms of platelet count and MPV, but PCT levels were significantly lower in ACC group. There was no statistically significant difference between recurrent and/or metastasis positive patients and negative ones according to NLR, PLR, RDW and MPV. There was a statistically significant difference in RDW levels and tumor diameter between the groups. Our study is the first to evaluate hemocytometer parameters in differentiating adrenal adenomas and carcinomas, and also in the prognosis of ACC. The present study suggested that the hemocytometer parameters may be a marker in the differential diagnosis of adrenal adenomas and carcinomas. However, our study also showed that these parameters had no prognostic value in ACC.Nedavna istraživanja pokazuju da su upalni odgovor i povišeni trombociti udruženi s nekim vrstama karcinoma. Cilj našega istraživanja bio je procijeniti hemocitometrijske parametre u razlikovanju adrenalnog adenoma i karcinoma, kao i prognostičku vrijednost hemocitometrijskih parametara u adrenokortikalnom karcinomu (adrenocortical carcinoma, ACC). U istraživanje smo uključili 30 bolesnika s nefunkcionalnim adrenalnim adenomom i 13 bolesnika s ACC operiranih između 2005. i 2017. godine i poslije operacije praćene u našoj ustanovi. Kod svih bolesnika uključenih u studiju prijeoperacijski su izmjereni sljedeći parametri: omjer neutrofila i limfocita (neutrophil/lymphocyte ratio, NLR), omjer trombocita i limfocita (platelet/lymphocyte ratio, PLR ), širina distribucije eritrocita (red blood cell distribution width, RDW ), srednji volumen trombocita (mean platelet volume, MPV) i pleteletkrit (PCT). Utvrđena je statistički značajna razlika između skupina bolesnika s adrenalnim adenomom i onih s ACC u broju neutrofila i limfocita, NLR i PLR. Nije bilo značajne razlike među skupinama u broju trombocita i MPV, ali su razine PCT bile značajno niže u skupini s ACC. Nije bilo statistički značajne razlike u NLR, PLR, RDW i MPV između bolesnika s opetovanim ACC i/ili metastazama i onih bez tih stanja. Statistički značajna razlika između skupina nađena je za razine RDW i promjer tumora. Naše istraživanje je prvo te vrste u kojem su se procjenjivali hemocitometrijski parametri u razlikovanju adrenalnih adenoma i karcinoma te u prognozi ACC. Rezultati studije ukazuju na to da bi se hemocitometrijski parametri mogli primijeniti kao biljezi u diferencijalnoj dijagnostici adrenalnih adenoma i karcinoma. Međutim, naše je istraživanje pokazalo kako ovi parametri nemaju prognostičku vrijednost kod ACC

Painful and painless thyroiditis

Tiroidit, tiroidin çeşitli nedenlerle ortaya çıkan inflamasyonudur. Birçok neden, otoimmünite, enfeksiyonlar, radyasyon, ilaçlar tiroidit gelişimine neden olabilmektedir. Tiroiditlerin nedenleri gibi klinik tabloları da çok çeşitlidir. Bu nedenle ayrım ve sınıflama yapmak her zaman mümkün olamamaktadır. Hastalarda herhangi bir semptom olmaksızın tanı tesadüfen konulabildiği gibi, hastalar boyunda şiddetli ağrı, şişlik, guatr ile de başvurabilmektedirler. Hastalar ötiroidik olabilmekte, hipotiroidi veya tirotoksikoz da görülebilmektedir. Tedavi genellikle semptomları düzeltmeye yöneliktir. Tiroid disfonksiyonu saptanması halinde etyolojide göz önünde bulundurularak tedavi planlanmalıdırThyroiditis is the inflammation of the thyroid which caused by various reasons. Many reasons including autoimmunity, infection, radiation or medications may lead to the development of thyroiditis. Similar to the complexity of its causes, thyroiditis presents many varieties of clinical conditions. Therefore, making the exact distinction and classification of thyroiditis is not always possible. Thyroiditis may be incidentally diagnosed in patients without any symptoms, such as patients with severe neck pain, swelling or goiter. The patients may be euthyroid, as well as they may develop hypothyroidism or thyrotoxicosis. Most of the time, the treatment is employed towards the symptoms. Once the thyroid dysfunction is detected, treatment should be planned by taking the etiology into consideration

Medicine Science 2014;3(4):1697-707 Primary Medical Therapy and Acromegaly Case Report Curative Result with Primary Medical Therapy in an Elderly Acromegaly Patient

Abstrac

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

Fusidic acid resistance of methicillin resistant and sensitive staphylococcus strains ısolated from clinical specimens

Bu çalışma fusidik asitin stafilokoklara in-vitro etkisini belirlemek amacıyla yapılmıştır. Araştırmaya alınan suşlar Temmuz 2001- Haziran 2002 tarihleri arasında Afyon SSK Hastanesi Mikrobiyoloji Laboratuvarı’nda değerlendirmeye alınan çeşitli klinik örneklerden izole edilmiştir. Metisilin ve fusidik asit direnci agar disk difüzyon yöntemi ile araştırılmıştır. İzole edilen 122 stafilokok suşunun 46’sı (%38) Staphylococcus aureus, 76’sı (%62) koagülaz negatif stafilokok (KNS) olarak tanımlanmıştır. S. aureus suşlarının 29’u (%63) ve KNS’ların 50’si (%66) metisiline dirençli bu¬lunmuştur. Metisiline dirençli Staphylococcus aureus (MRSA) suşlarının 2’si (%7), metisilin duyarlı Staphylococcus aureus (MSSA) suşlarının 1’i (%6), metisilin dirençli koagülaz negatif stafilokok (MRKNS) suşlarının 16’sı (%32) ve metisilin duyarlı koagülaz negatif stafilokok (MSKNS) suşlarının 3’ü (%12) fusidik asite dirençli bulunmuştur. Bu sonuçlar, fusidik asitin stafilokokal enfeksiyonların tedavisinde tercihte gözardı edilmemesi gereken bir antibiyotik olduğunu göstermektedir.This study was carried out in order to determine the in-vitro effect of fusidic acid on stapyhlococci. The investigated strains were isolated from various clinical materials which evaluated in Microbiology Laboratory of Afyon Social Insurance Instution Hospital during the period from July 2001 to June 2002. Methicillin and fusidic acid resistance were investigated by agar disk diffusion method. Of the isolated 122 Stapylococcus strains 46 (38%) were identified as Staphylococcus aureus, 76 (62%) were coagulase negative staphylococci (CNS). Twenty nine (63%) of Staphylococcus aureus and 50 (66%) of coagulase negative Staphylococcus strains were methicillin resistant. Two (7%) of methicillin resistant Staphylococcus aureus (MRSA) strains, 1 (6%) of methicillin sensitive Staphylococcus aureus (MSSA) strains, 16 (32%) of methicillin resistant coagulase negative Staphylococcus (MRCNS) strains and 3 (12%) of methicillin sensitive coagulase negative Staphylococcus (MSCNS) strains were found to be resistant to fusidic acid. These results indicated that fusidic has not to be excluded in preference of the antibiotic treatment of staphylococcal in-fections

Fusidic acid resistance of methicillin resistant and sensitive staphylococcus strains ısolated from clinical specimens

Bu çalışma fusidik asitin stafilokoklara in-vitro etkisini belirlemek amacıyla yapılmıştır. Araştırmaya alınan suşlar Temmuz 2001- Haziran 2002 tarihleri arasında Afyon SSK Hastanesi Mikrobiyoloji Laboratuvarı’nda değerlendirmeye alınan çeşitli klinik örneklerden izole edilmiştir. Metisilin ve fusidik asit direnci agar disk difüzyon yöntemi ile araştırılmıştır. İzole edilen 122 stafilokok suşunun 46’sı (%38) Staphylococcus aureus, 76’sı (%62) koagülaz negatif stafilokok (KNS) olarak tanımlanmıştır. S. aureus suşlarının 29’u (%63) ve KNS’ların 50’si (%66) metisiline dirençli bu¬lunmuştur. Metisiline dirençli Staphylococcus aureus (MRSA) suşlarının 2’si (%7), metisilin duyarlı Staphylococcus aureus (MSSA) suşlarının 1’i (%6), metisilin dirençli koagülaz negatif stafilokok (MRKNS) suşlarının 16’sı (%32) ve metisilin duyarlı koagülaz negatif stafilokok (MSKNS) suşlarının 3’ü (%12) fusidik asite dirençli bulunmuştur. Bu sonuçlar, fusidik asitin stafilokokal enfeksiyonların tedavisinde tercihte gözardı edilmemesi gereken bir antibiyotik olduğunu göstermektedir.This study was carried out in order to determine the in-vitro effect of fusidic acid on stapyhlococci. The investigated strains were isolated from various clinical materials which evaluated in Microbiology Laboratory of Afyon Social Insurance Instution Hospital during the period from July 2001 to June 2002. Methicillin and fusidic acid resistance were investigated by agar disk diffusion method. Of the isolated 122 Stapylococcus strains 46 (38%) were identified as Staphylococcus aureus, 76 (62%) were coagulase negative staphylococci (CNS). Twenty nine (63%) of Staphylococcus aureus and 50 (66%) of coagulase negative Staphylococcus strains were methicillin resistant. Two (7%) of methicillin resistant Staphylococcus aureus (MRSA) strains, 1 (6%) of methicillin sensitive Staphylococcus aureus (MSSA) strains, 16 (32%) of methicillin resistant coagulase negative Staphylococcus (MRCNS) strains and 3 (12%) of methicillin sensitive coagulase negative Staphylococcus (MSCNS) strains were found to be resistant to fusidic acid. These results indicated that fusidic has not to be excluded in preference of the antibiotic treatment of staphylococcal in-fections

Atypical Thyroid Function Tests, Thyroid Hormone Resistance [Atipik Tiroid Fonksiyon Testleri: Tiroid Hormon Direnci]

The assessment of thyroid function tests for to the diagnose hyperthyroidism (thyrotoxicosis) or hypothyroidism does not constitute a nuisance when the clinical suspicion is strong. However, substantial proportion of discordant results with clinical findings or atypical results possible to come across in the thyroid function tests. In such cases, accurate diagnosis is very important for appropriate management to the patient, prevention of unnecessary tests and cost increases. For accurate diagnosis in these patients, a detailed clinical evaluation with specific laboratory studies are needed. Atypical hyperthyroxinemia (high thyroid hormone levels are incompatible with TSH) is an atypical thyroid function test pattern can be seen in the rare cases of thyrotropin releasing pituitary adenoma or thyroid hormone resistance syndrome. However, in this case, assay interferences and euthyroid situations such as thyroxin replacement therapy with poor-compliance, euthyroid sick syndrome including acute psychiatric disorders, hyperthyroxinemia due to drugs like heparin, disorders with protein binding abnormalities (familial dysalbuminemic hyperthyroxinemia, transthyretin related hyperthyroxinemia) which are seen more common, should be excluded primarily. Then should be consulted further examinations for the differential diagnosis of thyrotropin-secreting pituitary adenomas and thyroid hormone resistance syndrome. The Refetoff Syndrome is developing due to a defect in the beta-receptor and is most common in thyroid hormone resistance syndromes. It includes a combination of findings of hyperthyroidism and hypothyroidism and suggests an autosomal dominant inheritance feature. Therefore, family screening should be done in patients diagnosed. Mostly, beta blockers is sufficient in the treatment. Other rare syndromes of thyroid hormone resistance that occurs due to alpha-receptor defects, thyroid hormones membrane transport defect and thyroid hormone metabolism defect related with deficiency of deiodinases. The clinical pictures of this rare syndromes are more severe compared to classic syndrome and often the choice of treatment is only supportive therapy. [Med-Science 2014; 3(3.000): 1545-70