Miyokard enfarktüsü 18 ay sonrası yaşam kalitesi

Amaç: Akut miyokard infarktüs (AMI) sonrası hangi hastaların düşük yaşam kalitesi açısından risk altında olduğunun tanımlanması amaçlanmıştır. Yöntem: Bu çalışma AMI tanısı ile taburcu edilmiş 49 hastanın 18 ay sonra değerlendirildiği kesitsel bir çalışmadır. Yaşam kalitesi, SF-36 kullanılarak değerlendirilmiştir. Bulgular: Bayan hastalar ve komorbiditesi olanlar SF-36 alt ölçeklerinde düşük skorlar elde etmişlerdir ki bu da düşük yaşam kalitesini göstermektedir. Çalışma durumlarına göre de anlamlı farklar saptanmıştır. Üç yaşam kalitesi alanı ile yaş ve çocuk sayısı arasında anlamlı derecede negatif korelasyon saptanmıştır. Eğitim süresi açısından beş alanda, enfarktüs olmadan geçen süre için sadece tek anlamda anlamlı düzeyde pozitif korelasyon bulunmuştur. Sonuç: Cinsiyet, yaş, sosyoekonomik faktörler, komorbidite ve enfarktüs olmaksızın geçen süre; AMI sonrası yaşam kalitesinin önemli belirleyicileridir.Purpose: To identify patients who are at risk for poor health related quality of life after acute myocardial infarction (AMI). Methods: This is a cross-sectional study of 49 patients with the discharge diagnosis of acute myocardial infarction after 18 months period of time. The quality of life was assessed by using SF-36 questionnaire. Results: Female patients and patients with comorbidity had lower scores in SF-36 subscales implying poorer quality of life. Significant differences were also observed in working status. The three quality of life domains were significantly negatively correlated with age and the number of children. In terms of education time length; five domain scores and in terms of time span without infarction; only one domain was significantly positively correlated. Conclusion: Sex, age, socioeconomic factors, comorbidity, time span without infarction are the most important predictors of health related quality of life after AMI

Preoperative therapeutic plasmapheresis in thyrotoxic patients who did not effectively treated with antithyroid drugs, iodine and corticosteroid

Introduction: Preoperative treatment options in thyrotoxic patients are antithyroid drugs, potassium iodide, beta blockers and corticosteroids. Sometimes these treatment regimens have not been so successful for the patients to make them ready for the operation. So we thought that plasmapheresis (PP) could be an alternative to these treatments. Methods: Two thyrotoxic patients with Graves' disease and one patient with toxic multinodular goiter were included in the study. All patients were candidates to surgical operation due to the contraindication of other medical treatment choices. On admission, all patients had severe uncontrolled hyperthyroidism. In order to prepare our patients to operation, all the patients were given beta blockers and inorganic potassium iodide and corticosteroid at first but disease control could not be achieved in terms of thyrotoxicosis. So PP was performed at an average of 3 to 5 sessions. Results: After PP, all patients' thyroid hormone concentrations were significantly reduced. One patient had an anaphylactic reaction during 3th session of PP. Total thyroidectomy was performed to all patients without any complications. Conclusions: We concluded that PP could be used as an alternative therapeutic option in the preoperative management of severe thyrotoxic patients. © 2010 Düzce Medical Journal

Preoperative Therapeutic Plasmapheresis In Thyrotoxic Patients Who Did Not Effectively Treated With Antithyroid Drugs, Iodine And Corticosteroid

Introduction: Preoperative treatment options in thyrotoxic patients are antithyroid drugs,potassium iodide, beta blockers and corticosteroids. Sometimes these treatment regimens havenot been so successful for the patients to make them ready for the operation. So we thought thatplasmapheresis (PP) could be an alternative to these treatments. Methods: Two thyrotoxic patients with Graves’ disease and one patient with toxic multinodulargoiter were included in the study. All patients were candidates to surgical operation due to thecontraindication of other medical treatment choices. On admission, all patients had severeuncontrolled hyperthyroidism. In order to prepare our patients to operation, all the patients weregiven beta blockers and inorganic potassium iodide and corticosteroid at first but disease controlcould not be achieved in terms of thyrotoxicosis. So PP was performed at an average of 3 to 5sessions. Results: After PP, all patients’ thyroid hormone concentrations were significantly reduced. Onepatient had an anaphylactic reaction during 3th session of PP. Total thyroidectomy wasperformed to all patients without any complications.Conclusions: We concluded that PP could be used as an alternative therapeutic option in thepreoperative management of severe thyrotoxic patients

Helikobakter pylori enfeksiyonu B12 eksikliğinin gerçekten bir nedeni midir?

Aim: Aim of this study is to determine Helicobacter pylori infection rate in Vitamin B12 deficiency and determine whether H.pylori infection is really actual cause of Vitamin B12 deficiency. Material and Methods: We evaluated 40 vitamin B12 deficient patients and 25 healthy subjects. Those patients did not have known cause of vitamin B12 deficiency. We performed endoscopic evaluation and pathological examination for H.pylori. We determined 50% atrophic gastritis in vitamin B12 deficient group, but we did not observe any atrophic gastritis in the control group endoscopically. Results: There were H.pylori positivity in 11/40 (27.5%) in the patients group but 16/25 (64) in the control group in pathological examination (p<0.01). Pathological examination of patient group also illustrated that 11 patients had mild atrophy in 11 (27.5%), 5 had moderate atrophy (12.5%) and 3 patient (7.5%) had severe atrophy. In contrast, 3 patients had only mild atrophy (12%) in the control group. We also found that H.pylori (-) 17/29 (58.6%) patients and H.pylori (+) 3/11 (27.3%) patients had atrophic gastritis in gastroscopic evaluation. Conclusion: Patients who have vitamin B12 deficiency had lower ratio of H.pylori in gastric mucosa. On the other hand, the patient group had higher ratio of atrophic gastritis in pathological and gastroscopic examination. H.pylori positivity had been decreased progressively with aging in patients group. H.pylori has disappeared in following years as a result of atrophy in gastric mucosa. We conluded that atrophic mucosa is not suitable for colonization of H.pylori infection. © 2011 Düzce Medical Journal

THYROID-RELATED FACTORS THAT INFLUENCE PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMAS

WOS: 000300805400004PubMed: 21742606Objective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001). Conclusion: Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors. (Endocr Pract. 2012;18:26-33

Serum transforming growth factor-beta levels in patients with vitamin D deficiency

WOS: 000298148800028PubMed: 22153539Background: Transforming growth factor-beta 1 (TGF-beta 1) contributes to tissue repair by promoting tissue fibrosis, and elevations have been reported in patients with bone marrow fibrosis. The aim of this study was to evaluate the relationship between TGF-beta 1 levels and vitamin D deficiency. Methods: All patients presenting to the outpatient Endocrinology and Metabolic Diseases clinic between June and September of 2008 were approached, and consenting patients who were deemed suitable candidates were enrolled. Hematological parameters were measured, along with serum levels of total and ionized calcium, phosphorus, parathyroid hormone, iron, folic acid vitamin B12 levels, 25 OH vitamin D3 (25OHD(3)) and TGF-beta 1. Results: A total of 132 patients were included in the study. Patients were divided into 4 groups based on levels of 25OHD(3) [group 1 ( 30 ng/ml), 28 patients]. TGF-beta 1 levels were higher in patients in group 1 compared to the other groups. Transforming growth factor-beta levels correlated negatively with vitamin D3 and positively with leukocyte count, platelet count, of MCV and MCH. Multiple regression analyses revealed TGF-beta 1 levels to be associated with 25OHD(3) as well as with platelet count. Conclusions: Results of this study are suggestive of the presence of a significant relationship between TGF-beta and vitamin D deficiency. Increased TGF-beta 1 and platelet count may be an early indicator of bone marrow fibrosis in patients with vitamin D deficiency. Crown Copyright (C) 2011 Published by Elsevier B. V. on behalf of European Federation of Internal Medicine. All rights reserved

Comparison of Endoscopic and Microscopic Endonasal Transsphenoidal Surgery Approaches in Acromegalic Patients.

92nd Meeting and Expo of the Endocrine Society (ENDO 2010) -- JUN 19-22, 2010 -- San Diego, CAWOS: 000281989403267…Endocrine Societ

Clinical and radiological findings in macroprolactinemia

WOS: 000303584800021PubMed: 22187359Hyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8 +/- 10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0 +/- 10.1 vs. 30.7 +/- 9.8, P = 0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0 +/- 347.0 vs. 238.8 +/- 584.9, P = 0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P = 0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P = 0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P = 0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels

The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology (vol 45, pg 37, 2014)

WOS: 000331638200027Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were =1 cm, 82.9 % of the benign nodules were =1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients