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    A case of double parathyroid adenoma mimicing intrathoracic tumor
    (Lippincott Williams & Wilkins, 2008) Taskiran, Bengur; Altun, Betul Ugur; Usta, Ufuk; Guldiken, Sibel; Arikan, Ender; Van Tue-Rul, Arina
    Adenoma is the leading pathologic entity in primary hyperparathyroidism (85%-90%). Although brown tumors are rarely seen, they may be the initial presentation and confused with tumors of the contiguous structures. Bilateral neck exploration by an experienced surgeon is the preferred approach. However, computed tomography, magnetic resonance imaging, ultrasonography, and isotope scanning can delineate most cases (75%-85%). We present a man with 2 adenomas. The second tumor was not recognized until the first one was removed. Combined imaging modalities and the measurement of intraoperative parathormone did not help in identifying the second adenoma. We review the common problems associated with diagnosis and treatment of multiple parathyroid adenomas.
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    Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance
    (Taylor & Francis Ltd, 2006) Turgut, Nilda; Guldiken, Sibel; Balci, Kemal; Tugrul, Armagan; Berberoglu, Ufuk; Altun, Betul Ugur
    This article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio ( SRAR), dorsal sural/radial amplitude ratio ( DSRAR), sympathetic skin response ( SSR), and R-R interval variability ( RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls ( p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls ( p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects ( p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies ( sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies ( sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.
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    Frequency of rheumatic diseases in patients with autoimmune thyroid disease
    (Springer, 2007) Soy, Mehmet; Guldiken, Sibel; Arikan, Ender; Altun, Betul Ugur; Tugrul, Armagan
    We aimed to investigate the frequency of rheumatic diseases in patients suffering from autoimmune thyroid diseases (ATD). Sixty-five patients (56 F, 9 M), who were followed by diagnosis of ATD, were questioned and examined for the presence of rheumatic disease. Basic laboratory tests and antithyroid antibodies, antinuclear antibody and rheumatoid factor (RF) levels were also measured by appropriate methods. Various rheumatic diseases were detected in 40 (62%) of patients with ATD. The most frequent rheumatic conditions were fibromyalgia, recurrent aphthous stomatitis, osteoarthritis, keratoconjunctivitis sicca and xerostomia and carpal tunnel syndrome which were detected in 20 (31%), 13 (20%), 10 (15%), 9 (14%) and 8 (12%) of patients, respectively. Autoimmune diseases, except Sjogren's syndrome, which were detected in ten patients with ATD, are as follows-vitiligo: two; autoimmune hepatitis: two; oral lichen planus: one, ulcerative colitis: one, inflammatory arthritis in four patients (two of them had rheumatoid arthritis, one had psoriasis and psoriatic arthritis and one had mixed collagen tissue disease). RF was positive in two patients, one of them had rheumatoid arthritis and FANA was positive in six (9%) patients; all of them had hypothyroidism. The frequency of rheumatic diseases seems to be higher in patients suffering from ATD. Initial evaluation and a regular checking for rheumatic diseases in patients suffering from ATD were recommended.
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    Periosteum: Resorption or Formation Area?
    (Galenos Yayincilik, 2008) Altun, Betul Ugur
    Periosteum is a membrane that lines the outer surface of all bones, except at the joints of long bones. Endosteum lines the inner surface of all bones. Periosteal formation is observed in every stage of life, especially in childhood and early adulthood. Formation continues mechanically as a response to load. Periosteal resorption is observed especially in the flat bones in the growing period. In adulthood, resorption is a part of remodeling. The periosteal surface contains fewer osteoclasts than does the endosteal surface, and remodeling on the periosteal surface is much slower. For this reason, adult periosteum is defined as a formation area.
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    Spontaneous Cure of an Apoplectic Somatotropinoma in the Setting of Coronary Angiography
    (Galenos Yayincilik, 2008) Taskiran, Bengur; Guldiken, Sibel; Altun, Betul Ugur; Tuncbilek, Nermin; Tugrul, Armagan
    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.