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Öğe Autoimmune polyglandular syndrome type III in monozygotic twins: A case report(Taylor & Francis Ltd, 2004) Ugur-Altun, B; Arikan, E; Guldiken, S; Kara, M; Tugrul, AAutoimmune polyglandular syndrome is characterized by the coexistence of several autoimmune diseases, affecting predominantly the endocrine glands. Autoimmune polyglandular syndrome type III, as a subdivision of autoimmune polyglandular syndrome type H, is the co-occurrence of autoimmune thyroid disease with other autoimmune disorders without Addison disease. We present a rare case of autoimmune polyglandular syndrome type III in monozygotic twins. One of the twins also had autoimmune leukopenia. To our knowledge, leukopenia is the first mentioned coexistence in the literature of autoimmune polyglandular syndrome.Öğe Clearance of technetium-99m-labeled DTPA in hyperthyroidism without clinical evidence of lung disease, and relation to pulmonary function(Springer, 2005) Guldiken, S; Tugrul, A; Altiay, G; Hacimahmutoglu, S; Durmus-Altun, GObjective: The mechanisms of dyspnea and exercise intolerance have not been fully elucidated. We aimed to investigate the clearance rate of technetium-99m diethyltriaminepentaaceticacid (Tc-99m DTPA) from lungs in hyperthyroid patients without clinical evidence of lung disease and to explore the interactions between their Tc-99m DTPA radioaerosol lung scintigraphy, spirometric measurements, and the levels of thyroid hormones. Methods: We studied 19 hyperthyroid patients and 16 sex- and age-matched controls. Thyroid hormone levels were assessed. Spirometric lung function tests, diffusing capacity of the lung for carbon monoxide (DLCO) and the clearance rate of Tc-99m DTPA were performed in all participants. Ratio of DLCO value to the alveolar ventilation (DLCO/VA) and the means of half-time (T-1/2) of Tc-99m DTPA clearance rate, which were used to evaluate alveolar-capillary membrane permeability, were calculated. Results: There were no statistical differences between spirometfic parameters (VC, FVC, FEV1/FVC, FEF 25-75) of the two groups (p > 0.05). Although the mean FEV1 level was significantly lower in the hyperthyroid patients than the control subjects (p < 0.01), in five patients FEV1 was only less than 80 percent of the predicted value. No significant difference in the means of DLCO, DLCO/VA or T-1/2 values of Tc-99m DTPA clearance was observed between the two groups (p > 0.05). In hyperthyroid patients, there was a positive relation between DLCO/VA, DLCO/VA % and T-1/2 values of Tc-99m DTPA clearance (p < 0.01, r = 0.732, p < 0.01, r = 0.742, respectively). The lung volumes and the levels of thyroid hormones did not show a significant relationship to T-1/2 values of Tc-99m DTPA clearance in hyperthyroid group (p > 0.05). Conclusions: We conclude that increased thyroid hormones have no effect on permeability of alveolar-capillary membrane in hyperthyroid patients.Öğe Complete relief of pain in acute painful diabetic neuropathy of rapid glycaemic control (insulin neuritis) with venlafaxine HCL(Editrice Kurtis S R L, 2004) Guldiken, S; Guldiken, B; Arikan, E; Ugur, BA; Kara, M; Tugrul, AThis article reports a case of a diabetic patient who suffered from acute painful diabetic neuropathy, following an intensive insulin treatment after a poor glycaemic control period of 8 yr. On the 15(th) day of the insulin treatment, which enabled rapid successful glycaemic control, the patient began complaining of pain and a burning sensation in the lower extremities, especially during the night. Venlafaxine HCL was initiated and the patient was completely free of pain on the third day of the treatment. As insulin neuritis is infrequent among diabetic patients we consider it is worth reporting the dramatic effect of the venlafaxine HCL treatment. (C) 2004, Editrice Kurtis.Öğe Does body mass index of the patients with hypertension affect the risk of cardiovascular disease?(Nature Publishing Group, 2004) Arikan, E; Guldiken, S; Ugur-Altun, B; Kara, M; Tugrul, A[Abstract Not Available]Öğe Dysphagia as a primary manifestation of hyperthyroidism: A case report(Taylor & Francis Ltd, 2006) Guldiken, B; Guldiken, S; Turgut, N; Yuce, M; Arikan, E; Tugrul, AMyopathy effecting mainly skeletal muscles of the limbs are frequently seen in hyperthyroidism. Rarely bulbar muscles may also be involved, causing dysphagia, nasal speech, and aspiration. We report a 70-year-old woman with severe dysphagia and aspiration pneumonia. Clinical examination and laboratory tests showed an underlying Graves' disease. Her dysphagia improved dramatically by antithyroid therapy. Considering its excellent response to medical therapy, hyperthyroidism being a very rare factor - is well-worth to remember for the unexplained dysphagia cases.Öğe The effects of rosiglitazone treatment on the fibrinolytic system in patients with type 2 diabetes mellitus(Sage Publications Inc, 2006) Guldiken, S; Turgut, B; Demir, M; Arikan, E; Kara, M; Vural, O; Tugrul, APatients with type 2 diabetes mellitus (DM) are at risk for the development of cardiovascular diseases, which can in part be explained by disturbances in the hemostatic and fibrinolytic systems. The effects of rosiglitazone treatment on the fibrinolytic system and insulin sensitivity in patients with type 2 DM were assessed. Twenty-four patients with type 2 DM and 28 healthy subjects were enrolled in the study. Plasma global fibrinolytic capacity (GFC), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) levels were measured. Insulin resistance was calculated by hoemostasis model assessment. Patients with type 2 DM then were placed on rosiglitazone (4 mg/day, for 12 weeks) in addition coexistent medication, and baseline tests were repeated. There was no difference between mean t-PA levels of the two groups. PAI-1 levels were higher in diabetic patients than control subjects (p < 0.01). Diabetic patients had lower GFC and t-PA/PAI-1 levels than control subjects (p < 0.05, p < 0.05). PAI-1 levels were positively correlated with waist circumference in diabetic group (r = 0.4, p < 0.05). After rosiglitazone treatment, there was no difference in mean plasma levels of GFQ t-PA, PAI-1 and t-PA/PAI-1 in diabetics. Insulin sensitivity significantly improved after the addition of rosiglitazone treatment in diabetic patients (p < 0.01). The short-term and low-dose treatment with rosiglitazone in type 2 diabetic patients has no effects on the fibrinolytic system, although it improves insulin sensitivity.Öğe The evaluation of the median nerve in subclinical hypothyroidism by high-resolution sonography(Lippincott Williams & Wilkins, 2005) Arikan, E; Pekindil, G; Guldiken, S; Pekindil, YThe aim of this study is to evaluate whether subclinical hypothyroidism causes any alteration of the median nerve diameters by using sonography, and whether L-thyroxine treatment can improve the median nerve dimensions. Twenty-two female patients with subclinical hypothyroidism participated in this study. All patients were asked for the manifestations of carpal tunnel syndrome. They were examined and nerve conduction tests were performed. Right and left median nerve measurements (major and minor axis and cross-sectional area) were determined in all patients by high-resolution sonography before and after euthyroidism was achieved with L-thyroxine treatment. All sonographic measurements were within normal limits in 18 of 22 cases. Four patients had increased the measurements of the median nerve, but only 2 cases of 4 had increased cross-sectional area of median nerve and one of them had clinical symptoms simulating carpal tunnel syndrome. None of them has positive clinical signs of carpal tunnel syndrome. Nerve conduction velocities did not indicate carpal tunnel syndrome in patients with subclinical hypothyroidism. L-thyroxine treatment significantly decreased the mean cross-sectional area, minor and major axes of the right and left median nerves. Clinical symptoms were gradually improved. There was no correlation between the measurement of median nerve and thyroid hormones, thyroid-stimulating hormone, body mass index, and age. The duration of treatment with L-T-4 and dose did not correlate with the measurement of the median nerve. This study shows that subclinical hypothyroidism causes some alterations in the median nerve diameters in a few patients. L-Thyroxine replacement in subclinical hypothyroidism decreases the measurements of the median nerve.Öğe Exacerbations of Graves' disease after unilateral adrenalectomy for Cushing's syndrome(Editrice Kurtis S R L, 2004) Arikan, E; Guldiken, S; Altun, BU; Kara, M; Tugrul, ACushing's syndrome is characterized by endogenously increased production of glucocorticoids. The activity of immune system is regulated mainly by two systems in the body. Glucocorticoids and NF-kappaB counteract the effects of each other on the immune system. It has been reported that immune response is exaggerated after the amelioration of Cushing's syndrome. We report a rare case of exacerbation of Graves' disease after unilateral adrenalectomy for Cusing's syndrome. A 50-yr-obese woman with hypertension, dyslipidemia, impaired glucose tolerance and insulin resistance was admitted to outpatients clinic of endocrinology. The results of evaluation of glucocorticoids metabolism and adrenal magnetic resonance imaging revealed the Cusing's syndrome. We also assessed thyroid function tests because of the diagnosis of golter and thyroid hormone replacement in her medical history, and the presence of exophthalmia and tachycardia in examination. Althoug TSH level was detected at the lower border of normal range, free T-4 and free T-3 were in normal range and autoantibody of thyroidal peroxidase and thyroglobulin was higer than normal reference range. An operation was performed and a mass was removed from her left adrenal gland. The pathologic examination confirmed adrenal adenoma. She was re-admitted to the outpatient clinic 9 months after with complaints of palpitation, malaise and weight loss. Tests carried out to determine the thyroid function revealed Graves' disease. We prescribed propylthiouracil and P-blocker treatment. (C) 2004, Editrice Kurtis.Öğe Global fibrinolytic capacity in patients with subclinical hypothyroidism(Japan Endocrine Society, 2005) Guldiken, S; Demir, M; Turgut, B; Altun, BU; Arikan, E; Kara, MSubclinical hypothyroidism (SH) represents the earliest stages of hypothyroidism but the benefits of detecting and treating SH are not well known. The aim of this Study was to evaluate the alterations in global fibrinolytic capacity (GFC), which indicates the overall fibrinolytic activity, in patients with SH. The study group comprised of 15 patients with SH and 15 healthy controls. The GFC was significantly lower in patients with SH than in control group (p < 0.002). This result suggests a relative hypercoagulable state in SH.Öğe Is plasma level of von Willebrand factor the predictor of endothelial dysfunction in women with polycystic ovary syndrome?(Pergamon-Elsevier Science Ltd, 2005) Guldiken, S; Kilic-Okman, T; Demir, M; Arikan, E; Kucuk, M[Abstract Not Available]Öğe Relationship between homocysteine and insulin resistance in women with polycystic ovary syndrome(Japan Endocrine Society, 2004) Kilic-Okman, T; Guldiken, S; Kucuk, MHyperhomocysteinemia is a risk factor for atherosclerotic vascular diseases. It is known that plasma homocysteine levels are higher in polycystic ovary syndrome (PCOS) patients than in healthy subjects. The aim of our study was to determine the relationship between plasma homocysteine level and insulin resistance in women with PCOS. Twenty-nine patients (age, 23.90 +/- 5.86 years) and twenty-five healthy subjects (age, 25.24 +/- 4.28 years) were involved in the study. Plasma levels of fasting insulin, glucose, homocysteine, FSH, and LH levels were measured. A statistically significant difference in plasma concentrations of HOMA index, homocysteine, basal insulin levels and LH/FSH ratios was observed between groups (P = 0.001, P = 0.001, P = 0.001, and P = 0.01, respectively). There was no relationship between Hey and the other variables. In multiple logistic regression analysis, age, BMI and insulin resistance were not predictors of Hey.Öğe Relationships existing between the serum cytokine levels and bone mineral density in women in the premenopausal period affected by Graves' disease with subclinical hyperthyroidism(Taylor & Francis Inc, 2003) Ugur-Altun, B; Altun, A; Arikan, E; Guldiken, S; Tugrul, AWe examined the relationships existing between serum cytokine levels and bone mineral density (BMD) in women of premenopausal age affected by Graves' disease with subclinical hyperthyroidism. The study population consisted of 21 women with untreated hyperthyroid Graves' disease (group H) (age, 36 +/- 2 years), eight women with untreated subclinical hyperthyroid status (group SH) (age, 33 +/- 5 years) and 10 healthy women (group N) (age, 35 +/- 3 years). The following measurements were made in all patients: free T-4 (fT(4)), free T-3 (fT(3)), thyroid stimulating hormone (TSH), TSH receptor antibody (TRab), anti-thyroid peroxidase antibody (anti-TPO), anti-thyroglobulin antibody (anti-Tg), interleukin-2 receptor (IL-2r), interleukin-4 (IL-4), interleukin-8 (IL-8) and interleukin-13 (IL-13). IL-2r and IL-8 levels significantly increased in group H compared with group SH (p < 0.01 and p = 0.05, respectively) and group N (p < 0.001 and p = 0.02, respectively). IL-4 and IL-13 levels tended to be lower in groups H and SH compared with group N, although this difference did not reach statistical significance. Bone mineral density was significantly reduced in only two areas of the femur in group H compared with group N. There was no difference in BMD between groups SH and N. There was no correlation between thyroid hormones, serum cytokine levels and BMD in either group. In conclusion, these results suggest that there were no relationships existing between the serum level of these cytokines and BMD in women of premenopausal age affected by Graves' disease with subclinical hyperthyroidism.
