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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 The clinical characteristics of latent autoimmune diabetes in adults and its relation with chronic complications in metabolically poor controlled Turkish patients with Type 2 diabetes mellitus(Elsevier Science Inc, 2005) Arikan, E; Sabuncu, T; Ozer, EM; Hatemi, HIt has been reported that some patients with Type 2 diabetes mellitus (DM) have latent autoimmune diabetes in adults (LADA) and may show different clinical characteristics than those with Type 2 DM. We aimed to determine the ratio and clinical features of LADA in patients with diagnosed initially as Type 2 DM. We measured glutamic acid decarboxylase antibodies (GADA) in 54 patients, diagnosed clinically with Type 2 DM. Of 54 patients, 17 (31%) were GADA positive. GADA-positive patients had significantly earlier diabetes onset age (P<.001), lower BMI (P<.05), and lower serum C-peptide value (P<.001) than did those who were GADA negative. A higher proportion of the GADA-positive patients were receiving insulin therapy (P<.01). With respect to the duration of DM, familial history of DM, and the levels of blood pressures, fasting plasma glucose, and HbA1c, there was no difference between the two groups. Nephropathy and retinopathy were more frequent in GADA-positive than in GADA-negative patients. The prevalence of neuropathy was comparable between the two groups. GADA was negatively associated with BMI, C-peptide levels, and diabetes-onset age, but positively related to retinopathy, nephropathy, and insulin treatment. This study indicated that the important portion of the patients who were initially diagnosed as Type 2 DM may have LADA. In Type 2 diabetic patients who have lower BMI and diagnosis of diabetes in relatively younger age, the possibility of LADA should be taken into consideration. The higher prevalence of nephropathy and retinopathy in GADA-positive patients also suggests the importance of early diagnosis and strict metabolic control in these patients. (C) 2005 Elsevier Inc. All rights reserved.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 Early changes in parameters of bone and mineral metabolism during therapy for hyper- and hypothyroidism(Marcel Dekker Inc, 2001) Sabuncu, T; Aksoy, N; Arikan, E; Ugur, B; Tasan, E; Hatemi, HThe effects of thyroid hormones on various organs and metabolic systems have been the focus of intensive research. In this study we investigated the mechanisms of the changes in some parameters of bone and mineral metabolism before and during treatment off hyper- and hypothyroidism. Our study groups were as follows; 1) Untreated hyperthyroid patients (n = 38), 2) Hyperthyroid patients treated fbr three months (n = 21), 3) Untreated hypothyroid patients (n = 27), 4) Hypothyroid patients treated for three months (n = 20), and 5) Euthyroid control subjects (age, weight, sex and menopausal status matched) (n = 47). As expected, the mean serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and urinary Ca/creatinine and deoxypyridinoline (D-Pyr)/creatinine levels were higher in group-1 than in the control group. Serum PTH level was lower in group-1 than in group-5. However, after treatment for three months (group-2) we found that the serum and urinary levels of these parameters (except ALP) were not different than in the control group. Group-3 and group-4 did not show any differences in these parameters compared with group-5. Covariance analysis showed that urinary D-Pyr excretion had a positive, independent relationship to the serum free T3 level and age (P < 0.001 and P = 0.02, respectively). These results suggest that both bone formation and resorption markers increase in hyperthyroid patients, and with the treatment, particularly, in the period of first three months the bone resorption markers decrease rapidly, if the treatment is maintained the decrease slows, becoming more gradual. However, bone formation markers like ALP remain high in hyperthyroid patients during the treatment. In the light of this data, it is possible to conclude that osteoblastic activity lasts longer in hyperthyroidism. On the other hand, we demonstrated that these bone formation and resorption markers do not seem to be different in hypothyroid patients, even during the treatment, compared to the euthyroid controls.Öğe Effects of chronic renal failure and dialysis on lipoproteins(Elsevier Sci Ireland Ltd, 1999) Sen, S; Arikan, E; Altun, A; Çakir, E; Isikalp, H[Abstract Not Available]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 Endothelial damage and hemostatic markers in patients with uncomplicated mild-to-moderate hypertension and relationship with risk factor's(Westminster Publ Inc, 2005) Arikan, E; Sen, SEndothelial damage, high fibrinogen levels, and platelet activity are the important accelerating factors for the development of hypertension (HT). von Willebrand factor (vWF; endothelial damage marker), fibrinogen levels, and platelet aggregability were compared between patients with uncomplicated, mild-to-moderate hypertension and healthy subjects. The relationship between traditional cardiovascular risk factors and endothelial damage and prothrombotic state was evaluated. One hundred sixty-nine (54 males, 115 females) patients with untreated and uncomplicated mild-to-moderate HT, and age, gender, and body mass index-matched 124 (58 males, 83 females) healthy subjects were enrolled in this study. Plasma vWF, fibrinogen levels, adenosine diphosphate-induced platelet aggregability, insulin, glucose, serum lipids, and uric acid were measured. Patients with HT had significantly increased fibrinogen, vWF, platelet number and aggregability induced by adenosine diphosphate, triglycerides, total/HDL-C, glucose, uric acid levels, and insulin resistance than control group. vWF and hemostatic markers were comparable between smoker and nonsmoker subjects. Platelet aggregability was positively related to systolic and diastolic blood pressure, and vWF. Fibrinogen was positively associated with body mass index (BMI), systolic and diastolic blood pressure, total cholesterol (TC), uric acid, vWF, and insulin resistance. vWF was significantly related to age, systolic blood pressure, TC, LDL-C, and total/HDL-C. Systolic blood pressure was independently related to vWF. vWF and diastolic blood pressure were significant predictors for adenosine diphosphate-induced platelet aggregability. Systolic blood pressure and vWF were independent predictors for fibrinogen levels. Uncomplicated mild-to-moderate HT had endothelial damage and is associated with a prothrombotic state. Traditional cardiovascular risk factors such as age, BMI, dyslipidemia, and insulin resistance are important contributors to the development of endothelial damage and a prothrombotic state. Therefore, it is important to control these cardiovascular risk factors along with proper treatment of HT for preventing target organ damage in mild-to-moderate HT.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 Plasma total homocysteine level and its association with carotid intima-media thickness in obesity(Editrice Kurtis S R L, 2005) Uysal, O; Arikan, E; Cakir, BBackground: Elevated plasma concentrations of total homocysteine (tHcy) and obesity are risk factors for cardiovascular disease. The relationship between hyperhomocysteinemia and obesity has not been totally elucidated. Objective: The first aim of the study was to investigate whether anthropometric measurements and insulin resistance contribute to the variation in homocysteine levels in obese adults. Our second aim was to determine if any relationship exists between the carotid intima-media thickness (IMT) and plasma tHcy levels in obese subjects without traditional cardiovascular risk factors. Material and Methods: Fifty-five obese (15 male, 40 female) and 30 (111 male, 19 female) age- and sex-matched apparently healthy volunteers were included. Exclusion criteria were smoking, hypertension, diabetes, vitamin ingestion, hyperlipidemia, renal failure, liver disease, pregnancy, menopause and secondary obesity such as Cushing's syndrome, hypothyroidism. tHcy, folate, vitamin B-12 levels, fasting insulin, glucose, total cholesterol, triglycerides, HDL, LDL particles, uric acid, creatinine and creatinine clearance were measured. Non-invasive ultrasound measurements of carotid IMT were performed. Results: tHcy levels and carotid IMT were comparable between obese and nonobese subjects. Waist/hip ratio (WHR) was related to tHcy and carotid IMT. Hyperhomocysteinemic subjects (tHcy > 19.2 mu mol/l) had greater WH R than normo-homocysteinemic subjects. Both tHcy levels and carotid IMT were higher in male subjects both in obese and non-obese subjects. No association was observed between insulin resistance and tHcy and carotid IMT. Renal function and abdominal obesity were significant predictors of plasma tHcy levels. Conclusions: We concluded that, in obese subjects who are free from atherosclerosis and impaired renal function, plasma tHcy levels do not differ from healthy subjects. Plasma tHcy concentrations are not related to carotid IMT in obese subjects during the non-atherogenic stage. Although no significant difference was observed between insulin-resistant and insulin-sensitive subjects compared to the plasma tHcy levels, the relationship between tHcy levels and some components of the insulin resistance syndrome may support the opinion that tHcy may be considered a component of the insulin resistance syndrome.Öğe Relationship between insulin resistance assessed by HOMA-IR and exercise test variables in asymptomatic middle-aged patients with Type 2 diabetes(Springer, 2004) Ugur-Altun, B; Altun, A; Tatli, E; Arikan, E; Tugrul, AWe investigated the relationship between index of insulin resistance (IR) and exercise test variables in middle-aged asymptomatic patients with Type 2 diabetes. Methods: 90 patients (48 men, 42 women; age: 49+/-6 yr) were included in the study. We used homeostasis model assessment for IR (HOMA-IR) index as index of IR. All patients were subjected to treadmill exercise test. Four subjects were tested positive (4.4%). Study patients were separated into three groups: group I (no.=26) HOMA-IR index <2.24; group II (no.=26) index 2.24-3.59; group III (no.=38) index >3.59. Results: group I had less frequency of cardiovascular risk factors than group II and III (p=0.001). Systolic blood pressure baseline as well as peak exercise values, were higher in group III than in group I and II (p=0.048 vs p=0.01, respectively). Higher total exercise time and peak workload were found in group I than group II and III (p=0.04). The recovery of heart rate (Delta HRpr) was similar among the study groups. We found significant negative correlations between HOMA-IR and total exercise time and peak workload. In addition we found significant negative correlations between age vs chronotrophic index (CI), Delta HRpr, and peak workload. There were also similar negative correlations between duration of diabetes vs CI and Delta HRpr. Conclusions: IR is associated with a variety of cardiovascular risk factors. Some exercise test variables point out changes of autonomic tone during exercise in elevated IR group. Negative correlation between HOMA-IR and peak exercise capacity (METs) may well confirm increased mortality in hyperinsulinemia. (C) 2004, Editrice Kurtis.Öğe The relationship between the levels of plasma total homocysteine and insulin resistance in uncomplicated mild-to-moderate primary hypertension(Nature Publishing Group, 2006) Ustundag, S; Arikan, E; Sen, S; Esgin, H; Ciftci, SPrimary hypertension ( HT) is the most frequent independent risk factor for cardiovascular disease. It was demonstrated that plasma total homocysteine ( tHcy) is an important and modifiable cardiovascular risk factor, which correlates with the severity of atherosclerotic disease, 1 despite some discordant results. 2 Although data supporting the cause-effect relationship between HT and tHcy are limited, tHcy may play a role in the pathogenesis of HT.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.Öğe The role of nitric oxide in the protective effect of insulin against pentylenetetrazole-induced seizures in mice(John Wiley & Sons Ltd, 2000) Ulugol, A; Arikan, E; Dost, T; Dokmeci, D; Karadag, HC; Dokmeci, IBoth insulin, depending on the glycemic state, and nitric oxide (NO), depending on the experimental conditions, have been suggested to have either proconvulsant or anticonvulsant effects. It is also known that NO plays an important role in some of the peripheral effects of insulin. The aim of the present study was to investigate the effects of NO and insulin against convulsions produced by pentylenetetrazole (PTZ, 60 mg/kg, i.p.) in mice and whether NO plays a role in the effect of insulin. Nitric oxide synthase (NOS) inhibitor, N-G-nitro-L-arginine-methyl ester (L-NAME, 1-100 mg/kg, i.p.) shortened the onset of PTZ-induced convulsions and increased the incidence and mortality rate, at the higher doses. Insulin (1 U/kg, i.p.), when given with dextrose (3 g/kg, i.p.) to counteract the hypoglycemic effect of the hormone, prolonged the onset of convulsions and decreased the incidence and mortality rate. L-NAME pretreatment (3 mg/kg, i.p.), at the dose which it produced no effect on PTZ-induced convulsions, attenuated the protective effect of 1 U/kg insulin + 3 g/kg dextrose combination significantly. Concomitant administration of the NO synthesis precursor, L-arginine (500 mg/kg), completely reversed this facilitatory effect of L-NAME. Our results indicate that NO has a protective effect against PTZ-induced convulsions in mice; insulin has a similar effect when given with dextrose; and, NO production may play an important role in the anticonvulsant effect of insulin.Öğe The role of nitric oxide in the protective effect of insulin against pentylenetetrazole-induced seizures in mice [Meeting Abstract](Springer-Verlag, 2000) Ulugol, A; Arikan, E; Dost, T; Dokmeci, D; Karadag, H; Dokmeci, I[Abstract Not Available]Öğe Serum osteoprotegerin levels in the presence and severity of obesity: A healthy younger adult population study(Nature Publishing Group, 2004) Ugur-Altun, B; Altun, A; Uysal, O; Kunduracilar, H; Arikan, E; Tugrul, A[Abstract Not Available]
