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Öğe 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, ArinaAdenoma 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.Öğe Effect of obesity on TAFI in postmenopausal period(Elsevier Sci Ltd, 2010) Taskiran, Bengur; Guldiken, Sibel; Demir, Ahmet M.; Okman, Tulay K.; Arikan, Ender; Turgut, Burhan; Tugrul, Ayse A.Aim: The aim of the study was to evaluate how obesity effects the coagulation and fibrinolytic system in the postmenopausal period. Method: Forty-eight obese (body mass index (BMI) >= 30 kg/m(2)) and 38 nonobese (BMI < 30 kg/m(2)) postmenopausal women were enrolled in the study. Fat mass and insulin resistance were calculated. Plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), D-dimer, thrombomodulin, and thrombin activatable fibrinolysis inhibitor (TAFI) antigen were determined by ELISA method. TAFI activity was measured using the chromogenic assay. Results: Obese subjects had higher PAI-1 (73.5 +/- 35.7 ng/mL vs. 57.1 +/- 34.2 ng/mL, p < 0.05) levels but lower tPA/PAI-1 ratio (0.59 +/- 0.50 vs. 38 +/- 0.21, p < 0.05) than their nonobese counterparts. Obesity was not statistically significant for other haemostatic variables. BMI and fat mass were positively correlated with PAI-1 (r = 0.312, p = 0.003; r = 0.381, p = 0.005, respectively) and negatively correlated with tPA/PAI-1 ratio (r = -0.273, p = 0.01; r = -0.545, p = 0.01, respectively). HOMA scores were also positively correlated with PAI-1 levels (r = 0.236, p = 0.04). Conclusion: We found that tendency to hypercoagulability in the postmenopausal women was due to increased PAI-1 rather than TAFI levels, which may contribute to adverse cardiovascular outcomes in this cohort. Further studies should be undertaken to evaluate effects of weight loss on the coagulation and fibrinolytic system. (C) 2010 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.Öğe An Evaluation of Glucose Tolerance in Essential Hypertension(Yonsei Univ Coll Medicine, 2009) Tugrul, Armagan; Guldiken, Sibel; Ugur-Altun, Betul; Arikan, EnderPurpose: This study aimed to detemine the impaired glucose tolerance and diabetes prevalence in patients with essential hypertension (HT) and to compare the developed microvascular complications of these groups. Materials and Methods: An oral glucose tolerance test (OGTT) was performed on 338 essential hypertensive cases and glucose tolerances were classified according to ADA-2002 criteria. Results: Of the 338 cases, 32 people had diabetes (DM, 9.460/6), 78 people had glucose intolerance (IGT, 23.1%), and 228 people had only hypertension but not IGT and DM (67.4%). Both the mean ages of the DM group (56.9 +/- 6.7 years, p = 0.002) and IGT group (56.3 +/- 8.4 years, p = 0.003) were older than the mean age of the control group (51.1 +/- 6.4 years). The risk of IGT development was found to be four times greater in male cases than female cases when compared to the control group (p = 0.004, add ratio = 4.194). There were no significant differences in the body mass indexes (BMI's), hypertension durations, and microvascular complications between the groups. Conclusion: In conclusion, the risk of IGT and DM development in hypertensive cases increases with aging and longer hypertension duration. The risk of IGT development in hypertensive cases is four times more in males.Öğe Frequency of rheumatic diseases in patients with autoimmune thyroid disease(Springer, 2007) Soy, Mehmet; Guldiken, Sibel; Arikan, Ender; Altun, Betul Ugur; Tugrul, ArmaganWe 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.Öğe The levels of circulating markers of atherosclerosis and inflammation in subjects with different degrees of body mass index: Soluble CD40 ligand and high-sensitivity C-reactive protein(Pergamon-Elsevier Science Ltd, 2007) Guldiken, Sibel; Demir, Muzaffer; Arikan, Ender; Turgut, Burhan; Azcan, Sennur; Gerenli, Murat; Tugrul, ArmaganBackground: It is welt demonstrated that obesity is an independent risk factor for cardiovascular diseases. Recent studies have shown that obesity, insulin resistance and atherosclerosis are closely related phenomena in which low-grade inflammatory state and prothrombotic condition has pivotal roles. It has been shown that CD40-soluble CD40 ligand (sCD40L) interactions might constitute an important mediator for vascular inflammation. The aim of the present study was to assess sCD40L in relation to hs-CRP and cardiovascular risk factors in relation to body mass index (BMI). Materials and methods: Serum sCD40L and hs-CRP concentrations were measured in 52 obese patients and 28 non-obese subjects by ELISA. Insulin resistance was calculated by homeostasis model assessment-insulin resistance (HOMA-IR). We divided the participants into three groups depending in their BMI levels (Group 1: BMI < 25 kg/m(2), Group 2: BMI 30-34.9 kg/m(2), Group 3: BMI >= 35 kg/m(2)). Results: We determined that the mean sCD40L of group 3 was significantly higher than group 1 and group 2 (p < 0.05, p < 0.05, respectively). However, there was no significant correlation between plasma sCD40L levels and BMI. Plasma levels of hs-CRP were higher in obese group than the non-obese group (p < 0.001). The Levels of sCD40L were not significantly different between the two groups. The mean hs-CRP levels increased gradually in accordance with groups of BMI, there was a strong correlation between hs-CRP levels and BMI (r = 0.724, p < 0.001). There was no significant correlation between sCD40L and hs-CRP levels in all participants. Conclusions: It is still a subject for debate whether sCD40L Levels are increased or not in obesity. However, the results of this study showed that sCD40L is substantially increased in patients with severe obesity. In terms of causality, the relatively small sample size and cross-sectional design of this study are considered to be the limitation factors. (c) 2006 Elsevier Ltd. All rights reserved.Öğe Levels of high-sensitivity C-reactive protein, leptin, and resistin in patients with overt hypothyroidism and subclinical hypothyroidism(Lippincott Williams & Wilkins, 2008) Guldiken, Sibel; Demir, Muzaffer; Arikan, Ender; Azcan, Sennur; Tugrul, ArmaganHypothyroidism is associated with an increased risk for obesity and cardiovascular diseases. Resistin and leptin exert proinflammatory actions by activating a specific receptors which are expressed in human endothelial cells. The aim of the study was to investigate whether the relations between the leptin, resistin, and high-sensitivity C-reactive protein (hs-CRP), which is a marker of low-grade inflammation, in patients with subclinical (SH) and overt hypothyroidism (OH). The levels of leptin, resistin, and hs-CRP were measured in 25 patients with CH, 30 patients with SH, and in 25 healthy subjects, using enzyme-linked immunosorbent assay method. The leptin and resistin levels in patients with OH and SH were similar to those in the control group. The hs-CRP level in OH group was significantly higher than SH and control groups (P < 0.001, P < 0.001). In the OH group, hs-CRP levels were positively correlated with thyroid-stimulating hormone levels (P < 0.001, r = 0.728) and negatively correlated with fF4 levels (P = 0.01 r = -0.51). Combining the OH and SH groups, serum hs-CRP levels were significantly correlated with thyroid-stimulating hormone levels (P < 0.001, r = 0.765) and fr4 (P < 0.001, r = -0.716). No significant correlation was found between hs-CRP and leptin or resistin in patients with OH and SH. We suggest that the elevated hs-CRP levels in hypothyroidism may play a role in the increased risk for atherosclerosis in these patients.Öğe The Role of Serum Cytokines in the Pathogenesis of Hepatic Osteodystrophy in Male Cirrhotic Patients(Hindawi Ltd, 2012) Soylu, Ali Riza; Tuglu, Cengiz; Arikan, Ender; Yetisyigit, Tarkan; Kunduracilar, Hakan; Koker, Ibrahim Hakki; Unsal, GulbinObjective. In this study, we aimed to investigate the possible role of serum cytokines in the development of hepatic osteodystrophy. Matherial and Methods. 44 consecutive male cirrhotic patients (17 alcoholic, 20 hepatitis B, 7 hepatitis C), 15 age- and sex-matched chronic alcoholics without liver disease, and 17 age- and sex-matched healthy controls were included in the study during one year period. Bone mineral density was measured by dual X-ray absorptiometry in the lumbar vertebrate and femoral neck. Serum interleukin levels were measured by ELISA method. Results. Although osteopenia frequency between our cirrhotic patients was 20%, there was no difference in T-scores among the controls and other groups. Serum interleukin-1, interleukin-8, and tumor necrosis factor-alpha levels were not different between all groups. Serum interleukin-2 and interleukin-6 levels were higher in the cirrhotics than controls (P < 0.001). However, there were no significant difference between osteopenic and nonosteopenic cirrhotics. Conclusion. According to the results of the study in this small population of 44 male cirrhotic patients, frequency of hepatic osteopenia is small and serum interleukins 1, 2, 6, 8, and tumor necrosis factor-alpha may not play a role in the pathogenesis of hepatic osteodystrophy. Further studies in which large number of patients involved are necessary in this field.Öğe The roles of oxidized low-density lipoprotein and interleukin-6 levels in acute atherothrombotic and lacunar ischemic stroke(Sage Publications Inc, 2008) Guldiken, Baburhan; Guldiken, Sibel; Turgut, Burhan; Turgut, Nilda; Demir, Muzaffer; Celik, Yahya; Arikan, EnderThe role of circulating, oxidized low-density lipoprotein and interleukin-6 levels in acute ischemic stroke considering the primary-vessel disease was investigated. The study consisted of 28 patients with acute ischemic stroke and 23 control subjects. Patients were subdivided into large-vessel (n = 12) and small-vessel (n = 16) disease stroke groups according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The means of oxidized low-density lipoprotein and interleukin-6 levels of patients with acute ischemic stroke were higher than controls (P < .01, P < .05). Mean oxidized low-density lipoprotein level was higher in the large-vessel disease group than in the small-vessel disease group (P < .01). The mean of inteleukin-6 levels was higher in the small-vessel disease group (P < .01). The results of the present study showed that oxidative stress promotes large-vessel disease rather than small-vessel disease stroke, and inflammation may play important an role in the development of small-vessel disease stroke.Öğe Serum osteoprotegerin levels in patients with acute atherothrombotic stroke and lacunar infarct(Pergamon-Elsevier Science Ltd, 2007) Guldiken, Baburhan; Guldiken, Sibel; Turgut, Burhan; Turgut, Nilda; Demir, Muzaffer; Celik, Yahya; Arikan, EnderBackground: Arterial calcification is associated with increased risk of cardiovascular events. Osteoprotegerin (OPG) is a cytokine involved in the bone metabolism and vascular calcification. Recent data support a relationship between high serum levels of OPG and increased risk for cardiovascular disease in human. The aim of this study was to evaluate the OPG serum levels in acute ischemic stroke. Our study was further designed to detect differences in serum OPG levels between subtypes of ischemic stroke. Materials and methods: The study consisted of 51,patients with acute ischemic stroke and 28 control subjects. Stroke subtypes were defined by the TOAST classifications. Serum OPG levels were measured with the ELISA method. Results: OPG serum levels were significantly higher in patients with ischemic stroke than in control subjects (p < 0.001). OPG serum levels were significantly higher in large-vessel disease (LVD) subtype compared with small-vessel disease (SVD) subtype and controls (p < 0.001, p < 0.001). There was no significant difference in OPG serum levels between SVD group and control subjects. Serum OPG levels were correlated with age (r=0.407, p=0:005) and fasting glucose levels (r=0.542, p=0:001) in ischemic stroke group. Logistic regression analysis showed that plasma OPG levels (OR 2.1, 95% CI, 1.16 to 3.4, p=0.01) associated with presence of stroke independently of the other risk factors. Conclusions: High serum OPG levels were associated with the WD stroke subtype, suggesting that OPG levels may play role in pathogenesis of atherothrombotic stroke. The precise mechanism for the role of OPG in atherosclerosis needs to be investigated further. (c) 2006 Elsevier Ltd. All rights reserved.
