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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 Distal sensorimotor polyneuropathy affects skeletal muscle perfusion and metabolism by Tc-99m sestarnibi leg scintigraphy in patients with type 2 diabetes(Lippincott Williams & Wilkins, 2005) Ugur-Altun, B; Durmus-Altun, G; Ustun, F; Turgut, N; Altun, A; Tugrul, AWe evaluated the effects of distal symmetric sensorimotor polyneuropathy (DSP) on skeletal muscle perfusion and metabolism in patients with type 2 diabetes. Twenty-three patients with type 2 diabetes under-went electrophysiological and Tc-99m sesta-mibi leg scintigraphic studies. The study patients were divided into 2 groups: group I (n = 14) with DSP and group 11 (n = 9) without DSP. We found decreased Tc-99m sestamibi uptake ratios (UR) of both legs in patients with DSP (right UR 7.98 +/- 6.85, left UR 7.78 +/- 7.01 vs. right UR 8.91 +/- 7.98, left UR 8.67 +/- 8.23, respectively) than without DSP, although it did not reach statistical significance. The regression equation of right UR was (Tc-99m sestarnibi UR = [1.927 X velocity of tibial nerve] - [0.942 X amplitude of sural nerve] - 81.94). In conclusion, electrophysiological variables of tibial motor and sural sensory nerves predict Tc-99m sestarnibi UR at leg scintigraphy in patients with type 2 diabetes. Additionally, decreased Tc-99m sestarnibi UR in patients with type 2 diabetes with DSP was found.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 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 Factors related to exercise capacity in asymptomatic middle-aged type 2 diabetic patients(Elsevier Ireland Ltd, 2005) Ugur-Altun, B; Altun, A; Tatli, E; Tugrul, AAim: We aimed to look at the relationship between exercise capacity and metabolic variables in unselected consecutive asymptomatic middle-aged type 2 diabetic patients as a potential marker for undiagnosed coronary heart disease. Method: Ninety patients (49 6 years) were included in the study. All patients performed a treadmill exercise test using the Bruce protocol. According to achieved EC, patients were separated into three groups; Group I (n, 24) 8 > metabolic equivalents (METs) greater than or equal to 5, Group II (n, 54) 11 > METs > 8 and Group III (n, 12) METs > 11. Results: Patients in group I are more likely to be of female gender and to have a family history of coronary heart disease (CHD) than in group III (P = 0.015, P = 0.009, respectively). When compared to group 111, patients in group I had higher fasting insulin and fibrinogen levels (P = 0.049 and P = 0.01, respectively). Homeostasis model assessment for insulin resistance (HOMA-IR) index (P = 0.03) was also higher in group I than in group III. We found a significant negative correlation between achieved exercise capacity and age (r = -0.204, P = 0.048), fasting insulin (r = -0.209, P = 0.048), HOMA-IR (r = -0.204, P = 0.048) as well as fibrinogen (r = -0.301, P = 0.007). Conclusion: Reduced exercise capacity was associated with increased insulin resistance as assessed by HOMA-IR index in asymptornatic middle-aged type 2 diabetic patients. (C) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Incidental detection of single vertebral osteomyelitis in a patient operated on for parathyroid hyperplasia(Lippincott Williams & Wilkins, 2001) Çermik, TF; Yüksel, M; Yalniz, E; Kaya, M; Ugur, B; Tugrul, A; Berkarda, S[Abstract Not Available]Öğe The relationship between insulin resistance and serum osteoprotegerin level in obese patients(Nature Publishing Group, 2004) Ugur-Altun, B; Altun, A; Gerenli, M; Tugrul, A[Abstract Not Available]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 insulin resistance assessed by HOMA-IR and serum osteoprotegerin levels in obesity(Elsevier Ireland Ltd, 2005) Ugur-Altun, B; Altun, A; Gerenli, M; Tugrul, AAim: We investigated the relationship between insulin resistance and serum osteoprotegerin (OPG) levels in healthy obese subjects and healthy lean controls. Methods: Fifty obese subjects (age: 31 +/- 8 years) and 24 lean controls (age: 30 7 years) were included in the study. We used the homeostasis model assessment for insulin resistance (HOMA-IR) index as the index of insulin resistance. OPG levels were measured with the commercial ELISA kit. Obese subjects were studied in three groups: Group I (n = 25) HOMA-IR index < 2.24, Group II (n = 13) index 2.24-3.59, Group III (n = 12) index > 3.59. Group IV (n = 24) was the lean controls with HOMA-IR index < 2.24. Results: Obese subjects with increased insulin resistance (Group III) had lower OPG values than other groups (11.88 +/- 7.43 pg/ ml, 16.39 +/- 6.39 pg/ml, 17.37 +/- 9.61 pg/ml, and 18.1 +/- 6.65 pg/ml, respectively; Group I versus Group III p = 0.036; Group III versus Group IV p = 0.012). We also found significant inverse correlations between OPGc (corrected for BMI) and fasting glucose (r = -0.325, p = 0.005), fasting insulin (r = -0.404, p = 0.0001) as well as HOMA-IR (r = -0.428, p = 0.0001). Increased fibrinogen level was found in Group III than Group IV (9.32 +/- 1.97 mu mol/1 versus 7.47 +/- 1.65 mu mol/1, respectively; p = 0.005). In conclusion, insulin resistance in obesity is associated with decreased serum OPG levels and increased fibrinogen levels. The relationship between serum OPG levels and HOMA-IR may provide an insight into vascular endothelial dysfunction in obesity. (c) 2004 Elsevier Ireland Ltd. All rights reserved.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 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]
