Browsing by Author "Duran, Cevdet"
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Item Akromegali hastalarındaki tedavi sonuçlarımız(Uludağ Üniversitesi, 2003-12-10) Ertürk, Erdinç; Tuncel, Ercan; Kıyıcı, Sinem; Ersoy, Canan; Duran, Cevdet; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Endokrinoloji ve Metabolizma Hastalıkları Bilim Dalı.Akromegali tanılı hastaların 10 yıllık süre içinde merkezimizdeki tedavi sonuçlarını değerlendirmeyi amaçladık. Merkezimize başvuran toplam 52 akromegali hastası olmasına karşın klinik izlem bilgilerine ulaşılabilen 30 hasta (E/K: 13/17) çalışmaya alındı. Yaş ortalamaları 43 ± 10 (28-64) yıl, akromegali tanısı aldıklarındaki yaş ortalamaları 39 ± 9 (26-60) yıl ve ortalama izlem süreleri 42 ± 38 (5-127) ay idi. Kür olma kriteri serum GH seviyesinin bazal veya glukoz yüklemesi sonrası 2 ng/ml altına inmesi olarak kabul edildi. Tanı sonrası tüm hastaların değişik merkezlerde ve değişik cerrahlar tarafından transsfenoidal hipofizektomi operasyonu geçirdiği ve birinci operasyonda % 33 (10/30) oranında kür elde edildiği görüldü. Operasyon öncesi mikroadenomu olan hastalardaki (n=11) kür oranı % 63, makroadenomu olan hastalardaki (n=19) kür oranı % 15 idi. Aralarındaki fark istatistiksel olarak anlamlı bulundu (p<0.05). Postoperatif kür olmayan hastalarda uygulanan radyoterapi sonrası 11 olgunun ancak 4’ünde kür elde edilirken, bunların 2’sinde hipopitüitarizm geliştiği görüldü. Oktreotid-LAR tedavisi uygulanan 12 hastanın sadece 1’inde (% 8) 30 mg/ay dozuna rağmen GH seviyesinin 2 ng/ml altına indirilemediği görüldü. İkinci kez operasyon uygulanan 6 hastanın yalnızca 1 tanesinde (% 16) kür elde edilebilirken, beşinde (%83) operasyona sekonder hipopitüitarizm geliştiği görüldü. Birinci operasyon ile karşılaştırıldığında kür başarısı yönünden anlamlı farklılık saptanmaz iken, hipopitüitarizm gelişme riski anlamlı yüksek bulundu (p=0.008). Sonuç olarak mikroadenomu olan hastalarda transsfenoidal operasyon sonrası kür olasılığı yüksek iken makroadenomlularda bu olasılık çok düşük bulundu. Bizim elde ettiğimiz kür oranlarının yayınlardan daha düşük olmasının nedeni operasyonların tecrübeli sayılabilecek cerrahlar tarafından yapılmamış olmasına bağlandı. İkinci operasyon sonrasında kür elde etme olasılığı çok daha azalırken, komplikasyon görülme olasılığının arttığı görüldü. Makroadenom ve mikroadenomlularda uygulanan oktreotid tedavisinin büyüme hormonu seviyesini güvenli sayılan seviyelere baskıladığı ve operasyona seçenek olabileceği saptandı.Item Brown tumors of the maxillary sinus and patella in a patient with primary hyperparathyroidism(Lippincott Williams & Wilkins, 2005) Duran, Cevdet; Ersoy, Canan; Bolca, Naile; Kıyıcı, Sinem; Yalçınkaya, Ulviye; Ertürk, Erdinç; Tuncel, Ercan; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; AAH-8861-2021; AAJ-6536-2021; AAB-6174-2020; 12754039000; 6701485882; 13806674200; 12753880400; 6508300295; 7005488796; 7006929833; 6602297533Brown tumor is an important but rare complication of primary hyperparathyroidism. It is seen in approximately 1% of the cases. Common involvement areas are long bones, ribs, hand, skull, pelvic bones, and mandible. The maxillary sinus is a rare involvement site. Patellar bone involvement has not been reported. Because brown tumor and giant cell tumor have similar histopathologic findings, the differential diagnosis is important. We present a patient with ectopic parathyroid adenoma with multiple brown tumors located in uncommon areas such as the maxillary sinus and patella. A 54-year-old female patient was operated on 3 times for the suspicion of osteal giant cell tumor. After admission, the diagnosis of primary hyperparathyroidism was suggested by the clinical history. This was confirmed by biochemical, radiologic, and histopathologic determinations. Excision of an ectopic parathyroid adenoma normalized the metabolic status. The unusual brown tumor localizations were important in the differential diagnosis of lytic skeletal lesions.Item Comparison of composite whole body insulin sensitivity index derived from mixed meal test and oral glucose tolerance test in insulin resistant obese subjects(Springer, 2009-10) Duran, Cevdet; Selimoğlu, Hadi; Kıyıcı, Sinem; Güçlü, Metin; Ersoy, Canan; Özkaya, Güven; Ertürk, Erdinç; Tuncel, Ercan; İmamoğlu, Sazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0297-846X; ABI-4847-2020; AAJ-6536-2021; AAH-8861-2021; A-4421-2016; 12753880400; 15073842600; 6701485882; 16316866500; 7005488796; 7006929833; 6602297533Apart from fasting blood glucose (FBG) and insulin (FBI), oral glucose tolerance test (OGTT) is also used in calculating insulin sensitivity. During OGTT, insulin secretion may not reflect normal physiological insulin secretion. Based on this idea, hepatic and whole body insulin sensitivity rates were tested during OGTT and mixed meal test (MMT) in obese subjects. Thirty-one women with Quantitative Insulin Sensitivity Check Index (QUICKI) values below 0.350 and body mass index (BMI) a parts per thousand yen30 were included into the study. OGTT with 75-g glucose and MMT 300 kcal were applied to all cases. Data obtained from OGTT and MMT were used in the assessment of insulin sensitivity with Hemostasis of Model Assessment-Insulin Resistance (HOMA-IR) and Matsuda's Composite Whole Body Insulin Sensitivity Index (Matsuda's ISI). Mean BMI, FBG, and FBI were 36.8 +/- A 3.9 kg/m(2), 100.5 +/- A 0.10 mg/dl, 16.2 +/- A 5.3 mu g/ml, respectively. QUICKI was 0.31 +/- A 0.01 and HOMA-IR was 3.71 +/- A 0.88. Matsuda's ISI derived from OGTT was 6.96 +/- A 3.35 and from MMT was 11.32 +/- A 6.61. In analysis, it was demonstrated that there was a correlation between HOMA-IR, QUICKI, and Matsuda's ISIs derived from OGTT and MMT. Comparing the time periods separately, it was detected that despite similar increment in insulin levels, glucose levels were higher in OGTT than MMT at 15 and 30 min. Consequently, Matsuda's ISI was demonstrated to be effectively used with the data of MMT, as used with OGTT. Moreover, MMT was shown to be in parallel to physiologic insulin secretion and reflect pancreatic functions better compared to OGTT.Item Distribution of RET mutations and evaluation of treatment approaches in hereditary medullary thyroid carcinoma in Turkey(Galenos Yayıncılık, 2015-09-30) Aydoğan, Berna İmge; Yüksel, Bağdagül; Tuna, Mazhar Müslüm; Başaran, Mehtap Navdar; Ertörer, Melek Eda; Aydın, Kadriye; Guldiken, Sibel; Şimşek, Yasin; Karaca, Züleyha Cihan; Yılmaz, Merve; Aktürk, Mujde; Anaforoğlu, İnan; Kebapcı, Nur; Duran, Cevdet; Taşlıpınar, Abdullah; Kulaksızoğlu, Mustafa; Gursoy, Alptekin; Dağdelen, Selçuk; Erdoğan, Murat Faik; Kocaeli, Ayşen Akkurt; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; 57142602300Objective: This retrospective multicenter study, centrally conducted and supported by the Society of Endocrinology and Metabolism of Turkey, aimed to evaluate the impact of free RET proto-oncogene testing in medullary thyroid carcinoma (MTC) patients. Surgical timing, adequacy of the treatment, and frequency of prophylactic thyroidectomy (PTx) in mutation carriers were also assessed. Methods: Genetic testing for MTC and pheochromocytoma was conducted between July 2008 and January 2012 in 512 patients. Application forms and RET mutation analyses of these patients whose blood samples were sent from various centers around Turkey were assessed retrospectively. An evaluation form was sent to the physicians of the eligible 319 patients who had confirmed sporadic MTC, familial MTC (FMTC), multiple endocrine neoplasia type 2 (MEN2), or who were mutation carriers. Physicians were asked to give information about the surgical history, latest calcitonin levels, morbidity, mortality, genetic screening, and PTx among family members. Twenty-five centers responded by filling in the forms of 192 patients. Results: Among the 319 patients, RET mutation was detected in 71 (22.3%). Cys634Arg mutation was the most prevalent mutation (43.7%), followed by Val804Met in 18 patients (25.4%), and Cys634Tyr in 6 patients (8.5%). Among 192 MTC patients, the diagnosis was sporadic MTC in 146 (76.4%), FMTC in 14 (7.3%), MEN2A in 15 patients (7.9%), and MEN2B in one patient. The number of mutation carriers among 154 apparently sporadic MTC patients was 8 (5.2%). Ten patients were submitted to PTx out of twenty-four mutation carriers at a mean age of 35 +/- 19 years. Conclusion: Turkish people have a similar RET proto-oncogene mutation distribution when compared to other Mediterranean countries. Despite free RET gene testing, the number of the PTx in Turkey is limited and relatively late in the life span of the carriers. This is mainly due to patient and family incompliance and incomplete family counselling.Item The effect of metformin treatment on VEGF and PAI-1 Levels in obese type 2 diabetic patients(Elsevier, 2008-07) Ersoy, Canan; Kıyıcı, Sinem Kucuksaraç; Budak, Ferah Ah; Oral, Haluk Barbaros; Güçlü, Metin; Duran, Cevdet; Selimoǧlu, Hadi; Ertürk, Erdinç; Tuncel, Ercan; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı Anabilim Dalı.; 0000-0003-0463-6818; K-7285-2012; ABI-4847-2020; F-4657-2014; AAH-8861-2021; AAJ-6536-2021; 6701485882; 12753880400; 6701913697; 7004498001; 15073842600; 12754039000; 15074185600; 7005488796; 7006929833; 6602297533The aim of the study was to evaluate the effect of metformin on markers of endothelial function, vascular inflammation and factors of thrombosis in obese type 2 diabetic patients. Twenty-four type 2 diabetic patients (15 female, 9 male) previously under medical nutrition treatment (MNT) + regular exercise programme (REP) without chronic micro or macrovascular complications with the mean age of 50.5 +/- 1.5 years, diabetes duration of 17.9 +/- 6.3 months and body mass index (BMI) of 31.7 +/- 0.8 kg/m(2) were enrolled in the study. In the first 4 weeks, all the patients continued MNT + REP. In the following 12 weeks, metformin (mean daily dosage of 1381 +/- 85 mg) was added. After the first period with MNT + REP, BMI, waist circumference, fat percentage, blood pressure and HDL cholesterol decreased significantly. After metformin addition, there was a significant decrement in BMI, waist circumference, fat percentage, fasting and postprandial. plasma glucose, hemoglobin A1C, plasminogen activator inhibitor-1 (PAI-1), vascular endothelial growth factor (VEGF) and increment in P cell reserve values of the patients. Our results indicated that, metformin addition had beneficial effect on VEGF and PAI-1 levels in obese type 2 diabetic patients under MNT + REP, independent from its' favourable effects on BMI and glycemic control.Item Effect of rosiglitazone, metformin and medical nutrition treatment on arterial stiffness, serum MMP-9 and MCP-1 levels in drug naive type 2 diabetic patients(Elsevier, 2009-10) Duran, Cevdet; Kıyıcı, Sinem; Ersoy, Canan; Kaderli, Aysel Aydın; Fazlıoğlu, Murat; Budak, Ferah; Gül, Özen Öz; Sığırlı, Deniz; Baran, İbrahim; Tuncel, Ercan; Ertürk, Erdinç; İmamoğlu, Sazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAJ-6536-2021; AAA-7472-2021; F-4657-2014; AAI-1005-2021; 12753880400; 6701485882; 7801322152; 23988764000; 6701913697; 26040787100; 24482063400; 35572557400; 7006929833; 7005488796; 6602297533The aim of the study was to evaluate the long-term effect of rosiglitazone and metformin monotherapy with medical nutrition treatment (MNT) and of MNT alone on arterial stiffness, serum monocyte chemoattractant protein (MCP)-1 and matrix metalloproteinase (MMP)-9 in drug naive patients with type 2 diabetes mellitus. Fifty type 2 diabetic patients were randomized to receive rosiglitazone 4 mg/day (n = 19) or metformin 850 mg/day (n = 16) with MNT or MNT alone (n = 15), for 52 weeks. Arterial stiffness was assessed by using large and small artery elasticity index (SAEI and LAEI, respectively). SAEI, LAEI, serum MCP-1 and MMP-9 levels were measured at baseline and following 52 weeks of treatment. SAEI was improved only in the rosiglitazone group, and the difference was still statistically significant when the three groups were compared (p = 0.024). There were no differences in LAEI in inter- and intragroup comparisons at the end of the study. Serum MMP-9 levels were decreased in the metformin (-13.5 +/- 34.8%, p = 0.02) and rosiglitazone (-27.2 +/- 51.0%, p = 0.023) groups compared with baseline values, whereas no significant change was seen in serum MCP-1 levels. These results suggest that rosightazone monotherapy has favorable effects on arterial stiffness compared with metformin monotherapy independent of glycemic control.Item The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome(Springer, 2010-04) Selimoğlu, Hadi; Duran, Cevdet; Kıyıcı, Sinem; Ersoy, Canan; Güçlü, Metin; Özkaya, Güven; Tuncel, Ercan; Ertürk, Erdinç; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0297-846X; AAJ-6536-2021; ABI-4847-2020; A-4421-2016; AAH-8861-2021; 12753880400; 6701485882; 15073842600; 16316866500; 7006929833; 7005488796; 6602297533Insulin resistance (IR) is one of the common features of the polycystic ovary syndrome (PCOS), and recent studies indicate the possible role of vitamin D in the pathogenesis of IR and glucose metabolism. Aim of this study was aimed to determine the effect of vitamin D replacement therapy on glucose metabolism, insulin, and androgen levels in obese, insulin-resistant women with PCOS. Eleven women with PCOS were included in the study. Mean age of the patients was 23.6+/-5.7 yr, body mass index 33.9+/-5.1 kg/m(2). Six patients (54.5%) had acantosis nigricans and 10 (90.9%) oligoamenorrhea. The mean Ferriman Gallwey score was 14.1+/-4.6. Only 2 women were within the normal limits of vitamin D levels as >20 ng/ml. Three weeks after the administration of the single dose of 300,000 units of vitamin D3 orally, 25-hydroxyvitamin D3 significantly increased from 16.9+/-16 ng/ml to 37.1+/-14.6 ng/ml (p: 0.027) and only 2 women were detected to have vitamin D3 levels <20 ng/ml. Although glucose and insulin levels were decreased non-significantly, homeostasis model assesment (HOMA)-IR significantly decreased from 4.41+/-1.38 to 3.67+/-1.48 (p: 0.043). No significant alterations were witnessed at the levels of DHEAS, total and free testosterone, androstenedione. No correlation was found between vitamin D with HOMA and other hormonal parameters. In conclusion, women with PCOS have mostly insufficient vitamin D levels, and vitamin D replacement therapy may have a benefical effect on IR in obese women with PCOS.Item Frequency of thyroid nodules among patients with colonic polyps(Hindawi, 2012) Duran, Cevdet; Göktürk, Hüseyin Savaş; Kulaksızoğlu, Mustafa; Bakdık, Süleyman; Ünler, Gülhan Kanat; Erbayrak, Mustafa; Pamuk, Barıs Önder; Gönen, Mustafa Sait; Özkaya, Güven; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0297-846X; A-4421-2016; 16316866500Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P = 0.058). Mean ages were similar in both groups (53.3 +/- 11.4 versus, 51.8 +/- 11.4, P = 0.373). Thyroid nodule was detected in 44 (66.7%) patients with polyps and in 61 (41.8%) controls (P = 0.001). Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P = 0.03). Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P = 0.023). Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.Item The investigation of the efficacy of insulin glargine on glycemic control when combined with either repaglinide or acarbose in obese type 2 diabetic patients(Springer, 2009-01) Duran, Cevdet; Tuncel, Ercan; Ersoy, Canan; Ercan, İlker; Selimoğlu, Hadi; Kıyıcı, Sinem; Güçlü, Metin; Ertürk, Erdinç; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyostatik Anabilim Dalı.; ABF-2367-2020; ABI-4847-2020; AAJ-6536-2021; AAH-8861-2021; 7006929833; 6701485882; 6603789069; 15074185600; 12753880400; 15073842600; 7005488796; 6602297533Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >= mmol/l and hemoglobin glycated (A1C) >= 9% under maximal CAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty Patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9 +/- 1.4% to 7.7 +/- 1.1% in group 1 and 11.0 +/- 1.4% to 8.1 +/- 1.4% in group 2. FBG levels were significantly decreased from 11.9 +/- 2.7 to 7.1 +/- 2.3 mmol/l in group 1 and 11.1 +/- 2.5 to 6.8 +/- 1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3 +/- 3.8 to 10.3 +/- 3.0 mmol/l in group 1 and 14.0 +/- 3.1 to 8.9 +/- 2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Syptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulance incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.Item Maksimum doz oral hipoglisemik ajanlarla optimal glisemik regülasyon sağlanamayan tip 2 diyabetik hastalarda repaglinid-glargin insülin kombinasyonu, akarboz-glargin insülin kombinasyonu ve tek başına glargin insülin tedavilerinin glisemik parametrel(Uludağ Üniversitesi, 2006) Duran, Cevdet; Tuncel, Ercan; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Endokrinoloji ve Metabolizma Bilim Dalı.Tip 2 diyabetik hastalarda hastalık süresi ilerledikçe diyet ve oral antidiyabetik (OAD) tedaviye rağmen kan glukoz regülasyonu sağlanamaz ve sıklıkla insülin tedavisine ihtiyaç duyulur. Son yıllarda sadece insülin tedavisi yerine insülin ve OAD kombinasyonu önerilmektedir. Bu çalışmamızda insülin glargin (IG)'in tek başına, repaglinid veya akarboz ile kombinasyonlarının glisemik parametreler üzerine etkisi araştırıldı.Maksimum doz OAD kullanımına rağmen açlık kan glukozu (AKG) 140 mg/dl,Hemoglobin A1C'si (A1C) %9'un üzerinde olan 20 hastaya IG ve repaglinid (gurup 1), 18 hastaya IG ve akarboz (gurup 2), 10 hastaya ise IG monoterapisi (gurup 3) uygulandı.Üç aylık tedavi sonrası AKG'nda başlangıca göre gurup 1'de %35.29, gurup2'de %37.28, gurup 3'de %5.04 düşüş oldu. Gurup 1 ve 2'de bu düşüş başlangıca ve gurup 3'e göre anlamlıydı. Tokluk kan glukozu gurup 1'de%14.84, gurup 2'de %31.05 azalırken, gurup 3'de %7.79 arttı. Bu değişim sadece gurup 2'de başlangıca ve gurup 3'e göre anlamlıydı. HemoglobinA1C'de gurup 1'de %27.78, gurup 2'de %25.17, gurup 3'de %10.92 düşüş oldu. Tüm guruplarda A1C'de düşüş oranları başlangıca göre ve gurup 1 ve2'de gurup 3'e göre anlamlıydı. Tedaviyle sekiz ölçüm kan glukozu sonuçları gün ortalaması gurup 1 ve 2'de anlamlı olarak azalırken, gurup 3'de arttı. Bu değişim gurup 1 ve 2'de gurup 3'e göre anlamlıydı. Tedavi süresince gurup 1'de başlangıca ve gurup 3'e göre daha fazla kiloartışı oldu. Hipoglisemik atak sıklığı bütün guruplarda benzerdi.Sonuç olarak maksimum doz OAD'lerle glisemik regülasyon sağlanamayan tip 2 diyabetik hastalarda repaglinid ve akarboz'un IG ile kombinasyonu glisemik parametreler üzerine benzer ve olumlu etki göstermektedir.Item Medüller tiroid kanserlerinde kemoterapi(Uludağ Üniversitesi, 2003-10-13) Ersoy, Canan; Ertürk, Erdinç; Tuncel, Ercan; Güçlü, Metin; Taşlı, Babürşah; Demiray, Hülya; Duran, Cevdet; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı/Endokrinoloji Bilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Nükleer Tıp Anabilim Dalı.Medüller tiroid kanserleri (MTK) tüm tiroid kanserlerinin %5-10’unu oluşturmaktadır. MTK’lerinin tedavisinde total tiroidektomi ve lenf nodu diseksiyonu önerilmekte, eksternal radyoterapi, radyonüklid tedavi ve kemoterapinin palyatif amaçlı kullanılabileceği bildirilmektedir. Küratif olmayan kemoterapi rejimleri progresif MTK’ler için kullanılmaktadırlar. Hızlı progresyon nedeniyle kemoterapi uyguladığımız biri sporadik, diğeri MEN 2B MTK tanılı iki olgumuzdaki sonuçlarımızla kemoterapinin MTK’deki yerini gözden geçirmeyi amaçladık.Item Physical activity alters urinary albumin/creatinine ratio in type 1 diabetic patient(Journal Sports Science and Medicine, 2004-03) Tuncel, Ercan; Ertürk, Erdinç; Ersoy, Canan; Kıyıcı, Sinem; Duran, Cevdet; Kuru, Nesrin; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; AAB-6174-2020; AAH-8861-2021; AAJ-6536-2021; 7006929833; 7005488796; 6701485882; 12753880400; 12754039000; 6602517402; 6602297533While the best way to identify microalbuminuria is to determine albumin excretion rate (AER) in a 24 h urine sample. Published data have shown that calculation of an albumin/creatinine ratio (ACR) in a spot urine sample has reasonable rate of sensitivity and specificity. We aimed to evaluate the effect of daily exercise on ACR and estimate the best time for the examination of the ACR in a spot urine sample. Sixteen eligible patients with Type 1 diabetes mellitus were asked to perform varying degree of exercise periods. Urinary albumin and creatinine excretion rates during each period were determined. ACR and AER of timed urinary samples were compared with the 24 hour urinary AER. We found significant correlations between timed and 24 hour urinary AER. According to diagnostic performance tests, ACR and AER of timed urine samples were both found to be significantly more sensitive during resting period when compared with mild or moderate active periods. It is concluded that ACR and AER of a timed urine sample are sensitive and specific methods for determining microalbuminuria, while overnight resting samples give the impression of being more diagnostic.Item Preoperative parathyroid hormone levels are correlated with parathyroid adenoma volume and bone mineral density but not serum calcium levels(Edizioni Minerva Medica, 2011-06) Duran, Cevdet; Kıyıcı, Sinem Küçüksaraç; Cander, Soner; Gül, Özen Öz; Sığırlı, Deniz; Ünal, Oğuz Kaan; Saraydaroǧlu, Özlem; Ersoy, Canan; Tuncel, Ercan; Ertürk, Erdinç; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; AAJ-6536-2021; AAH-9701-2021; AAI-1005-2021; AAA-7472-2021; AAH-8861-2021; 12753880400; 25027068600; 26040787100; 24482063400; 36716200600; 15074395500; 6701485882; 7006929833; 7005488796; 6602297533Aim. The aim of this study was to determine the relationship between biochemical parameters, parathyroid adenoma volume, and bone mineral density with respect to intact parathyroid hormone (iPTH) levels in patients with primary hyperparathyroidism. Methods. Data were collected retrospectively from patients with primary hyperparathyroidism who were diagnosed and followed in our clinic between 2005 and 2008. Forty-eight (female/male=42/6) patients with a mean age of 52.8 +/- 13.1 years were enrolled into the study. Results. Bone pain was the most common presenting feature, seen in 41.7% of patients, while 29.1% of patients were asymptomatic. The mean serum calcium and iPTH concentrations were 2.9 +/- 0.6 mmol/L and 657.1 +/- 682 ng/L, respectively. The mean total Z/T scores of dual-energy X-ray absorptiometry (DEXA) scan at the femur and lumbar spine were -0.4 +/- 1.6/-1.0 +/- 1.7 and -1.4 +/- 1.6/-2.2 +/- 1.5, respectively. Preoperative iPTH levels were correlated with serum phosphate (r=-0.412, P=0.005), alkaline phosphatase (r=0.698, P=0.0001), and femur (r=-0.402, P=0.020) and lumbar spine total Z scores (r=-0.441, P=0.013), whereas parathyroid adenoma volume was correlated with iPTH (r=0.367, P=0.036) and alkaline phosphatase (r=0.570, P=0.001). There was no correlation between iPTH, serum calcium levels and total T scores at the femur and lumbar spine. After excluding patients with 25-OHD insufficiency, there was still no correlation between serum iPTH and calcium levels. Parathyroid adenoma volume, serum iPTH and calcium levels were also not different between patients with and without 25-OHD insufficiency. Conclusion. These results suggest that serum iPTH level may be useful in predicting parathyroid adenoma volume and it is also well correlated with femur and lumbar spine Z scores.Item Prostate cancer metastasis to thyroid gland(Sage Publications, 2007-05) Selimoǧlu, Hadi; Duran, Cevdet; Saraydaroǧlu, Özlem; Güçlü, Metin; Kıyıcı, Sinem Küçüksaraç; Ersoy, Canan Özyardımcı; Eren, Ali Mehmet; Tuncel, Ercan; İmamoğlu, Şazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; AAH-8861-2021; ABI-4847-2020; ABH-7279-2020; AAB-6174-2020; 15074185600; 12754039000; 15074395500; 15073842600; 12753880400; 6701485882; 57192111728; 7006929833; 6602297533Metastases to the thyroid gland are rarely encountered in clinical practice. They may originate from various primary sites, mainly kidney, lung, breast, esophagus and uterus. Prostate cancer is one of the most frequent malignancies in men. It generally has a favorable course, and autopsy series have shown occult prostate cancer in many subjects, especially in aged males. However, prostate cancer sometimes exhibits an aggressive behavior and cases with a poor prognosis have been reported. Occasional reports of metastasis from prostate cancer to the thyroid gland have been documented. We describe the case of a 73-year-old patient presenting with thyroid metastasis from long-standing prostate cancer.Item Rapid preparation of hyperthyroid patients for thyroidectomy(Ortadoğu Yayınları, 2011-08) Duran, Cevdet; Kıyıcı, Sinem; Gül, Özen Öz; Cander, Soner; Kırdak, Turkay; Ünal, Oğuz Kaan; Ersoy, Canan; Tuncel, Ercan; Ertürk, Erdinç; İmamoğlu, Sazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; AAJ-6536-2021; AAH-8861-2021; AAI-1005-2021Objective: Preoperative preparation of hyperthyroid patients is extremely important to avoid complications due to severe thyrotoxicosis during surgery. We investigated the effects of lugol's solution (LS) with or without thionamides in the rapid preparation of the patients for thyroid surgery and compared the effect of LS in patients with Graves' disease (GD) and toxic multinodular goiter (TMNG). Material and Methods: Data were collected retrospectively from 44 patients with hyperthyroidism who were followed up in our clinic. Twenty-two patients with GD, 19 patients with TMNG and three patients with solitary toxic adenoma were enrolled into the study. To restore euthyroidism before surgery, 27 patients were treated with LS (group 1) while 17 patients received LS and thionamides (group 2). Results: Mean daily total dosage of LS and duration of treatment to restore euthyroidism were not statistically different between groups 1 and 2. When the two treatment groups were compared, there was no significant difference in baseline parameters and percentage of changes of serum fT4 and fT3 levels. Duration of LS treatment and dosages of LS and thionamides were also similar in patients with GD and TMNG. Percentage of changes in serum fT4 and fT3 levels after LS treatment were not statistically different in two groups of patients. All patients were clinically euthyroid before surgery. Condusion: LS treatment, either alone or together with antithyroid drugs, is a safe and effective choice for the rapid preparation of hyperthyroid patients for thyroidectomy, independent from the etiology of hyperthyroidism.Item Serum monocyte chemoattractant protein-1 and monocyte adhesion molecules in type 1 diabetic patients with nephropathy(Elsevier Science, 2006) Kıyıcı, Sinem; Ertürk, Erdinç; Budak, Ferah; Ersoy, Canan; Tuncel, Ercan; Duran, Cevdet; Oral, Barbaros; Sığırcı, Deniz; İmamoğlu, Sazi; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İmmünoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0463-6818; F-4657-2014; K-7285-2012; AAJ-6536-2021; AAH-8861-2021; AAB-6174-2020Background. Monocyte chemoattractant protein (MCP)-1 is suggested to be implicated in the pathogenesis of diabetic nephropathy by activating and recruiting monocytes to the glomerulus via regulation of adhesion molecule expressions. The aim of this study was to test potential associations between serum concentrations of MCP-1, monocyte expression of Mac-1 and LFA-1 and nephropathy in type 1 diabetes mellitus. Methods. Serum MCP-1 levels and expression of monocyte adhesion molecules in 51 type 1 diabetic patients with and without diabetic nephropathy were compared with matched 15 healthy control subjects. Concentrations of serum MCP-1 were determined by enzyme-linked immunosorbent assays whereas monocyte expression of adhesion molecules Mac-1 and LFA-1 was measured by flow cytometry. Results. Serum MCP-1 levels and expression of Mac-1, but not LFA-1, were significantly higher in diabetic patients compared with controls. The mean serum MCP-1 level was 137.2 +/- 71.4 pg/mL in control patients, whereas it was 246.2 +/- 114.9 pg/ml in diabetic patients (p = 0.002). Serum MCP-1 levels were positively correlated with HbA1c and plasma fasting glucose levels. There was no difference in serum levels of MCP-1 and expression of monocyte adhesion molecules between type 1 diabetic patients with and without diabetic nephropathy. Conclusions. In type 1 diabetic patients, the levels of circulating MCP-1 concentration and expression of Mac-1 is mostly influenced by glycemic control rather than the existence of diabetic nephropathy.Item Thyroid carcinoma with insular component: Report of three cases with different clinical pictures(Wichtig Publishing, 2006) Kırdak, Türkay; Saraydaroğlu, Özlem; Duran, Cevdet; Yerci, Ömer; Korun, Nusret; Uludağ Üniversitesi/Tıp Fakültesi/Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; AAH-9701-2021; AAB-6174-2020; 8704181100; 15074395500; 12754039000; 6603810549; 6602316874Insular carcinoma of the thyroid is situated morphologically and biologically in an intermediate position between the well-differentiated and undifferentiated tumors and presents a variable clinical course in a widely heterogeneous spectrum. The present cancer staging system (TNM) for thyroid cancer considers differentiated and undifferentiated tumors while ignoring this Intermediate type, which is also called poorly differentiated tumor. In addition to the limited data on this rare disease, some poorly differentiated thyroid tumors contain differentiated cancer areas at various rates. These factors may cause difficulties in estimating disease aggressiveness and prognosis. To solve this problem, various microscopic and immunohistochemical parameters can be assessed. In this paper we describe 3 patients affected by thyroid carcinoma with an insular component, who presented different clinical pictures. When these cases were examined, the TNM system failed in stage grouping for poorly differentiated thyroid tumors. Case 1 and case 2 had similar clinical stages according to the TNM staging system for differentiated tumors, but had different prognoses. Case 3, with more limited disease, had the highest rate of poorly differentiated areas but the lowest Ki-67 proliferation index. In conclusion, it is difficult to make claims about the clinical behavior and prognosis of thyroid carcinoma with an insular component based on the 3 cases reported in this study, but it can be speculated that there is a gap in the TNM system with regard to the staging of insular thyroid carcinoma. In this situation the assessment of microscopic and immunohistochemical features of the tumor may help to predict disease aggressiveness and patient risk. However, it is clear that there is a need for large-scale studies evaluating the prognostic importance of histopathological and immunohistochemical features in determining risk groups.Item Tumor size predictive for malignancy in indeterminate follicular thyroid lesions(Lippincott Williams & Wilkins, 2006) Duran, Cevdet; Saraydaroğlu, Özlem; Ersoy, Canan; Selimoğlu, Hadi; Kıyıcı, Sinem; Öz, Özen; Güçlü, Metin; Tuncel, Ercan; Yerci, Ömer; İmamoğlu, Sazı; Uludağ Üniversitesi/Tıp Fakültesi/Endokrinoloji ve Metabolizma Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Patoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; AAH-9701-2021; AAB-6174-2020; AAH-8861-2021; 12754039000; 15074395500; 6701485882; 15074185600; 12753880400; 15074213200; 15073842600; 7006929833; 6603810549; 6602297533Fine needle aspiration biopsy is of little value in distinguishing benign and malignant thyroid follicular neoplasms. In this study, we investigated clinical and histopathologic characteristics of cytologically indeterminate thyroid follicular lesions (ITFL) in attempt to predict malignancy as determined by histopathologic examination. Fifty-seven patients diagnosed with ITFL underwent thyroidectomy. The mean patient age was 50.4 +/- 13.4 years. Based on the histopathologic findings, cases were classified into 3 categories: nonfollicular lesion (NF), follicular adenoma (FA), and follicular carcinoma (FC). The NF group contained 19 subjects with nodular colloidal goiter (NCG), 3 with Hashimoto thyroiditis. and one with granulomatous thyroiditis. The FA group contained 7 classic follicular and 8 Hurtle cell adenomas. The FC group contained 6 classic follicular, 8 Hurtle cell, and one insular carcinoma. The mean nodule size was significantly larger in the FC group than in the FA and NF groups (4.2 +/- 2.4 cm vs 2.2 +/- 0.9 cm and 2.5 +/- 1.3 cm, respectively, P < 0.05). Using a value of nodule size of 3 cm, the sensitivity and specificity for solvent malignant histology are 66.7% and 83.3%, respectively. These data show that nodule size of ITFL is predictive of malignancy. A nodule size greater than 3 cm is associated with a higher probability of malignancy and suggests total thyroidectomy as an initial therapeutic intervention.