1,721,067 research outputs found
Effect of cyclin D1 Gene (CCND1) polymorphism in prolactinoma patients and clinical - pathological features influencing tumor invasiveness
No full textProlaktinomalar çoğunlukla benign seyirli olmakla beraber tümör boyutu, invazifliği ve tedaviye yanıt açısından farklılıklar gösterebilmektedir. Bu çalışmada prolaktinomalı olgularda siklin D1 gen polimorfizminin tümör davranış özellikleri üzerine etkisinin incelenmesi ve laktotrof adenomun radyolojik ve patolojik özelliklerinin medikal ve cerrahi tedaviye yanıtı üzerine etkisinin değerlendirilmesi amaçlanmıştır.Çalışmaya prolaktinoma tanısı ile takip edilen 113 hasta dahil edildi. Tüm hastalardan periferik kan örneklemesi ile siklin D1 genindeki A870G polimorfizmi belirlenerek genotipleme yapıldı. Radyolojik bulgularına göre invazif/noninvazif, mikro/makro/dev adenom guruplarına ve opere olan hastalar histopatolojik incelemede Ki67 indeksi oranına göre sınıflandırıldı. Guruplar arasında siklin D1 gen polimorfizmi karşılaştırıldı. Ayrıca hastaların tanı yaşı, cinsiyeti, tümör boyutu ve serum prolaktin seviyesinin tümör agresivitesi ile ilişkisi araştırıldı.Çalışmaya alınan 113 hastanın erkek/kadın oranı 27/86 ve tanı yaşı ortalamaları 34.4 yıl (Erkeklerde 40.3, kadınlarda 32.6) idi. 68 hasta (%60.2) noninvazif, 45 hasta (%39.8) invazif gurupta yer aldı. 15 (%13.3) hastada GG, 58 (%51.3) hastada GA ve 40 (%35.4) hastada AA genotipi tespit edildi. Noninvazif ve invazif gurupta A allel sıklığı %60.3 ve %62.2 idi. İnvazif ve noninvazif gurupların genotip dağılımları ve allel sıklıklarında anlamlı farklılık tesbit edilmedi. Erkek hastalarda tümör boyutu, makroadenom ve invazif adenom oranı anlamlı olarak yüksek bulundu. Ki67 indeksi ile invazif/noninvazif guruplar arasında anlamlı bir ilişki saptanmadı. Prolaktin seviyeleri ve tümör boyutu arasında pozitif korelasyon saptandı. İnvazif gurupta tümör çapında ve prolaktin seviyesinde azalma oranları anlamlı olarak yüksek bulundu.Siklin D1 A870G polimorfizminin prolaktinomalarda tümör davranışı üzerinde önemli rol oynamamaktadır. İnvazif adenomlarda tedavi yanıtı noninvaziflerden daha kötü değildir. Tümör invazifliği prolaktinomalarda prognozu olumsuz etkilememektedir.Although most prolactinomas are benign, they may show differences in tumor size, invasiveness and treatment response. In this study, we aimed to evaluate the effect of cyclin D1 gene polymorphism on attribute of tumor behaviour and to investigate the effects of radiological and pathological features of adenoma on the response to medical and surgical treatment in prolactinomas.One hundred and thirteen patients followed with the diagnosis of prolactinoma were included the study. The cyclin D1 gene A870G polymorphism was determined in all patients with peripheral blood sampling. Patients were classified into invasive / non-invasive and micro / macro / giant adenoma groups according to the radiological findings and categorized according to their Ki67 index. Cyclin D1 gene polynorphism was compared between each group. Age at diagnosis, gender, tumor size, serum prolactin levels were evaluated in the relation to the tumor aggressiveness.In total of 113 patients, male / female ratio was 27/86 and the mean age at diagnosis was 34.4 year (men 40.3, women 32.6). Sixty-eight patients (60.2%) took place in non-invasive group while 45 patients (39.8%) were in invasive group. GG, GA and AA genotype were found in 15 (13.3%), 58 (51.3%) and 40 (35.4%) of patients respectively. A allele frequency was 60.3% in noninvasive and 62.2% in invasive groups. Genotype distributions and allele frequencies in invasive and noninvasive groups were not significantly different. In male patients, tumor size, rate of macroadenomas and invasive adenomas were significantly higher. There was not a significant relationship between Ki 67 index and invasive / noninvasive groups. There was a positive correlation between prolactin levels and tumor size. Reduction in tumor size and serum prolactin levels were significantly higher in invasive group.Cyclin D1 A870G polymorphism does not play an important role in tumor behavior in prolactinomas. Treatment response in invasive adenomas is not bad than noninvasive adenomas. Tumor invasiveness is not an important factor on the prognosis of prolactinomas
The efficacy and safety of sorafenib treatment on radioiodine-reftactory metastatic differantiated thyroid carcinomas: A single center experience
No full textDiferansiye tiroid karsinomları (DTK) tiroid foliküler epitelyal hücrelerden gelişen ve tüm tiroid karsinomlarının %90’ını oluşturan kanserlerdir. Çalışmamızda iyot refrakter metastatik DTK’larda sorafenib tedavisinin etkinliği ve güvenliğinin değerlendirilmesi planlandı. Çalışmamıza merkezimizde iyot refrakter metastatik DTK nedeniyle sorafenib tedavisi alan 6 hasta dahil edildi. Sorafenib tedavisi sonrası izlemde hastalarda en sık cilt döküntüleri olmak üzere, hipertansiyon, yüksek ventrikül hızlı atriyal fibrilasyon ve özefajit gibi ilaca bağlı yan etkiler gözlendi. Cilt lezyonları tüm hastalarda tedavinin 1. ayında ve hafif şiddette gelişmiş olup, ilaç doz azaltımı sonrası semptomlar 1 ay içinde düzeldi. Bir hasta perikardiyal effüzyon gelişimi ve iki hasta akciğer metastazlarında progresyon sonrası eksitus oldu. Tedavi sonrası 3 hastada progresif hastalık, 1 hastada stabil hastalık ve 1 hastada parsiyel yanıt saptandı. Sorafenib tedavisinin etkinliği konvansiyonel kemoterapilere göre daha yüksek olmakla birlikte, gelişebilecek yan etkiler nedeniyle deneyimli merkezlerce uygulanmalı, hastalar yan etkiler konusunda bilgilendirilmelidir.Differentiated thyroid carcinomas (DTC) are originated from thyroid follicular epithelial cells and comprises %90 of all thyroid carcinomas. The aim of this study was to assess the efficacy and safety of sorafenib treatment on iodine refractory metastatic differentiated thyroid carcinomas. Six patients who have received sorafenib treatment due to refractory metastatic DTC were included in the study. During follow-up skin rashes were the most frequent adverse effect after sorafenib treatment followed by hypertension, high ventricular rate atrial fibrillation and esophagitis. Skin lesions were mild and occurred in the first month of the treatment, after dose reduction symptoms resolved within 1 month. One patient had died of pericardial effusion and two patients had died of progressive pulmonary metastasis. Progressive disease was observed in 3 patients, stable disease in 1 patient and partial response in 1 patient after treatment.Although the efficacy of sorafenib is higher than the conventional chemotherapeutics, it should be used in experienced centers because of the possible side effects that can develope and patients should be informed about those side effects
Operasyon öyküsü olan ve olmayan dev prolaktinomalı hastalarda medikal tedavi sonuçlarının değerlendirilmesi
No full textIn this single-center retrospective study, we aimed to evaluate the results of medical therapy as primary or secondary treatment following surgery and compare follow-up outcomes between the two approaches. Patients were grouped as medical therapy alone (Group M) and surgery plus medical therapy (Group S+M). Patients' demographics, such as age and gender, and age at the diagnosis were recorded. Differences between the pre-and post-treatment tumor size, prolactin (PRL) levels, Knosp grades, tumor response to treatment, improvement in hypofunctions, visual field, and biochemical control were recorded and compared between the two groups. A total of 41 patients diagnosed with giant prolactinomas were included in the study. Hypopituitarism was found in 82.93%, hypogonadism in 80.59%, GH deficiency in 51.22%, ACTH deficiency in 36.59%, and TSH deficiency in 41.46% of the patients. Visual field defects were found by 60.53%. Tumor volume at diagnosis was significantly higher in Group M (p 0.05). This study's results demonstrate no statistically significant difference between medical therapy alone and surgery plus medical therapy regarding the reduction of tumor volume and normalization of PRL values in patients with giant prolactinomas. Surgery should be reserved for severe compression conditions, and potentially unnecessary surgical approaches should be avoided.Bu tek merkezli retrospektif çalışmada, primer tedavi veya cerrahi sonrası sekonder tedavi olarak medikal tedavinin sonuçlarını değerlendirmeyi ve iki yaklaşım arasındaki takip sonuçlarını karşılaştırmayı amaçladık. Hastalar tek başına medikal tedavi (Grup M) ve cerrahi + medikal tedavi (Grup S+M) olarak gruplandırıldı. Hastaların yaş ve cinsiyet gibi demografik özellikleri ve tanı anındaki yaşları kaydedildi. Tedavi öncesi ve sonrası tümör boyutu, prolaktin (PRL) düzeyleri, Knosp dereceleri, tedaviye tümör yanıtı, hipofonksiyonlarda iyileşme, görme alanı ve biyokimyasal kontrol arasındaki farklar kaydedildi ve iki grup arasında karşılaştırıldı.Çalışmaya dev prolaktinoma tanısı konulan toplam 41 hasta dahil edildi. Hastaların %82.93'ünde hipopituitarizm, %80.59'unda hipogonadizm, %51.22'sinde GH eksikliği, %36.59'unda ACTH eksikliği ve %41.46'sında TSH eksikliği saptandı. Görme alanı defekti %60.53 oranında saptanmıştır. Tanı anındaki tümör hacmi Grup M'de anlamlı olarak daha yüksekti (p0.05). Bu çalışmanın sonuçları, dev prolaktinomalı hastalarda tümör hacminin küçülmesi ve PRL değerlerinin normalleşmesi açısından tek başına medikal tedavi ile cerrahi+medikal tedavi arasında anlamlı bir fark olmadığını göstermektedir. Cerrahi, ciddi bası durumları için saklanmalı ve potansiyel olarak gereksiz cerrahi yaklaşımlardan kaçınılmalıdır
Anthropometric outcomes in type 2 diabetic patients with new dapagliflozin treatment; actual clinical experience data of six months retrospective glycemic control from single center
No full textIntroduction: Dapagliflozin is an antidiabetic drug that has been used as a member of the new antidiabetic drug group that acts by inhibiting SGLT-2 and increasing urinary glucose excretion. With numerous controlled experimental studies of dapagliflozin, evaluation of real-life data after entry into clinical practice is an important condition. In our study, the effects of dapagliflozin on glycemic control and anthropometric measurements were investigated retrospectively.Methods: A-total of thirty-one type 2 diabetics were enrolled in the study. Data of before dapagliflozin and three and six months of treatment were recorded.Results: Dapagliflozin reduced HbA1c levels by 0,9% at 3 months and 0,79% at 6 months. Fasting plasma glucose decreased 41,1 mg/dl in the 3rd and 42 mg/dl in the 6th, postprandiyal glucose decreased 86,3 mg/dl in the 3rd and 74,2 mg/dl in the 6th. In the 3rd and 6th, body weights decreased by 3,3 kg and 4,2 kg, BMI decreased by 1,3 kg/m(2) and 1,6 kg/m(2) respectively. Similarly, it was observed that the waist circumference decreased by 1,3 cmat the end of 6th.Conclusion: Our data show that SGLT-2 inhibitors provide glycemic control with reduce HbA1c levels by 0.8-0.9%, and reduce fasting and postprandial plasma glucose levels without increasing the risk of hypoglycemia and causing weight lose around 5% at the six mounths. SGLT-2 inhibitors were found to be more effective in reduce postprandiyal plasma glucose in patients who did not use insulin and fasting plasma glucose in patients with diabetes mellitus less than 10 years. (c) 2018 Published by Elsevier Ltd on behalf of Diabetes India
Co-existence of papillary and medullary thyroid carcinoma: Reports of three cases
No full textMedullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) are two different types of thyroid carcinoma. They have different features in terms of cellular origin, histopathology, clinical features, prevalence, and prognosis. PTC originates from follicular cells, while MTC from parafollicular cells. MTC and PTC co-existence is a rare phenomenon and occurs in less than 1% of all thyroid tumors. We report three cases with coexistent MTC and PTC in the same thyroid. The papillary component was dominant in two cases and the medullary in one case. While the first case was given radioactive iodine therapy, the third was treated with vandetanib. The second case was followed up postoperatively and did not receive treatment other than levothyroxine replacement. The co-existence of these tumors requires a different clinical approach in treatment and follow-up, depending on which type is dominant
A rare complication due to propylthiouracil use: Lupus-like syndrome
No full textPropylthiouracil and methimazole are frequently used in the management of hyperthyroidism. A 36 year old female patient with toxic multinodular goiter, developed polyarthralgia, neutropenia, hypergammaglobulinemia, and microscopic hematuria after treatment with propylthiouracil (PTU). Antinuclear antibody (ANA) was positive whereas anti-double stranded DNA, antihistone antibody were negative. PTU was discontinued and all symptoms subsided gradually. All these findings suggest that she developed a PTU-induced lupus-like syndrome
Evaluation of treatment satisfaction in patients with type 1 diabetes using CSII and MDI
No full textInsulin analogs applied with continuous subcutaneous insulin infusion (pump) in the treatment of diabetes
No full textDiabetes mellitus (DM) is an important health problem that should be treated efficiently because of its high prevalence and high morbidity and mortality due to its complications. In patients with DM, the application of a treatment which provides physiologic insulin secretion as such in healthy individuals is directly related with the prevention of diabetes complications. Insulin analogs, which were developed in recent years and shown to have pharmacokinetic and pharmacodynamic superiority to human insulin, have made it possible to obtain natural insulin pattern in the body. In addition to development of insulin analogs, introduction of insulin application method of "continuous subcutaneous insulin infusion" (insulin pump) has led a new era in the treatment of DM. In this review, treatment of type 1 and 2 DM patients with insulin analogs, particularly insulin aspart, applied with insulin pump was discussed in the light of the current literature
The effect of basal analog insulin on the glycemic variability in type 2 diabetics
No full textPurpose: The aim of this study was to investigate the effect of insulin detemir and glargine on glycemic variability as determined by capillary blood glucose measurements in Type 2 diabetics treated with oral antidiabetic drugs.Material and Method: A total of 64 insulin-naive type 2 diabetics with a HbA1c level of 7.5%-10% were included in the study. The patients were randomized into 3 groups according to the basal insulin analog started; Group 1 (n=22) was started on once-daily detemir, Group 2 (n=22) twice-daily detemir, and Group 3 (n=20) insulin glargine. Basal insulin doses were titrated according to the morning/evening fasting capillary blood glucose levels. Standard deviations of the 8-point intraday fasting and postprandial blood glucose values were compared.Results: The fasting blood glucose intraday standard deviation values showed an improvement of 22.4% in Group 1, 21.4% in Group 2, and 26.4% in Group 3, while the intraday standard deviation for the postprandial values showed an improvement of 14.4%, 15.2%, and 38.7%, respectively (p>0.05). The standard deviation values did not show statistical significance when the groups were compared with each other. Baseline HbA1c values and insulin doses negatively correlated with the glycemic variability.Dicussion: Basal insulin added to treatment in Type 2 diabetics provided an improvement of 14.4% to 38.7% in glycemic variability. There was no significant difference between insulin glargine and detemir regarding this effect
Painful and painless thyroiditis
No full textTiroidit, tiroidin çeşitli nedenlerle ortaya çıkan inflamasyonudur. Birçok neden, otoimmünite, enfeksiyonlar, radyasyon, ilaçlar tiroidit gelişimine neden olabilmektedir. Tiroiditlerin nedenleri gibi klinik tabloları da çok çeşitlidir. Bu nedenle ayrım ve sınıflama yapmak her zaman mümkün olamamaktadır. Hastalarda herhangi bir semptom olmaksızın tanı tesadüfen konulabildiği gibi, hastalar boyunda şiddetli ağrı, şişlik, guatr ile de başvurabilmektedirler. Hastalar ötiroidik olabilmekte, hipotiroidi veya tirotoksikoz da görülebilmektedir. Tedavi genellikle semptomları düzeltmeye yöneliktir. Tiroid disfonksiyonu saptanması halinde etyolojide göz önünde bulundurularak tedavi planlanmalıdırThyroiditis is the inflammation of the thyroid which caused by various reasons. Many reasons including autoimmunity, infection, radiation or medications may lead to the development of thyroiditis. Similar to the complexity of its causes, thyroiditis presents many varieties of clinical conditions. Therefore, making the exact distinction and classification of thyroiditis is not always possible. Thyroiditis may be incidentally diagnosed in patients without any symptoms, such as patients with severe neck pain, swelling or goiter. The patients may be euthyroid, as well as they may develop hypothyroidism or thyrotoxicosis. Most of the time, the treatment is employed towards the symptoms. Once the thyroid dysfunction is detected, treatment should be planned by taking the etiology into consideration
- …
