ABSTRACT There are some rare but severe insulin resistance disord ers with severe target cell resistance to insulin. In this article, we describe an unusual case of severe insulin resistance syndrome with spontaneous remission periods. A 34-year-old male patient with Type 2 for 13 years was admitted to the inpatient clinic because of very high blood glucose levels. Although his diabetes mellitus insulin dose was increased to 260 U/day administered with four daily insulin injections, his blood glucose levels did not respond. In a steady state of treatment his blood glucose levels suddenly decreased to hypoglycemic levels and his insulin requirement ceased. After 14 months of follow-up in euglycemic status without insulin therapy, hyperglycemic symptoms recurred. Hyperglycemic and euglycemic episodes recurred again twice with shorter euglycemic periods. Insulin receptor antibody was detected. These findings are consistent with autoimmune severe insulin resistance syndrome type B with spontaneous remission.

ABSTRACT We evaluated the feasibility and effectiveness of the continuous subcutaneous insulin infusion (CSN) therapy as compared to conventional injection treatment (CIT) in a diabetes clinic in a one month randomized study of 42 type l diabetic patients. During the first month, the daily insulin dose was reduced by 44 % in patients who were treated with CSII compared with CIT (p<0.005). Blood glucose levels measured four times in a day (05, 11, 17 and 23 hours) were lower during CSII than CIT (p<0.001, p<0.001, p<0.001, p<0.001). The blood total glycosylated hemoglobin (HbA1) levels fell in the first month of CSII therapy compared to CIT (p<0.001). in the CSII group, serum total cholesterol (TC) low density lipoprotein cholesterol (LDL), very low density lipoprotein cholesterol (VLDL) and triglyceride (TG) levels were lower and high density lipoprotein cholesterol (HDL) levels were higher than in the CIT group (p<0.02, p<0.01, p<0.005, p<0.05). There were no ketoacidotic or hypoglycemic episodes, mechanical problems with the pump or needle-site infections in our study. These results indicate that CSII treatment is more effective than CIT on metabolic control in Type l Diabetes.

ABSTRACT Diabetic foot is one of the chronic but preventable complications of diabetes mellitus. Although the preventive measures of diabetic foot are simple and far from being expensive, treatment measures are difficult and the cost is high. This complication may also lead to foot loses and patient morbidity if unproperly treated. These facts highlight the importance of the education of diabetic patients about the subject. We evaluated our diabetic foot cases due to the classification, follow up and treatment in a three year period in the view of the literature.

ABSTRACT This prospective study was conducted to investigate the serum thyroid hormone levels in traumatized critically III patients. TSH, TT4, FT4, TT3 and FT3 levels were measured within 24 hr. of Intensive care unit admission (first day) in 17 multiple traumatized male patients. On the day the same hormone level measurements were repeated. Ali of the hormone levels were higher on the 5th day than the 1st day, levels in the survivor group, being respectively (p<0.02, p<0.01, p<0.05, p<0.02, p<0.02). in the nonsurvivor group, it was determined that on the 5th day TT4, FT4, TT3 levels and decreased (p<0.02, p<0.05, p<0.05). In conclusion, we are convinced that there was a high relation between low serum thyroid hormone levels and mortality.

ABSTRACT Increased lipoprotein (a) [Lp(a)] concentrations have been recognized as a risk factor for coronary artery disease (CAD) in nondiabetic individuals, although its contribution to CAD in subjects with impaired glucose tolerance (IGT) is not established. We investigated the relationship between IGT and Lp(a) concentrations in 125 subjects suffering from anginal symptoms who had undergone the coronary angiography (96 male, 29 female, 28-75 years of age). They had no history of hyperglycemic symptoms, diabetes mellitus or hypertension. Subjects were divided into two groups according to the results of coronary angiogram: group 1 with CAD (n=90) and the group 2 with normal coronary arteries (n=35). Each group was divided into two subgroups according to the results of the oral glucose tolerance test (OGTT): subgroup a with IGT and subgroup b with normal OGTT. Subjects of group 1 a and 1 b had significantly higher Lp(a) concentrations than group 2a and 2b respectively (p=0.0062, p=0.02). The Lp(a) concentration was also significantly higher in group 1a than in group 1b (p=0.035), whereas there was no difference between group 2 a and 2 b (p=0.8). In considering subjects with IGT there was no difference between the serum insulin levels of the group with CAD and the group with normal coronary arteries. There was also no significant difference between the serum insulin levels of groups 1b and 2b. In conclusion, this study demonstrates that serum insulin levels are not associated with serum Lp(a) levels and that serum Lp(a) levels are higher in the CAD with impaired glucose tolerance than with normal glucose tolerance.

ABSTRACT Although thyroid cancers are quite rare in the population, thyroid nodules are common and about 5 % of all thyroid nodules are reported to be malignant. Factors predisposing to thyroid malignancies are different, one of them being ionizing radiation. We evaluated 2225 patients with a thyroid mass between the years 1996-2001 in our thyroid outpatient clinic and fine needle aspiration biopsy (FNAB) was performed to 2012 cases who accepted. Among all cases FNAB revealed malignancy in 59 patients. In this study we aimed to deliniate the histopathological pattern of thyroid cancers in the Southern Marmara region in the last decade and compare it with our previous results obtained with a similar analysis conducted between the years 1985-1995. We found a statistically insignificant increment in papillary thyroid cancer frequency while follicular and anaplastic thyroid cancers were decreasing and medullary cancer was unchanged. In conclusion, the increment in papillary/follicular ratio might be due to iodine replacement procedures which were obliged and supported by the goverment in recent years and more importantly to the possible effect of radiation fallout that occured in Chernobyl in 1986 which Turkey might be affected as well as the other countries being in the neighbourhood.

ABSTRACT Distinguishing between benign and malignant lesions in patients with thyroid nodules is essential to avoid a large number of unnecessary operations. Fine needle aspiration biopsy (FNAB) has become a popular technique in the evaluation of patients with thyroid nodules. This report describes our experience with FNAB technique the role of FNAB, radionuclide imaging and ultrasound In the initial evaluation of the patient and determines the accuracy of aspiration cytology. 968 fine needle aspiration biopsies from 781 patients were performed and 123 of them were operated. Cytological diagnosis of all FNAB is shown below: malignant lesions 17 (1.8 %), Hashimoto thyroiditis 20 (2.1 %), subacute thyroiditis 5 (0.5 %), suspicious follicular proliferation 6 (0.6 %), inadequate specimen 165 (17.0 %) and other benign lesions 755 (80-0 %). Sampling errors and cytodiagnostic errors were calculated as 7,7 % (9/123) and 4.0 % (5/123) respectively. Rates are calculated as false positive 33 %, false negative 3 %, sensitivity 77 %, specificity 95 %, positive predictive value 67 %, negative predictive value 53 % and accuracy 93 %. The technical success, sensitivity, positive predictive value and accuracy rates in our series are compatible with the literature but not in perfect ranges. Our results confirm the accuracy of FNAB in the diagnosis of thyroid malignancies. The primary shortcomings consist of difficulty in obtaining representative smears of the lesion at aspiration and a small number of inaccurate results in predicting the specific histological diagnosis. initial examination by ultrasound and radionuclide imaging results showed that cystic and hot nodules had a lower occurrence of malignant lesions but they were not always benign.

ABSTRACT Methimazole (MMI) is presented as being the most potent antithyroid drug in humans. The antithyroid effectiveness of MMI depends primarily on its ability to inhibit hormone synthesis within the thyroid. Limited studies have suggested that MMI has a duration of action of 20-40 hours within the thyroid. A prospective randomized study was performed to compare the antithyroid effectiveness of a small single dose (15 mg once daily, N=38) and the conventional divided doses (10 mg three times daily, N=52) of MMI in restoring the euthyroid state in Graves hyperthyroid patients. Serum total and free thyroxine and triiodothyronine concentrations were determined during theraphy (2nd, 4th and 8th weeks). Decreases in serum thyroxine and triiodothyronine concentrations during treatment were similar in both groups. There was no difference between the time required to achieve the euthyroid state (6.92±1.72 vs 7.05±1.88 weeks) respectively. No change in hematological and other parameters were observed in the two groups. However only after two patients of the divided dose group had transient pruritus and a skin rash that ended after several days. Finally we concluded that a small single and the conventional divided dose of MMI are equally effective. A single daily dose will be more convenient and may be of particular importance when long term antithyroid treatment is given.

ABSTRACT In this study we aimed to examine the effect of losartan, the prototype of type 1 angiotensin II receptor antagonist, on adrenal steroidogenesis and glucose metabolism in diabetic patients. Ten female patients with Type 2 diabetes mellitus, aged 60.5±8.4 years (range 51-73 years) were studied. The study consisted of an 8-week 50 mg/day losartan therapy. Before treatment and in at two-weekly intervals clinic visits heart rate and blood pressure measurements were taken and serum glucose, fructosamine, urea, creatinine, sodium, potassium, uric acid, AST, ALT, total and HDL cholesterol, triglyceride, ACTH, DHEA-S O4, androstenedione, 17-OH progesterone , aldosterone, and plasma renin activity levels were assayed. Basal and synacthenstimulated adrenal steroidogenesis were evaluated before and at the 8 th week of losartan treatment. Losartan produced a significant decrease in both systolic and diastolic blood pressures. There was no statistically significant difference between biochemical results before and after the therapy. Serum cortisol levels after ACTH stimulation displayed an almost equal elevation in pre and post-treatment periods. We conclude that the angiotensin II receptor blocker, losartan, at a dosage of 50 mg once daily was significantly effective in decreasing both systolic and diastolic blood pressure and can be used safely in diabetic patients. We also demonstrated that losartan does not have any detrimental effect on adrenal steroidogenesis.

BACKGROUND:We investigated the effect of short-term telmisartan usage in addition to lifestyle changes such as diet and exercise on insulin resistance, lipid metabolism, and serum adiponectin and tumor necrosis factor-alpha (TNF-α) levels in hypertensive patients with metabolic syndrome (MetS).METHODS:A total of 36 hypertensive patients with MetS were randomized to telmisartan and control groups in an open-labeled prospective study.RESULTS:There were significant decreases in anthropometric variables of patients according to baseline measurements in both groups at the end of the study. Serum insulin level and insulin resistance assessed by homeostasis model assessment-insulin resistance were decreased significantly in the telmisartan group (P = 0.040 and P = 0.034, respectively) compared with the controls, while there was no statistically significant change in the lipid profiles of the two groups. Serum adiponectin level was increased by 19.1% ± 41.7% in the telmisartan group, but intergroup analysis revealed no significant change. There was also no significant change in serum TNF-α level in either group.CONCLUSION:It has been observed that even short-term telmisartan treatment had favorable effects on insulin resistance and glucose metabolism compared with lifestyle changes alone. The fundamental effect of telmisartan treatment on insulin resistance renders it a good therapeutic option for hypertensive patients with MetS.

Aims: To evaluate the potential of urinary miR-451 as a biomarker at different stages of diabetic nephropathy. Methods: A total of 45 subjects having stage 3 chronic kidney disease (n=15) or stage 5 chronic kidney disease (n=15) and 15 healthy volunteers were included. Data on patient demographics, laboratory findings [creatinine, estimated glomerular filtration rate, urinary protein excretion] target genes and functions of the selected MicroRNAs associated with diabetic nephropathy and fold differences in the level of MicroRNA expression in blood and urine and the correlation of urine and plasma MicroRNA expression with estimated glomerular filtration rate were recorded. Results: MiR-195 expression level among stage 3 chronic kidney disease patients was higher in plasma samples compared to the control group, while it was significantly lower in the urine samples (p=0.036). In the stage 5 chronic kidney disease patient group, while the expression level was significantly higher in the plasma samples (p=0.005), urine sample expression was lower but not significantly different than the control group. Compared to the controls, miR-451 expression level was higher in the plasma samples of stage 3 chronic kidney disease patients, but significantly lower in the urine samples (p=0.019). Among the stage 5 chronic kidney disease patients, there was significantly higher level of expression in plasma samples (p=0.007) and significantly lower expression in urine samples (p=0.022) than the control group. Conclusions: Our study is original with its investigation of MicroRNA expressions at different stages of chronic kidney disease. Especially the statistically significant changes in the expression of miR-195 and miR-451 make these MicroRNAs come forward as good noninvasive biomarker candidates.

The aim of the study was to assess the prevalence of female sexual function and related factors in Turkish women with type 2 diabetes mellitus (T2DM). A total of 93 female patients diagnosed with T2DM (age 48.0 +/- 7.2 years (Mean +/- SD) were included. Data on age, diabetes age, HbA1c level, educational level, diabetes treatment, diabetes-related complications, co-morbid disorders and concomitant medications were recorded, as were the scores obtained using a Female Sexual Function Index (FSFI) questionnaire. Sexual dysfunction was noted in 55.9% of patients including problems related to desire (60.2%), arousal (52.7%), lubrication (55.9%), orgasm (51.6%) and satisfaction (58.1%) as well as pain during sexual intercourse (54.8%). Total scores were correlated negatively to age (r = -0.329, p = 0.001) and duration of diabetes (r = -0.246, p = 0.018), while significantly higher in patients with than without hypertension (19.6 vs. 22.4, p = 0.012) and with than without insulin therapy (20.0 vs. 23.7, p = 0.050). Our findings indicate the adverse effects of T2DM on sexual function in 55.9% of women in all domains of sexual response cycle, although this seems to be associated with older age, longer duration of diabetes, insulin and antidepressant therapy, presence of hypertension as well as end-organ complications of neuropathy and coronary artery disease (CAD).

Purpose: This open-label, single-arm, phase 4 study was designed to evaluate the efficacy of intensive insulin glargine titration in type 2 diabetes mellitus (T2DM) patients for 6 months to reach good glycaemic control.Material and Method: Two hundred-forty one insulin-naive T2DM patients were included. The primary efficacy variable was the glycaemic control (HbA1c level of <= 7%). The secondary variables were a fasting blood glucose (FBG) level of <100 mg/dL, the final dose of basal insulin, number of dose adjustments, time to dose titration in reaching target HbA1c level of <= 7%, weight gain and treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Hypoglycemia, severe hypoglycemia and adverse events were also assessed.Results: The mean (+/-SD) HbA1c level of 8.8+/-0.6% at baseline decreased to 7.4+/-0.9% on day-90 (p<0.001) and to 7.3+/-0.9% on day-180 (p<0.001). The percentage of patients with HbA1c <=%7 was 36.9% on day-90 and 40% on day-180. The mean FBG of 186.3+/-52.5 mg/dL at baseline decreased to 111.5+/-36.6 mg/dL on day-90 (p<0.001) and to 114.1+/-34.8 mg/dL on day-180 (p<0.001). The mean insulin glargine dose on the last day of FBG measurement (day-89) was 32.7+/-15.5 IU and the mean number of titrations was 12.7+/-6.6. These values on day-179 were 36.8+/-19.4 IU and 5.8+/-5.7, respectively. The total DTSQ score (20.3+/-7.7) and scores for each item at baseline showed improvement on day-180 (p<0.001). The most frequently reported adverse reactions were hypoglycaemia (49.7%) and weight gain (9.5%). Serious hypoglycaemia cases reported during the first and the second 3-month periods were 11.2% and 13.3%, respectively.Discussion: In conclusion, the use of insulin glargine with intensive dose titration is effective and safe in T2DM patients.

Diabetes 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.

Context: Although patients with acromegaly may have an increased risk of developing several types of cancers, the degree of risk for malignancy in these patients is unresolved. Objective: The present study aimed to investigate the potential genotoxic effects of acromegaly on the cell cycle in peripheral blood lymphocyte cultures. Design: This was a single center, crossover, case-control study conducted on the acromegalic patients in Turkey. Setting: The study was conducted in the outpatient clinic of a university hospital. Patients: Seventy-one consecutively screened acromegalic patients and 56 controls participated in the study. Intervention: Patients were included, regardless of the disease activity status and their treatment duration before the study. Main Outcome Measures: The primary end point was the frequency of micronucleus (MN) in the peripheral blood lymphocyte cultures, and the secondary end point was its clinical correlations. Results: The MN level was 3.82 ± 1.49 in the control group and 18.00 ± 6.13 in the acromegalic group (P < .01), whereas the nuclear division index (NDI) was 1.79 ± 0.12 in the control group and 1.68 ± 0.07 in the acromegalic group (P < .01). Neither MN nor NDI was correlated with age, GH, IGF-I, initial GH, initial IGF-I, duration of the remission period, and initial tumor size. Only the MN level was positively correlated with the duration of disease (r = 0.323, P = .014). Conclusion: Our results indicated that acromegalic patients had genotoxic damage at a substantial level, and there was a positive correlation between the duration of disease and genotoxicity level.

AIM:To compare once- versus twice-daily insulin detemir added on OADS therapy in insulin-naive type 2 diabetes patients in terms of efficacy and safety. METHODS:An open-label study performed at a single center, comprised a randomized, crossover 24 week with insulin-naive type 2 diabetes patients. Insulin detemir was initiated with mean 0.12 U/kg in all patients (Group I once-daily, Group II twice-daily) and titrated for 24 week. RESULTS:A total of 50 patients completed the study (Group I n:25, Group II n:25). With use of once- and twice-daily insulin, HbA1c values were decreased by 1.8% (±2.0) and 1.5% (±1.4) within the first 12 weeks (p<0.01), whereas increased by 0.21% (±0.7) and 0.14% (±0.8) in the second 12 weeks (p>0.05). The increases in the insulin doses were found as 0.22 U/kg and 0.35 U/kg with once- and twice-daily insulin use, respectively (p:0.04). Although minor hypoglycemic events were similar in both groups in the first 12 weeks, 2-fold increase was found in the patients shifting from once- to twice-daily dose. Within the first and second periods, the body weight of the patients was observed an increase of 0.4 and 1.6 kg with once-daily dose, whereas a decrease of 0.1 and 2.1 kg in the twice-daily dose, in the same period. CONCLUSION:Once-daily use of insulin detemir up to 0.4 U/kg was found to have similar efficacy and safety as twice-daily use. Twice dose use of insulin did not provide a prominent glycemic control advantage on 1.5-fold higher use of insulin.