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    18f-fluorodeoxyglucose pet/ct can be an alternative method to assessment of insulin resistance
    (Acta Endocrinologica Foundation, 2019) Tuzcu, Şadiye Altun; Çetin, F. A.; Pekkolay, Zafer; Tuzcu, Alpaslan Kemal
    Background. Insulin resistance is routinely measured by homeostasis model assessment of insulin resistance (HOMA-IR).Positron emission tomography of 18F-fluorodeoxyglucose combined with computed tomography (18F-FDG PET/CT) is a valuable assessment tool for patients with cancer or staging tumors. 18F-FDG PET/CT imaging can also be utilised to detect the metabolic activity of glucose in the adipose tissue, liver and muscles. The aim of this study was to determine insulin sensitivity in the liver, muscle visceral adipose and subcutaneous adipose tissue separately via18F-FDG PET/CT. Materials and method. Sixty three adult patients who underwent whole body 18F-FDG PET/CT scanning for clinical purposes (diagnosis or staging of cancer) between July and August of 2016 were included in the study. Patients were divided into two groups according to their BMI (Group 1: BMI<25kg/m2, Group 2: BMI>25kg/ m2). HOMA-IR,fasting glucose,insulin, triglycerides, total cholesterol, HDL levels were measured. We calculated SUV as the tissue activity of the ROI (MBq/g)/(injected dose [MBq]/ body weight [g]) on PET images and measured the maximum SUVs (SUVmax) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT),liver and rectus muscle ROIs (2 cm). SUV corrected by blood glucose level (SUVgluc) was calculated as SUVmax×blood glucose level/100. Student-t test, Chi-square test and Pearson correlation test were used for statistical analysis. Results. Mean glucose,insulin,HOMA-IR levels of the group-2 were statistically higher than of group-1. Muscle SUVmax and liver SUVmax of group-1 were statistically higher than of group-2. Muscle SUVgluc of group-1 was statistically higher than of group-2. HOMA-IR was negatively correlated with both SUVmax(r=-0.340, p=0.01) and muscle SUVmax(r=-0.373, p=0.005) Conclusion. 18F-FDG PET/CT has shown that the muscle tissue maximum FDG uptake was lower in the insulin resistance group. Therefore, 18-FDG PET/CT could be a valuable tool for diagnosing insulin resistance.
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    5-Alpha Reductase Deficiency: A Review of Five Cases Diagnosed with Ambiguous Genitalia
    (Galenos Yayincilik, 2017) Pekkolay, Zafer; Kilinc, Faruk; Tuzcu, Sadiye Altun; Soylu, Hikmet; Tuzcu, Alpaslan Kemal
    5-alpha reductase is an enzyme which is responsible for the conversion of testosterone to dihydrotestosterone (DHT) in the peripheral tissues. It plays a key role in the development of male external genitalia. The present study was carried to make a clinical presentation of five male patients diagnosed with 5-alpha reductase deficiency resulting in the developmental disorder of male sexuality as well as to draw attention to the patients' medical history, physical examination and laboratory features. A test group comprising of five male subjects previously diagnosed with 5-alpha reductase deciency after being hospitalized and a series of examinations between April 2007 and July 2014, were enrolled in the study. Physical examination, hormonal profiles, radiological findings and karyotype analyses of the patients were carried out and their previous medical history was recorded. All the patients with karyotype 46 XY were raised as a female. They had external genitalia similar to each other and expressed a lower level of DHT. The patients with a disorder of male sex development, who expressed lower levels of dihydrotestosterone, must be checked for 5-alpha reductase deficiency.c
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    68Ga-DOTATATE PET/CT Can Be an Alternative Imaging Method in Insulinoma Patients
    (Soc Nuclear Medicine Inc, 2017) Tuzcu, Sadiye Altun; Pekkolay, Zafer; Kilinc, Faruk; Tuzcu, Alpaslan Kemal
    Insulinomas are the most common cause of hypoglycemia, resulting from endogenous hyperinsulinism. The diagnosis of insulinoma is established by demonstrating inappropriately high serum insulin concentrations during a spontaneous or induced episode of hypoglycemia. Most insulinomas are islet-cell tumors. They are often small (<2 cm), benign, and difficult to localize with current imaging techniques. Insulinomas can be detected using either noninvasive procedures (e.g., transabdominal ultrasonography, spiral CT, MRI, In-111-pentetreotide imaging, and F-18-L-dihydroxyphenylalanine PET) or invasive procedures (e.g., endoscopic ultrasonography) or a selective arterial calcium stimulation test with hepatic venous sampling. Methods: We performed Ga-68-DOTATATE PET/CT on 3 patients with insulinoma. Results: All patients' insulinomas were shown clearly with Ga-68-DOTATATE PET/CT. Conclusion: Ga-68-DOTATATE PET/CT imaging may be a useful noninvasive imaging technique to localize insulinomas preoperatively.
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    Adrenal İnsidentalomalı 78 Hastanın Demografik ve Klinik Özellikleri
    (2015) Kılınç, Faruk; Pekkolay, Zafer; Tuna, Mazhar Müslüm; Soylu, Hikmet; Tuzcu, Alpaslan Kemal; Barutçu, Sezgin
    Adrenal insidentalomalar (AI); adrenal bezde herhangi bir hastalık kuşkusu yokken görüntüleme yöntemleri veya abdominal laparotomide tesadüfen saptanan kitlelerdir. Abdominal ultrasonografi, BT ve MR kullanımının artması ile adrenal insidentalomaların tespit edilme sıklığı da artmıştır. Bu çalışmamızda, AI nedeniyle takip edilen hastalarmızın demografik ve klinik verilerini sunmayı amaçladık. Bu çalışmaya 2007-2013 yılları arasında Dicle Üniversitesi Tıp Fakültesi Endokrinoloji Anabilim Dalı'na başvuran 78 hasta ( 53 kadın; 25 erkek) dahil edildi. Hasta dosyalarından hastalara ait fizik muayene, USG, BT sonuçları kaydedildi. Serum kortizolü, idrar metanefrini, idrar normetanefrini, idrar VMA, serum aldosteronu ve serum renin değerleri kaydedildi. Hastaların yaş ortalaması 48.6 ± 14.9 idi. Tespit edilen kitlelerin lokalizasyonu açısından anlamlı farklılık saptanmadı. Hastaların vücut kitle indeksi 28.54 ± 5.82 idi. 45 hastada (% 57.7) non-fonksiyonel adenom, 10 hastada (% 12.8) subklinik cushing, 11 hastada (% 14.1) feokromasitoma, 3 hastada (% 3.8) adrenal karsinom, 2 hastada (% 2.6) hiperaldosteronizm, 2 hastada (% 2.6) ganglionörom, 1 hastada (% 1.3) myelolipom, 1 hastada adrenal adenom, 1 hastada adrenal kist, 1 hastada schwannom ve 1 hastada da küçük yuvarlak hücreli tümör tespit edildi. Radyolojik görüntüleme sıklığı arttıkça adrenal insidentaloma olgularının sayısı da artmaktadır. Her adrenal insidentaloma, malign olup olmadığı ve hormonal işlevi olup olmadığı açısından değerlendirimelidir.
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    Akromegali hastalarında Growth hormon ve insülin like growth faktör-1 düzeyi ile aterosklerotik risk belirteçleri arasındaki ilişki
    (Dicle Üniversitesi Tıp Fakültesi, 2023) Bodakçi, Erdal; Kılınç, Faruk; Tuna, Mazhar Müslüm; Pekkolay, Zafer; Karabulut, Aziz; Tuzcu, Alpaslan Kemal
    Amaç: Akromegali hastalarında büyüme hormonu (BH) ve insülin benzeri büyüme faktörü- 1(IGF-1) düzeyi ile hastalık süresi ile aktif ve remisyonda bulunan hastaların epikardiyal yağ kalınlığı ve karotis intima-media kalınlığı arasındaki ilişkiyi araştırmayı amaçladık. Yöntemler: Bu çalışmaya 40 akromegalik hasta (23 kadın, 17 erkek) ve 40 kontrol grubu (23 kadın, 17 erkek) dahil edildi. Hastaların kilo, boy, vücut kitle indeksi, bel çevresi, sistolik ve diastolik kan basınçları, lipid paneli, insülin, glukoz, üre, kreatinin, BH, IGF-1 düzeyi ölçüldü ve tam kan sayımı yapıldı. Ekokardiyografik olarak epikardiyal yağ kalınlığı ve doppler ultrasonografi ile karotis intima-media kalınlığına bakıldı. Bulgular: Hastaların yaş ortalaması 39.5 ± 10.1, kontrol grubunun yaş ortalaması 39.3 ± 10.1 yıldı. Tüm hastaların BH ve IGF-1 düzeyi kontrol grubundan yüksekti(p<0.001). Hastaların epikardiyal yağ kalınlığı kontrol grubundan anlamlı düzeyde yüksekti(p<0.001). Hastaların karotis intima-media kalınlığı kontrol grubundan daha kalındı(p<0.001). Hastaların epikardiyal yağ kalınlığı ve karotis intima-media kalınlığı arasında pozitif bir korelasyon vardı(R2 linear: 0,495). Sonuç: Akromegali hastalarında kontrol sağlıklı grubuna göre epikardiyal yağ ve karotis intima-media kalınlığının daha yüksek bulunması akromegalide aterosklerozun erken gelişebileceğinin göstergesi olabilir.
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    Akromegali hastalarının metabolik özelliklerinin değerlendirilmesi
    (Modestum Publishing Ltd., 2015) Kılınç, Faruk; Pekkolay, Zafer; Gözel, Nevzat; Uslu, Hikmet; Yılmaz, Ahmet; Yıldırım, Yaşar; Şahpaz, Fatih; Tuzcu, Alpaslan Kemal
    Amaç: Akromegali aşırı miktarda büyüme hormonu (BH) ve insülin benzeri büyüme faktörü (IGF-1) salınımı ile karakterize bir sendromdur. Bu çalışmada, kliniğimizde akromegali tanısı ile takip edilen hastalarda tespit edilen metabolik bozuklukların paylaşılması amaçlanmıştır. Yöntemler: Çalışmamıza 2010 ile 2015 yılları arasında polikliniğimizde akromegali tanısıyla izlenen 105 hasta alındı. Hastaların yaş, cinsiyet, tutulum özelliği, ek sistemik ve metabolik hastalıkları ve laboratuvar bulguları retrospektif olarak kaydedildi. Bulgular: Çalışmaya alınan 105 hastanın 56'sı kadın (%53,3), 49'u erkek (%46,7) idi. Hastaların yaşları 23-78 yıl (ortalama 42,1±16,7) arasındaydı. Hastaların 34'ünde (%32,3) hipertansiyon, 20'sinde (%19,04) diyabetes mellitus, ve 11'inde (%10,4) bozulmuş glukoz toleransı saptandı.Sonuç: Somatik bozukluklar (el ve ayaklarda büyüme gibi) hastalığın ana özelliğidir ancak prognozu belirleyen kardiyovasküler, respiratuvar ve metabolik komplikasyonlardır. Akromegalide hipertansiyon ve diyabet sıktır, kardiyovasküler hastalıklar ölüm nedenleri arasında ilk sıradadır. Çalışmamızın bu açıdan ülkemize ait verilerin oluşmasına katkıda bulunacağını düşünmekteyiz.
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    Alternative methods for the diagnosis of macroprolactinemia: urine prolactin level and serum / urine prolactin ratio
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Pekkolay, Zafer; Tuna, Mazhar Müslüm; Güven, Mehmet; Tuzcu, Şadiye Altun; Kaplan, İbrahim; Akkuş, Zeki; Tuzcu, Alpaslan Kemal
    Objective: The aim of this study was to investigate the urine prolactin and serum/urine prolactin ratio for accuracy diagnosis of macroprolactinemia. Methods: In the retrospective cross-sectional analysis, prolactin levels (high or normal) in the reproductive period of men and women were included in the study. Polyethylene glycol (PEG) precipitation method was used for the detection of macroprolactinemia. Then, patients were divided into three groups as macroprolactinemia, prolactinoma and healthy control group. In patients, prolactin values in spot urine with simultaneous serum prolactin values were calculated. The non-parametric Kruskal-Wallis test was used to compare the groups. The receiver-operating characteristic (ROC) curve was determined to evaluate the predictive power of serum/urine prolactin ratio Results: A total of 41 patients were included in the study. Female/male:36 (87.8%)/ 5 (12.2%). Urinary prolactin median(minimum-maximum) values were macroprolactinemia, prolactinoma and control group, respectively; 0.06(0.05-0.10), 0.11(0.02-0.95), 0.08(0.05-0.25) ng/ml. Serum/urine ratio median (minium-maximum) values were macroprolactinemia, prolactinoma, and control group, respectively; 633(51-1032), 990(104-9635), 395.5(138-953). When the groups were compared, the patients with prolactinoma had higher urinary prolactin levels(p <0.01). Serum/urine prolactin ratio was found to be the highest in prolactinoma patients and the lowest in the control group and a significant difference was observed in groups (p <0.01). ROC analysis(control-macroprolactin) for serum/urine prolactin ratio (Sensitivity 84.6 specificity 93.7 cut off >549,5 AUC=0.83) p<0.01 Conclusion: Urinary prolactin level and serum/urine prolactin ratio may be used in diagnosis of macroprolactinemia.
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    Alternative treatment of resistant hypoparathyroidism by intermittent infusion of teriparatide using an insulin pump: A case report
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Pekkolay, Zafer; Kilinc, Faruk; Soylu, Hikmet; Balsak, Belma; Guven, Mehmet; Tuzcu, Sadiye Altun; Kara, Ali Veysel
    Hypoparathyroidism usually responds to oral active vitamin D and calcium, but, although rare, some patients do not respond to this treatment. A 47-year-old Caucasian female presented to our medical unit with classical oral treatment-resistant hypocalcemia after thyroidectomy. Teriparatide was infused through the insulin pump with dosage set to 1 unit which equals to 2.5 mu g of teriparatide. In conclusion, intermittent subcutaneous infusion of teriparatide using an insulin pump is a safe and effective treatment modality to ensure normocalcemic conditions in patients with classical treatment-resistant hypoparathyroidism.
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    Are there differences in the management of acute pancreatitis cases due to severe hypertriglyceridemia in pregnant women?
    (International Scientific Information, Inc., 2018) Kılınç, Faruk; Şenateş, Ebubekir; Demircan, Fatih; Pekkolay, Zafer; Gözel, Nevzat; Güven, Mehmet; Bahçecioǧlu, İbrahim Halil; Tuzcu, Alpaslan Kemal
    Background: The aim of this study was to determine the prognosis of severe disease and treatment approaches of both normal and pregnant, especially in patients with severe pancreatitis due to hypertriglyceridemia. Material/Methods: We included 30 patients (20 females and 10 males) in this study whose follow-ups and treatments were performed after a diagnosis of hypertriglyceridemia-induced acute pancreatitis between January 2011 and May 2017. Patient personal information, such as age, sex, pre-treatment and post-treatment triglyceride levels, receipt of anti-hyperlipidemic treatments or plasmapheresis, and family history, were collected from hospital records and patient files. Patients with severe pancreatitis history, score, and prognosis were included to increase the value of our study. Mild and moderate cases were excluded. Results: The mean age of the patients was 35±6 years. Twenty-four patients (80%) received an anti-hyperlipidemic treatment before their pancreatitis attacks. Plasmapheresis was performed on 8 patients before their pancreatitis attacks. Eighteen patients (60%) had a family history suggesting familial hypertriglyceridemia. Twelve patients (40%) were pregnant. Conclusions: The treatment of hypertriglyceridemia-induced acute pancreatitis was mostly confined to supportive, palliative treatments. However, plasmapheresis is a possible treatment option and should be used in the early stages of this disease. The response to medical treatment and support treatment was better in pregnant patients than in the other patient group, and pregnant patients did not require plasmapheresis.
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    Association of clinical and laboratory parameters with ambulatory arterial stiffness index in acromegaly patients
    (Professional Medical Publications, 2018) Kilinc, Faruk; Pekkolay, Zafer; Demircan, Fatih; Gozel, Nevzat; Tuzcu, Alpaslan Kemal
    Objective: In this study, we determined the relationship between the ambulatory arterial stiffness index (AASI) and clinical and laboratory parameters in patients with acromegaly. Methods: Sixty-five patients with acromegaly, who visited to Dicle University Medical Faculty Department of Endocrinology (33 females and 32 males), were included in this study. The study control group consisted of 65 subjects. Demographic and clinical data were recorded. Laboratory data (complete blood count, blood urea nitrogen, creatinine, electrolytes, albumin, lipid profile, growth hormone [GH], insulin-like growth factor-1, and the 75-g oral glucose tolerance test) performed over the last year were evaluated. The AASI was obtained from 24-hour ambulatory blood pressure monitoring records of all patients. This study was completed in 15 months from 2013 to 2015. Results: Twelve patients (18.4%) had diabetes and 21 patients (32%) had hypertension. The mean AASI value was 0.41 +/- 0.14. The mean AASI value in the control group was 0.25 +/- 0.09. Growth hormone (GH) levels were positively correlated with the AASI values. AASI values tended to be higher in hypertensive subjects than that in normotensive individuals. Conclusions: Our results show that the AASI value increased in patients with acromegaly, independent of the increase in blood pressure. The AASI was strongly dependent on the degree of the GH increase in patients with acromegaly and may have an important role predicting cardiovascular risk in patients with acromegaly.
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    Biochemical characteristics and calcium and PTH levels of patients with high normal and elevated serum 25(OH)D levels in Turkey: DeVIT-TOX survey
    (Springer London Ltd, 2021) Pekkolay, Zafer; Yavuz, Dilek Gogas; Saygili, Emre Sedar; Degertekin, Ceyla Konca; Topaloglu, Omercan; Onder, Cagatay Emir; Soylu, Hikmet
    A Summary Vitamin D intake over the recommended dose is usually associated with high serum 25(OH)D levels and generally not associated with symptoms of hypercalcemia. High doses of cholecalciferol need to be avoided to protect against vitamin D toxicity and related complications. Strict adherence to the clinical guidelines for treating vitamin D deficiency can ensure safe and effective treatment. Purpose We observed a tendency to use high doses of cholecalciferol for vitamin D deficiency treatment or vitamin D supplementation. We aimed to determine the biochemical characteristics of patients with high normal and elevated serum 25(OH)D levels. Methods An online invitation was sent to all tertiary endocrinology clinics in Turkey to complete an online retrospective survey (DeVIT-TOX Survey) for patients diagnosed with high serum 25(OH)D levels (> 88 ng/mL) between January 2019 and December 2019. The patients were evaluated according to the presence of signs and symptoms of hypercalcemia and doses of vitamin D intake, evaluated into the following three groups according to their 25(OH)D levels: group 1, > 150 ng/mL; group 2, 149-100 ng/mL; and group 3, 99-88 ng/mL. Results A total of 253 patients were included in the final analysis (female/male: 215/38; mean age, 51.5 +/- 15.6 years). The average serum 25(OH)D level was 119.9 +/- 33 (range, 88-455) ng/mL, and the average serum calcium level was 9.8 +/- 0.7 (range, 8.1-13.1) mg/dL. Most (n = 201; 75.4%) patients were asymptomatic despite having high serum 25(OH)D and calcium levels. The serum 25(OH)D level was significantly higher in the symptomatic groups than in the asymptomatic groups (138.6 +/- 64 ng/mL vs. 117.7 +/- 31 ng/mL, p < 0.05). The most common cause (73.5%) associated with high serum 25(OH) D levels was the inappropriate prescription of a high dose of oral vitamin D (600.000-1.500.000 IU) for treating vitamin D deficiency/insufficiency in a short time (1-3 months). The cut-off value of 25 (OH) D level in patients with hypercalcemia was found to be 89 ng/mL [median 116.5 (89-216)]. Conclusions High dose of vitamin D intake is associated with a high serum 25 OH D level, without symptoms of hypercalcemia. Inappropriate prescription of vitamin D is the primary cause for elevated 25(OH) D levels and related hypercalcemia. Hypercalcemia may not be observed in every patient at very high 25(OH) D levels. Adherence to the recommendation of guidelines is essential to ensure safe and effective treatment of vitamin D deficiency.
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    Bir üniversite hastanesi endokrinoloji kliniğinde eksenatid verilen hastaların klinik ve laboratuvar özellikleri
    (Dicle Üniversitesi Tıp Fakültesi, 2014) Kılınç, Faruk; Alpağat, Gülistan; Demircan, Fatih; Pekkolay, Zafer; Gözel, Nevzat; Tuzcu, Alpaslan Kemal
    Amaç: Eksenatid, GLP-1 reseptörlerine yüksek afinitede bağlanmakta ve endojen GLP-1 etkisi olan glikoz bağımlı insülin sekresyonu, gastrik boşalmanın geciktirilmesi, glukagon süpresyonu, iştah baskılanması ve β-hücre kitlesini artırıcı etkilerini göstermektedir. Tip 2 diyabet tedavisinde metformin ve sulfonilüre veya her ikisinin beraber kullanılmasıyla glisemik kontrol sağlanamayan özellikle obez hastalarda kullanılmaktadır. İyi glisemik kontrol ve kilo kaybı sağlaması nedeniyle kan şekerleri yüksek seyreden oral antidiyabetik tedavinin yetersiz kaldığı vakalarda insülin tedavisine eklenmiştir. Çalışmamızda; kliniğimizde en az 4 ay ve daha fazla süreyle eksenatid tedavisi alan hastaların biyokimyasal ve klinik parametrelerini paylaşmayı planladık. Yöntemler: Çalışmaya Temmuz 2011 ile Aralık 2013 tarihleri arasında eksenatid başlanan ve en az 4 (ort: 7,3) ay takipleri tamamlanan 26 (2 erkek, 24 kadın) hasta alındı. Hastaların hepsi tedavi öncesi metformin yanında kombine oral antidiyabetik tedavi altında iken, 6 hasta metformin tedavisine ek olarak insülin tedavisi almaktaydı. Bulgular: Çalışmaya alınan hastalarda tedavi sonrası Hemoglobin A1c düzeylerinde kadınlarda %0.98, erkeklerde % 1.4, vücut ağırlığında (kg) kadınlarda % 0.64, erkeklerde % 0.57, beden kitle indeksi ölçümlerinde kadınlarda % 0.61, erkeklerde % 0.56 düşme gözlendi. Sonuç: İnsülin, metformin veya oral antidiyabetik tedaviyi kombine veya tek başına alan obez hastalarda tedaviye eksenatide eklenmesi ile hastalarda kilo kaybı ve Hemoglobin A1c düzeylerinde düşme tespit edilmiştir
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    Brain metastases in HER2-positive metastatic breast cancer patients who received chemotherapy with or without trastuzumab
    (Springer Japan Kk, 2015) Kaplan, Muhammet Ali; Ertugrul, Hamza; Firat, Ugur; Kucukoner, Mehmet; Inal, Ali; Urakci, Zuhat; Pekkolay, Zafer
    Objective The aim of this study was to assess whether trastuzumab usage is a risk factor for the development of brain metastasis (BM) in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and factors affecting survival after development of BM. Materials and methods One hundred thirty-two patients treated with (treatment group) or without trastuzumab (control group) with brain metastasis were retrospectively analyzed. Results Ninety of the 132 HER2-positive MBC patients were in the treatment group and 42 were in the control group. BM was significantly increased in patients who were treated with trastuzumab in two or more lines (58.5 vs 24.1 %, p < 0.001). Trastuzumab and lapatinib usage after BM and age were independent prognostic factors for overall survival in univariate and multivariate analysis. Conclusion The risk for BM was increased in patients who were treated with trastuzumab in two or more lines. Using trastuzumab and lapatinib after BM and age were independent prognostic factors for time to death from BM.
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    A case of mediastinitis accompanied with hyperosmolar nonketotic coma
    (Kare Publ, 2016) Tuna, Mazhar Muslum; Kilinc, Faruk; Pekkolay, Zafer; Soylu, Hikmet; Tuzcu, Alpaslan Kemal
    Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. A 61 years old male patient with type 2 diabetes was admitted to our hospital, with complaint of generalized worsening and fever. A diagnosis of nonketotic hyperosmolar coma was done and proper treatment started immediately. Neck tomography revealed abscess formation in the upper mediastinum. The needle aspirat culture failed to show bacterial growth. After five days of antibiotic treatment the patient's symptoms resolved. The abscess formation and pleural effusion almost disappeared on control tomography. No similar case presentation was seen in the current literature. Apart from this case, mediastinit should be keep in mind when a patient suffered from dysphagia, fever and cervical swelling. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.
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    A case report of allgrove syndrome with neurological involvement
    (Society of TURAZ BİLİM, 2015) Pekkolay, Zafer; Kılınç, Faruk; Tuna, Mazhar Müslüm; Soylu, Hikmet; Ateş, Kenan; Tuzcu, Alpaslan Kemal
    Allgrove syndrome is a very rare seen disorder with an autosomal recessive trait. The three characteristics of disease are alacrima, achalasia and adrenal failure. Alacrimia is the first manifestation in most cases. Achalasia and adrenal failure are seen later. Neurological involvement is rare and usually occurs in older age. A woman 22 years old admitted to our hospital with adrenal failure crisis. She had alacrimia and used teardrop for many years. Achalasia was diagnosed after evaluation of her dysphagia. Thus, diagnosis of Allgrove syndrome was done. Autonomic cardiac dysfunction and peripheral motor neuropathy were detected. In conclusion, Allgrove syndrome is rare and has life threatening potential due to adrenal failure. Early diagnosis and appropriate treatment may improve life quality and expectancy. Patients with relevant symptoms should be evaluated for autonomic neuropathy.
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    A Case Report of Allgrove Syndrome with Neurological Involvement
    (2015) Tuzcu, Alpaslan Kemal; Soylu, Hikmet; Kılınç, Faruk; Tuna, Mazhar Müslüm; Ateş, Kenan; Pekkolay, Zafer
    Allgrove syndrome is a very rare seen disorder with an autosomal recessive trait. The three characteristics of disease are alacrima, achalasia and adrenal failure. Alacrimia is the first manifestation in most cases. Achalasia and adrenal failure are seen later. Neurological involvement is rare and usually occurs in older age. A woman 22 years old admitted to our hospital with adrenal failure crisis. She had alacrimia and used teardrop for many years. Achalasia was diagnosed after evaluation of her dysphagia. Thus, diagnosis of Allgrove syndrome was done. Autonomic cardiac dysfunction and peripheral motor neuropathy were detected. In conclusion, Allgrove syndrome is rare and has life threatening potential due to adrenal failure. Early diagnosis and appropriate treatment may improve life quality and expectancy. Patients with relevant symptoms should be evaluated for autonomic neuropathy
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    Clinical predictors of incipient vertebral fractures and bone mineral density in kidney transplant patients
    (Springer, 2022) Yavuz, Dilek Gogas; Aydın, Kadriye; Apaydın, Tuğçe; Velioğlu, Arzu; Mert, Meral; Pekkolay, Zafer; Aydın, Emre
    Purpose Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods Two hundred sixty-four patients (F/M 124/140, 45.3 +/- 13 years) who had undergone kidney transplantation in tertiary care centers were included. Vertebral fractures were assessed semiquantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results Vertebral fractures were observed in 56.4% (n = 114) of the study group. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). Bone mineral density (BMD) levels were in the normal range in 40.3% (n = 46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n = 23) and the osteopenic range in 40.3% (n = 46). Vertebral fractures were associated with age, duration of hemodialysis, BMI, and femoral neck Z score (R-2 37.8%, p = 0.027). Conclusion As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients.
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    Comparison of C-peptide levels in monogenic forms of diabetes with other types of diabetes: A single-center study
    (Acta Endocrinologica Foundation, 2023) Geneş, Dilek; Pekkolay, Zafer; Şimşek, Mehmet; Saraçoğlu, H.; Turgut, M.; Tekeş, Selahattin; Tuzcu, Alpaslan Kemal
    Objective. This study aimed to evaluate the utility of C-peptide levels in the differentiation of monogenic forms of diabetes from type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in clinical practice. Subjects and Methods. A total of 104 patients aged >16 who visited the Dicle University’s Faculty of Medicine between April 2011 and December 2020 and were diagnosed with monogenic diabetes by genetic analysis or with T1DM and T2DM were randomly selected for retrospective evaluation. The C-peptide levels of these patients at the time of diagnosis of diabetes were compared. Results. Of the 104 patients, 24 (23%) were diagnosed with maturity-onset diabetes of the young (MODY), 40 (38.5%) with T1DM, and 40 (38.5%) with T2DM. Median C-peptide levels (ng/mL) (interquartile range) were 1.78 (1.24-2.88) in MODY group, 0.86 (0.34- 1.22) in T1DM group, and 2.38 (1.58-4.27) in T2DM group. Conclusions. There was a difference in C-peptide levels between MODY and T1DM groups but not between MODY and T2DM groups. As per clinical evaluations, although C-peptide levels of patients with MODY are similar to those of patients with T2DM patients, the possibility of C-peptide levels being similar to those required for T1DM diagnosis should also be considered.
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    Does oxidative status affect serum sclerostin levels in patients with type 2 diabetes mellitus?
    (Medical University of Plovdiv, 2023) Sabancılar, İlhan; Unsal, Velid; Demir, Fidel; Toprak, Gülten; Pekkolay, Zafer
    Introduction: Sclerostin is a glycoprotein known as a negative regulator of bone formation, predominantly expressed by mature osteocytes. There is no causative evidence information on the role of sclerostin in the pathogenesis of type 2 diabetes mellitus (T2DM) in humans. Aim: This study aimed to investigate the relationship between serum sclerostin levels and oxidative status and biochemical parameters in T2DM patients and healthy people. Materials and methods: This cross-sectional study, conducted in a clinical trial center, included 45 subjects with T2DM and 45 subjects as controls. Results: Serum sclerostin, total oxidative status (TOS), albumin, and ferritin levels were significantly higher in T2DM patients than in the control group (p<0.05). Total antioxidant status (TAS) was significantly higher in the control group (p<0.05). There was a weak positive correlation between sclerostin and TOS (r=0.23, p=0.03) and a weak negative correlation between sclerostin and TAS (r=−0.28, p=0.03). Conclusions: We have demonstrated that serum sclerostin levels increase in patients with T2DM and that the increased sclerostin levels are associated with oxidative stress.
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    The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy
    (Springer, 2020) Erdem, Seyfettin; Karahan, Mine; Ava, Sedat; Pekkolay, Zafer; Demirtas, Atilim Armagan; Keklikci, Ugur
    Purpose This study aimed to compare static and dynamic pupil responses of diabetic patients with and without nonproliferative diabetic retinopathy (DR) and normal healthy individuals under different lighting conditions via quantitative automated pupillometry. Methods Forty patients with DM with nonproliferative DR (group 1), 40 patients with DM without DR (group 2), and 40 healthy controls (group 3) underwent a complete ophthalmologic examination. Static pupillometry [scotopic pupil diameter (PD), mesopic PD, low photopic PD, and high photopic PD] and dynamic pupillometry (resting PD, contraction amplitude, latency, duration, velocity of contraction, dilatation latency, and duration and velocity at rest) were measured via automatic quantitative pupillometry. Results Analysis of variance revealed that scotopic PD [F(2, 117) = 6.42;p = 0.02], mesopic PD [F(2, 117) = 3.20;p = 0.04], and low photopic PD [F(2, 117) = 4.86;p = 0.009] were significantly different among the groups. Scotopic PD and low photopic PD were significantly lower in group 1 than in group 2 (p = 0.03 andp = 0.03, respectively). Meanwhile, the resting diameter, velocity of pupil contraction, and velocity of pupil dilatation were found to be significantly lower (p = 0.02,p = 0.01, andp = 0.008, respectively), and the duration of pupil contraction was significantly higher in group 1 than in group 3 (p = 0.03). Conclusion Both DM patients with and without nonproliferative DR exhibited pupillary involvement. Automated pupillometry may be an easily applicable, noninvasive screening option for reducing mortality and morbidity rates associated with diabetic autonomic neuropathy.