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    Acanthosis nigricans with vitiligo and insulin resistance
    (Blackwell Science Ltd, 2000) Harman, M; Akdeniz, S; Çetin, H; Tuzcu, A
    [Abstract Not Available]
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    Analysis of 1242 cases with upper gastrointestinal system bleeding in Southeastern Turkey
    (H G E Update Medical Publishing S A, 2005) Dursun, M; Yilmaz, S; Yükselen, V; Canoruç, F; Tuzcu, A
    Background/Aims: There are few detailed reports on gastrointestinal system bleeding in Turkey. The aim of this study is to analyze the characteristics of the patients with upper gastrointestinal system bleeding who were hospitalized in our clinic. Methodology: The patients who were hospitalized in Dicle University Hospital Department of Gastroenterology from March 1992 to June 2002 were analyzed retrospectively. Results: During this period of time, 296 females (23.8%) and 946 males (76.2%), total 1242 patients were hospitalized for upper gastrointestinal system bleeding. Mean age was 47 for both sexes. Distribution of the cases was as follows: 31.6% duodenal ulcer (n: 393), 30.5% esophageal variceal bleeding (n: 379), 13.7% erosive gastritis (n: 171), 6.8% erosive duodenitis (n: 85), 4.9% gastric ulcer (n: 62), 2.8% carcinoma (n: 35), and 3.5% other causes. Peptic ulcer related bleeding was the most encountered reason (37.5%, n: 466). Four percent of the cases other than esophageal variceal bleeding underwent urgent surgical intervention. Eleven percent of the cases (n: 138) resulted in death of which 65.9% were esophageal variceal bleeding (n: 91). Conclusions: The most striking result is the very high rate of esophageal variceal bleeding. This finding is in concordance with the high prevalence of the viral hepatitis in the region.
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    Changes in serum levels of leptin, cytokines and lipoprotein in preeclamptic and normotensive pregnant women
    (Parthenon Publishing Group, 2004) Koçyigit, Y; Atamer, Y; Atamer, A; Tuzcu, A; Akkus, Z
    The aim of this study was to investigate the changes in serum levels of leptin, cytokines and lipoproteins in women with pre-eclampsia and to evaluate their clinical significance in the pathogenesis of pre-eclampsia. We performed a prospective study involving 45 women with pre-eclampsia in the third trimester of pregnancy and 30 normotensive women in the third trimester of pregnancy. Serum level of leptin was measured by enzyme immunoassay using a Cayman chemical kit, Serum levels of tumor necrosis factor (TNF)-alpha, intertleukin (IL)-1beta, soluble IL-2 receptor (sIL-2R), IL-6 and IL-8 were measured by using a nonradioimmunoassay chemiluminescent method. Serum lipid concentrations were measured by an Abbott Aeroset (USA) autoanalyzer. Serum levels of apolipoprotein (Apo)A-I and ApoB were evaluated by nephelometrics assays. Differences between groups were evaluated with Student's unpaired t test and, when a variable was not normally distributed, the Mann-Whitney U test was used. The relationship between the variable was explored by the Pearson correlation test. Serum levels of leptin, TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 in the preeclamptic women were significantly higher than in normotensive women (p < 0.001). In the pre-eclamptic women serum levels of triglycerides, total cholesterol and low-density lipoprotein (LDL)-cholesterol were significantly increased (p < 0.001), while high-density lipoprotein (HDL)-cholesterol and Apo-A were significantly decreased compared to levels in normotensive pregnant women (p < 0.001). No significant differences were noted between the groups in Apo-? (p > 0.05). Serum levels of TNF-? were significantly correlated with the serum levels of IL-6, IL-8, triglycerides, sIL-2R, Apo-A and hematocrit in pre-eclamptic women (r = 0.418, p < 0.05 - r = 0.389, p < 0.01; r = 0.312, p < 0.05; r 0.318, p < 0.05; r 0.340, p < 0.05 and r = 0.41, p < 0,01, respectively). A negative correlation was seen between serum level of leptin and both IL-1? and Apo-A in pre-eclamptic women (r = 0.44, p < 0.05; r = 0.39, p < 0.05, respectively). Serum levels of IL-6 were also signficantly correlated with the serum levels of HDL-cholesterol, LDL-cholesterol and body mass index (BMI) in preeclamptic women (r = 0.40, p < 0.01; r = 0.568, p < 0. 0 1; r 0. 3 0, p < 0. 05, respectively). In addition, serum level of IL-8 were significantly correlated with the serum levels of HDL-cholesterol, total cholesterol and BMI in pre-eclamptic women (r = 0.368, p < 0.05; r = 0.513, p < 0.01 and r = 0.41, p < 0.01, respectively). We found that the pre-eclampsia associated with increases in serum levels of leptin, TNF-?, cytokines, triglycerides, total cholesterol and LDL-cholesterol was associated with a significant reduction in serum levels of HDL-cholesterol and Apo-A. These association may be due to the abnormal lipid metabolism and immune activation involved in the pathogenesis of this disease.
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    The comparison of insulin sensitivity in non-diabetic hemodialysis patients treated with and without recombinant human erythropoietin
    (Georg Thieme Verlag Kg, 2004) Tuzcu, A; Bahceci, M; Yilmaz, E; Bahceci, S; Tuzcu, S
    Background: Patients with end-stage renal disease (ESRD) are known to have insulin resistance. Treatment with EPO is associated with improvement in insulin sensitivity in uremic patients. The aim of this study was to compare insulin sensitivity and pancreatic B cell function in adult non-diabetic uremic hemodialysis patients treated with or without rHuEPO. Subjects and Methods: Three groups of subjects were included to the study: hemodialysis patients treated with rHuEPO [EPO(+) group] or without rHuEPO [EPO(-) group], and healthy controls. Anthropometrical parameters, lipid levels, fasting glucose and insulin levels were measured in all subjects. Homeostasis Model Assessment (HOMA) was used to compare insulin sensitivity. ANOVA, independent t-test, and Pearson correlation were used for statistical analysis. Results: Mean insulin level of control group (20.04 +/- 7.2 pmol/l) was significantly lower than EPO(+) group (p<0.04) and EPO(-) group (p<0.0001). HOMA-(%B) levels in the EPO(+) group were significantly lower than in the EPO(-) group (106 +/- 42, 140 +/- 63 respectively, p<0.02). HOMA(%B) levels in the control group (66 17) were significantly lower than in the EPO(+) and EPO(-) group (p<0.005 an p<0. respectively). HOMA-(%S) levels in the EPO(+) groups was significantly higher than in the EPO(-) group (91 +/- 40, 56 +/- 26, respectively; p<0.01). HOMA-(%S) levels of control group (125 +/- 24) was significantly higher than EPO(+) and EPO(-) groups (p<0.02, p<0.0001 respectively). We found a positive correlation between duration of erythropoietin treatment and insulin sensitivity (r = 0.484, p<0.002). Conclusions: Firstly, patients treated with EPO are insulin sensitive compared to patients not treated with EPO. Secondly, duration of erythropoietin treatment is positively correlated with insulin sensitivity in hemodialysis patients.
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    The determination of insulin sensitivity in hemodialysis and continuous ambulatory peritoneal dialysis in nondiabetic patients with end-stage renal disease
    (Saudi Med J, 2005) Tuzcu, A; Bahceci, M; Yilmaz, ME; Turgut, C; Kara, IH
    Objectives: To determine the beta-cell function and insulin sensitivity with homeostasis model assessment (HOMA) and area under curve (AUC) in nondiabetic uremic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients cross sectionally. Methods: The study was performed between January to August 2001 in the Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey. Fifty-one HD patients, 45 CAPD patients, and 50 healthy control subjects were included in the study. Height, weight, waist and hip circumference, fat mass and percentage of body fat, and body mass index (BMI) were measured. The total high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglyceride, urea, creatinine, insulin, potassium, parathyroid hormone (PTH) and 1,25 dihydroxycholecalciferol levels were measured. Oral glucose tolerance test (OGTT) was performed in the mid-week dialysis-free interval in HD patients, whereas after at least a night without dialysis exchanges in CAPD group. Area under curve both of insulin and glucose were calculated. The HOMA [insulin sensitivity (%S)] and AUC were used as indices of tissue insulin sensitivity. Results: The LDL-cholesterol levels of patients with CAPD was higher than the HD group (p<0.001) and control group (p<0.0001). The baseline glucose levels of the 2 groups were not significantly different. Baseline insulin levels of CAPD group were higher than the HD group (p<0.001) and the control group (p<0.0001). Area under curve for glucose (AUCgluc) and insulin (AUCins) value of CAPD patients were higher than the HD patients than the control group (p<0.0001). The HOMA [beta-cell function (%B)] values of CAPD group were higher than both HD (p<0.02) and control Group (p<0.04). The HOMA [insulin sensitivity (%S)] levels of CAPD group was significantly lower than the HD patients (p<0.002) and the control group (p<0.001). Conclusions: The CAPD treatment may lead to insulin insensitivity in non-diabetic end-stage renal disease patients and the high glucose content of CAPD Solutions may be responsible for insulin resistance in CAPD patients.
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    The efficacy of flumazenil in subclinical to mild hepatic encephalopathic ambulatory patients - A prospective, randomised, double-blind, placebo-controlled study
    (E M H Swiss Medical Publishers Ltd, 2003) Dursun, M; Caliskan, M; Canoruc, F; Aluclu, U; Canoruc, N; Tuzcu, A; Yilmaz, S
    Objectives: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with fulminant hepatic failure and chronic liver disease. Its pathogenesis is unclear. One of the factors implicated is enhanced GABA-ergic tone, which is probably related to increased concentrations of cerebral benzodiazepine (BNZ). In the present study, we tested flumazenil, a cerebral BNZ antagonist, in cirrhosis patients with hepatic encephalopathy. Methods: Out of 47 patients, 7 were excluded prior to randomization for various reasons. Twenty patients were included in the flumazenil group and 20 in the placebo group in a prospective, randomized, double-blind, placebo-controlled study. Patients were given. flumazenil (1 mg/h, continuous IV infusion) or an equal volume of saline solution for 5 hours. Before and after treatment, portosystemic encephalopathy (PSE) stage and number connection test (NCT) scores were checked every half hour for 5 hours. EEG was recorded 15 minutes before and I hour after treatment. Results: While significant improvements were determined in PSE stage and NCT score in the flumazenil group, there were no such improvements in the placebo group. There was no statistically significant difference between pre- and post-treatment EEGs in either group. Conclusion: It was concluded that continuous IV infusion of flumazenil had beneficial and safe effects in the treatment of hepatic encephalopathy patients.
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    Evaluation of optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia
    (H G E Update Medical Publishing S A, 2004) Dursun, M; Yilmaz, S; Yükselen, V; Kilinç, N; Canoruç, F; Tuzcu, A
    Background/Aims: The study is designed to identify the optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia. Methodology: Ninety-two patients were included in the study, gastric biopsies were obtained from 5 different sites: lesser curvature of the mid-antrum (A(1)), greater curvature of the mid-antrum (A(2)), incisura angularis (IA), lesser curvature of the mid-corpus (B-1), greater curvature of the mid-corpus (B-2). Helicobacter pylori was evaluated in sections stained with toluidine blue, and histopathological. examination was performed in sections stained with hematoxylineosin. Results: Seventy-three patients were positive for Helicobacter pylori at least in one biopsy site. Helicobacter pylori was positive in 47 patients (64.3%) in A(1), in 54 patients (73.9%) in A(2), in 60 patients (82.1%) in IA, 44 patients (60.2%) in B-1, and in 42 patients (57.5%) in B-2. The highest positivity determined was in the combination of A(2) and IA sites (95.8%). Gastric atrophy was determined in 35 of 73 patients (27.1% in A(1), 20% in A(2),25.7% in IA, 20% in B-1, and 7% in B-2). Intestinal metaplasia was determined in B-1 of the Helicobacter pylori-positive patients (18% in A(1), 16% in A(2), 30.9% in IA, 21.8% in B-1, 12.7% in B-2). Conclusions: It is considered that taking biopsies from both A(1) and IA sites has the highest sensitivity in detecting Helicobacter pylori. However, it is difficult to define a specific site for detecting gastric atrophy and intestinal metaplasia.
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    Horizontal transmission of HBV infection among students in Turkey
    (Nature Publishing Group, 2000) Degertekin, H; Tuzcu, A; Yalçin, K
    In this study, the HBsAg carrier state and the role of horizontal transmission were investigated among primary and high school students in southeastern Anatolia where HBsAg seropositivity is remarkably high. In total, 350 students from primary school first grade, 350 students from fifth grade, 400 students from high school eleventh grade and 400 healthy adults as a control group were studied. In all cases HBsAg and anti-HBs were screened by ELISA. HBsAg positivity was 2.4% in first grade, 6.1% in fifth and 6.7% in eleventh grade students. Anti-HBs positivity was 14% in first grade, 20% in fifth and 21% in eleventh grade students. HBsAg positivity was 9% and anti-HBs, 49% in the control group. There is a significant difference between first and fifth grade students for HBsAS positivity (2.1% vs 6.1% and P < 0.05). This difference decreased during the high school years (6.2% and P > 0.05). There is also a similar statistically significant difference for anti-HBs positivity during the primary school years (14% vs 20%, P < 0.05). These findings show that the risk of horizontal transmission of HBV is especially important during elementary school years between the ages of 7 and 11 y. All infants or at least elementary school first grade students in Turkey should have HBV vaccinations.
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    Insulin sensitivity and hyperprolactinemia
    (Editrice Kurtis S R L, 2003) Tuzcu, A; Bahceci, M; Dursun, M; Turgut, C; Bahceci, S
    It has been shown that prolactin (PRL) induces glucose intolerance, hyperinsulinemia and insulin resistance in several animal species. In women with microprolactinomas, the sensitivity to insulin is lower in hyperprolactinemia than in normoprolactinemia. Thirty non-obese women with hyperprolactinemia and 30 healthy non-obese women were included into the study. Age, body weight (bw), height, body mass index (BMI), waist circumference, hip circumference and waist to hip ratio of both patients with hyperprolactinemia and control subjects were not different. Mean serum prolactin level was higher in hyperprolactinemic patients than in control group (84.5 +/- 51.1 ng/ml and 13.8 +/- 5.3 ng/ml respectively, p<0.002). Mean HOMA-(%B) index of hyperprolactinemic patients was higher than in control subjects (121 +/- 49 and 84 +/- 38, respectively, p<0.02). Mean HOMA-(%S) index was lower in hyperprolactinemic patients (56 39 and 105 55, respectively, p<0.006). Serum total testosterone, free testosterone, androstenedione, estradiol, cortisol, sex hormone binding globulin and DHEA-S levels in both hyperprolactinemic women and healthy subjects, statistically did not show any difference between the two groups. The present data indicate that hyperprolactinemia is associated with an insulin-resistant state. This resistant state may not be a result of obesity, androgenic hormones, and SHBG or pregnancy. It may be the result of serum free fatty acids (FFA) levels, decrement in the number of insulin receptors (by a down-regulation of insulin receptors) or post-binding defect in insulin action or more. (C) 2003, Eclitrice Kurtis.
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    Is hyperprolactinemia associated with insulin resistance in non-obese patients with polycystic ovary syndrome?
    (Editrice Kurtis S R L, 2003) Bahceci, M; Tuzcu, A; Bahceci, S; Tuzcu, S
    Insulin resistance is common in polycystic ovary syndrome (PCOS). Moderate elevations in serum PRL concentration may contribute to insulin resistance in PCOS. The aim of this study was to determine PRL on development of insulin resistance in non-obese hyperprolactinemic patients with PCOS. Ninety-eight non-obese subjects with PCOS and 100 non-obese healthy control were accepted in the study. Serum glucose, lipids, androgens, free androgen index (FAI), gonadotropins, fat mass and percentage, SHBG, and insulin levels were measured. Homeostasis model assessment (HOMA) was used as index of pancreatic beta-cell function and tissue insulin sensitivity. Independent t-test was used in comparison of results. In patients with PCOS, FAI and mean HOMA-(%B) level were higher than in the control group (p<0.0001), whereas mean HOMA-(%S) in subjects with PCOS was lower than in the control group (p<0.0001). Patients with PCOS were divided into subgroups according to their serum prolactin level (<24 or greater than or equal to24 ng/ml). Although FAI was not different, mean insulin and HOMA-(%B) levels in hyperprolactinemic patients were higher than in normoprolactinemic subjects (p<0.001). HOMA-(%S) in hyperprolactinemic patients with PCOS was lower than in normoprolactinemic patients (p<0.002). In conclusion, PCOS is associated with insulin resistance; non-obese hyperprolactinemic PCOS patients may be more insulin-resistant than normoprolactinemics and there may be an association between hyperprolactinemia and insulin resistance in PCOS. (C) 2003, Editrice Kurtis.
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    Is serum C-reactive protein concentration correlated with HbA1c and insulin resistance in Type 2 diabetic men with or without coronary heart disease?
    (Springer, 2005) Bahceci, M; Tuzcu, A; Ogun, C; Canoruc, N; Iltimur, K; Aslan, C
    Background and aims: C-reactive protein (CRP) is an inflammatory marker that predicts coronary heart disease (CHD) risk. Diabetes mellitus (DM) counts as a CHD risk equivalent. We aimed to compare serum high sensitivity CRIP (hs-CRP) levels in Type 2 diabetic (T2DM) men without CHD, non-diabetic CHD patients and T2DM patients with CHD. Subjects and methods: Four groups were formed; Group 1 [DM(+) CHD(-), no.=25], Group 2 [DM(-) CHD(+) no.=25], Group 3 [DM(+), CHD(+), no.=25], and Group 4 (controls, no.=30). Serum hs-CRP, insulin, glucose, total, HDL-, LDL- and VLDL-cholesterol, triglyceride levels and homeostasis model assessment for insulin resistance (HOMA-IR) index were determined. Results: Mean hs-CRP level of Group 1 (0.6 +/- 0.29) was not different statistically from Group 2 (1.44 +/- 0.97). Mean hs-CRP levels were higher in men with CHD, whether they were diabetic (Group 3; 3.83 +/- 2.01 mg/dl) or non-diabetic (Group 4), than in control subjects (0.16 +/- 0.15; p=0.0001 and p < 0.004, respectively). Mean hs-CRP level of Group 3 was also higher than Group 2 (p=0.0001). There was a positive correlation between serum hs-CRP and glycated hemoglobin (HbA(1c); r=0.277, p < 0.01), fasting insulin (r=0.336, p < 0.02) and HOMA-IR (r=0.348, p < 0.02) in T2DM men with or without CHD. Conclusions: T2DM men without CHD had similar CRP levels with non-diabetic CHD patients, whereas CRP levels of T2DM men with CHD were higher than non-diabetic men with CHD. Because of a positive correlation between serum hs-CRP and HbA(1c) fasting insulin and HOMA-IR, inflammation, insulin resistance and hyperglycemia jointly contribute to the cardiovascular risk in T2DM men. (c) 2005, Editrice Kurtis.
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    A novel missense mutation of 5-alpha reductase type 2 gene (SRD5A2) leads to severe male pseudohermaphroditism in a Turkish family
    (Elsevier Science Inc, 2005) Bahceci, M; Ersay, AR; Tuzcu, A; Hiort, O; Richter-Unruh, A; Gokalp, D
    Objectives. To analyze the steroid 5-alpha reductase type 2 gene (SRD5A2) in 2 siblings with severe male pseudohermaphroditism suspected to have 5-alpha reductase deficiency in a Turkish family. Methods. Two female siblings of a family with 7 children were referred to the urology department because of bilateral inguinal masses. The patients had presented after birth with ambiguous genitalia, but no further diagnostic procedures had been performed, and they were raised as girls until the ages of 13 and 15 years. At this time, both had striking ambiguity of the genitalia, with a clitoris-like phallus, severely bifid scrotum, pseudovaginal perineoscrotal hypospadias, a rudimentary prostate, and inguinal testes. Karyotype was 46,XY. Basal and stimulated levels of serum testosterone (T), dihydrotestosterone (DHT), and T/DHT ratio indicated 5-alpha reductase deficiency. Molecular genetic analysis was performed on deoxyribonucleic acid from peripheral blood leukocytes by single-stranded conformational polymorphism analysis and direct sequencing. Results. Analysis of the SRD5A2 gene revealed a new homozygous missense mutation in exon 2. At codon 123, we identified a GGA to AGA change resulting in a missense amino acid change from glycine to arginine (G123R). Both parents and the 2 healthy sisters and 3 brothers were all heterozygous at codon 123 for the same mutation. Conclusions. We report a novel homozygous missense mutation in exon 2 of the 5-alpha reductase type 2 gene that led to severe undervirilization in 2 siblings.
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    Octreotide may be useful in diabetic foot ulcers with purulent discharge and deep penetrating sinuses
    (Bio Scientifica Ltd, 2005) Bahceci, M; Tuzcu, A; Gokalp, D; Akdeniz, S
    [Abstract Not Available]
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    Polyglandular autoimmune syndrome type III accompanied by common variable immunodeficiency
    (Parthenon Publishing Group, 2004) Bahceci, M; Tuzcu, A; Pasa, S; Ayyildiz, O; Tuzcu, S
    We identified polyglandular autoimmune (PGA) syndrome type III in a 24-year-old nurse with common variable immunodeficiency (CVID). An immune-mediated disorder, membranoproliferative glomerulonephritis, was diagnosed when she was 15 years old. Clinical examination and laboratory findings revealed a PGA syndrome due to the presence of hypergonadotropic hypogonadism, insufficient growth hormone response and thyroid autoimmunity. The patient had neither adrenal disease nor hypoparathyroidism. Therefore we concluded that this patient has PGA syndrome type III. This is an interesting case, because we could not find any previous report Of such coexistence between PGA type III and CVID in a Medline search. Coexistence of these two entities may be a result of autoimmunity and the association of both conditions with human leukocyte antigen.
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    Risperidone-associated transient diabetic ketoacidosis and diabetes mellitus type 1 in a patient treated with valproate and lithium - A case report
    (Georg Thieme Verlag Kg, 2005) Mithat, B; Tuzcu, A; Bulent, C; Cengiz, T
    A 37-year-old man treated with valproate and lithium for bipolar affective disorder since 1999 and with risperidone since March 2003 was admitted to our clinic due to metabolic acidosis. Serum glucose was 647 mg/dL and urine ketones were positive. The patient was accepted as diabetic ketoacidosis (DKA). Risperidone, valproate, and lithium were immediately stopped, and the patient was treated with insulin and IV fluid replacement. Serum insulin and C-peptide levels were too low, and islet cell antibody and anti-GAD antibody were positive. We accepted him as type 1 diabetes mellitus (DM type 1). After the intensive treatment of diabetes, insulin requirements decreased gradually and diabetes mellitus disappeared completely within three months. Conclusion: Risperidone may lead to transient DM type 1 and DKA.
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    Serious clopidogrel associated renal hematoma in a type 2 diabetic patient with primary hyperparathyroidism after extracorporeal shock wave lithotripsy
    (Saudi Med J, 2005) Bahceci, M; Tuzcu, A; Akay, F; Agil, C; Akay, H
    Renal hematoma after extracorporeal shock wave lithotripsy (SWL) is a rare complication. We report a case of a large renal hematoma following SWL that resulted in nephrectomy in a type 2 diabetic patient with primary hyperparathyroidism using clopidogrel due to coronary heart disease (CHD). Although it was claimed that preoperative use of clopidogrel was not associated with increased bleeding, all patients who are scheduled for SWL should be interrogated in terms of using of platelet aggregation inhibitors such as clopidogrel, and these drugs should be interrupted appropriately before undergoing SWL.
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    Serum C-reactive protein (CRP) levels and insulin resistance in non-obese women with polycystic ovarian syndrome, and effect of bicalutamide on hirsutism, CRP levels and insulin resistance
    (Karger, 2004) Bahceci, M; Tuzcu, A; Canoruc, N; Tuzun, Y; Kidir, V; Aslan, C
    Background/Aims: Insulin resistance is associated with serum C-reactive protein (CRP) levels. We aimed to evaluate the effect of bicalutamide on insulin resistance and serum CRP levels in non-obese polycystic ovarian syndrome (PCOS) patients. Methods: 40 non-obese patients (BMI less than or equal to25 kg/m(2)) with PCOS and, 40 age- and BMI-matched healthy women were studied. Patients received bicalutamide orally at the dose of 25 mg/day. Serum CRP levels were measured with immunometric assay. Homeostasis model assessment (HOMA-IR) index was used for insulin resistance. Results: Mean Ferriman-Gallwey score (FGS) (p = 0.001), insulin (p = 0.001), serum glucose (p = 0.001), prolactin (p < 0.003), total (p < 0.04) and free testosterone (p = 0.001) and free androgen index (FAI) levels (p = 0.001) of PCOS subjects were higher than in the control group. Mean HOMA-IR of PCOS patients was higher than in control subjects (2.43 +/- 1.2 and 0.94 +/- 0.37, p = 0.001). CRP levels in subjects with PCOS was also higher than in control subjects (4.27 +/- 1.33 and 0.98 +/- 0.19, p = 0.001). After bicalutamide treatment, FGS, free and total testosterone and FAI decreased (p = 0.001). HOMA-IR, prolactin and CRP levels did not show any statistical difference with bicalutamide treatment. Conclusions: PCOS patients had insulin resistance and a high CRP level. Bicalutamide treatment did not influence insulin resistance and CRP level in PCOS, and this ineffectiveness of bicalutamide on CRP levels may be the result of insulin resistance and/or high prolactin levels at this time. Copyright (C) 2004 S. Karger AG, Basel.
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    Serum prostate specific antigen levels in women with polycystic ovary syndrome and the effect of flutamide plus desogestrel/ethinyl estradiol combination
    (Editrice Kurtis S R L, 2004) Bahceci, M; Bilge, M; Tuzcu, A; Tuzcu, S; Bahceci, S
    Background: Prostate-specific antigen (PSA) is expressed in many female tissues and its concentrations were higher in hirsute subjects. We aimed to determine serum PSA level in hirsute women and evaluate the effect of flutamide+ desogestrel/ethynil estradiol combination. Subjects and study design: Thirty patients with polycystic ovary syndrome (PCOS) and 30 healthy controls were studied. Hirsutism was defined by modified Ferriman-Gallwey score (FGS). Free androgen index (FAI) was used for hyperandrogenism. Patients received flutamide (500 mg/d) and oral contraceptive (desogestrel+ethinyl estradiol) for 9 months. Results: Mean FGS (p<0.0001), insulin (p<0.01), FAI (0.0001), androstenedione (p<0.0001), LH (p<0.05), and free testosterone (p<0.003) levels of patients with PCOS were higher than the control group. Mean serum total and free PSA level of PCOS patients were higher than the control group (p<0.0001 and p<0.0001). We found a positive correlation between total PSA levels and FGS (r=0.568, p<0.001), FAI and FGS (r=0.456 and p<0.01). There was also a positive correlation between FAI and total PSA (r=0.503 and p<0.005). At the end of treatment, FGS, androstenedione, free and total testosterone, FAI, serum PSA and LH levels decreased significantly [serum total PSA was 0,0208 +/- 0,0178 ng/ml at baseline and 0,0061 +/- 0,0044 ng/ml after treatment (p<0.0001)]. Conclusions: 1. Serum prostate specific antigen level is higher in patients with PCOS; 2. There is a positive correlation among FGS, FAI and PSA levels; 3. Serum PSA levels decrease with antiandrogen treatment; 4. Serum PSA measurement might be a marker for hirsutism. (C) 2004, Editrice Kurtis.
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    Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia
    (Japan Endocrine Society, 2005) Tuzcu, A; Bahceci, M; Gokalp, D; Tuzun, Y; Gunes, K
    The association between coronary heart disease and subclinical hypothyroidism (SCH) is unclear. We aimed to determine hs-CRP concentrations in patients with SCH. Seventy-seven patients (age 34.6 +/- 13.7 yr) with SCH (TSH >4.2 muIU/ml and serum free thyroxine level between 0.932-1.71 ng/dL), and 80 control subjects (age 33.9 +/- 13.3 yr) were studied. Thyroid hormones, C-reactive protein, insulin, glucose, total, HDL, LDL and VLDL-cholesterol levels and HOMA-IR index were also determined. TSH levels of SCH group were higher than control (7.4 +/- 2.9 and 1.55 +/- 0.78 muIU/ml, respectively, p=0.0001). However, FT4 levels were lower than control subjects (1.18 +/- 0.22 ng/dL and 1.38 +/- 0.26, respectively, p=0.001). Serum hs-CRP levels of subjects with SCH were higher than control subjects (4.2 +/- 0.8 mg/l and 1.05 +/- 0.3 mg/l respectively, p=0.0001). Insulin levels of SCH group were higher than control (8.5 +/- 4.3 muU/ml and 7.1 +/- 3.1 muU/ml respectively, p<0.02) but, Homa-IR levels of the two groups were not different. Mean total and LDL-cholesterol levels of SCH group were higher than control (p=0.01 and p<0.02). We also found a positive correlation between hs-CRP levels and insulin (r=0.362, p=0.002 in men, r=0.358, p=0.0001 in women), TSH (r=0.611, p=0.0001 in men, r=0.411 p=0.0001 in women), and prolactin (r=0.340, p=0.01 in men r=0.553, p=0.0001 in women). Conclusions: Patients with SCH, irrespective of gender, have higher serum hs-CRP, insulin, total and LDL-cholesterol levels than healthy subjects. 2-High hs-CRP level, and thereby low grade inflammation may be associated with fasting hyperinsulinemia before insulin resistance becomes evident in patients with SCH.