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Öğe Acromegaly with No Evidence of Pituitary Adenoma or Ectopic Source(Galenos Yayincilik, 2017) Sari, Isilay Kalan; Demirci, Huseyin; Durmaz, Senay ArikanAcromegaly is caused by the uncontrolled hypersecretion of growth hormone (GH) and secondary increases of insulin-like growth factor-1. More than 95% of patients with acromegaly have a growth hormone-secreting pituitary adenoma. Ectopic GH or growth hormone releasing hormone (GHRH)-secreting tumors are rare cause of acromegaly. Pituitary adenomas that cause the hypersecretion of GH are nearly always visible on magnetic resonance imaging. Rarely, patients without an ectopic source may have normal pituitary imaging. In managing this rare circumstance, exploring pituitary or medical treatment with a somatostatin analog might be useful. We describe a patient with acromegaly with no pituitary adenoma and no evidence of ectopic source, who was treated with long-acting octreotide.Öğe Atypical Diabetic Ketoacidosis: Case Report(Aves, 2015) Demirci, Huseyin; Cosar, Ramazan; Ciftci, Ozcan; Sari, Isilay KalanBackground: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus and can lead to death if untreated. It is a complex metabolic state characterised by hyperglycaemia, acidosis and ketonuria. Bonsai is one of the herbal incense products that contains synthetic cannabinoid and can be easily accessible via the internet in many countries. It cannot be detected in blood and urine studies using conventional methods. Synthetic cannabinoid abuse is associated with severe side effects, including tachycardia, high blood pressure, acidosis, excess sedation and coma. Case Report: A 17-year-old male patient was brought to the emergency department with sudden onset of dyspnoea. Laboratory investigations revealed hyperglycaemia, acidosis and ketonuria. He was admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis. He was not considered a typical case of diabetic ketoacidosis because of the tendency to hypokalaemia, persistent tachycardia and bronchoscopic findings. We learned from his friends that he had used cannabis for a week and used bonzai on the day that he was brought to the emergency service. Conclusion: Diabetic ketoacidosis with prolonged acidosis and tendency to hypokalaemia are investigated for the consumption of synthetic cannabinoids.Öğe Klinefelter Syndrome with Portal Vein Aneurysm: Case Report(Gazi Univ, Fac Med, 2018) Sari, Isilay Kalan; Cosar, Ramazan; Yilmaz, Sevda; Demirci, HuseyinKlinefelter syndrome (KS) is the most common chromosomal disorder in men characterized by clinical features of hypogonadism and infertility. About 90% of cases have classically 47, XXY karyotype and the remaining have additional X or Y chromosomes, high grade aneuploidies or X chromosome structural abnormalities. Portal vein aneurysms are very rare. Reported cases are increasing due to use of modern imaging techniques in clinic practise. Here we report a 19-year-old man with KS who was admitted with complaints of abdominal pain, nausea and vomiting. Further investigations revealed 23 mm anechoic, saccular expansion in the left branch of the portal vein. It is well known that KS is associated with venous thromboembolic diseases including portal venous thrombosis, but association with portal vein aneurysm has not been previously reported.Öğe Lower plasma pantoprazole level predicts Helicobacter pylori treatment failure in patients with type 2 diabetes mellitus(Wiley, 2015) Sapmaz, Ferdane; Kalkan, Ismail H.; Suslu, Incilay; Demirci, Huseyin; Atasoy, Pinar; Guliter, SefaObjectiveWe aimed to compare the plasma pantoprazole level (PPL) between patients with type 2 diabetes mellitus and non-diabetic patients during Helicobacter pylori (H. pylori) eradication treatment and to explore the role of PPL in predicting the treatment success rates. MethodsThis study included 40 diabetic and 40 non-diabetic treatment-naive H.pylori-infected patients. Bismuth-based standard quadruple treatment for H.pylori eradication was used for 14 days in both groups. PPL was measured using the square-wave voltammetry method. ResultsH.pylori eradication rate (60.0% vs 87.5%, P=0.005) and PPL (0.25 0.03 g/mL vs 0.34 +/- 0.03 g/mL, P < 0.001) was significantly lower in the diabetic group compared with the controls. Patients with treatment failure had lower PPL than those with successful treatment (P<0.001). The receiver operating characteristics curve demonstrated that PPL had a significant predictive value for the outcome of H.pylori eradication. ConclusionType 2 diabetic patients had lower PPL than the non-diabetic controls, which led to their lower H. pylori eradication rates.Öğe The Relationship between Serum Homocysteine Levels and Nonproliferative Diabetic Retinopathy in Type 2 Diabetes Mellitus(Gazi Univ, Fac Med, 2015) Demirci, Huseyin; Onaran, Zafer; Gokcmar, Nesrin; Erdamar, Husamettin; Ornek, NurgulObjective: To evaluate the relationship between serum homocysteine levels and the presence of nonproliferative diabetic retinopathy (NPDR) in type 2 Diabetes Mellitus (T2DM) patients Methods: One-hundred patients with a diagnosis of T2DM and 30 healthy control subjects whose age and sex were similar were included in this study. In diabetic patients retinopathy was assessed by ophthalmological examination. Homocysteine, fasting glucose, HbA1C, triglyceride, total cholesterol, high density lipoprotein and low density lipoprotein levels were analyzed in the blood samples in both groups. Also microalbumin levels were analyzed in 24-hour urine samples. T2DM patients were further divided into two groups according to the presence of retinopathy as patients with NPDR (Group 1, n=32) and without retinopathy (Group 2, n=68). Results: There was no statistically significant difference in the homocysteine levels between the T2DM group and the control group (13.13 +/- 4.35 mu mol/l and 12.29 +/- 4.81 mu mol/l, respectively, p>0.05). Although homocysteine levels were higher in the patients with diabetic retinopathy (Group 1) than the diabetic patients without any diabetic complication (Group 2), the difference was not statistically significant (13.21 +/- 4.23mmol/l and 12.96 +/- 4.60mmol/l, respectively, p>0.05). Conclusion: There was no increase in serum homocysteine levels in T2DM when there was no additional diabetic or cardiovascular complication other than NPDR. Our study, by demonstrating that serum homocysteine level was irrelevant to the presence of NPDR, suggests that homocysteine does not play a role at the early stages of retinopathy.
