Alveolar-capillary adaptation to chronic hypoxia in the fatty lung

AIM

Obese diabetic (ZDF fa/fa) rats with genetic leptin resistance suffer chronic lipotoxicity associated with age-related lung restriction and abnormal alveolar ultrastructure. We hypothesized that these abnormalities impair adaptation to ambient hypoxia.

METHODS

Male fa/fa and lean (+/+) ZDF rats (4-months old) were exposed to 21 or 13% O2 for 3 weeks. Lung function was measured under anaesthesia. Lung tissue was assayed for DNA damage and ultrastructure measured by morphometry.

RESULTS

In normoxia, lung volume, compliance and diffusing capacity were lower, while blood flow was higher in fa/fa than +/+ rats. In hypoxia, fa/fa animals lost more weight, circulating hematocrit rose higher, and lung volume failed to increase compared to +/+. In fa/fa, the hypoxia-induced increase in post-mortem lung volume was attenuated (19%) vs. +/+ (39%). Alveolar ducts were 35% smaller in normoxia but enlarged twofold more in hypoxia compared to +/+. Hypoxia induced broad increases (90-100%) in the volumes and surface areas of alveolar septal components in +/+ lungs; these increases were moderately attenuated in fa/fa lungs (58-75%), especially that of type II epithelium volume (16 vs. 61% in +/+). In fa/fa compared to +/+ lungs, oxidative DNA damage was greater with increased hypoxia induced efflux of alveolar macrophages. Harmonic mean thickness of the diffusion barrier was higher, indicating higher structural resistance to gas transfer.

CONCLUSION

Chronic lipotoxicity impaired hypoxia-induced lung expansion and compensatory alveolar growth with disproportionate effect on resident alveolar progenitor cells. The moderate structural impairment was offset by physiological adaptation primarily via a higher hematocrit.

Rotator cuff metastases: a report of two cases with literature review

Context:

Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far.

Case Report:

The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper.

Conclusion:

Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered.

Isolated brain stem edema in a pediatric patient with head trauma: a case report

Brain stem is the most vital part of our body and is a transitional region of the brain that connects the cerebrum with the spinal cord. Though, being small in size, it is full of indispensible functions such as the breathing, heart beat. Injury to the brain stem has similar effects as a brain injury, but it is more fatal. Use of the Glasgow Coma Score as a prognostic indicator of outcome in patients with head injuries is widely accepted in clinical practice. Traumatic brain stem edema in children is rare, but is associated with poor outcome. The question is that whether it is being aware of computerized tomography appearance of the posterior fossa when initial evaluating pediatric patients with head trauma at emergency clinics. Normal and edematous brain stem without an additional pathology are slightly different and not distinguished easily. On the other hand, brain stem edema should be promptly identified and appropriately treated in a short time.

Efficacy of zoledronic acid treatment in Paget disease of bone

Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease. We retrospectively reviewed remission and relapse statuses of 12 patients with Paget disease. Remission was achieved in all patients after treatment. We recommend zoledronic acid in the first-line treatment of Paget disease.

INTRODUCTION

Paget disease is a disease of bone of unknown etiology with increased bone turnover that results in defective bone microarchitecture and bone deformity. Bisphosphonates are used in symptomatic Paget disease of bone. Clinical trials have shown that zoledronic acid was more effective than other bisphosphonates in the treatment of Paget disease.

METHODS

In this study, we retrospectively reviewed the remission and relapse statuses of 12 patients with Paget disease of bone who were seen as outpatients between October 2011 and October 2013.We evaluated alkaline phosphates, osteocalcin, and deoxypyridinoline levels measured before and at 6th, 12th, and 18th months of treatment.

RESULTS

Pretreatment and posttreatment values for alkaline phosphates, deoxypyridinoline, and osteocalcin were as follows: 473 ± 256 U/L, 14.99 ± 7.63 mmol/L, 21.09 ± 3.18 ng/ml, and 82 ± 13 U/L, 5.14 ± 1.11 mmol/L, and 8.57 ± 4.31 ng/ml. Remission was achieved in all patients after treatment. The levels indicated that remission continued at 12th and 18th months of treatment. There was statistically significant difference between pretreatment and posttreatment values. No statistically significant difference between the levels measured at 6th, 12th, and 18th months of treatment was detected.

CONCLUSION

We recommend zoledronic acid in the first-line treatment of Paget disease of bone in achieving and maintaining remission.

Endoscopic management of gastric band erosions: a 7-year series of 14 patients

BACKGROUND

Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands.

METHODS

We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter.

RESULTS

Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric penetration of the connecting tube broken close to the band.

CONCLUSION

The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.

Vitamin D deficiency rickets in infants presenting with hypocalcaemic convulsions

AIM

Hypocalcaemia evaluation of the clinical, biochemical and radiologicalfeatures of 91 infants with rickets who presented as hypocalcaemic convulsions.

SUBJECTS AND METHODS

Ninety-one hypocalcaemic infants who were brought to hospital with convulsion and diag-nosed with rickets related to vitamin D deficiency according to their clinical, biochemical and radio-logicalfeatures were retrospectively reviewed.

RESULTS

Mean values of the laboratory data were as follows: calcium 5.55 +/- 0.79 mg/dL, phosphorus 4.77 +/- 1.66 mg/dL, alkaline phosphatase 1525.5 +/- 925.4 U/L and parathormone 256.8 +/- 158.3 pg/mL. Serum 25-OH vitamin D levels were below normal (< 20 ng/mL) in 37 infants.

CONCLUSION

Vitamin D deficiency should be considered in infants presenting with hypocalcaemia. To avoid complications such as convulsions, clinicians should give vitamin D supplementation to such infants.

Bacteriophage therapy in implant-related infections: an experimental study

BACKGROUND

Implant-related infections with bacteria resistant to multiple antibiotics represent one of the major problems in orthopaedic surgery. It was our hypothesis that local application of bacteriophages, which are bacteria-destroying viruses, would be effective against biofilm-forming bacteria.

METHODS

An implant-related infection model was created using methicillin-resistant Staphylococcus aureus (MRSA) in forty-eight rats and Pseudomonas aeruginosa in another forty-eight rats. Each group was divided into four subgroups; one subgroup received a bacterium-specific bacteriophage (Sb-1 in the MRSA group and PAT14 in the Pseudomonas aeruginosa group), one received antibiotic for fourteen days (20 mg/kg/day teicoplanin in the MRSA group, and 120 mg/kg/day imipenem + cilastatin and 25 mg/kg/day amikacin in the Pseudomonas group), one received antibiotic and bacteriophage, and one received no treatment. Animals receiving bacteriophage therapy were injected locally with 107 bacteriophages in a 0.1-mL suspension on three consecutive days. All animals were killed on the fifteenth day after initiation of treatment, and the tibia was excised. Results were assessed with use of microbiology, light microscopy, and electron microscopy.

RESULTS

In the MRSA group, the antibiotic administration significantly decreased the number of colony-forming units per subject in quantitative cultures (control subgroup, 50,586; bacteriophage, 30,788; antibiotic, 17,165; antibiotic + bacteriophage, 5000; p = 0.004 for the comparison of the latter group with the control). Biofilm was absent only in the antibiotic + bacteriophage subgroup. In the Pseudomonas group, the number of colony-forming units per subject in quantitative cultures was significantly lower in each treatment subgroup compared with the control subgroup (control subgroup, 14,749; bacteriophage, 6484 [p = 0.016]; antibiotic, 2619 [p = 0.01]; antibiotic + bacteriophage, 1705 [p < 0.001]). The value in the antibiotic + bacteriophage subgroup was also significantly lower than the values in the other subgroups (p = 0.006). Biofilm thickness did not differ significantly among the subgroups in the Pseudomonas group.

CONCLUSIONS

The addition of bacteriophage treatment to an appropriate antibiotic regimen helped to dissolve the biofilm of both types of bacteria studied. This effect on MRSA was more pronounced than that on Pseudomonas aeruginosa.

Protective effects of thymoquinone on vancomycin-induced nephrotoxicity in rats

AIM

Oxidative stress has been implicated as a potential responsible mechanism in the pathogenesis of vancomycin (VCM)-induced renal toxicity. Therefore, we aimed to investigate the protective effect of thymoquinone (TQ) against VCM-induced nephrotoxicity by tissue oxidant/antioxidant parameters and histological changes in rats.

MATERIALS AND METHODS

Wistar albino rats were randomly separated into four groups consisting of seven rats per group. The groups had normal saline (control group), VCM, VCM and TQ and TQ, respectively. VCM was injected intraperitoneally at a dose of 200 mg/kg and continued at 12-h intervals for 7 days. TQ was injected intraperitoneally at a dose of 10 mg/kg and continued at 24 h intervals for 8 days. Animals were killed and blood samples were analyzed for the levels of serum blood urea nitrogen (BUN) and creatinine (Cr). Kidney specimens were analyzed for levels of malondialdehyde (MDA) and activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as well as for histopathological changes.

RESULTS

We found that the levels of serum BUN, Cr and kidney tissue MDA were increased in the VCM group. Activities of SOD and GSH-Px in kidney tissue were decreased. TQ administration ameliorated significantly these changes.

CONCLUSION

These results indicate that the TQ produces a protective mechanism against VCM-induced nephrotoxicity and suggest a role of oxidative stress in pathogenesis.

Anterior cruciate ligament reconstruction improves the metabolic energy cost of level walking at customary speeds

PURPOSE

The metabolic energy cost of walking is altered by pathological changes in gait. It is thought that anterior cruciate ligament (ACL) deficiency alters the energy requirement for level walking through its effect on gait pattern. In this study, it is hypothesised that the metabolic energy cost of walking would improve after ACL reconstruction.

METHODS

Eight patients who were undergoing ACL reconstruction for an isolated rupture were included in this prospective study. Clinical examinations, Lysholm scores and metabolic tests were performed preoperatively and at 3, 6 and 12 months after ACL reconstruction using autologous quadruple hamstring tendons. For the metabolic evaluation, net oxygen cost was calculated while walking on a treadmill at 50-, 70- and 90-m/min velocities. A two-way factorial ANOVA was performed in order to evaluate the primary effects and interactions of the time point and velocity variables on net oxygen cost.

RESULTS

All patients had positive Lachman and anterior drawer tests preoperatively that became negative postoperatively and remained negative until the last follow-up point. The mean preoperative Lysholm score was 66, whereas the mean postoperative follow-up scores were 85, 91 and 94, respectively. The interaction between follow-up time point and velocity was not significant. Regardless of the selected velocity, the net oxygen cost was lower than that at preoperative levels at each postoperative time point (p < 0.05).

CONCLUSION

The results of the present study indicate that the energy cost of level walking in chronic ACL-deficient patients improves after ACL reconstruction. Cause-effect-based studies with correlation evaluations that compare kinetic, kinematic and electromyographic data and metabolic cost calculations should facilitate more accurate analyses.

LEVEL OF EVIDENCE

Therapeutic study, Level 4.

The importance of anti-insulin antibody in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion or multiple daily insulin injections therapy

To investigate the influence of two insulin administration modalities, continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) therapy with insulin analogues, on the development of insulin antibodies (IAs) in patients with type 1 diabetes mellitus and to assess the impact of IAs on glucose control and hypoglycaemia. 96 patients with type 1 diabetes mellitus treated with CSII (n = 48) or MDI (n = 48) were included in the study. Age, duration of diabetes, A1c, preprandial and postprandial blood glucose and hypoglycaemic events were compared between IA positive and negative patients. IA levels were higher in the CSII group (% 24.6 ± 14.2) than the MDI group (% 13.2 ± 9.9). Duration of diabetes and age were not associated with IA positiveness. While A1c, preprandial blood glucose and the frequency of hypoglycaemic events were similar in two groups, postprandial blood glucose was lower in IA positive group (P = 0.03). Patients with type 1 diabetes mellitus treated with CSII with insulin analogues had higher IA levels when compared to MDI therapy. However, the development of IAs did not impair the glycaemic control.

Pituitary apoplexy in an adrenocorticotropin-producing pituitary macroadenoma

Adrenocorticotropin (ACTH) producing macroadenomas and pituitary apoplexy are unusual in Cushing' s disease. A 20-year-old man who had been diagnosed Cushing' s disease 2 months ago, presented with sudden headache, nausea, and vomiting. His serum cortisol level was 0.4 μg/dl and ACTH level was 23.9 pg/ml. Magnetic resonance imaging of the pituitary gland disclosed a hemorrhage in the pituitary macroadenoma (22×19 mm). He was treated with IV methylprednisolone immediately and then the symptoms were relieved within the first day of the treatment. The hemorrhagic lesion was resected by transsphenoidal surgery successfully. Impaired secretion of pituitary hormones may be seen after the pituitary apoplexy. We communicate a case with pituitary apoplexy of an ACTH secreting pituitary macroadenoma, causing acute glucocorticoid insufficiency.

A new upper extremity sparing non-weight bearing orthosis

OBJECTIVES

Axillary and forearm crutches are commonly utilized in the treatment of foot and ankle injuries. In order to decrease the energy expenditure during mobilization, to prevent upper extremity complications, and to let the upper extremity free for other usages, we designed a new orthosis. The study is conducted to compare walking energy parameters of this newly designed orthosis with the axillary and forearm crutches.

MATERIALS AND METHODS

10 healthy young male volunteers walked on treadmill with three different orthoses in randomized order. Oxygen expenditure, oxygen cost, rate of perceived exertion (Borg scale), and observer stability assessment were analyzed.

RESULTS

Concerning oxygen consumption, perceived exertion, and observer stability assessment, the new device was found superior to the other devices (P<0.05). The new orthosis was superior to forearm crutches concerning oxygen cost (P=0.027) but not significantly different from the axillary crutches (P=0.062).

DISCUSSION

Compared to frequently used orthoses, the developed device provides mobilization using less or similar amount of energy. Additionally it spares one upper extremity to be used for other activities.

Plasma thrombin-activatable fibrinolysis inhibitor (TAFI) antigen levels in diabetic foot ulcers

Plasma TAFI may participate in arterial thrombosis in cardiovascular diseases (CVD) and may be involved in the mechanism of vascular endothelial damage in diabetic patients. The aim of this study was to investigate the association of plasma TAFI antigen level in the development of diabetic foot ulcer in Type 2 diabetes. The TAFI antigen levels were determined in 50 patients with diabetic foot ulcers and 34 patients without diabetic foot ulcers and 25 healthy individuals. We measured TAFIa/ai antigen in plasma samples with a commercially available ELISA Kit. Diabetic foot ulcer group and diabetic group were similar in terms of mean age and sex distribution. Diabetes duration, retinopathy, neuropathy, macrovascular disease and infection were related to diabetic foot ulcers. HbA1c, HDL-cholesterol and Folic Acid levels were decreased in the diabetic foot ulcer group. TAFI levels were 99.44 ± 55.94% in control group, 135.21 ± 61.05% in diabetic foot ulcer group, 136.75 ± 59.38% in diabetic group and was statistically different (P < 0.05). But no difference was seen in TAFI levels between the diabetic foot ulcer group and diabetic group (P > 0.05). No significant difference in plasma TAFI levels were seen between diabetic foot ulcer stages. TAFI antigen levels are increased in Type 2 diabetic patients, but are not related to diabetic foot ulcer development.

Thermogenic response and leptin levels rise after recovery of the euthyroid state

OBJECTIVE

The aims of the study were to compare: a) the thermogenic responses in subclinical hypothyroidism (SH) and euthyroid state; b) the relationship between thermogenic response and leptin level.

METHODS

Thirty women diagnosed with SH (mean age 39.9+/-4.1 yr; body mass index 23.2+/-2.5 kg/m(2)) were enrolled in the study. Thyroid function tests, leptin, and lipid profiles were measured during SH and after stable euthyroidism was recovered. Thermogenic response was measured by Water Immersion Calorimetry during SH and after the euthyroid state was attained.

RESULTS

The mean level of thermogenic response was found to be 1.45+/-0.43 kcal/kg*h in women with SH. It changed to 1.54+/-0.77 kcal/kg*h (p=0.01) in the euthyroid state; the change was statistically significant. Mean level of leptin was found to be 7.22+/-2.6 ng/ml in SH; and 15.8+/-8.0 ng/ml in the euthyroid state. There was a positive correlation between leptin and free T(3) (r=0.460, p=0.009) levels in SH. There were positive correlations between leptin level and fat mass in SH (r=0.820, p=0.01) and in the euthyroid state (r=0.700, p=0.03).

CONCLUSIONS

No correlations were found between thermogenic response and leptin levels in SH and in the euthyroid state. Thermogenic response and leptin levels rose after the euthyroid state was recovered.

The effect of the sildenafil citrate on cerebral vasospasm and apoptosis following experimental subarachnoid hemorrhage in rats

AIM

The therapeutic effect of sildenafil citrate on cerebral vasospasm after experimental subarachnoid hemorrhage (SAH) was studied in a rat model.

METHODS

We used four groups of seven rats were as follows: no SAH, no treatment; SAH only; SAH plus 2 days of peroral sildenafil citrate 5mg/kg treatment and SAH plus 2 days of peroral sildenafil citrate 15 mg/kg treatment. Three different parameters were evaluated including the diameter of the basilar artery, the level of lipid peroxidation and the degree of the apoptosis 48 hours following SAH.

RESULTS

The results showed that sildenafil citrate attenuated SAH-induced cerebral vasospasm in the treatment groups in terms of the diameter of the basilar artery and lipid peroxidation in the two treatment groups, but there was no difference in terms of the level of apoptosis.

CONCLUSION

This study indicates that further research on the therapeutic effect of sildenafil citrate can be combined with the use of any apoptosis-blocking agent for the treatment of cerebral vasospasm following experimental subarachnoid hemorrhage.

The relationship of the interleukin-6 -174 G>C gene polymorphism with cardiovascular risk factors in Turkish polycystic ovary syndrome patients

We aimed to evaluate the relationship between 174 promoter region of the interleukin-6 (IL-6) C/G gene polymorphism and high sensitive C-reactive protein (hs-CRP), fibrinogen and carotis intima-media thickness (CIMT), body mass index, homeostatic model assessment (HOMA) insulin resistance index, serum lipid parameters, in polycystic ovary syndrome (PCOS) patients carrying a potential risk for developing cardiovascular disease (CVD). We studied 88 PCOS patients and 119 healthy controls. PCOS was defined by the Rotterdam PCOS consensus criteria. The genotype IL-6 distribution did differ between the control group (CC 10.1%, GC 63.0%, GG 29.6%) and the PCOS patients (CC 5.7%, GC 29.5%, GG 64.8%) (P < 0.001). The frequency of the polymorphic G allele was also no similar for the group with PCOS as for the control group with 79.5% and 58.4% respectively (P < 0.001). Both in PCOS patients and in control group, no statistically significant difference was determined between C/C, G/C and G/G, and blood cholesterol levels, triglyceride levels, high-density lipoprotein levels, low density lipoprotein levels, fasting blood sugar levels, insulin levels, HOMA values, CIMT measurements either on the right or left side, hs-CRP, f-testosterone, fibrinogen and 17 alpha-hydroxy-progesterone levels (P > 0.05). Gene polymorphism of IL-6 -174 G>C is a risk factor for PCOS in Turkish patients, but we found no relationship between the cardiovascular risk factors and IL-6 -174 G>C gene polymorphism in women with PCOS and healthy subjects. Our negative results in risk factors of CVD can probably be explained by the fact that metabolic parameters and endothelial systems of patients may not yet be affected in this short time of period.

Optimal transport time and conditions for cartilage tissue samples and expanded chondrocyte suspensions

For autologous chondrocyte implantation, the chondral tissue obtained is transferred from the operating room to the laboratory using specialized carrier systems within 24 hours. Similar expenses are used for the transport of cultured chondrocytes. The purpose of this study was to find the optimal temperature, size of tissue, and time that the chondrocytes can stand without losing viability and proliferative capacity. Fresh calf cartilage was harvested and divided into 24 groups. Half of the samples were diced into 1- to 2-mm(3) pieces. All 12 groups were kept at either 4 degrees C, 25 degrees C, or 37 degrees C for 1, 3, 5, or 7 days and were seeded for cell culture. Times to reach confluence values were compared. Produced cell suspensions were grouped similarly and tested similarly. Neither the temperature nor the waiting days caused any difference in the proliferative capacity of the cells. Diced tissues yielded a shorter time to reach confluence values. Chondral tissue obtained from the patient can be transferred to the laboratory at temperatures ranging from 4 degrees C to 37 degrees C in up to 7 days. These conditions did not affect the proliferative capacity or the viability of the chondrocytes. Dicing the tissue prior to transport will shorten total culturing time. The expanded cell suspensions should be transferred at temperatures from 4 degrees C to 25 degrees C within 3 days. Specialized carrier systems to get the chondral tissue from the operating room to the laboratory and to take the expanded chondrocytes back to the operating room within hours may not be necessary.

The relation of adiponectin and tumor necrosis factor alpha levels between endothelial nitric oxide synthase, angiotensin-converting enzyme, transforming growth factor beta, and tumor necrosis factor alpha gene polymorphism in adrenal incidentalomas

OBJECTIVE

The aim of our study was to demonstrate demographic characteristics, presence of inflammatory markers, distribution of angiotensin-converting enzyme (ACE), tumor necrosis factor (TNF), endothelial nitric oxide synthase (eNOS) genotypes and relations among these parameters in these patients and control subjects.

RESEARCH DESIGN AND METHODS

Study samples were collected from 50 patients with adrenal mass and 30 control groups. The eNOS, ACE, TNF-alpha, transforming growth factor (TGF)-beta genes polymorphisms, TNF-alpha, adiponectin levels were analysed in 50 unrelated Turkish patients with a diagnosis of adrenal incidentaloma (AI).

RESULTS

There was statistically significant difference between TNF-alpha levels of patient and controls (p=0.048). We have not detected the connection between TGF-beta, TNF-alpha, ACE, eNOS gene polymorphism with serum TNF-alpha and adiponectin levels. In this study, we demonstrated that there were significant differences for ACE genotypes in the patients when compared to the controls (p<0.05). The percentages of the ID, DD, II genotypes for ACE gene polymorphism in the patients group were 30.0, 13.0, 7.0%, respectively.

CONCLUSIONS

According to different cases of eNOS, TGF-beta, ACE, and TNF-alpha gene genotypes; no statistical significant difference was found between basal cortisol, ACTH, DHEAS, metanephrine, renin, aldosterone, normetanephrine, 17-hydroxyprogesterone, 1 mg low-dose dexamethasone suppression test-cortisol response and AI size. In this study, I/D genotype was determined to be statistically higher in ACE gene in patients with AI (p=0.014).