Turkish pediatric residents' knowledge, perceptions, and practices of blood culture sampling

INTRODUCTION

Pediatrics is one of the medical specialties in which blood cultures for bloodstream infections are performed very frequently. This study aimed to evaluate pediatric residents' knowledge and perceptions of blood culture sampling.

MATERIAL AND METHODS

Between June 2019 and September 2019, a questionnaire comprising 20 questions about blood culture sampling was sent via email to participants who were pediatric residents at five different hospitals in Turkey. There were 11 true/false and nine multiple-choice questions that assessed three aspects of culture sampling: indications, sampling practice and knowledge, and contamination. The percentage of correct answers was used to calculate an overall score and subsection scores.

RESULTS

A total of 132 pediatric residents [102 (77%) female] with a mean age of 28.3±2.8 years completed the questionnaire. Forty-five (35%) were in their 1st year of residency. Sixty (46%) participants reported that they had not performed blood culture sampling in the last week. There was a negative relationship between years in training and the number of cultures performed (Kendal's tau-b=-0.297, p<0.001). The overall median score was 65 (range, 35-90) and it seemed to increase with years of training. The lowest median score was in the contamination subscale and only one (0.76%) participant correctly answered all questions concerning contamination.

CONCLUSION

Residents who obtained the majority of blood cultures had the lowest knowledge levels. Therefore, it is evident that the knowledge levels of pediatric residents must be increased in order to improve blood culture sampling practices in centers where they perform blood culture sampling.

Comparison of Early Total Thyroidectomy with Antithyroid Treatment in Patients with Moderate-Severe Graves' Orbitopathy: A Randomized Prospective Trial

BACKGROUND

The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial.

OBJECTIVES

We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner.

METHODS

Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia.

RESULTS

Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72).

CONCLUSION

Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).

Increasing diagnosis of thyroid papillary carcinoma follicular variant in south-east Anatolian region: comparison of characteristics of classical papillary and follicular variant thyroid cancers

We aimed to compare ratios of thyroid cancers diagnosed in our regional reference hospital Pathology Center in Sanliurfa city located in southeast Anatolia, and evaluate the characteristics related with follicular variant papillary thyroid carcinoma (FVPTC). We re-evaluated the specimens of last 5 years thyroidectomies by same five pathologists, by same criteria and immunohistochemical evaluation. Chi-square test was used to compare characteristics of classical pure papillary thyroid carcinomas and FVPTC groups. Stepwise multiple regression analysis was used to evaluate the factors related with presence of FVPTC. Among 400 thyroidectomies, there were 105 papillary thyroid carcinoma, 42 of them with pure PTC, and 56 with FVPC, also seven with other variants. There was increase in ratios of FVPTC/PTC between 2010 and 2011 (68.4 vs 76.7%, p < 0.005). Radius, vascular invasion, and extrathyroidal invasion showed statistically significant difference between pure PTC and FVPTC. In regression analysis radius (p = 0.001, OR = 2.611; 95%CI, 2.010-3.391), age (p = 0.018, OR = 0.959; 95%CI, 0.927-0.993), and multicentricity (p = 0.044, OR = 0.403; 95%CI, 0.167-0.975) were related with presence of FVPTC. Besides, further need for studies to understand whether total prevalence of FVPTC is higher in this region, and the related factors, our study showed that the ratio of FVPTC/PTC is higher in our reference hospital. Age of the patients and the radius and multicentricity of the nodules could be alarming factors for us to suspect for FVPTC.

Hypothyroidism, new nodule formation and increase in nodule size in patients who have undergone hemithyroidectomy

INTRODUCTION

The current medical literature has conflicting results about factors related to hypothyroidism and nodular recurrences during follow-up of hemithyroidectomized patients. We aimed to evaluate factors that may have a role in new nodule formation, hypothyroidism, increase in thyroid lobe and increase in nodule volumes in these patients with and without Hashimoto's thyroiditis (HT), and with and without levothyroxine (LT4) use.

MATERIAL AND METHODS

We enrolled 140 patients from five different hospitals in Ankara and evaluated their thyroid tests, autoantibody titre results and ultrasonographic findings longitudinally between two visits with a minimum 6-month interval.

RESULTS

In patients with HT there was no significant difference between the two visits but in patients without HT, thyroid stimulating hormone (TSH) levels and nodule volume were higher, and free T4 levels were lower in the second visit. Similarly, in patients with LT4 treatment there was no difference in TSH, free T4 levels, or lobe or nodule size between the two visits, but the patients without LT4 had free T4 levels lower in the second visit. Regression analysis revealed a relationship between first visit TSH levels and hypothyroidism during follow-up.

CONCLUSIONS

Patients who have undergone hemithyroidectomy without LT4 treatment and without HT diagnosis should be followed up more carefully for thyroid tests, new nodule formation and increase in nodule size. The TSH levels at the beginning of the follow-up may be helpful to estimate hypothyroidism in hemithyroidectomized patients.

25-Hydroxy vitamin D levels and endothelial vasodilator function in normotensive women

INTRODUCTION

Vitamin D was shown to be related to endothelial function and blood pressure. Reactive hyperaemia index (RHI) measurement by pulse arterial tonometry is a new method to evaluate vasodilator function of endothelium. We aimed to evaluate the relationship between vitamin D levels and RHI in women.

MATERIAL AND METHODS

We enrolled 56 normotensive, nonsmoker, normolipidemic and normoglycemic women, (23 with 25-OH-vitamin D levels>20 µg/l, and 33 with values lower than 20 µg/l). The cardiologist who was blind for vitamin D results executed measurements by pulse arterial tonometry. The measurement was performed on the lying patient with pre- and post-occlusion measurements of RHI by digital sensors placed on each index finger, by 5 min intervals. Pulse amplitudes were recorded, pre-occlusion and post-occlusion ratio was compared by the software of device. Stepwise linear regression and multiple regression analyses were performed to evaluate predictors of endothelial function.

RESULTS

The low vitamin D group had a lower RHI value than the normal vitamin D group (p = 0.042). In regression analysis, positive predictors of RHI were serum 25-OHD (β = 0.401; 95% CI 0.010-0.042, p = 0.002), serum albumin (β = 0.315; 95% CI 0.286-2.350, p = 0.013), and, inversely, serum calcium (β = -0.247; 95% CI (-1.347)-(-0.010), p = 0.047).

CONCLUSIONS

Serum 25-hydroxy vitamin D was significantly related to endothelial functions measured as RHI, even in healthy non-smoker women.

The Analgesic Effect of Dexketoprofen When Added to Lidocaine for Intravenous Regional Anaesthesia: A Prospective, Randomized, Placebo-Controlled Study

This prospective, randomized, placebo-controlled study evaluated the effects of dexketoprofen as an adjunct to lidocaine in intravenous regional anaesthesia (IVRA) or as a supplemental intravenous (i.v.) analgesic. Patients scheduled for elective hand or forearm soft-tissue surgery were randomly divided into three groups. All 45 patients received 0.5% lidocaine as IVRA. Dexketoprofen was given either i.v. or added into the IVRA solution and the control group received an equal volume of saline both i.v. and as part of the IVRA. The times of sensory and motor block onset, recovery time and postoperative analgesic consumption were recorded. Compared with controls, the addition of dexketoprofen to the IVRA solution resulted in more rapid onset of sensory and motor block, longer recovery time, decreased intra- and postoperative pain scores and decreased paracetamol use. It is concluded that coadministration of dexketoprofen with lidocaine in IVRA improves anaesthetic block and decreases postoperative analgesic requirements.

The relationship between calcium metabolism, insulin-like growth factor-1 and pulse pressure in normotensive, normolipidaemic and non-diabetic patients

INTRODUCTION

Recent evidence suggests an interaction between bone metabolism and blood pressure (BP) regulation. The aim of our study was to evaluate endocrinological and metabolic factors related to pulse pressure (PP) in normotensive, normolipidaemic, non-smoker subjects.

MATERIAL AND METHODS

We consecutively enrolled 156 adults (37 males, 119 females) in summer 2009. The BP and body mass index (BMI) were recorded, and serum samples were taken for 25-hydroxy vitamin D (25-OHD), insulin-like growth factor-1 (IGF-1), growth hormone (GH), parathormone (PTH), calcium, albumin, phosphorus, glucose, triglyceride and cholesterol levels.

RESULTS

In the postmenopausal group, PP was significantly associated with age and BMI, while in premenopausal patients it was inversely related to ionized calcium. In men, a reverse relationship was present between GH and IGF-1 levels and PP.

CONCLUSIONS

The PP was predicted by different parameters in different genders and these predictors change even in the same gender before and after menopause. Well-known predictors of PP such as age and BMI were more pronounced in postmenopausal women, but none of the groups showed a relationship between PP and 25-OHD or PTH.

An Evaluation of P Wave Dispersion, QT, Corrected QT and Corrected QT Dispersion Intervals on the Electrocardiograms of Malnourished Adults

The aim of our study was to investigate P wave dispersion (Pwd), QT, corrected QT (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) intervals in subjects with malnutrition diagnosed in the pre-anaesthetic assessment, compared to those without malnutrition.

A total of 76 adult patients were included. Main diagnoses, anthropometric measurement, body mass index, electrocardiogram and serum sodium, potassium, chloride, magnesium and calcium levels were recorded for all patients. Pwd, QT and QTd intervals were measured on all electrocardiogram records and QTc and QTcd intervals determined with the Bazett formula. Protein-energy malnutrition was diagnosed with the nutritional risk index.

No statistically significant difference was found between the age, gender and malignant cancer diagnosis rates between patients with malnutrition (group M) and those not suffering from malnutrition (group N) (P >0.05). Serum albumin, total protein, potassium, calcium, magnesium and chloride values of group M were found to be significantly lower than group N (P <0.05). In group M, Pwd, QT, QTc, QTd and QTcd intervals were significantly longer than in group N (P <0.001).

Patients diagnosed with malnutrition during pre-anaesthetic assessment had significantly longer Pwd, QTc and QTcd interval durations than the control group. We attribute such extended Pwd, QTc and QTcd durations in these patients to malnutrition and malnutrition-related electrolyte imbalance.

Current iodine status in Turkey

OBJECTIVES

To evaluate the current nationwide iodine status in Turkey by determining urinary iodine concentrations (UIC) and household salt iodine content. A follow- up monitoring study was also conducted in 30 urban areas.

METHODS

A school-based survey was conducted in 2007 by using multistage 'proportionate to population size' (PPS) cluster sampling method. The study population was composed of 900 school-age children (SAC) from different urban, suburban, and rural areas. UIC and iodine content of the table salt used at home were analyzed.

RESULTS

Median UIC was 107 microg/l (147 in urban, 42 in suburban and rural areas, p<0.001). There were severe iodine deficiency (ID) in 7.2%, moderate and mild ID in 20.6% and 19.3%, of the SAC, respectively. UIC was sufficient (>100 microg/l) in 50% of the study population, whereas it was excessive (>300 microg/l) in 10.5% of them. Of the 900 salt samples, 662 (73.5%) were iodized and 508 samples (56.5%) contained adequately iodized salt (iodine content >15 ppm). UIC of the study population and salt iodine levels correlated well (r=0.42, p<0.001).

CONCLUSIONS

Moderate to severe ID still exists in 27.8% of the Turkish population, which is much better compared to 1997 and 2002 surveys (i.e. 58%, 38.9%, respectively). The follow-up monitoring study (in 2007) demonstrated that ID has been eliminated in 20 of 30 cities surveyed, and median UIC was 130 microg/l. ID has been eliminated in most of the urban population, however, it is still an important problem in rural areas and in particular geographical regions, which should be the target of future programs.

A case of Riedel's thyroiditis with pleural and pericardial effusions

Riedel's thyroiditis (RT) is a rare type of chronic thyroiditis of unproven etiology and definite treatment. It can be associated with retroperitoneal, mediastinal, orbital, and hepatic fibrosis. Symptoms arise mainly due to compression of neighboring structures. Surgery is usually required for a definite diagnosis and decompression to relieve the symptoms. Glucocorticoids and tamoxifen are commonly used agents for the pharmacotherapy. We hereby describe the development of pleural and pericardial effusions during the clinical course of an RT case. A 39-year-old woman suffering from neck compression symptoms was admitted to the hospital. After a decompression isthmectomy, RT was diagnosed. She responded well to glucocorticoid therapy after surgery. However, symptoms reoccurred shortly after glucocorticoid withdrawal and the disease process extended to the mediastinum. Tamoxifen was started and the neck and mediastinal mass regressed and her symptoms disappeared considerably for more than 6 months. However, she was readmitted with severe dyspnea and chest pain. Further investigation revealed an exudative pleural and pericardial effusion and mediastinal enlargement. A thorough evaluation of the patient's effusions did not disclose any specific etiological insult. The patient was symptom-free with a considerable reduction of the soft tissue mass and no effusions, and treated successfully with colchicine, azathioprine, and glucocorticoids. To the best of our knowledge, this is the first case reported in the literature as an RT presenting with pleuropericardial effusions.

More than a decade of iodine prophylaxis is needed to eradicate goiter among school age children in a moderately iodine-deficient region

BACKGROUND

There are many studies regarding the effect of iodine supplementation on goiter, but relatively few reports on the duration of iodine supplementation required to eradicate goiter in iodine-deficient regions. In the current study, we aimed to determine goiter prevalence as determined by sonographic methods, as it relates to changes in median urinary iodine concentrations (UIC) among school age children (SAC), ages 9-11.

METHODS

This study was performed in Ankara, Turkey, before and 5-10 years after mandatory iodination of table salt. Three hundred to 400 SAC from the same primary schools were studied every year by measurement of UIC as part of Turkish Iodine Surveys. Sonographically determined thyroid volume of the SAC had been measured before the mandatory iodination in 1997 and 5-10 years afterward, in 2002 and 2007. The prevalence of goiter in children was evaluated using World Health Organization/International Council for the Control of Iodine Deficiency Disorders recommendations for age and sex.

RESULTS

Moderate iodine deficiency was present in 1997 (median UIC, 25.5 microg/L), and it improved to mild iodine deficiency in 2001 (median UIC, 87 microg/L). Sufficient iodine intake (median UIC, 117 microg/L) was achieved by the year 2004. Goiter prevalence was 25% in 1997, 12.3% in 2001, and decreased to 1.3% in 2004.

CONCLUSION

The time required to normalize the prevalence of goiter in SAC living in a moderately iodine-deficient environment was at least a decade. To achieve a goiter rate of less than 5% among SAC, it may require that, as a population, they were born and grew up under conditions of iodine sufficiency.

Effect of intratumoral lymphocyte density on the disease-free survival and overall survival in malignant epithelial tumors of the ovary

Malignant epithelial ovarian tumors are the fifth most common cancer of females which has the highest mortality rate among gynecological malignancies. Tumor-specific or related antigens that induce an immune response have been defined in tumors. Intratumoral T lymphocytes recognize these antigens and induce a cytolytic activity. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor expressed in many tumors. In this study, we studied the relation between clinicopathological findings and intratumoral T lymphocyte and VEGF expressions in malignant epithelial ovarian tumors. The presence of VEGF in ovarian surface epithelial carcinomas and CD3, CD4 and CD8 antibodies in tumor-infiltrated lymphocytes were investigated in 63 cases with an immunohistochemical method. Positive-stained intratumoral lymphocytes were graded on a scale of 0 to 3 (0 --> 0, +1 --> < or = 5, +2 --> 6-19, +3 --> > or = 20). VEGF was assessed according to the staining intensity (0: negative, +1: weak, +2: moderate, +3: strong). CD3 positivity was observed in intratumoral lymphocytes in all cases while only CD4 and CD8 positivities were observed in 30% and 80%, respectively. VEGF was positive in 73% of the cases. No significant relation was observed between VEGF expression and presence of intratumoral T lymphocyte and clinicopathological parameters. Moreover, they did not have any significant effect on disease-free survival and overall survival.

Adult height in Turkish patients with Turner syndrome without growth hormone treatment

Spontaneous adult height (AH) in Turner syndrome (TS) varies among populations. Population-specific AH data is essential to assess the efficacy of growth-promoting therapies in TS. A multicenter study was performed to establish AH of nongrowth hormone (GH)-treated Turkish patients with TS. One hundred ten patients with TS (diagnosed by karyotype) who reached AH (no growth in the previous year, or bone age > 15 years) without receiving GH treatment were included in the study. The average AH was found to be 141.6 +/- 7.0 cm at the age of 22.9 +/- 6.2 years, which is 18.4 cm below the population average and 16.4 cm below the patients' mid-parental heights. Bone age at start of estrogen replacement was 12.3 +/- 1.3 year. Karyotype distribution of the patients was 45X (43%), 45X/46XX (16%), 45X/46Xi (12%), 45XiXq (10%) and others (19%). When the patients were evaluated according to their karyotype as 45X and non-45X, no significant difference in AH was observed (142.4 +/- 6.9 cm vs 140.9 +/- 7.1 cm, respectively). Adult height of non-GH-treated Turkish TS patients obtained in this study was comparable to that of other Mediterranean populations, but shorter than that of Northern European patients. Karyotype does not seem to affect AH in TS.

Color flow Doppler sonography for the etiologic diagnosis of hyperthyroidism

Color flow Doppler sonography (CFDS) is gaining importance for the functional evaluation of the thyroid disorders. We aimed to determine the value of CFDS for the etiological diagnosis of hyperthyroidism. Fifty-five patients with hyperthyroidism (29 Graves' disease [GD] and 26 toxic adenoma [TA]), 24 patients with Hashimoto's thyroiditis (HT), and 39 euthyroid controls were included. Etiological diagnoses were carried out using standard methods. Conventional gray scale sonography was performed, followed by CFDS. Doppler patterns of the glands were scored and peak systolic velocity (PSV) measurements were obtained from intrathyroidal, perithyroidal, and perinodular vasculature. Vascular patterns were significantly more prominent, and the mean PSV values were significantly higher in the GD patients compared to the HT patients ( p < 0.001) and controls ( p < 0.001). Perinodular and intranodular signals and the mean perinodular PSV values were significantly higher in TAs compared to controls. CFDS could differentiate the untreated GD from the HT, which had similar gray scale findings. Hot nodules could also be differentiated from cold nodules with more prominent vascular patterns and significantly higher PSV values. As an inexpensive, fast, and noninvasive imaging procedure, CFDS could be helpful in the initial clinical evaluation and may avoid scintigraphy in a substantial number of thyrotoxic patients.

Expression of cyclooxygenase-2 and inducible nitric oxide synthase in ovarian surface epithelial carcinomas: is there any correlation with angiogenesis or clinicopathologic parameters?

Cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) products have been implicated in the regulation of immune system, tumor cell apoptosis, and angiogenesis in many human tumors. In this study, we investigated the expression of COX-2 and iNOS in ovarian carcinomas by immunohistochemistry and correlated the results with other prognostic parameters. Specimens from 100 ovarian carcinomas were studied by immunohistochemistry for COX-2 and iNOS expression, and angiogenesis microvessel density (MVD) was evaluated by CD34-stained microvessels. High COX-2 expression was observed in 85% of carcinomas. No correlation was found between COX-2 expression and clinicopathologic variables. Patients with high COX-2-expressed tumors had shorter overall survival, but it is not statistically significant. Expression of iNOS in serous and low-grade carcinomas was significantly higher than that in nonserous and high-grade carcinomas (P < 0.05). There was a positive correlation between COX-2 and iNOS expression (P= 0.009). No correlation of COX-2 and iNOS expression with MVD was found. Expression of iNOS showed no effect on survival of the patients. We found that iNOS expression might act in the first steps of carcinogenesis, whereas COX-2 expression was seen in more advanced tumors. Shorter overall survival of patients with high COX-2 expression might indicate new targets for therapy.

Thyroid consequences of the Chernobyl nuclear power station accident on the Turkish population

OBJECTIVE

The Chernobyl accident caused widespread effects across Europe and huge areas were radiocontaminated. The major impact of the accident on human health was a sharp increase in childhood thyroid carcinoma and autoimmune thyroid diseases in exposed populations. The thyroidal effects of the Chernobyl accident have been investigated in most European countries, except Turkey. The aim of the current study was therefore to determine the thyroidal consequences of the Chernobyl nuclear power station accident in a selected Turkish population.

DESIGN

This study was designed as a sectional, area study, between October 2000 and March 2001, in two different regions of Turkey. According to the data of the Turkish Atomic Energy Authority, the eastern part of the Black Sea region was the most radiocontaminated area in Turkey at the time of Chernobyl accident, while Middle Anatolia was not seriously affected. Thus, Rize city, which is located in the eastern Black Sea region, served as a study area, and 970 adolescents, living in this region, comprised our study group (group R). On the other hand, Beypazari, which is located in Middle Anatolia, was chosen as the control region, and 710 adolescents living in this location were enrolled into the study as controls (group B).

METHODS

During the study, thyroid ultrasounds were performed in all subjects and thyroid volumes were calculated. World Health Organization and International Council for Control of Iodine Deficiency Disorders criteria were used for the determination of goiter. Thyroid fine-needle aspiration biopsy with ultrasound guidance was performed when a nodule was detected. Blood samples for thyroid function tests and thyroid autoantibodies, and urine samples for urinary iodine excretion were collected from all subjects.

RESULTS

Thyroid function tests were similar in both groups, but thyroid volumes were found to be higher in group B (13.93+/-5.04 vs 17.66+/-5.58 ml; P<0.001). The prevalence of goiter was found to be 28.25% in group R and 61.95% in group B (P<0.001). Thyroid nodules were determined in 6.28% of subjects in group R and 4.22% of subjects in group B (P=0.065). No malignant lesions were found in either of the regions. Although the percentage of autoantibody-positive subjects did not differ between groups (21.25% in group R vs 18.72% in group B), the mean anti-thyroglobulin level was found to be higher in group R (63.25+/-378.60 vs 51.97+/-333.32 IU/ml; P<0.001) and the mean anti-thyroid peroxidase level was higher in group B (24.14+/-219.09 vs 48.82+/-568.50 IU/ml; P<0.001). The iodine status of the selected regions was found to be significantly different (median urinary iodine excretion was 131 microg/l in Rize and 54 microg/l in Beypazari).

CONCLUSIONS

Although there was a slight increase in nodule prevalence and thyroid antibody-positive subjects in the study group, it is hard to conclude that Turkey was affected by the Chernobyl accident. These results, at least the significant differences with regard to the prevalence of goiters between groups, may reflect the different iodine status of the selected regions.

Is it useful to routinely biopsy hot nodules in iodine deficient areas?

Incidence of nodular thyroid disease as well as that of functioning thyroid nodules (FTN) increases dramatically in iodine deficient (ID) areas. Cancer is extremely rare in FTN; thus, some do not routinely biopsy and treat them with radioactive iodine (RAI) straight away or follow-up. The outcome of 296 patients followed or treated at our institution for solitary or multiple FTN were retrospectively evaluated. Hospital records of 224 female, 72 male patients, with a mean +/- SD age of 54.9 +/- 12.4 yr and followed for 22 (0-156) months were examined. 175 patients had solitary, 121 had multiple hot or warm nodules. 230 (77.7%) of the patients received RAI treatment. 402 fine needle aspiration biopsies (FNABs) were performed on 260 patients and on 343 FTN (381 benign and 21 suspicious diagnoses). Eleven of the patients were operated for suspicious FNAB results and 10 were followed-up. Only one nodule turned out to be malignant. Malignancy is extremely rare in functioning thyroid nodules (0.34%) and some of malignant cases could be predicted by their suspicious clinical features. Routine practice of treating FTN with RAI therapy is reasonable in clinically low-risk patients. FNAB is reserved for cases with suspicious clinical features, resulting in fewer surgeries and reduced cost.

Relationship between thyroid autoimmunity and Yersinia enterocolitica antibodies

It has previously been proposed that subclinical Yersinia enterocolitica infection may play a role in autoimmune thyroid disease (AITD). In this study, we investigated the relationship between the thyroid autoantibodies and the antibodies that produced against different serotypes of Y. enterocolitica. A total of 215 subjects were included into the study (65 newly diagnosed Graves' disease [GD], 57 Hashimoto's thyroiditis [HT], 53 nontoxic diffuse goiter [NTDG], and 40 subjects for control group [CG]). Thyroid receptor antibodies (TRAb), thyroid and agglutinating antibodies against Y. enterocolitica serotype O:3, O:5, O:8, O:9 were measured in the blood samples. The highest incidence of Y. enterocolitica antibody positivity was measured in GD (53.8% for O:3, 29.2% for O:5, 44.6% for O:8, and 40% for O:9) and followed by HT. In patients with GD, TRAb levels were also higher than in patients with HT, NTDG, and CG. There was no difference between NTDG and CG in respect to the titer levels and the positivity of both TRAb and Y. enterocolitica antibodies. There was also a weak linear correlation between TRAb level and the titer of antibodies against Y. enterocolitica antigens. It can be concluded that Y. enterocolitica infection may play a role in etiology of GD in Turkey.

Iodine status and goiter prevalence in Turkey before mandatory iodization

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.

Twenty-four hour 17-hydroxyprogesterone response to adrenocorticotropine in adrenal incidentalomas: augmented response after adrenalectomy in two patients

The current study aimed to investigate the midterm (24 hour) response of 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEA-S) to synthetic high-dose adrenocorticotropin (ACTH) in adrenal incidentalomas (Al). Seventeen patients with Al and 40 age- and sex-matched controls received synthetic ACTH (tetracosactide, 1000 microg, IM). Plasma, 17-OHP and DHEA-S were collected in basal conditions and after 1, 4, 6, 8 and 24 hours. (HPA) axis was also evaluated using circadian serum cortisol, urinary free cortisol and over-night 2 mg dexamethasone suppression. Basal plasma 17-OHP levels did not differ among the groups. However, the increment in plasma 17-OHP in patients both in terms of peak [13.76 +/- 2.52, 4.77 +/- 0.30ng/ml, mean +/- S.E.M, p < 0.001] and area under the curve [190 +/- 46, 96.75 +/- 32 ng/ml/h, p < 0.001] were significantly higher than that of the controls. Stimulated 17OH-P levels never reached 9.1 ng/ml in controls. Sixty-five (11/17) % of the patients were found to have exaggerated response. Three of the patients were found to have subclinical Cushing's syndrome and interestingly, two augmented their 17-OHP response to ACTH after unilateral adrenalectomy and normalisation of their HPA axis. Basal DHEA-S levels of the patients were significantly lower [99.21 +/- 45, 230.18 +/- 34 microg/dl, p < 0.01] and stayed persistently lower than that of the controls. Evidence of a heterozygous 21 hydroxylase deficiency, as indicated by the exaggerated 17-OHP response to ACTH, has been widely reported in Al patients. However, to our knowledge to date there is no report on augmented 17-OHP response to ACTH after adrenalectomy. Possible reasons for the augmentation were discussed.

Moderate to severe iodine deficiency in three endemic goitre areas from the Black Sea region and the capital of Turkey

Endemic goitre is still an important and underestimated health concern in Turkey. The overall prevalence had been calculated as 30.3% by palpation in a national survey conducted in 1995. However, direct evidence that iodine deficiency (ID) is the major cause of the endemic were lacking until now. We measured sonographic thyroid volumes (STV), urinary iodine concentrations (UIC) in 1226 school age children (SAC) (9-11 year old) from Ankara the capital of Turkey located in the central Anatolia, and three highly endemic goitre areas of the Black Sea region. A considerable number of school age children (SAC) were found to have STV exceeding the recommended upper normal limits for their age and gender obtained from iodine-replete European children (i.e. 26.7, 40.3, 44.8 and 51.7% of children from Ankara, Kastamonu, Bayburt and Trabzon respectively). UIC indicated moderate to severe ID in these areas with median concentrations of 25.5, 30.5, 16.0 and 14 microg/L respectively. This study showed severe to moderate ID as the primary etiological factor for the goitre endemic observed in Ankara and the Black Sea region of Turkey.

Endemic goiter, thiocyanate overload, and selenium status in school-age children

Iodine deficiency (ID) and related disorders are still major, yet unresolved health concerns. Recently, in a systematic survey of school-age children (SAC), we reported severe to moderate ID, in Ankara and three cities from Black Sea region of Turkey. The current study attempted to evaluate selenium (Se) status, thiocyanate (SCN-) overload, and their possible contribution to the goiter endemics and thyroid hormone profile observed in these cities. Thyroid ultrasonography was performed and serum Se, SCN(-), thyroid hormones, sensitive TSH (sTSH) levels, and, urinary iodine concentrations (UICs) were determined from 251 SAC (9-11 yr old). Thyroid volumes (TVs) exceeding recommended upper normal limits and median UIC indicated goitre endemics and moderate to severe ID in the areas studied. Mean serum SCN(-) concentrations were found to be greater than the controls from the literature. The UIC/SCN(-) ratio was found to be lowest in Bayburt and Trabzon denoting that SCN(-) overload may contribute to the goiter endemics. Serum Se concentrations represent a marginal deficiency in the four areas studied. No significant correlations between serum Se concentrations and the other parameters studied (i.e., TV, SCN(-), thyroid hormones, sTSH, UIC) was detected. In conclusion, this study showed that selenium is also marginally deficient in the iodine-deficient endemic areas studied, but this has little or no impact on the thyroid hormone profile and the goiter endemics. SCN(-) overload may contribute to the endemics, especially for the areas where iodine is severely deficient. An effective iodine supplementation program will not only resolve the goiter endemics but also the consequence of SCN(-) overload as well in the endemic goiter areas studied.

The utilization of immunohistochemical prognostic factor in endometrial adenocarcinoma: is it cost effective?

This study investigated the relation between immunohistochemical prognostic factors and clinical stage and histopathological grade in endometrial adenocarcinoma. Twenty-seven patients with a mean age of 61 (38-74), who underwent radical surgery due to endometrial adenocarcinoma in our hospital between 1983-1998, were re-evaluated. For clinical staging FIGO criteria were used. Histopathological differentiation of the tumor was graded as good (grade 1), moderate (grade 2), and poor (grade 3). Estrogen and progesterone receptors, c-erb B2, UEA 1, Ki-67, PCNA and p53 were studied as immunohistochemical prognostic factors. There were no patients in stages IA and IIIB. Among the prognostic factors, PCNA was the most significantly stained marker, followed by c-erb B2, estrogen and progesterone receptors, regardless of the clinical stage and histopathological grade of the tumor. The least positivity was achieved with Ki-67. There was no significant difference when each prognostic factor was analysed with respect to clinical stage and histopathological grade. In our study no significant relation was found between the prognostic factors and the clinical stage and histopathological differentiation of the tumor. Therefore the cost effectiveness of the utilization of these factors should be reconsidered.

Immunohistochemical staining properties of PCNA, Ki-67, p53, beta-hCG and HPL in trophoblastic disease

OBJECTIVE

In this study proliferating markers PCNA (proliferating cell nuclear antigen) Ki-67 and mutation of supressor gene p53 were investigated in gestational trophoblastic disease (GTL). These markers were tested by using immunostaining with beta subunits of human chorionic gonadotropin (hCG) and human placental lactogen (HPL).

MATERIAL AND METHODS

Twenty curetting samples, 20 spontaneous abortions, 16 hydatidiform moles and two choriocarcinomas were studied and compared. Hydatidiform moles were subdivided into 10 complete and six partial moles by using flow cytometry analysis. All slides were stained with PCNA, Ki-67, p53, hCG, and HPL immunohistochemically. PCNA and Ki-67 stained slides were studied quantitatively to determine the PCNA and Ki-67 index. Other slides that were stained with p53, hCG, HPL were evaluated according to staining percentage and intensity. Staining properties of all groups were compared with each other. Variance analysis and the Mann Whitney U test were used for statistical analysis. Choriocarcinomas were not included in the statistical analysis. Ki-67 and the PCNA index in two choriocarcinoma cases found 81.4% and 41%, and 44% and 64%, respectively. One case was stained in 70% with (++) intensity by p53. While both were stained in 80% with (++) intensity by hCG, one was stained in 30% field (+) intensity by HPL.

RESULTS

The four groups of complete and incomplete diagnosed hydatiform moles, spontaneous abortions and retention curettage were matched in pairs and evaluated according to the PCNA index. This index showed significant differences among the groups. The differences among the Ki-67 index, p53, hCG and HPL staining properties were not statistically significant.

CONCLUSION

Our findings showed that PCNA is a significant and useful marker for trophoblastic diseases and can be used as a prognostic factor.

Degree of thyrotropin suppression in differentiated thyroid cancer without recurrence or metastases

Forty-eight patients with differentiated thyroid cancer (DTC), who had no evidence of tumor recurrence or metastases on studies such as radioiodine scanning, neck ultrasonography, and with thyrotropin (TSH) and thyroglobulin (Tg) levels less than 1 mU/L and 5 ng/mL, respectively, were included in the study. The mean age was 43 +/- 12 years (range 15-65) and all were receiving levothyroxine (LT4) treatment with a mean dose of 184 +/- 46 microg daily. Patients were divided into two groups; group A included patients that had baseline TSH levels of 0.4 mU/L or more, and group B patients had baseline TSH levels of less than 0.4 mU/L. LT4 doses for all patients were increased, and serum TSH and Tg measurements were reevaluated after 2 months of dose increments. The mean TSH of group A (patients with baseline TSH levels > or = 0.4 mU/L) decreased from 0.67 +/- 0.28 mU/L to 0.16 +/- 0.08 mU/L (p < 0.001), but mean serum Tg level showed no change after dose increments (2.92 +/- 1.36 ng/mL vs. 3.59 +/- 0.93 ng/mL at the second month; p > 0.05). Similar results were also observed in group B (patients with baseline TSH levels < 0.4 mU/L). Mean TSH level decreased from 0.26 +/- 0.07 mU/L to 0.1 +/- 0.05 mU/L (p = 0.006), but no decrease occurred in mean Tg level (3.0 +/- 1.16 ng/mL vs. 3.3 +/- 1.03 ng/mL; p > 0.05). The patients' data were reevaluated according to second-month TSH levels. Patients with a TSH level between 0.11 to 0.4 mU/L were set as "final TSH > 0.1 group," and patients with a TSH level equal or less than 0.1 mU/L were set as "final TSH < or = 0.1 group," and baseline and second-month Tg levels were assessed. The mean second month Tg levels did not differ in these two patient groups (3.7 +/- 0.74 ng/mL for final TSH > 0.1 group vs. 3.3 +/- 1.2 ng/mL for final TSH < or = 0.1 group; p > 0.05). No difference could be found between initial and second-month Tg levels in both groups (2.8 +/- 1.4 ng/mL vs. 3.7 +/- 0.74 ng/mL in final TSH > 0.1 group and 3.11 +/- 1.1 ng/mL vs. 3.3 +/- 1.2 in final TSH < or = 0.1 group; p > 0.05). In conclusion, these results indicate that serum Tg levels cannot be suppressed by maximal TSH suppression in tumor-free DTC patients. The suppression of TSH to less than 0.1 mU/L seems not to be necessary in most patients who have no evidence of active disease.

Effect of octreotide treatment on Graves' ophthalmopathy

In this study, nine patients with Graves' ophthalmopathy with positive clinical activity score (CAS), who were either unresponsive or not suitable for glucocorticoid treatment, were given 100 microg of octreotide three times daily, subcutaneously, for three months. The mean age was 49+/-13 years. All patients were under either propylthiouracil or methimazole therapy and were euthyroid for at least one month prior to the start of the octreotide treatment. The mean degree of proptosis as measured with the Hertel exophthalmometer decreased slightly after the treatment (22.0+/-3.0 vs 19.6+/-2.4 for the right eye and 22.2+/-1.9 vs 20.2+/-2.2 for the left eye; p<0.05). The mean activity score decreased from 3.2+/-0.8 to 1.7+/-1.1 (p<0.005) and the mean score of eye signs according to the NOSPECS classification showed improvement with octreotide therapy (3.2+/-0.7 vs. 2.2+/-1.4; p<0.05). Seven patients responded favorably to octreotide treatment. In the remaining two no improvement was observed. Four of the responders could be followed up for 20 months after the treatment and all maintained the favorable state of eye findings obtained with octreotide. We conclude that octreotide seems to be a safe and effective drug in Graves' ophthalmopathy, especially in improving soft tissue involvement, and can be used in patients who are unresponsive to glucocorticoid treatment or who cannot use these drugs for some reason.

Suppressive therapy with levothyroxine for euthyroid diffuse and nodular goiter

In this study, 35 patients with euthyroid diffuse goiter and 35 patients with euthyroid nodular goiter were treated with Levothyroxine (L-T4) for six months. The aim was to evaluate the efficacy of treatment on thyroid and nodule volumes and to evaluate the correlation between volume changes and thyroglobulin levels. Serum thyroid hormones, TSH, thyroglobulin, thyroid and nodule volumes were measured at the initial visit and after 6 months. Radioactive iodine uptakes of the thyroid gland were evaluated before treatment. The mean decrease of thyroid volume at six months was about 20% (20.4 +/- 8.8 ml vs. 16 +/- 7.9 ml, P<0.001) in patients with diffuse goiter. All patients with diffuse goiter showed some decrement in their goiter sizes. Thyroid nodules, in response to thyroid hormone treatment, showed a variable behavior. A reduction of 50% or more in volume was detected in 31% (11/35) of the patients. 54% of the patients (19/35) showed a 10-49% decrease in nodule volume. Five of the patients were found to be insensitive to the therapy. Their nodule volumes either increased or did not change during therapy. Free T4 and free T3 levels increased and TSH levels decreased with L-T4 treatment in all patient groups. Patients with higher TSH levels (within normal limits) showed more volume reduction in the diffuse goiter group. No uniform correlation was found between volume changes and thyroglobulin levels in either of the patient groups. In conclusion, suppressive thyroxine treatment is effective in reducing the size of the goiter, and nodules and thyroglobulin levels cannot be taken as an indicator of the efficacy of L-T4 therapy.

Value of re-aspirations in benign nodular thyroid disease

Fine-needle aspiration cytology (FNAC) is the most useful procedure for the evaluation of thyroid nodules. The requirement for repeated aspirations in the follow-up of benign nodular thyroid disease, however, is controversial. To determine the value of re-aspirations in benign nodular thyroid disease, we studied 457 fine-needle reaspirations performed on 216 patients (197 female, 19 male) aged 42.9+/-12 years with uninodular (n = 65) and multinodular (n = 151) thyroid disease. Two hundred fifty-seven of these were second, 137 were third, 46 were fourth, and 17 were fifth re-aspirations of the same nodule, performed in a mean follow-up time of 43.9+/-31 (3-156) months. FNAC results were benign in 407 (89%), insufficient for diagnosis in 31 (6.8%), suspicious in 16 (3.5%), and papillary carcinoma (PC) in 3 (0.7%). An initial benign diagnosis did not change after multiple aspirations in 213 (98.61%) of the cases. Three patients with initial aspirations read as benign had a diagnosis of PC from their second biopsies, (diagnosis confirmed at surgery). Re-examination of the initial FNAC revealed atypical features in 1 of the 3 patients. These 3 patients likely represent a false-negative result of the initial FNAC rather than benign nodular disease transformed to a malignant one during the follow-up period. In conclusion, a second aspiration of clinically suspicious nodules may correct a few initial false-negative results, but routine additional re-aspirations are not useful for clinically stable disease.

A potential risk for osteomalacia due to sociocultural lifestyle in Turkish women

Osteomalacia is a metabolic bone disease caused by deficiency of vitamin D or its active metabolites. Because poor sunlight exposure is one of the most common causes of osteomalacia, the disease seems to be rare in countries with adequate sunlight. We report nine Turkish female patients with osteomalacia with ages between 21 and 50 years. Osteomalacia was diagnosed on the basis of a history of bone aches or pains, muscle weakness, low or low normal serum calcium and urinary calcium, decreased concentrations of serum inorganic phosphorus and 25- hydroxyvitamin D and increased serum intact PTH and alkaline phosphatase levels. Radiographically, pseudo-fractures were present in seven of the patients. The patients' symptoms and signs were relieved with the treatment with vitamin D analogues and calcium. Their hypovitaminosis D are suggested to be caused by excessive clothing in the outdoors due to sociocultural and religious reasons. Excessive clothing may be a risk factor for osteomalacia in young to middle-aged and otherwise healthy women even in countries with adequate sunlight.

Furosemide and dDAVP for the treatment of pseudohypoaldosteronism type II

A 27-year-old Turkish male presented with fatigue, long lasting hypertension, hyperkalemia, hyperchloremic metabolic acidosis and normal glomerular filtration rate. His brother also showed hyperkalemia with no other features of the disease. Plasma renin levels were low and serum aldosterone levels were inappropriately low-normal to his hyperkalemia. Plasma cortisol levels were normal. Plasma renin aldosterone levels responded appropriately to postural changes, salt restriction and saline infusion. Fludrocortisone was ineffective in his hyperkalemia. The conditions were consistent with Type II pseudohypoaldosteronism (PHA). Furosemide and sodium bicarbonate were effective to control his hyperchloremia, metabolic acidosis and hypertension but partly effective for his hyperkalemia. dDAVP alone did not control the situation and hypertension and metabolic derangement reoccurred. Adding dDAVP to furosemide and sodium bicarbonate successfully controlled hyperkalemia, hyperchloremic acidosis and hypertension. The patient stayed normotensive with normal metabolic and biochemical parameters after 6 months with furosemide and dADVP although sodium bicarbonate had been discontinued after the first month of therapy. dDAVP is a useful adjunct to furosemide and non chloride anions which altogether successfully reverse the metabolic derangement in Type II PHA.

Melperone treatment in an organic delusional syndrome induced by hyperprolactinemia: a case report

A young female with organic delusional syndrome induced by hyperprolactinemia was admitted to the Psychiatry Clinic of Ankara Social Security Hospital. The most striking characteristic of her history was either worsening of the endocrinologic clinical outcome under conventional neuroleptic treatment or worsening of clinical psychiatric outcome under bromocriptine therapy. A new atypical neuroleptic, melperone, suggested to minimally affect plasma prolactin levels, was started. Her psychotic complaints significantly subsided and she was devoid of any symptomatological change regarding her endocrinological status. These results were discussed.

Omeprazole: calcitonin stimulation test for the diagnosis follow-up and family screening in medullary thyroid carcinoma

Medullary thyroid carcinoma (MTC) occurs sporadically but may also be inherited as part of the multiple endocrine neoplasia (MEN) type 2 syndrome. Screening of the patients and first degree relatives annually with basal and provocative tests for serum immunoreactive calcitonin (CT) levels is essential and enables potentially curative disease. Pentagastrin and calcium are the usual provocative agents used worldwide. We used endogenous gastrin (GT) release achieved by omeprazole, 20 mg b.i.d., to stimulate CT in 9 MTC, in 3 MEN 2A family members, and in 50 healthy control subjects. A steady and significant increase both in GT and CT levels was achieved in 9 MTC patients and 3 of the 14 family members tested, whereas in healthy controls the CT increase stimulated by GT was insignificant. Preliminary results showed that this new, safe, cheap, and outpatient-basis test can be used in MTC diagnosis, follow-up, and screening.

Non-Hodgkin's lymphoma presenting as thyroid and adrenal gland involvement

We report an unusual case of non-Hodgkin's lymphoma involving both the thyroid and adrenal glands. Malignant infiltration of the glands by B-cell immunoblastic type lymphoma were demonstrated by cytologic findings in needle biopsy. Staging studies showed minor nodal involvement. The patient was treated with combination chemotherapy. Simultaneous involvement of the thyroid and adrenal glands with non-Hodgkin's lymphoma is very rare. In this report, while presenting this rare coexistence, we also want to emphasize that fine-needle aspiration biopsy was useful in the diagnosis.

Normal growth and pubertal development during bromocriptine therapy in two patients with prolactinoma

The cases of two boys, a 14 years 10 months old and an 18-year-old, with delayed puberty are presented. The first patient also had a short stature. Both patients had a pituitary adenoma, as shown by computed tomography, with high prolactin levels. After bromocriptine therapy was started, there was a spontaneous progression of normal puberty. The first patient used a synthetic growth hormone together with bromocriptine, however, even after the growth hormone was stopped progression in puberty and gain in height continued. The favorable response obtained in these patients implies that bromocriptine can be an effective therapy for adolescent patients with prolactinoma.

The characteristics of nine patients with adrenal incidentalomas

With the widening use of computerized tomography, the incidentaloma, an adenoma found incidentally in the adrenal, in computerized tomograms obtained for problems not necessarily related to the adrenal, has emerged as a recent clinical entity. Nine cases with such tumors are presented, here, along with a brief review of the related medical literature. Endocrine and other studies have shown that two of these nine patients had hormone secreting adrenal tumors, two pheochromocytomas. Surgical resection of the tumor was performed in six of the cases and aspiration biopsy was done in four with three completely benign cytological examination results (Class I or II) and one Class III result. The tumor with the class III result turned out to be a benign pheochromocytoma. CT estimates of the tumor size were 25 mm to 80 mm in the whole group and 30 to 80 mm in the patients who were operated on. Operation and histopathologic examination revealed three cortical adenomas, two pheochromocytomas, and one myelolipoma. Although no malignant tumors were found, the percentage of functioning adrenal neoplasms is rather high (22.2%) in this group of nine incidentalomas. Cases of adrenal incidentaloma therefore require a thorough endocrine evaluation along with other examinations which allow the clinician to follow tumor size.

The use of antiandrogen flutamide in the treatment of hirsutism

In this study the efficacy of flutamide, an antiandrogen which does not have a steroid structure, or progestational and estrogenic activities, on hirsutism and hormone levels in polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) was investigated. Ten patients with PCOS and nine patients with IH between 19 and 36 years of age were selected for the study. They were given a 500 mg daily dose of flutamide and were followed up for clinical and hormonal effects at the second, sixth, eighth and twelfth months of the treatment. The severity of hirsutism was assessed according to the Ferriman-Gallwey's score. There was a slight decrease to below the pre-treatment level in serum LH at the end of the eighth month (P < 0.05) and there was also a persistent decrease in progesterone (P) after the second month of the treatment (P < 0.05). No other significant change was observed in ovarian or adrenal androgens. Clinical examinations revealed that after six months of the therapy the dose of flutamide had caused a significant alleviation of hirsutism and this continued during the following months.

Choriocarcinoma metastasis in the thyroid gland

We report a 34-year-old woman with intrathyroid metastasis of choriocarcinoma associated with pulmonary and brain metastasis. The patient presented with a solitary thyroid nodule. Needle biopsy showed anaplastic malignant cells. Pathologic evaluation after thyroidectomy showed choriocarcinoma in the thyroid gland and the patient subsequently underwent combined chemotherapy and radiotherapy with satisfactory response. This is only the third reported case of metastatic choriocarcinoma in the thyroid gland and emphasizes this rare clinical presentation of choriocarcinoma.

Sodium ipodate in the treatment of toxic diffuse goiter. Short-term and long-term effects on thyrotoxicosis

Iodinated radiocontrast medication has been successful in the treatment of thyrotoxicosis when used for short periods up to 21 days, but experience with long-term use is lacking. In the first part of this study, a group of seven patients each taking 1.5 g. sodium ipodate daily was observed for 21 days and compared to a similar group of seven thyrotoxic patients taking 400 mg. propylthiouracil (PTU) daily. Sodium ipodate brought about a more significant decrease in serum total T3 and T4 levels, and more prominent increase in reverse T3 levels in the first ten days of the treatment. In the second part, a group of seven patients with thyrotoxicosis were given sodium ipodate, 1.5 g, daily for 20 days and 0.75 g. thereafter and were compared to a similar group of seven patients who took PTU, 300 mg. daily for the first 20 days and 150 mg. daily afterwards. Serum thyroid hormone levels decreased in both groups at the end of the first month of treatment, but rose again, along with worsening of symptoms, in five patients on ipodate treatment. Therefore, sodium ipodate, an iodinated radiocontrast agent is unable to control thyrotoxicosis for longer than a month.

Investigation of the aetiopathogenesis of amelogenesis imperfecta through microscopic, submicroscopic and cytogenetic methods--a case report

A case of hypomineralized type of amelogenesis imperfecta has been evaluated by using microscopic, submicroscopic and cytogenetic techniques. It has been observed that some of the enamel contained hydroxyapatite crystals and showed normal mineralization, but some others consisted of transparent, crystal plates of octacalcium phosphate, revealing that these enamel prisms have hypomature characteristics. Extra chromosomes which belong to D-autosomes were found in the culture obtained from the peripheral blood of the patient, suggesting that the patient has 15% hyperdiploids. It is suggested that the structural disorders in some of the enamel prisms resulted from alterations in the environmental conditions related to chromosome anomalies.