Does insulin resistance increase thyroid volume in patients with polycystic ovary syndrome?

OBJECTIVE

To investigate the effect of gonadotropin, sex hormone levels and insulin resistance (IR) on thyroid functions and thyroid volume (TV) in polycystic ovary syndrome (PCOS).

SUBJECTS AND METHODS

69 new diagnosed PCOS patients (age 24.82 ± 6.17) and 56 healthy control female (age 26.69 ± 5.25) were involved to the study. Fasting plasma glucose, lipid profile, insulin, thyroid stimulating hormone (TSH), free thyroxine (fT4), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone levels and urine iodine were measured in all participants. Thyroid and pelvic ultrasound were performed in all participants.

RESULTS

Insulin, HOMA-IR, LH, E2 and TV were higher in PCOS group (p < 0.05). TV was significantly higher in PCOS patients with IR compared to non-IR PCOS patients (p < 0.001), while TSH, fT4, and urine iodine levels were similar between these groups (p > 0.05). There was a negative correlation between E2 and TSH (p < 0.05) and a positive correlation between TSH and TV (p < 0.05). There was a significant positive correlation between TV and LH, insulin, HOMA-IR (p < 0.05).

CONCLUSION

This study showed that TV was increased in patients with insulin resistance but differences in TSH and LH levels may affect TV changes as well.

Effect of Hemoconcentration on Dural Sinus Computed Tomography Density in a Pediatric Population

Unenhanced brain computed tomography (CT) is inexpensive, easily available, and the first-choice imaging modality for patients presenting with various neurologic symptoms. Venous thrombosis is not rare in childhood, but diagnosis can be difficult. In some cases, only denser vessels can be used to highlight an issue. The aim of this study was to retrospectively evaluate the relationship between X-ray attenuation and hemoconcentration in a pediatric population. This study enrolled 99 pediatric patients who had been referred radiology department for unenhanced brain CT. Images were retrospectively evaluated for measurement of dural sinus densities from four distinct dural sinus locations. Correlation between mean Hounsfield unit (HU) values and hemoglobin/hematocrit (Hb/Htc) levels, as well as age and gender were further analyzed. There was a strong correlation between mean HU and Hb levels (r = 0.411; standard deviation: 0.001) and also between mean HU and Htc levels (r = 0.393; p < 0.001). According to the results of this study, the mean sinus density and H:H (HU:Htc) values were 44.06 HU and 1.19, respectively, in a normal pediatric group. In conclusion, before deciding between a diagnosis of thrombosis and a determination of normal findings during an evaluation of unenhanced CT in a pediatric population, radiologists should consider complete blood count results as well as H:H ratios.

Interpretation of thyroid glands in a group of healthy children: real-time ultrasonography elastography study

BACKGROUND

This study aimed to determine the strain index (SI) of normal thyroid parenchyma in a group of healthy children, using ultrasound elastography (USE).

METHODS

The participants consisted of 54 healthy children. The USE of the normal thyroid parenchyma was performed by using the Hitachi Hi VisionPreirus model ultrasonography (US) device. By following sinusoidal waves at the base of the screen, regular and slight compressions and decompressions were made by the transducer. After the regular sinusoidal waves were acquired, standard region of interest (ROI) circles were used to measure the SI values of the thyroid glands by placing one ROI on a superficial part of the normal thyroid gland parenchyma and the other on the adjacent soft tissue at the same depth (within 10-mm proximity). Three measurements were obtained for each (right and left) thyroid gland, and the mean value was used for statistics.

RESULTS

The mean SI value of normal thyroid glands was 0.54±0.38 for the whole group. There was no statistically significant difference between girls and boys on the basis of age, weight, height, BMI (body mass index), and thyroid SI values (p=0.15, p=0.18, p=0.12, p=0.31, and p=0.96, respectively). No correlation was found between thyroid gland SI values and each of the following variables: age (r=0.22, p=0.15), gender (r=0.007, p=0.96), and BMI (r=0.26, p=0.09).

CONCLUSIONS

The study determined the normal elasticity values of thyroid glands in healthy children. Such information can serve as a baseline from which thyroid diseases can be examined.

The relationship between mean platelet volume and other platelet indices with testicular artery blood flow and fertility: a preliminary study

OBJECTIVES

To examine the relationship between platelets (PLT) and platelets indices such as mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) as noninvasive biomarkers with testicular artery blood flow and fertility.

METHODS

Fifty-seven healthy and fertile men with normal semen values and 52 patients with abnormal semen values were included in the study. The participants' PLT, MPV, PDW and PCT values were analyzed. Four different levels of the testicular artery, peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured using color Doppler ultrasound.

RESULTS

There was no significant difference in terms of platelet and platelet indices (MPV, PDW and PCT) between the fertile and infertile group. There were no between group differences in the RI values of the testicular- and intra-testicular artery. When all fertile and infertile participants were considered together, there was no statistically significant correlation between the parameters of the testicular artery blood flow (PSV, EDV and RI) and platelet and platelet indices (MPV, PDW and PCT) (P > 0.05).

CONCLUSIONS

There is not statistically significant correlation between any of the following parameters: platelets and platelet indices such as MPV, PDW and PCT, RI of the testicular artery, and fertility.

Penile Mondor's Disease: Primum Non Nocere!

PURPOSE

Penile Mondor’s disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical diagnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultrasonography for diagnosis of penile Mondor’s disease.

MATERIALS AND METHODS

Seven patients with the clinical presentation of penile Mondor’s disease were included in the study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients.

RESULTS

Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic purposes, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according to us.

CONCLUSION

Recovery from penile Mondor’s disease is usually spontaneous and smooth. A simple physical examination is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests should be avoided so that patients are not harmed.

The value of susceptibility weighted magnetic resonance imaging in evaluation of patients with familial cerebral cavernous angioma

OBJECTIVES

We investigated the imaging features of Cavernous angioma (CA) lesions and the value of Susceptibility-weighted imaging (SWI) by comparing with T2*-weighted gradient echo (GRE) sequences in patients with familial CA disease.

MATERIAL AND METHODS

We retrospectively evaluated 19 familial CA patients (8 men, 11 women; mean age, 36 years). T1-weighted, T2-weighted, T2*-weighted GRE, and SWI sequences were performed to all patients. The numbers of CA lesions seen on T2*-weighted GRE and SWI sequences were analyzed. The correlations between the numbers of lesions on both sequences with age were evaluated. CA lesions were classified according to the classification of Zabramski et al.

RESULTS

The number of CA lesions was higher on SWI than T2*-weighted GRE significantly (P<.001). There was a significant strong correlation between the age of the patients and number of lesions in the cohort on T2*-weighted GRE (r = 0.81, P<0.001) and SWI (r = 0.85, P<0.001) sequences. Approximately 44% of the CA lesions which were detected only by SWI could not be categorized according to the classification of Zabramski et al.

CONCLUSION

SWI can provide helpful additional information by determining the CA lesions more accurately than T2*-weighted GRE. Thus, routine clinical neuroimaging protocols should contain SWI to assess the true prevalence of lesions for optimal diagnosis and treatment. Moreover, this study show that the Zabramski classification is insufficient to identify all CA lesions, and a new type (type V) should be added to represent lesions that are seen on SWI but not on T2*-weighted GRE.

A patient with pneumopericardium secondary to extranodal T-cell lymphoma

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoma derived from either activated NK cells or cytotoxic T cells. Most cases with T/NK cell lymphoma present with extranodal manifestations. Primary nodal disease is very rare. The upper respiratory tract is the most common site involved in extranodal disease. Symptoms include epistaxis and nasal obstruction. T/NK cell lymphomas show aggressive and invasive clinical progression, with a poor prognosis. Without treatment, survival is measured in months. We report a case of a 51-year-old male patient with pneumopericardium as a complication of intestinal T/NK cell lymphoma. To the best of our knowledge, this is the first report showing pneumopericardium as a fatal complication of T/NK cell lymphoma. Pneumopericardium should be considered in patients diagnosed with T/NK cell lymphoma presenting with chest pain.