Engin Guney

Introduction Paget's disease of bone, osteitis deformans is a benign disease of bone that affects one or more bones. Its prevalence and clinical features show geographical region differences. In this study, it was aimed to investigate the treatment responses and follow-up results as a single center experience by using the demographic, clinical, laboratory and radiological characteristics of patients with Paget's Disease of the Bone. Method Fifty one patients who were diagnosed and followed up in Aydın Adnan Menderes University Endocrinology clinic between September 2004 and December 2021 were included in the study retrospectively. Results The mean age of onset of the disease was 61.8±12.5 years and the mean follow-up period was 9.3±8.2 years. It was observed that 68.63% of the patients were asymptomatic. Polyostotic involvement is present in 62.7% of the patients. It was observed that the disease most commonly involved the pelvis. It was determined that alkaline phosphatase value was above the upper reference limit in all patients at the time of diagnosis. All patients have increased activity in whole body bone scintigraphy. Except for one patient, all patients received bisphosphonate therapy. Remission was achieved in all patients who received zolendronic acid treatment as the first treatment. Since there was no response in the treatment of 8 patients receiving oral bisphosphonate and 2 patients receiving pamidronate, IV zolendronic acid treatment was started. Treatment response was achieved in 6 (75%) of 8 patients who did not go into remission with oral bisphosphonate, and in 1 (50%) of 2 patients who received pamidronate and did not go into remission, after switching to zolendronic acid, and serum alkaline phosphatase values were found to regress to the normal range. Conclusion In this study, it was determined that patients with asymptomatic alkaline phosphatase elevation should also be examined for Paget's disease of the bone and that zolendronic acid provides an effective treatment in Paget's disease of the bone.

Myeloperoxidase (MPO) is a lysosomal hemoprotein found in the azurophilic granules in neutrophils. Myeloperoxidase plays an important role in oxygen-dependent killing of bacteria, fungi, virus and malignant cells. Diabetes mellitus (DM) is listed among conditions that may lead to secondary MPO deficiency in neutrophils but inconsistent results concerning MPO activity in diabetic patients have been reported in the literature. In this study, we aimed to evaluate the relationship between glycemic control in patients with type 2 DM and MPO activity in neutrophils from a histochemical perspective. The study included 40 patients with type 2 DM with poor glycemic control, 30 patients with type 2 DM with good glycemic control and 31 healthy controls. Peripheral blood smears were analyzed for each patient included in the study. Myeloperoxidase dye was used for staining. Myeloperoxidase ratios in neutrophil were evaluated for proportions of staining with MPO in 100 neutrophils in each smear. SPSS 16.0 version was used for statistical analyses. Myeloperoxidase ratios in neutrophils were 70 (58.5–80) in type 2 DM patients with poor glycemic control compared to 80 (73.75–90) in those with good glycemic control and 88 (78–92) in healthy controls. The DM group with poor glycemic control was statistically significantly different from the other groups (p < 0.001). Poor glycemic control in diabetic patients results in decreased MPO activity in neutrophils histochemically.

Bisphosphonates are widely used for the treatment of metabolic bone disorders and their effects on lipid metabolism have also been investigated. Some studies reported that bisphosphonates have beneficial effects on serum cholesterol levels. In this study we aimed to assess the effects of bisphosphonates on lipid levels in hyperlipidemic patients who received bisphosphonates because of osteoporosis. 49 female patients (age: 54.2+/-7.2 years) with diagnosis of osteoporosis and hyperlipidemia were enrolled. Patients received alendronate 10 mg/day and they were followed up for 6 months. Pretreatment total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, apolipoprotein A1 and apolipoprotein B levels were measured and compared with post-treatment levels. Pretreatment and post-treatment levels of total cholesterol were 255.2+/-34.3; 233.02+/-37.0 mg/dL, triglyceride levels were 153.0+/-57.3; 129.1+/-54.4 mg/dL, and LDL levels were 170.7+/-30.5; 160.0+/-34.2 mg/dL, respectively. Reductions in total cholesterol, triglyceride and LDL-cholesterol levels were statistically significant; whereas differences in HDL-cholesterol, apolipoprotein-A1 and apolipoprotein-B levels were not significant. Data from our study suggest that alendronate therapy may have beneficial effects on lipid metabolism. Thus, when hyperlipidemia is detected in patients receiving bisphosphonates, it is considered reasonable to follow the patient for a while before initiating antihyperlipidemic agent to prevent unnecessary use of drugs.

Fine-needle aspiration biopsy (FNAB) is recommended for the initial evaluation of thyroid nodule. If a benign cytology is obtained, suppression therapy with levothyroxine is the first choice in the management of nodular goiter with a follow-up of nodule size with ultrasonography, but the effects of FNAB have not been taken into consideration in this approach. We aimed at evaluating the effect of FNAB on thyroid volume and other ultrasonographic dimensions by measurement of these parameters before and immediately after the procedure, and in later periods, and to clarify the necessity of regarding the effects of FNAB on thyroid. Forty-six patients (34 females, 12 males; mean age: 36.3±10.7 yr) with solitary thyroid nodules were included in the study. The nodules were solid in ultrasonography, thyroid function tests were normal and results of FNAB were found as benign cytology. Thyroid hormone suppression therapy was not initiated. Ultrasonographic measurements were made before FNAB, repeated immediately after FNAB, and 1 month and 6 months later. There were no statistically significant changes in the mean thyroid nodule volume, nodule area and circumference of patients before, immediately after FNAB, 1 month and 6 months later. Size differences and individual variability at each time period were analyzed. These parameters changed by more than 10% in a great majority (69.5–78.2%) of patients, and more than 50% change was observed in 17.3–26.0% of patients. Changes in thyroid dimensions were bi-directional, both increment and decrement being noticed. It was thought that this is the reason why there was no significant change in mean nodule volume, area and circumference. Evaluating the difference in nodule volume according to ultrasonographic parameters obtained before FNAB may be misleading because of the individual change in these parameters with FNAB. It may be useful to evaluate the nodule size and volume closely after FNAB to make a true correspondence of these parameters in the long term.

Diabetes Mellitus is associated with decreased insulin-like growth factor-I (IGF-I) levels and also, poor growth in diabetes is related with low circulating levels of IGF-I. Insulin acts via an increase of IGF-I synthesis on growth. We studied the effects of insulin and sulphonylureas on serum IGF-I levels and aimed to evaluate the restoration of IGF-I in different therapeutic strategies. Thirty male rats were used in the study and diabetes was induced by a single intraperitoneal injection of streptozotocin (35 mg/kg body weight). After confirmation of hyperglycemia, rats were divided into three groups. The first group was treated with insulin, and second group with glimepiride, third group was not treated (control group). IGF-I levels were measured at basal, after streptozotocin and at the end of the treatment period. Serum IGF-I levels were found to decrease from 577.2 ng/ml to 253.0 ng/ml after streptozotocin (p0.05). Serum IGF-I levels decrease in diabetes and insulin treatment restores IGF-I depletion significantly. And although less effective, treatment with glimepiride restores IGF-I levels significantly.