Marmara Medical School

İstanbul, Turkey

Marmara Medical School

İstanbul, Turkey
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Sancak S.,Section of Endocrinology and Metabolism | Hardt A.,University of Leipzig | Singer J.,University of Leipzig | Kloppel G.,University of Kiel | And 7 more authors.
Thyroid | Year: 2010

Background: There is a plethora of partly contradictory reports on somatostatin receptor (SSTR) expression in thyroid tumors. Therefore, our goal was to systematically determine SSTR2 expression in benign cold thyroid nodules (CNs), hot thyroid nodules (HNs), papillary carcinomas (PCs), and Graves' disease (GD) in comparison with intraindividual control tissues by means of immunohistochemistry. Methods: Tissue sections from 19 HNs, 10 CNs, 17 PCs and their surrounding tissues, and 8 GD thyroids were immunostained for SSTR2. Membranous SSTR2 staining was quantitated by evaluating 10 high-power fields (HPFs) systematically distributed along the largest diameter of the tissue section. Results: The area covered by thyroid epithelial cells in 10 HPFs expressed as median (in mm2) was 0.53 for CNs, 0.44 for HNs, 1.5 for PCs, 1.3 for GD, and 0.3 for the surrounding tissues. The SSTR2 staining density determined by dividing the area of SSTR2 positively stained thyroid epithelial cells (in mm2) by the area of all thyroid epithelial cells (in mm2) in 10 HPFs was 0.1662 for CNs, 0.0204 for HNs, 0.0369 for PCs, and 0.0386 for GD. Conclusions: SSTR2 expression is inhomogeneous in thyroid disease, with the highest density detected in CNs. It remains to be determined whether this finding could be of pathophysiologic or therapeutic relevance. The high SSTR2 density in CNs should be considered in the interpretation of SSTR scintigraphy-positive findings. © 2010 Mary Ann Liebert, Inc.


Sancak S.,Section of Endocrinology and Metabolism | Jaeschke H.,University of Leipzig | Eren F.,Marmara Medical School | Ozlem T.,Section of Endocrinology and Metabolism | And 8 more authors.
Hormone and Metabolic Research | Year: 2011

Whereas the majority of hot thyroid nodules are caused by somatic TSH-receptor mutations, the percentage of TSH-receptor mutation negative clonal hot nodules (HN) and thus the percentage of hot nodules likely caused by other somatic mutations are still debated. This is especially the case for toxic multinodular goiter (TMNG). 35 HNs [12 solitary hot nodules (SHN), 23 TMNG] were screened for somatic TSHR mutations in the exons 9 and 10 and for Gs mutations in the exons 7 and 8 using DGGE. Determination of X-chromosome inactivation was used for clonality analysis. Overall TSHR mutations were detected in 14 out of 35 (40%) HNs. A nonrandom X-chromosome inactivation pattern was detected in 18 out of 25 (72%) HNs suggesting a clonal origin. Of 15 TSHR or Gs mutation negative cases 13 (86.6%) showed nonrandom X-chromosome inactivation, indicating clonal origin. The frequency of activating TSHR and/or Gs mutations was higher in SHNs (9 of 12) than in TMNGs (6 of 23). There was no significant difference for the incidence of clonality for HNs between TMNGs or SHNs (p: 0.6396). Activating TSHR and/or Gs mutations were more frequent in SHNs than in TMNG. However, the frequency of clonality is similar for SHN and TMNG and there is no significant difference for the presence or absence of TSHR and/or Gs mutations of clonal or polyclonal HNs. The high percentage of clonal mutation-negative HNs in SHN and TMNG suggests alternative molecular aberrations leading to the development of TSHR mutation negative nodules. © Georg Thieme Verlag KG Stuttgart - New York.


Sancak S.,Section of Endocrinology and Metabolism | Hardt A.,University of Leipzig | Gartner R.,Endocrinology and Diabetes | Eszlinger M.,University of Leipzig | And 7 more authors.
Hormone and Metabolic Research | Year: 2010

The assessment of tumor vascularization by color flow Doppler sonography (CFDS) has been suggested for the distinction between benign and malignant thyroid nodules. Our objective was to investigate if the CFDS results reflect the percentage of histologically determined microvessels in adenomas (As), adenomatous nodules (ANs), and papillary carcinomas (PCs). Tissue sections from 10 adenomas, 8 ANs and 13 PC and surrounding tissue of 10 PCs and 2 benign nodules were immunostained for CD34. A computerized image analysis was used to determine the microvessel density in four hot spots and ten systematically selected fields. Preoperatively CFDS was performed and classified according to Frates etal. We found a consistent percentage increase of CD34 stained microvessels in PCs (83 and 96%) as compared to adenomas and ANs (38 and 49%) determined by the hot spot analysis and systematic field analysis. A ROC analysis on the basis of the histologically determined number of microvessels demonstrated 70% microvessels as an optimal cut point for the diagnosis of PC with the highest sensitivity of 92% and highest specificity of 89%. The analysis of the CFDS-classification IV for the distinction between PCs and adenomas and ANs showed a sensitivity of 62% with a specificity of 100%. The lower sensitivity of the CFDS classification as compared with the immunohistologic determination of the microvessel density indicates that the CFDS classification detects the pathognomonic intranodular microvessels only incompletely. The higher CFDS specificity is most likely due to the detection of other vascular aspects of malignancy in addition to intranodular microvessels. © Georg Thieme Verlag KG.


Akman M.,Marmara Medical School | Kivrakoglu E.,Tuberculosis Prevention and Treatment Unit | Cifcili S.,Marmara Medical School | Unalan P.C.,Marmara Medical School
Obesity and Metabolism | Year: 2010

Background and aims: Weight bias contributes to the production of health disparities. This study aims to investigate attitudes and professional practice patterns of primary health care providers towards obese patients. Methods: This study was designed as a cross-sectional survey carried out among primary care health professionals (PCHP) in one district of Istanbul. Among the total 134 doctors and nurses approached, 104 gave consent to participate (77.6%). All participants filled in a 24 item obesity perception survey (OPS) which contained two subtopics: personal attitudes and professional practice patterns. Participants were asked to rate each statement in the survey according to a 5 point Likert scale (from 0: totally disagree, to 5: totally agree). Results: Among the participants 23.1% (n=24) were male and 50.9% were physicians (n=53). The Cronbach's alpha for the whole perception scale was 0.86. Significantly more nurses than physicians do not want to work with (χ2=4.62; p=0.032) and prefer not to provide service to an obese person (χ2=8.17; p=0.004). When independent variables such as the personal attitudes subtopic score, body mass index, age, gender, professional status (nurse or doctor) and years of work experience were put in the stepwise linear regression analysis, the personal attitudes score was found to be accountable for 64% of the variance for professional practice patterns score (adjusted R2=0.64, p<0.000; B±SE: 0.69±0.05). Conclusions: Our findings showed that obesity elicited some negative attitudes from PCHPs and the professional practice patterns towards obese patients were associated with personal attitudes to a large extent. ©2010, Editrice Kurtis.


Karakoc-Aydiner E.,Marmara Medical School | Ozen A.O.,Marmara Medical School | Baris S.,Marmara Medical School | Ercan H.,Sureyyapasa Hospital | And 2 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2014

Background: The prevalence of primary immunodeficiency (PID) in the relatives of patients with common variable immunodeficiency (CVID) and IgA deficiency is high. Allergic disorders have been recorded in patients with humoral immunodeficiency. We aimed to determine the frequency of humoral immunodeficiency and atopy in the relatives of patients with CVID.Methods: The study population comprised 20 CVID patients and their relatives. All relatives were screened using a questionnaire covering demographic characteristics, warning signs of PID (adults and children), and core questions on asthma, rhinitis, and eczema from the International Study of Asthma and Allergies in Childhood (ISAAC). We also recorded absolute neutrophil and lymphocyte counts, serum immunoglobulin levels, pulmonary function values, and skin prick test results.Results: The study sample comprised 20 patients with CVID (15 males, 5 females; mean [SD] age, 16.4 [9] years) and 63 first-degree relatives (18 mothers, 16 fathers, 16 sisters, 10 brothers, and 3 offspring). The rate of parental consanguinity was 75%. Of 17 family members with positive PID warning signs, 6 had concomitant hypogammaglobulinemia (3 low IgM levels, 2 selective IgA deficiency, and 1 partial IgA deficiency). The ISAAC questionnaire revealed allergic rhinitis in 3 mothers, asthma in 2 fathers, and 1 sibling. Skin prick testing revealed sensitization to aeroallergens in 31.6% of cases in addition to 1 parent and 1 sibling.Conclusions: Almost half of the 20 families with a CVID patient had at least 1 additional member with hypogammaglobulinemia, leading us to recommend routine screening for relatives of CVID patients. © 2014 Esmon Publicidad.


Aslan A.,Marmara Medical School | Sancak S.,Marmara Medical School | Aslan M.,Marmara Medical School | Cimsit N.C.,Marmara Medical School | And 4 more authors.
Acta Endocrinologica | Year: 2013

Background. Fine needle aspiration biopsy (FNAB) is an important tool in the diagnosis of thyroid nodules. Aim. Our aim was to investigate the malignancy criteria in thyroid nodules by gray-scale ultrasonography (US) and duplex Doppler ultrasonography (DDUS), and their usefulness in reducing the number of unnecessary FNAB's. Study design. This was a prospective observational study. Subjects and methods. 181 benign and 18 malignant thyroid nodules were evaluated by US and DDUS before FNAB or thyroidectomy. US was used to note size, shape, internal structure, nodule echogenicity, marginal properties, peripheral hypoechogenic halo, and microcalcifications. DDUS studies were used to evaluate the maximum and minimum flow velocity (Vmax and Vmin), systolic/diastolic flow velocity ratio (S/D), pulsatility index (PI), resistive index (RI), acceleration time (AT) and acceleration value. Results. Contour irregularity, size and presence of microcalcifications (p<0.001, p=0.02 and p=0.002, respectively) and S/D, Vmin, PI, RI and AT were significantly different (p=0.004, p=0.007, p=0.032, p=0.003 and p=0.003, respectively) were significant for malignant nodules. Benign and malignant nodules with or without suspicious US findings had similar DDUS findings. Vmax, Vmin, PI, RI, and AT were significantly different in the presence of microcalcification (p=0.043, p=0.001, p=0.031, p=0.04, and p=0.019 respectively). AT was significantly different in the case of absence of microcalcification (p=0.019). Comparing the irregular margins, Vmin, PI and RI were significantly different (p=0.014, p=0.003, and p=0.014 respectively). Conclusion. Benign and malignant thyroid nodules can be differentiated using gray-scale US findings and DDUS based indices together to reduce the number of unnecessary FNAB's.

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