This study shows that 25(OH)D deficiency is associated with endothelial dysfunction and increased lipid peroxidation. Replacement of vitamin D has favorable effects on endothelial function. Vitamin D deficiency can be seen as an independent risk factor of atherosclerosis. Hypovitaminosis D-associated endothelial dysfunction may predispose to higher rates of cardiovascular disease in the winter.

Although only 4.5% to 16% of ovarian cysts in children are malignant, oophorectomy is common in such patients. Conservative expectant management and ovarian sparing surgery would avoid bilateral oophorectomies in children with ovarian cysts at low risk of malignancy. Pediatric or general surgeons who have limited expertise with pediatric gynecology often manage these children because of limited availability of pediatric and adolescent gynecologists with the special skills needed.The objective of this retrospective case-note study was to investigate the nature and surgical management of ovarian cysts in children at a large children's hospital to determine whether current management practices could be improved. Between 1991 and 2007, 155 cases identified through use of clinical coding of surgical cases and pathology databases were analyzed by use of Snap 9.Sixty-two ovarian cysts were found in children under 9 years of age who were prepubertal. There were 58 neoplastic cysts, but 36 (62%) were benign teratomas. Ten of the cysts were malignant. Preoperative diagnostic investigation was preformed in a minority of the patients: Of the 155 children, only 16 (10%) were investigated for tumor markers; 61 (39%) had an ultrasound scan; and 16 (10%) had a computed tomography or magnetic resonance imaging scan. An oophorectomy was performed in 90 (58%) of the children and an ovarian cystectomy was performed in 40 (26%). The ovary was removed in all cases with malignant cysts, and in 75 cases with benign or normal pathology (including 5 benign epithelial, 9 functional and 4 paraovarian cysts; 5 cases with normal ovarian tissue; 30 oophorectomies for benign teratomas, 21 for torsion and 1 for hemorrhage). Referral to a pediatric gynecologist occurred for only 24 (15.5%) of the patients following surgery for an ovarian cyst. This number excluded the 10 girls who were still in pain. None of the referrals were before surgery.These findings show that a large number of young girls with benign cysts who are at low risk of malignancy have cystectomy or oophorectomy when a conservative expectant management approach or ovarian-sparing surgery could have been justified. To prevent this practice, the investigators recommend greater use of preoperative diagnostic investigations including tumor markers and imaging, and the training of more gynecologists with the special skills in pediatric and adolescent gynecology needed to manage these patients. EDITORIAL COMMENT(In this retrospective analysis of ovarian cysts in children and adolescents from England, a surprisingly large number of patients were man-aged by oophorectomy and open laparotomy. Cases in this review (and certainly in most reports) were identified by searching the pathol- GYNECOLOGY Volume 65, Number 3 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTBecause hysterectomy, the standard treatment option for women of reproductive age with menorrhagia, is associated with serious complications and requires a relatively long-recovery period, the levonorgestrel-releasing intrauterine sys...

ObjectiveWe aimed to evaluate adherence to insulin treatment in terms of treatment persistence and daily adherence to insulin injections among insulin-naïve type 2 diabetic patients initiating insulin therapy with basal (long acting), basal-bolus, and premixed insulin regimens in a tertiary endocrinology outpatient clinic.MethodsA total of 433 (mean age of 55.5±13.0 years; 52.4% females) insulin-naïve type 2 diabetic patients initiated on insulin therapy were included in this questionnaire-based phone interview survey at the sixth month of therapy. Via the telephone interview questions, patients were required to provide information about persistence to insulin treatment, self-reported blood glucose values, and side effects; data on demographics and diabetes characteristics were obtained from medical records.ResultsSelf-reported treatment withdrawal occurred in 20.1% patients, while 20.3% patients were nonadherent to daily insulin. Negative beliefs about insulin therapy (24.1%) and forgetting injections (40.9%) were the most common reasons for treatment withdrawal and dose skipping, respectively. Younger age (49.5±15.0 vs 56.4±12.0 years) (P=0.001) and shorter duration of diabetes (4.8±4.3 vs 8.8±6.3 years) (P=0.0008) and treatment duration (5.2±2.4 vs 10.7±2.4 months) (P=0.0001) were noted, respectively, in discontinuers vs continuers. Basal bolus was the most commonly prescribed insulin regimen (51.0%), while associated with higher likelihood of skipping a dose than regular use (61.3% vs. 46.0%, P=0.04).ConclusionsPersistence to insulin therapy was poorer than anticipated but appeared to be higher in patients with the basal bolus regimen. Negative perceptions about insulin therapy seemed to be the main cause for poor adherence in our cohort.

Iatrogenic thyroid hormone excess seems to mimic the effects of endogenous thyroid hormone excess on paraoxonase activity, insulin sensitivity and oxidative stress. These findings suggest that TSH suppression with levothyroxine may increase oxidative stress and LDL oxidation and thereby promote atherogenesis.

Low- and high-level TSH suppression were equally effective in reducing nodule volume and thus, considering the complications of high-level TSH suppression, low-level TSH suppression should be used if one considers levothyroxine suppressive therapy to reduce thyroid nodule size.

Background Although patients with familial Mediterranean fever (FMF) are symptom-free between the attacks, subclinical inflammation may continue. Vitamin D (vit D) plays an important role in the modulation of immune system and might also influence the course of FMF. Endothelial dysfunction is previously demonstrated in Behcet's disease (BD) and vit D is implicated to modulate endothelial functions. Objectives We aimed to evaluate the status of serum 25(OH)Vit D3 levels and its association with disease activity, endothelial function and carotis intima media thickness (CIMT) in patients with FMF. Methods Sixty-two FMF (F/M: 42/20, mean age: 33.5 years), 43 ankylosing spondylitis (AS) (F/M: 19/24, mean age: 40.9 years) patients and 46 healthy controls (HC) (F/M: 26/20, mean age: 34.7 years) were studied. Serum 25(OH)Vit D3 levels were measured by HPLC method. Endothelial function was evaluated by brachial artery flow mediated dilatation (FMD) and CIMT with B-Mode ultrasound. The vitamin D-deficient BD patients received 1000 IU Vitamin D3 daily for 3 months. At the end of the third month of treatment, the subjects were re-evaluated for the same parameters (CIMT and FMD). Results The mean (SD) disease duration was 8.2 (7.8) vs 8.4 (6.5) years (p>0.05) in FMF and AS patients, respectively. All FMF patients were on attack-free period and all of them were on colchicine treatment. A significant difference was observed between the levels of 25(OH)Vit D3 between the groups [median (range): 11.3 (2.7-48.3), 12.7 (4-37) and 56 (14-125), FMF, AS and HC, respectively), p=0,001]. CIMT and FMD measurements were similar between groups (p>0.05). Serum 25(OH)Vit D3 levels were not observed to correlate with CIMT or FMD measurements. A significant increase of 25(OH)VitD3 levels after replacement therapy [11.3 (2.7-48.3), vs 30 (13-72) p=0.001] was observed after 3 months of therapy. Also, after replacement therapy, CIMT measurements improved (1,04 vs 0.50, p=0.001) and FMD measurements improved (4,9 vs 10,2, p=0.01) Conclusions A high presence of Vitamin D deficiency was observed in FMF patients from Turkey. Although impaired vascular endothelial function did not correlate with vitamin D levels, vitamin D deficiency may influence the course of the attacks and be related to some colchicine-resistant cases. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5994

ObjectiveAlthough levothyroxine (LT4) replacement therapy for hypothyroidism has been established as safe, inexpensive and effective, many studies from different countries reported out-of-reference range thyroid-stimulating hormone (TSH) values for the hypothyroid patients under LT4 treatment. The aim of this study was to determine TSH levels of primary hypothyroid patients under LT4 treatment and to assess self-reported compliance with daily LT4 intake in tertiary care centers in Turkey.DesignIn this cross-sectional, observational study, adult patients with primary hypothyroidism, receiving LT4 treatment for at least 6 months, were included. The patients were from 12 tertiary care centers in 9 cities of Turkey. TSH and free T4 levels were recorded from patient files and self-reported compliance with daily LT4 intake was assessed by interviewing the subjects at the last visit.ResultsA total of 1,755 subjects (46 ± 13 years; F/M: 89.9/10.1%) with primary hypothyroidism were enrolled. Of the hypothyroid subjects, 44.8% had out-of-reference range serum TSH levels. TSH values were over the reference range (TSH > 4 mIU/L) in 26.2% and were under the reference range (TSH < 0.5 mIU/L) in 18.6% of the patients. Total duration of LT4 treatment was 5.9 ± 4.7 years and mean dose was 1.2 ± 0.6 μg/kg/day. Non-compliant patients (31.1%) had higher TSH levels (6.9 ± 16 vs 3.8 ± 0.9 mIU/L, P = 0.01) compared to compliant patients.ConclusionThe results of this study revealed that nearly half of the hypothyroid patients had out-of-reference range serum TSH values, despite under LT4 treatment. Compliance with LT4 treatment seems to be one of the major determinants to reach the target TSH levels in hypothyroid patients.

Vitamin D supplementation increased insulin sensitivity and decreased androgen levels in vitamin-D-deficient women with PCOS but did not have any effect in vitamin-D-deficient non-PCOS women. These results may indicate the possible role of vitamin D in the complex pathogenesis of PCOS.