We report on a young female who had presented with fatigue, bilateral knee pain and gait disturbance. Primary hyperparathyroidism was diagnosed together with splenomegaly and anemia. Bone marrow biopsy revealed myelofibrosis. A parathyroid adenoma was excised during surgical intervention. As early as three months after the operation, hematologic parameters improved along with bone markers without any other intervention. The control bone marrow biopsy demonstrated well marked regression in marrow fibrosis. Her spleen has also gradually decreased in size. These findings indicate that her myelofibrosis was the result of primary hyperparathyroidism. Anemia associated with primary hyperparathyroidism may be due to bone marrow fibrosis.

Original Article / Özgün Araştırma Abs tractAim:Use of herbal products is relatively common among general population. We aimed to study the use of herbal products for any reason in patients with type 2 diabetes mellitus (DM).Methods: A questionnaire containing objective questions was filled for 120 type 2 diabetic patients. This form included sociodemographic characteristics, DM history, other comorbidities, diabetic complications, details about the use of the herbal product and knowledge of the physician.Results:60.8% of patients were female, 86.7% were married and 65% were primary school graduates. The mean age was 57.4±11.1 years 52.1% of patients used one or more herbal products after diagnosis of DM, while 10% used before diagnosis. 48.4% of subjects provided them from herb and spice sellers and 29% from gardens and vineyards. Only 6.5% of patients decided to use them on the advice of a health-care professional. 82.3% of subjects did not inform their physician. There was no relationship of use of herbal products, its frequency, type of the product and advisor with gender, marriage status and education status. Conclusion:Use of complementary and alternative medicine among diabetic patients is quite frequent and considering the low rate of informing the physician, placing restriction on these products as well as education of patients is of prime importance.

Excess N-terminal pro-brain natriuretic peptide secretion has been linked to cirrhosis in previously studies. The relationship of plasma N-terminal pro-brain natriuretic peptide levels and cardiac dysfunction determined by echocardiography were investigated in patients with nonalcoholic cirrhosis and a control group of chronic hepatitis. This study was designed as a cross-sectional study. Thirty-two men and thirty-three women who gave informed consent who were followed-up for chronic liver failure were enrolled. All patients gave clinical history, physical examination was carried out and information about ongoing medication has been obtained. Serum N-terminal pro-brain natriuretic peptide level was measured in all patients. The same cardiologist determined ejection fraction, end-diastolic left ventricular diameter, interventricular septum, and posterior wall on transthoracic echocardiography. Patients with extensive liver disease according to Child-Pugh classification from A to C had increasing N-terminal pro-brain natriuretic peptide levels in association (P < .001). According to the Child-Pugh classification there were no significant difference between groups for echocardiographic measurements (P > .05). N-terminal pro-brain natriuretic peptide may be an important marker for cardiac dysfunction in patients with chronic liver failure in accordance with Child-Pugh stage.

Obez ve normal kilolu hipotiroidi hastalarının beden kitle indeksi ve lipid değerlerinin karşılaştırılması Amaç: Hipotiroidi hastalarında obezite ve beraberinde hiperlipidemi görülmektedir. Bu çalışmada Haseki Eğt. Arş. Hastanesi lipit polikliniğinden takip edilen hipotirodi hastalarının laboratuar verileri değerlendirilerek hipotiroidik hastalarda obezite ile lipit değerleri ilişkisi araştırıldı. Gereç ve Yöntem: Haseki Eğt. Arş. Hastanesi lipit polikliniğinde 2003-2006 yıllarında takip edilen 37 hipotiroidi hastasının dosyası retrospektif olarak incelendi ve hastalar, başvuru sırasındaki vücut kitle indeksleri (VKİ) (≥30=obez) dikkate alınarak obez (vaka) ve nonobez (kontrol) olarak 2 gruba ayrıldı. Çalışmada hastaların yaş, cinsiyet, VKİ, glukoz, TSH, total kolesterol, LDL, HDL, trigliserit değerleri dikkate alındı. Bulgular: Çalışmaya alınan 37 hipotiroidi hastasından 19'u obez (vaka grubu), 18'i nonobez (kontrol grubu) olarak değerlendirildi. Vaka grubu 1 erkek, 18 kadın, kontrol grubu ise 6 erkek, 12 kadın hastadan oluştu. Vaka grubunun HDL değerleri anlamlı olarak düşük saptandı (p<0.01). Glukoz değerleri de anlamlı olarak yüksek saptandı (p<0.01). Vaka grubunun trigliserit değerleri kontrol grubuna kıyasla yüksek olmakla birlikte istatistiksel anlamlı bir fark yoktu (p=0.31). Gruplar arasında LDL ve total kolesterol açısından anlamlı bir farklılık saptanmadı. Sonuç: Hipotiroidili hastalarda obezite sık görülmekte olup, bu grupta hiperlipidemi ve glukoz intoleransına da daha sık rastlanmaktadır. Yaptığımız çalışmada VKİ'lerine göre obez ve nonobez olarak ikiye ayrılan hipotiroidi hastalarının total kolesterol ve LDL değerleri arasında anlamlı bir fark saptanmadı. Obez grubun trigliserit ve glukoz değerleri yüksek, HDL değerleri düşük saptandı. Hipotiroidi hastalarının tedavisi sırasında hiperlipidemi gözden kaçırılmamalı aynı zamanda tek başına hiperlipidemisi olan hastalarda tedavi öncesi tiroid hormonları görülmelidir.

No abstract