A prospective, randomised and single blind clinical trial was designed to compare intravenous methylprednisolone pulse (IVGC) with oral methylprednisolone (OGC) monotherapy in terms of effectiveness and tolerability in Graves' ophthalmopathy (GO). Fifty-two consecutive patients with untreated, moderately severe and active GO were randomly treated with either IVGC or OGC therapy for 12 weeks. IVGC therapy achieved a more rapid and significant improvement than OGC therapy according to clinical activity score (p < 0.01), proptosis (p < 0.038), lid width (p < 0.0001), extraocular muscle changes (p < 0.02), optic neuropathy. (p < 0.001), intraocular pressure (p < 0.04), visual acuity (p < 0.03), quality of life (p < 0.0001) and treatment response (p < 0.001). Diplopia was significantly improved in two groups but there was no difference between them (p < 0.6). Heavy smokers indicated alteration of ophthalmic signs with increased thyroid stimulating hormone (TSH)-receptor antibody during the therapy. In conclusion, IVGC therapy was more effective and better tolerated than OGC therapy in the management of GO.

Oxidative stress appears to be involved in the pathophysiology of GO. Relative to oral dosing, the intravenous administration of a glucocorticoid seems to yield more rapid improvement in disease activity. MDA might be useful as an indicator of clinical activity.

A 70-year-old woman with giant hiatal hernia presented with stable angina pectoris and three syncope attacks in the previous 3 months. Chest radiography showed marked cardiomegaly and an air-fluid level at the basal region of the heart. A mixed type large hiatal hernia that distorted the heart was detected in contrast-enhanced computed tomography and esophagogastroduodenography. Postprandial nonsustained ventricular tachycardia was present on 24-hour Holter ECG monitoring. The patient's symptoms were attributed to giant hiatal hernia and improved following surgery.

Our results suggest that increased intestinal absorption of dietary oxalate due to this type of medication in obese patients could make a substantial contribution to urinary oxalate excretion and may increase the risk of stone formation.

When a patient with diabetes mellitus presents with worsening polyuria and polydipsia, what is a sensible, cost-effective approach? We report the unique coincidence of type 2 diabetes mellitus and diabetes insipidus. A 46-year-old woman with poorly controlled type 2 diabetes complained of polyuria with a daily output of 5 L. Although urinalysis demonstrated significant glucosuria, diabetes insipidus was suspected owing to a low urine specific gravity (1.008). The low specific gravity persisted during a water deprivation test. Ultimately, diabetes insipidus was confirmed when urine specific gravity and urine osmolality normalized following desmopressin administration. This case emphasizes the importance of accurately interpreting the urine specific gravity in patients with polyuria and diabetes mellitus to detect diabetes insipidus. Diabetes insipidus is a disorder that is characterized by complete or partial deficiency of antidiuretic hormone or by unresponsiveness to this hormone, such that patients present with polyuria and polydipsia. When a patient presents with polyuria and polydipsia, both diabetes mellitus and diabetes insipidus are the diseases that should be part of the differential diagnosis. Except for the well-defined inherited disorder, the DIDMOAD syndrome, which is characterized by diabetes insipidus (DI), type 1 diabetes mellitus (DM), optic atrophy (OA), and deafness (D), 1 the concurrence of diabetes insipidus and diabetes mellitus, either type 1 or 2, has not been previously reported. In 1 isolated case, the association of diabetes insipidus and type 2 diabetes mellitus was described as a rare entity. 2 This case emphasizes the importance of accurately interpreting the urine specific gravity in patients with polyuria and diabetes mellitus, to detect diabetes insipidus. CASE REPORTA 46-year-old woman was referred to our hospital because of worsening polyuria and polydipsia of 2 months duration. She had a 10-year history of type 2 diabetes mellitus, with poor glycemic control that required insulin. On repeated urine analysis, a 24-hour urine collection revealed a urine specific gravity of 1.008. Therefore, we suspected that diabetes insipidus might be the underlying cause, owing to the presence of a persistently low urine specific gravity. A urine and plasma osmolality was subsequently performed, which were 138 and 285 mmol/kg, respectively. These findings were consistent with diabetes insipidus. A water deprivation test was then performed. No significant increase occurred, either in urine specific gravity or urine osmolality. After the administration of desmopressin, urine specific gravity increased to 1.019 (in a 24-hour urine collection) and urine osmolality increased to 488 mmol/kg. In view of these results, a diagnosis of central diabetes insipidus was made. The patient's family history was unremarkable. The patient did not receive any medications except for insulin. The patient had no history of neurosurgery or trauma and no evidence of systemic illness such as weight loss and fever. The ...

ACE gene polymorphism is not a significant parameter to determine coronary heart disease in Turkish type 2 diabetic patients.

SUMMARYThe aim of this study was to investigate the prevalence of hepatitis B and hepatitis C virus infections in type 2 diabetic patients in Gaziantep, Turkey. Six hundred and ninety‐two type 2 diabetic patients and 1014 healthy blood donors were included in the study. No significant difference was found between type 2 diabetic patients and the control group for seropositivity of HBsAg (5.3% vs 5.1%, p>0.05). In contrast, anti‐HCV was significantly more frequent in type 2 diabetic patients (7.5% vs 0.1%, p>0.0001). We found no significant difference for HBsAg seropositivity between type 2 diabetic patients with a disease duration of 12 months or less, but anti‐HCV seropositivity was significantly more frequent in diabetic patients with a longer disease duration (p<0.05). We suggest that HCV infection is not a trigger factor for type 2 diabetes mellitus but is frequently associated with it.

It has been suggested that an insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin converting enzyme (ACE) gene may be associated with essential hypertension. The aim of this study was to examine the association between ACE I/D polymorphism with blood pressure level and hypertension status in Turkish type 2 diabetic subjects. Hundred and seven hypertensive (78 female, 29 male) and 132 normotensive type 2 diabetic subjects (73 female, 59 male) and 138 sex and age matched control subjects (87 female, 51 male) without diabetes and hypertension were included into the study. The I/D polymorphism was determined by polymerase chain reaction (PCR). There were no statistically difference in genotypic and allelic frequencies of the ACE I/D polymorphism between the hypertensive and normotensive diabetic patients and control subjects. Also no significant differences was detected in systolic and diastolic blood pressure among three different genotypes. ACE I/D polymorphism does not seem to play an important role in the development of hypertension in Turkish type 2 diabetic subjects, but prospective studies may show an association between ACE gene polymorphism and the development of hypertension in diabetic subjects.