Effects of pulse methylprednisolone and oral methylprednisolone treatments on serum levels of oxidative stress markers in Graves' ophthalmopathy.

BACKGROUND: Recent evidence has shown that oxidative stress may play a role in the pathogenesis of autoimmune diseases, and this is an issue of considerable research interest in the field of infiltrative ophthalmopathy. Therefore, we evaluated both the relationship between Graves' ophthalmopathy (GO) and serum levels of certain indicators of oxidative stress, and the effects of methylprednisolone treatment on serum malondialdehyde (MDA) and glutathione (GSH) levels in patients with euthyroid GO. MATERIALS AND METHODS: We compared GO patients to both Graves' patients without ophthalmopathy and healthy controls. Ultimately, we assessed four subject groups. Graves' patients with ophthalmopathy (GO) were subcategorized into two groups: Group A subjects (n = 18) were given intravenous glucocorticoid and Group B patients (n = 15) were given oral glucocorticoid. Graves' patients without ophthalmopathy comprised Group C (n = 20), and healthy controls comprised Group D (n = 15). Serum levels of MDA and GSH were measured at baseline and after 4 and 24 weeks of observation via spectrophotometric methods. RESULTS: We found that serum MDA levels were significantly higher in the two GO groups (Groups A and B) than in GO patients without ophthalmopathy or healthy controls. Conversely, GSH levels were significantly lower in the two GO groups than in Groups C and D. MDA and GSH levels were not different between the latter two groups. MDA levels were strongly and positively correlated with a clinical activity score (CAS). In Group A, MDA levels and the CAS were significantly lower than in Group B at 4 weeks. After 24 weeks, however, MDA levels and the CAS were similar in these two groups. CONCLUSION: 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.

Evaluation of urinary oxalate levels in patients receiving gastrointestinal lipase inhibitor.

OBJECTIVE: The purpose of this study was to examine the possible effects of a gastrointestinal lipase inhibitor "Orlistat (Xenical)" on the intestinal absorption of oxalate and thereby on the urinary levels of oxalate excretion in overweight patients. METHODS AND PROCEDURES: Long-term follow-up data of 95 cases (57 men, 38 women; M/W=1.5) were documented. Patients were randomly assigned into two groups. While the patients in group I (n=55) were treated with orlistat (Xenical) for 6 months, patients in group II (n=40) received no specific medication. Calcium, oxalate, and citrate levels were determined in a 24-h urine collection from each patient. To evaluate the significance in the groups as well as the differences between the two groups, ANOVA test was performed and the results were given as mean +/- s.d. RESULTS: Comparative evaluation of urinary oxalate levels during 3-month follow-up clearly showed that urinary oxalate excretion significantly increased in 34/55 patients (61.8%) in the first group (P<0.05). Of these 34 patients, 30 (88.2%) continued to have increased urinary oxalate excretion during 6-month follow-up (P=0.001). However, our data did not show any significant effect of this medication on urinary citrate and calcium levels during 3- and 6-month follow-up evaluation (P=0.05). DISCUSSION: 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.

The value of urine specific gravity in detecting diabetes insipidus in a patient with uncontrolled diabetes mellitus: urine specific gravity in differential diagnosis.

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.

The relationship between serum total sialic acid levels and adenosine deaminase activity in obesity.

OBJECTIVE: To evaluate the relationship between serum adenosine deaminase (AD) activity and serum total sialic acid (TSA) levels in obese individuals. METHODS: We performed this study at the Department of Chemistry, Division Biochemistry, Kahramanmaras Sutcu Imam University Arts and Science Faculty, Turkey from 2003 to 2004. Fifty obese subjects and 25 non-obese healthy controls were included in the study. The serum AD activity and TSA concentrations were measured by spectrophotometric methods. RESULTS: The AD activity (p<0.01) and TSA concentrations (p<0.001) were significantly higher in the sera of obese subjects than those of non-obese control subjects. But, there was no statistically significant difference in the serum TSA levels and AD activity of the obese subjects with metabolic syndrome properties compared with those without metabolic syndrome properties. A significant correlation between the serum TSA and AD was found in the obese subjects (p<0.05, r: 0.33). CONCLUSION: Our findings suggest that there may be a closer interaction between the inflammatory events and obesity. However, our observations need to be confirmed by further studies to understand more regarding the underlying mechanisms.

Propylthiouracil-related hemorrhagic diathesis: a case report and review of the literature.

We present an unusual case of a drug-related hemorrhagic diathesis. One month prior to admission, the patient was diagnosed at another medical center as having Graves' disease and propylthiouracil therapy (PTU) was initiated. Since clinical recovery was not achieved, the PTU was quickly increased to an unconventional daily dose of 1,000 mg. The patient was referred to our hospital because of spontaneous epistaxis, multiple ecchymoses and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), which developed soon after the increase in PTU dose. Drug-related hemorrhagic diathesis was considered, after other possible causes had been eliminated. To the best of our knowledge, this is the first reported case of spontaneous hemorrhage due to PTU use.

Angiotensin-converting enzyme gene polymorphism and coronary heart disease in Turkish type 2 diabetic patients.

OBJECTIVE: It has been suggested that the insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) may be associated with atherosclerosis. The aim of the study was to examine the association between ACE gene polymorphism and coronary heart disease in Turkish type 2 diabetic patients. METHODS AND RESULTS: A total of 152 (97 female, 55 male) type 2 diabetic patients were included into the study. All patients underwent myocardial perfusion scintigraphic examination and forty-five of them with a perfusion defect underwent coronary angiography.Thirty-eight patients with a coronary stenosis of more than 50% on coronary angiography were considered as having coronary heart disease. The I/D polymorphism was determined by polymerase chain reaction. There was no statistically significant difference in genotypic and allelic frequencies of the ACE I/D polymorphism among patients with and without coronary heart disease (DD:ID:II (%), 32:58:11 and 39:44:17, respectively). CONCLUSIONS: ACE gene polymorphism is not a significant parameter to determine coronary heart disease in Turkish type 2 diabetic patients.