Slide Session : OS-END-20 ; Endocrinology : Hemorheological Approach for Early Detection of Diabetic NephropathyCardiovascular Risk Rates in Metabolic Syndrome and Atherosclerotic Marker Serum MatrIx MetalloproteIn-ase-9 Levels

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Esra Demir ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Metabolic syndrome (MS) is associated with increased cardiovascular risk. There are a lot of study that is releated with the correlation between metabolic syndrome and low grade inflammation. We have attempted to compare Framingham Risk Score(FRS) that calculates cardiovascular risc rates and Matrix Metalloproteinase- 9 levels that is an aterosclerotic proinflammatory marker, on metabolic syndrome`s between other healties. Method: We included 86 patients that contains 51 MS and 35 healties to this study..In both groups, age, length, weight, BMI, waist circumference, familial hearth disease and HT on family was registered. Framingham risk score (FRS) was calculated. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, Triglyceride levels saved. Blood samples for MMP -9 levels were taken and stored at -80 ℃. MMP-9 levels measured by the way of solid phase platinium ELISA (BIOSOURCE). Results: This case contained 86 patients, 51 of them is MS (%59.3) and the others are called as control group (%40.7). Ages of patients are changed between 20-55 years and the mean age is 38.52±10.02. FRS of MS patients were calculated statistically high compaired to control group (p=0.017). MMP-9 levels of MS patients were calculated statistically high compaired to control group (p=0.001).In both goups, there is no statistically significant relationship between MMP-9 levels and FRS (p>0.05) Conclusion: MMP-9 changes between the groups of MS young aged of 20-55 and health group may show us early atherosclerosis. At the group of high MMP-9 levels, even age releated cardiovasculary hearth disease risks are lower, risk was statistically calculated high compared to the other healthy populations. This situation is important in order to control risk factors as MS at early ages.

Poster Session:PS 0191 ; Endocrinology : In Circulation Increased Antithyroid Peroxidase Antibody and Matrix Metalloproteinase-9 Levels at Patients with Metabolic Syndrome

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Irem Kilic Utku ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Frequent changes in parameters like blood pressure, plasma lipid changes, waist circumference which are accepted as a metabolic syndrome (MS) are observed in thyroid patients with hypothyroid. In this study we investigated serum levels of TPO which is the diagnosis of hypothyroid and prognosis criteria antithyroid peroxidase antibody (Anti-TPO) in patients with MS and we analysed the correlation with matrix metalloproteinases-9 (MMP-9) which is accepted as an indicator of infl ammation in MS. Method: 51 patients with MS and 35 controls were enrolled in the study. Age, body mass index (BMI), waist circumference and hypertension (HT) values of both group were recorded in the beginning. Medical records of HT were noted and cardiovascular diseases in their family were queried. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, TG, TSH and Anti-TPO levels were measured. Blood samples for measuring MMP- 9 were stored at -80°C. Measurement of MMP-9 was performed by using solid phase platinum ELISA kits (Biosource). Results: Study was performed with 51(59,3%) MS group and 35(40,7%) control group. Both Anti-TPO and MMP-9 levels of patients with MS were statistically and signifi cantly higher than the levels of control group (p<0.01 for both group). There is a statistically signifi cant correlation (positive, 83.2%) between MMP-9 and TPO in patients with MS (p<0.01). There is a statistically signifi cant correlation (positive, 37.5%) between MMP-9 and TPO in controls (p<0.05). Discussion: Researching Anti-TPO in patients with MS might be an indicator of higher rate of both hypothyroid and MS. High levels of both MMP-9 (>76 mg/ml) and TPO show that TPO can be used as a cheaper and more easily provided marker in patients with MS without acute thyroid. Anti-TPO follow-up might be necessary in MS diagnosis and monitoring.

Poster Session:PS 0257 ; Gastroenterology : Gastric Xanthelasma an Incidental and Benign Lesion of Stomach: A Case Presentation

( Ece Yigit Taskin ),( Sibel Serin ),( Kevser Kutlu Tatar ),( Sema Basat ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Gastric Xanthalesmas are rare benign incidental yellow-white lesions between 0.5-10 mm in size. They are detected more frequently in female patients and the frequency of these lesions increases with age. Although the etiology of these lesions are unclear, chronic gastritis, gastrointestinal anastomosis, intestinal metaplasia, and H. pylori infection are found to be associated with GI xanthalesmas. They are usually located in antrum of the stomach in gastrointestinal tract, especially along the lesser curvature. In contrast to cutaneous xanthalesmas there is no evident association between GI xanthalesmas and hyperlipidemia. Methods: Here we present endoscopic and histological features of gastric xanthalesma in a 65 year old man with a history of chronic gastritis and iron defi ciency anemia. Results: Patient presented with iron defi ciency anemia. Upper GI endoscopy and colonoscopy has been done for investigation of the etiology. Colonoscopy showed diverticular disease of the colon. Upper GI endoscopy of the patient showed a 4mm foamy yellowish lipamatous lesion at the lesser curvature of the stomach (Image). Multiple biopsies are obtained from the lesion. The histology showed large foamy histiocytes containing a mixture of lipids in the mucosa and the submucosa. The multiple biopsies obtained from the antrum showed intestinal metaplasia and chronic gastritis with H.plylori positivity. Conclusion: Gastric xanthalesmas are asymptomatic benign and incidental endoscopic fi ndings. Even though they can be found in every part of Gastrointestinal tract from esophagus to colon, they are frequently observed in stomach. They are usually associated with chronic gastritis, Helicobacter pylori infection and intestinal metaplasia. Although the clinical signifi cance is unclear, gastric xanthalesmas are important lesions and biopsies should always be performed because they are frequently confused with malignant lesions.

Poster Session : PS 0453 ; Infectious Disease ; Infective Endocarditis Case Presented with Endogenous Endophtalmitis

( Kevser Kutlu Tatar ),( Sibel Serin ),( Ece Yigit Taskin ),( Betul Ayaz ),( Sema Ucak Basat ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Endogenous endophtalmitis (EE), a sight-threating emergency,has been reported as the 2-8% of all endophthalmitis cases. EE is most often associated with a diagnosed underlying medical condition, including DM, liver disease, cardiac disease, malignancy, in-dwelling catheters and intravenous drug abuse (IVDU). A woman, 69 year-old, diagnosed with EE was followed up in the ophthalmology clinic for vitrectomy, consulted due to abdominal pain, pyuria and high levels of cholestasis enzymes. The patient had DM, hypertension, and ischemic heart disease for the last decade and severe heart failure for the last month. She had femoral catheter for ultrafi ltration two weeks ago. She was transferred to the internal medicine clinic with the differential diagnosis of heart failure, acute cholecystitis and urinary tract infection. In the MRCP imaging following an abdominal US, a signal differentiation due to possible metastasis or abscess was identifi ed in the liver. Multiple calculus in the neck of the bile cyst and cystic duct, sludge in gallbladder, expansion in choledoch diameter and multiple calculus at the distal part of choledoch were detected. A bilobular and fi at contoured, 85x140mm lesion was found at the left adnexa. A third echocardiography in a month was performed for her recently diagnosed cardiac failure and 2/6 systolic murmur, which was detectable best from the mitral point. The last echocardiography showed %50 EF, intermediate-advanced mitral insufficiency and a mass-vegetation on mitral valve. TEE, performed afterwards, showed vegetation on mitral valve and the possibility of valve perforation. Due to the continuation of decompensation and total obstruction in circumfi ex artery seen on the coronary angiography, coronary bypass and vegetation removal operations were performed. In this case, we present a case which has almost all the etiological reasons together except IVDU and which was diagnosed as IE based upon the EE diagnosis.

Serum galactomannan levels in the diagnosis of invasive aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Hasan Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan A 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as “proven,” “probable,” or “possible” as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group.” Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/ specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.

Slide Session : OS-HEM-11 ; Hematology : Single Centre Experience of Serum Galactomannan Levels in the Diagnosis of Invasive Aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan Ali ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Invasive aspergillosis (IA)) is a serious cause of morbidity and mortality in immunocompromised patients with haematologic malignancy. The serum galactomannan enzyme immunoassay (GM-EIA; Platelia Aspergillus EIA; Bio-Rad) was cleared by the Food and Drug Administration at an optical density index cut-off of 0.5 for a probable diagnosis of invasive aspergillosis. In this prospective study GM-EIA (Platelia Aspergillus EIA, Bio-Rad) with 0.5cut-off value and sequential sensitivity-specificity for single, consecutive two and consecutive three positivity were investigated for the diagnosis of IA in neutropenic hematologic patients. Methods: Serum samples were taken twice a week from patients during their hospitalization. IA was classified according to European Organisation for Research and Treatment of Cancer and Mycoses Study Group Guidelines as “proven”, “probable”, and “possible”. The sensitivity was calculated from the results of patients with proven/propable and the specificity was calculated from the results of patients non-IPA patients. Results: In 165 consecutive febrile episodes in 106 patients, 80 (48.5%) episodes were defined with IA (4 proven, 11 probable, 65 possible) and 85 (51.5%) episodes were defined as non-IA. Per episode average 8.3 serum samples were examined for a total of 1385 serum samples. Cut-off value of single GM-EIA = 0.5 for proven/probable IA with sensitivity/specificity 100%/ 27%, two consecutive positive GM-EIA = 0.5 with sensitivity/specificity 86%/ 71% and three consecutive positive GM-EIA = 0.5 with sensitivity/specificity 73%/85% were obtained. Conclusions: Measuring the level of galactomannan twice a week and consecutive monitoring reduced the sensitivity and increased the specificity. Monitoring of the GM-EIA frequently from the first positivity can increase sensitivity/specificity.