Objective: Despite the high frequency of bilateral disease in patients with papillary thyroid cancer (PTC), the importance of bilaterality in the prognosis of the disease is still unclear. In this study, we aimed to figure out the effects of bilaterality in the prognosis of the disease.
Material and Method: A total of 113 patients with PTC, who were treated in our clinic with total thyroidectomy between 2011 and 2014, were divided into three groups: Group 1, patients with unilateral disease with single focus; Group 2, patients with unilateral disease with multiple foci; Group 3, patients with bilateral disease with multiple foci.
Results: There was a statistically significant difference between the presence of bilateral disease, compared to unilateral disease, in terms of lymphovascular invasion (p=0.001), the diameter of the tumor (p=0.028), extra- thyroidal disease (p=0.012), T stage of the disease (p=0.042) and lymph node metastasis (p=0.001).
Conclusion: Patients with bilateral papillary thyroid cancer are more likely to have larger tumors, higher extra- thyroidal dissemination rates, advanced T stages, lymph node metastasis and more aggressive tumors when compared to unilateral disease. Due to these considerations, the surveillance of the patients with bilateral papillary thyroid disease should be done more carefully and effectively.

Objective: In this study, we present functional and radiological results for patients treated for distal radius fractures with a non-bridging external (mini tube) fixator, which allows early movement.
Material and Method: A total of 27 patients (14 female and 13 male) with 29 distal radius fractures were included in the study. The mean age was 56.3 years (range: 23–83 years). According to the AO/ ASIF classification, three fractures were of type A, and 26 fractures were of the unstable type C. All the fractures were treated with close reduction and fixed with non-bridging external fixation. The radiological results were evaluated according to Stewart’s radiological-anatomical scoring system. The patients’ functional levels were evaluated according to the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, the MAYO Modified Wrist Score, and Stewart’s modification of the Gartland-Werley scoring system. The mean follow-up time was 20.7 months (range: 12–38 months).
Results: According to Stewart’s radiological-anatomical scoring system, out of 29 involved extremities in 27 patients, 7 (24.13%) wrists were excellent, 19 (65.51%) were good, and 3 (10.34%) were fair. No patient was graded as bad. According to Stewart’s functional scoring system, out of 29 extremities, 6 (20.6%) were excellent, 14 (48.2%) were good, and 7 were (24.1%) fair, but 2 patients
(6.8%) were bad.
Conclusion: Non-bridging external fixation is an easy to apply and effective method of treatment for closed reducible distal radius fractures, which allows early motion.

Objective: Pilon fractures are usually caused by high-energy traumas and associated with surrounding soft tissue damage. In addition to the patient’s medical state and comorbidities, the poor vascular supply of the distal tibia makes the reconstruction challenging in most of the cases.
Material and Methods: Eight patients with pilon fractures (AO types 43A-C) who were treated by the orthopaedics clinic between January 2012 and August 2015 were included in the study. These patients were consulted to our clinic due to full thickness soft tissue defect at the affected site during the operation, and were treated with reverse flow sural flap. Patients were analyzed retrospectively in terms of age, etiology, size of defect and postoperative complications.
Results: Between January 2012 and August 2015, 8 patients (4 females, 4 males) aged between 7 and 88 years (mean age: 46 years) underwent soft tissue reconstruction with reverse flow sural flap, due to tissue defect occurred after the pilon fracture. In the postoperative period, complications such as wound dehiscence, flap loss and infection were not encountered in any patients except one, who developed partial soft tissue necrosis and healed by secondary intention.
Conclusion: Pilon fractures are among the most difficult fractures of the ankle to treat, and have a high complication rate. Sural flap is a reliable way to reconstruct distal tibial defects in single or multiple-stage approaches.

Objective: The mortality rate in cardiovascular surgery procedures varies with different centers around the globe. Identification of risk factors for perioperative mortality and establishment of protocols for this may increase survival in patients. In this study, we investigated the mortality rates
and corresponding risk factors in cardiovascular surgery.
Material and Methods: A retrospective cohort study was performed in the patients who were admitted to the Cardiovascular Surgery Clinic and died in the perioperative period.
Results: A total of 4037 patients were admitted to the Cardiovascular Surgery Service between January 1, 2013 and December 31, 2016, during four years. In patients treated in intensive care unit, open heart surgery for 567 patients and peripheral vascular disease surgery for 525 patients were planned. Thirty patients who had open heart surgery and 14 patients who had peripheral vascular disease died in perioperative period at the intensive care unit. The general mortality rate in the Cardiovascular Surgery Clinic during this 4-year period was found as 1.1%. The mortality rate of open heart surgery was 5.1% whereas that of peripheral vascular surgery was 2.7%. Hypertension, chronic kidney disease and diabetes mellitus were detected as the most common accompanying systemic diseases. Ejection fraction (EF) was found as 48.4±13.7, Euroscore Additive as 10.0±4.2, cross-clamp time as 125.1±51.9 minutes and cardiopulmonary bypass (CPB) duration as 192.0±81.1 minutes in patients who were lost during open heart surgeries. The APACHE II scores of the patients who were scheduled for peripheral vascular disease and were lost in the perioperative period were detected as 26.1±8.5.
Conclusion: The mortality rate of open heart surgery in our clinic, when compared within the global scale is between developed and emerging countries. Presence of preoperative systemic diseases in cardiovascular surgery patients is significantly correlated with the mortality rate.

Objective: In this study, we aimed to evaluate the patients aged 65 years and older who underwent surgery for acute appendicitis.
Material and Methods: The data of the 33 patients aged 65 years and older who underwent appendectomy for acute appendicitis between January 2011 and December 2014 were retrospectively analyzed. The demographic data, duration of complaint, comorbid diseases, operative findings, the period between the onset of abdominal pain and the admission to the hospital, duration of hospital stay, complications and mortality rates were evaluated. Patients were divided into 2 groups according to their comorbidity status.
Results: There were 21 female and 12 male patients. The mean age of the patients was 73.9 years (range: 65-89 years). Of the patients, 10 patients had diabetes mellitus, 16 had hypertension, 3 patients had heart / valve disease, 3 had COPD and 2 had cerebrovascular disease. Appendectomy was performed with laparoscopy in 7 patients, with Mc Burney’s incision in 14 patients and 11 patients were operated with median incision; in 1 patient, the operation was initiated with laparoscopy then proceeded with Mc Burney’s incision. Ultrasound examination revealed acute appendicitis in 22 patients. Computed tomography was performed in 19 patients. The mean period of hospital stay was 5.66 days (range: 1-33 days). Eight of the patients were followed up in postoperative intensive care unit (ICU). Six patients developed wound infection and 2 patients developed intra-abdominal abscess. All complications were seen in group 1. There was a statistically significant difference between the groups (p<0.05). Mortality occurred in 1 patient.
Conclusion: Because of the high rate of complication in the presence of morbidity, the importance of preoperative evaluation, optimum preoperative care and completion of prophylaxis and incision selection according to the patient can reduce the rate of complication.

Objective: Of the second trimester maternal screening tests, the triple screening test, is used to determine the risk of certain fetal chromosomal abnormalities, particularly Down’s Syndrome. Besides the risk assessment for chromosomal abnormalities, many adverse pregnancy outcomes (APO) can be predicted with this test. In our study, we aimed to determine the relationship between the triple screening test results with APO and to define the cut-off values in serum markers for these APO.
Material and Methods: A total of 1372 pregnant women who had a triple screening test between April 2014 and 2015 and then gave birth in our hospital during the period of one year were included in the study. Complete demographic and clinical characteristics were obtained from records including age, weight, obstetric history, presence of any comorbid conditions, in vitro fertilization pregnancies, smoking, gestational weeks on triple screening test and at delivery, birth weight, type of delivery, gender of baby.
Results: The mean age of our study population was 27.9±5.6, whereas the median age was 28 years. The mean gestational week was 17.3±1.0 during the triple screening test, and 38.3±2.7 at the time of delivery. Most patients were multiparous and had vaginal delivery. The APO were encountered mostly in the older age multiparous patients and in cesarean group. The cut-off values for APO were determined to be > 0.935 MoM for AFP, < 0.945 MoM for E3 and > 0.945 MoM for hCG.
Conclusions: The second trimester screening test is applied to all patients in our clinic, due to its low cost and high effectiveness in predicting the chromosomal abnormalities. In fact, determination of risk for the APO with the first trimester screening test is more meaningful, because of the feasibility of prevention strategies such as bed rest and use of aspirin. Nevertheless, it is important to inform the patients about the benefits of the second trimester screening test to be predicting APO and recommend it.

Objective: Mad honey intoxication results from consuming honey which is produced from rhododendron flowers and containing Grayanotoxin (GTX). This intoxication is seen rarely, however it may lead some life-threatening signs. In this study, it was aimed to retrospectively discuss the effects of 38 mad honey intoxication cases on the organs in the light of demographic and biochemical blood gas parameters.
Material and Methods: We enrolled 38 patients diagnosed with “mad honey intoxication” retrospectively, who were admitted to our emergency department between January 2010 to December 2012.
Results: Of cases, 23 (60.5%) were male and 15 (39.5%) were female. Our cases were between the ages of 29 and 86 years. The mean age of cases was 55.42±12.63 years. The mean onset of symptoms after honey intake was determined to be 92.82±30.09 minutes. The mean heart rate when cases applied to hospital was found to be 49.74±11.41 beats/min. and the mean systolic and diastolic blood pressures were found to be 72.16±16.92 mmHg and 43.79±10.58 mmHg, respectively.
The mean amount of atropine treatment given to the patient was found to be 0.76±0.55 mg and the mean crystalloid fluid given was 1336.84±935.31 mL. Except the rhythm problems, gastrointestinal, respiratory and cardiovascular system findings were in normal range. There was no correlation found between the amount of honey consumed and the onset of symptoms in the cases.
Conclusion: Mad honey intoxication most often affects the cardiovascular system. Hypotension and bradycardia are the most common signs in these patients. Sufficient fluid hydration and 1-2 mg intravenous atropine are often adequate for the treatment.

Objective: Ventilator-associated pneumonia (VAP) is one of the leading nosocomial infections in intensive care units (ICUs), causing high mortality and increased health care costs. It is known that early diagnosis and treatment reduces mortality and morbidity. In this study, we aimed to assess the efficacy of Clinical Pulmonary Infection Score (CPIS) in early diagnosis in VAP.
Material and Methods: The study was performed on 43 cases. Clinical Pulmonary Infection Score parameters of each patient; body temperature, leukocyte count and morphology, volume and character of tracheal secretions, arterial oxygenation, pulmonary infiltration on chest X-ray, progression of pulmonary infiltration, microbiological culture results were recorded. Clinical Pulmonary Infection Scores were calculated at admission using the first five parameters of CPIS (basal CPIS) and after 48 hours following intubation, using seven parameters with the tracheal aspirate (TA) culture results. The patients were followed with CPIS calculated during the mechanical ventilation and with tracheal aspirate (TA) cultures obtained every three days. The patients were grouped as VAP (+) and VAP (-) in accordance with the obtained data.
Results: Basal CPIS levels were similar between the two groups (p>0.05), while significant differences were detected between the 48th hour and 5th day CPIS (p<0.01). There was difference between the pre-diagnosed CPIS levels of VAP (+) and VAP (-) cases (p<0.01).
Conclusion: Serial CPIS measurements can help the clinician in early diagnosis and treatment of VAP

Objective: To assess whether the emergency physicians are aware of legal obligations and responsibilities, and their point of view and knowledge levels on this topic.
Material and Methods: The study was conducted among emergency physicians as a face-to-face survey by giving verbal information, from different emergency departments of Turkey who attended the 4th International Euroasian Congress of Emergency, where 600 participants participated between 13-16 November 2014. All of the questions were organized in relation to the legal obligations of the physician.
Results: A total of 124 physicians participated in the questionnaire. Their mean age was 29.13±13.10, their medical experience was 29.13±13.10 years, and their mean emergency experience time was 7.17±4.90 years, and mean time after emergency residency was 2.96±4.00 years. It is striking that 43 (34.7%) of the participants answered the question “what is the most important legal responsibility of
emergency physicians?” as “to pay attention to patient care”. 116 (93.5%) of participants stated that handcuffs had to be removed during medical examination of the prisoners and detainees, and 100% of them reported that the patient’s privacy should be respected.
Conclusion: We think that physicians must be well-educated on legal issues during their undergraduate education to learn and apply the legislation about medical practice, and various courses and symposiums should be organized within the framework of in-service training.

Objective: Catheter knotting is a rare complication of coronary angiography. Treatment is controversial and differs from one laboratory to another.
Case: A 79 year-old patient was taken to the catheterization laboratory for diagnostic coronary angiography. Right coronary artery couldn’t be cannulated with 5-F JR4 diagnostic catheter due to severe subclavian artery tortuosity. After several clockwise and counterclockwise maneuvers, a catheter knot was formed in the brachial artery region. Due to multiple unsuccessful attempts for retrieval, the patient experienced severe forearm pain which led to discontinuation our maneuvers. Therefore, we decided to perform surgery for removal of the catheter. We pulled the catheter slowly until the knot reached the tip of the sheath. The knot being in the radial artery, a surgical arteriotomy
was performed safely under local anesthesia.
Conclusion: When all efforts fail, surgery can still be performed safely. In that situation, pulling the knot back into the radial artery should be tried vigorously

Objective: Appendiceal cystadenoma (AC) is a rare pathology diagnosed in 0.6% of all appendectomy operations. The purpose of the report was to present a rare case of ileal volvulus due to appendiceal cystadenoma, which was successfully treated with surgery.
Case: A woman aged 76 years was admitted to our emergency service with severe right lower quadrant pain. Abdominal tomography and X-ray showed features of generalized dilatation of bowel segments with periluminal fluid collections. Intraoperatively, we found bowel volvulus and a 2 cm mass at the appendiceal borders and an appendectomy was performed. The volvulated ileal segment was resected and restored with end-to-end anastomosis. Histopathologic examination of the mass revealed mucinous cystadenoma. Our patient was discharged from the hospital at postoperative one week with complete clinical recovery.
Conclusion: Obstruction of the appendiceal lumen by a mucinous neoplasia can cause appendicitis followed by secondary volvulus in different parts of the gastrointestinal tract. Our case was further complicated by ileal volvulus, which led to an extremely rare presentation.

Objective: To evaluate the efficacy of catumaxomab treatment for malignant ascites.
Cases: Four patients with malignant ascites who required paracentesis once or more a week and were considered for catumaxomab treatment, received catumaxomab following the therapeutical paracentesis, via intraperitoneal port catheter on the day 0., 3., 7. and 10. The frequency of paracentesis need and before and after the treatment wee compared and it was found that this frequency
was decreased in each of the patients.
Conclusion: Catumaxomab therapy can be a good choice of treatment for the patients who suffer from malignant ascites and must be considered to improve particularly these patients’ quality of lives.

Objective: Sclerosing stromal tumor of the ovary (SST) is a rare neoplasm of the sex cord stromal category. We present a case of a unilateral SST of the ovary in a 54 -year- old woman with abdominal swelling and describe the clinical and histological findings with reference to other reported cases.
Case: Histopathologically, the lesion was characterized by a pseudolobular pattern of the edematous stroma containing focal sclerosis areas, a heterogeneous cell population and marked vascularization.
Conclusion: Ovary sclerosing stromal tumor is most commonly seen in the 2nd and 3rd decades, but it should be kept in mind that it may also be seen in postmenopausal patients.

Objective: Elastofibroma dorsi (EFD) is a rare benign pseudotumor characteristically located at subscapular region. Although it is usually asymptomatic, it can present with swelling in the subscapular region, back pain and clicking with shoulder motion. In this case report we aimed to present a female patient with the diagnosis of bilateral elastofibroma dorsi.
Case Report: A 69-year-old woman consulted to our outpatient setting with back pain. Her complaints started 15 months ago. A computerized tomography scan was performed and bilateral ill-defined masses were detected in subscapular region. These masses were found consistent with EFD. The patient did not consent surgical excision. Therefore she was treated conservatively.
Conclusion: In clinical practice, a diagnosis can be made through careful examination and patients can be treated medically or by the means of physiotherapy modalities.