Hypocalcemia is a frequent complication after thyroid and parathyroid surgery. This study aims to evaluate the incidence, pathophysiology, early diagnosis, differential diagnosis, clinical and biochemical predictive factors, treatment of hypocalcemia. Hypocalcemia may be transient, that recovers within 6 months of surgery and permanent that persists more than 6 months after surgery. Postoperative hypocalcemia arises from hypoparathyroidism, hungry bone syndrome, hemodilution due to surgical stress and alkalosis which is caused by hyperventilation due to postoperative pain. The most common cause of postoperative hypocalcemia is hypoparathyroidism. Hypoparathyroidism is characterized by a parathyroid hormone (PTH) deficient leading to hypocalcemia, hyperphosphatemia and hypercalciuria. Postoperative hypoparathroidism occurs usually due to inadvertent or unavoidable the parathyroid gland or damage to it/its blood supply. Hungry bone syndrome can occur after surgery for hyperparathyroidism and Graves disease. The clinical manifestations of postsurgical hypocalcemia depend on the degree of hypocalcemia and rapidity of hypocalcemia onset. The classic symptoms of hypocalcemia is associated with neuromuscular excitability. They vary from numbness and tingling in the fingertips, toes and circumoral region in mild hypocalcemia to paraesthesias of the upper and lower extremities in moderate hypocalcemia. In the most severe forms, tetanic muscle cramps can occur in the form of carpopedal spasm or diffuse tetany. Some cases can occur bronchospasm and laryngospasm. Neurological symptoms such as confusion, disorientation, delirium or seizure, and cardiac abnormalities such as prolonged QT interval on electrocardiogram, arrhythmias, congestive heart failure can also occur. In patients without overt signs, underlying neuromuscular excitability can become evident with provocation tests such as Chvostek’s sign and Trousseau’s sign. Diagnostic workup for hypocalcemia includes measuring serum intact PTH, phosphorus, albumin, magnesium, 25-OH Vit D, and calcium. Clinical predictive factors of hypocalcemia include female sex, inadvertent excision of the parathyroid gland, parathyroid autotransplantation, Graves’ disease, surgery for recurrent goitre, reoperation for bleeding, and heavier thyroid specimens. Perioperative PTH and postoperative changes in calcium levels can be used as biochemical predictors of hypocalcemia. The management of hypocalcemia is best accomplished by identifying high-risk patients preoperatively, preserving function of parathyroid gland during surgery, identifying hypocalcemia via early predictors and implementing appropriate treatment if necessary. Moreover prevention or early identification and appropriate management of hypocalcemia prevents hypocalcemia-related complications and allows patients to be discharged from the hospital earlier. Treatment for hypocalcemia is based on combined theraphy with calcium and vitamin D analoques. Formal guidelines for the management of hypocalcemia are not available. However, there are some common procedures existing in clinical practice. According to the degree and speed onset of hypocalcemia and the severity symptoms, intravenous calcium may be needed until an oral regimen is established. The goal of theraphy is to control hypocalcemic symptoms and achieve and maintain a serum calcium level in the low normal range. The oral dose of calcium and vitamin D analogues should be individually tailored by checking serum calcium, phosphate, and PTH initially every week, and then every 2-3 weeks or monthly. Hypercalcemia must be avoided. New drugs such as recombinant human PTH currently in clinical trials offer promising treatment options.

Objective: The aim of this study was to evaluate the value of quantitative spectral Doppler ultrasound (DUS) flow measurements in ovarian tumors in postmenopausal women.
Material and Method: This prospective study included 23 postmenopausal women with preoperative diagnosis of ovarian tumor. Patients were examined with transvaginal DUS 2 to 4 days before surgery. The resistive index (RI) and pulsatility index (PI) of the mass were evaluated by transvaginal DUS examination.
Results: The histopathologic examination of the surgical specimens revealed 8 malignant, 13 benign and 1 borderline tumor. The mean RI and PI for malignant tumors were 0.37 (range 0.35-0.45) and 0.61 (range 0.43-0.85), respectively. The mean RI and PI for benign tumors were 0.61 (range 0.30-0.91) and 1.21 (range 0.36-3.02), respectively. The Mann-Whitney U test revealed a statistically significant (p<0.05) correlation between the DUS measurements and histopathologic results. The sensitivity, specificity, positive and negative predictive cut-off values for RI less than 0.4 was 77%, 85%, 77%, and 85% respectively, in the diagnosis of malignant lesions. The sensitivity, specificity, positive and negative predictive cut-off values for PI less than 0.7 was 77%, 78% 70%, and 84% respectively.
Conclusion: Quantitative transvaginal DUS flow measurements provides sensitive and specific results in differentiating benign from malignant ovarian tumors in postmenopausal women.

Objective: In different studies, it was determined that diabetes mellitus and hypertension can increase hs-CRP levels. In this study, we aim to compare the levels of hs-CRP between 2 groups with controlled or uncontrolled hypertension in patients who have both type 2 diabetes mellitus and hypertension.
Material and Method: We enrolled 64 female and 65 male, total 129 patient, into the study who admitted to our diabetes polyclinic between 2010 May and 2010 September. Patient’s sociodemographic properties, detailed histories, drug usage, anthropometric measures, physical examination findings and laboratuary results were investigated. Situations that affect CRP levels were excluded from the study. In this study, level of significance was considered to be p<0.05.
Results: In the study, 49.6% (n=64) of patients were female, and 50.4% (n=65) were male. Those who have regulated blood pressure was 65 (50.4%) and who have not regulated blood pressure was 64 (49.6%) people. Mean body mass index was 30.17±5.30 kg/m2. The mean duration of diabetes was 6.69±4.57 years, the mean duration of hypertension was 6.38±4.41 years. Those who have regulated hypertension, mean body mass index was 29.81±5.44, who have not regulated hypertension was 30.53±5.18. There was no statistically significant difference between the groups in terms of gender (p>0.05). There was no statistically significant difference between the groups in terms of HbA1c, total cholesterol, HDL- cholesterol, LDL- cholesterol, VLDL- cholesterol, triglyceride, TSH, fasting blood glucose, postprandial blood glucose, AST, ALT, proteinuria ve creatinine. Also, there was no statistically significant difference between the groups in terms of hs-CRP.
Conclucion: Patients with type 2 diabetes mellitus who have hypertension, it was determined that controlling the blood pressure did not constitute a significant difference in hs-CRP levels.

Objective: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. In this study, 4th finger median and ulnar nerve sensory latency difference test in minimal and mild carpal tunnel syndrome and the amplitude difference test between the 2nd finger median sensory response and the 5th finger ulnar sensory response were evaluated and their usefulness were discussed.
Material and Method: In this study, the patients admitted to Þiþli Etfal Training and Research Hospital Neurology Clinic, EMG laboratory with the diagnosis of CTS were included. In addition to conventional electrophysiological methods, 4th finger median - ulnar nerve sensory latency difference test was used. Electrophysiological studies were performed using Medelec Saphire 4E EMG device. Data was evaluated with Statistical Package for Social Sciences (SPSS) for Windows 17 program and descriptive analysis was performed.
Results: In 3 (17.64%) of the 17 patients who had abnormality in the 4th finger of median-ulnar sensory latency difference test, 2nd digit median nerve sensory response amplitude was found to be lower than the 5th digit ulnar nerve sensory amplitude response.
Conclusion: In our study, which is a preliminary study, a small number of patients whose 4th finger median-ulnar sensory latency difference test were abnormal also revealed a relative decrease in 2nd digit median nerve sensory response amplitude. Further studies with a larger group of patients are needed. The amplitude difference test between 2nd digit median and 5th digit ulnar sensory response may be an alternative sensitive method in order to obtain faster results and to identify early cases of CTS.

Objective: Although number of vacuum operative vaginal deliveries is low nowadays, it still remains important. In this study, maternal and fetal characteristics and perinatal outcomes of the vacuum operative vaginal deliveries were evaluated in a single center during 5 years period.
Material and Method: Study was conducted in Zeynep Kamil Obsetrics, Gynecology and Pediatrics Education and Research Hospital which is a reference hospital. Cases of vacuum operative vaginal deliveries between January 1998 and December 2012 were reviewed retrospectively. Cases where vacuum exctractor was used in single, live and cephalic presentation births were included in the study. Recorded data about maternal demographic characterisctics, intrapartum characteristiscs and neonatal outcomes were analysed with SPSS programme.
Results: During the last 5 years period, 31497 vaginal births occured. Incidence of vacuum exctractor usage during this period was evaluated to be 0.4% (n: 126). It was observed that, in the 5 years period, mean vacuum operative vaginal deliveries per year decreased from 0.4% (n: 37) to 0.2% (n: 11). None of the patients had history of strenuous delivery. Number of nullaparous patients and multiparous
patients were 93 (91.9%), 33 (26.2%); respectively. Sixteen percent of the patients (n: 21) had perianal laceration, vaginal laceration and cervical laceration. Five fetuses (3.9%) holded occiput posterior position and the remaining 121 fetuses (96%) holded occiput anterior position. Twenty one out of 126 newborn (16.6%) babies had cephal hematoma, 54 babies (42.8%) had caput succadenum. Intracranial hemorrhage, subgaleal hematoma or death was not observed. Babies born in occiput posterior position and occiput anterior position were compared according to cephal hematom occurence. Results were n: 3, 60% and n: 18, 14.8%; respectively. The difference was statistically significant.
Conclusion: Vacuum extractor usage loses in value by the day and it is not tought how to use it in daily practice routinely in residency training due to its serious complications. But when applied correctly under necessary conditions by experienced phsycians it does not cause maternal and fetal complications also it can decreases perinatal complications. Anyone who is trained in delivery should know to apply vacuum extractor.

Objective: IInternalized stigmatization is to accept negative stereotypes of the individual in society for himself and as a result of this, to withdraw himself from society in negative emotions like worthlessness and shame. In this study; we aim to determine, if there was any difference between Internalized stigmatization and functioning scores in depression and psychotic patients in remission and the effect of internalized stigmatization on functionality
Material and Method: 50 depression patients in remission and 50 psychotic patients in remission, who attended Sisli Etfal Educating and Researching Hospital Psychiatry department, were recruited in this Cross-sectional study. The primary independent variable was disease type, Internalized Stigmatization and functionality were dependent variables. Internalized Stigmatization of Mental Illness Scale and the Brief Assessment of Functioning Scale were used.
Results: Internalized stigmatization scores were nearly similar in both patient groups. Social withdrawal scores in psychotic patients and resistance to stigmatization scores of depressed patients were higher compared to the other group. Functioning subscale scores were statically different in patient groups, psychotic patients had difficulty in functioning more than depression patients.
Conclusion: In this study, we found that internalized stigmatization has a negative effect in functionality in both depressive and psychotic patients. Stigmatization effect should be considered, especially in psychotic patients, while giving medical and functionality therapies.

Objective: In our study, postoperative period of laparoscopic and open surgical techniques were comparatively evaluated in patients who underwent surgery for acute appendicitis,.
Material and Method: Patients, who underwent surgery for acute appendicitisin Sisli Hamidiye Etfal Training and Research Hospital, General Surgery Department, between 01.01.2004-20.02.2013 were retrospectively reviewed. Age, gender, preoperative examinations, surgical procedures, intraoperative findings, pathological examination data and postoperative periodwere evaluated. According to operational procedure, patients were allocated in two groups as Group A, conventional appendectomy and Group L, laparoscopic appendectomy.
Results: A total of 3046 patients diagnosed on acute appendicitis were operated. 66% of the patients were male, 34% were female, mean age was of 25.3 (16-98 ) years. Mean operation time was 45.32±8.63 minutes in Group A (n=2662), 49.71±10.11 minutes in Group L (n=384) (p<0.01). Time to return to normal activities was, 11.90±3.6 days in Group A, 7.3±2.5 days in Group L (p<0.01).
Conclusion: Length of hospital stay and time to return to normal activity was shorter in patients undergoing laparoscopic appendectomy compared to conventional appendectomy. Laparoscopic appendectomy is a safe procedure in a hospital with sufficient equipment and experienced team.

Objective: Persistent primary hyperparathyroidism due to failed parathyroidectomy is an uncommon but challenging problem as re-operation carries higher complication and failure rates. The purpose of this study was to evaluate the risk factors responsible for persistent hyperparathyroidism.
Material and Method: A retrospective analysis was performed on patients with primary hyperparathyroidism of whom underwent parathyroidectomy in our surgical department between 2000 and 2010. Patients underwent initial parathyroidectomy with at least 6 months of follow-up were included and were divided into two groups according to whether or not persistent disease. Patients in group 1 were not persistent, patients in group 2 were persistent. Both groups were compared in terms of sex, operation type, presence of ectopia, multipl gland disease and the presence of nodular thyroid disease. Groups were compared with Chi-square and Fisher’s exact tests. Relative risk was calculated.
Results: In the period of past 10-year, 159 parathyroid operations for primary hyperparathyroidism were performed in our department. In total, 132 patients met inclusion criteria, and the total success rate of parathyroidectomy was 97.72%. The mean age was 54.8+12.8 year and 81.1% were female. Among them, 124 patients (93.9%) (group 1) had no persistent disease, and 8 patients (6.1%) (group 2) had persistent disease. Ectopic glands and multigland disease were significantly higher in group 2 (p=0.001, p=0.0001 respectively) than group 1. The risk for persisten disease was increased 11.81-fold for patients who had ectopic gland and 32.29-fold for patients with double adenoma compared with patients with single adenoma. Operative approach and goiter did not have an impact on persistent disease.
Conclusion: Despite successful surgical treatment of primary hyperparathyroidism, acceptable rate of persistent disease may develop. Multiple gland disease, especially double adenoma and ectopic placement are the most important risk factors for persistent disease. Secondary surgery can be cured at a satisfactory rate with careful preoperative evaluation and imaging methods applied of patients with persistent disease.

Objective: Hypocalcemia following total thyroidectomy is the most common complication of this operation. This complication is related with severe symptoms of patients and delay of hospital stay. Several factors had been investigated to predict the hypocalcemia following total thyroidectomy in recent studies. In this study it is aimed to constitute a scoring system with the combination of more than one factor for predicting temporary hypocalcemia.
Material and Method: The retrospective data of the patients of whom underwent total thyroidectomy between the years of 2012-2013 were evaluated. All the parameters related with hypocalcemia are rated as ‘one’ point. Hypocalcemia is defined as total plasma calcium (Ca) level below 8 mg/dl. Temporary hypocalcemia is defined as recovery of hypoparathyroidizm in 6 months following total thyroidectomy. ‘’Multinomial logistic regression analysis’’, ‘’Chi-Squared test’’, ‘’Fisher’s exact test’’ and ‘’Mann-Whitney U test’’ were used for statistics.
Results: Temporary hypocalcemia occurred in 22 of 155 (14.2%) patients. The existence of parathyroid gland in surgical specimen (p<0.01), the low levels of early postoperative plasma calcium levels (p=0.0001), postoperative plasma magnesium levels (p=0.0001), postoperative plasma parathormone levels (p=0.0001) were statisticallly significant in paired comparison. The score of 3,4,5 were statisticallly significant for predicting the occurance of hypocalcemia (p=0.001). With the score of ≥3/≥4/≥5; sensitivity was 100%/77.27%/59.09%, specifitiy was 46.62%/77.44%/91.73%, negative predictive value was 0.00%/4.63%/6.87% positive predictive value 23.66%/36.17%/54.15% and diagnostic value was 54.19%/77.42%/87.10% respectively.
Conclusion: Postoperative hypocalcemia is multifactorial. Although the existence of 4,5,6, score is free indicator of predicting hypocalcemia, it would not be suggested as an exact scoring system because of the low negative and positive predicitive values. Patients with low values of postoperative early plasma calcium, magnesium and parathormone levels should be followed up carefully for hypocalcemia.

Objective: Iron deficiency is one of the major health problems in the world. The aim of this study was to evaluate cases hospitalized to pediatrics clinic with profound anemia (Hb < 7 g/dl) and investigated for iron deficiency anemia.
Material and Method: Patients with the diagnosis of iron deficiency investigated for etiologic reasons with evaluation according to age, gender, physical examination and laboratory findings.
Results: 15 were female (53.3%) and 13 were male (46.5%) from total of 28 cases. The ages of study group were between 4 and 18 with a mean of 13.25±4.68 years. 21 of cases were in adolescent age group defined as 11-18 age group. 11 were female (52.4%) and 10 were male (47.6%) in adolescent age group. 9 patients in this age group (42.8%) were admitted with bleeding. Upper gastrointestinal endoscopy performed 4 of the patients from cases with gastrointestinal bleeding and 3 of them detected helicobacter pylori positive from biopsy samples. Body Mass Index (BMI) of adolescent cases was calculated and from 13 cases; 4 were normal and only one of them was mildly obese. Prominent feature of the patients was scarcity of red meat consumption. The most obvious pathologic sign of physical examination was skin pallor found in all patients. Other findings were murmur at mesocardiac focus (46.4%) and tachycardia (14.3%). Laboratory findings at application moment were Hb 5.59±1.85 g/dl, MCV 68.76±16.4 fL, RDW 21,55±6.45%, white blood cell count 7167±4528/mm3, platelet count 326.000±241.013/mm3, serum iron level 18.2±9.92 µg/dl, serum iron binding capacity 444±110.13 µg/dl, transferrin saturation 4.03±2.26%, ferritin 8.83±12.1 ng/ml. 13 cases (46.4%) were transfused with packed red blood cells because they developed signs of cardiac failure. Iron therapy was administered to all
Conclusion: Profound anemia because of iron deficiency seen especially adolescent age group and only less than half associated with bleeding and all cases had scarcity of red meat consumption suggests nutritional deficiency.

Objective: We aimed to analyse the clinical spectrum, physical examination, laboratory and imaging findings of the children, admitted to emergency room (ER) because of acute abdominal pain, in the last one year in our study.
Material and Method: Four hundred fifty one patients, admitted to ER were analysed in terms of demographic properties, etiology, physical examination, laboratory and imaging results and course of the disease from the records of the patients between the dates of january 2012- december 2012, retrospectively.
Results: 3700 of 94750 patients (3.9%) were taken to ER because of acute abdominal pain and 451 of them (12.2%) were observed in ER. The mean age was 7.01±1.62 years, and female/male ratio was 1.6. Vomiting was the most common symptom, accompanied to abdominal pain (45.4%). Off all the patients, 21.5% (n=97 patients) had history of recurrent abdominal pain and 29.9% of them (n=29 patients) diagnosed Familial Mediterranean Fever (FMF). Laboratory findings did not help us to determine the etiology in 74.9% of the patients (n=338 patients). Abdominal ultrasonography was performed on 26.82% (n=121 patients) of the patients and 46.7% of them (n=64 patients) were normal and 26.2% of them (n=36 patients) showed mesenteric lymphadenitis. Surgical causes was found in 11.6% of the patients (n=51 patients), the most common cause was acute appendicitis. Ultrasonographic findings helped the diagnosis in 71.4% of the patients requiring surgical intervention. The etiology wasn’t found in 12.6% (n=57 patients) of the children. Acute gastroenteritis was the most common cause among non-surgical reasons. 12.8% of the children (n=58 patients) were hospitalised.
Conclusion: The most common cause of acute abdominal pain was non-surgical causes in ER. USG findings supported the diagnosis in patients requiring surgical intervention.

Amniotic fluid embolism, also referred to as anaphylactoid syndrome of pregnancy, is a rare obstetric emercency that may commonly manifest itself during pregnancy, delivery or immediate postpartum period. A case report of 24 year-old women, at 38 week’s gestation of her pregnancy who suffered probable amniotic fluid embolism at 12 h postpartum following caeseraen section under general anaesthesia, with the development of cardiopulmonary arrest and coagulopathy, is outlined. Based on a high index of suspicion, aggressive therapy was instituted immediately including critical care setting and she recovered completely. In this case report, we aimed to highlight the importance of early diagnosis and treatment for favourable outcome.

Transfusion related acute lung injury (TRALI) is a rarely seen and transfusion complication that may develop as a result of transfusion of blood products which contains plasma. TRALI can be mortal if it is not diagnosed and treated promptly. The most important step in management of this complication is to provide the early differential diagnosis of this condition. Hence here in we report a case of TRALI where the patient was firstly misdiagnosed and hospitalized as septic shock and acute heart failure due to clinical findings of chest pain, respiratory failure and hypotension.

Piyoderma gangrenosum (PG) is a rare, inflammatory skin disorder, which is often associated with systemic diseases. It is seen with the frequent ratio of 3/106 between the ages of 20 and 50, especially in women. Its etiology is obscure. In recent surveys, it has proven to be a disease of the immune system. We hereby present a case of a 34-year-old patient with PG rarely seen in surgical clinics and when misdiagnosed, causing progress with surgical debridement.