Gestational diabetes mellitus (GDM) is a frequent medical condition during pregnancy. It is known to be associated with increased risks of short and long-term complications for both the mother and the fetus during pregnancy and postpartum. There has been a lack of international uniformity in the approach to the screening and diagnosis of GDM. Controversies include universal versus selective screening, the optimal time for screening, appropriate tests and cut-off values and whether testing should be conducted in one or two steps. According to the data shown in The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, The International Association of Diabetes and Pregnancy Study Groups (IADPSG) developed a new consensus criteria for screening and diagnosis of GDM. However, as it has been thought that this will lead to an increase in the number of women diagnosed and treated for GDM and increase the cost of the treatment, there is a controversy between the associations about the widespread usage of these criterias. This review presents the update data on screening and treatment approach for GDM.

Objective: In this study, we searched the effects of breastfeeding, especially the effects of the period of breast feeding on the development of type-2 diabetes in women.
Method: The study included 410 participants who were type-2 diabetic and 410 participants who were non-diabetic. The age of the participants were among 40 and 65. The study was carried out retrospectively. The non-diabetic group was composed of the participants whose the blood glucose levels and the oral glucose tolerance (OGTT) test results had been normal for 3 months. All of the participants were researched and questioned for their education levels, how many children they had, their ages of first pregnancy, how long they had breastfeed and how long they had been diabetic.
Result: It was found out that the median value of the total period of diabetic participants’ breastfeeding was 18 months and the median value of the total period of the non-diabetic participants’ breast feeding was 22 months (p>0.05). When we categorized the total perid of breastfeeding as “less than 3 months’’, “more than 3 months’’, “less than 6 months’’, “6-12 months’’, “12 months and more than 12 months’’, meaningful difference wasn’t found out in terms of total period of breastfeeding for both of the groups (p>0.05). When we categorized the period of breastfeeding as “at least 3 months at a time’’ or “6 months at a time’’, the rates of breastfeeding for 3 months were found out to be similar for both groups; however, the rates of breastfeeding for 6 months at a time were found out to be higher in the non-diabetic participants than in the diabetic participants (p>0.05).
Conclusion: The rates breastfeeding for at least 6 months were found out to be higher in nondiabetic participants. We didn’t find out that there were effects of total period of breastfeeding on the development of diabetes. However, we found out that the development of diabetes decreased meaningfully during the period of breastfeeding for “more than 6 months at a time’’.

Objective: We aimed to assess adalimumab(ADA) and infliximab(IFX) efficacy on the patients of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) by using erithrocyte sedimentation rate (ESR), C-reactive protein (CRP), interferon gamma (IF-γ), interleukin-1 beta (IL-1β), interleukin 6 (IL- 6), matrix metalloproteinase 3 (MMP-3).
Material and Method: Sixteen RA, 15 AS patients were enrolled to this study. ADA was used on the half of RA patients, IFX was used on the other half randomly. ADA was used on 7 AS patients and IFX was used on 8 AS patients randomly too. Blood samples were taken at the weeks of 0, 1, 4 and 12. ESR and CRP were calculated at the same time with controls. Blood samples were hidden at the -20°C to evaluate after.
Results: There wasn’t any significant difference between the groups of RA and AS patients in terms of ESH and CRP levels (p>0.05). IF-γ was found lower on both patient groups and IL-6 and IL-1β were not included statistical analysis due to the wide range of values. MMP-3 levels was found correlated with ESR and CRP levels in both treatment and patient groups. MMP -3 was more supressed at ADA treated group on AS patients according to the IFX group on AS patients significantly (p<0.05).
Conclusion: MMP-3 was significantly more depressed on ADA treated group of the AS patients according to IFX treated group. We think many similar studies that include more patients needs to be done to say ADA’s better efficacy than in AS patients. It can be said that MMP-3 is a stable marker to determine the activity of chronic inflammatory diseases and monitoring response to therapy according to the cytokines.

Objective: Regional lymph node metastases are common in papillary thyroid cancer. In this study we aimed to evaluate the factors affecting central and lateral neck lymph node metastasis in patients with papillary thyroid cancer.
Material and Method: The clinical and pathological findings of 32 patients with papillary thyroid cancer who had undergone total thyroidectomy plus central and lateral compartment dissection were retrospectively analyzed between March 2012 and December 2013. The affect of age, gender, T stage, extrathyroidal extension, multifocality and lymphovascular invasion on central and lateral lymph node metastasis were evaluated.
Results: 12 of patients underwent total thyroidectomy and unilateral central neck dissection, 20 of patients underwent total thyroidectomy and bilateral central neck dissection. 12 of them underwent additional therapeutic unilateral lateral neck dissection. T stage was T1: 23, T2: 6, T3: 3. In twenty patients (62.5%) lymphovascular invasion, in 22 patients (68.5%) multifocality, in 16 patients (50%) extrathyroidal extension were identified. Central lymph node metastasis on 19 of 32 patients (59.4%) and lateral metastasis on 9 of 32 patients (28.1%) were identified. Central neck lymph node metastases were significantly higher in patients with extrathyroidal extention (p<0.05), multifocalitiy
(p<0.01), and lymphovascular invasion (p<0.01). Lateral neck lymph node metastases were higher in patients with central neck lymph node metastases (p<0.01).
Conclusion: The neck lymph node metastasis is common and central metastasis occur initially. The occurence risk of central metastasis is higher in patient with extrathyroidal extension, multifocality and lymphvascular invasion. The occurence risk of lateral metastasis is higher in the patients with central metastasis. Although there is no certain clinical and pathological indicator of lymph node metastasis, all patients should be evaluated carefully for lymph node metastasis and extrathyroidal extention radiologically before.

Objective: Currently, management of the appendiceal masses secondary to perforated appendicitis are controversial in the literature. Today, generally conservative treatment followed by interval appendectomy is performed. Aim of this study is to evaluate patients who were performed interval appendectomy after conservative treatment.
Material and Methods: A retrospective review of all patients undergoing interval appendectomy after conservative treatment was performed. Patients were evaluated for demographic data, symptoms and duration, leukocyte counts (WBC), c-reactive protein values (CRP), ultrasound (USG) findings, antibiotic regimens, operation findings, duration of hospitalization, timing of interval appendectomy. Appendectomy specimens were evaluated by pathological analysis.
Results: Between January 2010 to April 2014, 21 patients (9 male) were admitted to our clinic with acute appendiceal mass. Mean of the ages was 11.2±3.5 years, the most common symptoms were abdominal pain and vomiting, median of duration of symptoms was 6 (2-14) days. The values of WBC counts and CRP on admission and discharge were 17.8 (6-25.1)x103/mm3 and 10.1 (7.5-14)x103/mm3 for WBC, 10.8(11-321.2) mg/dl and 13.1 (0-59) mg/dl for CRP respectively. Acute appendiceal mass was defined with the USG in twelve patients, and with physical examination in nine patients. Tuberculosis was detected in one patient. Abscess formation was present in 6 patients. Percutaneous drainage with catheter was performed in 5 patients and aspiration in one. Median of durations of hospitalization was 6 (3-15) days on first admission. Ampicillin, gentamycin and metronidazole were started as standart therapy and were changed to ceftriaxone, piperacillin-tazobactam, ertapenem and imipenem according to clinical situation and culture results. Median of interval appendectomy time was 110 (65-199) days. Laparoscopic appendectomy was performed in 20 patients, open appendectomy in only one. On operation, there were almost normal appearance of appendix in 8, adherents to caecum and surrounding tissue in 4, adherent to omentum in 2, underwent lysis in 2, periappendicular abscess with acute appendicitis findings were revealed in one patient. One patient was operated prior to estimated time due to developing peritonitis findings in physical examination on 76th day so that she was operated before estimated time. Median of hospitalization duration of 2nd admission was 2 (1-3) days.
Conclusion: Conservative treatment followed by interval appendectomy is a safe and effective treatment in patients with appendicular mass due to perforated appendicitis. Percutaneous abscess drainage and broad-spectrum antibiotics are beneficial for conservative treatment. Tuberculosis and malignancy such as lymphomas should be remembered in patients with acute appendicular mass secondary to perforated appendicitis.

Objective: To report the indications of intravitreal injections, intravitreal drugs used and their complications rate
Material and Method: The charts of patients who received intravitreal injection/s for 5 years period were reviewed retrospectively. Indications for intravitreal injections, which drug was used to intravitreally, age and gender of patients, and complications of intravitreal injections were evaluated. All intravitreal injections were performed under topical anesthesia with instillation of 5% povidone iodine and irrigation with saline solution at upper temporal area through the pars plana using 27 gauge needle in the operating room. Ofloxacin 0.3% drop was used 4x1 in all cases for one week. The amount and generic name of drugs used in intravitreal injections were 1.25-2.5 mg of bevacizumab, 0.5 mg of ranibizumab and 4 or 2 mg (combined with 1.25 mg bevacizumab) of triamcinolone acetonide.
Results: This study includes 962 patients (514 females, 448 males). The mean age was 65±20.3 (18-89) old. Intravitreal injections were performed in 574 patients for diabetic macular edema, in 143 patients for age-related choroidal neovascularization, in 47 patients central retinal vein occlusion, in 107 patients for branch retinal vein occlusion, in 83 patients for proliferative diabetic retinopathy with/without intraocular hemorrhage, in 5 patients for central serous choroidopathy, and in 3 patients for adult vitelliform macular degeneration. Number of total injections was 4318 in 962 patients in 5 years. The name and ratio’s of intravitreal agents were as follows; bevacizumab (57%), ranibizumab (17%), triamcinolone acetonide (16%) and bevacizumab + triamcinolone acetonide (10%).
Conclusion: The most common indication for intravitreal injections was diabetic macular edema and the most common drug that injected intravitreally was bevacizumab. The most serious complication that occurred in 2 cases was endophthalmitis. Endophthalmitis rate was 0.046%. A spontaneously cleared vitreous hemorrhage occurred in one eye. Pseudoendophtalmitis was occurred in one case after triamcinolone injection. Retinal detachment was not recorded.

Objective: The aim of this study is to evaluate the results of the patients with mild and moderate stable type SCFE treated with in situ single screw fixation without reduction.
Material and Method: Twelve hips of ten patients with SCFE were treated between 2000-2012. Body mass index, range of motion (R.O.M.), slipping angles on lateral X-Ray were measured and evaluated pre and postoperatively. Heyman Herndon’s clinical and Boyer’s radiologic scoring systems were evaluated at last visit.
Results: The mean age was 11.4±1.5 (9-14) years. Mean following time was 62 (14-119) months. According to Southwick’s method mean slipping angle was 40° (26°-50°). Mean body mass index was 27 kg/m2. The mean preoperative flexion, internal and external rotation of the hips were 100° (50°-120°), 12° (0°-30°), 64° (20°-90°) and the mean postoperative flexion, internal and external rotation of the hips were 119° (100°-130°), 30° (10°-60°), 62° (50°-80°). Increase in R.O.M. of flexion and internal rotation was statistically significant (p<0.05). The results of Heyman Herndon’s clinical and Boyer’s radiologic classification were fully successful.
Conclusion: We believe that single screw fixation without reduction is excellent treatment method for mild and moderately slipped stable type capital femoral physis. We recommend close-follow up for the other side instead of prophylactic fixation.

Objective: Anesthetic management of elderly patients undergoing major orthopaedic operations is still a common problem. The aim of this study is to evaluate hemodynamic effects of unilateral spinal anesthesia in elderly patients undergoing total hip replacement.
Material And Methods: After local ethics committee approval and written informed consent, unilateral spinal anesthesia with hyperbaric bupivacaine 0.5% was applied to 20 patients, over the age of 65, undergoing total hip replacement. Hemodynamic measurements were recorded by arterial line with Vigileo-FloTrac™ system; baseline values, during the operation and after operation for 2 hours. Stroke volume, cardiac output, blood pressure and heart rate values were measured during perioperative and postoperative periods and compared by the baseline values.
Results: 60% of patients (12 people) were female, 40% (8 people) were male. Mean age was 77.6±1.75 years, mean hemoglobin value was 11.5±0.25 g/dl, mean ejection fraction was 60±1.76%. Cardiac output values decreased at 60th minute compared to baseline (p<0.05). Stroke volume at 30-50-60th minutes and 1-2nd hours postoperatively showed a decrease compared to the initial value (p<0.05). Mean arterial pressure decreased at 10th minute (p<0.05). Heart rate increased at 120th minute (p<0.05).
Concluions: Results showed a significant decrease in stroke volume and cardiac output. Unilateral spinal anesthesia leads to clinically significant hemodynamic changes in elderly patients. Cardiovascular monitoring is extremely useful in predicting hemodynamic effects of unilateral spinal anesthesia in elderly patients ungergoing total hip replacement.

Objective: In this study, we aimed to compare the impacts of application of three different drugs during rapid sequence anesthesia induction in hypertensive patients on responses to laryngoscopy and intubation.
Method: The study was planned as a randomized prospective study. 90 patients aged between 18-79 years old from the American society of anesthesiologists (ASA) II-III group with hypertension were included in this study. Patients were randomly divided into 3 groups of 30 people. After 3 minutes of pre-oxygenation, the patients in Group R received 1µg/ kg remifenatnil+5 mg/kg sodium thiopental, the patients in Group L received 1 mg/kg lidocaine+5mg/kg sodium thiopental, and the patients in Group F received 2µg/kg fentanil+5 mg/kg sodium thiopental through induction. As myorelaxant, 1 mg/kg rocuronium bromide was injected and intubation was performed after 60 seconds. All patients underwent intubation scoring. Hemodynamic parameters of the patients were recorded before induction, during intubation and on the 1st, 3rd, 5th and 10th minutes after intubation.
Results: There was no significant difference between the groups in terms of demographic data and intubation scoring. Systolic arterial pressures 1st, 3rd and 5th minutes after intubation found significantly higher in Group L compared to Group F and Group R. Diastolic and mean arterial pressures after intubation of 1st and 3rd minutes were found to be highest in Group L. In Group R systolic, diastolic and mean arterial pressures up to 10 minutes after intubation were detected under basal values. The heart pulse rates in the 1st and 3rd minutes after intubation were the highest in Group L and the lowest in Group R.
Conclusion: Remifentanil seems to be a better choice than lidocaine and fentanyl to reduce hemodynamic response in patients and to ensure hemodynamic stabilization during prompt anesthesia induction in hypertension patients.

Objective: Geriatric patients have the highest mortality and morbidity rates in the adult surgery population. Due to the comorbidities, it is not surprising that the mortality rates are high. In this study, a group of neurosurgery patients who are 65 years old and older were analyzed retrospectively.
Material and Methods: The age, sex, diagnose, age-related disease existence, type of operation, need emergence or elective situation, Glasgow Coma Scale value, operation time, application of arterial cannule, central venous catheter and gastric tube, intraoperative blood transfusion, intraoperative antihypertensive use and postoperative intensive care unit stay of the 65 years old and older nerosurgery patients, who had an operation for intracranial pathologies in the years between 2009 and 2010, were reached. The rates of sedoanalgesia performance, difficult airway, pneumothorax and mortality rates were recorded.
Results: 2567 patients were operated by the department of neurosurgery in the years of 2009 and 2010. 158 (6.1%) of these patients were in 65 years and elder age group. 66.5% of these patients were scheduled electively. The most common indication of operation was intracranial tumor with 36.1% rate. The hypertension, which was antihypertensive use needed, occured in 29% of these patients. Intraoperative blood transfusion was needed in 20.9% rate. 74.1% of these cases had postoperative intensive care unit stay. Mortality rate was 12.7%. Central venous catheterization was performed to 35.4% of the patients and pneumothorax occured in only 1.3% of them. The difficult airway was seen in the rate of 1.3%. Mean Glascow Coma Scale was 13.05±3.73 and mean operation time was 152.88±74.5 minutes.
Conclusion: The carefully performed preoperative evaluation, appropriate anesthetic management, rapid and atraumatic operation would help to reduce the perioperative complications in geriatric patients. The age is not a handicap alone by itself in geriatric neurosurgery patients, whose risk factors are managed appropriately.

Objective: The study was conducted to investigate the attitudes of working and non-working mothers, who have babies aged 6-12 months, regarding infant feeding.
Method: The study was carried out as a descriptive study in between September 15, 2013 and January 25, 2014 in three regions of Family Health Center (FHC) that accommodate mostly working women in a city center located in east Turkey. The study population consisted of the mothers having babies aged 6-12 months residing in these regions at the time of the research. The whole study population was studied without selecting any sample group. The mothers who have not accepted to participate in the research were not included in the study. The study was conducted with 78 working mothers and 123 non-working mothers. Data were collected by the researcher through a questionnaire prepared based on the literature through face-to-face interview method. Approval of the ethics committee, official permissions and informed consent were obtained from the mothers to conduct the study. The data were analyzed in the SPSS 18.0 software by percentage distribution and chi-square test.
Results: In the study, statistically significant difference was found between working and non-working mothers on the first food given to babies, on giving temporary supplementary foods in the first three days, planned duration of breastfeeding, peak times of breastfeeding, breast cleaning before breastfeeding, performing breast rotation, and milking and storing breast milk factors (p<0.05). It was found in the study that the employment status of the mothers affects their reasons for starting to give supplementary foods (p<0.05). It was determined that the majority of working mothers return to work in 3 to 6 months, and think that postnatal and breastfeeding leaves are insufficient.
Conclusion: As a result of the study, it was found that the behaviors of working and non-working mothers on feeding infants aged 6-12 months were affected by separate factors. Initiatives and training appropriate for the needs of working and non-working mothers regarding infant feeding are recommended.

Mastocytosis is a group of diseases characterised by emission of mast cell mediators and increase of mast cells primarily in skin and other tissues. It is a rare disease encountered both in adults and children. Two cases of solitary mastocytoma are presented in this study. In addition to the typical clinical and histopathological findings, one of the cases shows bullous solitary mastocytosis without systemic involvement.

Salt wasting is a situation of hyponatremia, hypernatriurea and dehydration because of body’s inability to hold sodium and as a result of lose sodium from kidneys and other exocrine glands. Pseudohypoaldestorenism is a salt wasting condition because of peripheral resistance to
aldosterone. Peripheral resistance can be seen primarily because of receptor defect from a mutation at mineralocorticoid receptor or epithelial sodium channel, and receptor resistance secondary to infection, uropathy and drugs. Generally in newborn period give findings as hyponatremia, hyperkalemia and metabolic acidosis and diagnose as significantly elevated plasma renin activity and aldosterone levels at investigations. Here in this case report; 11 days old girl applied with severe dehydration because of salt wasting presented because of primary pseudohypoaldosteronism which is a rare disorder.