Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and the most common cause of outpatient hypercalcemia. Historically, most patients presented with overt symptoms and signs of pHPT. With the advent and widespread use of automated blood analyzers, currently the majority of patients are diagnosed through routine biochemical laboratory testing done for other aims. The majority of patients are minimally symptomatic or asymptomatic. The clinical presentation of pHPT varies from asymptomatic disease to classic symptomatic disease in which renal and/or skeletal complications are observed. The term “mild pHPT” has been interpreted in many different ways over the past 30 years. Mild pHPT was clearly defined as a disease in asymptomatic patients who do not meet surgical criteria set out by the updated International Guidelines. Normocalcemic pHPT was first defined formally at the time of the ‘’Third International Workshop on the Management of Asymptomatic pHPT’’ in 2008. Normocalcemic pHPT, a variant of the traditional hypercalcemic presentation of pHPT, is characterized by consistently elevated PTH concentrations with normal total and ionized serum calcium (Ca) concentration in the absence of secondary causes for elevated PTH concentrations. Primary hyperparathyroidism may present as classic pHPT (in which both Ca and PTH are high), nonclassic (normohormonal or nonsuprese) pHPT (in which Ca is high and PTH is normal), normocalcemic pHPT (in which Ca is normal and PTH is high) biochemically. The only curative therapy for pHPT is parathyroidectomy. Parathyroidectomy is clearly indicated in all symptomatic patients. ‘’Fourth International Workshop on the Management of Asymptomatic pHPT’’ had been performed in 2013. Surgical indications for pHPT are determined according to the age, Ca level, skeletal and renal findings. In some patients with asymptomatic disease, surgery is not mandatory. On the other hand, even in these patients who don’t meet any criteria for parathyroidectomy, surgery is always an option because it is the only exact treatment for pHPT. The optimal treatment strategy for patients with normocalcemic pHPT has not yet been proved. Experts advise that patients be referred for parathyroidectomy if they have or progress complications of pHPT such as osteoporosis, fragility fractures or kidney stones, even if normocalcemia continues. Patients without complications at the time of diagnosis could be monitored for disease progression.

Objective: To evaluate the level of awareness among patients with thyroid disorders presenting to our hospital and determine patient profiles.
Material and Method: The present study was conducted using a survey technique on patients aged between 18 and 75 years, who were admitted to our hospital for follow-up for thyroid disease between December 1, 2014 and December 31, 2014. The pregnant women and those with a thyroid malignancy and patients who did not consent for the study were excluded. Demographic data such as age, gender, educational level, disease duration, control frequency as well as drug usage pattern, dose, duration and whether or not the patient received fixed dose drug regimen and food/drugs that are not to be taken with the drug were recorded. Type of salt used by the patients was also recorded.
Results: An interview was conducted with a total of 107 patients (4 males [3.7%] and 103 females [96.3%]) with a mean age of 46 years. Of these patients, 85 (79.4%) attended follow-up visits for more than a one-year period and most patients (n=56) were seen at least three times in the last year (52.4%). Of these patients, 69 (64.5%) had hypothyroidism, 11 (10.3%) had hyperthyroidism, and the remaining 27 patients (25.2%) had euthyroid nodular goitre. It was found that 78 patients (72.9%) were inaccurately or incompletely informed about their disease. Of the patients, 54 (50.4%) were aware that they needed to use iodized salt and 41 patients (38.4%) were not aware of what kind of salt they had to use. When the patients in the study were asked whether they were aware of food and drugs interacting with levothyroxine, 55 patients (86%) were not aware of these food and drugs. Approximately 30% of patients used iron supplements and proton pump inhibitors together with levothyroxine.
Conclusion: The patients with thyroid disorders had a low level of awareness and low level of knowledge about their disease, follow-up data and their treatments. The physicians must make an endeavor to increase the level of awareness among the patients.

Objective: To present the surgical results of pars plana vitrectomy and phacoemulsification (phacovitrectomy) plus intraocular lens (IOL) implantation in eyes with vitreoretinal pathology
Material and Method: This retrospective study included 91 eyes of 80 (44 female/36 male) consecutive patients undergoing phacovitrectomy plus IOL implantation during a 3-year period. Baseline and last best corrected visual acuity (BCVA), retinal pathologies, presence of systemic disease, preoperative lens status, history of any therapeutic intervention prior to surgery, type of intravitreal tamponade used, need for additional intervention, complications and the latest ocular examination results were considered.
Results: Mean age was 64.8±9.5 years. Diabetes mellitus (DM), hypertension (HT), DM+HT and coronary artery disease (CAD) were the accompanying systemic diseases, observed in 74%, 56%, 45% and 18.7% of the patients, respectively. Indications for phacovitrectomy were macular surface disease in 52%, vitreus hemorrhage (VH) in 31%, tractional retinal detachment (TRD), diabetic retinopathy or proliferative vitreoretinopathy (PVR) in 11% and rhegmatogenous retinal detachment (RRD) in 5.5% of the eyes. Mean preoperative and postoperative BCVA were 0.10±0.14, 0.22±0.22, (p<0.001), respectively. BCVA increased in 61%, remained stable in 24% of the eyes. The most common anterior and posterior segment complications were related to IOL in 16.5% and VH in 11% eyes, respectively. At the last visit, retina was attached with functional macula in 63 eyes. Foveal atrophy, macular hole formation, optic atrophy, VH, phthisis and recurrent RD were the causes of decrease or loss of vision.
Conclusion: Phacovitrectomy with IOL implantation is a safe and effective surgery providing good visualization during vitrectomy and preventing a cataract operation in another session in such a patient group with serious systemic diseases.

Objective: Periampullary diverticulum (PAD) is an acquried luminal pathology that is located in the second
segment of duodenum and Ampulla of Vater is located in or aside of it. We aimed to determine the frequency
of periampullary diverticulum in endoscopic retrograde cholangiopancreatography (ERCP) and the effect of
presence of periampullary diverticulum on ERCP success and complications.
Material and Method: The ERCP procedures held in Gastroenterologic Endoscopy Unit of Sisli Hamidiye Etfal
Training and Research Hospital between years 2011-2014 were retrospectively evaluated.
Results: Periampullary diverticulum was found in 112 of (11.8%) 948 cases who underwent ERCP with
various indications. A 1026 procedures were done to 836 patients without periampullary diverticulum
and 136 procedures were done to 112 patients with periampullary diverticulum. No statistically significant
difference was found in terms of number of ERCP procedure per patient between patients with and without
periampullary diverticulum (1.21 vs. 1.23 p=0.838). Common bile duct cannulation failed in 8 (7%) of patients
with periampullary diverticulum whereas this cannulation was unsuccessful in 54 (6.4%) of patients without
periampullary diverticulum (p=0.859). The mean age of cases with periampullary diverticulum (72.7±12.2
years) was statistically significantly higher than the ones without periampullary diverticulum (56.8±16.4
years) (p<0.001). The rate of female gender was statistically significantly higher in patients with periampullary
diverticulum compared to ones without (72.2% vs. 54.6%, p=0.042). No statistically significant difference
was found in terms of ERCP complications such as bleeding, pancreatitis, and perforation between two
groups.
Conclusion: Periampullary diverticula are more frequently found in elderly and female patients. Although
some of the studies reported increased rates of ERCP complications in patients with periampullary
diverticula, no significant difference was found in terms of ERCP complications between patients with and
without periampullary diverticulum in this study. These results are important because they demonstrate that
patients with periampullary diverticulum can undergo ERCP as safely and efficiently as the patients without
periampullary diverticulum when the procedure is done by careful endoscopists in experienced clinics.

Objective: The aim of this study is to compare choroidal thickness using enhanced depth imaging optical coherence tomography between primary open angle glaucoma patients with or without previous trabeculectomy.
Material and Method: Fourteen eyes of 12 patients with a history of previous trabeculectomy surgery (TRAB) at least 6 months ago and 20 eyes of 12 patients who has a diagnosis of primary open angle glaucoma (POAG) and did not experience trabeculectomy surgery were recruited to this cross-sectional non-randomised study. Patients with a history of uveitis, diabetic retinopathy, age related macular degeneration, refractive errors other than the determined limits, optic neuropathy or other retinal, choroidal or optic nerve diseases were excluded. Following the complete ophthalmologic examination, choroidal thickness was measured between the hyperreflective outer layer of retinal pigment epithelium and inner layer of sclera, at subfoveal region and 1.5 mm temporal and 1.5 nasal to the fovea, respectively, using RTVue-100 5.1 (EDI-OCT) device.
Results: The mean age of the patients in the TRAB group was 59.9±13.4 (range 29-76), while it was 58.4±9.7 (range 29-73) in POAG group. Groups showed homogeneous distribution in terms of age, gender, laterality, IOP, refractive errors, visual acuity, axial length and central corneal thickness (CCT) (p>0.05). The mean subfoveal, temporal and nasal choroidal thickness of TRAB group was higher (388.2±84.1, 372.4±77.1, 374.1±84.1 µm, respectively) compared to the POAG group (383±64, 358.6±62, 357.5±61.5 µm, respectively), but the difference was not statistically significant (p>0.05). There was a moderate negative correlation between IOP and subfoveal and nasal choroidal thickness in patients with POAG (p=0.048, r=-0.458; p=0.042, r=-0.458; respectively)
Conclusion: There was not any statistically significant difference regarding subfoveal and perifoveal choroidal thickness between patients with previous trabeculectomy at least 6 months ago and patients with diagnosis of POAG who had medically regulated IOP rates and did not experienced trabeculectomy. Patients with POAG may experience choroidal thinning in case of high IOP rates.

Objective: Renal failure is one of the most prominant adverse effect of the zoledronic acid (ZA) which is well known to decrease the skeletal-related events (SREs) in breast cancer patients developing bone metastasis. In this particular study, our object was to evaluate the incidence of this side effect and the risk factors leading to the development of renal failure.
Material and Method: A total of 97 patients who underwent ZA treatment for breast cancer with bone metastasis in our institute between March 2006 and December 2013 were evaluated. For the assesment of renal failure, serum creatinine levels were obtained before the treatment. Preliminary and the highest levels of creatinine levels during the treatment were used in calculation of creatinine clearance according to the Crockcroft-Gault formula. The age of the patients, the number ZA treatment periods, number of the infusions, the simultaneous anti-cancer treatments, non-steroidal anti-inflammatory drug use, diabetes mellitus and presence of hypertension were recorded.
Results: The mean age of the patients was 54±10 years and the treatment period of ZA was 37±18 months. In all of the patients participated in this study the preliminary creatinine levels were under 1.4 mg/dl. In 22 of our patients (23%) creatinine levels increased more than 0.5 mg/dL, besides creatinine clearance were found out to be decreased both of which were pointing out the renal toxicity. In two patients creatinine clearance was under 30 ml/min. and one of the patients has undergone renal dialysis. The only independent risk factor underlined was the advanced age (60 years ≤) (p=0.017).
Conclusion: As a conclusion breast cancer patients with bone metastasis undergoing ZA treatment are prone to the development of renal failure. In order to avoid this particular risk of developing renal failure, serum creatinine levels should strictly be monitored before the treatment and meticulous attention to the hydration should be given during the treatment especially in patients with advanced age.

Objective: Right colon tumor often presents with bleeding and related-symptoms. Therefore, most of these patients are diagnosed with anemia in the preoperative assessment. We aimed to investigate whether tumor location affect the frequency and volume of blood transfusion in patients who underwent colon cancer surgery.
Material and Method: A total of 192 patients who underwent colon cancer surgery between November 2007-February 2013 were included in the study. The patients were evaluated in 2 groups as patients with right colon tumor (Group A=94) and patients with left colon tumor (Group B=98). Collected data included demographic features, preoperative and postoperative hemoglobin (Hgb) values, packed red blood cell (PRBC) transfusion requirements, surgical procedures, complications and mortality results.
Results: There was no difference between the groups regarding demographic data. Preoperative Hgb values were significantly lower in Group A (10.9±2.08 mg/dL vs 11.6±2.02 mg/dL, p=0.031). Preoperative PRBC transfusion rates were significantly higher in Group A (19% vs 8%, p=0.034). While volume of in-hospital PRBC transfusion was statistically significant higher in Group A compared to Group B (0.56 U vs 0.23 U, respectively, p=0.038), the frequency of overall PRBC transfusion was similar (62% vs, 47%, p=0.06). Hospital stay, postoperative complications (18% vs 17%) and mortality (2% vs 5%) were not statistically different between two groups. Mortality was not associated with PRBC transfusion in both groups (p=0.515).
Conclusions: Preoperative Hgb values were found lower in patients with right colon cancer. This resulted in increased frequency and volume of PRBC transfusion during hospital stay but no increased mortality rate. We believe that within our results, the higher rates of transfusion in right colon cancer do not cause higher mortality and morbidity compared to patients with left colon cancer.

The importance of the transabdominal cervical length measurement to predict preterm delivery in low-risk pregnant women for premature birth.
Objective: The aim of the present study is to evaluate the efficacy of transabdominal cervical length measurement using ultrasound on predicting preterm birth.
Material and Method: The data retrospectively obtained from the records of the patients who were admitted to our department between March 2014 and January 2015 during fetal anatomic survey in 18-24 weeks of pregnancy were retrospectively assessed. Age, obstetric history, delivery week and transabdomial cervical length measurement using ultrasound were obtained form the records. The specificity and sensitivity values were calculated while accepting a cut-off value of 30 mm and 25 mm for cervical length.
Results: A total of 142 patients were enrolled. Eleven women had preterm birth, since 131 had term. The mean cervical length was 32.90±8.45 mm in women with preterm birth, and 35.31±7.54 mm in term (p>0.05).
Conclusion: The present study suggests that transabdominal cervical length measurement using ultrasound has a limited diagnostic value on the prediction of preterm birth.

Objective: Nodal involvement is important for the prognosis in skin cancers. In the absence of palpable lymph nodes or when the nodal involvement is suspicious, sentinel lymph node biopsy (SLNB) is the preferred method instead of agrressive regional lymph node dissection. In our study we aimed to share our experience regarding SLNB in malignant skin tumors.
Material and Method: From August 2009 to August 2015, 30 patients (17 male, 13 female) aged between 21-81, who underwent SLNB, were analysed retrospectively.
Results: Thirty-three SLNBs were performed in 30 patients. In all procedures sentinel lymph node was identified and excised successfully. Eight positive sentinel lymph nodes were obtained. Four patients, who had negative SLNB previously, developed symptoms on behalf of metastasis on followup, and underwent therapeutic lymph node dissection.
Conclusion: Patients, who have no clinical evidence of nodal involvement but suspicion of nodal status, should undergo SLNB procedure, which has a low morbidity and complication rate.

Objectives: The central neck dissection (CND) for thyroid cancer is applied prophylactically or therapeutically. Although it’s reported that minimum 8 lymph nodes should be resected in bilateral central dissection and minimum 4 in unilateral for proper staging, the extent of the applied central neck dissections are not clear yet. We aimed to evaluate the localizations and the number of the lymph nodes resected in central neck dissection in this study.
Material and Method: The number of the lymph nodes and their anatomical localisations of the patients whom underwent standard unilaterally or bilaterally central neck dissection in addition to total thyroidectomy for differentiated thyroid carcinoma by the same surgeon were evaluated. Chi-square and Fisher’s exact test were used for statistics.
Results: The mean age of 43 patients who underwent central neck dissection prophylactically or therapeutically for differentiated thyroid cancer was 45.7±15.1. Bilateral and unilateral central neck dissections were applied to 32 patients and 11 patients, respectively. The unilaterally resected number of lymph nodes was 9±6 (2-23), and bilaterally 14±6 (5-30), which was higher in the bilaterally dissected group (p<0.05). The number of prelaryngeal, pretracheal, right paratracheal and left paratracheal lymph nodes were 3±3, 2±3, 5±2, 5±4, respectively. The number of right paratracheal (p=0.001) and left paratracheal (p>0.01) lymph nodes were significantly higher than pretracheal. Additionally the number of right paratracheal lymph nodes was significantly higher (p=0.001) than prelaryngeal.
Conclusions: Although the average number of the resected lymph nodes was adequate and higher than the advised, it was seen that the number of resected lymph nodes was in a wide range, between 2-30. Although the 2/3 of the lymph nodes of the central neck area were located in the pretracheal region in cadaveric studies, the important part of the lymph nodes were in paratracheal region in the central neck dissection specimen. Central neck dissection should be applied according to anatomical borders of the regions and the lymph nodes of paratracheal region should not be excluded. Notably, the tissue behind the recurrent laryngeal nerve is important for the complete dissection of the right paratracheal area.

Intrinsic obstruction of the tracheal lumen is extremely rare and usually caused by hemangiomas, hamartomas, or webs. We report a congenital tracheal polyp in a term neonate causing intermittent desaturations and expiratory wheezing. To our knowledge, this represents the first report with congenital tracheal polyp in the neonatal period.

Introduction: Juvenile recurrent parotitis (JRP) is a nonspecific, nonobstructive, nonsuppurative disease that is characterized by intermittent swelling of one or both parotid glands in children. The aetiology is unknown but autoimmunity, ductal obstruction, immune deficiency, and infectious causes have all been proposed. The diagnosis is suggested from the history of the disease, the clinical examination and radiological findings. Several treatment modality is proposed. The first line of treatment consists of conservative observation such as antibiotics, analgesics.
Case Report: Herein, we report a 11-years old child patient with recurrent acute parotitis with the evaluaion of the etiology of disease and review the relevant literature.
Conclusion: JRP should be considered in the differential diagnosis of patients with acute recurrent parotis swelling. A high degree of clinical suspicion is needed to determine this rare potential etiology.

Jarcho-Levin syndrome is rare a congenital disorder characterized by numerical and structural costo-vertebral abnormalities. The subtypes of this syndrome are, spondylothoracic and spondylocostal dysostosis. Rib and vertebrae aberrations cause respiratory insufficiency and result in recurrent respiratory infections. Since it is a rare entity, a newborn diagnosed as spondylothoracic dysostosis with meningomyelocele, who had ventriculoperitoneal shunting due to severe hydrocephalus and could not be weaned from respiratory support due to chest deformity, is presented in this case report.

Five-months old patient admitted to our institute’s neurosurgery outpatient clinic for swelling and intermittent discharge at the occipital region; and diagnosed as “dermal sinus tract” following the tests. The patient was interned in the Neurosurgery Clinic and occipital dermal sinus repair was performed in 18/12/2008. The patient was discharged without any complications in 22/12/2008. The patient was under outpatient follow-up, while due to unrest and bad medical condition, he was brought back to the neurosurgery outpatient clinic. The CT evaluation of the patient revealed a cystic lesion at the posterior of the 4th ventricule, so the patient was admitted to the hospital again. Abscess drainage was performed at 06/04/2009 and the patient was admitted to the intensive care unit (ICU). The patient’s medical condition was bad, he was unconscious, and had no spontaneous respiration when he was taken to the ICU; thus, individualized nursing care was planned, and implemented, and success was achieved. Individualized nursing care was applied in terms of respiratory activity, infection risk, nutrition and fluid volume deficiency, providing of a safe environment and maintaining it, urinary retansion/incontinence, risk of disturbance of skin integrity and intolerance to activity. The body temperature was around 36-37°C, and the height and weight development remained within favorable range with the normal children. As a result of the individualized care plans performed by the experienced nurses in the ICU, the patient grew in the normal range as the children with the same ages, no pressure sore or infection developed. The patient was still being cared at the ICU when this article was written. This is the longest period of hospitalization of a child in the literature as we found out.