Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a minimally invasive, natural orifice transluminal endoscopic surgery (NOTES) technique with no visible scarring. Endoscopic lobectomy or total thyroidectomy can be performed completely under low CO2 pressure level with the aid of one 10 mm and two 5 mm ports applied from vestibular region through the mouth. Its application is increasing worldwide. It can be safely performed in selected patients in experienced centers. In this study, the development of minimally invasive thyroid surgery, patient selection and exclusion criteria for TOETVA, regional anatomy, surgical technique, preoperative and postoperative care, advantages and disadvantages and possible complications of the procedure will be discussed.

Late preterm infants (LPI) are defined as delivery between 340/7 – 366/7 weeks of gestational age. In recent years, the number of LPI has risen according to preterm births especially in developed countries. Even though the LPI are premature, they have been considered as mature infants. Respiratory problems are the most common consequences of LPI. Therefore it is important to understand respiratory problems of LPI clearly. This review presents the updated data of early respiratory problems of LPI.

Objective: Epidemiologic examination of the results of postnatal follow-up of infants born at our hospital.
Material and Method: All the babies born within two years (2014-2015) in our hospital were included in the study. Babies’ information, physical examination findings, interventions used in the delivery room, follow-up results and existing diseases were recorded daily. The obtained data were compared with the national data of our country.
Results: A total of 7246 newborns were born from 7172 pregnancies, 7175 (99.02%) live births and 71 (0.98%) stillbirths within the specified period. Rate of cesarean section, multiple pregnancy and major anomaly were 41.66%, 1.03% (n: 74) and 0.77% (n: 55) respectively. According to the gestational age, preterm delivery (<37 weeks) was 13.7% (n: 995), term delivery (38-42 weeks) was 84.8% (n: 6143) and postterm delivery (>42 weeks) was 1.5% (n: 108). Distribution of infants according to birth weight was determined as; <1000 grams 0.8% (n: 61), 1000-1500 grams 1.1% (n: 79), 1500-2500 grams 8.4% (n: 611), 2500-4000 84.5% (n: 6119) and > 4000 grams 5.2% (n: 376). The SGA rate in infants was 6.7%, the AGA rate was 79.8% and the LGA rate was 13.5%. It was found that 3.1% of babies were followed in newborn unit, 8.2% were admitted to neonatal intensive care unit and 1.4% were referred to other hospitals. In delivery room, babies were given oxygen at a rate of 7.5%, in 2.4% infants were used T-piece resuscitation support and 1.04% of babies were subjected to intubation and/or chest compression.
Conclusion: In our country, there are not enough studies about newborn babies’ short-term follow-up at delivery room. The preterm delivery rates and cesarean birth rates in our hospital were found to be below the country values but higher than the developed countries.

Objective: Plasmapheresis has been used in the management of immune-mediated renal diseases for the last 40 years. The rationale behind this approach is to remove pathogenic immune mediators, such as autoantibodies and immune complexes, from the circulation. In this study, we aimed to evaluate retrospectively the patients treated with plasmapheresis in our clinic.
Material and Method: A total of 27 patients who had been hospitalized and treated in our clinic in the last 10 years were evaluated. Demographic characteristics, biochemical parameters, biopsy results, plasmapheresis complications and survival analyses following treatments were recorded.
Results: The mean age of the patients was 39±18 (17-71) years and the mean number of plasmapheresis sessions was 13.9±8.8 (2-41). Six patients had Goodpasture Syndrome, 5 patients had ANCA (+) small vessel vasculitis, 5 patients had thrombotic microangiopathy, 4 patients had Systemic Lupus Erythematosus, 3 patients had Acute Humoral Rejection, 3 patients had primary crescentic glomerulonephritis and 1 patient had multiple myeloma. One patient died, 9 patients had renal improvement and 12 patients underwent dialysis due to end stage renal disease during the treatment. One patient with renal improvement experienced recurrence, and including this patient, Grade 2-3 renal failure continued in a total of 6 patients.
Conclusion: In conclusion, plasmapheresis should be considered as an adjuvant treatment in some specific groups in Nephrology Clinics. It can prevent progression to end stage renal failure and accelerate renal improvement.

Objective: As life expectancy increases, so does the prevalence of diseases observed in the elderly. Hip fractures that usually occur with simple falls are profoundly more common in the elderly population. In the present study, we aimed to examine the outcomes of patients with proximal femoral fractures aged >65 years who admitted to post-operative intensive care units and orthopaedic clinics.
Materials and Method: The study included 118 elderly patients (aged >65 years) who were available from medical records of hospital archives, with proximal femoral fractures who were surgically treated between 2010 and 2015 in our orthopaedic and traumatology clinics, with American Society of Anesthesiologists (ASA) 3 scores. Our aim was to evaluate the mortality rate during the early postoperative period (30 days). Patients were categorised into two groups based on where they were admitted to during the postoperative period.
Results: A total of patients over 65 years of age with 118 proximal femur fractures with an ASA score of 3 were evaluated in two groups; in the postoperative intensive care unit and in orthopaedic clinics. There was no significant difference between the two groups in terms of mortality rate during the early postoperative period.
Conclusion: For patients with proximal femoral fractures aged >65 years with an ASA score of 3 and who are thoroughly evaluated preoperatively, complications that may develop as a result of delays in the time-to-surgery, caused by postoperative intensive care requirements may be reduced by performing the surgery without delay

Objective: The aim of this study is to investigate the effectiveness of neurological rehabilitation in patients with traumatic brain injury. Materials and Method: Forty-five patients who were rehabilitated after traumatic brain injury were included in the study. The sociodemographic characteristics of the patients, the cause of the injury, the duration of coma and posttraumatic amnesia, the duration of stay in the other clinics after injury, the time between injury and admission to the rehabilitation clinic, the duration of stay in the rehabilitation clinic and long-term complications were determined. The functional differences between the admission of the patients and their final control examinations were compared using Disability Rating Scale (DRS), Functional Independence Measure (FIM), and Functional Ambulation Scale (FAS), and cognitive differences were compared using their recent status criteria, with Rancho Los Amigos Scale (RLAS).
Results: There was a significant improvement in the functional status of patients after neurological rehabilitation. There were statistically significant changes in DRS, FIM, FAS and RLAS scores after treatment compared to initial status. Better improvement in the functional status was detected in patients with lower initial DRS scores and higher FIM and RLAS scores.
Conclusion: The neurologic rehabilitation significantly affects the recovery of functional status after traumatic brain injury.

Objective: Craniosynostosis surgery in infants may require increased blood transfusions, leading to arterial blood gas variations. In this study, we aimed to evaluate the relation between blood transfusion and arterial blood gas changes in infants during craniosynostosis surgery.
Material and Methods: Data of all children, who were operated in our neurosurgery clinic during a five-year period were screened retrospectively. Demographics, arterial blood gas sample results, transfusion requirements in children who underwent craniosynostosis surgery were recorded.
Results: The mean age of 23 cases was 19.00±16.26 months, 73.9% of the patients underwent single/ multiple suture correction, and the mean duration of operation was 154.13±17.49 minutes. The mean transfused materials were 152.63±61.18 mL erythrocyte suspension and 125.00±57.74 mL fresh frozen plasma. At the end of the surgery, HCO3 was higher, base deficit was decreased and ionized calcium was higher compared to beginning and perioperative values. Preoperative and postoperative hemoglobin values (10.20±1.06 / 9.91±2.42) showed no difference (p=0.583).
Conclusions: Our data from this retrospective study has confirmed, that in children undergoing craniosynostosis surgery, perioperative and postoperative stable condition is related to adequateblood replacement compatible with arterial blood gas changes.

Objective: Urinary stone disease is associated with age, gender, diet, climate, and genetic causes. Infections, anatomic and metabolic abnormalities can lead to stone formation. We aimed to evaluate epidemiologic and metabolic factors in children with urolithiasis.
Material and Methods: A total of 89 patients (46 girls), aged between 0 and 18 years with diagnosis of urolithiasis, microlithiasis and a history of urolithiasis were recruited in this retrospective study. Medical records were assessed for current age, gender, age at diagnosis, presenting symptoms, family history, physical findings, medications, results of laboratory tests (including blood urea nitrogen, serum creatinine, electrolytes, blood gases, urinalysis: urinary calcium, uric acid, oxalate, cystine, citrate, magnesium and creatinine levels) and radiological findings.
Results: The mean age was 6.20±5.27 (range, 0.2-18.2 years). Stones were mostly located in the kidneys (n=52, 58.4%). Microlithiasis, urolithiasis and urolithiasis history were defined in 22 (24.7%), 64 (71.9%), and 3 (3.4%) patients, respectively. Anatomic abnormalities were determined in 17.9% of the patients. Of all patients, 31 (34.8%) had metabolic abnormalities in their urinary analyses. While 26 patients (29.2%) had one metabolic abnormality, five (5.6%) patients had more than one. Metabolic abnormalities were two times more in girls than in boys (p=0.027). The most common metabolic disorder detected was hypocitraturia (n=16, 17.9%), followed by hyperoxaluria (n=8, 8.9%), hypercalciuria (n=6, 6.7%), and hyperuricosuria (n=6, 6.7%).
Conclusions: Metabolic abnormalities were detected frequently in children with urinary stone disease. Hypocitraturia was the most common metabolic abnormality. Detailed evaluation is needed to manage patients with urolithiasis. Female gender may be accepted as a predisposing factor for metabolic abnormality.

Objective: The aim of this present study was to retrospectively evaluate the local therapeutic efficiency of radiofrequency ablation (RFA) treatment in patients with primary and metastatic liver cancer.
Material and Methods: A total of 35 patients who had undergone RFA in our clinic were included in the study and evaluated retrospectively. Patients were grouped according to their ages, lesion’s primary or metastatic formation, number of lesions and lesion sizes. Local tumor growth, new lesion formation and general survival factors were evaluated statistically.
Results: During the follow-up after RFA treatment, the residual tumor was determined in the treatment area in only one (1.9%) lesion. Total ablation was achieved in 50 lesions (98.0%). Local tumor growth occured in 9 lesions of eight patients (17.6%). During follow-up, development of a new lesion at a different liver region was seen in 22 (62.8%) patients. Following RFA, one patient had cholecystitis while intraperitoneal minimal hemorrhage was encountered in two patients.
Conclusion: As RFA treatment protects intact liver tissues, directly targets the tumor, and the mortality and morbidity rates are lower when compared to other treatments, it is currently considered safe for the treatment of liver tumors.

Objective: Cardiac troponins are accepted as the standard markers for diagnosis and risk management of patients with acute coronary syndromes. However, cardiac troponins are elevated in some patients presenting with non-cardiac situations. In this paper, a rare case of non-cardiac troponin elevation with acute cholecystitis is presented.
Case: A 56 year old female patient admitted to the emergency room with pain in the epigastric region. The abdominal ultrasound revealed acute cholecystitis. She had some coronary risk factors and electrocardiogram showed no segment deviation but troponin was positive. Acute coronary syndrome couldn’t be ruled out and coronary angiography revealed normal coronary arteries. Therefore, elevated troponin was linked to acute cholecystitis.
Conclusion: Although troponin elevation is a cornerstone marker for diagnosis the patients with acute coronary syndromes, there are various conditions with non-coronary-related troponin elevations. This can lead to misdiagnosis and unnecessary interventions. As a result, in patients with similar sypmtoms (pain in the epigastric region), electrocardiogram wave changes and elevated troponin levels, acute cholesystitis diagnosis should be considered.

Objective: We aimed to discuss the diagnostic and therapeutic difficulties of Riedel’s thyroiditis case which is a rarely seen disease of thyroid gland.
Case: A 43-year-old female patient who admitted to the hospital with a firm, painless midline mass, and shortness of breath. Diagnosis was made by radiographic imaging, fine needle aspiration biopsy, tru-cut biopsy and open biopsies. Surgical treatment was not planned due to extensive extrathyroidal spread of the disease. Systemic steroid treatment was decided to be initiated to the patient, who had tracheotomy due to tracheal compression, after examining the medical treatment protocols reported in the literature. A distinct decrease in the size of the thyroid mass was noticed at follow up.
Conclusion: Riedel thyroiditis is diagnosed in the presence of histopathological findings as well as radiological and physical examination findings. For diagnosis, primarily, it is important that the disease is suspected and that thyroid malignancies are excluded. Surgical treatment is not recommended because of the high morbidity except for the symptoms of compression, but there is also no standard medical treatment protocol. Therefore, reporting and discussion of the treatment choices of Riedel’s thyroiditis on an individual basis will be beneficial.

Objective: Mucopolysaccharidoses, develop with genetic transmission which cause destructive changes in various organs as a result of glycasoaminoglycans deposition in lysosomes. Herein, we are presenting a case with Morquio syndrome so as to attract attention to this rarely seen disease.
Case: A 11-year-old male patient presented to our hospital with complaints of short stature, andbone deformities. The parents were not relatives, and he had 3 healthy younger siblings. On physicalexamination, coarse facial features, hypertelorism, disproportionate short stature, genu valgum, pectus carinatum, kyphoscoliosis, were detected. He demonstrated a waddling gait. His neuromotor development was normal for his age. On bone radiograms, kyphoscoliosis, flared iliac wings, coxa valga, flattening of femoral epiphysis, widened ribs, and narrowed iliac wings were detected. Urine tests were positive for glycosaminoglycans (keratan sulphate). Enzymatic analysis revealed low levels of glucose-6-phosphatase [15 pmol/mg/hr, (n: 400-2000)], which made the final diagnosis.
Conclusions: Morquio syndrome has Aand B types with similar clinical manifestations which are transmitted as an autosomal recessive trait. Tip 4A is a disease due to a deficiency of galactosamine6-sulfatase (GALNS) enzyme, which is encoded by the 16q24.3 gene, while Type 4B is characterized by deficiency of beta galactosidase. In both types of the disease, keratan sulphate, and chondrotin
6 sulphate accumulate. Also in our case manifestations became more prominent around age 1, and gradually progressed. Our patient without mental problems had typical skeletal signs on radiograms which is named dysostosis multiplex. It is necessary to initiate enzyme replacement therapybefore the onset of gait disorders.

Congenital cystic adenomatoid malformation (CCAM) of lungs is a rare congenital lesion that is associated with abnormal proliferation of terminal bronchi and has an incidence of 1/4000 to 1/35000. Most of the cases (90%) are seen in the first two years of life and it is rarely seen in adolescents and the older age groups. Respiratory distress related to pulmonary compression and lung hypoplasia occur during the neonatal period, whereas recurrent and persistant pneumonia may occur at the older ages. The lesion is classified into five types by Stocker et al. Herein, we present a fourteen-year-old case who had no symptoms previously and diagnosed as type 2 cystic adenomatoid malformation with video-assisted thoracic surgery (VATS) due to persistent and treatment-resistant pneumonia

Objective: We present a 15-year-old male patient with a diagnosis of Familial Mediterranean Fever followed up for 6 years, then diagnosed with also Celiac disease.
Case: The patient with Familial Mediterranean Fever (FMF) was admitted to the pediatric emergency unit many times in the last month with the complaint of recurrent widespread and epigastric pain. Acute phase reactants were in normal range in nearly half of his admissions. Since he had a family history of Celiac disease, at the age of 10, he was referred for Celiac disease serology exmination, but the result was normal. Due to the presence of severe epigastric tenderness and pain at the last visit, gastroduodenoscopy was performed and multiple biopsies were obtained. After gastroduodenoscopy procedure, tissue transglutaminase (tTG) antibody IgA level was reanalysed and the result was >300 U/ml. The pathology result was also consistent with Celiac disease.
Conclusion: The diagnosis of Celiac disease is difficult in patients with FMF because both of them have similar clinical symptoms. Even if previous screening is negative for Celiac disease as in this case, Celiac disease should be considered as it may cause delay in diagnosis, particularly in patients with Familial Mediterranean Fever who have similar symptoms and a positive family history for celiac disease.