The eighth edition of the TNM classification system was announced. Thyroid cancers were included in the fourth edition of the TNM classification system which was published in 1987. Each version of the TNM system which is updated based on evidence in the literature, includes some important differences from the previous version for the differentiated thyroid carcinomas (DTCs), like other cancers. Seventeen different classification systems for thyroid cancer have been developed until today. Some of these systems are quite complex and are difficult to use in practice. It has been shown that the TNM system with the new regaulations is the most consistent and applicable staging system for DTC in different patient groups, and the TNM system is now the most commonly used classification system in thyroid cancer, as in other cancer types. The most important update of the eighth version is that the age as prognostic factor is regulated as younger and older than 55 years, which has been divided as younger/older than 45 years of age in prior editions. Furthermore, the change in the definition of T3 in the T stage is remarkable. In the seventh edition, the definition of minimally invasive extrathyroidal extension and the definition of perithyroidal soft tissue included in its example have been abolished. Macroscopic extension into any of the strap muscles was moved to the T3 category in the eighth edition. In N staging in the 7th edition, the upper mediastinal lymph node involvement which took place in N1b was moved to the N1a category. In the eighth edition, it is observed that generally in patients over 55 years old have a stage downgrade in all stages compared to the seventh edition. In the eighth edition, the appropriate tumor stage can easily be determined. In patients under the age of 55 years, patients with distant metastases were defined as stage II, and without as stage I. Patients with distant metastasis over the age of 55 years are defined as stage IVB. The stages of patients without distant metastases over the age of 55 years can be defined by other clinical features (intrathyroidal tumor, macroscopic extrathyroidal extension, lymph node metastasis and distant metastasis). If there is no lymph node metastasis in patients with intrathyroidal tumors smaller than 4 cm (T1,T2), it is called stage 1, and stage II, if lymph node metastasis is present. Patients with intrathyroidal tumors greater than 4 cm (T3) are placed in stage II, regardless of lymph node status (N0 or N1). In tumors with macroscopic extrathyroidal extension; irrespective of the lymph node metastasis, the tumor is in stage II if only invasive into the strap muscles, and stage III if extended to subcutaneous tissue, larynx, trachea, recurrent laryngeal nerve and esophagus, and stage IVA if extended to the prevertebral fascia, mediastinal vessels or if surrounded carotid artery. TNM classification is a staging system that reliably predicts disease-specific survival in the DTC. The eighth edition of TNM compared to the previous editions classifies a large proportion of patients with DTC in low-risk groups in terms of mortality, and initial evaluations show that it may be more suitable in predicting disease-specific survival.

There is not enough data about the frequency of illegal drug use during pregnancy in developing countries and consequently the incidence of neonatal abstinence syndrome in newborn infants is unknown. In recent years, a significant increase in the number of cases reported as neonatal abstinence syndrome has been detected in the literature. Due to the social and religious culture of our society, health care practitioners do not receive sufficient and accurate information from patients and their relatives. Often, this situation is revealed by the awareness of the health care practitioner. In this review, the illegal substances frequently used in pregnancy, the findings and treatment of these substances in the newborn baby, the current legal situation related to the subject in our country and the procedures of social services related to the subject were discussed and the procedures to be followed in this case were evaluated.

Objective: We performed a placebo-controlled, single-blind, pilot study to compare the efficacy and safety of low dose cosyntropin stimulation test with injection stress in the diagnosis of secondary adrenocortical insufficiency.
Material and Methods: Twenty-five patients (22 F, 3 M) with a low or normal plasma ACTH level, morning plasma cortisol level <15 μg/dL and an indication of cosyntropin stimulation test for secondary adrenocortical insufficiency were included in the study. On the first day, the test was performed with direct intravenous injection with 1 mL 0.9% saline. On the second day at the same time and with the same method, the test was repeated with 1 μg/mL cosyntropin solution. Immediately prior to the procedure, blood samples were taken from the cannula located in the other forearm for measurement of plasma cortisol at 30th and 60th minutes.
Results: The median ACTH value of the patients selected for the study was 22.10 pg/mL (14.00- 29.30) and the mean plasma cortisol level was 6.71±2.00 μg/dL. The baseline plasma cortisol values measured at one minute in the placebo-controlled tests for comparison of injection stress with 1 μg cosyntropin stimulation were similar, but a significant statistically significant difference was found between plasma cortisol values measured at 30th and 60th minutes (p<0.001).
Conclusion: Injection stress, which occurs during intravenous injection, does not cause an increase in cortisol responses. However, 1 μg cosyntropin stimulation test at the physiological doses produces a significant cortisol response, especially at 30 minutes.

Objective: Many elective surgery patients have pre-operative fear and anxiety at different levels. This research is intended to determine whether or not patients’ prolonged pre-operative waiting periods in the premedication room affect their anxiety levels.
Methods: After the ethics committee consent was obtained from the hospital where the study was conducted, the STAI FORM TX Pre-test form was completed to measure the situational anxiety of the patients, using face-to-face interviews right before surgery. While the patients were being taken to the operating room, the post-test survey form and a patient introductory information form were completed. Scores on the STAI FORM TX pre-test and post-test can range between 20 and 80. High scores indicate high levels of anxiety, and low scores indicate low levels of anxiety. This study found that average anxiety scores varied between 36 and 41.
Findings: This study included 250 patients (110 female and 140 male) whose median age was 43.1±15.7. The pre-operative situational anxiety scale pre-test score average of the patients was 40.8±5.1, while their post-test score average was 40.9±4.9. There was no statistically significant difference between the anxiety level scores on the STAI FORM TX pre-test and posttest (p=0.868). When the relationship between age group and STAI FORM TX (pre-test) differences were examined, the median anxiety score of the younger age group (15–30) were found to be significantly lower (p=0.004) than that of the middle age group (46–60). The STAI FORM TX pre-test score averages of the university graduates were found to be statistically significantly lower (p=0.006) than those of the patients who were only literate. The STAI FORM TX pre-test (p=0.001) and post-test (p=0.033) anxiety scores of the single participants were found to be statistically significantly lower than those of the married participants. It was also found that STAI FORM TX pre-test score averages of the patients who responded to the question, “How did you find the premedication room?” with the answer, “Good,” were higher than that of the patients responding to it with the answer, “Boring” (p=0.005). When the patients were asked about factors that could reduce their stress, 42.4% replied “being accompanied by a relative,” 28% replied “watching tv,” and 20.8% replied “listening to music.”
Conclusion: The STAI FORM TX scores indicated that all the surgery patients experienced anxiety. However, the patients’ prolonged waiting periods in the premedication room did significantly change their anxiety levels. The higher the patients’ levels of education were, the less anxiety they experienced. This suggests that more education leads to a better understanding and interpretation of information about their disease, which positively affects the feelings of educated patients. The married patients’ levels of anxiety may have been higher than those of the single patients due to feelings of responsibility as parents. In order to reduce the patients’ anxiety, they should be accompanied by a relative or allowed to relax with TV or music broadcasts.

Objective: The aim was to the evaluate Turkish and refugee newborns’ characteristics and analyze the results.
Material and Method: All Turkish and refugee neonates born and followed in University of Health Sciences, Bağcılar Training and Research Hospital’s neonatal monitoring unit between November 2015 and October 2016 were included to the study. Results: A total of 3109 neonates were included in the study. 62.5% (n=1303) of the Turkish newborns and 55% (n=559) of the refugee newborns were female (p=0.0001). Spontaneous vaginal delivery percentage was 58.3% (n=1213) in Turkish newborns and 57.7% (n=591) in refugees (p=0.001). Neonatal intensive care unit admission rates of refugee newborns were found significantly higher (8.8%) than Turkish neonates (p=0.004). There were no significant differences in birth weights, heights, head circumferences, gestational weeks and cord blood gas analysis and critical congenital heart diseases screening results were similar between the groups. Refugee mother’s antenatal followup rates (38.4%) were lower than Turkish mothers (73.8%) (p<0.0001). Refugee neonates were more frequently diagnosed with hyperbilirubinemia that required phototherapy (p=0.0004) and gestational diabetes diagnosis was detected more often in refugee mothers (p=0.001).
Conclusion: Refugees and Turkish neonates are born with anthropometric similarities. However, refugee newborns are more likely to require neonatal intensive care admission because they are more diagnosed with hyperbilirubinemia requiring phototherapy and they have more frequently gestational diabetes mothers. This may be related to the low antenatal follow-up rates of refugee mothers.

Objective: The aim of this study was the evaluation of the efficacy of examination of urine samples by Gram staining and MALDI-TOF MS system.
Materials and Methods: A total of 251 out of 555 urine samples sent for culture to Sisli Hamidiye Etfal Training and Research Hospital Clinical Microbiology Laboratory between September 14 to September 18, 2015 were randomly selected and included in the study. Detection of pure bacterial growth of ≥105CFU/ml was aimed by using Gram staining and MALDI-TOF MS. Urine samples yielding at least one bacterium in at least five microscopical fields by Gram staining were tested by MALDI-TOF MS (Bruker Daltonics, Germany). Urine culture was performed by using “Chromagar Orientation” medium (BD, USA). Culture, Gram staining and MALDI-TOF MS results were compared.
Results: In 28 (11.1%) of the 251 samples tested, bacterial growth of ≥105 CFU/ml was observed. While single bacterial agent was isolated in 27 of 28 samples, one sample yielded two different bacterial species. In 25 of 28 samples, bacteria with a single morphology was observed with Gram staining. MALDI-TOF MS could identify the bacterial agents in 18 of these 25 samples. While bacterial growth of ≥105 CFU/ml wasn’t observed in six samples yielding bacteria with a single morphology by Gram staining, contamination was observed in three samples. When MALDI-TOF MS results were investigated for these nine samples, it was observed that MALDI-TOF MS gave a result of “Escherichia coli” in one of the contaminated samples and no result was obtained in the remaining eight samples. When the culture is considered as the gold standard, three false-negative and nine false-positive results were observed by Gram staining while 10 false–negative and one false-positive results were observed by MALDI-TOF MS. The sensitivity, specificity, and positive and negative predictive values were 89.2%, 95.9%, 73.5%, and 98.6%, respectively, for Gram staining, and 64.2%, 99.5%, 94.7%, and 95.6%, respectively, for MALDI-TOF MS.
Conclusions: Combined use of Gram staining and MALDI-TOF MS in the direct testing of urine samples has allowed bacterial identification for more than half of the samples yielding bacterial growth of ≥105CFU/ml in culture,within two hours after receipt of the samples in the laboratory, with high specificity, and positive and negative predictive values. The use of MALDI-TOF MS with higher sensitivity rates will be useful in the diagnosis of urinary tract infections.

Objective: Studies in different ethnic groups, showed wide variations in terms of the absence of the palmaris longus tendon. The aim of our study is, to document the percentage of the absence of the palmaris longus muscle and flexor digitorum superficialis muscle variations among the Turkish population.
Material and Method: The study group constituted of adult patients who presented to department of Plastic, Reconstructive and Aesthetic Surgery for various reasons, other than a history of hand trauma and chronic illnesses. A total of 533 patients and their relatives (1066 hands) were included in the study. Among 533 people, the ability of isolated flexion of the proximal interphalangeal joint of all fingers (except thumb) and the presence of palmaris longus muscle were investigated with detailed physical examination.
Results: For 533 Turkish individuals (272 men and 261 women), aged between 18 and 66 years old, the overall prevalence of absence of palmaris longus muscle was 21.8% among Turkish population. The overall prevalence of variations of the flexor digitorum superficialis of the fifth digit was 23.7% in the Turkish population.
Conclusions: In operative techniques, where tendon grafting and tendon transfers are utilized, pre-operative consultation of the patient gains importance since the lack of palmaris longus tendon possibility is determined. Variations and deficiency of fifth digits’ flexor digitorum superficialis muscle function can not be proven on clinical examinations, so hand surgeons should be aware about flexor digitorum superficialis muscle variations in preoperative examinations and intraoperative dissections, and try to detect these variations by performing the specific examination tests (independent function, the connection with neighbor digits)

Objective: Anemia in adolescents is a significant health problem caused by multiple factors. With this study, we aimed to investigate anemia aetiology and its frequency among the adolescents.
Material and Method: A total of 74 patients were admitted to Pediatrics Clinic of Istanbul Şişli Hamidiye Etfal Training and Research Hospital between January 2012 and August 2013, who were aged between 10-19 years and diagnosed with anemia, were investigated regarding the aetiology.
Results: Female and male ratio were 74.3% and 25.7%, respectively, and the mean age of the patients was 14.7±1.8 years. The most common symptom was fatigue. Red meat consumption was detected to be low in patients who were diagnosed with iron deficiency anemia (IDA). Six of the patients had a history of bleeding. Menorrhagia was present in 23.6% of the females. As a result of certain laboratory tests, 81.1% of the patients were diagnosed with IDA. The aetiological evaluation revealed that the most common reason for the anemia was nutritional. Vitamin B12 deficiency and folic acid deficiency anemia were diagnosed in 13.5% and 1.4% of patients, respectively. Eleven patients underwent endoscopy, and the most common finding was gastritis. Apart from these diagnosis, we reported acute leukaemia in 3 patients, sepsis in 3 patients, hereditary spherocytosis, autoimmune hepatitis, autoimmune hemolytic anemia, aplastic anemia, a chronic renal failure and cholangitis in one patient each. While 39.2% of the patients were treated with hospitalization, 60.8% of the patients were under outpatient follow-up and treated.
Conclusion: An inappropriate diet and eating habit is the most common aetiology of anemia among the adolescents. Considering that this age group of patients are not under routine health care followup of pediatricians, it is necessary to examine the adolescent for anemia for early diagnosis, with investigating the causes and selecting the appropriate treatment.

Objective: Behcet’s Disease is a chronic multisystemic inflammatory vasculitis and presents with relapsing-remitting oral and genital ulcers accompanied by iridocyclitis. Although Behcet’s Disease affects people worldwide, it is seen commonly in Mediterranean, Middle East and Far East.
Material and Methods: We retrospectively reviewed 33 cases of Behçet’s disease with antenatal follow-up and deliveries performed between January 2012 and May 2017 in the department of obstetrics and gynecology, division of perinatology of our hospital.
Results: We observed that 27.2% of patients did not need treatment, while 72.8% of patients had colchicine, azathioprine, prednisolone, interferon-alpha, adalimumab and combination of these drugs as medical treatment. Only 8 of the 33 patients (24.2%) had relapse during follow-up period. Mean gestational age at time of delivery was 38.5±2.6 weeks of gestation and the mean birth weight was 3244±681 grams. Preterm delivery rates before 37 and 34 weeks of gestation were observed in 9% and 3% of patients, respectively. Intrauterine growth restriction (IUGR) was observed in three cases (9%) and there was only one case (3%) of preeclampsia.
Conclusions: Behcet’s Disease is not associated with unfavorable outcomes in pregnancy in most of the cases. Disease is in remission stage in most of the cases. Adverse effects of the medications on fetus, used to treat Behcet’s Disease were not observed. Hence, Behcet’s Disease affect women of childbearing age, it will continue to be an issue in pregnancy. Large-scale prospective controlled studies where information is based on more robust bases are needed to determine the pregnancy outcomes in Behcet’s Disease.

Objective: To present clinical findings, radiological and pathologic data of the intraorbital spaceoccupying lesions (ISOL) treated with surgical intervention.
Materials and Methods: The medical records of 81 patients who underwent surgery for ISOL between January 2010 and April 2017 were reviewed retrospectively. The demographical data of the patients, preoperative and postoperative ophthalmologic examination findings and the location of mass radiologically were examined in detail. The surgical approach and surgical technique, peroperative and postoperative complications, histopathological results, the duration of follow-up were recorded.
Results: A total of 81 patients (37 female, 44 male) were included in this study. The mean age was 37.14±23.53 year. Intraorbital Space-Occupying Lesions (ISOLs) were intraconal in 3 patients, extraconal in 71 and both intraconal and extraconal in 7 patients. The lesion was in the form of a nontumoral mass in 25 patients, while tumoral in 56 patients. Trans-conjunctival orbitotomy approach was performed in ten patients, while the orbitotomy via skin incision was performed in 71 patients.
Conclusions: Intraorbital Space-Occupying Lesions (ISOLs) cause functional and cosmetic important problems according to their localizations. The definitive treatment of these lesions is mostly surgical and full surgical excision may provide permanent healing.

Objective: Long QT syndrome is a rare syndrome with a high mortality rate in neonatal period. We report a newborn who was admitted to the outpatient clinic with complaints of cyanosis and breastfeeding difficulties, diagnosed as ventricular tachycardia due to long QT syndrome with no response to the treatment, and evaluate the diagnostic and therapeutic approaches in the context of current literature. Case: A newborn delivered at 41th week of pregnancy by cesarean delivery with a birth weight of 3460 grams was admitted to the emeregency outpatient clinic at postnatal seventh day with complaints of breastfeeding difficulty and cyanosis. Newborn was in a poor general condition with impaired peripherical circulation, with respiratory rate 80/min, heart rate 280/min, and oxygen saturation 60%. The newborn was intubated and admitted to the neonatal intensive care unit (NICU). Electrical cardioversion at 1 joule/kg was performed due to ventricular tachycardia (VT) detected at electrocardiography (ECG). After restoration of sinus rhythm, corrected QT (QTc) interval was measured as 0.53 sec. Echocardiography was performed and no structural cardiac anomaly was detected but severe mitral and tricuspid valve regurgitations were present and the ejection fraction (EF) was 30%. Because of recurrence of ventricular tachycardia (VT), synchronized cardioversion at 1 joule/ kg and 2 joule/kg were performed, followed by lidocaine therapy when no response was obtained. Due to the resistant VT, amiodarone, flecainide and esmolol were administered subsequently. Patient failed to respond to any antiarrhythmic treatment and was lost on day 3 of follow-up, after emerging ventricular fibrillation.
Conclusion: Long QT syndrome is a rare disease with high mortality in the newborn. Early diagnosis may help in terms of treatment but the main prognostic factors are the length of QT interval and the associated structural anomalies. Screening of newborns with risk factors by electrocardiography is controversial, but it may be considered in cases with determined risk factors. Also interventional procedures may be considered in severe cases resistant to medical treatments.

Objective: Endometriosis is the presence of functional endometrial gland and stromal tissue outside of the uterine cavity by the stimulation of ovarian hormones. The most common presenting symptoms are the abdominopelvic pain, dysmenorrhea, menstrual irregularities and infertility. Endometriosis is usually found in pelvis; however, it can appear in extrapelvic tissues such as the scar tissues, eyes, lungs, umbilicus, gallbladder, liver, skin and abdominal wall. Here we present a case of scar endometriosis developed after Ceaserean section.
Case: 37 year-old woman with a prior history of Cesarean section presented with complaints of chronic pain on her scar tissue and a palpable mass. Abdominal ultrasonography and magnetic resonance imaging showed heterogeneous mass with increased vascularity. Surgical excision was performed and the specimen was reported pathologically as endometriosis.
Conclusion: In the evaluation of masses with a close location to the incision line of patients with especially previous history of operation, periodically increasing pain with menstrual cycles should be questioned and diagnosis of endometriosis should be kept in mind.

Objective: Isolated hypoglossal nerve palsy is a rare complication of long lasting operations under general anesthesia like cosmetic surgeries and orthopedic operations, caused by the use of laryngeal mask or intubation tube. In this case report, we discuss the probable causes and treatment methods of this complication in the light of the current literature.
Case: In this study, we present a 35-year old patient who developed isolated left hypoglossal nerve palsy right after septorhinoplasty. The patient received B vitamin complex and a gradual tapering dose of oral methylprednisolone treatment of 1mg/kg and his tongue movements completely recovered after three months.
Conclusion: Hypoglossal nerve palsy is the consequence of neuropraxia caused by compression of the nerve in between the intubation tube or its cuff and the hyoid bone or cervical vertebra. In this case report, we evaluated factors that increase the complication rate, such as the use of nitrous oxide during the surgery, the malposition of the intubation tube or the laryngeal mask. Precautions such as using adequate size intubation tubes, gentle intubation of the patient without trauma, proper positioning of the intubation tube, avoiding long-time hyperextension of the position of the head of the patient and checking intracuff pressure continuously with a manometer would help to prevent these kind of complications.

Objective: Community acquired pneumonia is one of the leading causes of death worldwide, especially for small children. There is a wide range of etiological agents varying according to age. As conventional culture methods require longer test times for viral and atypical pathogens, nucleic acid tests with higher sensitivity and specificity are advantageous for rapid detection. Due to detection of several different agents in the same sample, multiplex polymerase chain reaction (PCR) test offers rapid diagnosis.
Case: In this paper, a 4-year-old boy was presented with a severe course of pneumonia/pleural effusion. The presence of the co-infection of H1N1 virus and human metapneumovirus has been demonstrated by PCR methods.
Conclusion: This case highlights the importance of detection of viral causes in the etiology of pneumonia, especially with PCR to avoid unnecessary antibiotic use.