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Background and Objectives: The accurate identification of hyper functioning parathyroid gland is needed for definitive surgical treatment in primary hyperparathyroidism. Ultrasonography and 99mTechnetium sestamibi scintigraphy are the two most used methods with varying sensitivities. This study aimed to assess the value of parathyroid hormone (PTH) assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation of lesions with negative or inconclusive scintigraphy results., Methods: We evaluated data of 28 lesions in 21 patients who underwent US-guided parathyroid fine-needle aspiration (FNA) with PTH washout, retrospectively. The PTH washout results and the reports of parathyroid surgery and imaging studies were reviewed., Results: Of operated 28 lesions 23 had positive and 5 had negative washout results. The median FNA-PTH washout was 2315.5 pg/ ml (min-max: 12.3-6978 pg/ ml). The calculated sensitivity of FNA-PTH washout was 85.7% and the specifity was 28.6%. The positive and negative predictive values were 78.3% and 40.0%, respectively., Conclusions: FNA-PTH can be used to establish the nature of the lesion, discriminate parathyroid gland from thyroid lesions or cervical lymph nodes, improving the surgical outcomes. It can be used to localise parathyroid lesions preoperatively when negative or discordant ultrasound and scintigraphy findings are obtained., (© 2018 Wiley Periodicals, Inc.)

Purpose : To evaluate the relationship between visual acuity, visual field and spectral domain optical coherence tomography (OCT) parameters, including retinal nerve fiber layer (RNFL), ganglion cell-internal plexiform layer (GC-IPL) thicknesses, and optic nerve head parameters in patients with severe glaucoma. Material and Methods : Patients with the diagnosis of severe glaucoma were recruited from the data gathered at our glaucoma department. A detailed ophthalmic examination was performed using the Standard Automated Perimetry (the 30-2 SITA standard program was used for VF testing). Cirrus EDI-OCT was used for peripapillary RNFL and GC-IPL thickness measurements. Optic nerve head parameters, including mean cup-to-disc (c/d) ratio, rim area, vertical c/d ratio, cup volume, were also measured by spectral domain OCT. Correlations between these structural parameters and functional parameters (visual acuity, VF parameters) were investigated. Results : Forty-one eyes of 34 patients with severe glaucoma were enrolled in this study. Correlations between BCVA and mean GC-IPL thickness ( p = .03), superior GC-IPL thickness ( p = .03), inferonasal GC-IPL thickness ( p = .01), superonasal GC-IPL thickness ( p = .01), superotemporal GC-IPL thickness ( p = .04), and rim area ( p = .00) were found to be positive statistically significant. There was also a positive statistically significant correlation between MD and inferotemporal GC-IPL thickness ( p = .03). Negative statistically significant correlations were found between BCVA and mean c/d ratio ( p = .00), vertical c/d ratio ( p = .02) and cup volume ( p = .00). Discussion : Mean, superior, inferonasal, superonasal, and superotemporal GC-IPL thicknesses and mean c/d ratio, vertical c/d ratio and cup volume were found to be correlated with BCVA in patients with severe glaucoma.

Purpose: The purpose of this study is to investigate adaptation, validity, and reliability of the Turkish version of the Child and Adolescent Social Support Scale for Healthy Behaviors (CASSS-HB)., Methods: The CASSS-HB was translated using translation and back-translation. This was a methodological study conducted with 860 students (11-14 years old). Content and construct validity were assessed to test the validity of the CASSS-HB. Exploratory and confirmatory factor analysis of the scale was performed and the reliability of the scale over time (the test-retest method) was examined., Results: Psychometric analyses of the Turkish version of the CASSS-HB indicate high reliability and good content and construct validity., Conclusions: It can be seen that the items comprising the scale appear to be acceptably capable of measuring the variable of social support in terms of healthy behavior in children and adolescents. Healthcare professionals can thus use the scale for determining the degree of social support students of the ages 11-14 receive in terms of developing healthy behavior., (Copyright © 2018. Published by Elsevier B.V.)

Objectives: To evaluate anterior segment parameters measured by dual Scheimpflug corneal topography in pseudoexfoliative glaucoma (PEXG), primary angle-closure glaucoma (PACG), and healthy eyes., Materials and Methods: One hundred forty-three eyes of 86 patients were included in this study. Forty-seven eyes of 38 patients with PEXG, 30 eyes of 15 patients with PACG, and 66 eyes of 33 healthy subjects were evaluated. Patients who underwent previous ophthalmic surgery and contact lens wearers were excluded. After full ophthalmological examination, mean central corneal thickness (CCT), white-to-white horizontal corneal diameter (WTW), pupillary diameter (PD), anterior chamber volume (ACV), anterior chamber depth (ACD), and mean anterior chamber angle were measured by dual Scheimpflug corneal topography and compared between the three groups. Statistical analyses were done using Statistical Package for Social Sciences for Windows 18.0 program., Results: No statistical difference was found in mean age or gender among the study groups (p>0.05). There were also no statistical differences in CCT, WTW, or PD among the groups (p=0.568, p=0.064, p=0.321, respectively). ACV, ACD, and mean anterior chamber angle values were significantly lower in the PACG group compared to the other groups (p=0.000 for all). There was no statistically significant difference in these measurements between the PEXG and normal eyes., Conclusion: ACV and depth and mean anterior chamber angle were statistically different (lower) in PACG when compared with PEXG and healthy eyes. Dual Scheimpflug corneal topography can be used as an objective method for the measurement of anterior segment parameters in glaucoma., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Purpose: The aim of this study was to evaluate the effect of initial intravitreal ranibizumab injection on visual acuity (VA) and central macular thickness (CMT) for the treatment of macular edema (ME) with and without serous retinal detachment (SRD) secondary to branch retinal vein occlusion (BRVO)., Materials and Methods: Fifty-two BRVO eyes, treated with intravitreal ranibizumab injection for ME with and without SRD, were retrospectively reviewed. Patients were divided into two groups according to spectral domain optical coherence tomography (SD-OCT). The efficacy of intravitreal ranibizumab injection at first month was assessed by analyzing the change in best-corrected VA and reduction in CMT with SD-OCT., Results: There were 21 patients with SRD and 31 patients with only CME (no-SRD). CMT was significantly greater in the SRD group than in the CME group (451±62.2 µm vs 383.5±37.2 µm, respectively, P <0.05). After initial intravitreal ranibizumab injection, mean VA improved from 0.87±0.26 logarithm of the minimum angle of resolution (LogMAR) to 0.54±0.27 LogMAR ( P <0.01) and CMT decreased from 451±62.2 µm to 379.3±58.6 µm ( P <0.001) in the SRD group. In the no-SRD group, mean VA improved from 0.69±0.25 LogMAR to 0.44±0.25 LogMAR ( P <0.001) and the CMT decreased from 383.5±37.2 µm to 337.7±39.4 µm ( P <0.001) at the first month visit. Eyes with SRD revealed better anatomic results and greater reduction of CMT after intravitreal ranibizumab injection ( P <0.01)., Conclusion: VA and CMT can be improved by intravitreal ranibizumab injection in BRVO patients with and without SRD. However, more marked improvement in macular morphology was achieved in patients with SRD than those without SRD., Competing Interests: Disclosure The authors have no financial or proprietary interest in any product, method, or material described herein, and report no conflicts of interest in this work.

Background/aim: To evaluate the malignancy risk of thyroid nodules in different clinical thyroid diseases. Materials and methods: Patients who underwent thyroidectomy between 2007 and 2014 were grouped as euthyroid, hypothyroid, and hyperthyroid. Further classification was made depending on the presence of solitary/multiple thyroid nodules. Results: Among 2870 patients, 1719 (59.9%) were euthyroid, 962 (33.5%) were hyperthyroid, and 189 (6.6%) were hypothyroid. Overall malignancy was detected in 980 (34.1%) patients. Malignancy rates were 42.1%, 42.9%, and 18.3% in the euthyroid, hypothyroid, and hyperthyroid groups, respectively (P < 0.001). A total 41.4% of patients with euthyroid nodular goiter (ENG) and 46.3% of patients with euthyroid multinodular goiter (EMNG) had thyroid malignancy (P = 0.169). Mean tumor size and capsular and vascular invasion were significantly lower in EMNG than in ENG. Among hypothyroid patients, 45.7% with solitary and 42.2% with multiple nodules were malignant (P = 0.705). When toxic nodular goiter and toxic multinodular goiter were analyzed together, malignancy rate was 24.7% (104/421), and when Graves with nodule/nodules was considered, it was 19.7% (59/299). Conclusion: In hypothyroid or euthyroid patients who underwent thyroidectomy, malignancy rate was higher than 40%, and was lower in hyperthyroid patients. Patients with multiple nodules carry a similar risk of malignancy as patients with solitary nodules, independent of the functional status.

Purpose: To evaluate the effect of smoking on ganglion cell complex and inner plexiform layer (GC-IPL) thickness measured by spectral domain optical coherence tomography (OCT)., Methods: The right eyes of 36 smoking (study group) and 36 never-smoking (control group) healthy subjects were included in this study. After full ophthalmologic examination, axial length measurement (AL), ganglion cell complex-inner plexiform layer (GC-IPL) thickness, retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) values were measured by OCT. Statistical analysis was performed to compare GC-IPL, RNFL thicknesses, and CMT values between groups., Results: The mean age [mean ± standard deviation (SD)] of 36 subjects in the study group was 26.2 ± 6.0 years, and the mean age of 36 subjects in control group was 25.7 ± 4.1 years. The mean ALs of the study group and the control group were 22.46 ± 0.88 and 22.36 ± 1.09 mm, respectively (p = 0.68). Mean GC-IPL thickness was 82.8 ± 3 µm in the study group and 84.3 ± 3 µm in the control group (p = 0.08). The mean RNFL values of study and control groups were 95. 8 ± 7.9 and 97. 3 ± 7.8 µm, respectively (p = 0.39). The mean CMT values of study and control groups were 248.3 ± 17.96 and 249.5 ± 17.18 µm, respectively (p = 0.78)., Conclusion: Smoking does not seem to have any effect on GC-IPL thickness, mean RNFL and CMT values. Further studies in larger groups are needed to reveal the effect of smoking on these parameters.

Objectives: In this study, we aimed to evaluate the usefulness of a new parameter -ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC)., Materials and Methods: The diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined., Results: Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features., Conclusion: Decreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The knowledge about the viral etiologies causing respiratory disease in adults is limited. Viral respiratory diseases may lead deterioration in certain patient populations. The aim of this study was to determine the viral etiologies of influenza-like illness among patients requiring hospitalization and to document the risk factors for mortality. This prospective study was performed in one of the 7 centers in Turkey in the context of influenza surveillance by the Global Influenza Hospital Surveillance Network. A 35-bed Adult Emergency Service and 10-bed Acute Care Unit were screened for consequent recruitment of eligible patients daily, on weekdays only. ICD-10 codes in the electronic health records and direct patient encounters were used to screen for the following eligibility diagnoses: acute respiratory tract infection, asthma, heart failure, pneumonia, influenza, chronic obstructive lung disease, dyspnea/respiratory abnormality, respiratory symptoms, cough and fever. A total of 334 patients who were admitted with the eligible ICD-10 codes within the 24th and 48th hours were screened during the study period and of those eligible ones, 106 consented and were swabbed. Nasal or nasopharyngeal swabs were collected using Virocult (Medical Wire & Equipment, UK) and sent to the central laboratory in 1-3 days. Swabs were collected and specimens were introduced to real-time polymerase chain reaction based multiplex kits, as well as, ABI 7500 platform with CDC primers and probes. A total of 106 patients were swabbed. Hospital mortality was 12.2%. More than one fourth of the patients needed a sort of mechanical ventilation support and at least one organ failure developed in one third of the patients. One or more viral pathogens were detected in 56 (52.8%) of the swabbed patients, with influenza H3N2 being the most prevalent one. Having a lower body mass index (OR, 0.845, p= 0.034) was associated with mortality. Chronic lung diseases were shown to confer a survival advantage (OR, 0.127, p= 0.009). Community acquired viral respiratory infections might lead to significant compromise in adult patients. Prevention of malnutrition might result in better outcomes in patients who need acute admission. The survival advantage of those with chronic lung diseases warrants further investigation.

Background: There are many variables that influence nose tip harmony. Even in a rhinoplasty that appears successful in profile, one may see nostril asymmetries, alar retractions, or irregularities in the soft triangle, and patients express their dissatisfaction with these simple deformities., Objectives: In this study, we define the ratio of caudal and cephalic excess of the lower lateral cartilage. We evaluate whether it is possible to eliminate nostril asymmetries and alar retractions by means of supporting the facet polygon with the help of a lower lateral cartilage auto-rim flap, a technique we have developed in our rhinoplasties., Methods: The auto-rim flap was used successively on 498 primary rhinoplasty patients on whom the same surgeon operated between May 2013 and June 2015, performing marginal incisions., Results: Of the 498 patients in the series, only 1 of the first 10 required a revision due to tip asymmetry related to the auto-rim flap. A minimal nostril asymmetry that did not require intervention occurred in 10 patients. In none of the patients could an increased alar retraction be seen postoperatively. All patients exhibited alar cartilage in the anatomically correct position., Conclusions: With the auto-rim flap technique, a part of the caudal excess of the alar cartilage remains as a flap in the facet region; therefore, there is no need in the cephalic region to perform more of an excision than what is strictly necessary., Level of Evidence: 4 Therapeutic., (© 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background/aim: Increasing evidence is available about the role of prolactin in the development of various cancers. The purpose of this study is to evaluate the frequency of thyroid cancer in patients with prolactinoma followed at a single site., Materials and Methods: The medical records of 182 patients diagnosed with prolactinoma were reviewed retrospectively. Serum prolactin, antithyroglobulin, antithyroid peroxidase antibody, thyroid-stimulating hormone, free T4, and free T3 values and pituitary gland magnetic resonance imaging and thyroid ultrasound reports were evaluated., Results: Forty-five (39.5%) patients were found to have a thyroid nodule (13 solitary, 32 multiple). Ten patients were administered a thyroidectomy, and differentiated thyroid cancer (DTC) was detected in 6 of these patients (6/114, 5.3%). One patient had lung metastasis. The control group consisted of 113 individuals (101 females, 12 males with a mean age of 32.1 ± 9.1). In the ultrasound reports, 28 of these individuals (24.8%) had a thyroid nodule (5 solitary, 23 multiple), and one individual (1/113, 0.8%) had DTC., Conclusion: When compared to the control group, thyroid volume and thyroid nodularity were significantly higher in patients with prolactinoma (P < 0.001, P = 0.018, respectively); however, no statistically significant difference existed for the incidence of thyroid cancer (P = 0.196).

Objective: Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP., Materials and Methods: Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded., Results: Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy., Conclusions: As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period.

Aim: The aim of this study was to evaluate the clinical presentation, risk factors, complications, treatment and outcomes of cholelithiasis in children., Methods: Children with cholelithiasis were reviewed for demographic information, predisposing factors, presenting symptoms, laboratory findings, complications, treatment and outcome, retrospectively., Results: A total of 254 children with cholelithiasis (mean age: 8.9 ± 5.2 years) were recruited to the study. Girls (52.8%) were significantly older than boys (P < 0.001). Symptomatic patients (59%) were significantly older than asymptomatic patients (P = 0.002). Abdominal pain was the most frequent symptom. No risk factors were identified in 56.6% of the patients. Ceftriaxone (20%) was the most commonly associated risk factor. At presentation, at least one of the following complications was seen in 14.1% of patients: cholecystitis (10.9%), obstructive jaundice (2.7%), pancreatitis (1.96%) and cholangitis (1.2%). There was no relationship between gallstone size and symptoms, aetiological factors and complications. The cholelithiasis dissolution rate was higher in younger children (P = 0.032), in those with biliary sludge (P < 0.0001) and ceftriaxone-related cholelithiasis (P < 0.001). Haemolytic anaemia (P = 0.001) and older age (P = 0.002) were associated with stable stones. Ursodeoxycholic acid was administered to 94.4% of patients at presentation. Twenty-nine patients underwent cholecystectomy, and seven patients underwent endoscopic retrograde cholangiopancreotography. Patients who were symptomatic at presentation had significantly more frequent symptoms at follow-up (P < 0.001) CONCLUSIONS: Dissolution rate of cholelithiasis was higher in younger children, biliary sludge formation and ceftriaxone-related cholelithiasis but lower in older children and haemolytic anaemia-related cholelithiasis., (© 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Tumor multifocality is not an unusual finding in papillary thyroid carcinoma (PTC), but its clinical significance is controversial. In this study, we aimed to evaluate impact of multifocality, tumor number, and total tumor diameter on clinicopathological features of PTC. Medical records of 912 patients who underwent thyroidectomy and diagnosed with PTC were reviewed retrospectively. Patients were grouped into four according to number of tumoral foci: N1 (1 focus), N2 (2 foci), N3 (3 foci), and N4 (≥4 foci). The diameter of the largest tumor was considered the primary tumor diameter (PTD), and total tumor diameter (TTD) was calculated as the sum of the maximal diameter of each lesion in multicentric tumors. Patients were further classified into subgroups according to PTD and TTD. Multifocal PTC was found in 308 (33.8 %) patients. Capsular invasion, extrathyroidal extension, and lymph node metastasis were significantly higher in patients with multifocal tumors compared to patients with unifocal PTC. As the number of tumor increased, extrathyroidal extension and lymph node metastasis also increased (p = 0.034 and p = 0.004, respectively). The risk of lymph node metastasis was 2.287 (OR = 2.287, p = 0.036) times higher in N3 and 3.449 (OR = 3.449, p = 0.001) times higher in N4 compared to N1. Capsular invasion, extrathyroidal extension, and lymph node metastasis were significantly higher in multifocal patients with PTD ≤10 mm and TTD >10 mm than unifocal patients with tumor diameter ≤10 mm (p < 0.001, p < 0.001 and p = 0.001, respectively). There was no significant difference in terms of these parameters in multifocal patients with PTD ≤10 mm and TTD >10 mm and unifocal patients with tumor diameter >10 mm. In this study, increased tumor number was associated with higher rates of capsular invasion, extrathyroidal extension, and lymph node metastasis. In a patient with multifocal papillary microcarcinoma, TTD >10 mm confers a similar risk of aggressive histopathological behavior with unifocal PTC greater than 10 mm.

The purpose of this study is to compare the choroidal thickness (CT) and ganglion cell complex (GCC) thickness of the normal fellow eyes and the amblyopic eyes using enhanced depth imaging optical coherence tomography (EDI-OCT) in young Turkish adults with hyperopic anisometropic amblyopia. Patients with unilateral hyperopic anisometropic amblyopia were enrolled and underwent a full ophthalmological assessment, including best-corrected visual acuity, cycloplegic refraction, and axial length (AL) measurements. Cirrus EDI-OCT was used to obtain subfoveal CT, GCC thickness, retinal nerve fiber layer (RNFL), and central macular thickness (CMT) measurements. Comparison was performed between the amblyopic eyes and the normal fellow eyes. Forty-three hyperopic anisometropic amblyopic patients were enrolled in this study. Mean age of 23 female and 20 male patients was 24.8 ± 7.4 years. Mean AL was 21.9 ± 1.3 and 22.4 ± 0.9 mm in amblyopic and fellow eyes, respectively (P < 0.05). Mean subfoveal CT measurements were 325.4 ± 44.2 and 317.9 ± 42.7 µ in amblyopic and fellow eyes, respectively. There was no statistically significant difference between the groups (P > 0.05). Mean GCC thickness was 83.8 ± 3.6 µ in amblyopic eyes and 83.5 ± 3.9 µ in the fellow eyes. Statistically significant difference was not seen between the groups (P > 0.05). Mean RNFL and mean CMT measurements were also similar in two groups (P > 0.05). Subfoveal CT, CMT, RNFL, and GCC thickness measurements were not statistically significant between hyperopic anisometropic amblyopic eyes and normal fellow eyes.

Objective: Prolactin is a multifunctional pituitary hormone. The effect of prolactin on platelet activation is not well understood. Prolactinomas are the most common type of pituitary adenomas, and they are medically responsive to dopamine agonists. Mean platelet volume (MPV) is a marker of platelet function and activation. The aim of this study was to evaluate MPV values before and 6 months of cabergoline treatment when normoprolactinemia was achieved., Subjects and Methods: A total of 101 newly diagnosed prolactinoma patients and 102 healthy control subjects were included in the study. Patients with hematological disorders that affect MPV and those on medications were excluded. Prolactin, platelet count and MPV levels were recorded before and 6 months after the initiation of cabergoline treatment (0.5 to 1 mg, two times a week)., Results: There was no significant difference in platelet count and MPV before and after 6 months of treatment with cabergoline in patients with prolactinoma compared with the control group (p > 0.05)., Conclusion: Our results showed that MPV, a marker of platelet function, was unchanged in patients with prolactinoma.

Background: The optimal therapeutic choice for Graves' hyperthyroidism in the presence of moderate-severe Graves' orbitopathy (GO) remains controversial., Objectives: We aimed to compare GO course in patients with moderate-severe GO treated with early total thyroidectomy (TTx) versus antithyroid drug (ATD) regimens, in a prospective, randomized manner., Methods: Forty-two patients with moderate-severe GO were enrolled. A total of 4.5 g of pulse corticosteroids were given intravenously to all patients before randomization. Patients in the first group were given TTx, whereas patients in the second group were treated with ATDs. TSH was kept between 0.4 and 1 mIU/l. The clinical course of GO was evaluated with proptosis, lid aperture, clinical activity score (CAS), and diplopia., Results: Eighteen and 24 patients were randomized to the TTx and ATD groups, respectively. Thyroid autoantibodies decreased significantly, and there were significant improvements in proptosis, lid aperture, and CAS in the TTx group. While in the ATD group the decrement in thyroid autoantibodies was not significant, there were significant improvements in proptosis and CAS. When the TTx group was compared with the ATD group, anti-TPO, anti-Tg, and TSH-receptor antibodies were significantly decreased in the TTx group (p < 0.01), but there was no significant difference with respect to proptosis, lid aperture, CAS, and diplopia between the two groups during a median (min.-max.) follow-up period of 60 months (36-72)., Conclusion: Although no definitive conclusions could be drawn from the study, mainly due to limited power, early TTx and the ATD treatment regimens, followed by intravenous pulse corticosteroid therapy, seemed to be equally effective on the course of GO in this relatively small group of patients with moderate-severe GO during a median (min.-max.) follow-up period of 60 months (36-72).

Objective: The aim of this study was to disclose the prevalence of myocardial ischemia, as detected by adenosine stress myocardial perfusion imaging (MPI) with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT), in asymptomatic diabetic and pre-diabetic patients and to find out whether ischemia predicted the occurrence of adverse cardiac/cerebrovascular events (ACCE) at follow-up., Methods: Forty-three diabetic and thirty-five pre-diabetic asymptomatic patients without any history of coronary artery disease, underwent MPI and were followed-up for a 12.8±2.2 (8-19) months for the occurrence of ACCE. Baseline variables that would predict the presence of ischemia and the value of ischemia on MPI for predicting the occurrence of ACCE at follow-up were evaluated by logistic regression analysis., Results: Ischemia was detected in ten (23.3%) of the diabetic and in four (11.4%) of the pre-diabetic patients. The presence of diabetes was the only independent predictor of myocardial ischemia [odds ratio (OR): 12.31, 95% confidence interval (CI): 1.83-82.66; p<0.01]. During 12.8±2.2 (8-19) months of follow-up, ACCE was observed in five out of 78 (6.4%) patients. Patients with ischemia were significantly more likely to have ACCE during follow-up as compared to those with normal MPI scans (event rates: 21.4% vs. 3.1%, OR: 8.455 95% CI: 1.264-56.562, p=0.038)., Conclusion: Myocardial ischemia as detected by adenosine stress SPECT/CT in a population of asymptomatic patients with diabetes mellitus or pre-diabetes appeared to predict the occurrence of ACCE at follow-up., Competing Interests: No conflict of interest was declared by the authors.

Purpose: The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO)., Methods: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded., Results: The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004)., Conclusion: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.

Surface aesthetics of an attractive nose result from certain lines, shadows, and highlights with specific proportions and breakpoints. Analysis emphasizes geometric polygons as aesthetic subunits. Evaluation of the complete nasal surface aesthetics is achieved using geometric polygons to define the existing deformity and aesthetic goals. The relationship between the dome triangles, interdomal triangle, facet polygons, and infralobular polygon are integrated to form the "diamond shape" light reflection on the nasal tip. The principles of geometric polygons allow the surgeon to analyze the deformities of the nose, define an operative plan to achieve specific goals, and select the appropriate operative technique., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Thyroid angiosarcoma is a rather rare malignancy featuring a poor prognosis, and which may interfere with other aggressive thyroid tumors; it is usually seen in the Alpine region., Case Presentation: A 74-year-old male was referred to our center with complaints of progressive neck swelling and dyspnea. He had multiple nodules featuring cystic degeneration and calcifications in the thyroid gland, together with multiple lymphadenopathies of the neck region. Fine-needle aspiration cytology (FNAC) confirmed the presence of anaplastic carcinoma. A total thyroidectomy was performed. During the postoperative period, multiple drainage were performed for recurrent hematomas, but hematoma development could not be prevented. On postoperative day 7, the patient died due to multiple-system failure. Histopathological investigation of the thyroidectomy specimen indicated that the lesion was an angiosarcoma., Discussion: The cytological diagnosis of thyroid angiosarcoma is quite difficult. Extracapsular invasion and distant organ metastasis during surgery are known as strong and negative prognostic factors for thyroid angiosarcoma. Treatment is quite difficult, since this tumor is locally aggressive, destructive, and features a high recurrence rate. In this case, since extracapsular invasion, as well as lymph node and lung metastasis were present at the time of surgery; the expected survival time was quite short., Conclusion: This case shows that during differential diagnosis, patients initially diagnosed with anaplastic carcinoma via FNAC may actually present with angiosarcoma. It may be helpful to review the treatment modalities for this cancer type, which has a rather poor prognosis and features severe bleeding, as well as local and distant metastasis., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Aim: Epicardial adipose tissue (EAT) is a new independent marker of coronary artery disease (CAD). The aim of this study was to investigate the relationship between epicardial fat thickness (EFT) and endothelial dysfunction (ED) in patients with type I diabetes mellitus (TIDM)., Methods and Results: Seventy-six type I diabetic patients (diabetes duration 11.7 ± 8,1 years, aged 30.6 ± 10 years; female/male: 38/38) and 36 healthy controls were enrolled into the study. Fasting plasma glucose (FPG), lipid panel, glycosylated hemoglobin (HbA1C), high-sensitive C-reactive protein (hsCRP), and fibrinogen levels were determined. EFT was measured via two-dimensional (2D) M-mode echocardiography. Endothelial function was assessed as flow-mediated dilatation (FMD) at the brachial artery using high-resolution ultrasound. EFT was significantly higher in patients compared to controls (3.56 ± 0.48 mm vs. 3.03 ± 0.48 mm, P < 0.001). In addition, significant differences were observed between the patient and control groups in terms of FMD (6.70% ± 1.63 vs. 9.99% ± 1.84, respectively, P < 0.001). EFT was shown to be correlated negatively with FMD (r: -0.94, P < 0.001) and positively with hsCRP (r: 0.41, P < 0.001) and fibrinogen (r: 0. 31, P = 0.007). Multiple regression analysis showed EFT to be an independent factor influencing the endothelial function., Conclusion: There was inverse relationship between EFT and endothelial function in this study. EFT measured easily by transthoracic echocardiography may be a useful parameter in the assessment of patients with TIDM., (© 2015, Wiley Periodicals, Inc.)

Background: Thyroid disorders are frequently seen in the community. Thyroid ultrasonography (US) is commonly used in the diagnosis of thyroid diseases. The relationship between heterogeneous echogenicity of thyroid gland and thyroid tests are well known., Methods: The aim of this study is to evaluate the correlation of normal US with the thyroid tests. A total of 681 individuals were enrolled in the study. Individuals were separated into two groups as normal (group 1) and hypoechoic (group 2) according to the echogenicity in US. Subjects with nodular thyroid lesions were excluded from the study. Thyroid stimulating hormone (TSH), free T4 (fT4), thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb) values were recorded in both groups and thyroid stimulating hormone receptor antibody (TRAb) was recorded in individuals with low TSH., Results: 86.1% of individuals in group 1 had normal TSH, 93.7% had normal thyroid antibodies and in 77.6% of individuals, all thyroid tests performed were normal. In the 6.9% of the group 2, all reviewed thyroid tests were normal (P<0.001)., Conclusions: Our study shows that US is correlated with normal thyroid function tests and is a valuable tool in the prediction of normal thyroid function.

Protein phosphorylation is one of the most important mechanisms to control cellular functions in response to external and endogenous signals. Mitogen-activated protein kinases (MAPK) are universal signaling molecules in eukaryotes that mediate the intracellular transmission of extracellular signals resulting in the induction of appropriate cellular responses. MAPK cascades are composed of four protein kinase modules: MAPKKK kinases (MAPKKKKs), MAPKK kinases (MAPKKKs), MAPK kinases (MAPKKs), and MAPKs. In plants, MAPKs are activated in response to abiotic stresses, wounding, and hormones, and during plant pathogen interactions and cell division. In this report, we performed a complete inventory of MAPK cascades genes in Vitis vinifera, the whole genome of which has been sequenced. By comparison with MAPK, MAPK kinases, MAPK kinase kinases and MAPK kinase kinase kinase kinase members of Arabidopsis thaliana, we revealed the existence of 14 MAPKs, 5 MAPKKs, 62 MAPKKKs, and 7 MAPKKKKs in Vitis vinifera. We identified orthologs of V. vinifera putative MAPKs in different species, and ESTs corresponding to members of MAPK cascades in various tissues. This work represents the first complete inventory of MAPK cascades in V. vinifera and could help elucidate the biological and physiological functions of these proteins in V. vinifera.

The purpose of this paper was to analyze the effect of Valsalva maneuver application before finalizing thyroidectomy operations on the identification of bleeding points and postoperational drainage. One hundred patients (age range, 24-76 years) with multinodular goiter, recurrent multinodular goiter, toxic diffuse multinodular goiter, or papillary thyroid cancer were included in the study and were divided into 2 groups of 50 randomly. Both groups underwent thyroidectomy operation, only 1 group received intraoperative Valsalva maneuver application (twice, 30 seconds of 30-cm PEEP). The size of the thyroid gland, the duration of operation, hospital stay, and drain usage were reported. Postoperational occurrences of drainage, hematoma, reoperation, and additional complications were compared between the groups. Valsalva maneuver application helped to identify minor bleeding points in 32% of the cases. There was no significant difference between the study groups regarding the thyroid gland size, operation duration, hospital stay, and the duration of drain usage (P > 0.05 for all). The amount of drainage as well as the frequencies of hematoma, reoperation, and further complications was not significantly different between the study groups (P > 0.05 for all). Intraoperative application of Valsalva maneuver is only useful to detect minor bleeding points in some patients during thyroidectomy operations, but it had no effect on the duration of postoperative drain usage, the amount of drainage, and risk of hematoma. Therefore, intraoperative application of Valsalva maneuver has no beneficial effect on postoperative hemorrhagic complication after thyroidectomy operations.

Introduction: Hypophosphatemia may cause acute respiratory failure and tissue hypoxia. In this study we investigated the effect of hypophosphatemia on weaning success., Patients and Methods: A nested case-control study was conducted in a retrospective cohort of 76 patients who received invasive mechanical ventilation in 2005-2010 in the Medical Intensive Care Unit (MICU) of university hospital. Case patients (failure group) were those who could not be weaned in the first trial or who required post-extubation mechanical ventilation after first extubation. Control patients (success group) were successfully extubated in the first weaning attempt., Results: Frequency of hypophosphatemia (P level < 2.5 mg/dL) at admission was 23.7%. Weaning failure rate was 71.1%. Risk of weaning failure in the presence of hypophosphatemia was 88.9%, whereas risk in the absence of hypophosphatemia was 65.5%, resulting in risk ratio of 1.36 (1.06 - 1.74) (p= 0.096). Mean (± SD) P levels in the success and failure groups were 3.6 ± 1.0 and 3.2 ± 1.0 mg/dL, respectively (p= 0.113). Logistic regression analysis revealed four independent risk factors which were presence of underlying chronic pulmonary disease, high organ dysfunction score (SOFA) at admission, high blood urea nitrogen at the day of weaning trial and low P level at admission to predict weaning failure. Each 1 mg/dL increment in P level resulted in decreased probability of weaning failure with an OR of 0.43 (0.21-0.88)., Conclusion: In conclusion, a relation between hypophosphatemia and weaning failure was determined which has to be confirmed with prospective cohort and interventional studies with adequate power.

Apoptosis is an active form of programmed cell death (PCD) that plays critical roles in the development, differentiation and resistance to pathogens in multicellular organisms. Ribosome inactivating proteins (RIPs) are able to induce apoptotic cell death in mammalian cells. In this study, using yeast as a model system, we showed that yeast cells expressing pokeweed antiviral protein (PAP), a single-chain ribosome-inactivating protein, exhibit apoptotic-like features, such as nuclear fragmentation and ROS production. We studied the interaction between PAP and AtBI-1 ( Arabidopsis thaliana Bax Inhibitor-1), a plant anti-apoptotic protein, which inhibits Bax induced cell death. Cells expressing PAP and AtBI-1 were able to survive on galactose media compared to PAP alone, indicating a reduction in the cytotoxicity of PAP in yeast. However, PAP was able to depurinate the ribosomes and to inhibit total translation in the presence of AtBI-1. A C-terminally deleted AtBI-1 was able to reduce the cytotoxicity of PAP. Since anti-apoptotic proteins form heterodimers to inhibit the biological activity of their partners, we used a co-immunoprecipitation assay to examine the binding of AtBI-1 to PAP. Both full length and C-terminal deleted AtBI-1 were capable of binding to PAP. These findings indicate that PAP induces cell death in yeast and AtBI-1 inhibits cell death induced by PAP without affecting ribosome depurination and translation inhibition., Competing Interests: Conflict of interest: The authors declare no conflict of interest.

Objective: The frequency of thyroid nodules accompanying Graves' disease and the risk of thyroid cancer in presence of accompanying nodules are controversial. The aim of this study was to evaluate the frequency of thyroid nodules and the risk of thyroid cancer in patients operated because of graves' disease., Subjects and Methods: Five hundred and twenty-six patients in whom thyroidectomy was performed because of Graves' disease between 2006 and 2013 were evaluated retrospectively. Patients who had received radioactive iodine treatment and external irradiation treatment in the neck region and who had had thyroid surgery previously were not included in the study., Results: While accompanying thyroid nodule was present in 177 (33.6%) of 526 Graves' patients, thyroid nodule was absent in 349 (66.4%) patients. Forty-two (8%) patients had thyroid cancer. The rate of thyroid cancer was 5.4% (n = 19) in the Graves' patients who had no nodule, whereas it was 13% (n = 23) in the patients who had nodule. The risk of thyroid cancer increased significantly in presence of nodule (p = 0.003). Three patients had recurrence. No patient had distant metastasis. No patient died during the follow-up period., Conclusions: Especially Graves' patients who have been decided to be followed up should be evaluated carefully during the follow-up in terms of thyroid cancer which may accompany.

In Turkey, vitamin D deficiency has been seen in children as well as in their mothers. We assessed the vitamin D status of 83 infants and their mothers, categorized into four groups according to season and mothers' clothing style. We measured serum levels of 25-hydroxy vitamin D, calcium, inorganic phosphorus and alkaline phosphatase in each mother-infant pair. In the summer, the rate of vitamin D deficiency was higher in mothers who wore clothing that covered nearly all of the body (55%) than in mothers whose clothing covered less of the body (13.6%) (p=0.016). In the winter, nearly half of both groups of mothers had vitamin D deficiency or insufficiency, and there were no significant differences based on their clothing style (p>0.05). In all groups of infants, vitamin D deficiency and insufficiency rates were found to be very low. It seems that 400 IU/daily vitamin D intake is adequate for infants in Turkey; for mothers, we propose vitamin D supplementation during the pregnancy and lactation period.

Tip rhinoplasty is a key component of aesthetic rhinoplasty. An understanding of the correlation between tip surface aesthetics and the underlying anatomic structures enables proper identification and correction of tip abnormalities. Surface aesthetics of the attractive nose are created by certain lines, shadows, and highlights with specific proportions and breakpoints. In this Featured Operative Technique, the authors describe a stepwise process for tip rhinoplasty that conceptualizes aesthetic subunits as geometric polygons to define the existing deformity, the operative plan, and the aesthetic goals. Tip rhinoplasty is described in detail, from initial markings through incisions and dissection. The autorim graft concept is explained, and lateral crural steal and footplate setback techniques are described for the attainment of symmetric domes with correct lateral crural resting angles. Methods in columellar reconstruction are described, including creating the columella (C') breakpoint and the infralobular caudal contour graft. The principal author (B.Ç.) has applied these techniques to 257 consecutive "polygon rhinoplasties" over the past 3 years., (© 2014 The American Society for Aesthetic Plastic Surgery, Inc.)

Purpose: We investigate changes in macular choroidal thickness in eyes without diabetic retinopathy of patients with various durations of diabetes, using enhanced depth imaging optical coherence tomography (EDI OCT)., Methods: The 134 Type-2 diabetic patients who presented without diabetic retinopathy were prospectively imaged using EDI OCT on Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) sd-OCT. The patients with diabetes were classified into three groups, according to the duration of diabetes: Group I (5-9 years, n = 63); Group II (10-14 years, n = 37); Group III (15-40 years, n = 34). The retinal and choroidal thickness was evaluated between these groups at central fovea and at the regions at 500-mm intervals up to 1500 mm temporal and nasal to the fovea., Results: The central foveal retinal thickness was significantly different between groups (group I: 273.05 ± 19.51 µ, group II: 267.12 ± 20.78 µ, group III: 261.34 ± 22.27 µ; p = 0.04). The choroidal thickness measurements at central fovea, at 500, 1000, and 1500 micron intervals temporal and nasal to the center of the fovea were not significantly different between groups. The duration of diabetes was weakly correlated with choroidal thickness in all measured distances and they were not statistically significant. The central foveal choroidal thickness was weakly correlated with serum creatinine (r = -0.18, p = 0.03)., Conclusion: Foveal retinal thickness was significantly decreased in patients with longer duration of diabetes. Duration of diabetes does not seem to be related to foveal chorodial thickness. On the other hand, the weak relation between creatinine and choroidal thickness may be evaluated further. The choroidal thickness changes that may be an early sign of nephropathy can be submitted to an easy, noninvasive scanning test at the same time.

Unlabelled: The combination of dorsal nasal reconstruction and camouflage of surface irregularities is an important step in rhinoplasty. We hereby present our technique of delivering diced cartilage in combination with bone dust to the nasal dorsum using the patient's blood as a carrier. We advocate use of an autologous material (blood) as a scaffold for graft delivery, dismissing the use of a foreign material or fascial wrapping of the graft. Using the patient's blood for this purpose not only stabilizes the graft into a malleable structure that is easily applicable to the nasal dorsum, it also decreases the potential for reaction against foreign material., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

IL-33 is a proinflammatory cytokine that is a member of IL-1 family. Previously the effect of IL-33 on kidney injury is showed in animal models. In this study, we searched if we can use IL-33 to show the early stage of kidney injury in diabetic patients. Three groups are identified: 26 patients in Group 1: Healthy group, that do not have any chronic diseases and not taking any medication; 42 patients in Group 2: DM (diabetes mellitus) group without any known kidney disease and with normal kidney functions; 32 patients in Group 3: DM + MA (microalbuminuria) group that are assumed to have nephropathy. IL-33 level of DM patient group is greater than healthy group; also IL-33 level of DM + MA patient group is greater than healthy group; but there is not any difference between DM and DM + MA group. The increase in IL-33 levels in diabetic nephropathy is not associated with kidney injury but the increase could be resulting because of diabetes. So IL-33 cannot be used in early recognition of diabetic nephropathy.

Objective: Several studies have shown that arterial stiffness and ventricular dysfunction are increased in individuals with type 2 diabetes. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta, and increased aortic stiffness is a risk factor for cardiovascular disease. The aim of this study was to evaluate the degree of aortic stiffness and its relationship with the left ventricular (LV) function in patients with prediabetes and healthy control subjects., Methods: The study groups were composed of 50 patients with prediabetes and 47 healthy adults with similar demographic characteristics. The LV systolic and diastolic functions were assessed using standard two dimensional (2D) echocardiography, M-mode echocardiography, pulsed-wave (PW) echocardiography and tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at a level 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry., Results: There were significant differences between the prediabetic and control groups in the degree of aortic strain (4.7 ± 2.8% vs. 14.9 ± 4.5%; respectively, p<0.001) and distensibility (2.0 ± 1.5 vs. 6.8 ± 2.3; 10(-3) cm(2) dyn(-1), respectively, p<0.001). In addition, significant differences were observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. The left atrial diameter was significantly larger in the prediabetics than in the controls (35.9 ± 3.9 vs. 33.7 ± 4.2; respectively, p=0.027)., Conclusion: AS is increased in patients with prediabetes. In addition, there is a significant relationship between the degree of aortic stiffness and the LV function in this patient population. Therefore, the aortic elasticity parameters calculated on 2D echocardiography are useful for predicting early cardiovascular risks in prediabetics.

The ATP-binding cassette (ABC) protein superfamily constitutes one of the largest protein families known in plants. In this report, we performed a complete inventory of ABC protein genes in Vitis vinifera, the whole genome of which has been sequenced. By comparison with ABC protein members of Arabidopsis thaliana, we identified 135 putative ABC proteins with 1 or 2 NBDs in V. vinifera. Of these, 120 encode intrinsic membrane proteins, and 15 encode proteins missing TMDs. V. vinifera ABC proteins can be divided into 13 subfamilies with 79 "full-size," 41 "half-size," and 15 "soluble" putative ABC proteins. The main feature of the Vitis ABC superfamily is the presence of 2 large subfamilies, ABCG (pleiotropic drug resistance and white-brown complex homolog) and ABCC (multidrug resistance-associated protein). We identified orthologs of V. vinifera putative ABC transporters in different species. This work represents the first complete inventory of ABC transporters in V. vinifera. The identification of Vitis ABC transporters and their comparative analysis with the Arabidopsis counterparts revealed a strong conservation between the 2 species. This inventory could help elucidate the biological and physiological functions of these transporters in V. vinifera.

Background: Although food allergy is an important health problem in Western countries, the prevalence varies among geographic regions. There is limited data on the prevalence of food allergy especially for adolescent age group, and the data from Turkey and Mediterranean region are even scarce., Methods: The study is a cross-sectional survey including a questionnaire followed by phone survey with families that have reported food allergy and clinical evaluation of children having a history compatible with food allergy after phone survey. The sample number of students has been calculated 9096 of a total of 210.000 students at the second stage (6th, 7th, and 8th grades) of state elementary schools in the metropolitan counties of Ankara province with the assumption of food allergy prevalence (P) = 1% and a δ value = 0.2 (α < 0.05, β = 0.8)., Results: Of 11,233 questionnaires distributed at 34 schools, 10,096 (89.4%) have been returned. The number of reported food allergy was 1139 (11.2%), and it was reduced to 133 (1.3%) after phone survey. After clinical evaluation by skin test, specific IgE and double-blind placebo-controlled food challenge (DBPCFC), proven IgE-mediated food allergy was determined in 15 (0.15%) children. The foods most commonly resulting food allergy were peanut 0.05% and treenuts 0.05%., Conclusion: The prevalence of food allergy among adolescent age group has been confirmed to be comparatively low in Turkey. Peanuts and treenuts were determined to be the most common causes of IgE-mediated food allergy., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To determine whether number of self-reported impulsivity symptoms was associated with conduct problems, substance use, academic problems, relational problems and exposure to physical violence in adolescents., Method: A survey was developed to be used in a nationally representative general community sample. A 2-staged, stratified and clustered sampling was used. For the first stage (school selection) an equal probability, systematic random sampling and for the second stage (class selection) a simple random selection was used. The statistical analysis included the full and usable surveys obtained from 26009 students (97.5% of the invited sample)., Results: After parental education, parental employment, economic status and age; presence of antisocial behaviors; substance abuse; and exposure to physical violence were controlled, presence of even one self-reported impulsivity symptom was associated with physical violence, frequent smoking, frequent alcohol use, substance use, self injurious behaviors, carrying weapons, gang membership, poor relations with others, academic failure and poor mental health. ORs increased with the number of self-reported impulsivity symptoms for several behaviors. Several other associations among conduct problems, substance use, academic failure and relational problems are also reported., Conclusion: Even one definite impulsivity symptom must be addressed since it is associated with serious behavioral and relational problems. There may be dose-response interaction between the number of definite impulsivity symptoms and behavioral and relational problems.