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Aim: Autoimmune polyendocrinopathy syndrome type 3 (APS3) is defined as the presence of autoimmune thyroid disease along with another autoimmune disorder other than Addison’s disease. If an autoimmune gastrointestinal disease is a component of the syndrome, it is defined as APS3b. In this study, we aimed to determine the frequency of APS3b in patients diagnosed with type 1 diabetes (T1D) in childhood. Material and Methods: A patient group of 446 children (232 males) with T1D whose follow-ups were conducted between 01.06.2013 and 31.08.2019 was included in the study. Hashimoto’s thyroiditis (HT) was defined with positive anti-TPO and/or anti-Tg test results whereas autoimmune enteropathy was defined with histologic findings which consisted with celiac disease (CD) in small bowel biopsy following a positive anti tissue transglutaminase IgA. Results: In total, 61 (13.7%) patients had HT and 34 (7.6%) patients had CD. While 87 (19.5%) of the patients had HT or CD, the occurrence of both HT and CD (APS3b) in the same patient was observed in only 4 patients (3 females) (0.9%). Patients with APS3b had low median age of diagnosis compared with patients with HT or CD alone, and patients with none of these two diseases, but the difference is not statistically significant (p=0.087). Conclusion: While HT or CD has been detected in approximately one-fifth of children with T1D, APS3b is rarely observed in this patient group.

OBJECTIVE: The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. MATERIALS AND METHODS: Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. RESULTS: Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p

GirişHipokalsemi, tiroid cerrahisi sonrası hastalarda sık görülen bir komplikasyondur. Özellikle kalıcı hipokalsemi en sık görülen komplikasyondur ve önemli morbiditeye neden olabilir. Ayrıca postoperatif hemoraji, tiroid cerrahisinin nadir görülen, hayatı tehdit eden bir komplikasyonudur. Bu çalışmada, oksitlenmiş rejenere selüloz gazlı bezi (OC) + geleneksel hemostaz ile geleneksel hemostazı tiroid cerrahisi ile ilgili komplikasyonla ve kalsiyum seviyelerinin farkını inceleyerek karşılaştırıyoruz..YÖNTEMLERİki yüz seksen sekiz hasta iki gruba ayrıldı: Grup 1 (144 hasta) konvansiyonel hemostaz, grup 2 (144 hasta) Okside selüloz + konvansiyonel hemostaz. Preoperatif ve postoperatif Ca düzeyleri, operasyon süresi, hastanede kalış süresi, komplikasyonlar (kanama, rekürren laringeal sinir yaralanması, hipokalsemi) değerlendirildi.SONUÇLARGruplar arasında cinsiyet, ameliyat öncesi ve sonrası Ca düzeyleri, hastanede kalış süresi, kanama, tekrarlayan sinir yaralanması açısından anlamlı fark yoktu. Ortalama yaş grup 1'de grup 2'ye göre anlamlı olarak daha yüksekti (52,4 yıla karşı 49,6 yıl, p, BACKGROUNDHypocalcemia is a frequent complication in patients after thyroid surgery. Especially permanent hypocalcemia is the most common complication and it can cause significant morbidity. Also postoperative haemorhage is uncommon life-threatening complication of thyroid surgery. In this study we compare calcium metabolism and complications between oxidized regenerated cellulose gauze (OC) + conventional haemostasis versus conventional haemostasis in thyroid surgery.METHODSTwo hundred and eighty eight patients were divided in to two groups: Group 1(144 patients) conventional haemostasis, group 2 (144 patients) Oxidized cellulose + conventional haemeostasis. Preoperative and postoperative Ca levels, operation time, hospital stay, complications (bleeding, recurrent laringeal nerve injury, hypocalcemia) were evaluated.RESULTSThere was no significant difference between groups in sex, preoperative and postoperative Ca levels, hospital stay, bleeding, recurrent nerve injury. The avarage age was significantly higher in group 1 compared to group 2( 52,4 years vs 49,6 years, p< 0,05). The operation time was significanly lower in group 2 compared to group 1(77,2 min.vs 87,2 min., p< 0,05). CONCLUSIONCompared with conventional haemostasis methods, we think that addition Oxidized Cellulose gauze for haemostasis does not create a positive- negative difference in calcium matebolism and does not make a difference in complication rates, while shortening the operation time.

A novel approach to blockage of pectoral nerves: Ultrasound guided Modified Clavipectoral Fascial Plane Block (PECs-Zero)

Rotor syndrome is defined as a self-limiting hyperbilirubinemia characterized by jaundice that does not need treatment, cause any morbidity or affect life expectancy. As far as the literature is evaluated, the number of patients with Rotor syndrome diagnosed at the molecular level is less than 20 until today. In this case presentation, we aimed to present two siblings with Rotor syndrome who were diagnosed at the molecular level. To the nest of our knowledge, these patients are the first Turkish patients with Rotor syndrome diagnosed at the molecular level.

WOS: 000462694300034, PubMed ID: 30639940, …

Anaplastic thyroid carcinoma (ATC) is a relatively uncommon highly malignant tumor originating from the follicular cells of the thyroid gland having a poor prognosis. It accounts for 2–5% of all thyroid carcinomas, and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 66-year-old male presented with dyspnea, neck pain, and voice changes. Ultrasonographic neck examination demonstrated an enlarged thyroid gland and substernal extension of the right thyroid lobe. Fine needle aspiration (FNA) from the thyroid nodule biopsy showed benign cytology. Because of symptomatic disease and radiologic malignancy doubt, operation has been done. Histopathologic examination with frozen section demonstrated anaplastic thyroid carcinoma. After total thyroidectomy, the patient is discharged. The patient died 20 days after the start of systemic treatment because of septic multiorgan failure derived from bronchopneumonic lung infection. In the evaluation of sudden growing neck masses in elderly patients, anaplastic thyroid cancer should be considered as a differential diagnosis, even if the needle biopsy is normal.

WOS: 000428609400007, PubMed ID: 29469018, Objectives: Many screening methods, such as the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) and the Pediatric Yorkhill Malnutrition Score (PYMS), have been developed to detect malnutrition in pediatric patients. We aimed to explore the prevalence of malnutrition risk in hospitalized children via symptoms and identification of contributing factors, and to examine the efficacy of malnutrition screening tools for hospitalized children. Methods: STRONGkids and PYMS were applied to 1513 inpatients at 37 hospitals in 26 cities from different regions of Turkey. Physical measurements were collected at hospital admission and at discharge. z-Scores of height-for-age, weight-for-age, weight-for-height, and body mass index-for-age were calculated. Results: Overall, 1513 patients were included in the study. A body mass index standard deviation score of less than -2 was present in 9.5% of the study population at hospital admission, whereas 11.2% of the participants had a weight-for-length/height score of less than -2 at hospital admission. According to STRONGkids results, the proportion of the patients with an underlying chronic disease was higher for the patients at high risk of malnutrition than for the patients at medium or low risk (91% compared with 47% or 45%, respectively). PYMS results indicated that patients at high risk of malnutrition have more chronic diseases (75%) than the patients at medium or low risk of malnutrition (55% and 44%, respectively). Conclusions: Use of anthropometric measurements in addition to screening tools to identify hospital malnutrition (such as PYMS, STRONGkids) will prevent some nutritional risk patients from being overlooked. (C) 2017 The Author(s). Published by Elsevier Inc., Nutricia Advanced Medical Nutrition, This study was supported by Nutricia Advanced Medical Nutrition.

WOS: 000436901600002, PubMed ID: 29655135, …

WOS: 000453630900013, PubMed ID: 30172021, …

A 14-year-old male child was hospitalized with complaints of a bronchial wheezing, cough, dyspnea, and sputum and a preliminary diagnosis of bronchial asthma and pneumonia. The patient was treated empirically for bronchial asthma and pneumonia, but gave neitherr clinical nor radiological response to treatment. On the high-resolution computerized tomography, a typical spiral image of Ascaris lumbricoides was identified inside a cavity in the upper lobe of the left lung with a diameter of 8x7 cm. Also,migratory pneumonic infiltrations progressing between the lower lobe and hilary region of the left lung were seen. Examination of the peripheral blood smear of the patient revealed eosinophilia (40%), while IgE was measured as 350 IU/mL. The patient was diagnosed as "Loeffler's syndrome" due to A. lumbricoides", and successfully treated with mebendazole 2x100 mg/day for three days. Loeffler's pneumonia should be considered when patients with bronchial asthma and pneumonia do not respond to specific treatment in developing countries. Radiological investigations may be available in the diagnosis of parasitic infections. In this case, early diagnosis by radiologic methods have prevented unnecessary drug use and related complications.

Cyclophosphamide (Cyc) is known to cause ovotoxicity and infertility in women. Our aim is to investigate the possible ovotoxic effects of Cyc and possible antioxidant and protective effects of blue-green algae, Spirulina (Sp), in rat ovaries. Eighteen rats were given: group I (n=6, control); group II (n=6, CP), a single dose Cyc; group III (n=6, Sp+Cyc), 7 days Sp+single dose Cyc. Tissue malondialdehyde (MDA) levels, superoxide dismutase (SOD), and catalase (CAT) activities are assessed biochemically. Normal and atretic primordial and primary follicle counts for all sections obtained for each ovary are calculated. Mean number of follicle counts for each group are compared. In Sp+Cyc group, tissue MDA levels were significantly lower than those in the CP and higher than those in the C group (CP>Sp+Cyc>C). Tissue SOD activity was significantly higher in Sp+Cyc group than that in the CP group and lower than that in the C group (C>Sp+Cyc>C). No statistically significant difference was found between the ovarian CAT activities in any group. Histomorphometrically, there was also no significant difference between the mean numbers of normal and atretic small follicle counts. Our results suggest that single dose Cyc has adverse effects on oxidant status of the ovaries and Sp has protective effects in Cyc-induced ovotoxicity.

WOS: 000396361900004, PubMed ID: 28251020, Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multicentric study of 694 patients with pHPT. Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease. Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT.

Ketamine, an N -methyl- d -aspartate (NMDA) receptor antagonist, is widely used for general anesthesia in pediatric practice. Significant safety concerns regarding the use of anesthesia during early development have arisen since the animal studies indicating administration of an NMDA receptor antagonist during the early stages of central nervous system development can produce neurotoxicity. A growing number of evidences in rodents and nonhuman primates have indicated that exposure to repeat doses of ketamine can induce neuroapoptosis and damage in the developing brain, mainly hippocampal neurodegeneration, causing persistent learning and memory impairment. However, the precise mechanisms of ketamine neurotoxicity are not completely understood. It is indicated that the upregulation of the NMDA type of glutamate receptors is responsible from ketamine-induced neurotoxicity by causing to a toxic accumulation of intracellular calcium. Neuronal apoptosis via reactive oxygen species-mediated mitochondrial pathway plays pivotal role in the ketamine neurotoxicity. Ketamine also alters the cortical neurogenesis of neural stem progenitor cells through a different manner. Thus, there is a growing need to develop innovative strategies to prevent this injury.

Chronic pain and related complications reported after the use of perforating fixation devices in hernia surgery have led to the use of tissue sealants. Fibrin sealant is a feasible option for mesh fixation; however data on cyanoacrylate glues are limited.32 Sprague-Dawley rats were divided into two groups and a 1.5 cm abdominal wall defect was created on each animal. The lesions were then repaired with 2 × 2 cm polypropylene meshes, fixed with n-butyl-cyanoacrylate in the first group and with polypropylene sutures in the second group. The rats were sacrificed on the 21st and 42nd days. The presence of infection, recurrence, and abdominal adhesions were evaluated, followed by biomechanical testing and histological examination.No mesh infection or hernia recurrences were recorded. There was no statistically significant difference between neither the adhesion scores nor the mean broken pressure of the two groups. Cyanoacrylate sealing was found equivalent to suturing in terms of tissue ingrowth, fibrosis, inflammatory infiltration, abscess formation, and necrosis. Furthermore, cyanoacrylate resulted in less foreign body reaction.Mesh fixation by cyanoacrylate may be considered as an alternative to suture fixation.

Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation (range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries (aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.

Thyroidectomies of hyperthyroidic patients are known to be more blood-spattered than the operations performed for euthyroid nodular diseases and require careful hemostasis. Our purpose was to evaluate the efficacy of the use of LigaSure in patients with hyperthyroidism.Between January 2004 and October 2005, 100 patients underwent total or near-total thyroidectomy. Bipolar vessel ligation system (LigaSure) was the choice of modality for hemostasis in half of these patients, and the conventional suture ligation technique was used for the rest. The following data were evaluated non-randomized and prospectively in this study: patients demographics, thyroid pathology, operative duration, presence of complications, and the duration of the hospital stay. Comparisons of the data were evaluated by the Wilcoxon and chi-square tests.Among the patients of the LigaSure group, 14 patients were detected to have hyperthyroidism (seven patients with Graves' disease and another seven patients with multinodular toxic goiter), while 36 patients were found to be euthyroidic. The durations of the operation time and of the hospital stay of the patients in the LigaSure group were significantly lower than the conventional thyroidectomy group (p0.05). The complication rates of the LigaSure and conventional thyroidectomy groups were 4 and 6%, respectively (p0.05).The use of LigaSure as an operative technique in the treatment of Graves' disease and toxic goiter is a safe and effective modality that provides a shorter hospital stay and a shorter operation time as well.

Fasciola hepatica is a parasitic infection is seen especially in developing countries. A 9-year-old boy with nausea, gastric pain, decreased appetite, and eating complaints was referred to our polyclinic and hospitalized with a prediagnosis of parasitic infection. His physical examination was normal, but anemia and significant eosinophilia were detected in the blood sample. F. hepatica serology was positive in blood, and signs of adult F. hepatica parasites were seen on abdominal ultrasonography. On further examination, F. hepatica signs were seen on abdominal computed tomography and magnetic resonance imaging. Triclabendazole was started in a single dose of 10 mg/kg, and the same dose was repeated one month later. Patient completely recovered after triclabendazole treatment. Systemic parasitic infection should be considered among patients with gastric pain, decreased appetite, and pica (especially soil eating). Serologic tests are also beneficial as well as radiologic techniques in the diagnosis of parasitic infections.

WOS: 000347411200004, PubMed ID: 25323837, PURPOSE The aim of this study was to evaluate the 10-gauge vacuum-assisted stereotactic biopsy (VASB) of isolated Breast Imaging Reporting and Data System (BI-RADS) 4 microcalcifications, using histology and follow-up results. METHODS From January 2011 to June 2013, VASB was performed on 132 lesions, and 66 microcalcification-only lesions of BI-RADS 4 were included into our study. VASB was performed using lateral decubitis stereotaxy for all patients. Pathologic results of VASB and further surgical biopsies were reviewed retrospectively. Patients who were diagnosed to have benign lesions by VASB were referred for follow-up. VASB and surgical histopathology results were compared to determine the underestimation ratios. RESULTS Fifteen out of 66 lesions from 63 patients (median age, 47 years; range, 34-88 years) were identified as malignant by VASB. Pathological results after surgery revealed three cases of invasive ductal carcinoma among the 12 VASB-diagnosed ductal carcinoma in situ (DCIS) lesions, for a DCIS underestimation rate of 25%. The atypical ductal hyperplasia underestimation rate was 0% for the three lesions. The follow-up period was at least 10 months, with an average of 22.7 months for all patients and 21.2 months for patients with VASB-diagnosed benign lesions. None of the patients had malignancy during the follow-ups. The false-negative rate was 0% in the follow-up of 48 patients. CONCLUSION VASB should be the standard method of choice for BI-RADS 4 microcalcifications. This method obviates the need for a surgical procedure in 73% of BI-RADS 4 microcalcification-only patients.

Salih Burcin Kavak,1 Ebru Kavak,2 Rasit Ilhan,1 Remzi Atilgan,1 Ozgur Arat,1 Ugur Deveci,3 Ekrem Sapmaz1 1Department of Obstetrics and Gynecology, Firat Medical Center, School of Medicine, Firat University, 2Department of Obstetrics and Gynecology, Special Medical Park Hospital, 3Department of Pediatrics, Firat Medical Center, School of Medicine, Firat University, Elazig, Turkey Background: We aimed to investigate the treatment efficacy of ampicillin prophylaxis accompanied by Lactobacillus casei rhamnosus over the latency period following preterm premature rupture of membranes (PPROM). Methods: Records of 40 patients who presented with PPROM between 230/7–316/7 weeks were analyzed retrospectively. Patients were divided into two groups: group 1 (n=20), treated with ampicillin; and group 2 (n=20), treated with ampicillin plus L. casei rhamnosus. Clinical and laboratory parameters were compared. Delta (∆) values of each laboratory parameter were calculated by subtracting the value at delivery from the values at admission to the clinic. Results: Gestational weeks at delivery (28.1±0.3 weeks versus 31.5±0.4 weeks), latency periods (12.3±1.5 days versus 41.4±4.4 days), 5-minute APGAR scores (6.8±0.1 versus 7.8±0.1), and birth weights (1,320±98 g versus 1,947±128 g) were significantly higher in group 2. White blood cell (WBC) (12,820±353/mm3 versus 11,107±298/mm3), and neutrophil counts (10.7±0.5×103/L versus 8.2±0.5×103/L) were significantly lower in group 2 at delivery. The ∆WBC (2,295±74/mm3 versus -798±-406/mm3), ∆C-reactive protein (5±0.04 mg/L versus 1.6±0.2 mg/L), and ∆neutrophil (3±0.2×103/L versus 0.2±-0.1×103/L) were significantly lower in group 2. Conclusion: It seems that addition of L. casei rhamnosus to ampicillin prolongs the latency period in patients with PPROM remote from term. Keywords: probiotic, antibiotic, latency period

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To the Editor: We read with great interest the article by Kumar et al. that reported the clinical course, complications and laboratory profile of Hepatitis A in children [1]. Although, they emphasized the hyperendemicity, fatal complications and cost effectiveness of Hepatitis A infection; and importance of improved sanitation and health education for its prevention, the importance of vaccination for preventing and control of Hepatitis A virus infection was not mentioned in their article. We think that vaccination against Hepatitis A would be significant part of planning for the prevention and control of viral hepatitis. Therefore, we want to make some comments on their article. Hepatitis A infection is a widespread disease, accounting for 1.4 million cases annually worldwide. In high endemic areas, the reported incidence of Hepatitis A infection may reach 150 per 100,000 per year [2]. The clinical spectrum of Hepatitis A infection ranges from asymptomatic infection to fulminant hepatitis. Clinical manifestations depend on the age of host: less than 30 % of infected young children are symptomatic, while approximately 80 % of adults manifest severe hepatitis with remarkably elevated serum aminotransferases [3]. Acute liver failure occurs in less than 1 % of cases. Hepatitis A infection is the most common detected cause of fulminant hepatitis among children in our country as well as worldwide [4]. The application of a routine Hepatitis A virus vaccine among children will reduce the potential for the development of severe complications. Hepatitis A incidence has declined 92 % with universal vaccination of young children in United States [5]. Universal Hepatitis Avirus immunization program has begun in Turkey since October 2012. Nearly 100 % of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even thougha single dose of the vaccine has protectiveeffects; still, manufacturers recommend two vaccine doses to ensure a longer-term protection of about 5 to 8 y after vaccination. Hepatitis A infection is an important public health problem indevelopingcounties.Vaccinationagainst hepatitisAvirusis necessary for children older than one year. We believe that in addition to improved sanitation and food safety, the universal Hepatitis Avirus immunization programs are the most important means in effort to reduce Hepatitis A virus infection and related severe complications.

Hydatid cyst may be found in almost any part of the body, but most often in the liver and the lungs. Other organs affected occasionally include the brain, muscle, kidney, heart, pancreas, adrenal, and thyroid gland. Hydatidosis located in the thyroid is an infrequent finding, even in endemic regions. In the present study, 2 cases of hydatid cyst of the thyroid gland are reported. Preoperative investigations, including thyroid scanning, thyroid ultrasonography, and aspiration of the nodule, could not help in establishing the diagnosis. The histopathologic examination revealed hydatid cyst. During the differential diagnosis of the cystic thyroid lesions, hydatid disease of the thyroid gland should be considered in endemic areas. Surgical intervention is mandatory. Chemotherapy is necessary to avoid recurrence.

Background. The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of routine drainage after thyroid surgery. Methods. In this prospective randomized trial, 400 patients who underwent either a total thyroidectomy or lobectomy for thyroid disorders were randomly allocated to either the nondrainage (group 1) or the drainage (group 2) group. The volume of fluid collection in the operative bed, postoperative pain, complications, and length of hospital stay were then recorded. Results. Both groups were homogeneous according to age, gender, thyroid volume, type of procedure performed, and histopathological diagnosis. After assessment by USG, no significant difference was found between the groups in the fluid collection of the thyroid bed (P=0.117), but the length of hospital stay was significantly reduced in group 1 (P=0.004). Conclusions. In our experience, the use of drain for thyroid surgery is not a routine procedure. However, it should be used in the presence of extensive dead space, particularly when there is retrosternal or intrathoracic extension, or when the patient is on anticoagulant treatment. This trial was registered with clinical Trials.gov NCT01771523. © 2013 Ugur Deveci et al.

WOS: 000327682600004, PubMed ID: 24368985, Purpose: Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the dim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively. Methods: In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded. Results: Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05). Conclusion: SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.)

WOS: 000329765600004, PubMed ID: 24557962, Background/aims: Non-traumatic spontaneous intramural hematoma of the small intestine is a rare clinical condition, most commonly caused by over-anticoagulation. In this study, the clinical approach algorithm for patients diagnosed with a spontaneous isolated intramural hematoma of the small intestine associated with over-anticoagulation and the long-term outcomes of the patients are presented. Material and Methods: The records of patients who were diagnosed with intramural hematoma in 3 different medical faculty hospitals between 2007 and 2011 were retrospectively analyzed. After excluding patients with trauma history, hematoma in organs other than the small intestine, and with etiological factors other than over-anticoagulation, 15 patients with an isolated intramural hematoma of the small intestine were evaluated within the scope of the study. Results: The sites of first admission were emergency departments for 10 patients (66.6%) and other clinics for 5 patients (33.3%). Thirteen patients (86.6%) received medical treatment and two patients (13.3%) underwent surgical treatment. During the hospitalization period, a total of two patients (13.3%) died. Out of the 11 patients with an average follow-up of 22 months (range: 4-48 months), no patient had a relapse of intramural hematoma and three patients (27.7%) died due to reasons not related to intramural hematoma. Conclusion: Intramural hematoma diagnosis should be known by all physicians, because the site of first admission may be different clinics, since the clinical presentation begins with non-specific complaints. Early and accurate diagnosis by non-invasive methods will preclude unnecessary surgical interventions.

Primary hyperparathyroidism (PHP) and myelofibrosis are rare entities in childhood. Myelofibrosis secondary to PHP is also extremely rare. We report a 15-year-old boy presented with generalized weakness, vomiting, and pallor. A parathyroid adenoma was detected on the left distal parathyroid gland. PHP was diagnosed together with hepatosplenomegaly and pancytopenia. Bone marrow biopsy revealed grade 3-4 reticulin fibrosis. As early as 2 months after the left distal parathyroidectomy, hematologic parameters improved without any other intervention. His liver and spleen also gradually decreased in size. We concluded that the pancytopenia was as a result of myelofibrosis from PHP.

We read with great interest the article by Valsami et al 1 that reported the importance of the direct antiglobulin test (DAT) in cord blood for predicting the development of hemolytic disease of the newborn (HDN). They concluded that, although ABO incompatibility remains the main cause of a positive DAT, other causes, such as alloimmunization and drug interactions should also be investigated. In addition, they suggested that the relevant impact of DAT positivity on the development of HDN should be considered. Although we agree with their conclusion, we think that the study has many limitations and therefore, we would like to make some constructive comments on their article. Firstly, although they mentioned that a positive DAT in ABO incompatibility is considered a major risk factor for the development of severe HDN, they didnot presentdata for a control group who had negativeDATs.Bycontrast,thepositivepredictivevalueofapositive DAT for the development of HDN is as low as 23%. 2 This is due to

WOS: 000310971100013, PubMed ID: 26816260, Purpose The purpose of this study was to compare the results of surgical procedures applied to rare intestinal obstruction cases due to bezoars and to identify effective factors for determining the type of surgical procedure to be applied. Methods The records of 62 patients who had received gastrointestinal surgical treatment due to bezoars were assessed retrospectively. The preoperative characteristics, perioperative findings and postoperative results of cases that had and had not undergone an enterotomy were compared Results The average patient age was 57.7 years (range, 26-84 years), and all patients had phytobezoars, except one. The most common location for bezoars was the jejunum (28 cases, 45.1 %). Sixteen cases (25.8 %) had multiple bezoars located in different parts of the gastrointestinal tract. While milking was applied to 26 cases (41.9 %) with small intestinal bezoars, an enterotomy was used to remove bezoars in 23 cases (37 %). More complications tended to be identified in patients who underwent an enterotomy; however, the difference was not significant (p = 0.553). Conclusions The frequency of previous abdominal surgery in patients suffering from an intestinal obstruction due to bezoars causes diagnostic conflict. The location of bezoars in the small intestine should also be considered when deciding the surgical procedure, as well as the physical properties of the bezoars. Our opinion is that conducting the milking procedure should not be insisted on, and that an enterotomy should be conducted when necessary.

This study aims to determine the seroprevalence of hepatitis A among children aged 1-16 years in eastern region of Turkey. The study was conducted at Tunceli State Hospital in Eastern Anatolia, Turkey. Anti-HAV IgM and Anti-HAV IgG antibodies were evaluated among 351 patients admitted to our pediatric policlinic. Anti-HAV IgM and Anti-HAV IgG serologic markers were determined using the ELISA method. The mean age of 351 pediatric patients was 7.5±4.2; of these, 198 (56.4%) were male and 153 (43.6%) were female. A total of 305 (86.9%) cases in this study were seronegative against hepatitis A. Anti-HAV IgG was positive among 46 (13.1%) patients, of these 22 (47.8%) were male and 24 (52.2%) were female. The mean age of seropositive cases was 8.4±4.8. Anti-HAV IgM seropositivity was not detected in the study. The application of a routine hepatitis A vaccine among children will reduce the potential for the development of severe complications. Key words: Hepatitis A, seroprevalence, children, vaccination.