AMAÇ: Annona muricata (graviola) tropikal bölgelerde yetiþen bir bitki olup; yerel halk tarafýndan pek çok hastalýða iyi geldiði düþünülmektedir. Spinal kord yaralanmasýnýn ne yazýk ki henüz kabul edilebilir bir medikal tedavi yöntemi yoktur. Bu çalýþmada, Annona muricata yaprak ekstraktýnýn deneysel sýçan modelinde omurilik yaralanmasý üzerindeki nöropeotektif etkilerini araþtýrdýk.
GEREÇ VE YÖNTEM: Toplam 40 Wistar albino sýçan rastgele beþ eþit gruba (n=8) ayrýldý. Grup 1, sadece laminektomi yapýlan kontrol grubuydu. Laminektomi sonrasý dört grupta travma oluþturuldu. Grup 2’ye (tedavi edilmemiþ travma grubu) hiç ilaç verilmedi. Grup 3’e travma sonrasý periton içine tek doz metilprednizolon (30 mg/kg) uygulandý. Grup 4’teki sýçanlar, travmadan bir hafta önce oral gavaj yoluyla düþük dozda (100 mg/kg) Annona muricata yapraðý ekstresi alýrken, Grup 5’teki sýçanlar ise travmadan bir hafta önce bu ekstrakttan yüksek dozda (300 mg/kg) oral gavaj yoluyla aldýlar. Travma oluþturulduktan 24 saat sonra kontrol grubuda dahil tüm sýçanlar sakrifiye edildi.
BULGULAR: Nöroprotektif etkiyi deðerlendirmek için alýnan doku örnekleri biyokimyasal ve histopatolojik olarak incelendi. Travma grubundaki inflamatuvar bulgular Annona muricata ile tedavi edilen her iki grupta da anlamlý olarak daha iyiydi. Klinik motor muayene ve eðik düzlem testi sonuçlarý açýsýndan gruplar arasýnda fark yoktu.
TARTIÞMA: Histopatolojik ve biyokimyasal sonuçlarýmýz Annona muricata’nýn travmatik omurilik yaralanmasýnda nöroprotektif etkiye sahip bir ajan olduðunu göstermiþtir.

BACKGROUND: Annona muricata (AM) (graviola) is a plant that grows in tropical regions and is thought to be good for many diseases by local people. Unfortunately, there is no acceptable medical treatment for spinal cord injury (SCI) yet. In our study, we investigated the neuropeotective effects of AM leaf extract on SCI in an experimental rat model.
METHODS: A total of 40 Wistar albino rats were randomly divided into five equal groups (n=8). Group 1 was the control group in which only laminectomy was performed. Trauma was induced in four groups after laminectomy. Group 2 (untreated trauma group) was given no medication. In Group 3, a single intraperitoneal dose of methylprednisolone (30 mg/kg) was administered after trauma. The rats in Groups 4 received a low dose (100 mg/kg) of AM leaf extracts by oral gavage one week before trauma while the rats in Group 5 received a high-dose (300 mg/kg) of these extracts by oral gavage one week before trauma. All rats, including the control group, were sacrificed 24 h after the trauma was created.
RESULTS: Tissue samples taken to evaluate the neuroprotective effect were examined biochemically and histopathologically. Inflam-matory findings in the trauma group were significantly better in both groups treated with AM. There was no difference between the groups in terms of clinical motor examination and inclined plane test results.
CONCLUSION: Our histopathological and biochemical results showed that AM is an agent with neuroprotective effects in trau-matic SCI.

AMAÇ: Galantamin, nöroprotektif etkileri ile bilinir ve þu anda Alzheimer hastalýðý olan bireylerin tedavisinde kullanýlmaktadýr. Bu çalýþmada da galantaminin yararlý etkilerini test etmek için sýçanlarda deneysel siyatik sinir hasarý (SCI) oluþturduk.
GEREÇ VE YÖNTEM: Otuz erkek Wistar albino sýçaný üç gruba ayrýldý: Sham, SCI + salin ve SCI + galantamin. Anestezi için kullanýlan bir intraperi-toneal ketamin ve ksilazin karýþýmýnýn uygulanmasýndan sonra, siyatik sinir hasarý sýçanlarýn orta uyluk bölgesinde cerrahi klips sýkýþtýrma ile indüklendi. Ameliyattan sonra tek bir günlük intraperitoneal galantamin dozu yedi gün boyunca uygulandý. Yaralanmadan bir hafta sonra da sinir dokusu kesitleri alýndý. Nöral kalýnlýk ve apoptotik hücre sayýlarýný deðerlendirmek için histopatoloji çalýþmalarý yapýldý. Galantaminin periferik sinir dejenerasyonu üzerindeki potansiyel yararlý etkisini belirlemek için ýþýk mikroskobu morfolojik inceleme için kullanýldý.
BULGULAR: Kontrol grubuna kýyasla salin grubundaki yaralanma seviyesinin distalindeki mikrovaskülaritede, sinir lifi kalýnlýðýnda ve apoptotik hücre sayýsýnda istatistiksel olarak anlamlý bir artýþ gözlemledik. Bununla birlikte, sinir lifi kalýnlýðý ve apoptotik hücre sayýsýndaki artýþlar galantamin grubunda salin grubuna göre daha azdý.
TARTIÞMA: Deneysel modelimizde kullandýðýmýz galantamin, periferik sinir hasarýndan sonra geliþen dejenerasyon üzerinde koruyucu bir etki gös-termektedir.

BACKGROUND: Galantamine is well-known for its neuroprotective effects and is currently used in the treatment of individuals with Alzheimer’s disease. In this study, we induced experimental sciatic nerve injury (SCI) in rats to test the beneficial effects of galantamine.
METHODS: Thirty male Wistar albino rats were divided into three groups, as follows: sham, SCI + saline, and SCI + galantamine. After the administration of an intraperitoneal ketamine and xylazine mixture, which was used for anesthesia, SCI was induced by sur-gical clip compression at the midthigh region of the rats. After surgery, a single daily intraperitoneal dose of galantamine was adminis-tered for 7 days, and nerve tissue sections were obtained 1 week after injury. Histopathology studies were performed to assess neural thickness and apoptotic cell counts, and light microscopic morphological examination was used to determine a potential beneficial effect of galantamine on peripheral nerve degeneration.
RESULTS: We observed a markedly increased microvasculature, increased nerve fiber thickness, and a statistically significant increase in apoptotic cell counts distal to the level of injury in the saline group compared with the sham group. However, the increases in nerve fiber thickness and apoptotic cell counts were less in the galantamine group compared with the saline group.
CONCLUSION: In our experimental model, pharmacological intervention with galantamine demonstrated a protective effect on degeneration after peripheral nerve injury.

AMAÇ: Bu çalýþmada, akut karýn nedeni olarak görülen çekum patojilerinin sunulmasý amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2015–Haziran 2019 tarihleri arasý akut karýn ön tanýsý ile ameliyat edilen ve primer çekum patolojisi saptanan hastalar geriye dönük olarak incelendi.
BULGULAR: Üçü kýz, beþi erkek olan toplam sekiz hastanýn yaþ ortalamasý 7.2±3.4’tü. Yakýnmalar hastalarýn tümünde karýn aðrýsý ve kusmaydý. Fizik muayeneleri akut karýn ile uyumluydu. Üç hastada ultrasonografi (USG), üçünde bilgisayarlý tomografi (BT) ve ikisinde de USG ve BT ile deðerlen-dirme yapýldý. Görüntüleme tetkiklerinde iki hastada akut apandisit, ikisinde invajinasyon (1 Meckel divertikülüne baðlý, 1 mezenter kistine baðlý), ikisinde ileus, birinde perfore apandisit ve birinde çekum divertikülü ön tanýsý düþünüldü. Ameliyatta beþ hastada çekumda kitle, birinde çekum diver-tiküliti, birinde çekum volvulusu ve bir hastada da inflame nekrotik çekum saptandý. Hastalarýn tümünde çekum rezeksiyonu ve ilekolonik anastomoz yapýldý. Histopatolojik inceleme üç hastada Burkitt lenfoma, ikisinde çekum divertikülü, birinde çekum duplikasyonu, birinde çekum tüberkülozu ve bir hastada da volvulusa baðlý gangrenöz nekroz olarak sonuçlandý. Hastalarýn ortalama takip süresi 25 aydý (daðýlým, 2 ay-4 yýl). Takipleri sorunsuz seyretti, lenfoma tanýlý hastalarda takip sürecinde nüks saptanmadý.
TARTIÞMA: Primer çekum patolojileri oldukça nadirdir. Bununla birlikte sunulan çalýþmada da olduðu gibi ameliyat öncesi taný güçlüðü, cerrahý ameliyat esnasýnda beklenmedik patolojiler ile karþý karþýya býrakabilmektedir. Bu da tedavi planlamasýnda standardizasyon yetersizliðine yol açmak-tadýr. Çalýþmadaki malignite tanýlý hastalar da göz önünde bulundurulduðunda çekum rezeksiyonu ile ileokolonik anastomoz yapýlmasý primer çekum patolojisi olan çocuklarda yeterli ve uygun bir tedavi seçeneðidir.

BACKGROUND: We aimed to present cecum pathologies which are the cause of acute abdomen.
METHODS: Between January 2015 and June 2019, patients that were operated with the diagnosis of acute abdomen and patients with the primary cecum pathologies were evaluated retrospectively.
RESULTS: There were eight patients, five males and three females. The mean age was 7.2±2.9 years. Complaints were abdominal pain and vomiting in all patients. Physical examination was consistent with acute abdomen. In the imaging studies, the preliminary diagnosis was considered as two patients had acute appendicitis, two had invagination (one due to Meckel diverticulum and one with mesenteric cyst), two had ileus, one had perforated appendicitis, and one had cecum diverticulum. In surgery, five patients had cecum mass, one had cecum diverticulitis, one had cecum volvulus, and one had inflamed necrotic cecum. All patients underwent cecum resection and ileocolonic anastomosis. Histopathologic examination was resulted as Burkitt’s lymphoma in three patients, cecum diverticulum in two, duplication of cecum in one, tuberculosis of cecum in one, and gangrenous necrosis due to volvulus in one patient. The mean follow-up period was 25 months (2 months–4 years). Follow-up was uneventful.
CONCLUSION: Primary cecum pathologies are very rare. This leads to lack of standardization in treatment planning. Considering the patients with malignancy in the series, ileocolonic anastomosis with cecum resection is an adequate and appropriate treatment option in children with primary cecum pathology.

AMAÇ: Hayvan iliþkili ölümler dünya genelinde olduðu gibi Türkiye’de de bir halk saðlýðý problemi olmaya devam etmektedir. Ýnsanlarýn invazyonu nedeni ile doðal yaþam alanlarýnýn daralmasý ve bu alanlarda yapýlan avcýlýk, odunculuk, eðlence ve sportif amaçlý etkinliklerden dolayý insanlarla vahþi hayvanlarýn karþýlaþma olasýlýðýný artýrmaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýzda Ocak 2007–Aralýk 2016 tarihleri arasýndaki 10 yýllýk sürede Adli Týp Kurumu Trabzon Grup Baþkanlýðý’nda otopsisi yapýlan toplam 8944 olguya ait adli dosya fiziksel olarak, geriye dönük yöntemle taranmýþtýr. Bu dosyalar içerisinden travmatik hayvan saldý-rýsý nedeniyle öldüðü tespit edilen olgularýn sosyo demografik özellikleri, yaralanmaya neden olan hayvanlarýn cinsleri ve nitelikleri, olay yeri bilgileri, tanýk ifadeleri, saðlýk kuruluþuna ait bilgiler, dýþ muayene ve otopsi bulgularý ve ölüm nedenleri çalýþma kapsamýnda incelenmiþtir.
BULGULAR: Travma nedeniyle ölüme neden olan hayvan türlerine bakýldýðýnda; 15 olgu ile en sýk karþýlaþýlanlarýn sýðýr cinsi büyükbaþ hayvanlar olduðu, ikinci sýklýkta karþýlaþýlan hayvan türünün yedi olgu ile at olduðu, dört olguda ayý, iki olguda kurt, iki olguda da yaban domuzu gibi vahþi hayvan türleri olduðu görülmüþtür.
TARTIÞMA: Otopsi sonuçlarýna göre ölüm nedenlerine bakýldýðýnda; en sýk karþýlaþýlan nedenin göðüs içi kanama ve göðüs içi organ yaralanmasý olduðu, en sýk yaralanan bölgenin göðüs ve sýrt, en sýk yaralama biçiminin ise künt-ezici travma þeklinde olduðu görülmüþtür.

BACKGROUND: Just as throughout the world in general, deaths related to animal attacks continue to be a public health problem in Turkey. A decrease in areas of natural habitat because of human invasion, and the use of these areas for hunting, wood-cutting, recreational and sporting activities has increased the possibility of humans encountering wild animals.
METHODS: A physical retrospective screening was made of the forensic records of a total of 8944 autopsy cases in the Forensic Medicine Institute of the Trabzon Group Directorate in the 10-year period between Januarry 2007 and December 2016.
RESULTS: When the types of animals causing the traumatic death were examined, the most frequent was cattle in 15 cases followed by horses in 7 cases, bears in 4 cases, wolves in 2 cases, and wild boars in 2 cases. According to the autopsy results, the cause of death was most often intrathoracic bleeding and intrathoracic organ damage, the regions of the body injured were seen to be most often the chest and back, and the most common form of injury was blunt/crush trauma.
CONCLUSION: From these records, cases were identified where the cause of death was traumatic animal attack, and examination was made of the sociodemographic characteristics, the type of animal that caused the injuries, information about the location of the incident, witness statements, information about the healthcare centre, findings of external examination and autopsy, and the cause.

AMAÇ: Diyabetik ayak ülserlerinin cerrahi tedavisinde konservatif deri greftleri ve otolog epidermal aþýlama gibi çeþitli invaziv tedavi sistemleri bulunmaktadýr. Bu çalýþmayla; diyabetik ayak ülseri acil durumlarýnda yeni bir epidermal greft aþýlama sisteminin uygulanabilirliðini deðerlendirmeyi amaçlamaktayýz.
GEREÇ VE YÖNTEM: Hastanemiz acil servise baþvuran ve yazýlý ve imzalý onam formlarý alýnarak otolog epidermal aþýlama sistemi kullanýlmýþ 15 diyabetik ayak ülseri hastasý ile geriye dönük klinik çalýþma planlandý. Hastalarýn uygulama öncesi yara alaný boyutu (cm2), yaranýn yeniden epiteli-zasyonunu tamamlama süresi, hem verici hem de alýcý bölgeler için yaranýn boyutundaki deðiþiklikler, tam dermal yanýt süresi, hastalarýn demografik özellikleri ve komorbiditeleri; “American Society of Anesthesiologists” (ASA) Fiziksel Durum Sýnýflandýrma Sistemi puanlarý, Visual Analog Scale (VAS) kullanýlarak aðrý skorlarý olmak üzere tüm klinik verileri; kaydedildi. Yaþ, cinsiyet, uygulama sonrasý yara alaný (cm2), iyileþme zamaný, ASA ve VAS deðiþkenleri birbirleriyle karþýlaþtýrýlarak istatistiksel olarak analiz edildi. P<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Tam yara iyileþmesi için geçen süre ortalama 5.9 (daðýlým, 4–8) haftaydý. Alýcý yara boyutu ile hastanýn yaþý; her iki yara türünün boyutu (cm2) ile her iki yara türü için tam küçültme süresi (hafta); her iki yara türünün iyileþmesini tamamlama süresi ile her iki cinsiyet arasýnda istatistiksel olarak bir fark yoktu (sýrasýyla, p=0.509, 0.788, 0.233). ASA skorlarý yaranýn tam iyileþmesi için gereken süreyi etkilemedi (p=0.749). TARTIÞMA: Bu çalýþma, diyabetik ayak ülseri olan homojen bir popülasyonda otolog epidermal aþýlama sisteminin etkinliðini deðerlendirmeye çalýþ-mýþtýr. Diyabetik ayak ülseri acilleri olan hastalarda epidermal aþýlama sistemi etkili ve güvenli bir þekilde kullanýlabilir.

BACKGROUND: There are various surgical and invasive treatment systems such as conservative skin grafts and autologous epider-mal grafting (AEG) for diabetic foot ulcers. This study aims to evaluate the feasibility of using a novel epidermal graft harvesting system
in diabetic foot ulcer emergencies.
METHODS: A retrospective clinical study was conducted with 15 diabetic foot ulcer patients, and after written and signed consent forms were taken, AEG system was applied to all patients. All of the clinical data of the patients such as their American Society of Anesthesiologists (ASA) Physical Status Classification System scores, size of pre-application wound area (cm2), time to complete re-epithelization of the wound, pain scores using the visual analog scale (VAS) for both donor and recipient sites, changes in size of wound, complete dermal response time, and patients’ demographics, comorbidities were recorded. The age, gender, pre-post appli-cation wound area (cm2), time of healing, ASA, and VAS variables were compared each other and analyzed statistically. P<0.05 was
considered as statistically significant.
RESULTS: The mean of time for complete wound healing was 5.9 (range 4–8) weeks. There was no statistically difference between recipient wound size and patient’s age; size of both types of wounds (cm2) and time (weeks) for complete reduction for both types of wounds; and time to complete both types of wound healing and gender (p=0.509, 0.788, and 0.233, respectively). ASA scores did not
impact the time required for complete healing of the wound (p=0.749).
CONCLUSION: The current study has tried to evaluate the efficacy of the AEG system in a homogenous population with diabetic foot ulcers. An epidermal harvesting system may be used effectively and safely in patients with diabetic foot ulcer emergencies.

AMAÇ: Nötrofil-lenfosit oraný (NLR), trombosit lenfosit oraný (PLR) ve kýrmýzý kan hücresi daðýlým geniþliði (RDW), daha önce farklý hastalýk durum-larýnda bir þiddet göstergesi olarak tanýmlanmýþ iltihap durumunun basit göstergeleridir. Bu çalýþma, bu basit hematolojik indekslerin akut pankreatit (AP) hastalarýnda CRP ve beyaz kan hücreleri gibi geleneksel enflamasyon belirteçleri ve bunlarýn, Akut Pankreatit Þiddeti Ýçin Ýndeksi (BISAP) ve Modifiye Glaskow Prognostik (mGPS) skorlarý ile iliþkisini deðerlendirmektedir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma Çanakkale Onsekiz Mart Üniversitesi Acil Servisi’nde yapýldý. Toplam 171 hasta (erkek/kadýn: 68 [%39.8) / 103 [%60.3)] AP’li ve 59 yaþ ve cinsiyet uyumlu saðlýklý (erkek/kadýn: 23 [%39] / 36 [%61]) kontroller bu çalýþmaya dahil edildi. Hastalar BISAP ve mGPS’ye göre ciddiyet ve istenmeyen sonuçlara göre gruplandýrýldý ve gruplar arasýnda NLR, PLR ve RDW deðerlerini karþýlaþtýrmak için analiz edildi.
BULGULAR: Akut pankreatit hastalarýnýn ve kontrol grubunun ortalama NLR deðerleri sýrasýyla 9.62±6.34 ve 2.04±1.08 (p<0.001) iken, AP has-talarýnýn ve kontrol grubunun ortalama PLR deðerleri sýrasýyla 221.83±122.43 ve 83.30±38.89 idi (p<0.001). RDW dýþýnda, diðer tüm hematolojik indekslerin hastalýk baþlangýcýnda, hem hafif hem de þiddetli hastalýkta yükseldiði (WBC için p<0.05; NLR, PLR ve CRP) tespit edildi. NLR ve PLR, AP ile iliþkili ciddi komplikasyonlarý tahmin etmek için önemli olduðu görüldü.
TARTIÞMA: Bu çalýþma AP’de NLR ve PLR’nin arttýðýný göstermiþtir. Ayrýca kan NLR ve PLR deðerleri, AP ile baðlantýlý hastalýk þiddetini ve olumsuz sonuçlarý tahmin edebilir ve hastalýk ciddiyetini tahmin etmek için yardýmcý bir belirteç olarak kullanýlabilir.

BACKGROUND: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte-ratio (PLR), and red blood cell distribution width (RDW) are simple indicators of inflammatory status previously established as a severity indicator in distinct disease states. This study aimed to determine the impact of these simple hematologic indices with conventional inflammation markers such as C-reactive pro-tein (CRP) and white blood cells in acute pancreatitis (AP) patients and their relationship with AP risk stratification scores including Bedside Index for Severity of Acute Pancreatitis (BISAP) and modified Glaskow Prognostic score (mGPS) scores.
METHODS: This retrospective study was performed in the emergency department of Canakkale Onsekiz Mart University. A total of 171 patients (male/female: 68 [39.8%]/103 [60.3%]) with AP and 59 age and gender matched healthy subjects (male/female: 23 [39%]/36[61%]) as controls were enrolled in the present study. The patients were grouped according to severity and adverse outcomes according to BISAP and mGPS and a comparative analysis was performed to compare the NLR, PLR, and RDW between groups.
RESULTS: The mean NLR values of AP patients and control group were 9.62±6.34 and 2.04±1.08, respectively (p<0.001), while the mean PLR values of AP patients and control group were 221.83±122.43 and 83.30±38.89, respectively (p<0.001). Except from RDW, all the other hematologic indices were found to be elevated (p<0.05 for WBC; NLR, PLR, and CRP) on both mild and severe disease at disease onset. NLR and PLR showed significant predictive ability for estimating serious complications associated with AP.
CONCLUSION: The present study showed that NLR and PLR is increased in AP. Moreover, peripheral blood NLR and PLR values can predict disease severity and adverse outcomes associated with AP and can be used as an adjunctive marker for estimating disease severity.

AMAÇ: Antidepresan ilaçlarýn, özellikle seçici serotonin geri alým inhibitörlerinin (SSRI’lar) kullanýmý son yýllarda artmýþtýr. SSRI’larý kullanmak se-rotonin metabolizmasýnda deðiþikliklere neden olabilir. Serotonin, trombosit agregasyonu saðlar, vasküler tonusun düzenlenmesinde ve pýhtýlaþma süreçlerinde rol oynar. Bu çalýþmanýn amacý cerrahi operasyon planlanan olgularda SSRI kullanýmýnýn pýhtýlaþma fonksiyonlarý üzerine etkilerini trom-boelastogram (TEG) ile deðerlendirmek ve kullanmayan olgularla karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþma, fiziksel durumu Amerikan Anesteziyoloji Derneði (ASA) sýnýflandýrmasýna göre ASA I-II olarak sýnýflandýrýlan 60 hasta için tasarlandý. Ameliyat öncesi hazýrlýk aþamasýnda rutin kan tetkiklerine ek olarak 2 ml tam kan örneði kullanýldý ve TEG analizi yapýldý. Hastalar SSRI kullanýcýsý ve kullanmayan olmak üzere iki gruba ayrýlarak incelendi.
BULGULAR: R deðeri SSRI kullanan grupta anlamlý olarak yüksek izlendi. SSRI kullanan grubun MA deðeri anlamlý olarak düþüktü. Diðer parametre-lerde istatistiksel olarak anlamlý bir fark yoktu. SSRI kullaným süresine göre yapýlan deðerlendirmede, kullaným süresi bir yýldan uzun ve bir yýldan az olanlar arasýnda istatistiksel olarak anlamlý bir fark yoktu.
TARTIÞMA: Tromboelastogram yöntemi ile pýhtýlaþma süreci deðerlendirildiðinde, SSRI kullananlarda pýhtýlaþma baþlangýcýnýn uzadýðý ve trombüs oluþumunun yavaþladýðý görüldü. Sonuçlar kanamanýn tek baþýna SSRI olduðunu ortaya koymadý, ancak sürecin yavaþlatýlmasýnýn özellikle cerrahi operasyonlar için önemli olabileceði sonucuna varýldý.

BACKGROUND: The use of antidepressant drugs, in particular selective serotonin reuptake inhibitors (SSRIs), has increased in recent years. Using SSRIs can cause changes in serotonin metabolism. Serotonin provides platelet aggregation and plays a role in the regulation of vascular tone and coagulation processes. The aim of this study was to evaluate the effects of SSRI use on coagulation functions with thromboelastogram (TEG) in patients undergoing surgical operation and to compare with non-user cases.
METHODS: The study was designed for 60 patients whose physical status was classified according to the American Society of Anes-thesiology (ASA) classification as ASA I–II were included in the study. During routine pre-operative blood tests, 2 ml complete blood sample used and TEG performed. The cases were divided into two groups as SSRI user and non-user and analyzed.
RESULTS: R value was higher in SSRI user patients than in non-user patients. The MA value was significantly lower in SSRI user. There was no statistically significant difference in other parameters. In the evaluation based on duration of SSRI use, there was no statistically significant difference between those whose duration of use was more than 1 year and <1 year.
CONCLUSION: When the coagulation process was evaluated by TEG method, it was seen that the onset of clotting was prolonged and thrombus formation was slowed down in SSRI users. The results did not reveal that SSRI alone was the cause of bleeding, but it was concluded that slowing the process might be important, especially for surgical operations.

AMAÇ: Sigmoid volvulus (SV), sigmoid kolonun kendi etrafýnda dönmesi, dünya genelinde nadir bir baðýrsak týkanýklýðý þeklidir. Bu nedenle SV’nin fizyopatolojisi, özellikle tetikleyici faktörler yeterince tanýmlanmamýþtýr. Bu çalýþmanýn amacý, SV’de tetikleyici faktörleri araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 1986 ile Temmuz 2020 arasýnda, SV’li ardýþýk 416 hastanýn kayýtlarý, ileriye yönelik olarak irdelendi. Kontrol olarak, son 24 ayda volvulus dýþý baðýrsak týkanýklýðý olan ardýþýk 100 hastanýn kayýtlarý ileriye yönelik olarak irdelendi. Premorbid semptomlar olarak akut ishal, ani ve aþýrý beden hareketleri, uzun açlýk süresini takiben aþýrý yemek yeme, öksürük nöbeti ve doðum deðerlendirildi.
BULGULAR: Premorbid semptomlardan bir ile beþ gün süren ishal, (42 hasta, %10,1, p<0.05), ekin biçme (35 hasta, %8.4, p<0.05) ve oruç sonrasý aþýrý yemek yeme (31 hasta, %7.5, p<0.05), SV’de istatistksel olarak belirgin tetikleyici faktörler olarak deðerlendirildi.
TARTIÞMA: Her ne kadar SV’de tetikleyici faktörler hakkýnda literatürde oldukça az çalýþma varsa da, artmýþ baðýrsak hareketliliði, aþýrý beden hare-ketleri ve uzamýþ açlýk süresini takiben aþýrý yemek yeme, SV’nin ortaya çýkmasýnda tetikleyici faktörler olarak görünmektedir.

BACKGROUND: Sigmoid volvulus (SV), the wrapping of the sigmoid colon around itself, is a rare intestinal obstruction form world-wide. For this reason, the physiopathology of SV, particularly the precipitating factors, are not clearly identified. The aim of this study is to evaluate the precipitating factors in SV.
METHODS: The clinical records of consecutive 416 patients with SV were reviewed prospectively from January 1986 to July 2020. As a control, the records of consecutive 100 patients with non-volvulus intestinal obstruction were reviewed prospectively in the past 24 months. The premorbid symptoms including acute diarrhea, sudden and excessive body motions, overeating after a prolonged starvation, coughing spell, and labor was evaluated.
RESULTS: Among the premorbid symptoms, 1–5-day interval of diarrhea (42 patients, 10.1%, p<0.05), harvesting activation (35 patients, 8.4%, p<0.05), and overeating after Ramadan fasting (31 patients, 7.5%, p<0.05) were found to be statistically significant precipitating factors in SV.
CONCLUSION: Although there are few studies about the precipitating factors of SV in the literature, increased bowel motility, excessive body motions, and overeating following a prolonged starvation look like the precipitating factors in the development of SV.

AMAÇ: Hastalýk profilleri Covid-19 pandemi sürecinde deðiþiklik göstermiþtir. Bu çalýþmada Covid-19 pandemi öncesi ve pandemi süresince akut apandisit olgularýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Ýlk Covid-19 olgusunun görüldüðü 11 Mart 2020 ve 11 Mayýs 2020 arasýnda ve geçen yýlýn ayný döneminde toplamda 130 hasta akut apandisit tanýsý ile ameliyat oldu. Hastalarýn verileri hastanenin elektronik arþivinden elde edildi. Bu hastalar iki gruba ayrýldý; pandemik grubu ve pandemik öncesi grup. Pandemi grubunda 46 hasta, pandemik öncesi grupta 84 hasta yer aldý. Ýki grup yaþ, cinsiyet, þikayetlerin süresi, hastanede kalýþ süresi, beyaz küre sayýmý, C-reaktif protein düzeyi ve ameliyat sonrasý komplikasyonlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Karýn aðrýsýnýn baþlangýcý ve baþvuru arasýnda geçen ortanca gün pandemi grubunda 6.5 gündü. Oysa ki bu süre pandemik öncesi grupta üç gündü (p<0.001). Diðer parametreler gruplar arasýnda istatistiksel olarak farklý deðildi (p>0.05).
TARTIÞMA: Covid-19 pandemi periyodu süresince hastaneye baþvurularda gecikme dikkat çekmiþtir. Ancak gecikmiþ tedavi kliniðe daha ciddi has-talýk olarak yansýmamýþtýr.

BACKGROUND: Disease profiles have changed in the COVID-19 pandemic. In this study, we aimed to compare acute appendicitis cases before and during the COVID-19 pandemic.
METHODS: A total of 130 patients were diagnosed with AA and operated between the days of first COVID-19 case on March 11, 2020, and May 11, 2020, and the same period of the previous year. Data of the patients were extracted from electronic archive of the hospital. Those patients were stratified into two groups; pandemic group and pre-pandemic group. The pandemic group comprised 46 patients and the pre-pandemic group, 84 patients. The two groups were compared in terms of age, gender, duration of symptoms, length of hospital stay, white blood cell count, C-reactive protein levels, and post-operative complications.
RESULTS: The median days passed from onset of abdominal pain to submission were 6.5 days in the pandemic period. However, it was 3 days in the pre-pandemic group (p<0.001). Other parameters were not statistically different between the groups (p>0.05).
CONCLUSION: During the COVID-19 pandemic period, delay in hospital submissions has attracted attention. However, delayed treatment did not reflect to the clinic as more severe disease.

AMAÇ: Komplike apandisitin erken ve doðru ameliyat öncesi tanýsý için yeni bir biyokimyasal belirteç olarak hiponatreminin eriþkin popülasyonunda prediktif deðerinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý ile ameliyat edilen ve intraoperatif olarak perforasyon tanýsý alan 732 hasta geriye dönük olarak deðerlendirildi. Perfore ve perfore olmayan apandisitli hastalarýn serum sodyum, C-reaktif protein (CRP) ve lökosit deðerleri karþýlaþtýrýldý.
BULGULAR: Perfore apandisit hastalarý istatistiksel olarak daha düþük serum Na deðerlerine sahipti (p<0.001). Buna benzer olarak perfore apandisit hastalarý olmayanlara göre daha yüksek serum CRP deðerlerine sahipti (p<0.001). Perfore akut apandisit tanýsý konan hastalarda plazma sodyum konsantrasyonunun duyarlýlýðý %63, özgüllüðü %66 idi. Plazma sodyum konsantrasyonunun ≤137.5 mEq/L eþik deðeri, mümkün olan en iyi duyarlýlýðý ve özgüllüðe sahipti.
TARTIÞMA: Hiponatremi, perfore apandisitin yeni bir belirtecidir ve bu nedenle apandisit ile uyumlu klinik prezentasyonu olan hastalarda komplikasyon þüphesi var ise serum sodyum düzeyi ölçümü dikkate alýnmalýdýr.

BACKGROUND: The aim of the study was to investigate the predictive value of hyponatremia as a new biochemical marker for the early and accurate preoperative diagnosis of complicated appendicitis in the adult population.
METHODS: 732 patients who were operated for acute appendicitis (AA) and diagnosed as perforation intraoperatively were evaluated retrospectively. Serum sodium, C-reactive protein (CRP), and leukocyte levels of patients with perforated and nonperforated appendicitis were compared.
RESULTS: Perforated appendicitis patients had statistically lower serum Na values (p<0.001). Similarly, patients without perforated appendicitis had higher serum CRP values (p<0.001). In patients diagnosed with perforated AA, the sensitivity of plasma sodium concentration was 63%, and the specificity was 66%. The threshold value of plasma sodium concentration ≤137.5 mEq/L had the best possible sensitivity and specificity.
CONCLUSION: Hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium level measurement should be considered in patients with a clinical presentation consistent with appendicitis if complications are suspected.

AMAÇ: Kalp hýzýnýn sistolik kan basýncýna oraný olarak tanýmlanan “þok indeksi”, acil durumlardaki hastalarýn dolaþým yetersizliðine iþaret eden basit ve güvenilir bir göstergedir. Hemorajik þok, sepsis, travma ve acil triajda etkinliði gösterilmiþtir. Bu çalýþma, þok indeksinin acil cerrahi sonrasý yoðun bakýma yatan hastalarda 28 günlük sað kalýmý öngörebilme kabiliyetini incelemek amacýyla planlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþma bir üniversite hastanesinin 20 yataklý yoðun bakým kliniðinde yürütüldü. 1 Ocak 2017–31 Aralýk 2019 tarihleri ara-sýnda, acil cerrahi sonrasý yoðun bakýma yatan hastalarýn kayýtlarý geriye dönük olarak tarandý. Yaþý <18 ve >90 olanlar, elektif cerrahiler, verilerinin kullanýmý için yazýlý onamý bulunmayanlar, verileri veya takibi eksik olan hastalar çalýþma dýþý tutuldu. Hastalarýn yaþý, cinsiyeti, cerrahi türü, eþlik eden medikal durumlarý, yoðun bakým mekanik ventilatör süreleri, yatýþ süreleri ve 28 günlük sað kalýmlarý kaydedildi. Seçilmiþ ameliyat öncesi ve sonrasý laboratuvar parametreleri (Hb, PLT, INR, pH) toplandý, SOFA skor ve þok indeksleri hesaplandý. Veriler sað kalým ile iliþkileri açýsýndan, %95 güven aralýðý ve p<0.05 anlamlýlýk düzeyleri kullanýlarak, istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Hastalarýn sað kalým oraný %95 idi. Abdominal and gastrointestinal cerrahiler olgularýn %47’sini oluþturmaktaydý. En sýk eþlik eden týbbi durumlar kardiyovasküler ve pulmoner hastalýklardý. Ýstatistiksel analizlerde, cerrahi türü veya eþlik eden týbbi hastalýklarýn sonlaným üzerine bir etkisi gösterilmedi. Hastalarýn ortalama yatýþ süresi 2.3 gündü. Ortalama mekanik ventilatör süresi 23 saat olup, sað kalan hastalarda bu süre belirgin olarak daha kýsaydý (p<0.001, t=-7.5). Ameliyat sonrasý yüksek Hb düzeyleri sað kalým ile iliþkiliydi (p=0.020, t=2.4). Ameliyat sonrasý INR yüksekliði sað kalým için negatif bir belirteçti (p=0.025, t=-2.3). Hem ameliyat öncesi hem de sonrasý pH düzeyleri önemli ölçüde sað kalým belirleyi-cisiydi (p=0.001, t=1.9 ve p<0.001, t=7.1). Ameliyat sonrasý þok indeksi deðerlerinin düþük olmasý mekanik ventilatör süresinin kýsa olacaðýna iþaret etmekteydi (p=0.010, t=1.9). Þok indeksinin Ameliyat öncesi ve özellikle de ameliyat sonrasý dönemde düþük olmasý ile sað kalým arasýnda belirgin bir iliþki gösterildi (p=0.001, t=-1.6 ve p=0.001, t=-2.9).
TARTIÞMA: Bu çalýþma, yoðun bakýma yatan acil cerrahi hastalarýn “þok indeksi” deðerlerinin hasta sað kalýmýný öngörmede oldukça baþarýlý olduðunu ortaya koymaktadýr. Biz, literatürün tozlu raflarýnda unutulmuþ olan “þok indeksinin” hak ettiði önemi göremediðine inanmaktayýz. Þok indeksi basit, kullanýþlý, güvenilir ve maliyet etkinliði oldukça yüksek bir deðerlendirme yöntemidir. Farklý hasta gruplarýnda þok indeksinin uygulanabilirliðini ve güvenilirliðini deðerlendirecek, daha geniþ, ileriye yönelik randomize kontrollü çalýþmalarýn planlanmasýna ihtiyaç vardýr.

BACKGROUND: Shock index (SI) is defined as the ratio of heart rate to systolic blood pressure and is a feasible and reliable tool to assess patients’ circulatory status in emergency conditions. Its efficiency was shown in hemorrhagic shock, sepsis, trauma, and emergency triages. This study was planned to evaluate predictive ability of SI on 28-day survival of intensive care unit (ICU) admitted emergency surgery (eSurg) patients.
METHODS: The study was conducted in a 20-bed capacity ICU of a University Hospital. Medical records of patients who were admitted to ICU after an eSurg between January 1, 2017, and December 31, 2019, were retrospectively scanned. Patients with age <18 and >90, elective surgeries, no written consents, missing data, and lost to follow-up were excluded from the study. Patients age, gender, surgery type, associated medical comorbidity, ICU mechanic ventilatory (MV) length, length of stay (LOS), and 28-day survival status were recorded. Selected pre-operative (pre-op) and post-operative (post-op) laboratory parameters (hemoglobin [Hb], platelet count, international normalized ratio [INR], and pH) were collected, sequential organ failure assessment and SI scores were calculated. Data were statistically processed with 95% confidence interval and p<0.05 significance in relation to survival.
RESULTS: Patient survival rate was 95%. Abdominal and gastrointestinal surgeries constituted 47% of the cases. The most frequent comorbidities were cardiovascular and pulmonary diseases. In statistical analyses, neither surgery type nor associated medical con-dition was related to patient outcome. The mean LOS was 2.3 days. The mean MV length was about 23 h and significantly shorter in survived patients (p<0.001, t=−7.5). The higher post-op Hb levels were related to the higher survival (p=0.020, t=2.4). Post-op higher INR levels were found as a negative prognostic factor for survival (p=0.025, t=−2.3). Both pre-op and post-op pH levels were significantly related to patient survival (p=0.001, t=1.9 and p<0.001, t=7.1). The lower post-op SI scores were predictive to the shorter MV lengths (p=0.010, t=1.9). A significant relation was presented between lower pre-op and especially post-op SI scores and patients’ survival (p=0.001, t=−1.6 and p=0.001, t=−2.9).
CONCLUSION: This study presented that SI scores successfully predicted patients’ survival in ICU admitted eSurg patients. We believe that the SI forgotten in the dusty shelves of the literature does not get the importance it deserves. SI is a simplistic, reliable, and highly cost-effective assessment tool. Larger prospective RCTs should be planned to assess feasibility and reliability of SI in different patient populations.

AMAÇ: Travmatik rektal yaralanmalar nadir görülür ve çeþitli sebeplere baðlý oluþabilir. Nedenine bakýlmaksýzýn yüksek morbiditeye neden olur, fistül ve/veya stomadan kaçýnabilmek için zamanýnda müdahale edilmesi gereklidir. Çalýþmamýzda güncel literatür bilgisi ýþýðýnda perineal ve sfinkter yaralanmasý olmadan oluþan izole rekto-vajinal septum yaralanmalarýna tedavi yaklaþýmlarýmýzý sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2015 ve Ocak 2020 arasýnda merkezimizde gerçekleþen ve canlý doðumla sonuçlanan spontan vajinal doðum sonuçlarý geriye dönük olarak analiz edildi. Ýzole rekto-vajinal yaralanmasý olan hastalarýn sonuçlarý demografik özellikleri, obstetrik bilgileri, travma, yaralan-manýn sýnýflamasý, erken ve geç sonuçlara göre deðerlendirildi.
BULGULAR: Ýzole septum yaralanmasý 12 kadýnda (%0.06) saptandý. Rosenshein sýnýflamasýna göre dokuz hastada (%75) tip III, iki hastada (%16.6) tip IV ve bir hastada (%8.3) tip V yaralanma olduðu tespit edildi. Tüm hastalarda vajina eksplorasyonunun izin verdiði ölçüde sýnýrlý tutularak erken cerrahi müdahale ile transvajinal primer tamir uygulandý.
TARTIÞMA: Vajinal doðum sonrasý detaylý perineal deðerlendirmeyi takiben eþ zamanlý rektal muayene de mutlaka yapýlmalýdýr. Erken dönemde saptanabilen doðum iliþkili rektal yaralanmasý olan uygun hastalarda stoma uygulanmadan yapýlacak primer tamir en iyi seçenek olabilir.

BACKGROUND: Traumatic rectal injuries are uncommon and can originate due to various causes. Rectal injuries have a high mor-bidity, regardless of cause, and detection at the time of occurrence is important to prevent fistula formation and/or stoma. In this article, treatment approaches in patients with isolated rectovaginal septum injury without perineal and sphincter injury during sponta-neous vaginal delivery are presented and the current literature is reviewed.
METHODS: The records of spontaneous vaginal deliveries that resulted in live births between January 2015 and January 2020 were analyzed retrospectively at our center. The records of patients with isolated rectovaginal septum injury were evaluated in terms of demographic and obstetric data, trauma, classification of injury, and early and late results.
RESULTS: Isolated septum injuries were detected 12 women (0.06%). Of the isolated rectovaginal septum injuries, 9 (75%) were clas-sified as Type III, 2 (16.6%) as Type IV, and 1 (8.3%) as a Type V injury according to the Rosenshein classification. Transvaginal repair was performed because all of the injuries underwent early surgical intervention, were limited, and exploration through the vagina was possible.
CONCLUSION: Rectal examination should be performed simultaneously with a detailed perineal examination after vaginal delivery. For birth-related rectal injuries detected early in appropriate patients, a primary repair without diversion stoma may be the best option.

AMAÇ: Harris Kalça Skoru (HKS), Modifiye HKS (MHKS) ve Oxford Kalça Skorlarý (OKS) primer total kalça protezi sonrasý fonksiyonel sonuçlarý deðerlendirmek için tasarlanmýþtýr. Bu çalýþmanýn amacý, primer total kalça protezi, revizyon total kalça protezi, Crowe 4 geliþimsel kalça displazisi son-rasý total kalça protezi ve kalça kýrýðý sonrasý hemiartroplasti uygulanan hastalarda HKS, MHKS ve OKS skorlarýnýn korelasyonunu deðerlendirmektir. GEREÇ VE YÖNTEM: Üç yüz doksan dokuz hastanýn (254 kadýn, 145 erkek) 128’i primer total kalça protezi, 36’sý revizyon total kalça protezi, 200’ü kalça kýrýðý sonrasý hemiartroplasti ve 35’i femoral kýsaltma osteotomisi ile total kalça protezi idi ve minimum 24 ay takip edildi. Her bir hasta için HKS, MHKS ve OKS skorlarý hesaplandý ve aralarýndaki korelasyonlarý analiz edildi.
BULGULAR: Tüm hastalarýn ortalama yaþý 67.5±14.3, ortalama HKS, MHKS ve OKS skorlarý ise 74.9±17.9, 75.7±18.7 and 38.7±12.5 idi. Tüm popülasyonda HKS ve MHKS arasýnda güçlü bir korelasyon mevcut idi (r=0.995, p=0.000). Ayný þekilde HKS ve OKS arasýnda (r=0.995, p=0.000) ve HKS ve OKS arasýnda da (r=0.845, p=0.003) güçlü bir korelasyon mevcut idi. Altgrup analizlerinde primer total kalça protezi, revizyon total kalça protezi, kalça kýrýðý sonrasý hemiartroplasti ve femoral kýsaltma osteotomisi ile total kalça protezi gruplarýnda da HKS ve MHKS arasýnda güçlü bir korelasyon saptandý (r=0.984, p=0.000; r=0.977, p=0.000; r=0.984, p=0.000; r=0.995, p=0.000). HKS ve OKS arasýnda da revizyon kalça protezi dýþýndaki alt gruplarda anlamlý korelasyon saptandý (r=0.851, p=0.023; r=0.587, p=0.069; r=0.989, p=0.002; r=0.965, p=0.000).
TARTIÞMA: MHKS ve OKS arasýndaki korelasyonu deðerlendiren ilk çalýþma olmuþtur. Bulgularýmýz hemiartroplasti, primer ve revizyon kalça protezi ve femoral kýsaltmalý kalça protezi sonrasý fonksiyonel sonuçlarýn deðerlendirilmesinde MHKS ve OKS’nin kullanýþlý skorlama olduðunu gösterdi.

BACKGROUND: Harris hip score (HHS), modified HHS (MHHS), and Oxford hip score (OHS) were designed to determine the functional outcomes after primary total hip arthroplasty (THA). The aim of this study was to evaluate the correlation between MHHS, HHS, and OHS in different populations of arthroplasty such as primary THA, revision THA, THA for Crowe Type IV developmental dysplasia of the hip (DDH), and hip hemiarthroplasty (HA).
METHODS: A total of 399 patients (254 females and 145 males) that included 128 cases of primary THA, 36 of revision THA, 200 of HA, and 35 of THA with femoral shortening osteotomy with a minimum of 24 months of follow-up were included. HHS, MHHS, and OHS were calculated for each patient and the correlation between theses scores was evaluated for each subgroup.
RESULTS: The overall mean age was 67.5±14.3 years. The mean HHS, MHHS, and OHS were 74.9±17.9, 75.7±18.7, and 38.7±12.5, respectively. A very strong correlation was observed between HHS and MHHS (r=0.995, p=0.000) as well as between HHS and OHS (r=0.845, p=0.003) in the general study population. In subgroup analysis, there was a very strong correlation between HHS and MHHS in primary THA, revision THA, THA in hip HA, and Crowe Type IV DDH groups (r=0.984, p=0.000; r=0.977, p=0.000; r=0.984, p=0.000; and r=0.995, p=0.000; respectively). However, there was a significant correlation between HHS and OHS in these groups except revision THA group (r=0.851, p=0.023; r=0.587, p=0.069; r=0.989, p=0.002; and r=0.965, p=0.000; respectively).
CONCLUSION: This is the first study to investigate the usefulness of MHHS and OHS in hip HA and THA in patients with Crowe Type IV DDH. Our findings suggest that MHHS and OHS are useful for evaluating functional outcomes with HA, primary and revision THA, and THA with femoral shortening osteotomy for Crowe type IV DDH.

AMAÇ: Fraility endeksinin son versiyonu olan 5 faktörlü modifiye Fraility Ýndeks, hastalarýn komorbidite durumlarýný puanlayarak tedavi sonrasý komplikasyon riskini hesaplayan bir araçtýr. Çalýþmamýzda, mFI-5’nin geriatrik ayak bileði kýrýklý hastalarda komplikasyonlarý öngörmedeki etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: 2015–2020 yýllarý arasýnda hastanemizde tedavi görmüþ 65 yaþ üzeri ayak bileði kýrýðý olan toplam 94 hasta incelendi. Weber tip A, B, C kýrýklar çalýþmaya dahil edildi. Her hasta için diyabetik durum, kronik obstrüktif akciðer hastalýðý, konjestif kalp yetersizliði, ilaç gerektiren hipertansiyon ve fonksiyonel durumu sýnýrlandýran baðýmsýzlýktan oluþan komorbidite durumlarý için mFI-5 hesaplandý. Multivaryans lojistik regresyon modelleri, mFI-5 puanýný olumsuz sonuçlarýn bir öngörücüsü olarak deðerlendirmek için kullanýldý.
BULGULAR: Yeniden yatýþ oraný, yara yeri enfeksiyonu, hayatý tehdit eden týbbi komplikasyonlar ile herhangi bir komplikasyon olup olmama du-rumunda, mFI-5 in bu komplikasyonlarý ön görmede etkili olduðu gözlenmiþtir (p<0.05). Herhangi bir komplikasyon olup olmama durumu ön görmede mFI-5 ile BMÝ, ASA, Age, hastanede yatýþ süresi ve operasyon süresi kýyaslandýðýnda mFI-5 in komplikasyonlarý öngörmede daha etkili bir araç olduðu gözlenmiþtir (p<0.05, OR=2.726, %95 Confidence Interval=1.285–5.783).
TARTIÞMA: MFI-5, geriatrik ayak bileði kýrýklarý sonrasý oluþabilecek komplikasyonlarý tahmin etmek için hassas bir araçtýr. MFI-5’i oluþturan 5 komorbidite, hasta öyküsü aracýlýðýyla kolayca elde edilir, bu da onu yüksek riskli hastalarý tanýmlamak, ameliyat öncesi riskleri belirlemek ve saðlýk hizmetini iyileþtirmek için pratik bir klinik araç haline getirir.

BACKGROUND: The 5-factor modified Frailty Index (mFI-5), which is the latest version of the Frailty Index, is a tool that calculates the risk of complications after treatment by scoring the comorbidity status of the patient. The aim of this study was to evaluate the efficacy of the mFI-5 in predicting complications in geriatric patients with an ankle fracture.
METHODS: A retrospective examination was made of a total of 94 patients aged >65 years who were treated for an ankle fracture in our hospital between 2015 and 2020. Weber type A, B, and C fractures were included in the study. For each patient, the mFI-5 was calculated for the comorbidity status of diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension requiring drugs, and non-independent functional status. Multivariance logistic regression analysis was used to evaluate the mFI-5 points as a predictor of negative outcomes.
RESULTS: The mFI-5 was observed to be effective in the prediction of the complications of hospital re-admission, wound site infec-tion, life-threatening medical complications, and the presence of any complication (p<0.05). In the prediction of whether or not there was any complication, the mFI-5 was determined to be a more effective tool than body mass index, American Society of Anesthesiol-ogist, age, length of stay in hospital, and duration of operation (p<0.05, OR=2.726, 95% Confidence Interval=1.285–5.783).
CONCLUSION: The mFI-5 is a sensitive tool for the prediction of complications which may develop following geriatric ankle frac-ture. The five comorbidities which constitute the mFI-5 are easily obtained from the patient anamnesis, and this renders it a practical clinical tool to identify high-risk patients, determine the preoperative risks, and improve the health-care service.

AMAÇ: Genel eklem hipermobilitesi (GEH), ön çapraz bað (ÖÇB) yaralanmasý ve ÖÇB greft yetmezliði için bir risk faktörüdür. Bu hastalarda ÖÇB rekonstrüksiyonuna ilaveten anterolateral ligament rekonstrüksiyonu ya da internal breysi (ALL-ÝB) önerilmektedir. Bu geriye dönük çalýþmanýn amacý, GEH olan hastalarda izole ÖÇB rekonstrüksiyonu ve kombine ÖÇB rekonstrüksiyonu- ALL-ÝB uygulamasýnýn fonksiyonel sonuçlarýný, re-rüptür ve rezidüel instabilite oranlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmaya 2015–1019 yýllarý arasýnda Beighton-Horan kriterlerine göre GEH tanýsý konulan ve dahil edilme kriterlerini karþýlayan 68 hasta dahil edildi. En az iki yýllýk takip süresi bulunmayan hastalar çalýþmaya dahil edilmedi. Grup 1’de izole ÖÇB rekonstrüksiyonu ve grup 2’de ise kombine ÖÇB rekonstrüksiyonu ve ALL-ÝB yapýlan hastalar yer aldý. Takiplerde hastalarýn ameliyat öncesi ve sonrasý fizik muayene sonuçlarý ile anteroposterior stabilite (KT-1000) ve diz skorlarý kaydedildi. Tüm muayene ve ölçümler tek hekim tarafýndan yapýlmýþtýr.
BULGULAR: Grup 1 ve 2 sýrasýyla 37 ve 31 hastadan oluþuyordu. Ortalama takip süresi sýrasýyla 30.1±4.1 ve 28.1±2.9 aydý. Ameliyat sonrasý, grup 2’de yer alan hastalarýn pivot-shift testi ile daha iyi rotasyonel stabiliteye sahip olduklarý görüldü (p=0.02). KT-1000 artrometri ile yapýlan ölçümlerde grup 2’de anteroposterior stabilitenin anlamlý derecede daha iyi olduðu görüldü (p=0.01). Ancak gruplar arasýnda benzer fonksiyonel sonuçlar (Lysholm için p=0.14, Cincinnati için p=0.11 ve IKDC içi p=0.19) ve benzer re-rüptür oranlarý olduðu görüldü (p=0.41).
TARTIÞMA: Hipermobil hastalarda kombine ÖÇB rekonstrüksiyonu ve ALL-ÝB daha iyi rotasyonel ve anteroposterior stabilite saðladýðý görülmüþtür. Ancak daha geniþ hasta çalýþmalarý ve ileriye yönelik randomize kontrollu çalýþmalarla tekniðin ve sonuçlarýnýn doðrulanmaya ihtiyacý vardýr.

BACKGROUND: Generalized joint hypermobility (GJH) is a risk factor for anterior cruciate ligament (ACL) injury and ACL graft failure and is considered an indication for anterolateral ligament (ALL) reconstruction. The aim of this retrospective study was to compare functional outcomes, rupture rates, and residual instability in patients with GJH undergoing isolated ACL reconstruction or combined ACL reconstruction and ALL augmentation with internal bracing (ALL-IB).
METHODS: Sixty-eight patients with GJH and unilateral ACL injury were randomly assigned to undergo either isolated ACL reconstruction (Group 1) or combined ACL reconstruction and ALL-IB (Group 2). The patients were evaluated pre- and postoperatively; their medical histories; physical examination results; anterior knee translation, as measured using the KT-1000 arthrometer; and scores of validated knee assessments were recorded.
RESULTS: Groups 1 and 2 consisted of 37 and 31 patients, respectively. The mean follow-up was 30.1±4.1 and 28.1±2.9 months, respectively. In the final evaluation, the patients in Group 2 showed better rotational stability, as evaluated by the pivot-shift test (p=0.013); better anteroposterior stability, as evaluated by KT-1000 arthrometry (p=0.001); similar function (p=0.14 for the Lysholm, p=0.11 for the Cincinnati, and p=0.19 for the International Knee Documentation Committee subjective score); and failure rate (p=0.41).
CONCLUSION: The functional outcomes were similar between the groups. The stability outcomes after combined ACL and ALL-IB were better than those after isolated ACL reconstruction in patients with GJH. However, the technique and its results need to be validated in larger patient series and prospective randomized controlled trials.

AMAÇ: Kliniðimize Mart 2010–Aralýk 2019 tarihleri arasýnda toraks travmasý sonucu müracaat etmiþ 412 olgu geriye dönük olarak incelenerek, künt ve penetran toraks travmalarý sonucu geliþen geç komplikasyonlar deðerlendirilmiþ ve travmayla ilgilenen hekimlere bu komplikasyonlarýn yönetimi için bir öngörü sunulmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Dört yüz on iki toraks travmalý olgudan bu çalýþmanýn ana temasýný oluþturan geç dönem komplikasyon geliþmiþ 62 olgu (%15.04) yaþ, cinsiyet, travma tipi, travma nedeni, travmanýn ilk geliþtiði dönemde geliþen toraks patolojileri ve yandaþ organ patolojileri, geliþen geç dönem komplikasyonlarý ve bunlara yönelik tedavi yöntemleri ile mortalite açýsýndan incelendi.
BULGULAR: Toraks travmasýna baðlý geç komplikasyon geliþmiþ 62 olgunun 47’si (%75.80) erkek, 15’i (%24.20) kadýn, yaþ ortalamasý 56.98±21.22 olarak tespit edildi. Posttravmatik geç dönem komplikasyon geliþen olgularýn travma tipi deðerlendirildiðinde künt travmalarýn %90.33 (n=56), penetran travmalarýn %9.47 (n=6) oranýnda olduðu ve künt travma olgularýnda en sýk nedenin trafik kazasý (%66.07), penetran travmalarda ise delici-kesici alet yaralanmasý (%83.33) olduðu saptandý. En sýk geliþen toraks patolojisi künt travmalarda pulmoner kontüzyon (%75), penetran travmalarda ise hemopnömotoraksdýr (%66.66). Gruplar ayrý ayrý incelendiðinde penetran travmalar için en sýk görülen geç dönem komplikasyon retansiyone hemotoraks (%66.66) iken, künt travmalý olgularda en sýk (%41.07) pnömonidir. Retansiyone posttravmatik hemotoraks tablosu ile gelen hastalarýn 17’sinde video yardýmlý torakoskopik cerrahi, sekiz olguya torakotomi uygulandý. Posttravmatik ampiyemle gelen olgularýn yedisine torakoskopi, dört olguya torakotomi ile dekortikasyon yapýldý. Geç komplikasyon geliþen olgularýn altýsý hayatýný kaybetdi. Mortalite oraný %9.67’dir. Mortalite geliþen olgularýn %83.33’ünde geç komplikasyon türü olarak pnömoni tespit edildi.
TARTIÞMA: Travma ile ilgilenen hekimlerin, ilk bakýda tespit edemeyecekleri ve daha sonra karþýlarýna gelebilecek geç dönem komplikasyonlar açýsýndan, hastanýn yaþý, tavma tipi baþta olmak üzere birçok etken faktörü gözününde bulundurarak hastasýnýn tedavi modalitelerini belirlemeleri uygun olacaktýr.

BACKGROUND: A total of 412 patients who applied to our clinic after a thoracic trauma between March 2010 and December 2019 were examined retrospectively In this study, late complications that developed as a result of blunt and penetrating thoracic traumas were evaluated and it was aimed to present a prediction for the management of these complications to physicians who are dealing with trauma.
METHODS: Among the 412 thoracic trauma cases, 62 cases (15.04%) who developed late-term complications which constituted the main theme of this study were evaluated in terms of age, gender, the type of trauma, the cause of trauma, thorax, and concomitant organ pathologies that developed when the trauma first occurred, the late-term complications, and the treatment methods for them while considering mortality.
RESULTS: Of 62 patients with late complications due to thoracic trauma, 47 (75.80%) were male, 15 (24.20%) were female, and the average age was 56.98±21.22. When the trauma type of the patients who developed posttraumatic late-term complications was evaluated, blunt traumas were seen in 90.33% (n=56) of the cases, whereas penetrating traumas were seen in 9.47% (n=6). Traffic accidents were the most common cause in blunt trauma cases (66.07%), whereas pointed and sharp-edged weapon injuries were the most common in penetrating traumas (83.33%). The most common thorax pathology is pulmonary contusion (75%) in blunt traumas and hemopneumothorax in penetrating traumas (66.66%). When the groups were analyzed separately, the most common late-term complication for penetrating traumas was retained hemothorax (66.66%), while pneumonia was the most common (41.07%) in blunt trauma cases. Video-assisted thoracoscopic surgery was performed in seventeen patients with retained post-traumatic hemothorax and thoracotomy was performed in eight cases. Seven patients with post-traumatic empyema underwent thoracoscopy, and four patients underwent decortication with thoracotomy. Six of the patients who developed late-term complications died. The mortality rate is 9.67%. Pneumonia was detected as a late complication type in 83.33% of cases with mortality.
CONCLUSION: It will be appropriate for the physicians who are interested in trauma to determine the treatment modalities of the patients by considering many factors such as the age of the patient and the trauma type in terms of the late complications that they will not be able to detect at first glance.

AMAÇ: Cerrahi tedavi yapýlan izole medial malleol kýrýklarýnda kanüllü vida, Kirschner teli fiksasyonu ile beraber mini plak vida kombinasyonunu deðerlendirmektir.
GEREÇ VE YÖNTEM: A grubunda medial malleol kýrýðý 4 mm kanülle vida ve Kirschner teli ile fikse edilmiþ grup, B grubunda ise medial malleol kýrýðý 4 mm kanüllü vida ve Kirschner teli ile fikse edilen ve ekstra stabilite için mini plak ile fiksasyon yapýlan gruptur. AOFAS skorlamasý ameliyat sonrasý 2, 6 ve 12. ayda alýnan skorlar göz önüne alýndý. Medial malleol üzerinde palpasyonla hassasiyet ameliyat sonrasý 12. ayda VAS of pain skalasý ile deðerlendirildi.
BULGULAR: Ýndependent t samples teste göre A ve B grubu arasýnda istatistiksel anlamlý bir fark vardýr (p<0.05). Ameliyat sonrasý altýncý ayda A grubu ile B grubu arasýnda independent t samples teste göre istatistiksel olarak anlamlý fark yoktur (p=0.27). Ameliyat sonrasý 6, 12 ve 24. ayda A grubu ile B grubu arasýnda independent t samples teste göre istatistiksel olarak anlamlý fark yoktur. Ýki grup arasýnda VAS of pain skorunda Fisher’s exact testine göre istatisksel olarak anlamlý fark bulunamadý.
TARTIÞMA: Medial malleol kýrýklarýnda kanulle vida, K-teli ile primer tespit edilen miniplak ile ek stabilte saðlanan olgularda erken dönem sonuçlarý ve erken dönemde günlük hayata dönüþ sadece kanülle vida ve K-teli yapýlan olgulara göre daha iyi ve hýzlýdýr. Orta dönemde iki teknik arasýnda anlamlý bir fark yoktur.

BACKGROUND: In this study, we aimed to compare a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner wire (K-wire) technique with additional miniplate fixation for the treatment of medial malleolar fractures.
METHODS: A total of 23 patients who were diagnosed with isolated fractures of the medial malleolus and operated in our center were retrospectively analyzed. The patients were divided into two groups: Group A, medial malleolar fracture fixed with a 4-mm cannulated screw and a K-wire (n=11) and Group B, a 4-mm cannulated screw and K-wire used for fixation with miniplate fixation for extra stability (n=12). Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score at 2, 6, 12, and 24 months postoperatively. At 12–24 months, the presence of pain and tenderness in the medial malleolus with palpation was evaluated using the visual analog scale (VAS) pain scores.
RESULTS: The mean time to union was 2.23±0.56 (range, 1.8–2.9) months in Group A and 2.46±0.45 (range, 1.9–3.1) months in Group B, indicating no statistically significant difference between the two groups (p>0.05). The mean AOFAS score at 2 months postoperatively was 60.40±7.78 (range, 46–79) in Group A and 73.60±10.80 (range, 53–87) in Group B, indicating a statistically significant difference between the groups (p<0.01). However, there was no statistically significant difference in the mean AOFAS scores at 6 and 12 months between the groups (p>0.05). The mean VAS pain scores at 12–24 months postoperatively did not significantly differ between the groups (p>0.05).
CONCLUSION: Our study results suggest that the treatment of medial malleolar fractures with a cannulated screw and K-wire with additional stabilization using a miniplate ensures favorable early outcomes with early return to daily living activities. However, both techniques have similar outcomes in the mid-term.

AMAÇ: Renal iskemi-reperfüzyon hasarý, böbrek cerrahilerinin yaný sýra travma ve þok gibi klinik durumlarda akut böbrek yetersizliðinin en sýk nedenidir. Okserutin, flavonoid ailesinin bir üyesidir ve antioksidan özelliklere sahiptir. Bu çalýþmanýn amacý, okserutinin renal iskemi-reperfüzyon hasarý üzerinde koruyucu etkisinin olup olmadýðýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: Yirmi sekiz erkek Wistar albino sýçaný rastgele üç gruba ayrýldý: Sham kontrol grubu (n=8), renal iskemi-reperfüzyon hasarý grubu (n=10) ve renal iskemi-reperfüzyon hasarý + okserutin grubu (n=10). Renal iskemi-reperfüzyon hasarý sol renal arterin 30 dakika klemplenmesi ve ardýndan bir saatlik reperfüzyon periyodu ile saðlandý. Daha sonra histopatolojik ve biyokimyasal inceleme için kan örnekleri ve sol böbrek dokusu örnekleri alýndý. Kan örneklerinde, böbrek fonksiyonunun göstergesi olan kan üre nitrojen, üre, kreatinin ve sistatin C düzeyleri ile enflamasyonun bir göstergesi olan tümör nekroz faktör-alfa deðerleri incelendi. Oksidatif stresin göstergeleri olan total antioksidan kapasite ve total oksidan kapasite böbrek dokularýnda incelendi. Böbrek hasarýnýn bir göstergesi olan apoptotik indeks ve ayrýca histopatolojik deðiþiklikler böbrek dokularýnda deðerlendirildi.
BULGULAR: Apoptotik indeks, total oksidan kapasite, tümör nekroz faktör-alfa, kan üre nitrojen ve üre düzeyleri renal iskemi-reperfüzyon hasarý + okserutin grubunda renal iskemi-reperfüzyon hasarý grubuna göre daha düþüktü (p<0.05). Sonuçlar, okserutinin histopatolojik ve biyokimyasal özelliklerinin sýçanlarý renal iskemi-reperfüzyon hasarýndan koruduðunu gösterdi.
TARTIÞMA: Bu çalýþmada elde edilen bulgular profilaktik okserutin uygulamasýnýn renal iskemi-reperfüzyon hasarýnýn neden olduðu apoptoz ve böbrek yetersizliði üzerinde koruyucu etkileri olduðunu göstermektedir. Bu nedenle okserutin, renal iskemi-reperfüzyon hasarýnýn tedavisinde etkili bir profilaktik ajan olarak kullanýlabilir.

BACKGROUND: Background: Renal ischemia-reperfusion injury (RIRI) is the most frequent cause of acute renal failure in clinical conditions such as trauma and shock as well as renal surgeries. Oxerutin is a member of the flavonoid family and possesses antioxidant properties. The aim of this study was to investigate whether oxerutin has protective effects on RIRI.
METHODS: Twenty-eight male Wistar albino rats were randomly divided into three groups: sham control group (n=8), RIRI group (n=10), and RIRI + oxerutin group (n=10). RIRI was achieved by clamping the left renal artery for 30 min, followed 1-h reperfusion period. Thereafter, blood samples and left kidney tissue samples were taken for histopathological and biochemical examination. Blood urea nitrogen (BUN), urea, creatinine, and cystatin C levels, which are indicators of kidney function, as well as tumor necrosis factor-alpha, which is an indicator of inflammation were analyzed in blood samples. Total antioxidant status and total oxidant status (TOS), which are indicators of oxidative stress were analyzed on renal tissues. The apoptotic index, an indicator of kidney damage, as well as histopathological changes were evaluated on renal tissues.
RESULTS: The apoptotic index, TOS, tumor necrosis factor-alpha, BUN, and urea levels were lower in the RIRI + oxerutin group than in the RIRI group (p<0.05). The results demonstrated that the histopathological and biochemical properties of oxerutin protected rats from RIRI.
CONCLUSION: The findings obtained in this study show that prophylactic administration of oxerutin has protective effects on apoptosis and renal failure caused by RIRI. Therefore, oxerutin can be used as an effective prophylactic agent in the treatment of RIRI.

AMAÇ: Appendiks neoplazileri gastrointestinal sistemin nadir görülen tümörleridir. Bunlar içinde adenokanser, musinoz neoplazm ve nöroendokrin tümörler sýk olarak karþýmýza çýkar. Taný genellikle ameliyat sonrasý histopatolojik inceleme sonrasý konur. Bu çalýþmada, insidental olarak taný konan appendiks neoplazilerinin epidemiyolojisini, patolojik subtiplerini ve tedavi modalitelerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Nisan 2010–Aðustos 2020 tarihleri arasýnda apendektomi yapýlan 2821 hasta geriye dönük olarak deðerlendirildi. Hastalarýn demografik verileri, ameliyat öncesi klinik ve radyolojik bulgularý, ameliyat bulgularý, histopatoloji sonuçlarý, ek ameliyat ve týbbi tedavi uygulamalarý geriye dönük olarak hasta dosyalarýndan toplandý.
BULGULAR: Çalýþmaya dahil edilen hastalarýn %1.06’sýnda appendiks neoplazmý saptandý. Ortalama yaþ 44.6±17.5 (daðýlým, 17–83) olarak bulundu. Hastalardan sekizi nöroendokrin tümör, yedisi adenokanser, ondördü müsinöz neoplazi ve biri nöroma tanýsý almýþtý.
TARTIÞMA: Appendiks neoplazileri genellikle asemptomatik ve sýklýkla ameliyat sonrasý histopatolojik inceleme ile taný alan tümörlerdir. Patoloji adenokanser ise tedavide sað hemikolektomi önerilirken nöroendokrin tümörlerin tedavisi tümör boyutu, yerleþimi, mezoappendiks invazyonu ve lenf nodu tutulumu gibi faktörlerden etkilenir. Musinöz neoplazm varlýðýnda patolojik alt tipe ve tutuluma göre cerrahi yöntem belirlenir. Patolojik inceleme sonucu tümör saptanan hastalarda ek tedavi ve takip gereksinimi apendektomi sonrasý histopatolojik sonucun takip edilmesi gerekliliðini bir kez daha vurgulamaktadýr.

BACKGROUND: Appendix neoplasms are rare tumors of the gastrointestinal system. Appendiceal adenocarcinoma, appendiceal mucinous neoplasm, and neuroendocrine tumors (NETs) are the most encountered appendix-related neoplasms. The patients are usually got diagnosed after histopathological examination. This study aimed to explore the epidemiology, pathological subtypes, and treatment modalities of appendix neoplasms.
METHODS: A retrospective examination was made with 2821 patients who underwent appendectomy between April 2010 and August 2020. Demographic, clinical, radiological, surgical findings, and histopathological results were collected from the patient files.
RESULTS: Appendix neoplasms were detected in 1.06% of the patients included in the study. The mean age was 44.6±17.5 (17–83) years. Eight NETs, seven adenocarcinomas, fourteen mucinous neoplasms, and one neuroma were diagnosed with patients.
CONCLUSION: Appendiceal neoplasms are generally asymptomatic and often diagnosed with postoperative histopathological ex-amination. If the result is adenocarcinoma, right hemicolectomy recommends. Treatment of NETs depends on factors such as tumor size, location, mesoappendix invasion, and lymph node involvement. In the presence of mucinous neoplasm, surgical intervention is determined according to the pathological subtype and involvement of mesoappendix. The need for additional surgical intervention or medical treatment for patients with tumor, histopathological results must be followed carefully after appendectomy.

AMAÇ: 30 Ekim 2020’de meydana gelen depremin yýkýcý özellikleri ile hem hastane öncesi hem de pandemi yoðunluðu yaþayan hastane ve acil servis organizasyonu hakkýnda bildirim yaparak afet yönetimi konusunda güncel bir kaynak saðlamak için bu çalýþma yapýldý.
GEREÇ VE YÖNTEM: Bu çalýþma çok merkezli, kesitsel geriye dönük olarak 2020 Ege Denizi - Ýzmir depreminden etkilenen olgular üzerinde ger-çekleþti. Deprem bölgesinde yer alan iki hastane ile ambulans servisi verileri deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilme kriterlerine uygun 313 (%60.4’ü kadýn) hasta alýndý. En küçüðü altý aylýk bebek, en büyüðü 91 yaþýnda olmak üzere çalýþmaya katýlanlarýn yaþ ortalamasý 38.0±21.0 olarak saptandý. Depremden etkilenenlerin %41.5’inin ilk üç saat içinde acil servislere geldiði ve ilk saatlerde en fazla sarý triyaj kodlu hastalarýn olduðu saptandý. Göçük altýndan kurtarýlan hastalar deðerlendirildiðinde %35.2’si sað olarak taburcu edildi. Göçük altýndan 24 saat sonra sað kurtarýlarak taburcu edilen toplam dört hasta (üçü 48 saatten fazla olmak üzere- en uzun göçük altýnda kalma süresi 91 saat) vardý. Acil servislere geldiðinde sað olan hastalarýn 32’sinde (%15.9) rabdomiyoliz olduðu, dört (%1.9) hastaya akut böbrek yetersizliðine baðlý acil serviste hemodiyaliz yapýldýðý, sekiz (%3.8) hastaya fasyotomi ve amputasyon gibi diðer acil operasyonlara alýndýðý saptandý. Olay yerinde, hastane öncesi ve hastane sonrasý toplam 122 hastanýn öldüðü 191 hastanýn da hastanelerden taburcu edildiði saptandý. Acil servisten 139 hasta taburcu olduðu, 15 hastanýn yoðun bakým yatýþý, 41 hastaya servis yatýþý verildiði 112 hastanýn ilk deðerlendirme sonrasý doðrudan morglara alýndýðý saptandý. Ýzmir depreminde 500’den fazla bina aðýr hasar aldý ancak ölümlerin çoðunluðu birbirine çok yakýn lokalizasyonda olan çok katlý dokuz binanýn yýkýlmasý sonrasý olduðu saptandý.
TARTIÞMA: Deprem gibi yýkýcý bir felaketin ardýndan yaþanýlan ilk saatler, hem arama-kurtarma hem de acil týp sistemi için çok önemlidir. Acil servis-ler deprem gibi afet durumlarý için doðru kayýt, doðru veri giriþi, doðru triyaj, yeterli kaynak, yeterli ekip, yeterli ekipman sayýsý ile yeterli tedavi alanlarý konusunda hazýr olmalý, afet konusunda yeterli eðitim verilmeli, uygulanabilir afet yardým planlarý hazýrlanmalý ve düzenli tatbikatlar yapýlmalýdýr.

BACKGROUND: This article aims to provide an up-to-date resource on disaster management by reporting about the destructive fea-tures of the earthquake that occurred on October 30, 2020, and about the hospital and emergency service organization during a pandemic.
METHODS: This study was carried out with a multicentered, cross-sectional retrospective design on the victims of the 2020 Aegean Sea - Izmir earthquake. Local ethics committee approval was obtained. The data obtained by obtaining permission from two hospitals and ambulance services (transport data) located in the region where earthquake-related destruction was most prominent were evalu-ated. Patient data including demographic data, time of arrival to the emergency department, duration of stay under the debris, triage codes (green: not urgent, slightly injured; yellow: may be delayed, injured; red: critically injured; and black: dead), type of injuries, dura-tion of stay in the emergency department, crush syndrome, rhabdomyolysis, need for invasive procedures (e.g., surgery and dialysis), intensive care admission, hospital admission, and discharge were evaluated.
RESULTS: In total, 313 patients (60.4% females) were included in the study according to the inclusion criteria. The mean age of the participants was 38.0±21.0 years, with the youngest being a 6-month-old baby and the oldest a 91-year-old individual. Approximately 41.5% of the earthquake victims presented to the emergency department within the first 3 h of the earthquake, and patients with yellow triage code were the most common in the 1st h. Further, 35.2% of the patients who were rescued from under the debris were discharged alive. Four patients were discharged alive after being rescued from under the debris 24 h following the earthquake, of whom three were rescued after >48 h (longest duration, 91 h). Further, 32 (15.9%) patients who survived upon presentation to the emergency department had rhabdomyolysis, 4 (1.9%) underwent hemodialysis in the emergency department due to acute renal failure, and 8 (3.8%) underwent other emergency operations such as fasciotomy and amputation. In total, 122 patients died and 191 patients were discharged from the hospitals. Furthermore, 139 patients were discharged from the emergency department, 15 were admitted to the intensive care unit, 41 were hospitalized in the relevant clinics, and 112 were directly transferred to the morgue following preliminary evaluation.
CONCLUSION: Emergency services should be ready in terms of accurate registration, correct data entry, correct triage assignment, sufficient resources, adequate team, sufficient equipment, and adequate treatment areas for disasters such as earthquakes. Further, ade-quate disaster trainings should be provided, feasible disaster relief plans should be prepared, and regular exercises should be conducted.

AMAÇ: Donmaya baðlý yaralanmalar, acil týbbýn en karmaþýk ve güncel sorunlarýndan biri olmaya devam etmektedir. Sýcak iklime sahip bölgelerde, donmaya baðlý yanýklarý daha az sýklýkta olup, özellikle bölgemizde daha çok erkeklerin karþýlaþtýðý bir travmadýr. Hastalarýn çoðu saðlýk merkezlerine ve yanýk merkezlerine erken dönemde ulaþýmda sorun yaþamaktadýr.
GEREÇ VE YÖNTEM: Gazi Yaþargil Eðitim ve Araþtýrma Hastanesi Yanýk Merkezi’ne donmaya baðlý yaralanmalar nedeniyle baþvuran yaþlarý 13 ila 82 arasýnda deðiþen 16 kiþi geriye dönük olarak incelendi. Yaþ, cinsiyet, yaralanma süresi, ekstremite yaralanmalarý, bakteriyolojik incelemeler ve hastalarýn genel ýsýnmasý dahil olmak üzere her hastaya ait veriler hastalarýn dosyalarýndan ve bilgisayar kayýtlarýndan elde edildi.
BULGULAR: Travmalý tüm hastalara ilk müdahale yapýldýktan sonra yaralanan bölgede dolaþým bozukluðu belirlendi ve buna göre tedavi saðlandý. Bu hastalarýn tedavisi çok uzun ve pahalý operasyonlar gerektirdi ve bu da çoðu kez engelli olmalarýna neden oldu.
TARTIÞMA: Soðuk kýþ aylarýnda, bilinçsiz buz kullanýmý ve Türkiye sýnýrýndaki daðlardan kaçak geçiþler nedeniyle sýklýkla derin donma yanýklarý görülmektedir.

BACKGROUND: Frostbite injuries remain to be one of the most complex and current problems of emergency medicine. Although cold burns are less frequent in hot climatic regions, it is a trauma, especially for men in our region. Also, most of the patients have difficulties in gaining early access to health and burn centers.
METHODS: We performed a retrospective analysis on sixteen patients aged between 13 and 82, who were presented to Gazi Yaþargil Training and Research Hospital Burn Center due to frostbite injuries. Data of each patient, including age, gender, injury time, extremity injuries, bacteriological observations, and general warming, were obtained from patients’ files and computer records.
RESULTS: After providing the first intervention to all the patients with trauma, a circulatory disorder of the injury area was deter-mined, and the treatment was provided accordingly. The treatment of these patients required very long and expensive operations, which often resulted in making them disabled.
CONCLUSION: Deep frostbites in the cold winter months are frequently observed due to the unconscious use of ice and illegal crossings from the mountains at the Turkey border.

AMAÇ: Dünyada çocuklardaki abdominal cerrahinin en sýk nedeni akut apandisittir (AA). Bilim ve teknolojideki geliþmelere raðmen günümüzde hala AA teþhisi zordur ve sonuçta komplikasyonlar da sýktýr. Komplike apandisitin erken tespit edilmesi, cerrahi planlamasý, sonraki tedaviler ve hastalýðýn seyrini tahmin etmede büyük önem taþýmaktadýr. Ýmmatür granülosit (IG), enflamasyonun ciddiyetini tahmin etmede geleneksel enflamasyon belir-teçlerine göre yeni ve daha etkin bir belirteçtir. Amacýmýz AA taný ve þiddetinde IG etkinliðini belirlemektir.
GEREÇ VE YÖNTEM: Bu ileriye yönelik çalýþmamýza AA teþhis edilen 88 hasta grubu ve 58 saðlýklý çocuktan oluþan kontrol grubu dahil edildi. Pa-tolojik olarak doðrulanmýþ AA hastalarý akut basit apandisit (ABA) ve akut perfore apandisit (APA) olarak iki alt gruba ayrýldý. Gruplarýn demografik özellikleri, beyaz kan hücresi (WBC), nötrofil-lenfosit oraný (NLO), ortalama trombosit hacmi (MPV), IG% ve C-reaktif protein (CRP) deðerleri analiz edildi. Parametrelerin taný doðruluklarýný ve öngörücü performanslarýný karþýlaþtýrmak için receiver operating characteristics (ROC) analizi kullanýldý. BULGULAR: AA hastalarýnýn IG, WBC sayýsý, NLO ve MPV deðerleri kontrol grubuna göre daha yüksekti (sýrasýyla, p=0.28, p=0.22, p<0.001, p=0.001). ABA ile APA arasýnda bakýlan enflamatuvar belirteçlerden sadece IG% diðer belirteçlere göre istatistiksel olarak anlamlý þekilde farklýlýk gösteriyordu (p<0.001). ROC analizinde IG’nin APA varlýðý için en uygun kestirim deðerinin >%0.2 olarak tespit edildi (duyarlýlýk %81.8, özgüllük %85.2, EAA: 0.83).
TARTIÞMA: Bu çalýþmada, daha yüksek IG düzeylerine sahip AA’lý hastalarda perforasyon geliþme olasýlýðýnýn daha yüksek olabileceðini gösterdik. Klinisyenlere çocuk acil servisinde yüksek riskli AA hastalarýný tespit etmelerine yardýmcý olmak için fizik muayene, görüntüleme çalýþmalarý ve labo-ratuvar testleriyle birlikte IG deðerlerini kullanýlmasýný öneririz.

BACKGROUND: Acute appendicitis (AA) is the most common reason for pediatric abdominal surgery in the world. Despite ad-vances in science and technology, diagnosing AA is still difficult today, and complications are common as a result. The early prediction of complicated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. The immature granulocyte (IG) is a new and more effective marker in predicting the severity of inflammation than traditional markers. Our aim is to determine the effectiveness of IG% in the diagnosis and severity of AA.
METHODS: Eighty-eight patients diagnosed with AA and a control group of fifty-eight healthy children were included in this prospec-tive study. Patients with pathologically confirmed AA were divided into two subgroups: acute simple appendicitis (ASA) and acute perforated appendicitis (APA). The demographic characteristics, white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), IG%, and C-reactive protein (CRP) values were analyzed. Receiver operating characteristics (ROC) anal-ysis was used to compare the diagnostic accuracies and predictive performances.
RESULTS: Patients with AA had higher IG%, WBC count, NLR, and MPV value than control group (p=0.28, p=0.22, p<0.001, p=0.001, respectively). Only IG% showed statistically significant difference from other inflammatory markers evaluated in ASA and APA patients (p<0.001). ROC analysis showed that IG% is a good predictor for the presence of APA at an optimal cut-off for IG being 0.2% (sensitivity 81.8%, specificity 85.2%, area under the ROC curve 0.83).
CONCLUSION: In the present study, we demonstrated that AA patients with higher IG levels might be more likely to develop perforation. The IG values combined with a physical examination, imaging studies, and other laboratory tests may help clinicians to identify high-risk AA patients in the pediatric emergency department.

AMAÇ: Ameliyat sonrasý aðrý, açýk kalp ameliyatlarýnda solunum sistemi baþta olmak üzere birçok organ fonksiyonlarýný ve mortaliteyi etkiler. Geri-atrik hastalar açýk kalp cerrahisi sonrasý daha fazla organ disfonksiyonu ve mortalite riski altýndadýrlar. Açýk kalp cerrahisi geçiren geriatrik hastalarda torasik epidural analjezi (TEA) ve intravenöz analjezinin kýsa dönem sonuçlarýný ve mortalitesini karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya 2010–2020 yýllarý arasýnda açýk kalp cerrahisi geçiren 65 yaþ üstü hastalar alýndý. Hastalar torasik epidural analjezi uygulananlar (Grup E) ve intravenöz parasetamol veya tramadol veya deksmedetomidin uygulananlar (Grup I) olmak üzere iki gruba ayrýldý. Has-talarýn ameliyat sonrasý sedasyon ve analjezi gereksinimleri, mekanik ventilasyon süreleri, kan glukoz düzeyi, karaciðer ve böbrek fonksiyon testleri, geliþen komplikasyonlar, yoðun bakýmda ve hastanede kalýþ süreleri ve mortalite oranlarý karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 408’i Grup E, 140’ý Grup I olmak üzere toplam 548 hasta dahil edildi. Gruplar arasý karþýlaþtýrmalar sonucunda sedasyon gereksinimi, analjezi gereksinimi, mekanik ventilasyon süresi, ekstübasyon sonrasý yüz maskesi oksijen gereksinimi, noninvaziv mekanik Grup E’de ventilasyon ihtiyacý, yeniden entübasyon gereksinimi ve kan þekeri düzeyi Grup I’e göre daha düþük bulundu. Ayrýca yoðun bakýmda geçirilen süreler ve hastanede kalýþ süreleri Grup E’de Grup I’e göre daha düþük bulundu. Hastane mortalitesi açýsýndan iki grup arasýnda fark bulunmadý. TARTIÞMA: Torasik epidural analjezi, açýk kalp cerrahisi geçiren yaþlý hastalarda oluþturduðu analjezi ve sedasyon ile daha iyi solunumsal durum ve kan þekeri regülasyonu saðlayarak yoðunbakým ve hastanede kalýþ süresini kýsaltmýþtýr.

BACKGROUND: In open-heart surgeries, many organ functions, particularly the respiratory system, are affected by post-operative pain, and so is mortality. Following open-heart surgery, geriatric patients have a higher risk of organ dysfunction and mortality. We aimed to compare the short-term outcomes and mortality of thoracic epidural analgesia (TEA) and intravenous (IV) analgesia in geri-atric patients undergoing open heart surgery.
METHODS: This study included patients over the age of 65 who had open-heart surgery between 2010 and 2020. The patients were divided into two groups: Those who received TEA (Group E) and those who received IV paracetamol or tramadol or dexmedetomi-dine (Group I). The patients’ post-operative sedation and analgesia requirements, mechanical ventilation (MV) duration, blood glucose levels, liver and kidney function tests, complications, intensive care and hospital stay lengths, and mortality rates were all compared.
RESULTS: The study included a total of 548 patients, with 408 in Group E and 140 in Group I. As a result of the comparisons be-tween the groups, sedation requirement, analgesia requirement, MV duration, post-extubation facial mask oxygen requirement, non-invasive MV need, re-intubation requirement, and blood glucose level were found to be lower in Group E than in Group I. Moreover, periods spent in intensive care and lengths of hospital stay were found to be lower in Group E than Group I. There was no difference found between the two groups in terms of hospital mortality.
CONCLUSION: In elderly patients undergoing open-heart surgery, TEA reduced the length of time in intensive care and hospital stays by improving the respiratory status and blood glucose regulation by supplying analgesia and sedation.

AMAÇ: Akut apandisitler her yaþ grubunu ve her iki cinsiyeti de içerisine alan toplumda yaygýn görülen bir hastalýk olup akut batýnýn en sýk sebep-lerinden biridir. Komplike ve non-komplike ayrýmýnýn ameliyat öncesinde yapýlmasý önemlidir. Çalýþmanýn amacý, acil servise akut apandisit ile gelen hastalarda, hastalýðýnýn komplike veya non-komplike olduðunu belirlemede kullanýlabilecek laboratuvar parametrelerinin saptanmasýdýr.
GEREÇ VE YÖNTEM: Çalýþmaya, Mayýs 2019–Kasým 2020 tarihleri arasýnda, acil genel cerrahi servisine baþvurmuþ, apandisit tanýsý konulmuþ, kadýn ve erkek hastalar alýndý. Hastalara ait demografik veriler (yaþ, cinsiyet, protokol numaralarý), tam kan sayýmlarý (DNI [Delta nötrofil indeks], hemoglobin, monosit, nötrofil, eozinofil, bazofil, trombosit, platelet distribution width [PDW], mean platelet volume [MPV], reticulocyte distribu-tion width [RDW]), biyokimyasal parametreleri [amilaz, direk bilirubin, indirek bilirubin, albumin, kalsiyum], laktat dehidrogenaz [LDH]), muayene muayene bilgileri hastane otomasyon sisteminden elde edilip SPSS programý ile kayýt altýna alýndý. Komplike ve non-komplike olarak iki gruba ayrýlan hastalarýn parametreleri karþýlaþtýrýldý.
BULGULAR: Komplike ve nonkomplike hasta gruplarý karþýlaþtýrýldýðýnda; beyaz küre, monosit, nötrofil, DNI, total bilirubin ve direkt bilirubin deðer-leri açýsýndan istatistiki fark saptanmýþtýr (p deðerleri sýrasý ile; <0.001, 0.003, <0.001, <0.001ve 0.008’dir).
TARTIÞMA: Akut apandisitte, komplike ve non-komplike ayrýmýný yapmada, laboratuvar parametreleri olarak WBC, monosit, nötrofil, eozinofil, DNI, bilirubin deðerleri kullanýlabilir.

BACKGROUND: Acute appendicitis (AA) is a common disease that includes all age groups and both genders in societies and is one of the most common causes of acute abdomen. It is important to distinguish between complicated and non-complicated appendicitis before surgery. This study aims to determine laboratory parameters that can be used to determine whether the disease is complicated or non-complicated in patients admitted to the emergency department with AA.
METHODS: Female and male patients admitted to the Emergency General Surgery Department between May 2019 and November 2020 and diagnosed with appendicitis were included in the study. Demographic data (age, gender, and protocol numbers), complete blood counts (Delta neutrophil index [DNI], hemoglobin, monocyte, neutrophil, eosinophil, basophil, platelet, platelet distribution width, mean platelet volume, reticulocyte distribution width), biochemical parameters (amylase, direct bilirubin, indirect bilirubin, albumin, calcium, and lactate dehydrogenase), and examination information were obtained from the hospital automation system and recorded via SPSS software. Parameters of patients were divided into two groups as complicated and non-complicated appendicitis groups were compared.
RESULTS: White blood cell (WBC), monocyte, neutrophil, DNI, total bilirubin, and direct bilirubin values were found to be statisti-cally significantly higher in the complicated appendicitis group compared to the non-complicated appendicitis group (p-values; <0.001, 0.003, <0.001, <0.001 and 0.008, respectively).
CONCLUSION: DNI, bilirubin values, WBC, monocyte, neutrophil, and eosinophil can be used as laboratory parameters to distin-guish between complicated and non-complicated AA.

Özofagus kanseri nedeni ile oral alýmý olmayan COVID-19 tanýlý olguda, COVID-19 tedavisi baþlanabilmesi için yapýlan gastrostomi prosedürü ve pandemi rehberleri eþliðinde uygulanan COVID-19 protokollerini sunmayý amaçladýk. Elli beþ yaþýnda özofagus skuamoz hücreli karsinom yeni tanýlý kadýn hasta neoadjuvan kemoradyoterapi öncesi özofagusta tam obstrüksiyon nedeniyle oral alamadýðý için cerrahi gastrostomi açýlmasý için konsülte edildi. Kliniðimize baþvuru anýnda yeni baþlayan öksürük þikayetinin olmasý ve ölçülen vücut sýcaklýðýnýn yüksek olmasý (38°C) nedeni ile COVID-19 açýsýndan tetkik edildi ve PCR ile kesin tanýsý konuldu. Oral COVID-19 tedavisine baþlanabilmesi için yarý acil þartlarda COVID-19 bulaþ önleme rehberlerine uyularak cerrahi gastrostomi açýldý. Gastrostomi kateterinden COVÝD-19 tedavisi, nutrisyon ve destek tedavisi baþlandý. Hastamýz tedavisinin yedinci gününde klinik olarak stabil seyretmektedir. Pandemi mücadelesi içerisinde COVID-19 hastasýnda acil cerrahi giriþim ihtiyacý olabilir. Cerrahi iþlem uygulanacaðý zaman tüm saðlýk personelini COVID-19 bulaþýndan koruyacak tanýmlanmýþ rehberlere uyulmalýdýr.

We present here a gastrostomy procedure performed on a patient diagnosed with COVID-19 with no oral intake due to esophageal cancer in order to permit the initiation of COVID-19 treatment, and the COVID-19 protocols followed as per the pandemic guidelines. A 55-year-old female patient diagnosed recently with esophageal squamous-cell carcinoma was consulted for a surgical gastrostomy in the absence of oral intake due to complete esophageal obstruction prior to neoadjuvant chemotherapy. The patient had a new-onset cough and elevated body temperature (38°C) on admission to our clinic, and so was tested for COVID-19, with the final diagnosis established with PCR. In order to initiate COVID-19 treatment, a surgical gastrostomy was performed under semi-emergency conditions, following COVID-19 infection prevention guidelines. COVID-19 treatment, nutrition, and supportive therapy were initiated through the gastrostomy catheter. The patient is clinically stable on day 7 of treatment. A COVID-19 patient may require emergency surgical intervention during the fight against pandemic. When a surgical procedure is performed, all guidelines defined to protect healthcare workers from COVID-19 infection should be followed.

Schwannomun travmatik rüptürü ile meydana gelen hemotoraks olgusu nadiren bildirilmiþtir. Glasgow Koma Skoru 13 olan yüksek bir yerden düþmüþ, 18 yaþýndaki bir kadýnýn toraks yaralanma olgusunu sunuyoruz. Akciðer grafisinde sol taraflý masif plevral efüzyon saptandý. Göðüs tomografisinde sol akciðer bazal bölgesinde 105x80 mm oluþum saptandý. Hastaya interkostal tüp yerleþtirilerek 2000 cc kan drenajýndan sonra acil torakotomi uygulandý. Tümörün patolojik tanýsý Schwannom (Neurilemmoma) idi. Bu olgu çalýþmasýnda, daha önce bilinmeyen mediastinal kitle için ilgili literatürle birlikte travmatik hemotoraks sunmak istiyoruz.

A case of hemothorax caused by traumatic rupture of schwannoma is rarely reported. We present a case of thorax injury of an 18-year-old woman who had fallen from a high place with a Glasgow Coma Score 13. Chest X-ray showed a left-sided massive pleural effusion. Chest tomography revealed a 105×80 mm formation in the left lung basal region. The patient underwent an emergency thoracotomy after 2000 cc blood drainage with intercostal tube placement. Tumor’s pathologic diagnosis was schwannoma (neurilemmoma). In this case study, we would like to present a traumatic hemothorax for the previously unknown mediastinal mass with the relevant literature.