Penetran toraks travmalý hastalarýn çoðunluðu ameliyatsýz tedavi edilmektedir. Cerrahi gerektiren hastalarýn klinik tablosu, genellikle fizyolojik instabiliteyle birlikte seyretmektedir. Bu hastalarýn durumunun kritik oluþu ve birçok Avrupa ülkesinde toraks travmasýnýn seyrek görülmesi, uzmanlýk eðitimlerini genellikle genel cerrahi alanýnda almýþ travma cerrahlarýna güçlük çýkarmaktadýr. Çoðu genel cerrah, temel kardiyotorasik operatif cerrahi konusunda genel bir bilgi ve kendi eðitim yýllarýndan kaynaklanan ve muhtemelen cerrahi kitaplarýný okumak suretiyle artan bir bilgiye sahiptir. Bu kitaplarýn çoðuna dahil edilen ayrýntýlar, maalesef bu güç olgunun üstesinden gelmek üzere genel cerraha yeterli donatým saðlamaya yetecek kadar kapsamlý deðildir. Bu uzmanlarýn bu anatomik bölgede, kardiyotorasik travma kitaplarýndan edinilmiþ beceri ve bilgileri kardiyotorasik cerrah arkadaþlarýnýn operatif becerisi ve bilgisi ile karþýlaþtýrýlamaz. Kardiyotorasik cerrahlar tarafýndan temel ve kolay olarak kabul edilen teknikler, genel cerrahlar için yabancý ve zor olabilir. Kardiyotorasik travma cerrahisinde karþýlaþýlabilecek tehlikeli noktalarý ve güçlükleri biliyor olmak, bu uzmanlarýn operasyon sýrasýndaki hatalardan sakýnmalarýna ve kendi hasta sonuçlarýný geliþtirmelerine olanak saðlayacaktýr. Bu yazýda, göðüs bölgesine nafiz penetran travmalarý ameliyat eden cerrahlarýn yaygýn þekilde karþýlaþtýklarý tehlikeler vurgulandý.

The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

Askeri ve sivil yaþamda travma sonucu geliþen ölümler ciddi toplumsal sorunlardandýr; amaç yaralanmalarý azaltmak ve ölümleri kabul edilebilir seviyelere çekebilmektir. Bu nedenle saðlýk personelinin travma ve resüsitasyon bilgilerine hakim olmasý, yaralý ve travmalý hastaya güncel týbbi yaklaþým esaslarýný bilmesi gerekir. Travma koþullarýnda erken yaþam kurtarýcý giriþimler, ileri hat cerrahi timleri tarafýndan uygulanan hasar kontrol cerrahileri ve týbbi tahliye sistemlerindeki geliþmeler tedavinin etkin uygulanabilmesini saðlamakta ve mortalite oranlarýný azaltmaktadýr. Son yýllarda bu tür olgularýn tedavisindeki yaklaþýmda büyük farklýlýklar meydana gelmiþtir. Uygun bir týbbi yaklaþýmýn esaslarýný belirlemek arzusuyla literatür taramasý gerçekleþtirilen çalýþmamýzda, sah(r)ada uygulamaya sokulan ya da uygulanmasý önerilen giriþim stratejilerini gözden geçirmek ve olabildiði oranda bir konsensüs saðlamak amaçlanmýþtýr.

Death caused by trauma is a major social problem in both the military and the civilian world. The goal is to reduce injuries and deaths to acceptable limits. Thus, healthcare providers should have the necessary information on trauma and resuscitation and be aware of current principles of approach to trauma patients. Early life-saving procedures in the trauma setting, damage control surgeries performed by an advanced line of surgical teams, and improvement in medical evacuation systems provide effective treatment in trauma casualties and reduce the mortality rate. Significant changes have occurred recently in the treatment of trauma cases. In our study, we aimed to search the literature in order to describe the principles of proper medical approach, to review the operational strategies recommended in the field and to develop a consensus to the extent possible.

AMAÇ: Hemorajik þok oluþturulan köpeklerde, pirasetamýn þoka baðlý nitrik oksit düzeylerinde deðiþikliðe ve beyin dokusunda oluþan hipoksiye etkisinin olup olmadýðý araþtýrýldý. GEREÇ-YÖNTEM: Denekler randomize olarak 10’ar köpekten oluþan dört gruba ayrýldý. Grup I, bir saatlik hemorajik þoka uðratýldý ve hemorajik þok sonrasý tedavi verilmedi. Grup II, bir saatlik hemorajik þoka uðratýldý ve þok sonrasý kan ile birlikte serum fizyolojik verildi. Grup III, bir saat hemorajik þoka uðratýldý ve þok sonrasý kan ile birlikte intravenöz pirasetam verildi. Grup IV’e ise þok ve tedavi uygulanmadý. Deneyin baþlangýcýnda, 60., 120. ve 180. dakikalarda nitrik oksit analizi için kan örnekleri alýndý. Deneyin sonunda, histopatolojik inceleme için beyin doku örnekleri çýkarýldý. BULGULAR: Kan basýncý ve nabýz deðerlerindeki düzelmenin Grup III’deki deneklerde Grup II’deki deneklere göre daha iyi olduðu saptandý. Grup I’de nitrik oksit seviyelerinde yükselme olmasýna raðmen, pirasetamla nitrik oksit seviyeleri arasýnda herhangi bir iliþki saptanmadý. Deneyin sonunda, Grup III’de hemorajik þoka baðlý geliþen beyin hasarýndaki düzelmenin kontrol grubuna göre daha iyi olduðu saptandý. SONUÇ: Tedaviye eklenen pirasetam hemorajik þokta iskemik hasarý azaltabilir.

BACKGROUND: To demonstrate the effect of piracetam on changes in brain tissue and serum nitric oxide levels in dogs submitted to hemorrhagic shock. METHODS: The subjects were randomized into four subgroups each consisting of 10 dogs. Hemorrhagic shock was induced in Group I for 1 hour and no treatment was given to this group. Blood and saline solutions were administered to Group II following 1 hour hemorrhagic shock. Blood and piracetam were given to Group III following 1 hour shock. No shock was induced and no treatment was applied to Group IV. Blood samples were obtained at the onset of the experiment and at 60, 120 and 180 minutes for nitric oxide analysis. For histopathological examination, brain tissue samples were obtained at the end of the experiment. RESULTS: The observed improvement in blood pressure and pulse rates in Group III was more than in Group II. Nitric oxide levels were increased in Group I; however, no correlation between piracetam and nitric oxide levels was determined. It was seen that recovery in brain damage in Group III was greater than in the control group. CONCLUSION: Piracetam, added to the treatment, may decrease ischemic damage in hemorrhagic shock.

AMAÇ: Mekanik ventilasyon gerektiren hastalarda kritik hastalýðýn basit, pahalý olmayan ve dinamik bir göstergesi olarak vücut kitle indeksi (VKÝ) ve C-reaktif proteinin (CRP) öngörme deðeri bilinmemektedir. Bu nedenle, bu çalýþma, yoðun bakým ünitesine (YBÜ) kabul edilen travma hastalarýndaki VKÝ ve CRP göstergeleriyle mekanik ventilasyon süresi arasýndaki bir iliþki varlýðýný ve insidansýný belirlemek amacýyla yürütüldü.
GEREÇ-YÖNTEM: Bu prospektif gözlemsel çalýþma, 72 kritik travma hastasý üzerinde gerçekleþtirildi. YBÜ’ye kabul edilen hastalar, mekanik ventilasyon süresine göre Grup A (≤7 gün) ve Grup B (>7 gün) þeklinde sýnýflandý. Hastalarýn biyolojik durumu, YBÜ’ye kabul ediliþte (T1), yatýrýldýktan sonraki 48. ve 72. saatte, mekanik ventilasyona baþlandýðý gün (T2) veya mekanik ventilasyonun kesildiði günlerde (T3) deðerlendirildi. T2 veya T3’de, ayný zamanda VKÝ, serum albümin ve Ardýþýk Organ Yetersizliðinin Deðerlendirilmesi (Sequential Organ Failure Assessment-SOFA) skoru ile ilgili veriler de toplandý.BULGULAR: T3’de, SOFA skoru, VKÝ, albümin ve CRP, A grubuna kýyasla B grubunda anlamlý þekilde daha yüksek oldu (p<0,01). B grubu hastalarýndaki düþük VKÝ (≤20 kg/m2) veya yüksek CRP insidansý (>10 mg/L), T2 veya T3’de A grubu hastalarýna kýyasla anlamlý þekilde daha yüksek oldu (p<0,05). Yedi günden daha uzun süreli mekanik ventilasyonun en güçlü prediktörü CRP oldu ve bunu T3’de VKÝ izledi.
SONUÇ: Hem VKÝ hem CRP, SOFA skoru ile kýyaslanabilir þekilde uzamýþ mekanik ventilasyon riskinin tahmin edilmesinde kullanýlabilmektedir.

BACKGROUND: The predictive ability of body mass index (BMI) or C-reactive protein (CRP) as a simple, inexpensive, and dynamic marker of critical illness in patients requiring mechanical ventilation (MV) is unknown. This study was thus conducted to determine the incidence and presence of a relationship between the predictors of BMI or CRP and duration of MV in trauma patients admitted to the intensive care unit (ICU).
METHODS: This prospective observational study included 72 critically ill trauma patients. Admitted patients were categorized by duration of MV to Group A (≤7 days) and Group B (>7 days). The biological status of patients was assessed by the serial measurement of CRP on admission to the ICU (T1), at 48 and 72 hours after admission, and on the day of beginning (T2) or discontinuation (T3) of MV. Data on BMI, serum albumin, and the Sequential Organ Failure Assessment (SOFA) score were also collected at T2 or T3.
RESULTS: At T3, the SOFA score, BMI, albumin, and CRP were significantly higher in patients in Group B compared with Group A (p<0.01). The incidence of low BMI (≤20 kg/m2) or high CRP (>10 mg/L) in patients in Group B was significantly higher at T2 or T3 compared with Group A (p<0.05). At T3, CRP was determined as the most powerful predictor of >7 days of MV followed by BMI. CONCLUSION: Both BMI and CRP, comparable with the SOFA score, can be used in estimating the risk of prolonged MV.

AMAÇ: Kafa travmalý hastalarýn doðrudan beyin cerrahisi birimlerine kabul edilmesindeki kýsýtlýlýk dünyanýn birçok bölümünde pratikte yaþanan ortak bir durumdur. Bu çalýþma, kafa travmalý hastalarýn beyin cerrahlarýndan görüþ alýnmasýndan önceki ilk nörolojik muayenelerinin ve tedavilerinin yeterli derecede yapýlýp yapýlamadýðýný deðerlendirmek ve ayný zamanda kafa yaralanmasý olan hastalarýn tedavisinde, kýlavuzlarýn sýký bir þekilde kullanýmýnýn etkilerini saptamak için yapýldý. GEREÇ-YÖNTEM: Acil servisteki farklý doktorlarýn, ayný beyin cerrahýna kafa travmalý hastalarý danýþmalarý, ileriye dönük olarak iki farklý altý aylýk dönemde incelendi: Beyin cerrahý olmayan doktorlarýn kafa travmalý hastalardan beyin cerrahisi giriþimleri gerektirenlerin seçimi konusunda eðitim almadýklarý birinci dönem ve eðitim sonrasý ikinci dönem. BULGULAR: Birinci dönem; kafa travmalý hastalarýn ilk nörolojik muayeneleri, tedavileri beyin cerrahý olmayan doktorlar tarafýndan doðru olarak gerçekleþtirilemiyordu. Buna karþýn ikinci dönem, beyin cerrahý olmayan doktorlar en azýndan altý ay sistematik nöroþirürji eðitimi aldýktan sonra beyin cerrahisi giriþimleri gerektiren hastalarý daha doðru olarak seçebiliyorlardý. SONUÇ: Uzmanlýk eðitimi almýþ travma cerrahlarýnýn bulunmadýðý hastanelerde, beyin cerrahlarý acil serviste nöroþirürjikal olgularýn seçimi konusunda beyin cerrahý olmayan doktorlarý eðitmelidirler. Bu eðitimde, kafa yaralanmalarýnýn tedavisi kýlavuzlarýnýn kullanýlmasý çok etkilidir.

BACKGROUND: Restriction of the direct admission of all head-injured patients to the neurosurgical unit remains common practice in many parts of the world. This study was conducted to assess if the initial neurological examination of patients with a head trauma and their management are adequately performed before the referrals and also to determine whether strict use of guidelines for the management of patients with head injuries can be effective. METHODS: The referrals of head-injured patients from different doctors in the emergency department to the same neurosurgeon were assessed prospectively in two separate 6-month periods: the period before training of the non-neurosurgeon physicians on the selection of cases that require a neurosurgical intervention and the period after training. RESULTS: The first part of study showed that initial neurological examination of patients with a head trauma and their management were not performed correctly by the non-neurosurgeon physicians. However, the second study period showed that non-neurosurgeon physicians performed a more accurate selection of patients requiring a neurosurgical intervention after receiving systematic neurosurgical training for at least 6 months. CONCLUSION: In hospitals where there are no specialist trauma surgeons, neurosurgeons should train non-neurosurgeons regarding the accurate selection of neurosurgical cases that need an emergency intervention. In this training, use of guidelines for the management of head injuries is very effective.

AMAÇ: Bu çalýþmada, çocukluk döneminde görülen traktöre baðlý el yaralanmalarý gözden geçirildi. GEREÇ-YÖNTEM: Merkezimize 70 çocuk hasta (53 erkek, 17 kýz; daðýlým 1-11 yaþ) kabul edildi. Hastalar cinsiyet, yaþ, hasarlanmanýn tipi, tedavinin þekli ve fonksiyonel sonuçlar açýsýndan analiz edildi. Tedavinin ilk basamaðý geniþ debridman ve irigasyondu. Kompleks yumuþak doku defekti olan hastalar çok seanslý rekonstrüksiyon giriþimleri ile tedavi edildi. Amputasyon veya kýsmi amputasyonlarda dolaþýmý olmayan parmaklara amputasyon uygulandý.BULGULAR: En sýk karþýlaþýlan hasarlanma tipi, amputasyonlar ve kompleks yumuþak doku defektleri idi. Diðer hasarlanmalar içerisinde, kýrýklar, kýsmi amputasyonlar ve cilt defektleri yer almakta idi. Yirmi olguda cilt defekti kýsmi kalýnlýkta deri grefti ile kapatýldý ve fonksiyonel sonuçlar iyi idi. Kompleks yumuþak doku hasarlanmasý olan 40 olguda cilt defekti flep ile kapatýldý. Fonksiyonel sonuçlar bu olgularýn 30’unda iyi ve 10’unda orta idi. Tam amputasyon olan 50 parmak da hasarlanmadan hemen sonra revaskülarizasyon denendi ancak olgularýn hepsinde baþarýsýzlýkla sonuçlandý. Fonksiyonel sonuçlar olgularýn 40’ýnda iyi, 5’inde orta ve 5’inde kötü idi. Bütün kýrýklar 6 hafta içerisinde iyileþti ve kemik iyileþmesi ile ilgili komplikasyon gözlenmedi. SONUÇ: Bu ciddi el yaralanmalarýnda agresif debridman, kýrýk redüksiyonu ve erken yumuþak doku örtümü temel tedavi yöntemleridir.

BACKGROUND: The purpose of this study was to review tractor-related childhood hand injuries. METHODS: Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits. RESULTS: The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed. CONCLUSION: The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries.

AMAÇ: Akut karýn bulgularý oluþturan, apendiksin müsinöz kistadenomlarý araþtýrýldý.
GEREÇ-YÖNTEM: Histopatolojik olarak apendiksin müsinöz kistadenomu tanýsý alan 11 hasta geriye dönük olarak deðerlendirildi. Hastalarýn, dosya taramalarýndan elde edilen, demografik veriler, klinik özellikler, ultrasonografi (USG), kolonoskopi ve bilgisayarlý tomografi (BT) bulgularý, patoloji raporlarý, ameliyat öncesi, ameliyat ve sonrasý bulgularý incelendi. BULGULAR: Patolojik incelemesi yapýlan apendektomi parçalarýnda müsinöz kistadenom görülme sýklýðý %0,95 olarak saptandý. Toplam 11 olgunun beþi kadýndý. Ortalama yaþ 70 (50-85) idi. Olgularda en sýk görülen klinik bulgu ise karýn aðrýsýydý (%81,8). Karýn USG’si yapýlan sekiz olguda kistik kitle ve kist duvar kalsifikasyonlarý izlendi. BT incelemelerinde sekiz olguda düzgün kenarlý kistik kitle ve kist duvar kalsifikasyonu izlendi. Kolonoskopik inceleme yapýlan bir olguda ise kolonda kitle izlendi. Diðer bir olguda ise eþlik eden kolon kanseri saptandý. Olgularýn dokuzuna apandektomi, ikisine sað hemikolektomi ameliyatlarý yapýldý. SONUÇ: Kolonoskopi, USG ve BT mukosel tanýsý ve yandaþ kanser olgularýnýn araþtýrýlmasýnda faydalý yöntemler olmasýna raðmen kesin taný, ameliyat bulgularý ve ameliyat sonrasý yapýlan patolojik incelemelerle belirlenir. Apendiksin müsinöz kistadenomlarýnýn tedavisi apandektomidir, ancak ameliyat esnasýnda mukosel içeriðinin batýn içine dökülmemesine özen gösterilmelidir.

BACKGROUND: We aimed to assess the acute abdominal conditions due to appendiceal mucinous cystadenomas. METHODS: We retrospectively evaluated 11 patients with histopathologically confirmed appendiceal mucinous cystadenoma. Patient charts and data on patient demographics; clinical features; ultrasonography (US), colonoscopy and computed tomography (CT) findings; pathology reports; and operative and postoperative management were reviewed. RESULTS: The incidence of appendiceal mucinous cystadenoma was 0.95% of all appendectomy specimens reviewed. In our review, there were 11 patients, five of whom were women. The median age was 70 years (50-85 years), and the most common presentation was abdominal pain (81.8%). On US in eight patients, findings were abdominal cystic mass and cyst wall calcification. The CT finding was well-encapsulated cystic mass in eight patients. In one case, a colonic mass was found in colonoscopic examinations. There was one patient with concomitant colon cancer. Appendectomy was performed in nine patients and right hemicolectomy was performed in two patients. CONCLUSION: Colonoscopy, US, and CT are useful tools in diagnosing mucocele and synchronous cancer. However, diagnosis is usually made intraoperatively or postoperatively on histopathological examination. Appendectomy is the standard of care for mucinous cystadenoma. Furthermore, it is important to prevent spillage of the mucocele content.

AMAÇ: Bu çalýþmada, çoklu travmalý olgularda mortalitenin öngörülmesinde hem Yaralanma Þiddeti Ölçeði (ISS) ile Yeni Yaralanma Þiddeti Ölçeði (NISS) etkinliði karþýlaþtýrýldý, hem de “Travma ve Yaralanma Þiddeti Ölçeði’nde (TRISS) ISS’nin yerini NISS alabilir mi?” sorusuna cevaplar arandý. GEREÇ-YÖNTEM: En az iki organ sistemi yaralanmasý olan 16 yaþ üstü 550 travma olgusunun Revize Edilmiþ Travma Skoru (RTS), ISS ve NISS’leri saptandý. Bu olgularýn TRISS’leri önce önerilen yönteme göre; ISS, RTS, yaþ parametreleriyle (TRISS 1) sonra NISS, RTS ve yaþ parametreleriyle (TRISS 2) hesaplandý. Her skorun cut-off deðerleri ROC analizi ile belirlendi. Belirlenen cut-off deðerlerine göre sýnýflanan travma skorlarý, diðer olasý risk faktörleriyle birlikte lojistik regresyon analizine konuldu ve mortaliteyi etkilemedeki risk düzeyi araþtýrýldý.
BULGULAR: ISS, NISS, TRISS 1 ve TRISS 2’için ideal cut-off deðerleri sýrasýyla 21.0 (AUC: 0,907), 25.0 (AUC: 0,914), 90 (AUC: 0,934), 86 (AUC: 0,935) olarak hesaplandý. Mortalitenin öngörülmesinde ISS ile NISS ve TRISS 1 ile TRISS 2 arasýnda istatistiksel olarak anlamlý bir farklýlýk saptanmadý. SONUÇ: Sonuç olarak, mortaliteyi öngörmede ISS ile NISS arasýnda anlamlý bir fark yoktur. TRISS modelinde ISS yerine NISS kullanýlmasý anlamlý bir farklýlýða yol açmamaktadýr ve bu nedenle önerilebilir.

BACKGROUND: This study was performed to compare the efficacies of Injury Severity Score (ISS) and New Injury Severity Score (NISS), and to investigate whether replacing ISS with NISS in Trauma and Injury Severity Score (TRISS) changes the predictive power for mortality. METHODS: We retrospectively analyzed 550 patients aged over 16 years seen in our center over a period of four years who had injuries in at least two organ systems. The ISS, NISS and TRISS were calculated for each patient. TRISS was calculated in two ways: TRISS 1 with age, Revised Trauma Score (RTS) and ISS, and TRISS 2 with age, RTS and NISS. The cut-off values for TRISS 1, TRISS 2, ISS and NISS were determined by ROC analysis. RESULTS: The ideal cut-off values for the prediction of mortality were 21.0 (AUC: 0.907) for ISS and 25.0 (AUC: 0.914) for NISS. There was no statistically significant difference between the ROC curves of ISS and NISS. The ideal cut-off values for predicting mortality were 90 (AUC: 0.934) for TRISS 1 and 86 (AUC: 0.935) for TRISS 2. There was no statistically significant difference between the ROC curves of TRISS 1 and TRISS 2. CONCLUSION: Use of NISS instead of ISS in the TRISS model demonstrated no significant difference, and it can thus be recommended for use.

AMAÇ: Travma nedeniyle acil servise baþvuran 65 yaþ ve üstü bireylerin travma nedenleri, travma sonucu ortaya çýkan bulgular, yandaþ hastalýklarýnýn ve ilaç kullanýmýnýn travma etyolojisi üzerine olan etkisi araþtýrýldý. GEREÇ-YÖNTEM: Bu çalýþma Yeditepe Üniversitesi Hastanesi acil servisinde Ocak 2005 ile Þubat 2006 tarihleri arasýnda gerçekleþtirildi. Çalýþmaya, travma nedeniyle acil servise getirilen 65 yaþ ve üstü 91 olgu (48 erkek [%52,7], 43 kadýn [%47,3]; ortalama yaþ 73±5,42; daðýlým 65-92) dahil edildi. Olgularýn yaþlarý, cinsiyetleri, baþvuru nedenleri, yaralanma tipleri, yandaþ hastalýklarý, ilaç kullanýmlarý ve Yaralanma Þiddeti Ölçeði incelendi. BULGULAR: Hastalarýn 57’si (%62,6) düþük enerjili düþme, 13’ü (%14,3) yüksek enerjili düþme, 6’sý (%6,6) düþük enerjili araç kazasý ve 14’ü (%15,4) yüksek enerjili araç kazasý nedeniyle baþvurdu. Düþme nedeniyle baþvuran hastalarda, hipertansiyon, düþme dýþý nedenlere göre anlamlý olarak daha sýk rastlandý (p=0,003). Düþük enerjili düþmelerde femur kýrýðý daha sýk gözlendi (p=0,026). Yüksek enerjili düþmelerle vertebra kýrýðý arasýnda anlamlý bir iliþki saptandý (p=0,037). Düþük enerjili motorlu araç kazalarýnda yumuþak doku travmasý anlamlý olarak daha yüksek idi (p=0,01). Yüksek enerjili motorlu araç kazalarý ile kot kýrýðý arasýnda anlamlý olarak iliþki vardý (p<0,001). SONUÇ: Akut ya da kronik hastalýklar ve ilaçlarýn etkileri yaþlý bireylerin yaralanma riskini arttýrmaktadýr. Bu nedenlerden dolayý tüm yaþlý travma hastalarý deðerlendirilirken ilaç kullanýmý, yandaþ hastalýk öyküsü dikkatle sorgulanmalý ve travmaya neden olan faktörler de göz önünde bulundurulmalýdýr.

BACKGROUND: The objective of this study was to evaluate the causes and demographics of trauma patients 65 years of age and older, and also the effects of co-morbidities and drug use on trauma. METHODS: This study was performed in Medicine Faculty of Yeditepe University Hospital Department of Emergency Medicine Outpatients Clinic between January 2005 - February 2006. Ninety-one trauma patients (48 males [52.7%], 43 females [47.3%]; mean age 73±5.42; range 65 to 92 years) 65 years of age and older were included into the study. Age, gender, trauma causes, injury types, co-morbidities, drug consumption and injury severity scores were recorded onto the study form.
RESULTS: Fifty-seven (62.6%) patients were admitted to the emergency department because of low-energy fall, 13 patients (14.3%) for high-energy falls, 6 patients (6.6%) for low-energy motor vehicle crush, and 14 patients (15.4%) for high-energy motor vehicle crush. Hypertension was significantly more frequent in falls than the other trauma mechanisms (p=0.003). There was a higher rate of femur fracture in low-energy falls than the others (p=0.026). However, the rate of vertebral fracture was higher in high-energy falls (p=0.037). Soft tissue injuries were seen most often in low-energy motor vehicle crush injuries (p=0.01) while rib fractures were seen most frequently in high-energy motor vehicle crush injury (p<0.01). CONCLUSION: Acute or chronic disease and drug side effects may facilitate the exposure of elderly people to trauma. Drug consumption, co-morbid diseases and trauma causes should be taken into consideration during the evaluation of elderly trauma patients.

AMAÇ: V. Ulusal Travma ve Acil Cerrahi Kongresi’nde sunulan bildiri özetlerinin öz yazým kýlavuzuna uygunluðu deðerlendirildi; demografi, metodoloji ve yazým tekniði yönünden incelendi. GEREÇ-YÖNTEM: Kongre kitapçýðýndaki 451 bildiri deðerlendirmeye alýndý. Deðerlendirilen parametreler; çalýþmanýn türü ve içeriði, çalýþmanýn yapýldýðý kurumlar, yazar sayýsý, baþlýk kullanýmýnýn uyumluluðu, yapýsal öz kullanýmý, sözcük sayýsý, dilin akýcýlýðý, uygun istatistiksel deðerlendirme ve sonuç-öz iliþkisiydi. BULGULAR: Çalýþmalarýn %49’u retrospektif, %29’u olgu sunumuydu. Bildirilerin %33’ü izole organ yaralanmasý, %26’sý tek sistem yaralanmasý, %24’ü çoklu sistem yaralanmasýna iliþkindi. Çalýþmalarýn %43’ü üniversite, %38’i devlet hastanesi kökenliydi. Çalýþmalarýn %40’ý genel cerrahiyle ilgiliydi, %29’u ise multidisiplinerdi. Çalýþmalardaki ortalama yazar sayýsý 5,6±1,8 idi; üniversite ve devlet hastaneleri arasýnda istatistiksel olarak anlamlý farklýlýk saptandý (p=0,001). Bildirilerin %91’inde yapýsal öz vardý, %57’si 100-250, %42’si ise 250-500 sözcük içermekteydi. Çalýþmalarýn %73’ü akýcý olarak deðerlendirildi. Tüm bildirilerin %19’unda istatistiksel yöntem uygulandýðý belirlendi. Bildirilerin çoðu akýcý idi. Ýstatistiksel analiz uygulama yönünden üniversite ve devlet hastaneleri arasýnda anlamlý fark saptandý (p=0,001). Sonuç-öz iliþkisi bildirilerin %71’inde yeterli olarak deðerlendirildi. SONUÇ: Bildiri özeti yazma konusunda bazý sorunlarýmýzýn olduðu saptanmýþtýr. Yapýsal öz kullanýmý, akýcýlýk ve yazým kurallarýna uyumu artýrmaktadýr. Özellikle çoklu yaralanlamalarý irdeleyen klinik çalýþmalar ve deneysel çalýþmalar özendirilmeli, bu yönde araþtýrmalar teþvik edilmelidir.

BACKGROUND: The aim of this study was to evaluate demographics, methodological data and writing style of abstracts presented at the 5th Congress of National Trauma and Emergency Surgery. METHODS: Study design, institutions and number of authors, appropriateness of the title, use of a structured abstract, word count, fluency, accuracy of the statistical evaluation, and conclusion-abstract accordance were assessed in 451 abstracts. RESULTS: Nearly 49% of abstracts were retrospective and 29% were case reports in design. 33%, 26%, and 24% of abstracts were related to isolated organ, single system and multi-system injuries, respectively. Approximately two-fifths of presentations were university-based. Approximately one-third of presentations were multidisciplinary in origin. The mean number of authors was 5.6±1.8, and a statistical significance was found between abstract contributions from university versus other hospitals (p=0.001). Three-fourths of the abstracts had an appropriate title and 91% were structured. Word count was 100-250 in 57% and 250-500 in 42% of abstracts. Statistical analysis was used in only 19% of abstracts. Most of the abstracts were fluent. Conclusion-abstract accordance was present in 71% of the abstracts. CONCLUSION: Our results indicate there are some deficiencies in the abstract writing process. The use of a structured abstract may intensify fluency and compliance to abstract writing guidelines. Clinical studies regarding multi-traumatized patient groups and experimental studies should be encouraged.

Apandikolitiyazis, apandis içerisinde taþlaþma meydana gelmesi þeklinde tanýmlanan bir durumdur. Apandis taþlarý, akut apandisitli hastalarda %10 oranýnda bulunur, fakat daha sýklýkla perfore apandisitte ve apse oluþumunda görülür. Biz burada genitoüriner sistemin akut hastalýklarýný taklit eden ve tanýsal karýþýklýða neden olan apandikolitiyazise baðlý bir akut apandisit olgusu sunuyoruz. Otuz sekiz yaþýndaki bir erkek hasta þiddetli, ani baþlangýçlý, tekrarlayan, sað kasýk bölgesine doðru yayýlan, bulantýnýn eþlik ettiði kramp tarzý karýn sað alt kadran aðrýsý ile acil servise baþvurdu. Fiziksel incelemede karýn sað alt kadranda defans muskuler ve ribaund hassasiyeti, sað üreter trasesinde hassasiyet ve sað kostovertebral açý hassasiyeti saptandý. Direkt grafide, sað böbrek taþý ve karýn sað alt kadranda 3 cm çapýnda insidental opasite olduðu görüldü. Hastaya apandektomi yapýldý. Taný operasyonla ve apandikolitiyazisi gösteren apandektomi materyalinin direkt grafisiyle konuldu. Akut apandisit, çeþitli genitoüriner hastalýklar þeklinde ortaya çýkabilir. Akut apandisitle birlikte veya birlikte olmadan bir apandis taþý olasýlýðý, akut alt karýn ve pelvik hastalýklarýn ayýrýcý tanýsýnda ve sýk görülen akut ürolojik hastalýklardan dolayý her zaman düþünülmelidir.

Appendicolithiasis is a condition characterized by a concretion in the vermiform appendix. Appendicoliths are found in 10% of patients with acute appendicitis, but they are seen more frequently in perforated appendicitis and in abscess formation. We herein report a case of acute appendicitis due to appendicolithiasis, which mimics acute disorders of the genitourinary tract and causes diagnostic confusion. A 38-year-old man presented to our emergency department with a history of intense, acute, recurrent, crampy right lower quadrant pain radiating to the right groin region, accompanied by nausea. Physical examination revealed muscular defense and rebound tenderness in the right lower quadrant, tenderness in the line of the right ureter and right costovertebral angle tenderness. On X-ray examination, a right kidney stone was identified as was an incidental 3-cm density in the right lower quadrant. The patient underwent appendectomy. The diagnosis was made by operation and also X-ray examination of the appendectomy material showing appendicolithiasis. Acute appendicitis may manifest as a variety of genitourinary disorders. The possibility of an appendicolith with or without acute appendicitis must always be considered in the differential diagnosis of acute lower abdominal and pelvic disorders, and in the consideration of common acute urological disorders.

Nadir görülen bir ev içi yaralanma olan perioral elektrik yanýklarý estetik ve fonksiyonel açýdan deformiteye yol açmaktadýrlar. Bu yüzden bölgenin rekonstrüksiyonu da özellik arz etmektedir. Perioral elektrik yanýklarý genelde üç yaþ altý çocuklarda elektrik kablosunun ýsýrýlmasý ile meydana gelir. Acil servise getirilen 11 aylýk kýz çocuðunda; prize takýlý televizyonun elektrik kablosunu ýsýrma sonucu perioral elektrik yanýðý saptandý. Dudaðýn %60’ýný kapsayan, altta mentuma uzanan, sol kommissürü içine alan, üst dudaðýn sol yarýsýnýn ýslak mukozasýna uzanan ve dilin distalini ve aðýz tabanýný kapsayan yanýk alan mevcut idi. Yanýðýn meydana gelmesini takiben sekizinci günde çevre saðlam doku ile yanýklý doku tamamen birbirinden ayrýldý ve alt labial arterden kanama meydana geldi. Alt dudak defektini kapatmak için defekt lateralinden, inferior pediküllü, nazolabial flep kullanýldý. Flebin mukoza tabakasý diseke edilip, ilerletilerek alt dudak vermillonu oluþturuldu. Bu olgu ile birlikte perioral elektrik yanýklarýnda tedavi prensipleri ve seçenekleri sunuldu.

Perioral electrical burns are rarely seen household injuries that cause both functional and aesthetic deformities requiring special consideration for reconstruction. The cause is usually a child younger than 3 years old biting an electrical cord. An eleven-month-old girl admitted to the emergency room with perioral electrical burn after biting an electrical cable of a television. Her burn area included 60% of the lower lip, down to the mentum, and including left commissure, distal part of the tongue and the floor of the mouth. On the 8th day following the burn, the burned necrotic tissues separated from the healthy living tissues and a bleeding from the labial artery was observed. To reconstruct the lip defect, an inferior-based nasolabial flap from the lateral side was used. The mucosa of the flap was dissected and advanced to form the lower lip vermillion. With this case presentation, the principles and options for perioral electrical burns are presented.

Cerrahi pratikte apendektomi ameliyatý en sýk yapýlan iþlemlerden birisidir. Güdük apandisiti inkomplet apendektomi sonrasý rezidüel olarak kalan apandiksin enflamasyonu sonrasý ender görülen komplikasyondur. Klinik olarak akut karýn tablosuna yol açmaktadýr. Bu yazýda, apendektomi ameliyatýndan 12 yýl sonra güdük apandisiti olan olgu sunuldu. Akut apandisit tanýsý konulan olgu ameliyat edildi, ameliyat sonrasý dördüncü gün sorunsuz olarak taburcu edildi. Güdük apandisit akut karýnýn nadir görülen bir nedenidir ve ayýrýcý tanýda dikkate alýnmalýdýr.

Appendectomy is one of the most common procedures in surgical practice. Stump appendicitis is an acute inflammation of the residual part of the appendix and a rare complication of incomplete appendectomy. It may present clinically as acute abdomen. We report a case of stump appendicitis 12 years after open appendectomy. After the diagnosis of acute appendicitis, the patient was operated and discharged from the hospital four days after operation without any complications. Stump appendicitis is a rare cause of acute abdomen and should be taken into consideration in the differential diagnosis.

Ýlerleyen nöroradyolojik yöntemler sayesinde travmatik karotis diseksiyonlarýnýn sanýldýðý kadar seyrek olmadýðý anlaþýlmýþtýr. Asemptomatik olduðu için tanýsý konulamayan bazý olgularda geç dönemde nörolojik defisit geliþebildiðinden þüpheli hasta grubunda karotis diseksiyonunun akla gelmesi ve uygun þekilde araþtýrýlmasý gereklidir. Bu yazýda, geçirdiði trafik kazasý sonrasýnda karotis interna arter diseksiyonu ve buna baðlý serebral enfarkt geliþen bir hasta sunuldu. Hastalýðýn patogenezi, klinik özellikleri ve uygulanan taný ve tedavi yöntemlerinin seçimi literatür bilgisi ýþýðýnda tartýþýldý, sýk rastlanmayan ancak akýlda tutulmasý gereken bu durum hakkýnda güncel bilginin aktarýlmasý amaçlandý.

With the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.