Çoklu travma hastalarýndaki volüm replasmanýnda kullanýlma endikasyonu bulunan deðiþik sývýlarý, endikasyonlarýný, etki mekanizmalarýný ve yan etkilerini aydýnlatmak suretiyle karþýlaþtýrdýk. 1997 ve 2008 yýllarý arasýndaki yayýnlar (dizin dergileri) kapsamlý olarak incelendi. Travma hastalarýnda hangi sývýlarýn kullanýlmasý gerektiði konusunda halen bir fikir birliði bulunmamaktadýr. Mevcut sistematik gözden geçirmeler, kolloid sývýlarýn kristaloid sývýlara karþý herhangi bir üstünlüðünü ortaya koymamýþtýr. Kristaloidler, hipovolemiye baðlý olarak interstisiyel ve intraselüler alanlardan intravasküler alana sývý geçiþi ile kolaylaþan fizyolojik internal dilüsyonu artýrýrlar. Resüsitasyonda kullanýlan en yeni hipertonik solüsyonlar, kan hacmini geniþletmekte ve kan basýncýný yükseltmekte büyük bir kaliteye sahiptirler. Dekstran solüsyonunun hiperonkotik etkisi, intravasküler volümde, uygulanan hacimden daha fazla bir baþlangýç geniþlemesi oluþturur. Kristaloidlere kýyasla önemsiz volüm geniþletme yetenekleri ve potansiyel anafilaktik reaksiyon riskleri nedeniyle, jelatinler, geliþmiþ ülkelerde artýk kullanýlmamaktadýrlar. Bazý uzmanlar daha hýzlý intravasküler volüm restorasyonu oluþturabilen koloidleri kullanmayý tercih etse bile, travmada kristaloidler daha fazla kullanýlmaktadýr. Bu arada, volüm açýðýnýn restorasyonu ile ilgili olarak kristaloidlere göre açýk bir koloid üstünlüðünü gösteren inandýrýcý hiçbir kanýt bulunmamaktadýr.

We aimed to compare different fluids indicated in volume replacement in multiple trauma patients, enlightening the indications, mechanisms of action and side effects. An extensive review of references (indexed journals) between 1997 and 2008 was performed. There is not yet a consensus about which fluids should be used in trauma patients. The systematic reviews available did not show a benefit of colloid solutions over crystalloid fluids. Crystalloids intensify physiological internal dilution, furthered by water migration from interstitial and intracellular spaces into intravascular space due to hypovolemia. The most recent hypertonic solutions used in resuscitation have a large role in expanding blood volume and making blood pressure rise. The hyperoncotic effect of dextran solution produces an initial expansion of intravascular volume that is bigger than the administered volume. Gelatins are no longer used in developed countries due to their insignificant ability regarding volume expansion when compared to crystalloids and the potential risks of anaphylactic reactions. The crystalloids are used more in trauma, even if some authors prefer the use of colloids, which can produce a quicker restoration of the intravascular volume. No convincing evidence shows a clear superiority of colloids over crystalloids for restoration of the volume depletion.

AMAÇ
Az sayýdaki çalýþmada, siklosporin-A (CsA) içeren immünsüpresif tedavi alan hastalarda kas ve/veya tendon patolojileri görüldüðü bildirilmiþtir. Çalýþmamýzda, (i) CsA ile düþük doz ve uzun süreli tedavinin ardýndan mikroskobik düzeyde çizgili kas dokusu ve tendonlarda deðiþiklik olup olmadýðý ve (ii) tedaviye CsA’nýn çözücüsü Cremophor-EL ya da steroid eklenmesinin ek bir deðiþiklik oluþturup oluþturmadýðý araþtýrýldý.
GEREÇ VE YÖNTEM
230-300 gr aðýrlýðýnda, diþi ve eriþkin 24 adet Sprague-Dawley cinsi sýçan, rastgele dört gruba ayrýldý. Grup 1 kontrol olarak ayrýlýrken, diðer üç gruba 2,5 ay süre ile CsA (4 mg/kg/gün) periton içine verildi. Grup 2’ye CsA’nýn oral formu, Grup 3’e CsA’nýn Cremophor-EL içeren intravenöz (ÝV) formu verildi. Grup 4’e ise CsA’nýn ÝV formu ile birlikte prednizolon (1 mg/kg/gün) uygulandý. Aþil tendonlarý ve triseps kaslarýndan hazýrlanan doku örnekleri ýþýk mikroskobunda incelendi.
BULGULAR
Tüm deney gruplarýnda kaslarda lokal dejenerasyon, bað dokusu artýþý, mononükleer hücre sayýsýnda artýþ gözlendi. Tendonlarda herhangi bir deðiþiklik yoktu.
SONUÇ
Çalýþma, uzun süreli ve düþük dozda CsA kullanýmý sonucu kas dokusunda morfolojik deðiþiklikler olmuþtur. Tendonlarda herhangi bir deðiþiklik gözlenmemiþtir. Cremophor-EL veya steroidlere baðlý olabilecek ek bir deðiþiklik belirlenememiþtir. CsA nedeni ile oluþmuþ bu deðiþikliklere, travma ya da cerrahi giriþim sonrasý kaslarda oluþabilecek hasarýn eklenmesi ile çok daha dramatik bir tablo oluþabileceði göz ardý edilmemelidir. Bu sonucu destekleyen birkaç olgu sunumu vardýr.

BACKGROUND
Limited studies report that patients receiving immunosuppressive therapy, including cyclosporin A (CsA), face muscle and/or tendon pathologies. The current study aimed (i) to investigate if CsA cause changes in the microscopic structure of striated muscle tissues and tendons after long–term low-dose therapy and (ii) to examine if the vehicle of CsA, Cremophor EL, or steroid administration might cause additional effects.
METHODS
Twenty-four adult female Sprague-Dawley rats weighing 230-300 g were divided at random into four groups. Group 1 served as the control. Groups 2-4 received CsA intraperitoneally for 2.5 months: Group 2 received the oral form of CsA, Group 3 received the intravenous form of CsA, which contains Cremophor EL, and Group 4 received the intravenous form of CsA and prednisolone. Samples from the Achilles tendons and triceps surae muscles were examined at light microscope level.
RESULTS
Focal necrotic areas, enlargement of connective tissue and increase in mononuclear cells were clear on muscles in the experimental groups. No morphologic effects were observed on tendons.
CONCLUSION
Long-term low-dose CsA therapy causes focal microscopic changes in muscles but not in tendons. No additional effects were demonstrated with Cremophor EL or steroids. It should be noted that muscle tissue damage after trauma or surgeries in patients receiving CsA might be more dramatic due to the pathologic changes already caused by CsA, as supported by several case reports.

AMAÇ
Homolog kan transfüzyonunun immünmodülatuvar etkilerinin cerrahi hastalarda kanser nüksü ve enfeksiyon geliþimi üzerine olumsuz etkileri olabileceði yönünde bulgular vardýr. Bu olumsuz etkileri ortadan kaldýrmaya yönelik bir yaklaþým otolog kan transfüzyonudur. Bununla birlikte, otolog transfüzyonun bu açýdan yararý netlik kazanmamýþtýr. Bu çalýþmada, sýçanda karýn içi enfeksiyon modelinde otolog ve homolog kan transfüzyonunun TNF-alfa düzeyleri ve saðkalým üzerine etkileri araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada toplam 92 adet Spreague-Dawley cinsi sýçan kullanýldý. 44 sýçanda kan transfüzyonunu takip eden 7. günde çekal ligasyon delme yöntemi ile karýn içi enfeksiyon oluþturuldu, ardýndan 90. dakika ve 6. saatte kan örnekleri alýnarak ELISA yöntemi ile TNF-alfa düzeylerine bakýldý. 48 sýçanda ise (Saðkalýmýn deðerlendirilmesi için kullanýlan sýçanlar homolog ve otolog gruplarda 12’þer sýçandan oluþtu.) transfüzyon ve çekal ligasyon delme iþlemini takiben bir hafta süreyle saðkalým gözlendi.
BULGULAR
Çalýþma sonucunda otolog transfüzyon grubuna göre, homolog kan transfüzyonu grubunda TNF-alfa yanýtýnda belirgin bir baskýlanma olduðu görüldü, fakat gruplar arasýnda saðkalým açýsýndan bir fark bulunamadý.
SONUÇ
Bu bulgulara dayanarak, otolog kan transfüzyonunun transfüzyona baðlý immünmodülasyonu azaltacak bir seçenek olduðu, fakat karýn içi enfeksiyonda mortaliteyi azaltmadýðý sonucuna varýlmýþtýr.

BACKGROUND
Autologous blood transfusion is one of the approaches used for prevention of the undesirable immunomodulatory effects of homologous blood transfusion that can cause an increase in cancer recurrence and surgical site infections. On the other hand, the benefits of autologous blood transfusion in that respect are not yet clearly identified. In this experimental study, we investigated the differences in effects of autologous and homologous blood transfusion on tumor necrosis factor (TNF)-alpha levels and survival in an intraabdominal infection model in rats.
METHODS
A total of 92 Sprague-Dawley rats were used in the study. Forty-four of those rats were divided into autologous and homologous transfusion groups, and intraabdominal infection was instituted by cecal ligation puncture method on the 7th day after blood transfusion. Blood samples were taken at the 90th minute and at 6-hour intervals after cecal ligation puncture and were used for measurement of TNF-alpha levels by ELISA method. In the remaining 48 rats, survival was investigated within the first week of cecal ligation puncture.
RESULTS
Our results revealed significantly depressed TNF-alpha levels in the homologous blood transfusion group, but with respect to survival, no difference was detected between the groups.
CONCLUSION
Based on these findings, we concluded that autologous blood transfusion decreases transfusion-related immunomodulation but does not cause a decrease in mortality due to intraabdominal infection.

AMAÇ
Gram-pozitif veya gram-negatif peritoniti bulunan hastalarýn peritoneal sývýlarýnda hem endotoksin hem de interlökin-6 (IL-6) konsantrasyonlarýnýn yüksekliði, bu hastalarýn periferik kanlarýndaki endotoksin ve IL-6 konsantrasyonlarýnýn yüksekliðinin bin katýdýr. Bir bakteriyel (gram-pozitif) peritonit modelinde, peritonun endotoksin ve IL-6’ya yönelik rezorpsiyon kapasitesi deðerlendirildi.
GEREÇ VE YÖNTEM
Wistar cinsi 93 adet erkek sýçana, fosfat tamponlu serum fizyolojik (FTS) içinde önceden müsin ile iþleme tabi tutulan stafilokoklar veya tek baþýna FTS intraperitoneal (ÝP) enjeksiyon þeklinde uygulandý. Rezorpsiyon çalýþmalarý, 4., 8., 12. ve 24. saatte gerçekleþtirildi. Sýçanlarýn 44’üne endotoksin, kalan 49’una da IL-6 ÝP yolla enjekte edildi. 0., 5., 10., 15., 30. ve 60. dk’dan sonra kan örnekleri alýndý. Endotoksin ve IL-6, sýrasýyla LAL testi ve ELISA tekniði kullanýlarak ölçüldü.
BULGULAR
Kontrol grubunun kanlarýnda endotoksin veya IL-6 saptanmadý. Peritonit grubunda, plazma endotoksin ve IL-6 seviyeleri anlamlý þekilde yüksek bulundu. ÝP endotoksin enjeksiyonundan sonra plazma endotoksin seviyelerinde ilave bir artýþ gerçekleþmedi. ÝP IL-6 enjeksiyonunu takiben, peritonitin 4. saatinde periferik kandan gerçekleþtirilen IL-6 örneklenmesi ile ilgili olarak zamanla bir artýþ oluþtu.
SONUÇ
Bu akut gram-pozitif peritonit modelinde, endotoksin ve IL-6 ile ilgili peritoneal rezorpsiyonda belirgin bir azalma oluþmuþtur.

BACKGROUND
Elevations in both endotoxin and interleukin-6 (IL-6) concentrations in peritoneal exudates are a thousand times higher than their respective concentrations in the peripheral blood in patients with gram-positive or gram-negative peritonitis. We aimed in this study to evaluate the resorption capacity of the peritoneum for endotoxin and IL-6 in a model of bacterial (gram-positive) peritonitis.
METHODS
Intraperitoneal (i.p.) injection of mucin-pretreated staphylococci in phosphate buffered saline (PBS) or of PBS alone was performed in 93 male Wistar rats. Studies of resorption were undertaken at time points of 4 hours (h), 8h, 12h and 24h. Endotoxin was intraperitoneally injected in 44 rats and IL-6 in 49 rats. After 0, 5, 10, 15, 30 and 60 minutes (min), blood was sampled. Endotoxin and IL-6 were measured using the limulus-amoebocyte-lysate (LAL) test and ELISA technique, respectively.
RESULTS
No endotoxin or IL-6 was measured in the blood of controls. Plasma endotoxin and IL-6 levels were significantly high in the peritonitis groups. There was no further increase in endotoxin plasma levels after i.p. injection of endotoxin. Following i.p. injection of IL-6, there was an increase in IL-6 level over the time of sampling in the peripheral blood at 4h of peritonitis.
CONCLUSION
There was a clear reduction in peritoneal resorption of endotoxin and IL-6 in this acute model of gram-positive peritonitis.

AMAÇ
Bu çalýþmada, metilen mavisinin travmatik tavþan karaciðerinin vital ve devaskülarize alanlarýnýn ayýrýmý konusundaki etkisi araþtýrýldý.
GEREÇ VE YÖNTEM
Yirmi adet saðlýklý tavþan rastgele iki eþit gruba ayrýldý. Cerrahi iþlem, karýn üst bölgede orta hattan gerçekleþtirilen 5 cm uzunluðunda bir insizyonla uygulandý. Karaciðer hasarý oluþturulduktan sonra, portal ven yoluyla dilüe edilmiþ metilen mavisi enjekte edildi ve boyanmaya baþlanma zamanlarý ile boyanýn kaybolduðu zamanlar kaydedildi.
BULGULAR
Yirmi tavþanýn hepsi de deney bitimine kadar yaþadý. Deneklerde karaciðerin perfüze olmayan alanlarý boyanmadý. Kontrol tavþanlarýnda, karaciðer parankimi homojen olarak boyandý. Normal parankimdeki ortalama boyanmaya baþlama zamaný, deneklerde 18,1±1,3 sn olurken kontrollerde de 17,7±1,4 sn oldu (p=AD). Ortalama diskolorasyon zamaný, deneklerde 53,1±3,7 sn ve kontrollerde de 53,1±3,2 sn oldu (p=AD).
SONUÇ
Cerrahi giriþim gerektiren majör karaciðer yaralanmalarýnda, karaciðerin perfüze olmayan alanlarýnýn saptanmasý için metilen mavisi enjeksiyonu kullanýlabilir.

BACKGROUND
In this study, the efficacy of methylene blue in the differentiation of devascularized and vital areas in a traumatic liver model in rabbits was investigated.
METHODS
Twenty healthy rabbits were selected and randomly divided into two equal groups. Surgery was performed through an upper abdominal mid-line incision 5 cm in length. After induction of liver injury, diluted methylene blue was injected through the portal vein and staining onset and discoloration times were recorded.
RESULTS
All 20 rabbits survived until the end of the experiment. In cases, non-perfused areas of the liver remained unstained. In control rabbits, liver parenchyma was stained homogeneously. The mean onset time of staining in normal parenchyma was 18.1±1.3 sec in cases and 17.7±1.4 sec in controls (p=NS). The mean discoloration time was 53.1±3.7 sec in cases and 53.1±3.2 sec in controls (p=NS).
CONCLUSION
In major liver injuries requiring surgical intervention, methylene blue injection can be used for detection of non-perfused areas in the liver.

AMAÇ
Bu çalýþmanýn amacý, anorektal bölgeyi içine alan Fournier gangreni olgularýnda koruyucu kolostominin gerekliliðini deðerlendirmektir.
GEREÇ VE YÖNTEM
Perianal bölgeyi içine alan 37 Fournier gangreni olgusunun týbbi kayýtlarý geriye dönük olarak deðerlendirildi. On sekiz hastaya sadece debridman uygulanýrken (Grup D), 19 hastaya debridmanýn yanýsýra Hartmann kolostomisi de uygulandý (Grup D ve HC).
BULGULAR
Gruplara arasýnda yaþ (p=0,73), cinsiyet (p=1,00), diabetes mellitus varlýðý (p=0,88), eþlik eden hastalýklar (p=0,57) ve uygulanan debridman sayýsý (p=0,75) yönünden istatistik olarak anlamlý fark saptanmadý. Medikal ve cerrahi komplikasyonlar, mortalite oranlarý, hastanede ve yoðun bakým ünitesinde kalma süreleri arasýnda anlamlý fark saptanmadý (p>0,05). Fekal diversiyon 11 hastada ilk operasyonda yapýlýrken, 6 hastada ikinci, 2 hastada ise üçüncü debridman sýrasýnda uygulandý. Bu hastalarda morbidite ayný iken, mortalite arasýnda istatistiksel olarak anlamlý fark saptandý (p=0,031).
SONUÇ
Fournier gangreni, hala zor bir klinik problemdir. Etkin multidisipliner yaklaþýmlara karþýn mortalite oraný yüksektir. Fekal diversiyon Fournier gangreni tedavisinde hala tartýþmalýdýr. Eðer gerekli ise koruyucu kolostomi ilk debridman sýrasýnda uygulanmalýdýr.

BACKGROUND
The aim of this study was to evaluate the necessity of preventive colostomy for Fournier’s gangrene of the anorectal region.
METHODS
The medical records of 37 patients with perianal Fournier’s gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC).
RESULTS
There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031).
CONCLUSION
Fournier’s gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier’s gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.

AMAÇ
Künt kalýn baðýrsak yaralanmalarý nadirdir ancak, künt travma hastasýnýn tedavisini zorlaþtýrýp sonucu kötüleþtirebilirler. Bu çalýþmada, künt karýn travmasý sonucu oluþan kalýn baðýrsak yaralanmalarý incelendi.
GEREÇ VE YÖNTEM
Altmýþ dört hastanýn (60 erkek, 4 kadýn; ort. yaþ 39,3; daðýlým 16-69) kayýtlarý geriye dönük olarak incelendi. Kayýtlar, klinik prezentasyon, araþtýrmalar, tanýsal yöntemler, eþlik eden yaralanmalar, yaralanma ile ameliyat arasýnda geçen zaman, kalýn baðýrsak yaralanmasýnýn yeri, ameliyatta yapýlan iþlemler, morbidite ve mortalite açýsýndan incelendi.
BULGULAR
Olgularýn 53’üne tek aþamalý ameliyat uygulanýrken (%82,8), 11’inde (%17,2) iki aþamalý ameliyat tercih edildi. Seçilen cerrahi yöntem, fekal bulaþýn ve kalýn baðýrsak yaralanmasýnýn derecesi ile kuvvetli bir þekilde iliþkili bulundu (p<0,01). Kalýn baðýrsak yaralanmasýna baðlý karýn komplikasyonlarýn genel oraný %26,5 (n=17) idi. Kalýn baðýrsak yaralanmasýna baðlý olmayan 6, baðlý olan 1 ölüm oldu. Müracaatta þok olmasý, þiddetli fekal bulaþ, kalýn baðýrsak yaralanmasý skalasý (CIS) ve eþlik eden yaralanmalar, komplikasyon ve ölümlerle iliþkili bulundu.
SONUÇ
Baþvuruda þokta olan, þiddetli fekal bulaþ olan ve yüksek CIS derecesi olan hastalarda iki aþamalý ameliyatýn uygun olduðu çýkarýmýna varýldý.

BACKGROUND
Blunt colonic injuries are rare but can complicate the management of the blunt trauma patient and worsen the outcome. We analyzed in this study the colonic injuries caused by blunt abdominal trauma.
METHODS
The records of 64 patients (60 male, 4 female; mean age 39.3 years; range 16 to 69 years) were investigated retrospectively. The records were reviewed for clinical presentation, investigations, diagnostic methods, associated injuries, time from injury to operation, site of colon injury, operative management, morbidity, and mortality.
RESULTS
One-stage operation was performed in 53 cases (82.8%) and two-stage operation in 11 cases (17.2%). The treatment chosen was strongly related with the degree of fecal contamination and grade of colonic injury (p<0.01). The overall incidence of colonic injury-related abdominal complications was 26.5% (17 cases). There were six non-colon-related and one colon-related mortalities. Shock at presentation, severe fecal contamination, colon injury scale (CIS) grade, and associated injuries were related with complications and mortality.
CONCLUSION
We conclude that in patients with shock at presentation, severe fecal contamination and higher CIS grade, two-staged operation is appropriate.

AMAÇ
Sivil toplumdaki þiddet olaylarýnda ateþli silahlarýn ve bombalarýn sýk kullanýlmasý nedeniyle, penetran kardiyak travma, ciddi travma formunu oluþturmaktadýr. Silahlarla oluþan kardiyak yaralanmalarla ilgili olarak 16 yýllýk deneyimimizi bildiriyoruz.
GEREÇ VE YÖNTEM
Ateþli silahla, kardiyak yaralanmalý 40 olguyu (30 erkek, 10 kadýn) gözden geçiren retrospektif bir çalýþma gerçekleþtirildi. Yaralanmalarýn þekli, tedavisi ve sonuçlar deðerlendirildi.
BULGULAR
Olgular 14 ile 68 yaþ arasýnda idi. Hastalarýn hastaneye ulaþtýrýlmasý için geçen ortalama süre 4,1 saat idi. Hastalarýn %40’ý ateþli silah ile yaralanýrken, %60’ý da kalbe gelen saçma veya þarapnel nedeniyle yaralanmýþtý. Kurþun yaralanmasý bulunan grubun %37,5’i hayatta kalýrken, þarapnel/saçma grubunun %66,6’sý hayatta kaldý. Ýzole kardiyak yaralanmasý bulunan hastalardaki saðkalým %60 iken, diðer yaralanmalar da eþlik edenlerde saðkalým yalnýzca %40 oldu. Kalbin tek odacýðýna yönelik yaralanma hastalarýn %87,5’inde kaydedildi ve bu hastalarda saðkalým %62,8 oldu. Resüsite edilen hastalarda 14 komplikasyon kaydedildi. Bir hasta aþýrý kanamaya yönelik olarak yeniden ameliyata alýndý ve gözden kaçmýþ bir sað ventrikül yaralanmasý onarýldý.
SONUÇ
Ateþli silahla kardiyak yaralanmalarda en iyi sonuçlar hastalar erken ameliyata alýndýðýnda elde edilir ve klinik sonuç, hastaneye baþvuru sýrasýndaki klinik durum, tedaviye kadar geçen zaman, yaralanmanýn þekli ve eþlik eden yaralanmalarý da içeren çok sayýda faktöre baðlýdýr.

BACKGROUND
Penetrating cardiac trauma represents an increasingly important form of trauma due to the frequent use of firearms and bombs in civilian violence. We report our experience over the past 16 years with missile-induced cardiac injuries.
METHODS
A retrospective study reviewing 40 cases (30 males, 10 females) of missile cardiac injuries was conducted. The nature of injuries, management and outcomes were analyzed.
RESULTS
The ages ranged from 14-68 years. The mean time in which patients reached the hospital was 4.1 hours. Forty percent of the patients had firearm injuries and the remaining 60% had pellet or splinter injuries to the heart. Survival was noted in 37.5% in the gunshot group and in 66.6% in the splinter/pellet group. The survival in patients with isolated cardiac injury was 60%, while it was only 40% in those with associated injuries. Single-chamber injury was noted in 87.5% of the patients and the survival in these was 62.8%. Fourteen complications were noted in the patients who were resuscitated. One patient was re-explored for excessive bleeding and a missed right ventricular perforation was repaired.
CONCLUSION
In missile cardiac injuries, results are best if operated early, and outcome depends upon multiple factors including clinical status at arrival, time interval till management, nature of injury, and associated injuries.

AMAÇ
Periferik damar yaralanmalarý sýklýkla ölümcül ve ölümcül olmayan travmalarda saptanmaktadýr. Tedavide önemli ilerlemeler kaydedilmesine karþýn, bunlar hala önemli ölüm nedenleri olarak kalmaktadýr.
GEREÇ VE YÖNTEM
Bu çalýþmada, 1996 ile 2006 yýllarý arasýnda Adli Týp Kurumu Bursa Grup Baþkanlýðý Morgu’nda yapýlan 6796 otopsiye ait raporlar retrospektif olarak incelendi.
BULGULAR
Çalýþmaya, damar yaralanmasýna baðlý hayatýný kaybettiði saptanan 63 (%0,9) olgu dahil edildi. Olgularýn 57’si (%90,5) erkek olup, yaþ ortalamasý 36 bulundu; yaralanmalarýn %58,7’si kesici delici alet yaralanmasýna baðlý idi. Olgularýn %85,7’sinde orijinin cinayet olduðu belirlendi; %25’inde kan alkol seviyesi 44 ile 256 mg/dL arasýnda saptandý.
SONUÇ
Ekstremite damar yaralanmalarýnda, mortaliteyi azaltmak açýsýndan tecrübeli cerrahi ekibin bulunmasý, bunun yanýnda efektif hastane öncesi acil giriþim yapýlmasý hayati önem taþýmaktadýr. Primer ekstremite damar yaralanmasýna baðlý ölen kiþilerin otopsilerinde; yaralanan damar, yaralanma sayýsý ve ölümcül yaralanma sayýsý, yaralanma yerleþimi ve tarafý özellikle üzerinde durulmasý gereken konulardýr.

BACKGROUND
Peripheral vascular injuries are frequently encountered in lethal and nonlethal trauma. Although significant improvements in treatment have been achieved, such injuries are still important causes of mortality.
METHODS
In this study, the records of 6769 autopsies performed between 1996 and 2006 at the Council of Forensic Medicine Bursa Group Chairmanship Morgue Department were evaluated retrospectively.
RESULTS
The 63 cases (0.9%) who were determined to have died due to vascular injury were included in this study. Fifty-seven cases (90.5%) were men (mean age: 36 years); 58.7% of the injuries were due to stab wounds. The femoral artery and vein were the most frequently injured vessels. The origin was a homicide in 85.7% of the cases. In 25% of the cases, blood alcohol levels were between 44 and 256 mg/dL.
CONCLUSION
The availability of experienced surgical teams and effective prehospital emergency care are vital for decreasing the mortality due to extremity vascular injuries. In the autopsy of a patient who died primarily due to extremity vascular injury, the injured vessel, numbers of injuries and of lethal injuries, and locations and sides of the injuries shed light on the possible presence of intention.

AMAÇ
Penetran kalp yaralanmalarý, dramatik ve ölümcül travmalardýr. Bu hastalarýn birçoðu, hastaneye ciddi þok veya ölü olarak ulaþýrlar. Erken taný ve ameliyat prognozu belirler. Bu çalýþmada, kliniðimizde tedavi edilen penetran kalp yaralanmalý olgulardaki yaralanma biçimi, acil servise geliþ tablosu, geliþ süresi ile tedavi yaklaþýmlarýnýn morbidite ve mortalite üzerine olan etkileri deðerlendirildi.
GEREÇ VE YÖNTEM
Penetran kalp yaralanmalý 52 hasta retrospektif olarak incelendi. Hastalarýn demografik karekterleri, yaralanmanýn sebepleri, hastaneye geliþ zamaný, acil servis inceleme bulgularý, kullanýlan taný yöntemleri ve uygulanan cerrahi yöntemlerin sonuçlar üzerine etkisi incelendi.
BULGULAR
Erkek-kadýn oraný 48: 4 olup yaþ ortalamasý 27,86±13,73 idi. Kýrk altý hastada (%88,5) delici alet, dört hastada ateþli silah ve iki hastada iyatrojenik yaralanma etyolojide rol oynamaktaydý. Tüm hastalara acil cerrahi giriþim uygulandý. Kardiyak yaralanmalar primer dikiþle tamir edildi. Sekiz olgu ile hastane mortalitesi %15,4 olarak saptandý.
SONUÇ
Penetran kardiyak yaralanmalarda kanama ve/veya tamponad nedeniyle çok kýsa sürede þok geliþebilir. Erken taný ve acil torakotomi penetran kardiyak yaralanma sonrasý hastalarýn yaþamasýnda temel faktörlerdir.

BACKGROUND
Penetrating cardiac injuries are a dramatic and lethal form of trauma. Most of these patients reach the hospital already dead or in severe shock. The prognosis is determined by early diagnosis and operation. In this study, we discuss the effects of the etiology of trauma, the state of presentation in the emergency department, and the treatment approaches on the morbidity and mortality in penetrating cardiac trauma treated in our clinic.
METHODS
Fifty-two patients treated due to penetrating cardiac injury were investigated retrospectively. Demographic characteristics, etiology of the injury, arrival time at the hospital, physical examination findings in the emergency room, diagnostic methods used, and surgical methods applied were determined along with the results.
RESULTS
The male to female ratio was 48: 4, and mean age was 27.86±13.73. The etiology was stab injury in 46, gun shot injury in four and iatrogenic trauma in two patients. Surgery was applied in emergency condition for all cases. Cardiac injury was repaired using primary repair technique. Hospital mortality was determined as 15.4% (8 patients).
CONCLUSION
Penetrating cardiac injuries lead to shock in a very short period of time because of bleeding and/or pericardial tamponade. Early diagnosis and prompt thoracotomy are the fundamental factors affecting patient outcome after penetrating cardiac injury.

AMAÇ
Spontan pnömotoraks’lý (SP) hastalar iki gruba ayrýlarak yaþ, cinsiyet, taný yöntemleri, uygulanan tedavi þekli ve sonuçlarý açýsýndan geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM
Haziran 1997 ile Mayýs 2005 tarihleri arasýnda SP nedeniyle tedavi edilen 348 hasta (320 erkek, 28 kadýn; ort. yaþ 34,5; daðýlým 14-80) çalýþmaya alýndý. Hastalarýn 274’ü (%78,7) primer SP’li, 74’ü (%21,3) sekonder SP’li idi. Sekonder SP’li hastalarda tüberküloz en sýk sebepti. Hastalarýn %10’una ilk tedavi olarak nazal oksijen ve aspirasyon, %90’ýna tüp torakostomi uygulandý.
BULGULAR
Nazal oksijen ve aspirasyon ile baþarý oraný primer SP’li hastalarda %85,7, sekonder SP’li hastalarda %66,7 olarak bulundu. Tüp torakostomi ile baþarý oraný primer SP ve sekonder SP’li hastalarýnda benzerdi (%88,4 ve %85,7). Tüp torakostominin baþarýsýz olduðu primer SP’li 29 (%11,6) hastanýn 15’ine aksiller torakotomi, 14’üne video yardýmlý torakoskopik cerrahi (VATS) yapýldý. VATS ile cerrahi uygulanan bir (%7,1) hastada nüks meydana geldi.
SONUÇ
Tüp torakostominin baþarý oraný hem primer SP’li, hem de sekonder SP’li hastalarda yüksektir. Bununla beraber tüp torakostominin baþarýsýz olduðu hastalarda cerrahi yöntemler güvenle ve düþük nüks oranlarý ile uygulanabilir.

BACKGROUND
In this study, spontaneous pneumothorax (SP) cases were divided into two groups and retrospectively evaluated according to age, sex, diagnostic methods, treatments, and results.
METHODS
Between June 1997 and May 2005, 348 patients (320 males, 28 females; mean age 34.5; range 14 to 80 years) with SP were enrolled into our study. There were 274 (78.7%) primary SP and 74 (21.3%) secondary SP patients. Tuberculosis was the most common cause in secondary SP patients. Nasal oxygen and aspiration was the first-line therapeutic option in 10% of patients and tube thoracostomy was performed in 90%.
RESULTS
Nasal oxygen and aspiration success ratio was 85.7% in primary SP patients and 66.7% in secondary SP patients. Tube thoracostomy success ratio was nearly the same in patients with primary and secondary SP (88.4% and 85.7%). Of the 29 patients (11.6%) with primary SP with unsuccessful result of tube thoracotomy, 15 underwent axillary thoracotomy and 14 underwent video-assisted thoracoscopic surgery (VATS). One patient among these 14 who underwent VATS (7.1%) had recurrence.
CONCLUSION
Tube thoracostomy success ratio was high in both primary and secondary SP patients. Surgical procedures can be applied safely, with low recurrence rate, when the tube thoracostomy remains unsuccessful.

AMAÇ
Cerrahi ve konservatif tedavi kriterleri henüz kesinleþmemiþ önkol çift kýrýðý olan büyük çocuk ve genç eriþkinlerde tedavi sonrasý ortalama iki yýllýk izlem sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM
Mart 2001 ile Aralýk 2003 tarihleri arasýnda, önkol çift kýrýðý tanýsýyla kliniðimize baþvuran ve yaþlarý 10-18 arasýnda deðiþen cerrahi veya konservatif olarak tedavi edilmiþ, epifizleri kapanmamýþ 41 hastadan en az bir yýl takibi olup düzenli kontrole gelen 34 hasta çalýþmaya dahil edildi. Hastalarýn 23’üne konservatif, 11’ine cerrahi tedavi uygulandý. Hastalar kaynama süresi, fonksiyonel ve kozmetik açýdan deðerlendirildi. Ortalama izlem süresi iki yýldý (daðýlým 12-36 ay).
BULGULAR
Konservatif tedavi edilen 23 hastanýn 21’inde (%91) Anderson kriterlerine göre mükemmel ve iyi sonuç, cerrahi tedavi edilen 11 hastanýn 9’unda (%82) Anderson’a göre mükemmel ve iyi sonuç görüldü. Kötü sonuçlar konservatif grupta kabul edilen 15° üzeri açýlanmasý olduðu halde ameliyatý kabul etmeyen hastalarda görüldü. Cerrahi grupta ise 1 hastada implant yetersizliði sonucunda ikinci ameliyat gerekmesi nedeniyle kötü sonuç alýndý.
SONUÇ
Önkol çift kýrýklý büyük çocuklarda öncelikle konservatif tedavi denenmeli, takiplerinde redüksiyonda kayma ve 15 derecenin üzerinde açýlanma olan hastalara cerrahi tedavi planlanmalýdýr.

BACKGROUND
We aimed to assess treatment outcomes of forearm fractures in patients aged between 10-18 years, for whom strict guidelines for surgical and conservative treatment are not yet clear.
METHODS
From a total of 41 patients between the ages of 10-18 years, 34 patients with a minimum of one-year follow-up in our clinic with the diagnosis of forearm fracture were evaluated retrospectively. All the patients had open epiphyses. Twenty-three of these patients were treated conservatively and 11 surgically. Patients were evaluated according to time of union, function and cosmesis. Average follow-up was two years (12-36 months).
RESULTS
Conservative treatment gave excellent and good results in 21 (91%), while surgical treatment gave excellent and good results in 9 (82%) of the patients when evaluated according to Anderson’s criteria. A bad result was seen in one patient who did not accept an operation, and had an angulation of over 15 degrees. We also had one bad result in the operatively treated group because of implant failure and a need for a second operation.
CONCLUSION
According to our results, conservative treatment should be the mainstay in the treatment of childhood fractures of the forearm. However, we should not hesitate in considering surgical treatment when the patients have a malalignment of more than 15 degrees.

AMAÇ
Spinal þok dönemi sonrasý, suprasakral lezyonlar klasik olarak detrusor hiperrefleksisi (veya aþýrý detrusor aktivitesi) ve detrusor sfinkter dissinerjisi ile sonuçlanýr. Sakral lezyonlar ise alt motor nöron hasarý ile arefleksif mesane ve yüksek mesane kompliyansý ile kendini gösterir. Buna raðmen bazý yazarlar spinal kord travmasý ile ürodinamik bulgularýn her zaman korele olmadýðýný göstermiþtir. Bu çalýþmada, travma seviyesi ile ürodinamik bulgularýn iliþkisi deðerlendirildi.
GEREÇ VE YÖNTEM
Posttravmatik spinal kord lezyonlu 51 hasta radyolojik olarak belirlenen travma seviyesi, travmanýn nörolojik seviyesi ve spinal hasarýn þiddetine göre sýnýflandýrýldý. Daha sonra tüm hastalara ürodinami iþlemi uygulandý.
BULGULAR
Suprasakral lezyonlu 36 hastanýn 26’sýnda (%72,2) hiperrefleksi ya da aþýrý detrusor aktivitesi (p<0,05), 29’unda (%80,5) detrusor sfinkter dissinerjisi (p<0,05), 9’unda (%25) normal kompliyans ve 1’inde (%2,8) arefleksi saptandý. Sakral lezyonlu 14 hastadan 6’sýnda (%42,8) arefleksi, 2’sinde (%14,3) hiperrefleksi ya da aþýrý detrusor aktivitesi, 2’sinde detrusor sfinkter dissinerjisi ve 6’sýnda (%42,8) normal kompliyans saptandý.
SONUÇ
Spinal kord travmalý hastalarýn somatik nörolojik bulgular veya görüntüleme yöntemlerinde saptanan seviye ile ürodinamik bulgular arasýnda her zaman korelasyon olmayabilir. Bu çalýþma tek baþýna klinik nörolojik muayenenin ürolojik disfonksiyonu tahmin etmede uygun bir parametre olmadýðýný, ürodinamik deðerlendirmenin her hasta için kesin taný koyabilen yöntem olduðunu göstermiþtir.

BACKGROUND
After the spinal shock period, suprasacral injuries classically result in detrusor hyperreflexia/overactive bladder and detrusor sphincter dyssynergia. Sacral cord injuries produce detrusor areflexia consistent with lower motor neuron injury and often increased bladder compliance. However, previous investigators have noted an inexact correlation between spinal cord injury level and urodynamic findings. The aim of this study was to evaluate the relationship between level of injury and urodynamic findings.
METHODS
Fifty-one patients with post-traumatic spinal cord injury were classified by the radiographically determined level of injury, clinical neurologic level and completeness of injury. Urodynamic studies were performed in all patients.
RESULTS
Twenty-six of 36 patients with suprasacral injuries had hyperreflexia/overactive bladder (72.2%). Twenty-nine (80.5%) had detrusor sphincter dyssynergia, 9 (25%) had normal compliance and 1 (2.8%) had areflexia. Six of the 14 patients with sacral injuries had areflexia (42.8%), 2 (14.3%) had hyperreflexia/overactive bladder, 2 (14.3%) had detrusor sphincter dyssynergia, and 6 (42.8%) had normal compliance.
CONCLUSION
The correlation between somatic neurologic findings or spinal imaging studies and urodynamic findings in patients with spinal cord injury is not exact. These data suggest that the neurologic examination alone is not an adequate parameter to predict urological dysfunction and that urodynamic evaluation provides a more precise diagnosis for each patient.

AMAÇ
Femur þaft kýrýklarý, genç yetiþkin nüfusta, yüksek enerjili travmalarla oluþan, beraberinde diðer organ yaralanmalarýnýn olabildiði kýrýklardýr. Bu çalýþmada, femur þaft kýrýðý olan 20 hastanýn þiþirilebilir intramedüller çivi ile tedavi sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM
Yaþ ortalamasý 34,7 olan hastalardan birinin kýrýðý ateþli silah yaralanmasýna baðlý tip 3A açýk, kalan 19 hastanýnki kapalý kýrýktý. Kýrýklarýn 2’si (%10) femurun proksimal üçte bir, 15’i (%75) orta üçte bir, 3’ü (%15) alt üçte birlik bölümündeydi. Hastalara elektif þartlarda, skopi altýnda kapalý redüksiyon, intramedüller oyma ve þiþirilebilen intramedüller çivilerle (Fixion, Disc-O-Tech, Ýsrail) iç fiksasyon uygulandý. Kapalý olarak redükte edilemeyen kýrýklarda ikinci bir insizyonla açýk redüksiyon saðlandý. Ortalama ameliyat süresi 26,3 dakikaydý.
BULGULAR
Tüm hastalarda kaynama saðlandý. En kýsa kaynama süresi 12, en uzun kaynama süresi 24 hafta ve ortalama kaynama süresi 15,2 haftadaydý. Thorensen ölçütlerine göre hastalarýn 15’inde (%75) mükemmel, 4’ünde (%20) iyi, 1’inde (%5) orta derecede sonuç alýndý.
SONUÇ
Majör komplikasyon olmaksýzýn kaynama saðlayan þiþirilebilir intramedüller çiviler klasik çivilerdeki distal kilitleme ve fazla radyasyona maruz kalma gibi sorunlara alternatif çözümler sunmaktadýr. Sonuçlarýmýz, þiþirilebilir intramedüller çivilerin femur kýrýklarýnýn tedavisinde hýzlý, basit ve etkili bir çözüm saðlayan, klasik çivilere alternatif bir yöntem olduðunu göstermektedir.

BACKGROUND
Femoral shaft fractures are usually seen in the young population as a result of high energy traumas and are often accompanied by major organ injuries. In this paper, we aimed to assess the clinical results of expandable femoral intramedullary nails in the treatment of 20 femoral shaft fractures.
METHODS
The average age was 34.7. One fracture was the result of a gunshot wound, type 3A open fracture, and the other 19 fractures were closed. Under fluoroscopic control, all patients underwent elective closed reduction and internal fixation with intramedullary expandable femoral nails (Fixion, Disc-O-Tech; Israel). In case of failed or unacceptable closed reduction, open reduction was achieved with a second incision over the fracture site. Average operation time was 26.3 minutes.
RESULTS
Full union was achieved in all patients. The shortest union time was 12 weeks and the longest 24 weeks, with an average of 15.2 weeks. Results in 15 patients (75%) were excellent, in 4 patients (20%) good and in 1 patient (5%) moderate according to Thorensen criteria.
CONCLUSION
Use of expandable nails provides union without major complications and offers advantages such as less exposure to radiation as seen in distal locking of classical intramedullary nails. In conclusion, the good results of this study show that the expandable femoral intramedullary nail provides a successful option to classical intramedullary nails.

AMAÇ
Motosiklet kazalarý travmalara baðlý mortalite ve morbiditenin önemli bir nedenidir. Bu çalýþmanýn amacý, motosiklet ile iliþkili herhangi bir kaza nedeni ile acil servise baþvuran hastalarýn özelliklerinin deðerlendirilmesidir.
GEREÇ VE YÖNTEM
Akdeniz Üniversitesi Hastanesi Acil Servisi’nde 01 Temmuz 2005 ile 30 Eylül 2005 tarihleri arasýnda hastalarýn verileri ileriye dönük olarak kaydedildi.
BULGULAR
Acil servise motosiklet kazasý nedeni ile 142 hastanýn baþvurduðu saptandý. Hastalarýn 16’sýnýn dosyasýna ulaþýlamadýðý ve 4’ü halen hastanede yattýðý için deðerlendirmeye alýnmadý. Kalan 122 yaralanma olgusunun 72’si (%59) taburcu olurken 40’ý (%32,8) hastaneye yatýrýldý, 7’si (%5,7) yatýþ amacý ile sevk edilirken, 3’ünün (%2,5) tedaviyi kabul etmediði saptandý. Sadece 11 yaralýnýn kaza sýrasýnda kask taktýðý öðrenildi. Ortanca yatýþ süresi 5 gün (en az 1, en çok 43 gün) olarak bulundu.
SONUÇ
Motosiklet kazalarý güvenlik önlemlerinin kýsýtlýlýðý ve travma mekanizmasýnýn farklýlýðý nedeni ile araç içi kazalara göre daha ciddi yaralanmalara neden olmaktadýr. Kazalarýn sýklýðý, yüksek yatýþ oranlarý, hastanede kalýþ süresinin uzunluðu ve yüksek týbbi harcamalar motosiklet kazalarýnýn halk saðlýðý ve ekonomik açýdan önemli bir sorun olduðunu göstermektedir. Kazalarýn önlenmesi amacý ile motosiklet sürücülerinin mevcut yasal düzenlemelere uyumunun denetlenmesi yanýnda, güvenlik önlemlerinin artýrýlmasý ve sürücülerin bilinçlendirilmesi için çalýþmalar yapýlmalýdýr. Bu çalýþmalarýn kaza ve yaralanmalarý önleme üzerindeki etkileri yeniden deðerlendirilmelidir.

BACKGROUND
Motorcycle accidents are one of the major causes of traumatic injuries and deaths. The purpose of this study was to analyze the features of the victims presenting with motorcycle-related injuries.
METHODS
This study was conducted prospectively from July 1 to September 30, 2005 at the Emergency Department (ED) of Akdeniz University Hospital.
RESULTS
During the study period, 142 patients presented to the ED with motorcycle-related injuries. Sixteen patients were excluded from the analysis because their forms were incomplete and four were still under treatment in the hospital. Of the 122 injured, 72 (59.0%) were discharged and 40 (32.8%) were admitted. Only 11 patients declared use of a helmet. Median length of stay in the hospital was five days.
CONCLUSION
Motorcycle accidents result in more serious injuries than motor vehicle accidents due to the limited safety precautions and the difference in injury mechanism. The frequency of accidents, higher admission rates, longer periods of admissions, and higher total hospital costs highlight motorcycle accidents as a major public health issue and an economical burden. To prevent accidents, compliance with the legal requirements should be regularly audited. Studies should be done to increase motorcycle safety precautions, and education programs should be organized for motorcyclists. The effects of these interventions should be analyzed.

Künt travmaya baðlý pankreatik laserasyon nadirdir ve retroperitoneal organ yaralanmasýyla birlikteliði enderdir. Renal yaralanmalar klinik ve radyografik görüntüleme incelemesinde kolaylýkla saptanabilirken, pankreatik yaralanmalara klinik olarak taný koymak zordur ve bazý durumlarda da pankreatik yaralanmalar taný konulmadan kalmaktadýr. Her ne kadar ultrasonografi travma hastalarýnýn ilk deðerlendirilmesinde önerilmese ve intra veya perihepatik biliomalarýn takibinde yeri sýnýrlý da olsa, pankreas yaralanmalarýnýn araþtýrýlmasýnda yetkin bir tetkik olduðu gösterilmiþtir. Bu yazýda, ultrasonografiyle saptanan pankreatik yaralanmasý olan 23 yaþýndaki bir erkek olgu sunuldu.

Pancreatic laceration due to blunt trauma is relatively uncommon and it is less likely to accompany injury of a retroperitoneal organ. While renal injuries are easily detectable in both clinical and radiographic imaging examination, pancreatic injuries are difficult to diagnose clinically and in several cases remain occult. Although ultrasonography is not generally recommended for initial assessment of the trauma patient and its role is limited in the follow-up of contained intra- or perihepatic bilomas that are treated conservatively, it was demonstrated to be capable for exploration of pancreatic injuries as well. We present a case of a 23-year-old male with pancreatic injury found in ultrasonography.

Üç yýldýr, demir eksikliði ve anemi þikayetleri olan otuz yedi yaþýndaki kadýn hasta, subileus nedeniyle hastaneye yatýrýlarak takibe alýndý. Enteroklizis yöntemiyle jejunumun proksimal kýsmýnda bir týkanýklýk ve polipoid kitleye ait dolma defekti gözlendi. Hastaya, ince baðýrsak rezeksiyonu yapýldý. Histopatolojik deðerlendirme sonucu submukozal lipomdu. Sonuç olarak, klinik ileus ve aneminin tanýsal sürecinde lipomu da içeren ince baðýrsak selim tümörleri göz önünde tutulmalýdýr.

A 37-year-old female patient with a history of iron deficiency anemia for three years had been hospitalized and followed up with subileus. An obstruction at the proximal part of the jejunum was found by enteroclysis method and a filling defect due to a polypoid mass was determined. The small intestine was resected. It was reported as a submucosal lipoma based on results of the histopathological examination. In conclusion, benign tumors of the small intestine, including intestinal lipomas, should be considered during the diagnostic process of clinical ileus and anemia.

Bu yazýda, rutinde kullanýlmayan bir alet yardýmýyla, yabancý cismin rektumdan transanal yolla çýkarýldýðý bir olgu sunuldu. Rektumda kalan yabancý cisim þikayetiyle baþvuran hastanýn psikoz yakýnmasý vardý ve stoma yoluyla uygulanacak laparotomi uygulamasý çok zor olacaktý. Bu nedenle, yabancý cismi transanal yoldan geri çýkarmak üzere giriþimin gerçekleþtirilmesine karar verildi. Retraktörler ve endoskopi ile gerçekleþtirilen giriþimlerin baþarýsýz olmasýndan sonra, yabancý cismi transanal yoldan geri çýkarmak için Kielland obstetrik forsepsi baþarýlý bir þekilde kullanýldý. Bu çalýþmanýn yazarlarý, yabancý cisimleri rektumdan geri çýkarmak üzere Kielland obstetrik forsepsinin kullanýldýðý baþka herhangi bir makale bulamamýþlardýr.

We present a case report of trans-anal extraction of a foreign body from the rectum using an unconventional instrument. Our patient presented with impacted retained rectal foreign bodies. As the patient suffered from psychosis, a laparotomy with a stoma would have been difficult to manage. It was thus decided to make every effort to retrieve the objects transanally. After failed attempts with retractors and endoscopy, Kielland obstetric forceps were used successfully to retrieve the foreign body transanally. The authors have found no other report describing use of Kielland obstetrical forceps to retrieve foreign bodies from the rectum.

Fever may appear due to known causes such as infections, but may sometimes occur as a result of unknown pathologies. These pathologies can be included in a miscellaneous group of fever of unknown origin. We report one case of bladder stone including a foreign body in a 40-year-old man with a stroke admitted for high fever, blocked miction and bladder symptoms.

Yüksek ateþ, enfeksiyon gibi belli bir nedene baðlý olarak geliþebildiði gibi, nedeni belirlenemeyen patolojilere baðlý da geliþebilir. Bu patolojiler nedeni bilinmeyen ateþin deðiþik gurublarýný içerebilir. Biz burada, yüksek ateþ, üriner sistem semptomlarý ve idrar yapamama þikayeti ile baþvuran 40 yaþýndaki bir erkek hastayý sunduk.

Yüksek voltajlý elekrik yaralanmasýna baðlý paryeto-oksipital bölgede tam kalýnlýkta saçlý deri ve kalvaryal kemik nekrozu geliþen 15 yaþýndaki erkek hastada yaralanma sonrasý 5. günde nekrotik yumuþak dokular debride edildi, cansýz kalvaryal kemik yerinde býrakýldý ve üzeri bipediküllü perikraniyal flep ve bipediküllü skalp flebi ile iki tabakalý olarak kapatýldý. Ameliyat sonrasýnda herhangi bir komplikasyon izlenmez iken geç takiplerinde cansýz kemik bölgesinde orijinal boyuttan daha küçük bir rezorpsiyon alaný gözlendi.

A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of ‘bipedicled pericranial flap’ and ‘bipedicled scalp flap’. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.