Acil servislerde verilen saðlýk hizmetinin ve özellikle de acil bakým hemþireliðinin önemi gün geçtikçe artmakta, bu birimlerde hizmet veren hemþirelerin diðer hemþirelerden daha farklý özelliklere sahip olmalarý ve mutlaka özel eðitimden geçmeleri gerekmektedir. Türkiye’deki mevcut duruma baktýðýmýz zaman, acil hemþireliði konusunda olumlu geliþmeler bulunmakla birlikte, bu alanda standartlarýn geliþtirilerek görev tanýmlarýnýn yapýlmasýna gereksinim vardýr.

As the demand for high quality Accident and Emergency Departments and nursing staff increases throughout Turkey, the need for more specialized emergency nurse training has also increased. Although there have been a number of positive developments regarding emergency nursing standards, the general quality of emergency nurse training needs to be improved and job definitions amended to better reflect the specialist duties of emergency nurses.

AMAÇ
Deneysel adezyon formasyonu oluþturulan sýçanlarda, melatonin ve fosfolipidin adezyon geliþimine etkilerinin vasküler endotelyal büyüme faktörü (VEGF) ekspresyonu ile iliþkisi araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada 60 adet Wistar-Albino cinsi sýçan, rastgele 15’erlik sham, kontrol ve iki adet çalýþma gruplarýna ayrýldý. Sham grubuna sadece laparotomi yapýldý. Kontrol grubu ve çalýþma gruplarýnda sað alt kadranda pariyetal peritonda abrazyon yapýldý, çekum, ileum ve uterusun sað boynuzunda serozal defekt oluþturuldu; kontrol grubunda periton boþluðuna Ringer laktat verildi. Çalýþma gruplarýndan birine melatonin, diðerine fosfolipid süspansiyonu verildi. Bütün gruplarda 15 gün sonra relaparotomi yapýlarak, adezyon geliþimi deðerlendirilip skorlama yapýldý.
BULGULAR
Kontrol grubuna göre sham, melatonin ve fosfolipid gruplarýnda adezyon geliþimi belirgin olarak düþüktü (p<0,05). Kontrol grubunda yapýþýklýk olan alanlarda VEGF boyamasý diðer gruplara göre anlamlý derecede yüksekti (p<0,05). Melatonin ve fosfolipid grubunda VEGF boyamasý ile normal alanlardaki VEGF boyamasý arasýnda anlamlý fark yoktu (p>0,05).
SONUÇ
Deneysel adezyon modeli oluþturulan sýçanlarda melatonin ve fosfolipid adezyon geliþimini azaltmaktadýr. Geliþen adezyonun þiddeti ile VEGF ekspresyonu arasýnda paralellik vardý. Þiddetli adezyon geliþen alanlarda VEGF ekspresyonu artmýþtý.

BACKGROUND
The aim of this experimental study was to investigate the effects of melatonin and phospholipid on adhesion formation and the correlation with vascular endothelial growth factor (VEGF) expression in rats.
METHODS
Sixty Wistar-Albino rats were divided into four groups as sham, control and two study groups, each including 15 rats. In the sham group, laparotomy was the only procedure. Left lower parietal peritoneum was abraded after laparotomy and serosal defects formed on the cecum, ileum and right uterine horn in the study and control groups. Ringer lactate was then applied to the control group, while melatonin and phospholipid suspension were applied separately in the two study groups. Relaparotomy was performed in all groups on the 15th day to score and evaluate the adhesion formation.
RESULTS
Adhesion formation was significantly lower in the sham, melatonin and phospholipid groups than in the control group (p<0.05). VEGF staining was significantly higher in the control group with adhesion areas compared to the other groups (p<0.05). When VEGF staining was compared, there was no significant difference between VEGF- stained and normal areas in the melatonin and phospholipid groups.
CONCLUSION
Melatonin and phospholipid decreased the adhesion formation in an experimental adhesion model in rats. There is a correlation between adhesion severity and VEGF expression.

AMAÇ
Bu deneysel araþtýrmada, hemorajik þokta Ringer laktat (RL), %6’lýk hidroksietil niþasta (130/0,4-HES) ve RL-HES kombinasyonu ile resüsitasyonun böbrekler üzerine etkileri araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada aðýrlýklarý 2198-3435 g olan 24 adet erkek Yeni Zelanda beyaz tavþaný rastgele dört gruba ayrýldý. Hemorajik þok, ortalama arter basýncý 30 mmHg ve kan laktatý >4 mM/L olacak þekilde oluþturuldu. Grup 1’de sývý replasmaný uygulanmaz iken, Grup 2’de RL, Grup 3’te HES ve Grup 4’te de RL+HES ile sývý replasmaný ile þok düzeltildi.
BULGULAR
Bütün gruplarda, serum kreatinin ve kan üre azotu düzeyleri hemorajik þoktan ve sývý resüsitasyonundan sonra normal sýnýrlarda kaldý. Laktat dehidrogenaz ve a-1 mikroglobulin düzeyleri þoktan ve sývý resüsitasyonundan sonra anlamlý olarak arttý (p<0,05). Ancak, gruplar arasýnda bir fark yoktu (p>0,05). Sistatin-C düzeyleri þoktan sonra artmasýna karþýn (p<0,05) sývý replasmaný ile normal deðerlere geri geldi. IL-6 ve TNF-a düzeyleri þoktan sonra bütün deneklerde arttý (p<0,05). Ancak, sývý replasmanýndan sonra gruplar arasýnda bir fark gözlenmedi (p>0,05). Böbreklerin histopatolojik incelemelerinde gruplar arasýnda bir fark bulunmadý (p>0,05).
SONUÇ
%6’lýk HES (130/0,4), gerek tek baþýna gerekse RL ile beraber hemorajik þokun tedavisinde kullanýldýðýnda tavþan böbrekleri üzerine zararlý bir etkisi olmadý.

BACKGROUND
This experimental study examined the effects of resuscitation with Ringer’s lactate (RL), 6% hydroxyethyl starch (130/0.4-HES), and the combination of RL and HES on renal function in hemorrhagic shock (HS).
METHODS
Twenty-four male New Zealand white rabbits weighing 2198-3435 g were divided at random into four groups. HS was constituted by maintaining the mean arterial blood pressure at 30 mmHg and blood lactate at >4 mM/L. Subsequently, Group 1 (control) was not resuscitated, while the study rabbits’ resuscitation was initiated with RL (Group 2), HES (Group 3), or the combination of RL and HES (Group 4).
RESULTS
In all groups, the serum creatinine and blood urea nitrogen (BUN) levels were observed to be within normal limits, while the lactate dehydrogenase and α-1 microglobulin levels statistically significantly increased when time points were compared with beginning values (p<0.05). Furthermore, cystatin-C levels were observed to be increased after the HS (p<0.05), but returned to the normal level after resuscitation in all the study groups. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels were increased in all the rabbits after HS (p<0.05), and there were no significant differences among the study groups after resuscitation (p>0.05). There were no differences in the histological imaging between the groups (p>0.05).
CONCLUSION
The 6% HES (130/0.4) did not have any harmful effects on the kidney when it was used alone or in combination with crystalloid for resuscitation of HS in rabbits.

AMAÇ
Bu deneysel çalýþmada, duedenum birinci kýsýmda oluþturulan peptik ülser perforasyonu tedavisinde “expanded polytetrafluoroethylene” (ePTFE) greft ile primer dikiþ yöntemleri makroskopik ve mikroskopik olarak karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Wistar Albino sýçanlar rastgele her grupta 12’þer tane olacak þekilde iki gruba ayrýldý. Tüm deneklerde duedenum birinci kýsým ön yüzünde 3 mm çapýnda, tüm duedenum çapýnýn %50’sini geçmeyecek þekilde duodenal perforasyon oluþturuldu. Makroskopik olarak batýn içi kaçak, peritonit varlýðý ve karýn içi adezyonlar deðerlendirildi. Adezyonun þiddetini deðerlendirmek için adezyon þiddeti skorlama sistemi kullanýldý. Histolojik preparat skorlama ölçütleri mikroskopik deðerlendirme için kullanýldý.
BULGULAR
Her iki grubun adezyon þiddeti skorlamasýnýn istatistiksel analizinde anlamlý fark saptanmadý. Ancak, gruplar bir bütün olarak deðerlendirildiðinde adezyon siddeti skorlamasý anlamlýydý (p=0,045). Mikroskopik deðerlendirmenin istatistiksel analizinde “none to minimal cell accumulation, thin immatür granulation, moderately thick granulation” olarak sýnýflandýrýlan gruplarda primer dikiþ ve ePTFE arasýnda anlamlý fark bulunmadý (p=0,089, p=0,178, p=0,755). Ancak, “thick vascular granulation” olarak sýnýflandýrýlan grupta anlamlý fark bulundu (p=0,005).
SONUÇ
ePTFE greft uygulanmasý kolay, güvenilir ve sonuçlarý primer dikiþe benzer bir tekniktir. Ancak, bizim çalýþmamýzdaki sonuçlarýn daha büyük deneysel serilerde ve insan çalýþmalarýyla desteklenmesi gerekmektedir.

BACKGROUND
In this experimental study, we treated peptic ulcer perforation in the first portion of the duodenum using an ePTFE (expanded polytetrafluoroethylene) soft tissue graft and compared results with primary suturing.
METHODS
Wistar Albino rats were randomized into two groups. A duodenal defect of 3 mm was created in the first portion of the duodenum in all 24 rats. Macroscopic evaluation was done to determine presence of intraabdominal leakage, peritonitis, intraabdominal adhesions, and the level of adhesion, if present. The adhesion severity scoring system was used to score severity of adhesions. Histology section score criteria were used for scoring in microscopic evaluation.
RESULTS
There was no statistically significant difference between the two groups in the adhesion severity scoring according to grades. However, when overall scoring was considered, a statistically significant difference was determined between the two groups (p=0.045). According to microscopic examination, there was no statistically significant difference between the two groups when classified into none to minimal cell accumulation, thin immature granulations and moderately thick granulation (p=0.089, p=0.178, p=0.755); however, there was a statistically significant difference between the two groups in the thick vascular granulation class (p=0.005).
CONCLUSION
Use of the ePTFE graft method is easy, and results are comparable to those achieved with primary suturing. However, our results need further confirmation with larger series in animals and also with human studies.

AMAÇ
Cerrahi yoðun bakým ünitesindeki (YBÜ) mekanik ventilasyon gereksinimi (MVN) ve süresinin (DMV) öngörülmesinde iki farklý skorlama sisteminin etkinliði incelendi.
GEREÇ VE YÖNTEM
Bu prospektif gözlemsel çalýþmaya, 24 saatten daha uzun süreyle YBÜ’de yatýrýlan ve kabul edilme sýrasýnda ve taburcu edilene veya ölene kadar her 48 saatte bir ardýþýk organ yetersizliði deðerlendirme (SOFA) skoru ve enfeksiyon olasýlýðý skoru (IPS) hesaplanan ardýþýk 144 hasta dahil edildi. Her iki skorlama sisteminin duyarlýlýðý ve özgüllüðü, ki-kare yöntemi ile ölçüldü. Youden indeksi ve alýcý çalýþma karakteristiði (ROC) eðrisi altýndaki alan da elde edildi.
BULGULAR
MVN’nin öngörülmesi ile ilgili olarak, sýrasýyla hastaneye yatýrýlma günü (0) ile 2. ve 4. günlerde en iyi kesilme noktalarý SOFA için 2,5, 3,5, 2,5 ve IPS için de 10,5, 10,5, 9,5 oldu. MVN’nin öngörülmesi ile ilgili olarak, SOFA, ROC eðrisi altýndaki alan ve Youden indeksinde 0., 2. ve 4. günlerde IPS’ninkilere göre anlamlý þekilde daha iyi sonuçlar verdi (p<0,05). Ýki skorlama sisteminin hiçbiri, MV altýnda üç günden daha uzun süreli respiratuvar desteðin öngörülmesi konusunda iyi bir ayýrým saðlayamadý.
SONUÇ
MVN’nin öngörülmesi ile ilgili olarak, SOFA skorlama sistemi, 0., 2. ve 4. günlerde IPS’den daha iyi doðruluða sahiptir.

BACKGROUND
This study examines the efficacy of two different scoring systems in predicting mechanical ventilation need (MVN) and duration (DMV) in a surgical intensive care unit (ICU).
METHODS
This prospective observational study included 144 consecutive patients admitted to the ICU for more than 24 hours for whom the Sequential Organ Failure Assessment (SOFA) score and the Infection Probability Score (IPS) were calculated on admission and every 48 hours until discharge or death. Sensitivity and specificity of the two scoring systems were measured by the chi-square method. The Youden index and area under the Receiver Operating Characteristic (ROC) curve were also obtained.
RESULTS
For prediction of MVN, the best cut-off points were 2.5, 3.5, 2.5 for SOFA and 10.5, 10.5, 9.5 for IPS on the day of admission (0) and days 2 and 4, respectively. For the prediction of MVN, SOFA on days 0, 2 and 4 yielded significantly better results in the area under the ROC curve and Youden index than those of IPS (p<0.05). Neither of the two scoring systems provided good discrimination in prediction of more than 3 days respiratory support under MV.
CONCLUSION
For prediction of MVN, the SOFA scoring system on days 0, 2 and 4 has better accuracy than IPS.

AMAÇ
Anjiyografi, þüpheli bulgularýn varlýðýnda “altýn standart” taný yöntemidir; ancak, pahalý, uzun süren ve invaziv bir yöntemdir. Bu çalýþmada, gereksiz anjiyografi sayýsýný azaltmak amacýyla, hýzlý ve kolay uygulanabilir bir yöntem olan ayak bilek basýnç indeksinin (ABÝ) þüpheli periferik arter yaralanmalarýnýn tanýsýndaki rolü araþtýrýldý.
GEREÇ VE YÖNTEM
Periferik arter yaralanmasý þüphesi olan 1772 hastanýn verileri prospektif olarak incelendi. Fiziksel incelemede arter yaralanmasýnýn kesin bulgularý saptanan 283 (%16) hastaya acil cerrahi giriþim uygulandý. Þüpheli bulgularý olan 1489 (%84) hastanýn ABÝ hesaplandý. ABÝ ≥1 olan hastalar konservatif takip edilirken, ABÝ <1 olan hastalara dupleks USG ve/veya anjiyografi yapýldý. Arteriyel yaralanma saptanan hastalar ameliyata alýndý.
BULGULAR
Þüpheli bulgularý olan 1489 hastadan ABÝ ≥1 olan 1343 (%90) hastanýn 7’sinde (%0,5) takip sýrasýnda erken dönemde arter yaralanmasý saptanarak cerrahi giriþim uygulandý, morbidite gözlenmedi. ABÝ <1 olan 146 (%10) hastanýn 39’unda (%26,7) arter yaralanmasý saptandý. Þüpheli periferik arter yaralanmasýnda 1’in altýndaki ABÝ duyarlýlýðý %84,8; özgünlüðü %92,6; pozitif kestirim gücü %26,7; negatif kestirim gücü %99,5; taný deðeri %92,3 idi.
SONUÇ
Periferik arteriyel yaralanmaya ait þüpheli bulgularýn varlýðýnda, ABÝ ≥1 saptanmasý arteriyel yaralanmayý %99,5 oranýnda dýþlar ve hastalarýn %90’ýnda ek tetkik yapýlmasýný önler. Bu hastalarda, ileri tetkiklere geçilmeden önce ABÝ tercih edilecek ilk taný yöntemi olmalýdýr.

BACKGROUND
Angiography is the “gold standard” diagnostic tool for patients presenting soft signs of arterial injury. To reduce the number of unnecessary angiographies, we aimed to evaluate the role of the ankle brachial pressure index (ABPI) in the diagnosis of peripheral arterial injury in extremity trauma with soft signs.
METHODS
The data of 1772 patients with the suspicion of peripheral arterial injury was recorded prospectively. Two hundred eighty-three patients (16%) with any hard sign underwent immediate surgery. ABPI was calculated in 1489 patients with soft signs. Patients with ABPI <1 were evaluated by duplex ultrasonography and/or angiography, and if arterial injury was detected, the patients underwent surgery. Patients with an ABPI ≥1 were followed up conservatively.
RESULTS
1343 (90%) patients had ABPI ≥1; seven (0.5%) of them developed symptoms and signs of arterial injury and healed without morbidity. One hundred forty-six (10%) patients had ABPI <1; with DUS/angiography, arterial injury was detected in 39 of them (26.7%), and they underwent surgery. The sensitivity of ABPI <1 was 84.8%; specificity 92.6%; positive predictive value 26.7%; negative predictive value 99.5%; and overall accuracy 92.3%.
CONCLUSION
ABPI excludes arterial injury in 99.5% of patients with soft signs of arterial injury and avoids unnecessary examinations in 90% of patients. In the management of extremities with soft signs, ABPI measurement should be the first-line diagnostic choice.

AMAÇ
Glasgow Koma Skoru (GKS) yaygýn, basit, güvenli ve travma hastalarýnýn bilinç deðerlendirilmesinde iyi bir iletiþim skalasýdýr. Ancak, son yýllarda GKS’den daha ayrýntýlý bir sistem gerekliliði sorgulanmaktadýr. Düzeltilmiþ akut fizyoloji ve kronik saðlýk deðerlendirilmesi sistemi (APACHE II) GKS ile birlikte 12 fizyolojik parametre içeren fizyolojik temelli bir skaladýr. Ayrýca mortaliteyi etkileyen kronik hastalýk ve ileri yaþ deðiþkenlerini de içermesi GKS’den daha üstün olduðunu düþündürmektedir.
GEREÇ VE YÖNTEM
Bu çalýþmada, 2003 ve 2004 yýllarýnda kafa travmasý ile birlikte sistemik travma geçirmiþ 266 olgu (195 erkek,71 kadýn; ort. yaþ 60,5; daðýlým 14-87) geriye dönük olarak deðerlendirildi.
BULGULAR
Mortalite ileri yaþ grubunda artmýþtý (p<0,001). Ortalama APACHE II skoru yaþayanlarda 38,0, ölen olgularda 68,7 (p<0,001), ortalama GKS puaný yaþayanlarda 10.4 ölen olgularda 6,3 (p<0,001) bulundu. Mortalite tahmininde APACHE II GKS’den daha belirgin sýnýr puaný saðladý (p<0,001). Duyarlýlýk ve özgünlük için yapýlan ROC eðrisinde, APACHE II (0,892±0,028) eðrisi altýnda kalan alan GKS’den daha büyüktü (0,862±0,029).
SONUÇ
Mortalite deðerlendirmesinde, özellikle acil servislerde GKS kafa travmalý olgularda yeterli öngörü saðlayan, basit ve kolay uygulanmakla birlikte sistemik travma geçirmiþ olgularda APACHE II hastanýn önemli fizyolojik parametrelerini de içermesi nedeniyle GKS’den üstündür.

BACKGROUND
The Glasgow Coma Scale (GCS) is popular, simple, and reliable, and provides information about the level of consciousness in trauma patients. Nevertheless, the necessity of using a more complex system than GCS has been questioned recently. The revised Acute Physiology and Chronic Health Evaluation system (APACHE II) is a physiologically based system including 12 physiological variables, and it also includes GCS. In addition, it is thought to be superior to GCS due to recognition of increasing age and significant chronic health problems, which adversely affect mortality.
METHODS
This retrospective study included 266 patients (195 males, 71 females; mean age 60.5; range 14 to 87 years) with head injury associated with systemic trauma in 2003 and 2004.
RESULTS
Mortality increased in the elderly group (p<0.001). Mean survival score in APACHE II was 38.0 and death score was 68.7 (p<0.001); these values in GCS were 10.4 and 6.3, respectively (p<0.001). APACHE II at the cut-off point was better than GCS in the prediction of death and survival in patients (p<0.01). The area under the receiver operating characteristic curve for sensitivity and specificity was larger in APACHE II (0.892±0.028) than GCS (0.862±0.029).
CONCLUSION
For the assessment of mortality, the GCS score still provides simple, less-time consuming and effective information concerning head injury patients, especially in emergencies; however, for the prediction of mortality in multitrauma patients, APACHE II is superior to GCS since it includes the main physiologic parameters of patients.

AMAÇ
Bu prospektif çalýþmada, akut apandisitte konservatif tedavi ve cerrahi tedavinin güvenilirlik ve etkinlik açýsýndan karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Mart 2005 ile Mart 2006 arasý klinik olarak akut apandisit tanýsý alan 290 hasta acil servise baþvurdu. Bu hastalarýn 107’sine ameliyatsýz antibiyotik tedavisi (Grup 1), 183’üne cerrahi tedavi (Grup 2) uygulandý. Grup 1’de taburcu edilen hastalar 10. gün, 3. ay, 6 ay ve 1. yýlda rutin kontrollere çaðrýldýlar. Her iki grup yaþ, cinsiyet, ortalama hastanede kalýþ süresi, modifiye Alvarado skoru, morbidite, mortalite ve maliyet etkinliði açýsýndan deðerlendirildi.
BULGULAR
Grup 1 ve Grup 2’de erkek/kadýn oraný ve ortalama yaþlar sýrasýyla 65/42 ile 30,98±1,30 ve 125/58 ile 26,25±0,79 idi. Grup 1’de hastalarýn 19’u ameliyat edildi. Ameliyat endikasyonu tedaviye direnç, hastanýn kararý, baþka merkezlerde ameliyat idi. Ortalama hastanede kalýþ süresi Grup 1’de istatistiksel olarak daha uzun olsa da ortalama maliyet Grup 1’de 433 $ iken Grup 2’de 559 $ olarak hesaplandý. Morbidite oranlarý her iki grupta benzer olup hiç mortalite görülmedi.
SONUÇ
Günümüzde altýn standart tedavi þekli cerrahi giriþim olarak bilinen akut apandisitte, seçilen olgularda antibiyoterapi ile ameliyatsýz takibin baþarý oranýnýn yüksek ve düþük maliyetli bir alternatif olabileceðini düþünüyoruz.

BACKGROUND
In this prospective study, operative and nonoperative management of acute appendicitis were evaluated regarding their safety and cost effectiveness.
METHODS
Two hundred ninety patients presenting to our Emergency Department between March 2005 and March 2006 with acute appendicitis were included in this prospective study. Nonoperative medical therapy was performed in 107 patients (Group 1), and 183 patients were treated surgically (Group 2). Routine follow-up controls were done on the 10th day, at the 3rd and 6th months and at the first year after discharge in Group 1. Both groups were compared regarding age, gender, mean hospital stay, modified Alvarado score, morbidity, mortality, and cost effectiveness.
RESULTS
The male/female ratio of Groups 1 and 2 were 65/42 (mean age: 30.98±1.30) and 125/58 (mean age: 26.25±0.79), respectively. In Group 1, 19 patients were operated. Operation indications were resistance to therapy, patient’s request, and operation in another hospital. Although the mean hospital stay of Group 1 was statistically significantly longer than Group 2, the mean cost of the therapy was $559 in Group 2 and $433 in Group 1. Morbidity rates were similar, with no mortality in either group.
CONCLUSION
With its high success rate and cost effectiveness, medical treatment seems to be a good alternative to the gold standard therapy of surgery in management of acute appendicitis.

AMAÇ
Bu retrospektif çalýþma, daha iyi uzun süreli sonucu öngörebilecek prognostik faktörleri belirlemek amacýyla yürütüldü.
GEREÇ VE YÖNTEM
1 Ocak 1993 ile 31 Aralýk 2004 tarihleri arasýnda, 97 hasta AlKhoba’daki Kral Fahd Üniversitesi Hastanesi’nde tedavi edildi. Bunlarýn elli sekizi deðerlendirildi. Kalçalar, Merle d’Aubigne sýnýflamasýna ve fonksiyonel temele göre deðerlendirildi.
BULGULAR
Ortalama yaþlarý 29,6±9,8 (18-57) yýl olan ve 59,5±18,8 (24-120) ay süreyle takip edilen 52 erkek ve 6 kadýn hasta deðerlendirildi. Çýkýklar hastalarýn 43’ünde karayolunda gerçekleþen trafik kazasýna baðlýydý; 57 hastada kapalý redüksiyon, bir hastada açýk redüksiyon uygulandý. Traksiyon ortalama 4,71±1,07 hafta süreyle uygulandý. Hastalarýn 43’ünde mükemmel sonuçlar elde edildi. Yalnýzca üç haftalýk bir immobilizasyon uygulanan hastalar olumsuz seyretti.
SONUÇ
Bizim çalýþmamýz travmatik kalça çýkýklarýnda, çýkýklarýn erken redüksiyon ve en az dört haftalýk immobilizasyonla birlikte iyi sonuçlar elde edilebileceðini göstermektedir.

BACKGROUND
This retrospective study was carried out to identify prognostic factors that can predict a better long-term outcome.
METHODS
Between 1 January 1993 and 31 December 2004, 97 patients were treated at King Fahd University Hospital, AlKhobar. Fifty-eight patients were analyzed. Hips were evaluated on functional basis as per the classification of Merle d’Aubigne.
RESULTS
There were 52 males and 6 females, with a mean age of 29.6±9.8 (18-57) years and follow-up of 59.5±18.8 (24-120) months. In 43 patients, the dislocations were due to road traffic accidents. In 57 patients, closed reduction was done, while one patient required open reduction. Traction was applied for 4.71±1.07 weeks on average. Forty-three patients had excellent results. Patients with only a three-week immobilization period fared badly.
CONCLUSION
Our study indicates that good results in traumatic hip dislocation can be achieved with early reduction of dislocation and immobilization for at least four weeks.

AMAÇ
Þiddetli duodenal yaralanmalarda primer onarým ve/veya tüp duodenostomi uygulamalarýnýn etkinliði deðerlendirildi ve bu konudaki deneyimlerimiz sunuldu.
GEREÇ VE YÖNTEM
Duodenum yaralanmasý nedeniyle ameliyat edilen 67 hasta deðerlendirildi. Ameliyat tekniði, primer onarým ve tüp duodenostomi uygulanan hastalar olarak sýnýflandýrýldý.
BULGULAR
Elli dokuz hastada penetran ve sekiz hastada ise künt duodenum yaralanmasý mevcuttu. En sýk yaralanan duodenum kýsým ikinci segmentti. Her iki tedavi grubu arasýnda morbidite ve mortlite oraný açýsýndan bir fark yoktu. Morbidite geliþmeyen 35 hastada hastanede yatýþ süresi, tüp duodenostomi uygulanan grupta 18,53±1,85 gün ve primer onarým uygulanan grupta ise 11,45±1,92 gün olup, bu sonuç istatistiksel olarak anlamlýydý. Morbidite geliþen 32 hastada hastanede kalýþ süresi ise tüp duodenostomi uygulanan grupta 47.05±10.46 gün ve primer onarým uygulanan grupta 47,05±10,46 gün idi. Bu sonuç istatistiksel olarak anlamlý deðildi.
SONUÇ
Þiddetli duodenum yaralanmalarýnda primer onarým uygun bir tedavi yöntemidir. Tüp duodenostomi uygulamasý, hastanede kalýþ süresini artýrdýðý gibi hastanýn klinik gidiþatýna ek bir katkýsý olmadýðý görülmüþtür.

BACKGROUND
The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive operative repair of severe duodenal injuries.
METHODS
Sixty-seven patients who underwent surgery for duodenal injuries were evaluated. Management of duodenal injury was classified as primary repair and tube decompression.
RESULTS
Fifty-nine patients were injured by a penetrating mechanism, and eight were injured by blunt mechanism. The most common injury site was in the second portion of the duodenum. There were no significant differences between the two groups with respect to morbidity and mortality rate. In 35 patients without morbidity, the mean length of hospital stay was 18.53±1.85 days in the tube duodenostomy group and 11.45±1.92 days in the primary repair group, and the difference was statistically significant. In the 32 patients with morbidity, the mean length of hospital stay was 47.05±10.46 days in the tube duodenostomy group and 49.86±10.86 days in primary repair group, but there was no statistically significant difference between the groups.
CONCLUSION
Primary repair is suitable in the vast majority of duodenal injuries; tube duodenostomy increases the length of hospital stay and does not improve clinical outcome.

AMAÇ
Bu çalýþma, acil servisteki kritik hasta yakýnlarýnýn gereksinimlerinin ve bu gereksinimlerin karþýlanma durumunun saptanmasý amacý ile tanýmlayýcý olarak yapýldý.
GEREÇ VE YÖNTEM
Çalýþma, bir üniversite ve devlet hastanesinin acil servislerinde Þubat-Mayýs 2007 tarihleri arasýnda 353 kritik hasta yakýný ile yürütüldü. Araþtýrmanýn verileri acil serviste kritik hasta yakýnlarýnýn gereksinimlerini saptama ölçeði ve hasta yakýnlarýnýn gereksinimlerinin karþýlanma durumu ve demografik özelliklere yönelik formlarla yüz yüze görüþme tekniði kullanýlarak toplandý.
BULGULAR
Acil servisteki çoðu hasta yakýnýnýn hasta hakkýnda bilgilenme ve hastanýn bakýmýna katýlma ile ilgili gereksinimlerini kendi kiþisel ve fiziksel gereksinimlerinden daha önemli bulduklarý belirlendi. Hasta yakýnlarýnýn en önemli olarak belirttikleri 10 gereksinim maddesinden 9’unun iletiþim gereksinimi ile ilgili olduðu bulundu. Hasta yakýnlarýnýn acil servis çalýþanlarý tarafýndan karþýlanan gereksinimlerinin, en önemli ve önemli olarak belirttikleri gereksinimler olduðu saptandý.
SONUÇ
Acil servise baþvuran kritik durumdaki hasta yakýnlarýnýn gereksinimlerinin belirlenmesi, saðlýk çalýþanlarýnýn bu gereksinimlere yönelik farkýndalýklarýnýn artmasýna ve karþýlanmasý yönündeki hizmetlerinin geliþtirilmesine katký saðlayabilir. Hasta yakýnlarýnýn gereksinimleri doðrultusunda desteklenmeleri ise acil servislerdeki bakýmýn kalitesini ve hasta yakýnlarýnýn memnuniyetini arttýrabilir.

BACKGROUND
This study was designed as a definitive study to determine the needs of the critical patient’s family and whether or not these needs are met.
METHODS
The study was conducted in the emergency departments (EDs) of a University and a state hospital between February-May 2007 with the families of 353 critical patients. The data was collected by face to face interview technique using the Needs of the Critically Ill Patients’ Family Members in Emergency Department Scale and questionnaires and a personal information form.
RESULTS
It was determined that the patient’s family valued their right and need to be informed of the patient’s status and take part in their care more than their own personal needs. In a more general perspective, nine of the 10 most frequently stated needs regarded communication. It was also found that the needs to be provided by the ED staff were listed as the most important or important.
CONCLUSION
Defining the needs of the family of critical patients in the ED may help raise awareness of the health care providers about this issue, thereby helping to improve the service. Support of patients’ relatives in regards to their needs would increase satisfaction of the patients’ relatives and the quality of care in the ED.

AMAÇ
On beþ yaþ altý çocuklarda en önemli ölüm nedenlerinden biri trafik kazalarýdýr. Çocuk güvenlik koltuklarý doðru kullanýldýðýnda çocuklarý kaza anýnda ölüm ve yaralanmalardan korurlar. Bu çalýþmada, anne-babalarýn çocuk güvenlik koltuðu kullaným oranlarý ve bu konu hakkýndaki bilgi düzeyleri deðerlendirildi.
GEREÇ VE YÖNTEM
Çalýþma Mayýs-Haziran 2007 tarihlerinde Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesi Çocuk Saðlýðý ve Hastalýklarý polikliniklerine baþvuran, çalýþmaya katýlmaya onay veren anne-babalara anket formu doldurtmak suretiyle yapýldý; 532 anne-baba çalýþmaya alýndý.
BULGULAR
Katýlanlarýn %28’i çocuk güvenlik koltuklarýnýn ne olduðunu bilmediðini, %54’ü bildiðini fakat kullanmadýðýný, %20’si ise kullandýðýný ifade etti. Kullananlar içinde doðru kullanma oraný ise sadece %10 idi. Çocuk güvenlik koltuðu kullanýmý annebabanýn sosyoekonomik durumu ile iliþkili bulundu.
SONUÇ
Çocuk güvenlik koltuklarýnýn kullanýmýnýn artmasý ve doðru kullaným ile ilgili eðitimlerin verilmesi ile çocuklarýn kaza anýndaki ölüm ve yaralanmalarý azaltýlabilir. Çocuk hekimlerinin ve diðer saðlýk çalýþanlarýnýn anne-babalarý çocuk güvenlik koltuklarý hakkýnda bilgilendirmesi saðlanmalý ve bu gereçlerin kullanýmýnýn zorunlu hale getirilmesi ile ilgili kanunlar ve düzenlemeler yapýlmalýdýr.

BACKGROUND
One of the major causes of death among children younger than 15 years is vehicular injury. Car safety seats protect children in a crash if they are used correctly. The objective of this study was to assess the level of parental knowledge and their attitudes regarding car safety seats.
METHODS
The survey was conducted in May and June 2007 at Bakirkoy Dr. Sadi Konuk Research-Training Hospital. Randomly selected parents were asked to complete an anonymous self-administered questionnaire after providing informed consent. Five hundred thirty-two Turkish parents were sampled.
RESULTS
Twenty-eight percent of the parents did not know what a car safety seat was. While 20% of parents reported using a car safety seat, only 10% used them correctly. Car safety seat use was correlated with higher socioeconomic status.
CONCLUSION
Increased education of parents regarding the proper use of child safety seats can protect children from potentially fatal injuries. Health care professionals are obligated to give information to parents regarding car safety seats and their proper use. This study should alert planners and policy makers regarding the need to implement educational prevention programs concerning car safety for children in Turkey.

AMAÇ
8 Ekim 2005 tarihinde Kuzey Pakistan’ý büyük bir deprem vurdu. Bu çalýþmada, hastaneye yatýrýlan yaralýlarýn yaralanma tipleri ile uygulanan iþlemler deðerlendirildi ve bu deneyimlere dayanarak afetlere karþý hazýrlýklý olma ve afet yöntemi ile ilgili olarak öneriler sunuldu. Bu çalýþma, Rawalpindi’deki Asker Hastanesi’nde yürütülen tanýmlayýcý bir çalýþmadýr.
GEREÇ VE YÖNTEM
Çalýþmaya dahil edilme kriterleri, tedavi için hastaneye yatýrýlmayý gerektiren bütün hastalarý kapsadý. Ayaktan tedavi görebilecek küçük yaralanmalýlar ve hastaneye ulaþtýðýnda ölmüþ olan kiþiler çalýþma dýþýnda býrakýldý. Hastaneye yatýrýlan hastalarýn dosyalarý, yaralanma tipi, uygulanan prosedürler, komplikasyonlar ve ölüm nedenleri analiz edildi.
BULGULAR
Baþvuran toplam hasta sayýsý 1698 idi ve bunlarýn 862 tanesi (%50,8) hastaneye yatýrýldý; 1046 tane (%45,7) majör giriþimi içeren toplam 2289 ameliyat yapýldý. On altý adet (%1,5) amputasyon uygulanmasý gerekti. Hastanede 17 hasta yaþamýný yitirdi (%1,9); dýþarýdan 76 ceset getirildi.
SONUÇ
Hayat ve uzuv kurtarma ile ilgili ilk günlerden sonra, vardiyalarý baþlatmak, gönüllü insan gücünü erkenden ve mantýklý bir þekilde kullanmak ve plastik cerrahi, ortopedi ve spinal cerrahi konularýna özellikle önem vermek kaydýyla insan gücünü hýzlý bir þekilde ekiplere bölmek önemlidir. Tetanozun önlenmesi yaþamsal öneme sahiptir.

BACKGROUND
A massive earthquake struck North Pakistan on 8 October 2005. The objective of this study was to evaluate the types of injuries and the procedures carried out on the admitted casualties, and to present recommendations based on these experiences for improvement in disaster preparedness and management. This is a descriptive study conducted at the Military Hospital, Rawalpindi.
METHODS
Inclusion criteria included all patients who required admission for treatment. Patients who had minor injuries not requiring indoor treatment and those who were dead on arrival were excluded from this study. The files of admitted patients were analyzed for type of injuries, procedures performed, complications, and causes of death.
RESULTS
The total number of patients received was 1698, of which 862 (50.8%) were admitted. A total of 2289 operations were performed including 1046 (45.7%) major interventions. Sixteen (1.5%) amputations were necessary. Seventeen deaths (1.9%) occurred in hospital, while 76 dead bodies were received.
CONCLUSION
After the initial days of life- and limb saving, it is important to quickly divide the manpower into teams with a major emphasis on plastic, orthopedics and spinal surgery, to start shifts and to utilize the volunteer manpower early and judiciously. Prevention of tetanus is essential.

AMAÇ
Solunum sistemine aspire edilen yabancý cisimlerin belirlenip, çýkarýlmasý komplikasyonlarýn önlenmesi açýsýndan önemlidir. Yabancý cisim aspirasyonu her yaþta görülmekle beraber daha çok çocukluk yaþ grubunda sýktýr. Hava yolunun bir kýsmýnýn ya da tamamýnýn týkanmasýna baðlý olarak farklý belirti ve bulgularla seyreder. Acil müdahale edilmezse ölüme neden olabilir. Kliniðimizde yabancý cisim aspirasyonu nedeniyle giriþimde bulunulan olgular deðerlendirildi.
GEREÇ VE YÖNTEM
Bu çalýþmada, kliniðimizde 1995-2007 yýllarý arasýnda yabancý cisim aspirasyonu tanýlý 96 olgu incelendi. Olgularýn yaþ daðýlýmý 10 ay ile 70 yaþ arasýndaydý. Vakalarýn çoðunluðu çocukluk yaþ grubundaydý. Altmýþ ikisi (%64,58) kýz-kadýn, 34’ü (%35,42) erkek idi. Aspirasyon hikâyesi ile tedavi arasýndaki süre 1 saat ile 10 yýl arasýnda deðiþmekteydi.
BULGULAR
Bronkoskopik uygulamalar rijit bronkoskop ile genel anestezi altýnda kontrollü ventilasyonla gerçekleþtirildi. Olgularýn 83’ünde (%86,5) yabancý cisim saptandý ve bronkoskopik gözlem sýrasýnda yabancý cisim forsepsleri yardýmýyla çýkartýldý; 13’ünde (%13,5) torakotomi gerekli oldu. Geç dönemde baþvuran 5 (%5,2) olguda geliþmiþ olan geri dönüþsüz akciðer patolojisi nedeni ile akciðer rezeksiyonu uygulandý.
SONUÇ
Bu çalýþma, yabancý cisimlerin çocuklar kadar eriþkinler için de önemli olduðunu ve yabancý cisimden þüphelenmenin ve iyi bir öykünün en önemli taný ölçütü olduðunu ve fiziksel inceleme ile radyolojik deðerlendirmenin hasta için önemini vurgulamaktadýr.

BACKGROUND
Determining and removing aspirated foreign bodies from the airways is important in preventing complications. Foreign body aspiration is usually seen in childhood but can occur at any age. Complete or partial obstruction of the main bronchial system produces different findings, and death can result if emergency treatment is not given. We analyzed patients treated for foreign body aspiration in our clinic.
METHODS
In this report, 96 cases were examined in our clinic for aspiration of foreign bodies between 1995 and 2007. Patients were aged between 10 months and 70 years. Most cases were in the pediatric age group. Sixty-two (62%) patients were female and 34 (38%) were male. The period between aspiration and treatment varied from 1 hour to 10 years.
RESULTS
Bronchoscopies were established with controlled ventilation under general anesthesia. The foreign bodies were seen and extracted in 83 patients (86.5%) using foreign body forceps. Thirteen (13.5%) cases underwent thoracotomy. In the late period, pulmonary resection was performed in 5 (5.2%) cases because of irreversible pathology.
CONCLUSION
This study reports that foreign body aspiration is important in adults as well as in children, and suspicion and history are the most important diagnostic criteria. Radiologic findings with physical examination are of great importance in the evaluation of these patients.

AMAÇ
Su parklarýna ve özellikle de su kaydýraklarýna baðlý oluþan yaralanmalarýn özelliklerini belirlemektir.
GEREÇ VE YÖNTEM
Bu prospektif gözlemsel çalýþma, yýllýk hasta sayýsý 50,000 olan üniversite hastanesi acil servisinde Mayýs 2005 ile Eylül 2006 tarihleri arasýnda yapýldý. Çalýþma formuna bütün hastalarýn tanýmlayýcý özellikleri, yaralanmanýn tipi ve mekanizmasý ile hastalarýn son tanýsý kayýt edildi. Çalýþma süresi boyunca acil servise su parkýnda meydana gelen yaralanma nedeniyle 73 hasta baþvurdu. Hastalarýn yaþ ortalamasý 23,92±15,05’di ve 48 hasta (%65,8) erkekti.
BULGULAR
Yaralanma mekanizmasý; hastalarýn 23’ünde (%31,5) su kaydýraðýnda, 16’sýnda (%21,9) havuzda ve 34’ünde (%46,6) ýslak zeminde kayýp düþme þeklindeydi. Acil servis deðerlendirmeleri sonucunda, hastalarýn 15’inde (%20,5) spinal travma, 16’sýnda (%21,9) kafa travmasý 15’inde (%20,5) maksillofasiyal travma ve 30’unda da (%41) diðer yaralanmalarýn olduðu saptandý.
SONUÇ
Su parkýndaki yaralanmalarda çocuklarda özellikle kafa ve maksillofasiyal travma görülürken eriþkinlerde ekstremite ve spinal yaralanmalar daha sýk görülmektedir. Yeterli ve gerekli güvenlik önlemleri alýnmayan su parký aktiviteleri sýrasýnda ölümcül yaralanmalar meydana gelebilir.

BACKGROUND
The purpose of this study was to identify water park injuries, particularly injuries related to waterslides.
METHODS
This prospective observational study was carried out between May 2005 and September 2006 in a university hospital emergency clinic, which has 50,000 annual visits. The study form, including patient demographics, types and mechanisms of injuries and the final diagnoses, was completed for all patients. A total of 73 patients were enrolled into the study. The mean age of the patients was 23.92±15.05 and 48 patients (65.8%) were male.
RESULTS
The mechanisms of injury were as follows: 23 patients (31.5%) were injured on waterslides, 16 (21.9%) were injured in pools and 34 (46.6%) were injured by slipping and falling on the wet surfaces. After the emergency department evaluations, 15 patients (20.5%) were diagnosed to have spinal trauma, 16 (21.9%) head trauma, 15 (20.5%) maxillofacial trauma, and 30 (41%) other injuries.
CONCLUSION
In water park injuries, while children have especially head and maxillofacial trauma, extremity and spinal injuries are more frequent in the adult group. Unless sufficient and required safety precautions are maintained during water park activities, fatal injuries may occur.

Trakeo-innominat arter fistülü (TÝF) nadir ancak trakeostominin dramatik ve öldürücü bir komplikasyonudur. Bu çalýþmada cerrahi olarak tedavi edilen iki TÝF olgusu sunulmuþtur. Her iki hastaya da ligasyon uygulandý. Birinci hasta ameliyattan on saat sonra solunum yetersizliði nedeni ile hayatýný kaybetti. Ýkinci hasta ameliyatýnýn 12. günü normal nörolojik muayene ile taburcu edildi. TÝF’nin oluþum mekanizmasýnda basýnca baðlý nekroz önemli bir faktördür. Bu nedenle, predisposan faktörler ve önlem almak için tedbirli olmak gereklidir. Diðer yandan bu hastalar acil olarak cerrahiye alýnmalýdýr.

Tracheo-innominate artery fistula (TIF) is a rare but catastrophic and almost always fatal complication of tracheostomy. Two surgically intervened TIF cases are presented. In both cases, innominate artery ligation was performed. The first patient died due to respiratory failure 10 hours after operation. The second patient was discharged with normal neurologic examination on the 12th day of operation. Since the mechanism of injury leading to TIF is pressure necrosis, it is of vital importance to be aware of the predisposing factors and to take preventive measures. On the other hand, only patients treated with emergency surgery tend to survive.

Akut karýn aðrýsý ve sað inguinal bölgede hassasiyet þikayeti olan 57 yaþýndaki erkek hastanýn, vermiform apendiskte bulunan apendiks epiploikanýn çok ender görülen torsiyonunu bildiren olgu sunuldu. Dar bir sapýn içinden vermiform appendiksin ucunun devamýnda enfarkte olmuþ bir apendiks epiploika görüldü. Histolojik inceleme, konjesyon, akut enflamasyon ve yað nekrozu gösteren lobule olmuþ bir yaðlý fibröz doku sonucunu bildirdi. Apendiks, bu koþullar haricinde normaldi.

An extremely rare case of torsion of an appendix epiploica attached to the vermiform appendix is reported in a 57-year-old male who presented with acute abdominal pain and tender right inguinal fossa. An infarcted appendix epiploica was seen attached near the tip of an otherwise unremarkable vermiform appendix through a narrow stalk. The histological examination revealed lobulated fibrofatty tissue showing congestion, acute inflammation and fat necrosis. The appendix was otherwise unremarkable.

Kompleks alt ekstremite yaralanmalarýnda, serbest flep uygulamalarý ile yumuþak doku defektlerinin tek seansta, iyi kanlanan bir doku ile ve baþarýlý bir þekilde rekonstrüksiyonu mümkün olmaktadýr. Yirmi dokuz yaþýnda erkek hasta, görev sýrasýnda mayýna basma sonucu, sol ayak özellikle de dýþ kýsýmda, ayak tabanýný da içerecek þekilde, kombine ve kirli bir yaralanma ile Sarýkamýþ Askeri Hastanesi acil servisine getirildi. Ýlk müdahalesi sonrasýnda geniþ debridman yapýlan hastada, mevcut doku defekti yaralanmadan bir hafta sonra serbest rektus abdominis kas flebi ve tam kalýnlýklý deri grefti ile örtüldü. Rekonstrüktif iþlemin baþarýlý olmasýyla, hastanýn ayaðý amputasyondan korundu ve günlük yaþantýsýna dönebildi. Bu olgu sunumunda, uygulama sýrasýnda karþýlaþýlan olan bir takým zorluklara deðinildi ve büyük þehirlerimizin dýþýndaki saðlýk merkezlerinde yapýlacak benzer uygulamalar için önerilerde bulunuldu.

Major soft tissue defects of the foot usually require free tissue transfer for successful reconstruction. A 29-year-old man who injured his left foot in a mine explosion was admitted to Sarýkamýþ Military Hospital. Initial examination showed an extreme crush injury including soft tissue and bone structures of the lateral part of the foot. All necrotic tissues were extensively debrided and the soft tissue defect was reconstructed with a free rectus abdominis muscle flap and full thickness skin graft one week after the injury. The operation outcome was successful. After the rehabilitation period, the patient returned to a normal social life with minimal difficulties. The aims of this report were to alert reconstructive microsurgeons to the possible difficulties that can be encountered during free tissue transfer in small hospitals remote from city centers and to propose some possible solutions.

Brakiyel arter psödoanevrizmasýnýn penetran travma sonrasý geç baþvurusu nadiren bildirilmiþtir. Bu yazýda, antekübital fossa bölgesine nafiz penetran bir travma ve arkasýndan da dirseðinde ani bir þiþlik ve duyarlýlýk oluþmasýndan üç ay sonra baþvuran 23 yaþýnda bir erkek olgu sunuldu. Doppler ultrasonografi ve bilgisayarlý tomografi anjiyografisi büyük bir psödoanevrizma varlýðýný doðruladý. Normal arteriyel dolaþýmý saðlayacak þekilde araya yerleþtirilen bir safen ven interpozisyon greftiyle cerrahi rekonstrüksiyon gerçekleþtirildi.

Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.

Genç yaþta interkondiler distal humerus kýrýðý oldukça nadir görülen bir durumdur. Bugüne kadar literatürde üç olgu rapor edilmiþtir. Biz, her ikisi de erkek çocuk olan 15 ve 14 yaþlarýnda iki olguyu tanýmlýyoruz. Bu yaralanmadaki stabilite, cerrahi olmayan tedavi uygulanmasýna ve olumlu bir sonuç elde edilmesine olanak saðlamýþtýr.

Intercondylar fracture of the distal humerus in youth is an extremely rare injury. Three cases have been reported in the literature to date. We describe two cases, aged 15 and 14 years, both of whom were boys. The stability in this injury allowed non-operative treatment and a favorable outcome.