AMAÇ
Ýskemi, baðýrsak kaynaklý acillere neden olan ve tedavilerini güçleþtiren belalý bir sorundur. Riskli kolon anastomozlarýnýn iyileþme sürecine olumlu katkýlarý olan bir yöntem veya ajan bulmak cerrahi araþtýrma alanýnda popüler bir konudur. Bir ekstraselüler matriks proteini olan amelogeninin gastrointestinal anastomozlarýn iyileþme sürecindeki rolü ile ilgili bilgi bulunmamaktadýr. Bu çalýþmada, amelogeninin iskemik kolon anastomozu üzerine etkileri deðerlendirilmiþtir.
GEREÇ VE YÖNTEM
Yetiþkin, erkek, 200-250 g aðýrlýðýnda Wistar Albino cinsi sýçanlar üç eþ gruba ayrýldý: normal kolon anastomozu grubu (n=8); iskemik kolon anastomozu grubu (n=8); amelogenin uygulanan iskemik kolon anastomozu grubu (n=8). Eþit ve yeterli miktarda amelogenin anastomoz hattýný tamamen örtecek þekilde topikal olarak uygulandý. Tüm sýçanlar ameliyat sonrasý dördüncü günde öldürüldü. Patlama basýncý ve perianastomotik kolon dokusu hidroksiprolin seviyesi ölçüldü.
BULGULAR
Ýskemik kolon anastomozu patlama basýncý, normal kolon anastomozu ve amelogenin uygulanan iskemik kolon anastomozu düzeyinden anlamlý olarak düþüktü (sýrasýyla p=0,006, p=0,008).
SONUÇ
Amelogenin uygulamasý iskemik kolon anastomozunun fiziksel saðlamlýðýný destekler.

BACKGROUND
Ischemia is a troublesome problem that can cause intestinal emergencies and complicate the treatment. Identification of a chemical agent with beneficial effects on the healing process in risky colon anastomosis with the aim of reducing leakage rates is a popular topic in the era of surgical research. Data is lacking about the role of amelogenin, an extracellular matrix protein, during the healing process of gastrointestinal anastomosis. In this study, the effects of amelogenin treatment on ischemic colon anastomosis were evaluated.
METHODS
Adult male Wistar Albino rats weighing 200-250 g were divided into three weight-matched groups as normal colon anastomosis group (n=8), ischemic colon anastomosis group (n=8), and amelogenin-treated ischemic colon anastomosis group (n=8). Sufficient equal volume of amelogenin to cover the anastomosis area entirely was applied topically. All animals were sacrificed on postoperative day four. Bursting pressure levels were measured. Peri-anastomotic colon tissue hydroxyproline levels were also assessed.
RESULTS
Bursting pressure level of the ischemic colon anastomosis group was significantly lower than the normal colon anastomosis and the amelogenin-treated ischemic colon anastomosis groups, respectively (p=0.006, p=0.008).
CONCLUSION
Amelogenin treatment supports the physical strength of ischemic colon anastomosis.

AMAÇ
Çalýþmanýn amacý, abdominal kompartma sendromunun (AKS) erken tanýsýnda kobalt-albümin baðlanma testinin (KABT) rolünü incelemektir.
GEREÇ VE YÖNTEM
Her grupta altý hayvan olmak üzere, 24 anestezi uygulanmýþ ve ventile edilen tavþan rastgele dört gruba ayrýldý. 25 mmHg karýn içi hipertansiyon gaz verme yoluyla, sýrasýyla 15., 30., 45. ve 60. dakikalarda elde edildi. Hayvanlar öldürülmeden önce her birinden 5 mL kan örneði alýndý. Örnekler üzerinde KABT testi uygulandý ve hasar þiddet skoru olarak gösterilen baðýrsak örneklerinin patolojik tanýlarý ile karþýlaþtýrýldý.
BULGULAR
Dördüncü gruptaki iskemi modifiye albümin (ÝMA) hem Grup 1 hem de Grup 2’den istatistiksel olarak daha büyük bulundu (sýrasýyla 0,65±0,16, 0,60±0,25 ve 0,61±0,14) (p<0,05). Grup 3 ve Grup 4’ün ÝMA deðerleri arasýnda istatistiksel bir fark bulunmadý. Grup 4, Grup 1 ve Grup 2 ile karþýlaþtýrýldýðýnda (sýrasýyla p<0,004 and 0,006) ve Grup 3, Grup 1 ile karþýlaþtýrýldýðýnda hasar þiddet skoru istatistiksel olarak anlamlý bulundu (p<0,004). Grup 1 ve Grup 2 arasýnda da istatistiksel olarak anlamlý fark bulundu (p<0,004).
SONUÇ
AKS’nin erken tanýsýnda iskeminin baþlangýcýnda KABT önemli bir rol oynamaktadýr.

BACKGROUND
The purpose of our study was to examine the role of cobalt-albumin binding assay (CABA) for the early diagnosis of abdominal compartment syndrome (ACS).
METHODS
Twenty-four anesthetized and ventilated rabbits were randomly assigned to four groups as 1 to 4, with each group comprised of six animals. Intraabdominal hypertension of 25 mmHg was induced for 15, 30, 45, and 60 minutes by insufflation in the four groups, respectively. Five ml of blood was drawn from each animal before the animals were sacrificed. A CABA test was performed on the samples and results were compared with pathologic diagnosis of intestinal samples shown as a score of damage severity values.
RESULTS
Ischemia-modified albumin (IMA) in Group 4 was significantly higher than in Group 1 and Group 2 (0.65±0.16, 0.60±0.25 and 0.61±0.14, respectively; p<0.05). However, there was no significant difference between the IMA of Group 3 and Group 4. Score of damage severity values reached statistically significant levels in Group 4 compared with Group 1 and Group 2 (p<0.004 and 0.006, respectively) and in Group 3 compared with Group 1 (p<0.004). There was also a statistically significant difference between Groups 1 and 2 (p<0.004).
CONCLUSION
CABA plays an important role in the early diagnosis of ACS at the beginning of intestinal ischemia.

AMAÇ
Bu çalýþmanýn baþlýca amacý, Katar’daki sürücüler arasýndaki karayolu trafik kazalarýnýn (KTK) paternini araþtýrmak ve KTK ile iliþkili faktörleri incelemektir.
GEREÇ VE YÖNTEM
Bu çalýþma, Þubat-Haziran 2009 tarihleri arasýnda Katar Devleti Saðlýk Merkezlerinde yürütülen kesitsel çalýþmadýr. Rastgele yöntemle seçilen 1675 Katarlý sürücüden oluþan grupla çalýþýldý. Sürücülerin 1228’i %74,6’lýk bir yanýt oranýyla sorularý yanýtlayýp bu çalýþmaya katýlmayý kabul etti. Ýyi eðitimli araþtýrma asistanlarý tarafýndan yüz yüze görüþülerek; sosyodemografik bilgi, sürücülük öyküsü, araç tipi, sürücü tutumu, kazalarýn ve kaza þeklinin ayrýntýlarýný kapsayan bir anket yapýldý.
BULGULAR
Bulgular þöyleydi: Çalýþma, Katarlý sürücülerin %26,6’sýnýn KTK’ya karýþtýðýný gösterdi. KTK öyküsü bulunan sürücülerin %69,4’ü erkek idi. 25-34 yaþ grubundaki sürücüler, daha yüksek kaza riskini (%31,2) gösterdi. Arazi taþýtý ve spor amaçlý taþýt özelliðe sahip araçlarla (%23,5) sürücüleri (%45,6), KTK’dan daha fazla etkilendi. Kaza geçiren sürücülerin %23,5’i, araç sürerken her zaman emniyet kemeri kullanmýyodu. Sürücülerin yarýsýndan daha azý, araç sürerken yeme ve içme (%37,9) ve cep telefonu kullanmakta (%41,9) idi. Sürücülerin yarýsýndan daha fazlasý, trafik kuralý ihlali (%57,2) ve hýz sýnýrýný aþma (%25,7) ile trafik kazasýna karýþtý. Her iki grup (trafik kazasý geçiren ve geçirmeyen sürücüler) arasýnda trafik kuralý ihlali (<0,001) ve hýz sýnýrýný aþma (<0,001) açýsýndan ileri derecede anlamlý fark gözlendi. Kazalarýn çoðu güneþli günlerde (%84,7), daha azýysa tatiller (%5,5) ve hafta sonlarý (%12,5) oldu. Yana doðru savrularak devrilmek (%17,7), açýlý çarpýþma (%14,3) ve arkadan çarpma (%10,7) en sýk rapor edilen KTK þekli oldu.
SONUÇ
Çalýþma bulgularý Katar Devleti’ndeki sürücüler arasýndaki yüksek KTK riskini ortaya koymuþtur. Sosyodemografik faktörler arasýnda, erkek ve 25-34 yaþ grubundan genç sürücülerin daha yüksek bir kazaya karýþma durumuna sahip olduðu bulunmuþtur. Ýnsan davranýþlarýnýn, bütün KTK ve özellikle de trafik kuralý ihlallerine katkýda bulunan asýl faktör olduðu belirlenmiþtir.

BACKGROUND
The main objective of this study was to explore the patterns of road traffic crashes (RTCs) among drivers in Qatar and to examine the contributing factors involved.
METHODS
This study was a cross-sectional survey conducted from February to June 2009 at the Primary Health Care Centers in the State of Qatar. A random sample of 1675 Qatari drivers were approached, and 1228 of them responded and agreed to participate in this study, with a response rate of 74.6%. Face to face interview was conducted by well-trained research assistants based on a questionnaire covering sociodemographic information, driving history, type of vehicle, driver behavior, details of crashes, and accident pattern.
RESULTS
The study revealed that 26.6% of the studied Qatari drivers were involved in RTCs. 69.4% of the drivers with a history of RTCs were male. Drivers in the age group 25-34 years showed a higher risk of having a crash (31.2%). Drivers of cars (45.6%) and 4WD/SUVs (23.5%) were more frequently involved in RTCs. 23.5% of drivers who had RTC did not always wear their seat belt while driving. 37.9% of the drivers with RTC were engaged in eating and drinking and 41.9% were using their mobile phones while driving. More than half of the drivers with RTCs had traffic violations (57.2%), with 25.7% exceeding the speed limit. A highly significant difference was observed between the two groups (drivers with and without RTC) in terms of presence of traffic violation (<0.001) and exceeding the speed limit (<0.001). Most of the crashes happened during sunny days (84.7%) with fewer crashes on holidays (5.5%) and weekends (12.5%). Overturn skid (17.7%), angle collision (14.3%) and rear-end hit (10.7%) were the most frequently reported patterns of RTCs.
CONCLUSION
The study findings revealed the high risk of RTCs among drivers in the State of Qatar. Among the sociodemographic factors, male drivers and young drivers aged 25-34 years were found to have a higher accident involvement. Human behavior was identified as the main contributing factor of all RTCs, especially presence of traffic violations.

AMAÇ
Wenchuan depremi, kitlesel yaralanmalara yol açan çok büyük yýkýcý felaketlere neden olmuþtur. Burada sunulan tanýmlayýcý analiz, yalnýzca mevcut çalýþma için deðil ayný zamanda daha sonraki deprem felaketi yanýtý için de bir kaynak olarak hizmet etmektedir.
GEREÇ VE YÖNTEM
Kas iskelet yaralanmasý bulunan toplam 205 hasta, iki eðitim hastanesine kabul edildi. Yaralanma profili, yakýnmalar, hasar yerleþimleri ile tipleri, tedavi ve prognoz bilgilerini içeren týbbi kayýtlar geriye dönük olarak deðerlendirildi.
BULGULAR
Hastalarýn 205’inde majör yaralanma kýrýk (%78,0) idi. On dokuzunda ezilme sendromu olmak üzere ezilme yaralanmasý bulunan 40 hasta vardý. Açýk kýrýklar, çoklu kýrýklar ve parçalanmýþ kýrýklar yaygýndý. Sinir yaralanmalarýyla birlikte olan kýrýklar ve enfeksiyonlarla birlikte olan travma da yaygýndý. Yapýlan cerrahi tedaviler þöyleydi: Debridman, kemik traksiyonu, eksternal fiksasyon, açýk redüksiyon, internal fiksasyon ve spinal fiksasyon. Bütün hastalar, birkaç komplikasyon, düþük deformite oraný ile etkin bir þekilde tedavi edildi ve hiçbir ölüm görülmedi.
SONUÇ
Büyük bir depremden sonraki acil durum ile ilgili olarak, hastane öncesi acil bakým çok önemlidir. Hastalar hastaneye nakledildikten sonra, hastalarýn kendi klinik özelliklerine göre kiþiselleþtirilmiþ tedavi uygulamalý ve ayný zamanda mortalite oraný ile sakatlýk oranýný azaltmak üzere iliþkili komplikasyonlarý önlemeli ve zamanýnda tedavi etmeliyiz.

BACKGROUND
The Wenchuan earthquake was an enormous devastating disaster and caused mass casualties. The descriptive analysis presented here serves as a reference not only for present injury intervention but also for future earthquake disaster response.
METHODS
A total of 205 patients with a musculoskeletal injury were admitted in two teaching hospitals. We conducted a retrospective review of medical records to document the injury profile, chief complaints, damage locations and types, subsequent treatment, and prognosis.
RESULTS
Of the 205 patients, fracture was the major type of injury (78.0%). Forty patients were determined to have crush injuries and 19 patients had crush syndromes. Open fractures, multiple fractures and comminuted fractures were common. Fracture-associated neural injuries and trauma-associated infections were also common. Surgical treatments included debridement, bone traction, external fixation, open reduction and internal fixation, and spinal fixation. All the patients were effectively treated with few complications, a low deformity rate and no death.
CONCLUSION
For emergency conditions after a major earthquake, pre-hospital emergency care is highly important. After the patients are transported to the hospital, we should plan individualized treatment according to the patients’ respective clinical features, and at the same time, prevent and cure the related complications in a timely manner in order to reduce mortality and disability rates.

AMAÇ
Tüberküloz abdominal koza, ameliyat öncesi dönemde nadir olarak taný konulan ender bir hastalýktýr. Baðýrsak, bir membran içinde, koza gibi bir þekilde kýlýfla kaplanýr. Histopatoloji doðrulayýcýdýr.
GEREÇ VE YÖNTEM
Bu prospektif olgu incelemesinde, Nisan 2005 ile Nisan 2008 tarihine kadar olan dönemde tüberküloz abdominal koza tanýsý alan hastalar (8 kadýn, 3 erkek) deðerlendirildi.
BULGULAR
Tüm hastalarda ince baðýrsak týkanýklýðý özellikleri vardý. Bütün hastalara laparotomi uygulandý; etkilenen bölgede büyük omentumun bulunmamasý ile baðýrsak tüberkülozu belirtisi bulunmamasý karakteristik bulgu idi. Gerekli olan iþlem membranýn soyulmasýydý ve hastalarýn hepsi ameliyat sonrasý antitüberküloz tedavisi aldý. Her olguda, membran histopatolojisinde tüberküloz kanýtý bulundu.
SONUÇ
Tüberküloz abdominal koza nadir görülür. Kadýnlar yaygýn olarak etkilenir. Cerrahi tercih edilen tedavidir.

BACKGROUND
Tuberculous abdominal cocoon is a rare disease, and diagnosis is seldom made preoperatively. The bowel is encased in a membrane in a cocoon-like fashion. Histopathology is confirmatory.
METHODS
This prospective case note review was a study of patients diagnosed with tuberculous abdominal cocoon from April 2005 - April 2008. There were 8 females and 3 males.
RESULTS
All patients had features of small bowel obstruction. All had laparotomy and the characteristic finding of absence of the greater omentum from the involved area and the absence of any stigmata of gut tuberculosis. Peeling of membrane is all that is required, and patients received anti-tubercular therapy postoperatively. In each case, evidence of tuberculosis on histopathology of membrane was present.
CONCLUSION
Tuberculous abdominal cocoon is a rare entity. Females are commonly affected. Surgery is the preferred treatment.

AMAÇ
Servikal özofagusun geç perforasyonu tedavisine yönelik farklý yöntemler belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM
Yabancý cisim nedenli 10 adet geç servikal özofajiyal perforasyon olgusu incelendi. Olgular, tanýlarýna ve tedavilerine göre üç gruba bölündü. Grup I: Servikal apseli olgular; bu hastalar daha sonra servikal insizyonla drene edildi ve primer olarak tamir edildi, Grup II: Servikal apseli olgular; bu hastalar daha sonra servikal insizyonla drene edildi ve yabancý cisim granülomu olan apseler çýkartýldý ve Grup III. Yabancý cisimler çýkartýldý. Bütün olgulara geniþ spektrumlu antibiyotikler verildi ve oral yolla herhangi bir gýda almalarý bir hasta dýþýnda kýsýtlandý.
BULGULAR
Bütün hastalar mortalite gerçekleþmeksizin düzeldi ve normal yutma fonksiyonu korundu. Her gruptaki tedavi zamaný farklý idi.
SONUÇ
Yabancý cismin çýkartýlmasýnda, oral yolla gýda alýmýnýn yasaklanmasý ve geniþ spektrumlu antibiyotikler verilmesini içeren konservatif tedavi uygundur. Apse ile birlikte olan perforasyonlar, strip kas flep tamiri ve irrigasyon drenajý ile bir arada uygulanan debridman yoluyla cerrahi olarak tedavi edilebilir. Granüloma daha sonra servikal insizyon ve vakum drenaj ile çýkartýlabilir.

BACKGROUND
We aimed to identify different methods of treating late perforation of the cervical esophagus.
METHODS
Ten late cervical esophageal perforations were caused by foreign bodies. The subjects were divided into three groups according to their diagnosis and treatment as follows: Group I: Cases with cervical abscess were drained by lateral cervical incision and primarily repaired, Group II: Cases with cervical abscess were drained by lateral cervical incision, and any foreign body granulomas found were removed, and Group III: Foreign bodies were removed. All cases were given broad-spectrum antibiotics and were prohibited from any oral food, except Case 5.
RESULTS
All patients recovered without mortality and retained normal swallow function. The time for treatment in each group was different.
CONCLUSION
The conservative management of removal of foreign body, prohibition of oral food and administration of broad-spectrum antibiotics is supported. Perforations with the presence of abscess can be surgically treated by debridement closure combined with strip muscle flap repair and irrigation drainage. Granuloma can be removed by lateral cervical incision and vacuum sealing drainage.

AMAÇ
Bu yazýda, bacaklarda serbest flep transferiyle tek arterli travmalý ekstremitenin kurtarýldýðý olgularda, uç-yan anastomoz tekniði deneyimlerimizi vurgulayarak tanýmlamak amaçlandý.
GEREÇ VE YÖNTEM
Travma sonrasý ekstremite rekonstrüksiyonu için serbest flep transferi ihtiyacý olan 32 hasta Mart 2006 ile Kasým 2008 tarihleri arasýnda hastanemize sevk edildi. Tüm hastalara anjiyografi yapýldý. On bir olgu tek bir arterli olarak doðrulandý (Gustilo IIIC). Alýcýnýn ve vericinin akýmlarýnýn sürdürüldüðü 11 hastada, tek arterli ekstremite rekonstrüksiyonunda ekstremite kurtarýlmasý için uç-yan anastomoz tekniði uygulandý.
BULGULAR
Anastomoz uygulanan arterler, popliteal arter (n=3), posterior tibial arter (n=2), peroneal arter (n=5) ve radial arterdi (n=1). Yaralanma ile flep rekonstrüksiyonu arasýnda geçen ortalama süre 34 gündü. Tüm hastalarda ciddi kýrýklar, kemik açýðýyla birlikte yumuþak doku defekti vardý. Ameliyat sonrasý hastanede kalýþ süresi 12-18 gün idi. Yaralanma ve sevk edilme arasýndaki süre 27-45 gün idi. Kýsmi kalýnlýkta deri grefti sekiz hastaya yapýldý.
SONUÇ
Tek bir arterle ekstremite kurtarýlmasý için uç-yan anastomozla serbest flep transferi güvenli bir iþlemdir, bir ven grefti ve T ve Y þeklinde anastomoz gerekli deðildir.

BACKGROUND
The purpose of this article is to describe and highlight our experience of end-to-side anastomosis technique in such cases for limbs salvage in the single artery of a traumatized extremity with free-flap transfer.
METHODS
Thirty-two traumatized patients in need of free-flap transfer for their extremity reconstruction were referred to our hospital from March 2006 to November 2008. Angiography was performed in all patients. A single artery was confirmed in 11 cases (Gustilo IIIC). End-to-side anastomosis was applied for limb salvage in single-artery extremity reconstruction, such as preserving recipient’s flow and preserving donor’s flow in 11 patients.
RESULTS
The anastomosis arteries included the popliteal artery (n=3), posterior tibial artery (n=2), peroneal artery (n=5) and radial artery (n=1). The mean time from the injury to the flap reconstruction was 34 days. All patients had severe fracture or bone deficit plus soft tissue defect. Postoperative hospital stay was 12-18 days. Time interval between the injury and referral was 27-45 days. Split thickness skin graft was performed in eight patients.
CONCLUSION
Free-flap transfer by end-to-side anastomosis for limb salvage with a single artery is a safe procedure, so a vein graft and T and Y shape anastomosis are not necessary.

AMAÇ
Doktorlar tarafýndan hazýrlanmýþ belli bir protokole dayalý hemþire kontrollü sedasyon ile sedasyon uygulamasýna gün içi ara verilerek uygulanan doktor kontrollü sedasyonun mekanik ventilasyon süresine etkisini karþýlaþtýrdýk.
GEREÇ VE YÖNTEM
Mekanik ventilasyon tedavisi uygulanan ve sedasyon gereksinimi olan 50 hasta çalýþmaya alýndý. Grup P’de (n=25) herhangi bir sedasyon protokolü kullanýlmadan, sedatif infüzyonuna gün içi ara verilerek, doktor kontrollü sedasyon; Grup N’de (n=25) doktorlar tarafýndan hazýrlanmýþ belli bir protokole göre, hemþire kontrollü sedasyon uygulandý. Bu grupta istenen sedasyon düzeyine ulaþýlamaz ise doktora bilgi verildi ve doktor tarafýndan ek sedatif ilaç baþlandý. Hastalarýn demografik özellikleri, mekanik ventilasyon, sedasyon, yoðun bakým ünitesinde yatýþ süreleri ve mortalite karþýlaþtýrýldý.
BULGULAR
Demografik veriler, yoðun bakým yatýþ süresi ve mortalite iki grupta da benzerdi. Sedasyon ve mekanik ventilasyon süresi, Grup P’de Grup N’ye göre anlamlý olarak kýsaydý. Hafif sedasyon Grup P’de, derin sedasyon ise Grup N’de daha sýk gözlendi.
SONUÇ
Sedatif infüzyonuna gün içi ara verilerek saðlanan sedasyonun, protokole baðlý hemþire-kontrollü sedasyondan daha kýsa sedasyon ve mekanik ventilasyon süresi saðladýðý saptandý. Hemþire-kontrollü sedasyon, uygulanabilir bulunmasýna raðmen, eðer yeterli sayýda hemþire yoksa hemþire-kontrollü sedasyon protokolünün uygulanmasýnýn uygun olmadýðýný düþünmekteyiz.

BACKGROUND
We aimed to compare the effects of nursing-implemented sedation protocol and daily interruption of sedative infusion on the duration of mechanical ventilation.
METHODS
Fifty patients receiving mechanical ventilation and requiring sedation in the intensive care unit (ICU) were randomly selected to receive either daily interruption of sedative infusion (Group P, n=25) or nursing-implemented sedation protocol (Group N, n=25). In Group P, daily interruption of sedative infusions without any sedation protocol was performed by physicians. In Group N, nursing-implemented sedation protocol prepared by physicians was applied. In this group, if the ideal level of sedation was not achieved, information was given by nurses to physicians. Patients in each group were compared according to demographic variables, duration of mechanical ventilation and sedation, length of stay in the ICU, and mortality.
RESULTS
Demographic variables, length of stay in the ICU and mortality were similar between the two groups. In Group P, duration of sedation and mechanical ventilation were significantly shorter than in Group N. Light sedation was seen more frequently in Group P and deep sedation in Group N.
CONCLUSION
Daily interruption of sedative infusions provided shorter duration of sedation and mechanical ventilation than nursing-implemented sedation with protocol. Although nurse-implemented sedation protocol has been found acceptable, if the number of nurses is lacking, we believe the nurse-implemented sedation protocol should not be applied.

AMAÇ
Üst ekstremite vasküler yaralanma sýklýðý giderek artmakla beraber, mortalite ve morbidite oranlarý %0-%8 arasýnda kalmaktadýr. Son yýllarda self-mutilasyon olgularý belirgin olarak karþýmýza çýkmaktadýr. Üst ekstremite vasküler yaralanmalarýnda self-mutilasyon ve diðer penetran travma sonuçlarýný karþýlaþtýrmak ve self-mutilasyonun toplum için oluþturduðu tehditi ortaya koymak amacýyla bu çalýþmayý planladýk.
GEREÇ VE YÖNTEM
Üst ekstremite penetran vasküler yaralanmasý tanýsýyla ameliyat edilen 249 hastanýn verileri retrospektif olarak deðerlendirildi. Hastalarýn 214’ü (%86) erkek, 35’i kadýndý (%14). Ortalama yaþ 24,76±11,28 idi (daðýlým, 2-69 yaþ). Hastalarýn 129’u (%52) self-mutilatördü.

BULGULAR
En sýk yaralanan arter ulnar arterdi (n=140, %56). Ölüm ve uzuv kaybý yaþanmadý. Ancak, penetran travmalý 8 hastada parmak hareket kýsýtlýlýðý ortaya çýktý. Erkek baskýnlýðý, madde baðýmlýlýðý ve eþlik eden sinir yaralanmasý varlýðý self-mutilatör grupta anlamlý olarak daha yaygýndý (sýrasýyla p deðerleri <0,001, <0,001 ve 0,005). Buna karþýlýk brakiyal arter yaralanma sýklýðý, ven greft interpozisyon kullanýmý ve fasyotomi oranlarý penetran travma grubunda daha yüksekti (p deðerleri <0,001).
SONUÇ
Üst ekstremite penetran travmalarýnda, yaralanma þekli ve sebebi dikkatlice sorgulanmalý, self-mutilasyon varlýðýnda madde baðýmlýlýðý araþtýrýlmalý ve self-mutilatör hastalara hemen psikiyatrik destek baþlanmasý saðlanmalýdýr.

BACKGROUND
Although vascular trauma of the upper extremity is increasingly more common, mortality and morbidity rates remain low, at between 0-8%. Self-mutilation has become evident in recent years. We planned this study to compare the results of self-mutilation with other penetrating trauma in upper extremity vascular injuries and also to emphasize the dangers of self-mutilation for society.
METHODS
Data of 249 patients with penetrating vascular injury of the upper extremity were retrospectively analyzed. There were 214 male (86%) and 35 female (14%) patients, with a mean age of 24.76 ± 11.28 years (range: 2-69 years). Of these, 129 (52%) were self-mutilators.
RESULTS
The ulnar artery was the most frequently affected (n=140, 56%). There was no mortality or limb loss. However, eight (3.21%) patients, who had penetrating trauma, had restriction in finger motions. Male predominance, substance abuse and associated nerve injury were significantly more common among self-mutilators (p values <0.001, <0.001 and 0.005, respectively), whereas brachial artery injury, vein graft interposition and fasciotomy rates were higher among the penetrating trauma group (p<0.001 for all).
CONCLUSION
The form of and reason for injuries and presence of substance abuse in case of self-mutilation must be investigated cautiously, and the immediate commencement of psychiatric treatment must be provided to the self-mutilators.

AMAÇ
Spontan rektus kýlýf hematomu (RKH) akut karýn aðýsýnýn sýklýkla gözden kaçan nadir bir nedenidir. Bu çalýþmada, spontan RKH’nin taný ve tedavisindeki tecrübelerimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM
Bu çalýþmada, Ocak 2000-Temmuz 2009 tarihleri arasýnda acil cerrahi polikliniðine baþvuran ve spontan RKH tanýsý alan 15 hastanýn (12 kadýn, 3 erkek; ortalama yaþ 64,5 yýl; daðýlým 20-79 yýl) týbbi kayýtlarý retrospektif olarak incelendi.
BULGULAR
Tüm olgularýn baþvuru nedeni akut karýn aðrýsý ve/veya karýnda kitle idi. Toplam 11 olgu (%73) antikoagülan ve/veya antiagregan tedavisi almaktaydý. Antikoagülan/antiagregan tedavisin endikasyonlarý arasýnda en sýk olanlarý 5 hastada (%33) atriyel fibrilasyon ve 3 hastada (%20) mitral kapak replasmaný yer almakta idi. Taný 14 olguda (%93) karýn ultrasonografisi ve/veya bilgisayarlý tomografi ile kondu. Hastalarýn 12’si (%80) ortalama 8,8 gün (daðýlým 3-24 gün) yatýþ süresi sonrasý konservatif tedavi ile sorunsuz bir þekilde taburcu edildi. Mortalite oraný %20 idi.
SONUÇ
Akut karýn aðrýsý ile baþvuran ve antikoagülan tedavisi almakta olan ileri yaþ hastalarýnda spontan RKH’den þüphe edilmelidir. Erken taný konservatif tedaviye olanak saðlayarak gereksiz cerrahi giriþimleri önler.

BACKGROUND
Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.
METHODS
This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).
RESULTS
All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.
CONCLUSION
Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

AMAÇ
Koroziv madde içen çocuklarda özofagus yaralanma þiddetinin göstergelerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Bir yýllýk süre içinde kazayla koroziv madde içen ve tanýsal endoskopi yapýlan çocuklarýn bilgileri geriye dönük olarak incelendi. Koroziv madde içen ve endoskopi yapýlan toplam 134 çocuk (74 erkek ve 60 kýz) bu çalýþmaya dahil edildi. Hastalar düþük ve yüksek dereceli özofagus yaralanmasý olarak iki gruba ayrýldý. Düþük ve yüksek derecede özofagus yaralanmasý saptanan hastalardaki sýk görülen bulgu, belirti ve kan beyaz küre sayýsýnýn tahmin edici deðerleri istatistiksel olarak analiz edildi.
BULGULAR
Ýlk incelemede hastalarýn çoðunda (%70) belirti veya bulgu yoktu. Aðýzdan salya akmasý ve aðýz içi yaralar yüksek dereceli yaralanmalarda anlamlý olarak yüksek idi (p<0,05). Ortalama beyaz küre sayýsý, yüksek dereceli özofagus yaralanmalý grupta düþük dereceli yaralanmalý gruptan anlamlý olarak yüksek bulundu (p<0,05). Klinik bulgularýn duyarlýlýðý, seçiciliði ve tahmin edici deðerleri analiz edildiðinde, hiçbirinin özofagus yaralanmasýný tahmin etmede deðerli olmadýðý bulundu. Ortalama beyaz küre sayýsý duyarlý bulundu, ancak iyi bir gösterge olmadýðý bulundu.
SONUÇ
Çalýþmamýz kazayla koroziv içen çocuklarda klinik bulgular ile özofagus yaralanma þiddeti arasýnda iliþki olduðunu gösterdi, kesin taný için özofagusun doðrudan gözlenmesi gerekmektedir.

BACKGROUND
The aim of the study was to investigate the indicators of corrosive esophageal injury (EI) severity in children.
METHODS
We retrospectively reviewed data from children who accidentally ingested corrosive substance and underwent endoscopic evaluation over a one-year period. A total of 134 consecutive children with corrosive agent ingestion who underwent diagnostic endoscopy (74 boys, 60 girls) were included in this study. Patients were divided into two groups as low-grade and high-grade EI. Statistical differences and predictive values of common signs and symptoms and white blood cell (WBC) count of patients with low- and high-grade EI were analyzed.
RESULTS
The majority of patients (70%) were asymptomatic at the initial examination. We found that drooling saliva and oral lesions were significantly more frequent in high-grade injury (p<0.05). Mean WBC count in the high-grade EI group was significantly higher than in the low-grade EI group (p=0.000). Sensitivity, specificity and predictive values of clinical findings in children were analyzed; none of them was shown to be valuable for estimating EI severity. WBC count was sensitive, but it is not a good predictor.
CONCLUSION
Our study demonstrated the relationship between clinical findings and corrosive EI severity in children with accidental corrosive ingestion, but direct visualization of the esophagus is required for definitive diagnosis.

AMAÇ
Cerrahi travma ve ilgili komplikasyonlarý azaltmak için, ciddi panfasiyal kýrýklara minimal invazif yaklaþýmlarýn kullanýmý gittikçe artmaktadýr. Bu çalýþmada, ciddi panfasiyal kýrýklarda ideal cerrahi yaklaþýmlar amaçlanmýþtýr.
GEREÇ VE YÖNTEM
On altý panfasiyal kýrýklý hasta çalýþmaya dahil edildi. Le Fort III kýrýklý altý, Le Fort II kýrýklý dört ve iki taraflý maksilla ve orbital taban kýrýklý altý hastada minimal invazif yaklaþýmlar kullanýldý. Orbital, maksiller, zigomatikomaksiller bileþke ve nazoetmoidal kýrýklara yaklaþmak için sýrasý ile subsilier, aðýz içi vestibular ve lateral kaþ insizyonlarý kullanýldý.

BULGULAR
Tüm kýrýklar miniplak ve vidalar ile onarýldý. Hematom, yara enfeksiyonu ya da diðer komplikasyonlar gözlenmedi.

SONUÇ
Ciddi panfasiyal kýrýklarda, minimal invazif yaklaþýmlarýn estetik sonuçlar açýsýndan uygun ve etkin olduðu göz önünde bulundurulmalýdýr.

BACKGROUND
Minimally invasive approaches to severe panfacial fractures are being used increasingly to reduce surgical trauma and the related complications. In this study, it was aimed to determine the ideal surgical approaches in severe panfacial fractures.
METHODS
Sixteen patients with severe panfacial fractures were included in this study. Minimally invasive approaches were used for Le Fort III fracture in six patients, for Le Fort II fracture in four patients, and for bilateral maxillary and orbital floor fractures in six patients. We used subciliary, intraoral vestibular, lateral eyebrow incisions to reach orbital, maxillary, zygomaticomaxillary buttress, and nasoethmoidal fractures, respectively.
RESULTS
All fractures were repaired with miniplates and screws. No hematoma, wound infections or other complications were observed.
CONCLUSION
Minimally invasive approaches in severe panfacial fractures are considered suitable and effective in terms of aesthetic results.

AMAÇ
Þiddet olaylarýnýn sýklýðý artmaktadýr. Bu artýþ acil servis çalýþanlarýnýn konu ile ilgili görevliler gelene kadar saklama, koruma, kayýt tutma ve kanýt toplama durumlarýnda önemini artýrmýþtýr. Bu çalýþmada, acil servislerde çalýþan saðlýk bakým personelinin adli olgularda delillerin korunmasý ve saklanmasý ile ilgili bilgi ve uygulamalarý incelendi.
GEREÇ VE YÖNTEM
Tanýmlayýcý tipte planlanan bu araþtýrma Ekim 2008 ile Ocak 2009 tarihleri arasýnda Bolu il merkezinde acil servisi bulunan hastanelerde, araþtýrmaya katýlmaya istekli hemþireler, saðlýk memurlarý ve acil týp teknikerleri olmak üzere 44 saðlýk bakým personeli ile gerçekleþtirildi.
BULGULAR
Saðlýk bakým personelinin %90,9’unun adli olgu ile karþýlaþtýðý, %65,9’unun adli olgularla ilgili eðitim almadýðý ve %22,7 hastanýn elbiselerini dikkatlice çýkartýp saklamayacaðý görüldü. Saðlýk bakým personelinin %90,9’unun adli bir olgularda üzerine düþen görev ve sorumluluklarý tam olarak yerine getirdiðini düþünmelerine raðmen, onlarýn %18,2’sinin delillerin saklanmasý ve korunmasý konusunda yeteri kadar bilgiye sahip olduðu görüldü.
SONUÇ
Saðlýk bakým personelinin büyük çoðunluðunun delillerin saklanmasý ve korunmasý konusunda yeteri kadar bilgiye sahip olmadýðý görüldü.

BACKGROUND
The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases.
METHODS
This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009.
RESULTS
It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.
CONCLUSION
It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.

AMAÇ
Araþtýrma eðitmenler aracýlýðý ile 0-6 yaþ grubu çocuðu olan ailelere ev kazalarý konusunda eðitim verilmesi ve evlerinin ev kazalarý açýsýndan daha güvenli hale getirilmesi amacýyla yapýldý.
GEREÇ VE YÖNTEM
Eðitici özelliði olan, 0-6 yaþ grubuyla ve aileleriyle doðrudan ilgilenen toplam 563 kiþiye eðitim verildi. Eðitmenler 0-6 yaþ grubu çocuk sahibi 10 anne ile görüþerek, toplam 5117 anneye öncelikle ev kazasý güvenlik testini uygulayarak, annelere kýsa bir eðitim ve broþürler verdiler. Ev kazasý güvenlik puaný düþük olan toplam 500 eve ev kazasý güvenlik ürünleri daðýtýldý ve malzemelerin kullaným durumu deðerlendirildi.
BULGULAR
Eðitmenlerin test öncesi ve sonrasý puan ortalamalarý arasýnda istatistiksel olarak anlamlý bir fark saptandý. Ev kazasý güvenlik testinin ortalama puaný ev kazasý güvenlik ürünleri daðýtýlmadan önce 75,50±8,22, daðýtýldýktan sonra 90,50±7,77 olarak bulundu ve aralarýnda istatistiksel olarak anlamlý bir fark saptandý (p<0,05).
SONUÇ
0-6 yaþ dönemindeki çocuklarýn kazalardan korunmasýnda ailelerin risk faktörleri ve korunma yollarý konusunda eðitilmesi, evlerin güvenli hale getirilmesi önerilebilir.

BACKGROUND
Research was carried out to train families with children between the ages of 0-6 years regarding home accidents and how to make their homes safer.
METHODS
Five hundred and sixty-three people who exhibited potential trainer qualities and who dealt directly children aged 0-6 years and their families were trained. Trainers applied a home accident safety test to 5117 mothers. Each trainer interviewed 10 mothers with children aged 0-6 years, and a short training was provided and brochures were delivered. Home accident safety products were distributed to 500 homes with low home accident safety scores, and these homes were evaluated regarding the usage of the products.
RESULTS
A significant difference was found between pretest-posttest average scores of trainers. The average score on the home accident safety test was 75.50±8.22 before the distribution of home accident safety products, and this increased to 90.50±7.77 after the distribution of those products, and the difference was statistically significant (p<0.05).
CONCLUSION
Training the families on risk factors and ways of making their homes safer could be recommended to protect children aged 0-6 years from home accidents.

Primer apendajitis epiploika, kolonun epiploik apendikslerinin kendi kendini sýnýrlayýcý nadir bir enflamatuvar hastalýðýdýr. Cerrahi gerektiren bir hastalýk olmayýp, cerrahi tedavi gerektiren akut karýn hastalýklarýný taklit edebilir. Bu yazýda, ender görülen bu hastalýðýn bilgisayarlý tomografi (BT) bulgularý sunuldu. Yirmi bir yaþýnda erkek hasta, son üç gündür sol lumbar bölgede aðrý þikayeti ile acile baþvurdu. Fiziksel incelemesinde subfebril ateþ, sol lumbar bölgede hassasiyet ve defans, laboratuvar incelemesinde lökositoz saptandý. Karýna yönelik BT incelemesinde, inen kolon anterior komþuluðunda, yað dansitesinde, çevresel hiperdens rimi bulunan kitlesel lezyon saptandý.
Radyolojik olarak primer apendajitis epiploika olarak deðerlendirilip antibiyoterapi baþlandý. Semptom baþlangýcýnýn dokuzuncu gününde klinik iyileþme görüldü.

Primary epiploic appendagitis is a rare, self-limiting inflammatory disease of epiploic appendices of the colon. Although treatment options do not include surgery, it sometimes mimics acute abdominal diseases for which surgery is required for treatment. We present the computed tomography findings of this rare disease in our case report. A 21-year-old male patient admitted to the emergency ward with a three-day history of left lumbar pain. Physical examination revealed low-grade fever and tenderness and defense with left lumbar localization; laboratory findings revealed leukocytosis. Abdominal computed tomography workup showed a mass lesion with fat density in the anterior neighborhood of the descending colon, with a hyperdense rim. Antibiotic treatment was started after radiological assessment as primary epiploic appendagitis. Clinical healing was seen on the ninth day from the onset of symptoms.

Kapalý vertikal sakral kýrýk ve simfizis pubis ayrýlmasý ile birlikte olan lumbosakral bileþke yaralanmasý, özellikle geç baþvuran çok nadir bir yaralanma þeklidir. Bildiðimiz kadarýyla literatürde, pelvik kýrýklarla birlikte olan ve kronik bir durumda baþvuran böyle bir lumbosakral yaralanmanýn karmaþýklýðý ile ilgili hiçbir bilgi sunulmamýþ veya böyle bir olgu tanýmlanmamýþtýr. Biz, nörolojik defisitlerle birlikte olan ve geç baþvuran kompleks bir lumbosakral kýrýk-dislokasyonu, pelvik halka ayrýlmasý ve bir vertikal sakral kýrýk olgusunu ortaya koymayý ve bu olgunun tedavisindeki güçlükler ile kesin tedavi için kullanýlan ameliyat tekniðini vurgulamayý amaçladýk. Ýlk olay üç ay önce olmuþtu. Ýskelet traksiyonu ile kapalý redüksiyon baþarýsýz olmuþtu; bu nedenle, pedikül vidalar, iliyak vidalar ve çubuk (rods) sistemi yoluyla indirekt redüksiyon yöntemiyle cerrahi düzeltme gerçekleþtirilmiþtir. Posterior bir yaklaþýmla, posterior lumbo-pelvik segmental fiksasyon ve posterolateral füzyon ile kesin stabilizasyon gerçekleþtirilmiþtir. Cerrahiden bir yýl sonra, neredeyse tam bir deformite düzeltmesi ve solid posterolateral füzyon ile birlikte, klinik yanýt tatmin edici olmuþtur. Hasta, ameliyat öncesi nörolojik defisitten kýsmen kurtulmuþtur. Biz, burada, geç dönemde baþvuran sýradýþý ve kesin tedaviden önce titiz bir tedavi, görüntüleme ile cerrahi teknik planlamasý gerektiren kompleks spondilo-pelvik yaralanma paternine sahip bir hasta bildirmekteyiz.

Combination of lumbosacral junction injury with closed vertical shear sacral fracture and disruption of the symphysis pubis is a very rare pattern of injury, particularly with a late presentation. To our knowledge, the complexity of such a lumbosacral injury with pelvic fractures, which was presented with a chronic condition, has never been addressed or identified in the previous literature. We aimed to demonstrate a case with a late presentation of a complex lumbosacral fracture-dislocation, pelvic ring disruption and a vertical shear sacral fracture with neurological deficits and to emphasize the difficulties in the management in this case and the operative technique used for the definitive treatment. The initial event had occurred three months earlier. Closed reduction by skeletal traction had failed; therefore, surgical correction was performed by means of indirect reduction via pedicle screws, iliac screws and rods system. Definitive stabilization with posterior lumbo-pelvic segmental fixation and posterolateral fusion were performed using a posterior approach. At one year after surgery, the clinical result was satisfactory with almost complete correction of a deformity and solid posterolateral fusion. The patient had partial recovery from the preoperative neurological deficit. We report herein a patient with a very unusual complex spondylo-pelvic injury pattern with late presentation, which required meticulous planning of management, imaging, and surgical technique before definitive treatment.

Bu yazýda, primer hiperparatiroidden kaynaklanan çoklu kistik lezyonlar ve kistik lezyonlar seviyesindeki patolojik femur ve karþý tibia kýrýklarý olan genç kadýn hasta bildirilmektedir. Hastanýn hikayesinde dispepsi, iþtah kaybý, miyalji, artralji, yorgunluk ve kilo kaybý gibi müphem bulgulardan dolayý 6 yýl önce hastaneye baþvurma hikayesi vardý, fakat herhangi bir hastalýk saptanmamýþtý. Zamanla iþtahsýzlýk ve zayýflamasýnýn devam ettiði, son 1 yýldýr sadece yardýmla yürüyebildiði öðrenildi. Fakat bizim incelememize kadar hastada primer hiperparatiroidi atlanmýþ idi. Kýrýklarýn, biyopsi ile osteitis fibroza sistikadan kaynaklandýðý teyit edildikten sonra intramedüller çivileme ve primer greftleme ile tedavi edildi. Kýrýklar sorunsuz bir þekilde kaynadý. Sonuç olarak, bu tür müphem þikayetleri olan hastalarýn biyokimyasal ve radyolojik yöntemlerle taranmasý ve hastalýðýn atlanmamasý oldukça önemlidir.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient’s history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

Bu yazýda, pelvis kýrýðý, karaciðer laserasyonu ve çýkan kolon yaralanmasýný içeren çoklu organ yaralanmasýnýn eþlik ettiði yüksek enerji tipi travmatik karýn duvarý fýtýðý (TKDF) olgusu sunuldu. Travmanýn nedeni, yaklaþýk 8 metre yüksekten toprak zemin üzerine düþme idi. Düz zemine düþme esnasýnda karna etki eden kuvvetler farklý olduðundan, hasar mekanizmasý düþük enerjili bisiklet ya da motorsiklet gidonunun neden olduðu herniden veya yüksek enerji tipi diðer TKDF’den farklý olabilir. Literatürde yüksek enerji tipi TKDF raporlarý kýsýtlý sayýda olup, hepsi de açýlý veya kývrýmlý yüzey üzerine düþme hakkýndadýr. Bildiðimiz kadarýyla bu yayýn, düz yüzey üzerine düþme sonucu oluþan TKDF konusunda tektir. Taný ve tedavi özetlenmiþ, literatür gözden geçirilmiþ ve hasar mekanizmasý tartýþýlmýþtýr.

This article reports a case of high-energy type traumatic abdominal wall hernia (TAWH) associated with multiple organ injuries including pelvic fractures, liver laceration and ascending colon perforation. The cause of the trauma was falling to the ground from a height of approximately 8 meters. Since the forces affecting the abdomen are unique when falling on a flat surface, the mechanism of defect may be different between a low-energy type handlebar hernia and high-energy type TAWH. Only a few cases of high-energy type TAWH exist in the literature, all reporting falling on or hitting an angled or curved material. To our knowledge, this is the only report of TAWH resulting from falling onto a flat surface. The diagnosis and management are summarized, the literature data are reviewed, and the mechanism of action is discussed.

Motorlu taþýt kazalarýnýn giderek artan oranlarda karþýmýza çýkmasý kalp ve büyük damar yaralanmalarýnýn daha sýk görülmesine yol açmaktadýr. Ýnen aortanýn gerek akut, gerekse kronik travmatik lezyonlarýnda endovasküler tedavi, bu konuda uzmanlaþmýþ merkezlerde düþük morbidite ve mortalite ile uygulanabilmektedir. Burada motorlu taþýt kazasý sonrasý akut veya kronik travmatik torasik aort anevrizmasý geliþen beþ olgunun endovasküler stent-greft ile baþarýlý tedavisi anlatýlmýþtýr.

Endovascular stent-grafting of the aorta, as an alternative to open surgical techniques, is gaining in popularity everyday, especially in high-risk patients. Acute or chronic traumatic lesions of the descending aorta, especially after motor vehicle accidents, constitute such a group with a high-risk of morbidity and mortality. Here, we report the successful endovascular repair of acute and chronic traumatic thoracic aortic aneurysms after motor vehicle accidents in five patients.

Ýyi huylu, soliter çekum ülseri genellikle çekum hastalýklarý içerisine dahil edilmeyen nadir bir klinik durumdur. Etyolojisi belli deðildir ve taný koydurucu bulgularý yoktur. Ameliyat öncesi ve ameliyat esnasýnda taný koymak zordur. Kesin taný genellikle çekumda tümör þüphesi nedeniyle sað hemikolektomi sonrasý çýkarýlan parçanýn histolojik incelemesi ile konur. Bu yazýda, ilk deðerlendirmede plastron apandisiti taklit eden tek çekal ülserli 70 yaþýnda kadýn hastayý sunduk.

The benign solitary cecal ulcer is a rare clinical entity that is not usually included in the differential diagnosis of the cecal diseases. The etiology is unknown, and there are no pathognomonic lesions or symptoms. Pre-operative and intra-operative diagnosis is difficult. Definitive diagnosis is generally obtained by histologic evaluation of the surgical specimen after a right hemicolectomy performed for a suspected neoplasm of the cecum. We herein describe a 70-year-old woman with solitary cecal ulcer presenting with abdominal pain, palpable mass on the right lower quadrant and leukocytosis, mimicking plastron appendicitis on initial evaluation.