AMAÇ
Bu çalýþmada, antioksidan özelliði bilinen glutaminin kullanýmýnýn iskemi-reperfüzyon sonrasý oluþabilecek oksidasyon hasarý üzerindeki etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM
Çalýþma grubu Wistar Albino sýçanlarla oluþturuldu. Grup 1, abdominal kompartman grubuydu. Anestezi altýndaki sýçanlarýn karnýna basýnç uygulandý. Gaz boþaltýldýktan 3 gün sonra sýçanlar sakrifiye edildi, karaciðer, baðýrsak ve akciðer doku parçalarýnda oksidatif hasar parametresi olarak malonildialdehit (MDA) ve glutatyon (GSH) seviyeleri ile enflamatuvar parametre olarak miyeloperoksidaz (MPO) aktivitesi ölçüldü. Alýnan kan örneklerinde serum alanin-aminoasit transferaz (ALT) ve aspartat-aminoasit transferaz (AST) seviyeleri ölçüldü. Grup 2, abdominal kompartman ve glutamin uygulanan gruptu. Sýçanlara 1 hafta boyunca yüksek doz glutamin mide gavajý yolu ile verildi. Gavaj iþlemi sonrasý ilk gruptaki batýn içi basýnç uygulamasý yapýldý, 3 gün daha glutamin verilen sýçanlar sakrifiye edildi, Grup 1’deki iþlemlerin aynýsý yapýldý. Grup 3 glutamin grubuydu. Grup 4 sham kontrol grubuydu.
BULGULAR
Abdominal kompartman yaratýlan sýçanlarda MDA düzeyi ve MPO aktivitesi kontrol grubuna göre anlamlý oranda artmýþtý. Glutamin ile MDA düzeyi ve MPO aktivitesi azaldý, GSH seviyesi arttý.
SONUÇ
Oksidatif hasar parametrelerine bakýldýðýnda, glutaminin, reperfüzyon hasarýný azaltýcý etkisinin antienflamatuvar ve antioksidan etkilerine baðlý olduðu düþünülmüþtür.

BACKGROUND
The aim was to investigate whether or not glutamine, an antioxidant effective amino acid, improves the reperfusion-induced oxidative injury of abdominal hypertension.
METHODS
Wistar Albino rats were used. Group 1: Abdominal compartment syndrome alone: With the rats under anesthesia, intraabdominal pressure was obtained. Three days later, the rats were sacrificed, and intestine, lung and liver samples were removed for determination of tissue malondialdehyde (MDA) and glutathione (GSH) levels as oxidative injury parameters and of myeloperoxidase (MPO) activity as an inflammatory parameter. Trunk blood was analyzed for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Group 2: Abdominal compartment syndrome and glutamine: intragastric glutamine was given for seven days before and three days following establishment of the abdominal compartment syndrome model. The same examination procedure was then performed. Group 3: Glutamine administration alone. Group 4: Control group.
RESULTS
Intraabdominal pressure significantly increased the intestine, lung and liver MDA levels and MPO activities in comparison to the control group. Glutamine was associated with decreased MDA levels and MPO activities and increased GSH levels.
CONCLUSION
Glutamine appears to have protective effects against reperfusion-induced oxidative damage via its anti-inflammatory and antioxidant effect.

AMAÇ
Bu çalýþmada, sýçanlarda oluþturulan deneysel duodenum perforasyonunda klasik cerrahi teknikler ile adezyon bariyerleri olan DuraSeal ya da fibrin yapýþtýrýcýyla yapýlan dikiþsiz onarým tekniklerinin karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Kýrk adet yetiþkin, aðýrlýklarý 250-300 g arasýnda olan, diþi Wistar Albino sýçan rastgele dört adet eþit gruba ayrýldý. Primer onarým grubu, primer onarým ve omentoplasti grubu, fibrin yapýþtýrýcý uygulanan grup ve DuraSeal uygulanan grup. Doku iyileþmesini deðerlendirmek amacýyla patlama basýncý, doku hidroksiprolin seviyesi ve histopatolojik inceleme parametre olarak kullanýldý.
BULGULAR
Primer onarým, primer onarým ve omentoplasti gruplarýnýn patlama basýncý deðerleri fibrin yapýþtýrýcý ve DuraSeal grubu patlama basýncý deðerlerine göre anlamlý olarak yüksekti (p<0,001). Biyokimyasal ve histolojik parametreler açýsýndan tüm gruplar arasýnda anlamlý farklýlýk yoktu.
SONUÇ
Deðerlendirdiðimiz dikiþsiz onarým tekniklerinin konvansiyonel onarým tekniklerine üstün etkilerinin olmadýðýný gözlemledik. Dikiþsiz onarým gruplarýnýn sonuçlarý benzerdi. DuraSeal, fibrin yapýþtýrýcý gibi dikiþsiz onarým alanýnda alternatif olabilir. Bu çýkarým farklý yara iyileþmesi belirteçleri ve farklý yöntemlerle planlanmýþ çalýþmalarla desteklenmelidir.

BACKGROUND
The purpose of the study was to compare classical primary suture repair and sutureless repair with fibrin glue or DuraSeal adhesion barrier for the closure of duodenal perforation in rats.
METHODS
Forty adult female Wistar Albino rats weighing between 250-300g were randomly divided into four equal groups. Primary repair, primary repair and omentoplasty, or application of fibrin glue or DuraSeal adhesion barrier was performed in each of the four groups, respectively. The bursting pressure, tissue hydroxyproline levels and histopathology were evaluated.
RESULTS
Bursting pressure values of the primary repair and primary repair and omentoplasty groups were significantly higher than in the fibrin glue and DuraSeal groups (p<0.001). There were no significant differences between the experimental groups regarding hydroxyproline levels and histological parameters.
CONCLUSION
The sutureless methods (Fibrin glue, DuraSeal) have no superior effects when compared with the conventional repair techniques. We observed similar results between the sutureless repair groups; thus, DuraSeal can be considered an alternative to fibrin glue for this purpose. This suggestion must be supported with new studies, however, which would be planned with other wound healing markers and different designs.

AMAÇ
Bu deneysel çalýþma, sýçanlarda spinal kord yaralanmasýnda curcuminin antioksidan etki yoluyla faydasýný araþtýrmak için yapýldý.
GEREÇ VE YÖNTEM
Yirmi dört adet Wistar albino sýçan 3 gruba randomize edildi. Spinal kord yaralanmasý aðýrlýk düþürme modeliyle gerçekleþtirildi. Grup 1’e laminektomi ardýndan spinal kord yaralanmasý uygulandý ve herhangi bir tedavi verilmedi. Grup 2’ye laminektomi ardýndan spinal kord yaralanmasý uygulandý ve curcumin verildi (200 mg/kg/gün aðýzdan). Grup 3’e laminektomi ardýndan spinal kord yaralanmasý uygulandý ve metilprednizolon verildi (30 mg/kg periton içine), 24 saat sonra tüm sýçanlardan kan örnekleri alýndý, sonra serum süperoksit dismutaz (SOD) ve malondialdehit (MDA) düzeyleri belirlendi ve elde edilen sonuçlar karþýlaþtýrýldý.
BULGULAR
Curcumin grubunda SOD düzeyi kontrol ve metilprednizolon grubundan daha yüksekti (p<0,001 ve p<0,012). Curcumin grubunda MDA düzeyi kontrol grubundan daha düþüktü (p<0,042). Benzer þekilde metilprednizolon grubunda MDA düzeyi kontrol grubundan daha düþüktü (p<0,001).
SONUÇ
Bu çalýþmanýn sonuçlarý curcuminin etkin biçimde oksidatif hasara karþý spinal kord dokularýný koruduðunu gösterir.

BACKGROUND
This experimental study was performed to investigate the benefit of curcumin via its antioxidant effect on spinal cord injury (SCI) in rats.
METHODS
Twenty-four adult Wistar albino rats were randomized into three groups. SCI was performed by the weight-drop model. Group 1 underwent laminectomy followed by SCI and received no medication. Group 2 underwent laminectomy followed by SCI and received curcumin (200 mg/kg/day orally). Group 3 underwent laminectomy followed by SCI and received methylprednisolone (30 mg/kg intraperitoneally). Twenty-four hours later, blood samples were obtained from all rats; serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were determined, and the obtained results were compared.
RESULTS
SOD level in the curcumin group was higher than in the control group (p<0.000) and methylprednisolone group (p<0.012). MDA level in the curcumin group was lower than in the control group (p<0.042). Similarly, the MDA level in the methylprednisolone group was lower than in the control group (p<0.001).
CONCLUSION
The results of the present study show that curcumin effectively protects the spinal cord tissues against oxidative damage.

AMAÇ
En sýk akut karýn nedenlerinden birisi olan akut apandisitin tanýsýnda öncelikle kullanýlan inceleme yönteminden biri de ultrasonografidir (USG). Bu çalýþmada USG’nin akut apandisit tanýsýndaki güvenilirliði araþtýrýldý.
GEREÇ VE YÖNTEM
Prospektif olarak yapýlan bu çalýþmada 2007 yýlýnda acil cerrahi polikliniðimize baþvuran hastalarda fiziksel inceleme ve laboratuvar incelemeleri sonucu akut apandisit öntanýsýyla ameliyata karar verilen 235 hastaya tüm karýn USG’si yapýldý. Daha sonra bu hastalara apendektomi yapýldý; piyesler histopatolojik olarak incelendi.
BULGULAR
Bu çalýþmaya 235 hasta alýndý. Bu hastalarýn 193’ünün (%82,1) histopatolojik sonucu akut apandisit geldi, 42’sinin (%17,9) ise histopatolojik sonucu akut apandisit çýkmadý. USG sonucu akut apandisit olan 150 hastanýn histopatolojik olarak 133’ünün (%88,67) akut apandisit olduðu, USG’nin normal olduðu 85 hastanýn ise histopatolojik olarak 60’ýnýn akut apandisit olduðu saptandý. Histopatolojik tanýsý akut apandisit olan hastalarýn %31,1’ine USG ile taný konamadý.
SONUÇ
USG’si akut apandisit olan hastalarýn histopatolojisinin akut apandisit olmasý arasýnda duyarlýlýk %69, özgüllük %60, pozitif kestirim deðeri 0,89, negatif kestirim deðeri 0,30, doðruluk 0,67 bulunmuþtur. USG akut apandisit tanýsýný koymada ancak yardýmcý bir yöntem olabileceði ve USG’nin anamnez ve fiziksel incelemenin önüne geçirilmemesi gerektiði kanaatine varýldý.

BACKGROUND
Abdominal ultrasonography (US) is the most commonly used diagnostic tool for diagnosing acute appendicitis, which is one of the most common causes of acute surgical abdomen. In this study, we examined the reliability of US for diagnosing acute appendicitis.
METHODS
In this prospective study, we performed abdominal US on 235 patients admitted to our surgical emergency department during 2007 and diagnosed as acute surgical abdomen according to the physical examination and laboratory findings. These patients were surgically treated by appendectomy, and the materials were pathologically examined.
RESULTS
Two hundred thirty-five patients were admitted to this study. One hundred ninety-three of these patients (82.1%) were diagnosed as acute appendicitis, and 42 (17.9%) were diagnosed differently. One hundred thirty-three (88.67%) of 150 patients diagnosed as acute appendicitis on US examinations were also reported as acute appendicitis on histopathological examination. Sixty of 85 patients diagnosed differently on US examination were reported as acute appendicitis on histopathological examination.
CONCLUSION
The sensitivity of abdominal US for diagnosing acute appendicitis was determined as 69%. The specificity was calculated as 60%, positive predictive value as 0.89, negative predictive value as 0.30, and accuracy as 0.67. Abdominal US is a helpful diagnostic tool for diagnosing acute appendicitis. However, it should not be seen as superior to anamnesis and physical examination findings.

AMAÇ
Acil servislerde çalýþan hekimler adli rapor düzenleme görevini sýklýkla yerine getirmektedir. Pek çok nedenden dolayý bu raporlarda istenmeyen hatalar bulunmakta ve bu hatalar devam eden adli iþlemlerde sorunlara yol açmaktadýr. Bu çalýþmada, üniversite hastanesinde belirli bir süre içinde düzenlenen adli raporlar deðerlendirilerek hata ve eksiklikler yönünden gözden geçirilmesi amaçlandý.
GEREÇ VE YÖNTEM
01.06.2005 - 30.06.2009 tarihleri arasýnda Pamukkale Üniversitesi Araþtýrma Uygulama Hastanesi Acil Servisinde düzenlenen adli raporlarýn olgu türlerine göre daðýlýmlarý belirlendi ve içeriðindeki yanlýþlýk ve eksiklikler ile okunaklýlýðý araþtýrýldý. Belirlenen süre içerisinde acil servise müracaat ettiði anlaþýlan 3499 adli olgudan raporuna ulaþýlabilen 3219’u deðerlendirmeye alýndý.
BULGULAR
En sýk olgu türünün trafik kazalarý ile kesici-delici alet yaralanmalarý olduðu, hayati tehlike kavramýnýn doðruluðu yönünden sýkça hata yapýldýðý, kimlik bilgileri ile olay saati ve muayene saati hususlarýnýn sýkça eksik býrakýldýðý tespit edildi.
SONUÇ
Hekimlerin adli rapor düzenlerken kesin rapor düzenlemekten önemli ölçüde imtina etmeleri, bilgi ve bulgularýn yeterli olduðu olgularda bile geçici rapor düzenleme yoluna gitme eðiliminde bulunmalarý bu konudaki eðitim eksikliklerine baðlýdýr. Ayný zamanda hayati tehlike, basit týbbi giriþimle giderilebilirlik gibi konulardaki yanlýþlýklar da bu konudaki eðitim ve hassasiyet eksikliðinden kaynaklanmaktadýr. Mezuniyet öncesi ve sonrasý adli týp eðitimi üst düzeyde önemsenmeli, hekimlerin yasal sorumluluklarý konusunda farkýndalýk yaratýlarak, bu konuda periyodik meslek içi eðitimler düzenlenmelidir.

BACKGROUND
Doctors working in emergency services often fulfill the task of preparing judicial reports. For a number of reasons, these reports have undesirable mistakes that become problematic in subsequent judicial processes. This study aimed to evaluate the judicial reports that were prepared over a certain period at a university hospital with regard to any mistakes or deficiencies.
METHODS
The distribution of the judicial reports prepared between 01 June 2005 and 30 June 2009 in the emergency service of a University Research and Training Hospital was determined with respect to the types of cases, and their contents were studied for mistakes, deficiencies and legibility. Out of 3499 visits to the emergency service during the specified period, 3219 judicial reports that were accessible were considered in the evaluation.
RESULTS
It was determined that the most frequent types of cases were traffic accidents and injuries by sharp and penetrating instruments. Furthermore, many mistakes were made frequently regarding the presence of life-threatening conditions, and personal identification information and times of the event and examination were often incomplete.
CONCLUSION
The fact that the doctors largely failed to prepare precise reports and tended to write unsatisfactory reports even for cases with adequate information and findings was attributed to their insufficient training in this area. At the same time, mistakes in life-threatening situations and in treatment by using simple medical interventions stem from lack of training and sensibility. Pre- and post-graduate forensic medicine education must be considered highly important, and periodic on-the-job training must be organized, creating a better awareness among doctors regarding their legal responsibilities.

AMAÇ
Nekrotizan fasiit, nadir görülen ancak hayatý tehdit eden, esas olarak yüzeyel fasiya ve deri altý dokuyu tutan bir yumuþak doku enfeksiyonudur.
GEREÇ VE YÖNTEM
Bu çalýþmada 2004-2008 yýllarý arasýnda nekrotizan fasiit tanýsýyla Akdeniz Üniversitesi Týp Fakültesi Ýnfeksiyon Hastalýklarý ve Klinik Mikrobiyoloji servisinde yatan ve diðer kliniklerde yatarken enfeksiyon hastalýklarý ve klinik mikrobiyoloji konsültasyonlarýyla takip ve tedavi edilen 44 hasta retrospektif olarak incelendi. Hastanemizdeki etkenlerin daðýlýmý, yerleþim yeri, eþlik eden hastalýklar ve risk faktörlerinin ortaya konulmasý amaçlandý.
BULGULAR
Çalýþmamýz sonucunda diyabetes mellitus, travma ve cerrahi, nekrotizan fasiit oluþumunda rol oynayan predispozan faktörler arasýnda yer alýrken en sýk alt ekstremitede ve perianal bölgede yerleþtiði tespit edildi. Etyolojide polimikrobiyal etkenler ilk sýrada yer alýrken mortalite oraný %25 olarak saptandý.
SONUÇ
Bu çalýþmayla enfeksiyon acilleri arasýnda yer alan nekrotizan fasiit olgularýnýn hastanemizdeki izlem sonuçlarý deðerlendirilmiþtir.

BACKGROUND
Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue.
METHODS
We conducted a retrospective study of 44 patients with necrotizing fasciitis between 2004 and 2008 in Akdeniz University Hospital, Department of Infectious Diseases and Clinical Microbiology and other departments. The aim of this study was to determine the causative agents of the necrotizing fasciitis, and the localization, predisposing factors, and comorbid conditions.
RESULTS
We found that diabetes mellitus, trauma and surgery were the most important predisposing factors. Moreover, the lower extremity and perianal region were the most frequently involved sites. Polymicrobial agents were the most frequent and the mortality was found as 25%.
CONCLUSION
In conclusion, necrotizing fasciitis cases followed in our hospital were evaluated in this study.

AMAÇ
Acil plastik cerrahi polikliniðine baþvuran hasta sayýsý toplumlarýn sosyokültürel özelliklerine baðlý olarak ciddi farklýlýklar göstermektedir. Çalýþma bölgesinin yaygýnlýðý nedeni ile de plastik cerrahinin acil travmatolojideki önemi giderek artmaktadýr.
GEREÇ VE YÖNTEM
Bu çalýþmada, 2000-2004 yýllarý arasýnda Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Acil Plastik Cerrahi polikliniðine baþvuran 10,732 hastanýn etyoloji, cinsiyet, yaþ daðýlýmý, yaralanma özellikleri ve tedavileri retrospektif olarak deðerlendirildi.
BULGULAR
Baþvuran hastalarýn %64’ünde ön kol ve el yaralanmalarý, %28’inde maksillofasyal yaralanma ve %8’inde doku defektleri vardý. Hastalarda 4/1 oranýnda erkek baskýnlýðý vardý, yaþ ortalamasý 22,9 idi. Üst ekstremite yaralanmasý ile baþvuran hastalarýn %81’i erkek ve yaþ ortalamalarý 22,3 olarak bulundu. Üst ekstremite yaralanmasý olan hastalarda en sýk etyolojik neden, %33 ile cam kesisi idi. Maksillofasyal travma nedeniyle baþvuran hastalarýn yaþ ortalamasý 23,2 olarak saptandý. Baþ-boyun yaralanmasý olan hastalarýn %38’inde travma sebebi trafik kazasý idi.
SONUÇ
Tedavi edilen hasta sýklýðý ve özelliði göz önüne alýndýðýnda plastik cerrahinin acil travmatolojideki yeri ve öneminin her geçen gün artmakta olduðunu ve benzer bir çalýþma olmadýðý için bu çalýþmanýn literatüre katkýsý olacaðýný düþünmekteyiz.

BACKGROUND
The number of patients applying to the emergency Plastic and Reconstructive Surgery outpatient clinic varies considerably depending on the sociocultural profiles of societies. Due to the abundance of anatomic regions comprising the targets of this field of specialization, plastic surgery is continuously gaining in importance in emergency traumatology.
METHODS
In this study, 10,732 patients admitted to the outpatient clinic of Emergency Plastic Surgery in Þiþli Etfal Training and Research Hospital were evaluated retrospectively regarding etiology, sex, age distribution, injury characteristics, and treatment.
RESULTS
While 64% of all patients had forearm and hand injuries, 28% had maxillofacial injuries, and 8% had tissue defects. There was a male: female ratio of 4: 1, and the mean age of all patients was 22.9 years. The mean age of patients (males 81%) admitted with upper extremity injuries was 22.3 years. Most of the upper extremity injuries were due to glassware cuts (33%). The mean age of patients admitted with maxillofacial trauma was 23.2 years. Among the patients with head-and-neck injuries, the most frequent cause of trauma was traffic accidents (38%).
CONCLUSION
Regarding the frequency and characteristics of the patients treated, we suggest that plastic surgery shows a progressively increasing significance and widening field of practice in emergency traumatology and, as no similar study currently exists, ours will contribute significantly to the literature.

AMAÇ
Bu çalýþmada, trakeobronþiyal yaralanmalarýn taný ve tedavisinde kullanýlan yöntemleri araþtýrdýk ve literatürle karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM
Kliniðimizde 2003-2008 yýllarý arasýnda trakeobronþiyal yaralanma nedeni ile ameliyat edilen 9 olgu (7 erkek, 2 kadýn) çalýþmaya dahil edildi. Travma sonrasý trakeobronþiyal yaralanma nedeni ile ameliyat edilen 7 olgu ile entübasyon sonrasý trakeal yaralanma görülen 2 olgu incelendi. Olgular, yaþ, cinsiyet, travma tipi, klinik bulgular, yaralanma bölgesi, uygulanan giriþim ve sonuçlarý açýsýndan deðerlendirildi.
BULGULAR
Yaralanma 6 olguda künt travma, 1 olguda penetran travma sonucu gerçekleþirken, 2 olguda ise iyatrojenikti. Yaralanma 5 olguda trakeal, 4 olguda ise bronþiyal seviyede idi. Bir olguya üst bilobektomi, bir olguya trakeal rezeksiyon ve ucuca anastamoz, 3 olguya uçuca anastomoz ve 4 olguya ise primer tamir yapýldý. Bir olgu ameliyat sýrasýnda, bir olgu ise ameliyat sonrasý erken dönemde kaybedildi.
SONUÇ
Trakeobronþiyal yaralanmalarda erken taný önemlidir. Yaralanmanýn yerinin ve þeklini belirlenmesi için kullanýlan en önemli taný aracý bronkoskopidir. Tedavide rezeksiyondan mümkün olduðunca kaçýnýlmalý ve primer onarým tercih edilmelidir.

BACKGROUND
We aimed in this study to investigate and compare the diagnostic and therapeutic methods in tracheobronchial injuries.
METHODS
Nine cases (7 male, 2 female) operated between 2003 and 2008 because of tracheobronchial injury were included in the study. The cause of tracheobronchial injury was trauma in 7 cases and postintubation laceration in 2 cases. The cases were evaluated in terms of age, sex, type of trauma, clinical findings, localization of injury, performed diagnostic and therapeutic methods, and results.
RESULTS
The causes of tracheobronchial laceration were blunt trauma in 6 cases, penetrating trauma in 1 case and iatrogenic (postintubation) in 2 cases. Lacerations were in the trachea in 5 cases and at the bronchial level in 4 cases. Operations included right upper bilobectomy in 1 case, tracheal resection and end to end anastomosis in 1 case, end to end anastomosis in 3 cases, and primary repair in 4 cases. One case died during the operation and 1 case died postoperatively.
CONCLUSION
In tracheobronchial injuries, early diagnosis and treatment are very important. The most useful method is bronchoscopy for determining the type and localization of the injury. In treatment, primary repair should be preferred over anatomical resections whenever possible.

AMAÇ
Kafa travmalarý, özellikle kentlerde ve genç nüfusta en sýk görülen morbidite ve mortalite sebeplerinden biridir. Bu retrospektif çalýþmayla, kafa travmalarý ile ilgili ülkemiz epidemiyolojik veritabanýna katkýda bulunmayý amaçladýk.
GEREÇ VE YÖNTEM
Ocak 2003-Haziran 2008 tarihleri arasýnda, Samsun Mehmet Aydýn Eðitim ve Araþtýrma Hastanesi Nöroþirürji kliniðinde tedavi edilen 15 yaþ ve üstü 954 hasta retrospektif olarak incelendi. Hastalarýn 721’i (%75,5) erkek, 233’ü (%24,5) kadýndý. Hastalarýn %52,5’i 15-40 yaþ arasý genç nüfustu.
BULGULAR
Trafik kazalarý (%75) en sýk tespit edilen travma nedeniydi. Giriþ Glasgow Koma Skoruna (GKS) göre hastalarýn %48’inde hafif (GKS 13-15), %31’inde orta (GKS 9-12) ve %21’inde ise aðýr (GKS 3-8) kafa travmasý mevcuttu. Hastalarýn 177’si (%18,5) ameliyat edildi. Yapýlan ameliyatlar en sýk subdural hematom ve epidural hematom nedeniyleydi. Serimizde mortalite %19,4 (n=185) olarak bulundu. Bu hastalarýn travma nedeni incelendiðinde, trafik kazalarý yine ilk sýrada yer almýþtýr.
SONUÇ
Kafa travmalarý ile ilgili epidemiyolojik çalýþma ve verilerin artmasý, travmanýn oluþmadan engellenebilmesi açýsýndan önem taþýr. Serimizde, özellikle erkek hakimiyeti, travma sýklýðýnýn en yüksek olduðu yaþ gruplarý, travma ve mortalite sebepleri açýsýndan ülkemizde yapýlan diðer çalýþmalara benzer veriler elde edilmiþtir. Ancak, merkez bir hastane olmamýz sebebiyle orta ve aðýr kafa travmalarýnýn oransal fazlalýðý, mortalitemizi de etkilemiþtir.

BACKGROUND
Head traumas are among the most common causes of mortality and morbidity among young adults in urban areas. We aimed to contribute to the epidemiological database of our country with regard to head traumas.
METHODS
We retrospectively analyzed 954 patients older than 15 years with head trauma who were treated in the Neurosurgery Department of Samsun Mehmet Aydýn Education and Research Hospital between January 2003 and June 2008. Seven hundred twenty-one (75.5%) patients were male and 233 (24.5%) were female. Five hundred twenty-one (52.5%) were between 15-40 years old.
RESULTS
Traffic accident (75%) was the most common cause of head trauma. According to Glasgow Coma Score (GCS), 48% of the patients had mild (13-15), 31% moderate (9-12) and 21% severe (3-8) head injury. One hundred seventy-seven (18.5%) patients were operated. The commonest operations were performed for subdural and epidural hematomas. Mortality was 19.4% (185). Common causes of mortality were traffic accidents (77%) and gunshot injuries.
CONCLUSION
It is important to have local epidemiological studies and data about head traumas in order to prevent these traumas. In this study, the predominance of young men and the causes of trauma and mortality were similar to that reported in the related literature.

AMAÇ
Bu yazýda, çok nadir bir yaralanma olan femur baþý kýrýklarýnda tedavi stratejilerinin tartýþýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Mart 2006 ile Aralýk 2007 arasýnda acil servise femur baþý kýrýðý ile baþvuran beþ hastanýn altý kýrýðý incelendi. Cerrahi ve cerrahi dýþý yöntemlerle tedavi edilen hastalarýn fonksiyonel sonuçlarý karþýlaþtýrýldý.
BULGULAR
Hastalarýn yarýsý cerrahi yöntemle, yarýsý da cerrahi dýþý yöntemlerle tedavi edildi. Mükemmel ve iyi sonuçlarýn oraný %50 bulundu. Ýki taraflý yaralanmasý bulunan hastada avasküler nekroz geliþti. Bu hastada fonksiyonel sonuçlar kötü bulundu. Cerrahi ile tedavi edilen hastalardan birinde erken posttravmatik artrit görüldü, bu hastanýn fonksiyonel sonuçlarý orta bulundu.
SONUÇ
Minimum yumuþak doku travmasý ile anatomik redüksiyonun saðlanmasý bu kýrýklarýn tedavisindeki amacýmýz olmalýdýr. Parçalarýn en iyi görüntüsü hangi yaklaþýmla saðlanacaksa o yaklaþým tercih edilmelidir. Þu unutulmamalýdýr ki, tüm tedavi seçeneklerine raðmen bu hastalarýn fonksiyonel sonuçlarý kötü olabilmektedir.

BACKGROUND
In this article, we aimed to discuss treatment strategies in fracture of the femoral head, which is a very rare injury.
METHODS
We reviewed five patients (six fractures) who admitted to our emergency department due to femoral head fracture between March 2006 and December 2007. Functional outcomes of the patients who were treated operatively and nonoperatively were compared.
RESULTS
Half of the fractures were treated nonoperatively and half of them surgically. We observed a rate of 50% excellent to good results. Avascular necrosis developed in a patient with bilateral injury. The functional results were poor for this patient. Early posttraumatic arthritis was observed in a patient who was treated surgically; this patient had moderate results.
CONCLUSION
We should aim at anatomic reduction of the fragments with minimum soft tissue injury. The best approach should be chosen for excellent view of the fragments. We should not forget that half of these patients will have a poor outcome despite all treatment strategies.

AMAÇ
Bu çalýþmada, penis kýrýklarýn taný ve tedavisine yaklaþýmlar retrospektif olarak deðerlendirildi.
GEREÇ VE YÖNTEM
Ocak 1990 ile Ocak 2009 tarihleri arasýnda kliniðimize penis kýrýðý nedeniyle baþvuran 107 hasta retrospektif olarak deðerlendirildi. Hastalarýn yaþý, kýrýðýn nedeni, kýrýðýn oluþ zamaný, fiziksel inceleme bulgularý, radyolojik bulgular, uygulanan tedavi þekli ve ameliyat sonrasý komplikasyonlar kaydedildi. Beþ hastaya kavernozografi ve 8 hastaya retrograd üretrografi yapýldý.
BULGULAR
Cinsel iliþki ve uygunsuz ortamda erekte peniste detümesansý saðlamak için elle bükme penis kýrýðýnýn en sýk nedenleri olarak bulundu. Taný 102 hastada anamnez ve fiziksel incelemeyle kondu. Kavernozografi 5 hastada yapýldý. Üretral yaralanma düþünülen 8 hastaya retrograd üretrografi yapýldý. Yýrtýklar 101 hastada cerrahi olarak onarýldý, 6 hastaya ise konservatif tedavi yapýldý. Ameliyattan sonraki 6. ayda yapýlan kontrollerde konservatif tedavi yapýlan 6 hastanýn 3’ünde penil kurvatur geliþirken cerrahi yapýlan hastalarda hiçbir komplikasyon geliþmedi.
SONUÇ
Anamnez ve fiziksel inceleme ile kesin taný konulamayan hastalarda kavernozografi, üretra yaralanmasý þüphesi olanlara ise üretrografi yapýlmalýdýr. Penis kýrýðýnýn erken cerrahi onarýmý penis kurvatur geliþimini önlemek ve hýzlý iyileþmeyi saðlamak için önerilmektedir.

BACKGROUND
The aim of this study was to retrospectively evaluate our approach to the diagnosis and treatment of penile fracture.
METHODS
We retrospectively evaluated the results of 107 patients with penile fracture treated in our clinic between January 1990 and January 2009. Patient age, etiology of each fracture, history, physical examination results, radiologic findings, type of treatment, and postoperative complications were recorded. In 5 cases cavernosography was performed and in 8 cases retrograde urethrography.
RESULTS
The most common etiologies of penile fracture were coitus and manually bending the penis for detumescence. Diagnoses were made based on history and physical examination in 102 patients and cavernosography in 5 patients. In order to evaluate urethral injury in 8 cases, retrograde urethrography was performed. Rupture was repaired surgically in 101 patients, but 6 patients were treated conservatively. Among the 6 conservatively treated patients, 3 developed penile curvature 6 months post-treatment; no complications occurred in the surgically treated patients.
CONCLUSION
Cavernosography should be performed only when history and physical examination are insufficient for diagnosis, and retrograde urethrography should be performed when urethral injury is suspected. In order to prevent the development of penile curvature and to ensure rapid recovery, early surgical repair is advised.

AMAÇ
Yanýðý takiben ortaya çýkan mortalite oraný, önemli bir sonuç parametresidir. Bu çalýþmada, Tahran’da hastaneye yatýrýlan eriþkin yanýklý hastalarda mortalite ile birlikte olan faktörlerin belirlenmesi amaçlandý.
GEREÇ VE YÖNTEM
Bu çapraz karþýlaþtýrmalý çalýþma, Tahran’daki iki yanýk baþvuru merkezinde bir yýllýk periyotta yapýldý. Çalýþma periyodunda hastaneye yatýrýlan 1321 eriþkin (>15 yaþ) yanýklý hasta çalýþmaya kaydedildi. Mortalite ile birlikte olan faktörleri belirlemek üzere, tek deðiþkenli analiz ve çok deðiþkenli (lojistik regresyon) analiz yapýldý.
BULGULAR
Hastalarýn ortalama yaþý 33,1±14,9 yýl idi. Yanýklarýn büyük çoðunluðu kazaya baðlýydý (n=1076, %81,5). Yanýk mekanizmasý ile ilgili olarak, petrol ürünleri ile en sýk yanýk nedeni idi. Ortalama yüzde yanýk toplam vücut yüzey alaný (TVYA) %39,9±%25,8 idi. Mortalite oraný %33 oldu. Sepsis, en sýk mortalite nedeniydi. Bu çalýþmanýn sonuçlarýna göre eriþkin yanýk hastalarýnda iþ kazasý olmayan yanýklar, yanýk olan TVYA ve ikinci ve üçüncü derece yanýktan etkilenmiþ yüzey alaný mortalitenin baðýmsýz belirleycileridir.
SONUÇ
Bu çalýþma, çalýþýlan yanýk merkezlerinde yüksek bir mortalite oraný olduðunu göstermiþtir. Belirlenen risk faktörleri olan hastalar, yatýþlarý sýrasýnda yüksek riskli hastalar olarak sýnýflandýrýlmalý ve bu hastalara hastanede kalýþ süresince özel ilgi ve bakým gösterilmelidir.

BACKGROUND
The mortality rate following burn is an important outcome parameter. This study aimed to identify factors associated with mortality in adult hospitalized burn patients in Tehran, Iran.
METHODS
This cross-sectional study was performed during a one-year period in two referral burn centers in Tehran. During the study period, 1321 adult (>15 years) hospitalized burn patients were enrolled. Univariate and multivariate (logistic regression) analyses were performed to identify factors associated with mortality.
RESULTS
The mean age of the patients was 33.1±14.9 years. By far, the majority of burns were accidental (n=1076, 81.5%). Regarding the mechanism of burn, burn with petroleum products was the most frequent. Mean percent burned total body surface area (TBSA) was 39.9%±25.8%. The mortality rate was 33%. Sepsis was the most common cause of mortality. The results of the present study indicated that non work-related burns, burned TBSA and body surface area affected by second- or third-degree burns were independent determinants of mortality among adult hospitalized burn patients.
CONCLUSION
The present study showed a high mortality rate in the studied burn centers. Patients with identified risk factors should be categorized as high risk at the time of admission and need special attention and care during hospitalization.

AMAÇ
Abdominal tüberküloz (TB) insidansý, Batý ülkeleri ile geliþmiþ ülkelerde artmaktadýr. Bu patoloji, serbest intestinal perforasyonu da içeren birkaç komplikasyona sahiptir. Bu çalýþmanýn amacý, tüberkülozla iliþkili perforasyonlara yönelik çeþitli tedavileri tartýþan ilgili tüm literatürü analitik olarak özetlemektir.
GEREÇ VE YÖNTEM
Bologna Üniversite Hastanesi Acil Servis Departmaný’nýn son 13 yýldaki kayýtlarýný sorgulayan hasta veritabaný gözden geçirildi. 3 Mart 2009 tarihine kadar bildirilmiþ olan intestinal TB’ye baðlý raporlanan bütün intestinal perforasyonu olgularý geriye dönük olarak deðerlendirildi.
BULGULAR
Ýntestinal perforasyon ile baþvuran 119 abdominal tüberküloz olgusu yayýnlanmýþtýr. Cerrahi tedavi ile ilgili standardize kýlavuzlar bulunmamaktadýr. Bildirilen 119 olgudan, 40’ý (%33,6) rezeksiyon ve anastomozla, 17’si (%14,2) doðrudan dikiþlerle, 4’ü (%3,3) basit bir drenle tedavi edilmiþ ve 57 olgunun tedavisi de rapor edilmemiþtir.
SONUÇ
TB’ye baðlý baðýrsak delinmelerinin cerrahi tedavisi için en uygun stratejiyi analizle ayýrt edilecek hiçbir klinik kanýt saptanmadý. Perforasyonun doðrudan kapatýlmasý, tipik olarak yüksek morbidite ve mortaliteyle korelasyon göstermektedir. Perfore kýsmýn rezeksiyonu ile birlikte anastomoz gerçekleþtirilmesi daha iyi tedavi gibi görünmektedir. Yine de, farmakolojik tedavi, tedavinin esas ayaðý olarak kalmaya devam etmektedir.

BACKGROUND
The incidence of abdominal tuberculosis (TB) is increasing in western and developed countries. This pathology has several complications, including free intestinal perforation. The aim of this study was to analytically summarize all the pertinent literature discussing the various treatments for TB-related perforations.
METHODS
We reviewed the patient database of the Emergency Surgery Department of the Bologna University Hospital, checking the last 13 years. A retrospective review was conducted of all reported cases of intestinal perforation due to intestinal TB published through 3 March 2009.
RESULTS
119 cases of abdominal TB presenting with intestinal perforation were published. There are no standardized guidelines regarding the surgical treatment. Of the 119 reported cases, 40 (33.6%) were treated with resection and anastomosis, 17 (14.2%) with direct sutures, 4 (3.3%) with a simple drain, and in 57, the treatment was not reported.
CONCLUSION
No clinical evidence has been available for analysis to discern the optimal surgical strategy for treating intestinal perforations induced by TB. The direct closure of the perforation typically correlates with poor morbidity and mortality results. The better treatment seems to be the surgical resection of the perforated part with anastomosis. However, pharmacological therapy remains the essential pillar of treatment.

Bu yazýda, lunapark trenine (roller coaster) binmesini takiben iki taraflý internal karotid ve iki taraflý vertebral arter diseksiyonu ile beraber retinal arter oklüzyonu geliþen, bilgilerimize göre, literatürdeki ilk olguyu sunuyoruz. Otuz beþ yaþýnda saðlýklý bir kadýn hastada, lunapark trenine binmesini takiben, sað taraflý boyun aðrýsý ve frontal baþaðrýsý geliþmiþtir. Bundan beþ gün sonra hastanýn sað gözünde 2 saat süren tam görme kaybýný takiben, bu gözde görme düzelmiþ fakat normale göre çok düþük düzeyde kalmýþtýr. Hastanýn ilk muayenesinde sað gözde görmesi 20/200 ve sol gözde 20/20 düzeyinde bulunmuþtur. Fundus muayenesinde üst temporal arter boyunca ödem izlenmiþ, emboli görülmemiþtir. Hastanýn bunun dýþýnda nörolojik muayenesi normaldi. Yapýlan beyin anjiyografisinde, iki taraflý internal karotid ve iki taraflý vertebral arter diseksiyonu görülmüþtür. Hasta, konservatif tedavi ile stabil olarak kalmýþ ve görmesinde daha fazla düþme veya yeni nörolojik kayýp izlenmemiþtir. Baþ-boyun arter diseksiyonlarýnda prognoz çogunlukla iyidir, fakat olasý komplikasyonlarýn önlenmesi için erken teþhis çok önelidir. Lunapark treni gibi ani ve hýzlý hareketlere maruz kalýnmasýný takiben baþaðrýsý, boyun aðrýsý, baþ dönmesi gibi þikayetler geliþen hastalarda arteriyel diseksiyon için yüksek þüphe bulunmalýdýr.

We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

Ýnþaat çivileriyle oluþan delici baþ ve boyun yaralanmalarý, nadiren gözlenen, ölümcül ve geliþmekte olan ülkelerin önemli bir problemidir. Hastanýn nörovasküler durumu ve sistemik fiziksel incelemesi ilk bilinmesi gereken durumdur, çivinin çýkarýlmasýnda cerrahi ve/veya medikal olarak hangi yaklaþýmýn uygulanacaðý kritik önem taþýr. On yaþýnda, yüksekten düþtükten 1 saat sonra sol alnýnda þiþlik ve yabancý cisim batmasý þikayetiyle baþvuran bir kýz çocuðu sunuldu. Sol göz ýþýk refleksindeki zayýflýk ve huzursuzluðu dýþýnda nörolojik ve sistemik muayenesi normal idi. Radyolojik araþtýrmalar çivi baþýnýn sol supraorbital bölgeden girdiðini ve orbital tavan boyunca ilerleyerek frontal kemiðin altýndan ilerleyerek saplandýðýný gösterdi. Çivi sol piterional kraniyotomi ve lateral orbitotomi tekniði kullanýlarak baþarýyla çýkarýldý ve cerrahi sonrasý herhangi bir komplikasyon geliþmedi. Biz burada belkide “çivinin ters penetrasyonu” olarak tanýmlanabilecek nadir bir kraniyoserebral delici yaralanmayý ve orbital tavan boyunca ilerleyerek anterior fossaya baþ kýsmýyla saplanan bir yaralanma tipini sunduk. Ek olarak bu tip yaralanmalarda çivi baþ tarafýndan kraniyuma saplandýysa ameliyat öncesi ve sonrasý alýnmasý gereken önlem ve tedavi stratejileri tartýþtýþýldý.

Penetrating head and neck trauma with construction nails are uncommon life-threatening injuries and an important problem in developing countries. Assessment of the neurovascular and systemic physical status is a first requirement, and the decision concerning which surgical approach to perform for the removal of the nail is of critical importance. A 10-year-old girl was presented one hour after a fall injury with complaint of a swelling and foreign body lodgment on the left forehead. Neurological and systemic physical examinations were normal except for weak direct pupillary light reflex on the left side and the patient’s state of uneasiness. Radiological investigations showed that the head of the nail had entered from the left infra-orbital region and become lodged through the orbital roof, below the frontal bone. Surgical extraction of the nail in the operating room was performed successfully using left pterional craniotomy and lateral orbitotomy technique, and there was no complication after surgery. Here, we report a case with a rare craniocerebral penetrating wound and type, with the head of the nail lodged in the anterior fossa through the orbital roof, which may be defined as ‘reverse penetration of the nail’.

Bu yazýda, sülük ýsýrýðýna baðlý oluþan dört günlük taze rektal kanamalý olgu sunuldu. Kanamýnýn nedeni anoskopla rektumda olduðu saptanan sülüktü. Bu patolojik durum þehir alanlarýnda oldukça azdýr. Sülük endoparasitizmi az olmasýna raðmen, ciddi ve hatta ölümcül komplikasyonlara neden olmaktadýr. Ýnsanlarda aralýklý veya ciddi rektal kanama ile karþýlaþtýðýnda sülük infestasyon þüphesi akýlda tutulmalýdýr ve diðer tüm yabancý cisimlerde olduðu gibi cerrahi olarak incelenmelidir. Burada sülük ýsýrýðýna baðlý rektal kanama ile baþvuran bir hastayý sunduk. Sülük, herhangi bir cerrahi giriþim yapýlmaksýzýn el deðerlendirmesi ile (forseps ile) çýkarýldý.

We present herein a case with a four-day history of fresh rectal bleeding due to leech bite. The cause was found to be a leech in the rectum by anoscope. This pathological condition is extremely rare in urban areas. Leech endoparasitism, although rare, may cause serious, even lethal, complications. Suspicion of leech infestation should be kept in mind when faced with intermittent or severe rectal bleeding in humans, and should be investigated surgically as with all other foreign bodies. In the current study, we present a patient who admitted with rectal bleeding due to leech bite. The leech was removed by hand examination (by forceps) without requiring any surgical attempt.

Trafik kazasý sonucu olay yerinde hayatýný kaybeden yolcu, 18 yaþýnda, erkek, üniversite öðrencisidir. 01.10.2007 tarihinde yapýlan otopsisinde kalbin atrio-ventriküler bölgeden yatay olarak tam kat yýrtýlmýþ ve kopmuþ olduðu saptandý, iskelet sisteminde herhangi bir lezyon yoktu. Bu olgu kalpte tam kat yýrtýlmaya neden olabilecek derecede aðýr bir travmaya maruz kalmasýna raðmen hiçbir kemik lezyonu olmamasý açýsýndan nadir olgu olarak deðerlendirildi.

Our case is a male student which was dead because of traffic accident as passenger in October, 01, 2007. His heart was found to be lacerated and ruptured horizontally from atrio-ventricular region through all layer of the wall at autopsy. There were not any changes of skeletal system. Our case is considered as a rare and interesting case because there was no lesion on the bones, though the case was exposed to so massive trauma that cause rupture of heart from all layers.

Stronglodiasis, Strongyloides stercoralis’in diþi nematodlarý tarafýndan oluþturulan bir parazitozdur. S. stercoralis olgularýn %50’sinde asemptomatik olan ve mideyi etkileyebilen kronik bir enfeksiyon oluþturur. Mide tutulumu genelde gastriti taklit eden bulgulara neden olur. Biz burada 37 yaþýndaki kadýn hastada S. stercoralis’e baðlý oluþtuðunu düþündüðümüz bir mide delinmesi olgusunu sunuyoruz.

Strongyloidiasis is a parasitosis caused by the female nematode of the Strongyloides stercoralis. S. stercoralis causes a chronic infection that is asymptomatic in 50% of chronically infected patients, and it can also affect the stomach. Gastric involvement causes symptoms mostly mimicking gastritis. We report herein a case of gastric perforation in a 37-year-old woman, which was thought to be caused by S. stercoralis.

Pnömomediastinum ve subkutanöz amfizem divertikülit, toksik megakolon ve kolonoskopi sonrasý görülebilen kolon perforasyonunun çok nadir bir komplikasyonu olarak meydana gelebilir. Burada, geçirdiði trafik kazasýndan sonra ilk muayenesinde yokken, 3 gün sonra pnömotoraks olmaksýzýn pnömomediastinum ve subkutanöz amfizem geliþen 60 yaþýnda erkek hasta sunuldu. Çekilen bilgisayarlý tomografide sigmoid divertikül perforasyonu ile devamlýlýk gösteren serbest hava gözlendi. Laparotomide retroperitoneal kaviteye fistülize olmuþ perfore sigmoid divertikülü saptandý. Bu divertiküler perforasyonun künt karýn travmasýna sekonder geliþen sigmoid mezokolon yaralanmasýndan kaynaklandýðýný düþünmekteyiz. Tüm literatür taramamýzda mezosigmoid travmasý sonrasý sigmoid divertikül perforasyonu nedeniyle ortaya çýkmýþ pnömomediastinum ve subkutanöz amfizem olgusuna rastlayamadýk. Bu nedenle bu olgu bu konuda literatürdeki ilk olacaktýr.

Pneumomediastinum and subcutaneous emphysema are very rare reported signs of colonic perforation most often associated with diverticulitis, toxic megacolon and colonoscopy. We report a case of a 60-year-old man with subcutaneous emphysema and pneumomediastinum, which developed three days after a car accident without pneumothorax. A computed tomography scan demonstrated perforation of a sigmoid diverticulum in conjunction with air. A laparotomy was performed and revealed a perforated sigmoid diverticulum, fistulized into the retroperitoneal cavity. We suspect that this diverticular perforation was caused by the deterioration of the sigmoid mesocolon secondary to the blunt abdominal trauma. To our knowledge, this is the first report in the literature about pneumomediastinum and subcutaneous emphysema caused by sigmoid diverticular rupture following mesosigmoid trauma.