Cerrahi travma sonrasý geliþen yapýþýklýklar, hasarlý dokunun onarýmý için geliþen fibroproliferatif inflamatuar cevabýn doðal sonucudur. Prostaglandinler inflamatuar cevabýn en güçlü mediatörleridir. Çalýþmamýzda kullandýðýmýz Ketorolak Trometamin, non-steroid anti-inflamatuar bir ilaç olup potent analjezik etkisi ve parenteral formunun olmasý nedeni ile postoperatif aðrý tedavisi için önerilmektedir. Bu çalýþmada sýçanlar üzerinde deneysel adezyon modeli oluþturuldu ve Ketorolak Trometamin'in adezyon oluþumu üzerine etkisi incelendi 1mg/kg dozunda kullanýldýðýnda inflamasyonu inhibe ederek adezyon oluþumunu engellediði görüldü.

The adhesions which arise after surgical injury are the natural result of fibroproliferative inflamatory respond for repair of the damaged tissue. Prostaglandins are the strongest mediators of the inflamatory respond. Ketorolac trometamine is a nonsteroid anti inflamatory drug (NSAI) and is recommended f or the postoperative pain treatment because of its potent analgesic effect and parenteral form. In this study, an experimental postoperative adhesion model was performed on rats then, the effect of Ketorolac tromethamine on adhesion formation was examined. When we administered 1mg/kg Ketorolac tromethamine the inflamation in inhibited and the adhesion is formation reduced at the beginning of fibroproliferative inflamatory respond.

Karýn travmalarýnýn teþhisinde Fizik Muayene (FM) tek baþýna yeterli olamayabilmektedir. Diagnostik Peritoneal Lavaj (DPL) ve Bilgisayarlý Tomografiden yararlanmak teþhis hatalarýný azaltmada çok yararlý olur. Ancak BT'nin içi boþ organ yaralanmalarýnda spesifikliði azdýr, ayrýca unstabil hastalarda zaman kaybýna, kontrastlý çalýþmalarda ise allerjik komplikasyonlara neden olabilir. DPL iþlemi sýrasýnda karýn içi organ yaralanmalarý olabilir, ayrýca bu iþlem retroperitoneal yaralanmalarýn teþhisinde yetersiz kalabilmektedir. Çalýþmamýzda karaciðer ve diðer karýn içi organ yaralanmalarýnýn teþhisinde ileri tetkik ve tedaviyi yönlendirmede serum Aspartate Aminotransferaz (AST) ve Serum Alanýn Aminotransferaz (ALT) deðerlerinde deðiþimlerden yararlanmayý amaçladýk. Cumhuriyet Üniversitesi Týp Fakültesi Acil Servisine Genel Vücut Travmasý (GVT) ile baþvuran hastalarýn, karýn içi travma þüphesi olan 260'ý çalýþma kapsamýna alýndý. Hastalarýn yaralanmalarý kaydedilip, Yaralanma Þiddeti Skoru (YSS) hesaplandý. Bu hastalarýn 47'sinde karýn içi yaralanma mevcuttu. Karýn içinde laserasyonu olan hastalarýn serum AST deðerleri 179 4 U/L ve ALT deðerleri 181 2 U/L iken, laserasyonu olmayan hastalarda sýrasýyla 60 2 U/L idi ve farklýlýklar istatistiksel olarak anlamlýydý (p<0.01). Hastalarýn serum AST ve ALT düzeylerinde artýþ karaciðer ve diðer karýn içi organlardaki travmalarýn þiddeti ile doðru orantýlýydý. Hastalarýn AST ve ALT deðerlerindeki deðiþimler karýn içi travmalarýnýn deðerlendirmede ileri tetkik ve tedavilerini yönlendirmede yararlý olacaktýr.

A single physical examination is unreliable in the definitive of abdominal injury. Diagnostic Peritoneal Lavage (DPL) and abdominal computerized tomography (CT) has been shown to greatly reduce the risk of missed injuries. But the specificity of CT in hollow organ injuries is less, and also can cause time loss in unstable patient, and allergic complications in studies with contrast matter. While DPL is being performed iatrojenik intraabdominal injuries can happen and it is very also inaccurate diagnosing retroperitoneal injuries. In our study, we aimed to benefit from the variances in serum Aspartate Aminotransferase (AST) and serum Alanin Aminotransferase (ALT) values for giving direction to the detailed examination and treatment of liver and other intraabdominal injuries. Among the patients who applied Cumhuriyet University Faculty of Medicine Emergency Service with blunt abdominal trauma, 260 of them were taken in to the context of the study. All of the injuries sustained were noted after completion of the evaluation, and the Injury Severity Score (ISS) was calculated. 47 of these patients had intraabdominal injury. While mean serum AST values were 179 4 U/L and ALT values were 181 2 U/L in patients with intraabdominal injuries, these values were 60 2 U/L and 56 4 U/L respectively in patients with any injuries and the differences were statistically significant (p<0.01). The increase in the serum AST and ALT levels of the patients were directly proportional with the intensity of liver and other intraabdominal organ traumas. The variences in the patients' AST and ALT values, are beneficial in giving direction to the evaluation, detailed examination and treatment of intraabdominal traumas.

Acil saðlýk hizmetleri üç kategoride incelenmektedir. Bunlar; bireysel acil saðlýk hizmeti, büyük kazalar ve felaketlerdir. Bireysel acil saðlýk hizmeti, hastaneler ve acil servislerin rutin isleri arasýndadýr. Felaketler ise saðlýk ekiplerinin dýþýnda sivil savunma örgütlerinin de katýldýðý geniþ bir organizasyon gerektirir. Büyük kazalar, hastanelere çok sýk gelmezler, fakat geldiðinde de tüm hastane düzenini altüst ederler. Bu nedenle kitlesel kazalar ancak, hazýrlýklý ve planlý olunduðunda az kayýpla ve sekelle atlatýlabilir. Konumu nedeniyle sýk sýk büyüyen kazalara baðlý kitlesel hasta baþvurusu ile karþýlaþan hastanemiz acil servisinde, baþvuru sýrasýnda baþhekim muavinliði baþkanlýðýnda kriz masasý oluþturulmaktadýr. Bu kurulun bir çok týbbi ve sosyal sorunu çözdüðünü saptadýk ve tecrübemizin ülkemiz koþullarýna uygun olduðunu düþünüyoruz.

Emergency health services are considered under three categories. These are emergency health services for individual needs, major accidents and disarters. Emergency health services directed to individuals are rountly practisized in emergency clinics. On the other hand disarters require large organisations including the help of civilian health services. Major accidents are rare but they create enormaus difficulties for routine services in hospitals. Therefore training, organisation and planing of emergency health services, is the only way to solve such problems with minimal mortality and morbidity. We confront frequently with such major accidents, because of the location of our hospital. In these paper we would like to give some information about the organisation of our emergency health services in such accidents, which includes a crysis commitee under the management of on assistant director and proved to be effective in our conditions.

Travma sonucu ölüm resusitasyon, anestezi, cerrahi teknik ve postoperatif yoðun bakýmdaki geliþmelere raðmen yüksek seyretmeye devam ediyordu. Multiple travma sonrasý, önlenebilecek ölümlerin çoðu künt travmaya tanýyý koymada ve onu kontrol etmedeki baþarýsýzlýða baðlý idi.

The death rate from trauma continues to rise despite improved prehospital care as well as advances in resuscitation, anesthesia, surgical technique and postoperative intensive care. The majority of deaths which could be prevented after multiple trauma are due to failure to detect and manage blunt abdominal injuries successfully.

Fungal ve bakteriyel yanýklardaki deneyimlerimizi deðerlendirmek için prospektif bir çalýþma gerçekleþtirdik. "Yedi yýllýk bir süre içerisinde Atatürk Üniversitesi Týp Fakültesi Genel Cerrahi servisine baþvuran yanýklý 124 hastanýn 38'inde (%30.6) fungus izole edildi. Yanýk yara enfeksiyonu tespit edilen hastalarýn yanýk yüzdeleri %30'un üzerindeydi. Teþhis biopsi materyalinin histopatolojik incelenmesi ile konuldu. Dokuz hasta (%23,7) fungal invazyon nedeni ile kaybedildi. Ýki hastaya (%5,3) hastalýðýn ortadan kaldýrýlmasý amacý ile amputasyon yapýldý. Ýnvaziv sepsis baþlamadan önce agressif cerrahi ve yanýk tedavisi esnasýnda gerekli olmadýkça, geniþ spektrumlu antibiyotiklerin kullanýmýnýn kýsýtlanmasý yasamý tehdit eden fungal enfeksiyonlarýnýn önlenmesinde önemli rol oynayacaktýr.

To evaluate our experience with fungal burn wound infections, we performed a prospective study for comparison with bacterial burn wound infection. Within a 7 year period, 124 patients were admitted with burns to Department of General Surgery Atatürk University School of Medicine. All patients with burn wound infection had massif injury, with burn size averaging greather than 30% of the total body surface. The diagnosis was supported in each cases by histologic study of biopsy material. Fungi were recovered from 38 (30,6%) of the 124 patients. Nine patients (23,7%) died from fungal invasion. Two patients (5,3%) required amputation to eradicate disease. Agressive surgical management of the burn wound before the onset of invasive fungal sepsis, and restriction of the use of broad-spectrum antibiotics to the treatment of verified bacterial infection can best prevent this life-threatening complication.

1984-1995 yýllarý arasýnda Ankara Üniversitesi Týp Fakültesi Çocuk Cerrahisi Anabilim Dalýna fiziksel travma nedeniyle baþvuran 108 hasta retrospektif ve prospektif olarak deðerlendirildi. Sonuçlar 1987-1990 yýllarý arasýnda Türkiye il ve ilçe merkezlerinde kayda geçmiþ travmaya baðlý çocuk ölüm nedenleriyle karþýlaþtýrýldý. Travma öncesi, sýrasý ve sonrasýnda alýnabilecek önlemler ortaya kondu. Toplum, saðlýk personeli, aile ve çocuk eðitimi gibi aktif önlemler yanýnda, konut ve çevre düzeni, oyuncak ve araçlarýn yapým özellikleri, toksik veya zararlý olabilecek malzemeler, taþýtlar üzerine alýnabilecek yasal zorunluluklar gibi pasif önlemler önerildi. Travma sonrasý komplikasyonlar ve ölümlerin azaltýlabilmesi için ulusal düzeyde travma puanlama sistemleri ve bunlara baðlý oluþturulabilecek hasta yönlendirim (triage) düzenekleri tartýþýldý.

A retrospective and prospective evaluation was performed in 108 physical trauma patients, admitted to the Department of Pediatric Surgery Ankara University School of Medicine during 1984-1995. The results were compared to the causes to the causes of "pediatric trauma death registry" of Turkey's provinces and counties. Pre-event, event, and postevent prevention strategies were discussed. Active methods such as house and environmental design, engineering of toys and devices, legislation on toxic household agents, potential hazards and vehicles were suggested. National trauma scoring systems and patient triage organizations were discussed in order to minimize traumatic complications and death.

Kliniðimizde 1985-1995 yýllarý arasýnda künt karýn travmasý nedeni ile opere edilen 262 hastanýn kayýtlarý retrospektif olarak incelendi. Hastalarýn 218'i (%83.2) erkek, 44'ü (%16.8) kadýn idi. Hastalarýn %58.7'si 0-20 yaþ grubunda yer alýyordu. %54.0 sýklýk ile dalak en çok yaralanan organdý. En önemli künt karýn travmasý nedeni %51.1 sýklýk ile trafik kazalarý idi. Laparotomi endikasyonuna en sýk olarak klinik bulgular ve peritoneal lavaj ile karar verildi. Postoperatif komplikasyon oraný %23.8, mortalite oraný %9.1 (24 vaka) idi. Kaybedilen hastalarýn 20'sinde (%83.3) multisistem yaralanmasý, 4'ünde (%16.7) ise sadece batýn içi organ yaralanmasý vardý.

In this study, records of 262 patients who were operated because of blunt abdominal trauma in Atatürk University Faculty of Medicine General Surgery Department between 1985 and 1995 were reviewed. Of these 262 patients, 218 (832%) were male, 44 (16.8%) were female, and 58.7% ws in the range between 0-20 years old. Spleen was the most injured organ with an incidence of 54.0. Major cause was traffic accident in 51.1%. The indications of laparotomy were mostly based on the clinical findings and peritoneal lavage. Postoperative complication rate was 23.8, and mortality rate was 9.1% (24 cases). Four (16.7%) of the fatalities had only one intraabdominal organ injury, and 20 (83.3%) had multysystem injury.

1988-1992 yýllarý arasýnda Ýstanbul Týp Fakültesi Göz Hastalýklarý Anabilim Dalý, acil polikliniðine müracaat eden, delici göz yaralanmasý olan 770 olgunun takipleri sýrasýnda 90 gözde fitizis geliþimi görüldü. Fitizis geliþimine etki eden faktörler; olgularýn 40 yaþýndan büyük olmasý, yaralanmalarýn en sýk evde meydana gelmesi, korneaskleral olmasý, giriþ vizyonunun 0.1'den kötü olmasý, iris prolapsusunun, hifemanýn, lens hasarýnýn ve göz içi kanamasýnýn varlýðý olarak deðerlendirildi.

Of 770 eyes sustaining penetrating eye trauma and presenting at the Emergency Unit of Department of Ophthalmology Istanbul Faculty of Medicine between 1988 and 1992, 90 were found to develop phthisis during falow-up. Factors affecting phthisis were age above 40 years, home injuries, corneoscleral localization presenting vision lower than 0.1 and presence of iris prolapse, hyphema, lens injury and vitreaous hemorrhage.

Kliniðimizde Ocak 1990-Haziran 1995 yýllarý arasýnda 1255 kafa travmalý hasta yatýrýlarak tedavi edilmiþtir. Bu hastalardan 162'sinde (%12.5) çökme kýrýðý saptanarak bu çalýþmaya dahil edilmiþtir. 162 hastanýn 75'ini (%46.2) çocuk (0-16 yas), 87 (%53.8) tanesini eriþkin (17yaþ ve üzeri) yaþ grubu oluþturmuþtur. Biyolojide, çocuklarda düþme, eriþkinlerde ise trafik kazalarý ilk sýrayý almýþtýr. Hastalarýn klinik tablosu Glasgow Koma Skalasýna (GKS) göre deðerlendirilmiþtir. Çökme kýrýðý, her iki yaþ grubunda da en fazla parietal bölgede saptanmýþtýr. Çocuklarda kapalý, eriþkinlerde ise açýk çökme kýrýklarý daha fazla görülmüþtür. Her iki yaþ grubunda da çökme kýrýðý ile birlikte en fazla görülen patoloji kontüzyondur. Hastalarýn 129'una (%80) cerrahi, 33 'üne (%20) konservatif tedavi yapýlmýþtýr. Açýk çökme kýrýklarýnda dura ve/veya beyin laserasyonu çocuklarda %59, eriþkinlerde ise %71 oranýnda bulunmuþtur. Komplikasyon olarak posttravmatik erken epilepsi, çocuklarda %8, eriþkinlerde ise 10.3 oranýnda, enfeksiyon ise çocuklarda %4, eriþkinlerde ise %9 oranýnda tespit edilmiþtir. Sonuçlar Glasgow Sonuç Skalasýna (GSS) göre deðerlendirilmiþtir. Tam iyileþme çocuklarda %84, eriþkinlerde %60 oranýnda olurken, mortalite oraný ise eriþkinlerde %17, çocuklarda %4 olarak bulunmuþtur.

1255 patients with head trauma were hospitalized in our clinic between January 1990 and June 1995. Only 162 cases who had depressed skull fractures were accepted for this study. 75 (46.2%) of them were in paediatric age (0-16) and 87 (53.8%) patients were in adult group (17 and above). The most frequent aetiological factors were falling in paediatric group and motor accidents in adults. The neurological state of the patients were assessed by Glasgow Coma Scale (GCS). The most common location of depressed fracture of the skull was at parietal bone in both groups while closed fractures in paediatric age and open type depressed fractures in adult group were seen frequently The most accompaniment pathology of depressed skull fractures was cerebral contusion in both groups. 129 patients (80%) were managed surgically while 33 of them (20%) were treated by conservative procedures. In open depressed fractures, we observed dura and/or brain laceration in 54% of paediatric age and 71% of adult group. As complications, posttraumatic epilepsy was observed 8% in children, 10.3% in adult group and rate of infection was 4% in children, 9% in adults. According to Glaskow Outcome Scale (GOS), good recovery was seen in 84% of paediatric age and 60% of adult group, mortality rates of paediatric and adult groups were 4% and 17% respectively.

Kliniðimizde son 14 yýl içinde pankreas yaralanmasý nedeni ile tedavi edilen 67 hasta yaþ, cins, travmanýn sebebi, pankreatik yaralanmanýn derecesi, ilave organ yaralanmasýnýn olup olmamasý, uygulanan aperatif iþlemler, postoperatif komplikasyonlar ve mortaliteyi etkileyen faktörler yönünden incelendi. Hastalarýn 56'sý (%83.5) erkek olup, ortalama yaþ 24 idi. Pankreas yaralanmalarýnýn sebebi 48 hastada kunt travma, 10 hastada ateþli silah yaralanmasý, 9 hastada ise kesici-delici alet yaralanmasý idi. Hastalarýn 39'una periton lavajý ve 3'üne parasentez ile intraabdominal kanama tanýsý kondu. Ameliyat esnasýnda pankreastaki harabiyet Smego sýnýflamasýna göre yapýldý. Buna göre 44 hasta Grade I, 12 hasta Grade II, 10 hasta Grade III ve 1 hasta Grade IV olarak deðerlendirildi. En sýk görülen ilave organ yaralanmalarý sýrasý ile dalak, karaciðer ve mide idi. Pankreasa yönelik olarak basit drenaj, primer onarým, distal pankreatektomi gibi cerrahi iþlemler uygulandý. Postoperatif en sýk görülen komplikasyon yara enfeksiyonu olmuþtur. Bu seride 9 hasta kaybedilmiþ olup, en önemli mortalite sebebi ilave organ yaralanmalarýnýn yol açtýðý multipl organ yetmezliðidir. Bu çalýþmanýn sonucunda izole pankreas yaralanmalarýnýn nadir görüldüðü, morbidite ve mortaliteyi etkileyen en önemli faktörün ilave organ yaralanmalarýnýn olduðu tesbit edildi. Ayrýca intraabdominal kanama nedeni ile ameliyata alýnan hastalarda, pankreas yaralanmasýnýn kolaylýkla gözden kaçabileceði akýlda tutularak, eksplorasyonun çok dikkatli bir þekilde yapýlmasý gerekir.

67 patients who have been treated in our clinic in the last 14 years was studied in terms of age, sex, traumatic cause, grade of traumatic injury, associated organ injury, operative procedures used, post operative complications and factors affecting mortality. The 56 (%83.5%) of the subjects were male and avarage age was 24. The cause of pancreatic injuries was blunt abdominal trauma in 48 patients, gunshot wounds in 10 and stab wounds in 9. As 39 patients were diagnosed as peritoneal lavage and 3 as paracentesis, the rest were diagnosed by physical examining, laboratory and ultrasonographic findings. Pancreatic damage was classified according to Smego classification. As a result of this, 44 patients were found Grade I, 12 Grade II, 10 Grade III and 1 Grade IV. The common associated organic injuries were liver, spleen and stomach, respectively. On pancreas, surgery operations such as simple drainage, primer repair and distal pancreatectomy were carried out. Postoperative wound infection was the most common complication. 9 patients died and the most important mortality reason was found as the associated organ injuries. Apart from this, pancreatic exploration should be carried out very carefully considering that in the patients who were operated on because of abdominal bleeding, injuries might be easily missed.

1980-1994 yýllarý arasýnda Atatürk Üniversitesi Týp Fakültesi Acil Servisi'ne baþvuran ve Genel Cerrahi AB.D. 'da yatýrýlarak tedavi gören karýn içi organ ateþli silah yaralanmasý olan 98 hastanýn kayýtlarý retrospektif olarak incelendi. Hastalarýn 79'u (%82.3) erkekti. En genç hasta 2.5 yasýnda, en yaþlý hasta 80 yaþýnda olup yaþ ortalamasý 29.3 15.2 yýl idi. Vakalarýn 25'inde (%24) tek organ, 33 vakada (%31,6) iki organ, 28 vakada (%26,8) üç organ, 7 vakada (%6,7) dört organ, 1 vakada (%0,96) altý organ yaralanmasý mevcuttu. Bir vakada (%0,96) herhangi bir organ yaralanmasý tespit edilmedi. Vakalarýn 56'sýnda (%58,3) ince barsak, 45'inde (%46,8) kolon, 21 vakada (%21,8) karaciðer, 21 vakada (%21,8) mide, 15 vakada (%15,6) diyafragma, 13 vakada (%15,5) dalak, 4 vakada (%4,1) pankreas, 3 vakada (%3,1) duodenum, 5 vakada (%5,2) böbrek ve 1 vakada (%1,0) safra kesesi yaralanmasý olmuþtu. Bir vakada V.Cava Ýnferior ve V.Porta yaralanmasý vardý. Onaltý vaka (%16,6) kaybedildi. Ortalama hospitalizasyon süresi 14.5 10.4 gündü. Vakalarýn %75'inde birden fazla organýn yaralandýðý %30 hastada ikinci operasyonun gerektiði görüldü ve %17 civarýnda mortalitesi ile ateþli silah yaralanmalarý tedavi maliyeti, mortalitesi ve morbiditesi yüksek bir travma gurubudur.

From 1980 through 1994, 98 patients' records with penetrating gunshot wounds of the abdomen causing visseral or vascular injuries were reviewed retrospectively. There were 79 men (82.3%). The patients ages ranged from 2.5 to 80 years (average, 29 15,2 year). The most commonly injuried organs were the small bowel (58.3%), the colon (46.8%), the liver (21.8%), the diaphragma (15.6%) and the spleen (13.5%). One patient (1.0%) had vascular injury. There were one organ injury in 25 patients (24.0%), 2 organ injuries in 33 patients (31.6%), 3 organ injuries in 28patients (26.8%), 4 organ injuries in 7patients (6.7%) and 6 organ injuries in 1 patient (1.0%). The false-negative examinations rate 2%. The average hospitalization period was 14.5 10.4 day. Overall mortality rate was 16.6% (16 patients). The study suggest that penetrating gunshot wounds of the abdomen have a high cost unda high mortality and morbidity rate.

Retroperitoneal hematomlar (RPH) künt ve penetran abdominal travmalardan sonra oluþabilir. Ýnsidans çeþitli serilerde deðiþiklik göstermektedir. 1 Ocak 1990 ile 1 Haziran 1995 tarihleri arasýnda SSK Ýstanbul Hastanesi acil cerrahi kliniðine baþvuran ve yapýlan laparotomide RPH saptanan 27 travmatize olgu bu çalýþma kapsamýna dahil edilmiþtir. Hastalarýn 16'sýnda künt, 10'unda penetran yaralanma vardý.1 hastada da spontan retroperitoneal hematom mevcuttu. Hastalarýn yaþ ortalamasý 22, erkek/kadýn oraný 23/4 idi. Ortalama hastanede kalýþ süresi 12 gün, ortalama operasyon süresi 112 dk. idi. Hematom 4 olguda Zone I, 18 olguda Zone II, 4 olguda Zone III, 1 olguda da Zone I+III yerleþimli idi. 21 olguya peroperatuvar hematom eksplorasyonu yapýldý. Etyolojide 5 olguda izole böbrek yaralanmasý olmasýna karþýn, 2 olguda izole pelvik fraktür, 1 olguda izole mesane yaralanmasý, 13 olguda ise birden fazla organ yaralanmasý saptandý. Biyolojiye yönelik tedavi yapýldý. Postoperatif morbidite %19 (5 olgu), mortalite %11 (3 olgu) idi. Bu çalýþma bize retroperitoneal hematomlarýn lokalizasyonuna göre tedavi stratejisinin önemini göstermiþtir.

Retroperitoneal hematomas may occur after blunt and penetrating abdominal traumas and incidence differ in variable series. The management of retroperitoneal hematomas depends on the mechanism of the injury. During, periods of January 1990 and June 1995 with laparotomy retroperitoneal hematoma diagnosed 27 traumatized patients included in our story. 16 patients suffered from blunt and 10 patients penetrating trauma and in one patient there was spontane retroperitoneal hematoma. Mean age was 22, male/female ratio was 23/4, mean hospital stay was 12 days, mean operation time was 112 minutes. Retroperitoneal hematoma was located in Zone I in 4 cases. Zone II in 18 cases, Zone III in 4 cases, Zone I+HI in 1 case. 21 patients went under exploration during operation. In 5 cases isolate renal trauma, in 2 cases isolate pelvic fracture, in 1 case isolate urinary bladder trauma, and in 133cases multiple organ injury were the cause of the retroperitoneal hematoma. The therapy was related to the ethiology. In our study the overall mortality was 11% (3 cases ) and overall morbidity was 19% (5 cases). This study showed us the importance of choosing the therapy strategy according to the localization of the retroperitoneal hematoma.

Bu çalýþmada, 1990-1995 yýllarý arasýnda yumuþak doku ve iskelet lezyonu ile birlikte damar yaralanmasý nedeni ile vasküler ve ortopedik rekonstrüktif giriþim uygulanan 42 alt ekstremite travma olgusu Johansen ve Ark.kriterlerine göre retrospektif olarak incelenmiþtir. Çalýþmanýn amacý; Johansen ve Ark. 'nýn kriterlerine göre yapýlan bu deðerlendirme ile amputasyon oraný arasýnda bir iliþki olup olmadýðýný saptamaktýr. Yaralanma 32 vakada künt travma 10 vakada penetre travma sonucu oluþmuþtur. 42 vakanýn 34'ünde (%80.95) bir veya birden fazla iskelet lezyonu tespit edilmiþ olup 8 vakada (%19.04) parçalý ve/veya açýk kýrýk tespit edilmiþtir. Ýskemi süresi 2-12 saat ortalama 4.5 saattir. Travma Deðerlendirme Kriterleri'ne göre ortalama puan 5.98 1.58 bulunmuþtur. Uygulanan vasküler, ortopedik ve plastik cerrahi giriþimleri sonucu 30 (%71.42) ekstremite kurtulmuþ ve 12 vakada (%28.57) amputasyon gerekmiþtir. Amputasyon uygulanan vakalarda puan 7-10 (ortalama 9.44 1.18) iken kurtulan ekstremitelerde 3-10 (ortalama 5.10 0.57) idi. Aradaki fark anlamlý bulunmuþtur (P<0.001). Ayrýca ekstremitenin geleceði açýsýndan iskemi süresi, kemik-yumuþak doku lezyonunun derecesi ve sok mevcudiyeti anlamlý bulunmuþ, yaþýn ise sonuca önemli bir etkisi olmadýðý tespit edilmiþtir.

In this study 42 lover extremity vascular traumas combined with skeletal/soft-tissue damage have been analysed retrospectively, whether some factors are effective on the prognosis of the extremity. A "rating score" (Managed Extremity Severity Score) based on objective clinical criteria such as; severity of skeletal/ soft-tissue damage, limb ischemia, shock and age are used for discriminating salvageable and doomed limbs. Retrospective analysis in 42 patients demonstrated a significant difference between "rating scale" values for 12 limbs requiring amputation (mean 9.44 1.18) (>7) and ultimately salvaged (>7) (mean 5.10 0.57) (p<0.001).

Mandibula, yüz kemikleri içerisinde en fazla travmaya uðrayan ve kýrýlan kemiklerdendir. Yüzde fonksiyonel ve görünüm olarak önemli rol oynayan mandibula kýrýklarýnda doðru tedavi, kalacak sekelleri önleme açýsýndan önemlidir. 1990-1995 tarihleri arasýnda yüz travmasý nedeniyle kliniðimize baþvuran 112 hastada mandibula kýrýklarýnýn yaþ, cinsiyet, etyoloji, kýrýk lokalizasyonu ve eþlik eden diðer yüz kemiði kýrýklarýna göre istatistiksel dökümü yapýldý. Bu yazýda tedavi metodlarý, karþýlaþýlan komplikasyonlar deðerlendirildi.

Mandibular bone is one of the most traumatised and fractured face bone. Correct treatment of mandibular fractures of that is functionally, can play an important role in reducing the sequelas. Between 1990-1995 years, 112 patients applied to our clinic because of face trauma. Their mandibular fractures, according to age, sex, etiology, fracture area and concomitant other facial bone fractures were statistically documented. Treatment methods and complications were evaluated in this paper.

Kliniðimizde son 5 yýlda toraks travmasý nedeniyle yatýrýlan 239 olgu deðerlendirildi. Olgularýn 206'sý (%86,2) erkek, 33'ü (13,8) kadýndý. Yaþlarý 2-81 arasýnda, ortalama 42 idi. Travmalarýn 177'si (%74,1) künt, 62'si (%25,9) penetran idi. Trafik kazasý 130, delici-kesici alet yaralanmasý 37, yüksekten düþme 23, ateþli silah 22, darp 9 ve diðer sebepler 18 olguda etkendi. Pnömotoraks 53 (%22,2), hemotoraks 46 (%19,2), hemopnömotoraks 40 (%16,7) olguda saptandý. Ayrýca 55 (%23) olguda cilt altý amfizemi ve 63 (%26,3) olguda toraks içi lezyonu belirlendi. Kot fraktürü 145 (%60,7), klavikula fraktürü 24 (%10), sternum fraktürü 8 (%3,3) ve skapula fraktürü 4 (%1,7) olguda görüldü. 54 (%22,6) olguda diðer vücut travmalarý da eþlik etmekteydi. Yüzyirmiüç (%51,1) hastaya medikal tedavi, 101 hastaya (%42,2) tüp torakostomi uygulandý. Yirmi (%8,4) olguya cerrahi giriþim uygulandý. Yirmi intratorasik, 5 ekstratorasik olarak toplam 25 (%10,5) komplikasyon geliþmiþtir. Mortalite 7 olgu ile %2,9 olarak bulunmuþtur.

Two hundred thirty thoracic trauma patients were treated in our clinic between January 1990-June 1995. Of these patients two hundred six (86,2%) were male and 33 (13,8%) were female. Ages of patients were between 2-81 (Average 42). Blunt trauma cases were 74,1% with 177 and penetrating trauma were 25,9% with 62 patients. The causes were traffic accident in 130, stab wound in 37, blunt injury in 31, gun shot in 22, and other in 18 cases. Pneumothorax in 53 (22,2%), hemothorax in 46 (19,2%), and hernopneumothorax in 40 (16,7%) were found. Subcutaneus emphysema were seen in 55 (23%) and intrathoracic injury in 63 (26,3) cases. Rib fractures in 145 (60,7%), clavicula fracture in 24 (10%), sternum fracture in 8 (3,3%) and scapula fracture in 4 (1,7%) cases were found. Other systems were involved in 54 (%22,6) cases. Medical treatment were applied in 101 (42,2%) cases. Surgical intervention was needed in 20 (%8,4) cases. Twenty intrathoracic and 5 extrathoracic complications were developed. Mortality was %2,9 with 7 cases.

Anstabil pelvis kýrýklarýnýn tedavisinde amaç, doðru redaksiyondan sonra rijid fiksasyon saðlamaktadýr. Kliniðimizde 13 hastanýn anstabil kýrýðýnda pelvis halkasýnýn ön bölümündeki yaralanmalar için internal veya eksternal fiksasyon, arka bölümündeki yaralanmalar için açýk redüksiyon ve internal fiksasyon uygulandý. Ameliyattan sonra derin enfeksiyon veya sinir yaralanmasý görülmedi. Bir yýldan fazla izlenen 10 olguda geç deplasman meydana gelmedi. Bütün kýrýklar iyileþti.

The goal in the treatment of unstable pelvic fractures is to achieve and maintain an accurate reduction of the displaced hemipelvis. Open reduction and internal fixation of the posterior pelvic ring injury along with either internal or external fixation of the anterior pelvic ring injury was used in unstable pelvic fractures in 13 patients. The procedure was not associated with an increased rate of deep infection or neural injury. In the ten patients followed more than 1 year there were no late displacements of the hemipelvis and all of the fractures healed.

Politravmatize olgularda kafa ve yüz travmalarýyla birlikte rastlanan orbita kýrýklarý anatomik özellikleri sebebiyle beyin cerrahisi, plastik cerrahi, oftalmoloji ve genel cerrahi uzmanlarýný yakýndan ilgilendirmektedir. Bu sebeple tedavinin mültidisipliner yaklaþýmla planlanmasý önemlidir. Bu çalýþmada Cerrahpaþa Týp Fakültesi Hekimlikte Acil Vakalar Anabilim Dalý polikliniðine 1992-1995 yýllan arasýnda acil baþvuru ile gelen ve tedavi edilen 46 hastada saptanan toplam 60 orbita kýrýðý incelenmiþtir. Hastalarýn 18'i konservatif yöntemlerle, 15'i ekstrakranyal cerrahi giriþimlerle tedavi edilmiþtir (açýk redüksiyon ve plak + vida tespit, gereken olgularda otojen kemik grefti). 13 olguda ise frontal kraniyotomi ile orbita tavanýnýn redüksiyonu + duraplasti ve hematom boþaltýlmasý iþlemi uygulanmýþtýr. Erken dönemde yapýlan kalýcý giriþimle tüm patolojiler onarýlmýþ ve hem estetik hem de fonksiyonel açýdan yeterli sonuçlar alýnmýþ ve ileri dönemlerde tedavi gerektirecek problemlerle karþýlaþýlmamýþtýr. Erken dönemde yapýlan giriþimlerle kýrýk fragmanlar pozisyonlarýna daha rahat getirilerek tespit edilmekte ve ilk giriþimle daha tatmin edici sonuçlar alýnmaktadýr. Bu makalede, nöroþirurji, plastik cerrahi, göz hastalýklarý ve acil cerrahi uzmanlarýndan oluþan bir ekip tarafýndan orbita kýrýðý olan hastanýn çok yönlü olarak deðerlendirildikten sonra tek seansta dekompresyonun ve rekonstrüksiyonun birlikte yapýlmasýnýn en etkin tedavi yöntemi olduðu vurgulanmaktadýr.

Fractures of orbita which are found frequently together with injuries of head and face, are concerning to all neurosurgery, plastic surgery, ophtalmology and general surgery. The treatment must be orientated with multidisciplinary approach. Between 1992-1995, sixty fractures of periorbital bones in 46 patients is diagnosed and treated in our Department of Emergency Surgery. Eighteen of them received concervative treatment, 15 extracranial surgery and 13 reduction of superior orbital wall + duraplasty + drainage via frontal craniectomy. All types of fracture were operated on in the early stage of trauma and, satisfactory functional and cosmetic results have been obtained. In this study, we intended to emphasize the benefits of the single stage operation carried, out in coordination of differant surgical disciplines.

Bu çalýþmada Ocak 1993 ile Mayýs 1995 tarihleri arasýnda Bursa Devlet Hastanesi Hýzýr Acil Servisi'ne 112 No'lu telefon aracýlýðýyla yapýlan ilk yardým çaðrýlarý geriye dönük olarak deðerlendirildi. Bu 29 aylýk süre içinde hýzýr acil ambulans sistemine 692 baþvuru oldu. Gidilen çaðrýlarýn 144'ünün (%20.8) "Boþa Gitme" olduðu görüldü. Diðer 566 hasta ise ambulansla alýndý. Bu vakalar yaþ gruplarý, cinsiyet, vakanýn alýndýðý yer, hastalýk gruplarý ve uygulanan tedavi þekilleri açýsýndan deðerlendirildi. Bu vakalarýn cinsiyet daðýlýmý: 357 erkek (%63), 209 kadýn (%37) olarak belirlendi. Yaþ gruplarýna göre en büyük grubu 60 yaþ üzeri grup (%47.9) oluþturdu. Vakalarýn "alýndýðý yerlere" göre sýnýflandýrýlmasýnda en büyük grubu "evlerden alýnan" vakalar oluþturdu. Alýnan vakalarýn hastalýk gruplarýna göre sýnýflandýrýlmasýnda ilk sýrayý (%19.08) kalp hastalýklarýnýn aldýðý görüldü. Ýkinci sýrayý (%18.3) serebro-vasküler hastalýklar, üçüncü sýrayý ise (%7.4) trafik kazalarý aldý. Ambulansla alýnan vakalarýn %52.7'si yatarak tedavi edildiler. Sonuçta hýzýr acil servise telefonla yapýlan baþvurularda %20.8 oranýnda boþa gidildiði görüldü. Ayrýca Huzur evlerindeki saðlýk organizasyonunun yeniden yapýlanmasý gerektiði kanýsýna varýldý. Trafik kazalarýndan ambulansla alýnan vakalarýn sayýlarýnýn çok yetersiz olmasý acil hasta transport sisteminin yeniden düzenlenmesini gerektirmektedir.

In this study we evaluated the First Aid Call "112" telephone to Bursa State Hospital Emergency Ambulance Service in the Jan 1993-May 1995 period retrospectively. Over a 29 month period 962 patients called Emergency service for medical help in the 144 cases administration (%20.8) were considered as in vain and ambulance staff had not found the patients because of many reasons. The other 566 patients were transported to the hospital. All these calls were calculated. Census datas; age, sex, arrival place, classification and reasons for transport, management protocols were established. After exclusion of transports 63% of the cases (357 cases) were male and 37% of the cases were female. The transport rates increased by age. The main group of the cases were 60 or older persons (47,9%). The most of the cases were transported from their houses. The rate of the transport for the reasons were calculated. The 13% of the cases had a cardiovascular disease, 78,3% cases had a cerebrovascular disease, 7,4% of the cases had a traffic accident. The hospital administration incidence was 52,7%. In conclusion, in 144 cases (20,8%) ambulance staff could not find the patients. In the rest homes transport organisation has to be reestablished. In traffic accident, first aid call system and ambulance service has not known yet and also must be review.

Hastanemizde ayaktan tedavisi yapýlan 88 hastanýn yanýk bilgi formlarýndan elde edilen epidemiyolojik bilgiler retrospektif olarak deðerlendirildi. Hastalarýn yanýk yüzdesi, %20'nin altýnda olup II yanýklý 86 hastaya lokal tedavi, III yanýklý 2 hastaya ise debridman ve greftleme uygulanarak, iyileþme saðlandý. Hastalarýn %54.3'ü 15 yaþ altýndadýr. Erkek: kadýn oraný 3.9: 1'dir. Hastalarýn çoðu 5 veya daha kalabalýk, sosyoekonomik olarak kötü durumda olan (%52) ailelerdendir. Sýcak su ile yanýk ilk sýradadýr ( %74). Hastalarýn önemli bir kýsmý (%60) ev içinde yanmýþtýr. Soðuk su tatbiki en yaygýn ilk yardým sekli olup hastalarýn %93 'ü ilk 24 saat içinde hastaneye baþvurmuþlardýr. Bu çalýþma, çocuklara ve ailelerine evdeki kazalara karþý alýnmasý gereken önlemler konusunda yaygýn eðitimin önemini bir kez daha göstermektedir.

Epidemiologic data obtained from burn records of outpatient burn cases treated in TCDD Ankara Hospital were evaluated retrospectively. Burned surface area was under 20% in all cases. Complete healing was obtained by local treatment in 86 second degree cases and by debridement following grafting in 2 third degree cases. 54.3% of cases were under 15 years old. The ratio of male to female was 3.9: 1. Most of the patients belonged to a low socioeconomic group (57%) and were part of a family with at least 5 members. The majority of cases were hot water burns (74%). 60% of patients were burned at home. The most common form of first aid by the patients were burned in the home. The most common form of first aid by the patients was the application of cold water. 93% of patients were admitted to hospital in the first 24 hours. This study highlights the fact that children and parents must be better informed about the possible ways of preventing burns.

Hydatic cyst is endemic in our territory, but its location in spleen is rare. The diagnosis and treatment of spleen hydatic cyst was argued on account of a case with traumatic rupture of spleen hydatic cyst.

Most renal pedicle injuries commonly have resulted in loss of renal function. Immediate surgical repair of the pedicle through early vascular control is reguired if renal function is to be saved by restoration of blood to the ischemic kidney. If warm ischemia time is expected to exceed 60 minutes external and internal cooling of the kidney may achieve salvage of the functional renal parenchyma. We herein report our attempt at immediate treatment of a renal pedicle injury in a patient who had penetrating abdominal trauma, aiming at maximum preservation of functioning renal tissue.

We report a case who was admitted to our hospital with pleural effusion and diagnosed as perforated acute appedisitis with retroperitoneal abscess formation. Appendectomy and retroperitoneal abscess draninage was performed. Retroperitoneal appendicitis perforation, as cause of abscess formation and pleural effusion, is discussed, and the literature is reviewed.

Entamoeba histolytica is a parasite that lives in colon without damaging its environment. But when it involves mucosa and submucosa, it may manifest clinical symptoms. In this report, a case of colon perforation which was a rare complication of intestinal amebiasis was presented, and intestinal amebiasis cases in the literature were reviewed in the light of current diagnosis and treatment strategies.

Jejunogastric intussusception is one of the rare complications of stomach surgery. An acute case of jejunogastric intussusception, 19 year after gastrectomy for duodenal ulcer disease, presenting acute abdomen signs is diagnosed and operated on in early with resection + primary anastomosis. Diagnosis and treatment is discussed in correlation with the presented case.