AMAÇ: Bu çalýþmanýn amacý, deneysel travmatik beyin hasarý (TBH) modelinde interlökin 1 beta (IL-1β) inhibitörü Anakinra’nýn tedavi edici etkinliðinin deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Elli dört Wistar albino sýçana anestezi uygulamasý sonrasý kafatasý üzerine konan bir metal disk üzerine 2 metreden 450 g aðýrlýk düþürülerek deneysel kapalý kafa travmasý oluþturuldu. Hayvanlar üç ana gruba ayrýldý: Kontrol (n=18), TBH + salin (n=18; zaman baþýna altý hayvan) numuneler bir, altý ve 24 saat sonra alýndý ve TBH + Anakinra (n=18; zaman baþýna altý hayvan) numuneler bir, altý ve 24 saat sonra alýndý. IL-
1β, malondialdehit, glutatyon peroksidaz, süperoksit dismutaz ve katalaz düzeylerinin analizi için beyin dokusu ve kan örnekleri alýndý. Doku kesitleri histopatolojik olarak ýþýk mikroskobunda deðerlendirildi.
BULGULAR: Travma sonrasý, doku ve serum IL-1β düzeyleri önemli ölçüde artmýþtý ve bu düzeyler Anakinra verilmesinden sonra azaldý. TBH takiben glutatyon peroksidaz, süperoksit dismutaz ve katalaz aktivitesi azalmýþ ve Anakinra uygulanmasý bu antioksidan enzimlerin aktivitesini artýrmada etkili olmuþtur. Histopatolojik analiz Anakinra’nýn beyin dokusu ve sinir hücrelerini travmadan koruyabileðini doðrulamýþtýr.
TARTIÞMA: Anakinra’nýn TBH ile ortaya çýkan enflamasyon ve doku hasarý geliþimini azalttýðýný göstermektedir.

BACKGROUND: The aim of this study was to evaluate the therapeutic efficiency of Anakinra, an IL-1β antagonist with anti-inflammatory effects, in an experimental model of traumatic brain injury (TBI).
METHODS: Fifty-four rats underwent TBI after a weighted object was dropped onto a metal disc secured to their skulls. Animals were randomized into 3 main groups: control (n=18), TBI + saline (n=18; six animals per time-point) with samples obtained at the first, sixth and twenty-fourth h postoperatively, and TBI + Anakinra (n=18; six animals per time-point) with brain samples obtained at the first, sixth and twenty-fourth h postoperatively. Brain tissue and blood serum were extracted for the analysis of IL-1β, malondialdehyde, glutathione peroxidase, superoxide dismutase, and catalase levels. Tissue sections were evaluated histopathologically under a light microscope.
RESULTS: After trauma, tissue and serum IL-1β levels were significantly elevated and after Anakinra administration, these levels substantially decreased. Glutathione peroxidase, superoxide dismutase, and catalase activity decreased following TBI and Anakinra administration proved effective in increasing the activity of these antioxidant enzymes. Histopathological analysis confirmed that Anakinra might protect the brain tissue and nerve cells from injury.
CONCLUSION: Results demonstrate that Anakinra reduces the development of inflammation and tissue injury events associated with TBI.

AMAÇ: Çalýþma, güçlü bir antioksidan olan alfa lipoik asidin intraabdominal adezyon oluþumu üzerine olan etkisini saptamak amacýyla yapýldý.
GEREÇ VE YÖNTEM: Alfa lipoik asit grubu (Grup I), kontrol grubu (Grup II, n=8) ve Sham grubu (Grup III, n=8) olmak üzere üç grup üzerinde yürütülen bu çalýþmada 250-300 g canlý aðýrlýðýnda olan Wistar Albino cinsi 24 adet diþi sýçan kullanýldý. Genel anestezisi eþliðinde orta hat insizyonuyla laparotomi yapýldýktan sonra Grup I ve Grup II’de çekumun antimezenterik tarafýnda adezyon modeli oluþturuldu. Grup I’e 50 mg/kg alfa lipoik asid
intraperitoneal (IP) olarak verilirken Grup II’de cerrahi iþlem yapýldý fakat herhangi bir ilaç uygulanmadý. Grup III’te ise sadece laparatomi yapýldý. Sýçanlar 10. gün sonunda sakrifiye edilip makroskopik skorlama yapýldý ve doku örnekleri alýnarak biyokimyasal ve histopatolojik deðerlendirmeye tabi tutuldu.
BULGULAR: Makroskopik skorlamada ve histopatolojik incelemede Grup I’de, Grup II’ye göre adezyon derecesinin ve malondialdehid düzeyinin azaldýðý (p<0.01), glutation düzeyinin ise arttýðý (p<0.01) tespit edildi.
TARTIÞMA: Çalýþma bulgularý, alfa lipoik asidin IP olarak uygulandýðýnda intraabdominal adezyonu kontrol grubuna göre belirgin derecede azalttýðý (p<0.01) tespit edildi.

BACKGROUND: This study was performed to determine the effect of alpha lipoic acid, a powerful antioxidant, on intra-abdominal adhesion formation.
METHODS: Twenty-four female Wistar Albino rats weighing 250-300 g were used in this study conducted on three groups consisting of the alpha lipoic acid group (Group I, n=8), control group (Group II, n=8), and sham group (Group III, n=8). After performing laparotomy with a midline incision under general anesthesia, the adhesion model was created on the antimesenteric side of the caecum in Group I and Group II. 50 mg/kg alpha-lipoic acid was administered intraperitoneally (IP) in Group I while the surgical procedure
was performed but no drugs administered in Group II. Only laparotomy was performed in Group III. Rats were sacrificed at the end of the tenth day.
RESULTS: Macroscopic scoring was performed, tissue samples were obtained and subjected to biochemical and histopathological evaluation. The degree of adhesion and malondialdehyde level decreased (p<0.01), and glutathione levels had increased (p<0.01) in
Group I compared to Group II in macroscopic scoring.
CONCLUSION: Alpha lipoic acid was found to significantly decrease (p<0.01) intra-abdominal adhesion when administered IP compared to the control group.

AMAÇ: Penetran karýn travmalarýnda temel cerrahi yaklaþým, 1960’lý yýllarda Shaftan’nýn ortaya attýðý seçici gözlem yöntemiyle temelden deðiþmiþ ve tüm dünyada penetran karýn travmalý hastalarda rutin laparotomi uygulama yöntemi yerine seçici gözlem yöntemi kullanýlmasý aðýrlýk kazanmýþtýr. Bu durumda ameliyat edilmeden iyileþebilmiþ baðýrsak perforasyonlu hastalar olabileceði ihtimali doðmaktadýr. Bu konuyu araþtýrmak amacýyla deneysel bir model oluþturduk.
GEREÇ VE YÖNTEM: Elli adet wistar albino cinsi sýçan 10 adetlik beþ gruba ayrýldýktan sonra ince baðýrsaklarýnýn distal kýsmý hazýrlanan uygun ebattaki kesiciler ile 1 mm, 2 mm, 3 mm ve 4 mm olmak üzere farklý büyüklükte perfore edildi ve bir grup kontrol grubu olarak ayrýldý. Gruplardaki sýçanlar bir hafta süreyle takip edildikten sonra sakrifiye edilerek, perfore edilen baðýrsak lokalizasyonunun 1 cm proksimali ile distalini içerecek þekilde ileum segmenti ve periton dokusu histopatolojik inceleme için patoloji laboratuvarýna gönderildi.
BULGULAR: Çalýþma gruplarýmýzdaki sýçanlarda, 2 mm ve altýndaki ince baðýrsak perforasyonlarýnýn herhangi bir cerrahi giriþime gerek olmadan spontan olarak iyileþebilir olduðunu gözlemledik. Yedi günlük takibe karþýn 4 mm’lik baðýrsak yaralanmalarýnda halen devam eden perforasyonlar görüldü. Patolojik inceleme sonunda perforasyon çaplarý ile orantýlý olarak peritonitin þiddetlendiði ve baðýrsak duvarý onarýmýnýn azaldýðý saptandý.
TARTIÞMA: Sonuç olarak, sýçanlarda küçük çaplý ince baðýrsak perforasyonlarýnýn herhangi bir cerrahi müdahale gerekmeden organizma tarafýndan sýnýrlanabileceði gözlemlendi.

BACKGROUND: Selective observation method has started to replace routine laparotomy application for abdominal penetrating trauma patients after Shaftan’s selective observation method applied in the 1960s. In this respect, there is a possibility of bowel perforations
healing without operations. An experimental model was established in this study in order to clarify this possibility.
METHODS: Fifty Wistar-Albino rats were divided into five groups, ten in each. While one group served as the control, distal part of the small bowel of the rats in the other four groups was perforated 1, 2, 3, and 4 mm in diameter with appropriate cutters. After
a week of observation, test rats were sacrificed and relaparotomy was applied. The test material consisting of the perforated bowel, covering 1 cm of proximal and distal margins, and some peritoneal tissue was taken for histopathological examination.
RESULTS: Small bowel perforations with a diameter of 2 mm or below healed spontaneously without any operation. Peritonitis intensity increased in direct ratio with perforation diameters. Wall repair capacity of the bowel diminished with increasing perforation
diameters.
CONCLUSION: It was observed that small perforations in the small bowel of rats could be limited by the organism itself without a necessity of any surgical intervention.

AMAÇ: Aðrý giderimi için ilk olarak opiyatlarýn kullanýlmasý ekstremite kýrýklarý tedavisinin önemli bir bölümünü oluþturur. Ancak opiyat tüketiminin azaltýlmasý için baþka kombinasyonlar da ortaya atýlmýþtýr. Bu çalýþma, bu hastalarda aðrýyý hafifletmede morfin-midazolam kombinasyonuyla morfin enjeksiyonunu karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Alt ve üst ekstremite kýrýklarý olan hastalarda bir randomize çift-kör çalýþma yürütüldü. Hastalarýn morfin-midazolam çözeltisi veya morfin tedavisine yanýtlarý 15., 30., 45., 60., 120. ve 180. dakikalarda deðerlendirildi. Tedavinin baþarýsýný deðerlendirmek için Kaplan-Meier eðrileri ve genelleþtirilmiþ tahmin denklemleri incelendi. Anlamlýlýk düzeyi olarak p<0.05 kabul edildi.
BULGULAR: Çalýþmaya 18-60 yaþ arasý toplam 72 hasta (%80.6 erkek; yaþ ortalamasý: 35±17.9 yýl) alýndý. On beþinci, 30., 45. ve 60. dakikalarda morfin grubunda hastalarýn sýrasýyla %8.83; %22.2; %33.3 ve %63.9’unda, midazolam-morfin grunda ise %11.1; %27.7; %44.4 ve %63.8’inde aðrýnýn kontrolü baþarýldý. Üçüncü saate gelindiðinde morfin alanlarýn hepsinde aðrý kontrolü gerçekleþmiþken morfin-midazolam grubunda yalnýzca bir
hastada aðrý sebat etmiþtir. Log-sýra testi iki gruplar arasýnda herhangi bir anlamlý farklýlýk göstermedi (p=0.55).
TARTIÞMA: Bulgularýmýz midazolamýn morfine ilavesinin aðrý giderimi profilini iyileþtirmediðini göstermektedir.

BACKGROUND: Pain relief, using opiates as a primary choice, is an important part of treating limb fractures. Yet, in order to reduce opiate consumption, other combinations have been introduced. This study aimed to compare pain reduction by a combination of morphine–midazolam with morphine injection in patients with limb fractures.
METHODS: A randomized double-blind study of patients with upper or lower extremity fractures was conducted. Patients’ response to treatment with either morphine-midazolam solution or morphine at 15, 30, 45, 60, 120, and 180 minutes were assessed. The Kaplan-Meier curves and generalized estimating equations were examined to evaluate the success of treatment.
RESULTS: A total of seventy-two patients aged 18-60 (80.6% male; mean age: 35±17.9 years) were included. At 15, 30, 45, and 60 minutes, successful pain control was seen in 8.83 22.2%, 33.3% and 63.9% of the patients in the morphine group, and 11.1%, 27.7%,
44.4% and 63.8% in the midazolam-morphine group. By the third hour, pain-control was achieved in all patients receiving morphine while pain persisted in one patient receiving morphine-midazolam. Log-rank test showed no significant difference between the two
groups (p=0.55).
CONCLUSION: Our findings revealed that adding midazolam to morphine did not improve its pain-relief profile.

AMAÇ: Polikliniðimize baþvuran yanýk hasta profilini ortaya koymak ve tedavi yönetimini geçmiþ seriler ile karþýlaþtýrarak güncel durumu deðerlendirmektir.
GEREÇ VE YÖNTEM: Bir yýl süreyle polikliniðimize baþvuran hastalar ileriye yönelik çalýþmaya alýndý. Tüm hastalarýn kayýt altýna alýnan cinsiyet, yaþ, yanýk yüzdesi, yanýk yeri, yanýk nedeni, yanýk derecesi, pansuman malzemesi, pansuman sayýsý, tedavi þekli, olay yeri ve olayýn olduðu aya göre daðýlýmý incelendi.
BULGULAR: Toplam 1795 hastanýn yönetimleri poliklinikte tamamlanan 1511’inin ortalama yaþý 27.9, kadýn/erkek oraný 0.88 olmuþtur. Çoðunluðu 18-64 yaþ hastalar oluþtururken tüm gruplarda sýcak sývý yanýðý ilk sýradaydý (p<0.05, p<0.001). Hastalarýn %89.6’sý evde yaralanmýþtý (p<0.001). Ekstremiteler diðer bölgelere göre daha sýk yanan vücut bölgesiydi (p<0.001). Hastalarýn 446’sýna (%29.5) tek pansuman uygulanýrken %64.9’u ilk üç
pansuman sonrasýnda hastanemiz poliklinik takipleri sonlandýrýlmýþtýr. Derin dermal yanýklý hastalarda ortalama pansuman sayýsý daha fazla olmuþtur (ortalama 14.5, ortanca 14, p<0.001).
TARTIÞMA: Geçmiþ yýllar ile yapýlan karþýlaþtýrmada il nüfusu artýþýndan daha yüksek yanýk insidansý bulunmuþtur. Halen hastalarýn çoðunluðu az sayýda pansuman sonrasý takipleri için evlerine yakýn saðlýk birimlerine yönlendirilmektedir. Mevcut durumda hastalarýn deneyimli merkezlere gereksiz baþvurularý ile bu merkezlerin iþ yükünün artýrýlmasý yanýnda hastalara ilave ulaþým yükü ve zaman israfý yaþatýlmaktadýr. Güncel yanýk tedavi prensiplerinin birinci ve ikinci basamakta edinilmesi ile referans merkezin iþ yükü azaltýlabilecektir.

BACKGROUND: This study aimed to determine the profile of burn patients presented in our polyclinic and evaluate the current status in comparison to the treatment methods of past series.
METHODS: Burn patients presented in the polyclinic in a one-year period were included into this prospective study. The records of all patients were examined in respect of gender, age, burn percentage, burn location, cause of burn, degree of burn, dressing material, number of dressings, type of treatment, place of trauma, and month of trauma.
RESULTS: From a total of one thousand seven hundred and ninety-five patients presented, management was completed in the polyclinic for one thousand five hundred and eleven cases with a mean age of 27.9 years, with a female: male ratio of 0.88. While most patients were in the 18-64 age group, hot liquid burn was the leading cause in all age groups (p<0.05, p<0.001). Of the total patients, 89.6% were injured at home (p<0.001). The extremities were determined as the body area most often burned (p<0.001). While a single dressing was applied to 446 patients (29.5%), in 64.9% of cases polyclinic follow-up was terminated after the first 3 dressings. The mean number of dressings was greater in patients with deep dermal burns (mean 14.5, median 14, p<0.001).
CONCLUSION: A higher incidence of burns was found due to increasing urban populations compared to previous years. Currently, the majority of patients are referred to a healthcare facilty near their residences for follow-up after a few dressings. Unneccessary presentation
at specialist centres increases the workload of these centres and creates a burden of wasted time and transport expense for the patients. The application of current burn treatment principles in primary and secondary health facilities will reduce the workload of reference centres.

AMAÇ: Morbidite ve mortalite oranlarýnýn yüksek olmasý nedeniyle yanýklardaki mortalitede risk faktörleri ve Acinetobacter izolatlarýnýn buradaki rolünü deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2009’dan Mayýs 2011’e kadar yanýk ünitemizde yatýrýlarak tedavi edilen toplam 465 hasta geriye dönük olarak gözden geçirildi. Risk belirlenmesinde lojistik regresyon analizi kullanýldý.
BULGULAR: Mortalite oranlarý genelde %7.5, 17 yaþ altý %3.9, 18-64 yaþ arasý %12 ve 65 yaþ üzeri %24 idi (p<0.001). Total Vücut Yüzey Alaný (TBSA) %41’in üzerinde olan hastalarýn %64.3’ü (18 hasta) kaybedildi (p<0.001). TBSA%, ileri yaþ ve albümin seviyeleri mortalitede risk faktörü olarak bulundu. En sýk rastlanan bakteriyel izolat Acinetobacter baumanni idi.
TARTIÞMA: Yanýk oranlarý arttýkça mortalite oranlarýnýn da arttýðý görüldü. Yüksek mortalite oranlarýna raðmen Acinetobacter enfeksiyonlarý mortalitede risk faktörü olarak bulunmadý.

BACKGROUND: This study aimed to evaluate risk factors and the role of Acinetobacter isolates in mortality due to burns since morbidity and mortality rates are considerably high.
METHODS: A total of four hundred and sixty-five patients hospitalized in our Burn Care Unit between January 2009 and May 2011 were reviewed retrospectively. Logistic regression analysis was used in order to predict the risk.
RESULTS: Mortality rates were as follows: 7.5% in general, 3.9% for under 17 years of age, 12% for between 18-64 years of age, and 24% for over 65 years of age (p<0.001).
CONCLUSION: As the burnt body surface area increased, higher mortality rates were detected. Despite higher mortality rates, Acinetobacter infections were not found risk factors for mortality.

AMAÇ: Bu çalýþmanýn amacý akut pankreatitli hastalarda serum L-FABP düzeylerini deðerlendirmek ve saðlýklý olgular ile karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Çalýþmaya akut pankreatit tanýsý konulan 30 hasta ve yaþ ve cinsiyeti benzer 30 saðlýklý olgu alýndý. Serum L-FABP düzeyleri baþvuru anýnda ve iyileþme döneminde deðerlendirildi.
BULGULAR: Akut pankreatitli hastalarýn baþvuru anýnda serum L-FABP düzeyleri kontrol grubundan belirgin olarak yüksekti (41009.41±32401.31 pg/ml ve 17057.00±5015.74 pg/ml, p=0.008). Serum L-FABP düzeyleri iyileþme periyodunda baþvuru düzeylerine göre düþmekle birlikte aradaki fark istatistiksel olarak anlamlý deðildi. Bununla birlikte akut pankreatitli hastalarda serum L-FABP düzeyleri AST ve LDH düzeyleri ile korele idi.
TARTIÞMA: Akut pankreatitli hastalarda yüksek L-FABP düzeyleri pankreatik mikrosirkulatuar bozukluk ile iliþkili olabilir. Bu sonuçlar serum LFABP düzeylerinin akut pankreatitte kullanýlabilecek bir biyomarker olduðunu destekler niteliktedir.

BACKGROUND: The aim of this study was to assess the serum L-FABP levels in patients with acute pancreatitis and compare with healthy subjects.
METHODS: Thirty patients with acute pancreatitis and thirty consecutive healthy age- and sex-matched control subjects were included into the study. The serum levels of L-FABP were measured upon admission and at the remission period.
RESULTS: Upon admission, serum L-FABP concentration was significantly higher in patients with acute pancreatitis compared to control subjects (41009.41±32401.31 pg/ml vs. 17057.00±5015.74 pg/ml, p=0.008). Serum L-FABP levels decreased after the remission
period; however, the differences were not statistically significant. In addition, serum L-FABP levels showed significant correlation with AST and LDH levels.
CONCLUSION: Increased serum L-FABP levels may be related to the mechanism of pancreatic microcirculatory disturbance in patients with acute pancreatitis, suggesting that serum L-FABP could be used for a potential biomarker of acute pancreatitis.

AMAÇ: Çalýþmamýzdaki amaç 65 yaþ üstü kalça kýrýðý nedeni ile ameliyat olan kalça kýrýðýna etki eden mortalite faktörlerinin belirlenmesi.
GEREÇ VE YÖNTEM: Altmýþ beþ yaþ üstü 219 erkek, 89 kadýn toplam 308 hasta dahil edildi. Anestezi tipi olarak 203 hastaya spinal/epidural ve 105 hastaya genel anestezi verildi. Hastalarýn ASA deðerlendirilmesinde ASA 1-2 ve ASA 3-4 olarak iki grup belirlendi. Ameliyat öncesinde hastalarýn mevcut olan sistemik hastalýklarý belirlendi.
BULGULAR: Toplam 308 hastanýn 77’si (%25) öldü. Ayrýca ameliyat öncesinde olarak kardiyak hastalýðý olan hastalar, genel anestezi yapýlan hastalar, ASA3-4 grubu olan hastalar ve yaþ mortalite için anlamlý yüksek bulundu. Bu dört etkili faktöre lojistik regresyon analizi yapýldýðýnda ise yaþ, genel anestezi, kardiyak hastalýðýn varlýðý mortalite üzerinde etkilidir. Ancak ASA skoru yaþa ve kardiyak hastalýða baðýmlý olarak deðiþmektedir.
TARTIÞMA: Çoklu risk faktörlerinin bulunduðu durumlarda hangi faktörün gerçekte daha etkili olduðunu hesaplamak gerekli. Yaþ, ASA skoru, anastezi þekli ve kardiyak hastalýk varlýðý mortaliteyi etkilemektedir. Ancak ASA skoru kardiyak hastalýk ve yaþ faktörüne baðýmlý olarak mortaliteyi etkilemektedir.

BACKGROUND: The aim of this study was to determine the factors affecting postoperative mortality in patients older than 65 years of age undergoing surgery for hip fracture.
METHODS: A total of 308 patients (219 males and 89 females) were included into the study. Spinal-epidural anaesthesia was administered in 203 patients and general anaesthesia in 105 patients. In the evaluation of the patients regarding ASA, two groups were determined ASA 1-2 and ASA 3-4. Systemic diseases present in the patients were determined preoperatively.
RESULTS: Seventy-seven (25%) of the total 308 patients died. In addition, patients with preoperative cardiac disease, patients on whom general anaesthesia was administered, patients in the ASA 3-4 group, and age were found to be significantly higher in mortality.
When logistic regression analysis was performed for these four efficient factors, age, general anaesthesia, presence of cardiac disease were effective in mortality. However, ASA score changed depending on the age and cardiac disease.
CONCLUSION: In case of presence of multiple risk factors, it is necessary to determine which factor is, in fact, more effective. Age, ASA score, type of anaesthesia, and presence of cardiac disease are effective in mortality. However, ASA score affects mortality depending on the cardiac disease and age.

AMAÇ: Akut kolesistit tanýsýnda gri-skala ve power Doppler ultrasonografinin deðerini belirlemek için kantitatif sonografik ve intraoperatif bulgular arasýndaki iliþkiyi göstermek amaçlandý.
GEREÇ VE YÖNTEM: Kýrk kronik, 40 akut kolesistit hastasý deðerlendirildi. Akut kolesistit hastalarýna erken laparoskopik kolesistektomi uygulandý. Demografik özellikler, sonografik bulgular ve adezyon skoru incelendi. Veriler ileriye yönelik olarak toplandý (clinicaltrials.gov: NCT02156947).
BULGULAR: Duvar kalýnlýðý (≥3 mm) ve vaskülarite akut kolesistitte artmýþtý (p<0.01 ve <0.01). Vaskülarite ile adezyon arasýnda orta düzey iliþki saptanmasýna raðmen (p<0.01, r=0.59) perforasyon, konversiyon ve operasyon süresi açýsýndan iliþki saptanmadý. Duvar kalýnlýðý adezyon geliþimi ile iliþkili deðildi (p=0.36). Duvar kalýnlýðý ve vaskülarite için duyarlýlýk ve özgüllük sýrasýyla: %96.9, %72.7 ve %68, %87.2 idi. Her iki tanýsal deðerlendirme birleþtirildiðinde duyarlýlýk %69.7 iken, özgüllük %97.6’ya çýkmaktaydý.
TARTIÞMA: Vaskülarite, adezyon geliþimi ile iliþkili, ancak operasyon zorluðunu belirlemede yetersiz idi. Gri-skala ultrasonografinin özgüllüðünün power Doppler inceleme ile artýrýlabileceði görüldü, ancak istenilen tanýsal doðruluða sadece kantitatif ultrasonografik bulgular ile ulaþýlamayacaðý anlaþýldý.

BACKGROUND: This study aimed to evaluate the diagnostic value of gray-scale and power Doppler sonography for acute cholecystitis and show a correlation between sonographic and intraoperative findings, quantitively.
METHODS: Forty chronic and forty acute cholecystitis patients were examined. Early laparoscopic cholecystectomy was performed for acute cholecystitis. Demographic characteristics, sonographic findings, and adhesion scores were analyzed. Data were collected prospectively (clinicaltrials.gov: NCT02156947).
RESULTS: Wall thickness (≥3 mm) and vascularity increased in acute cholecystitis (p<0.01 and <0.01). Vascularity was found to be moderately correlated with adhesion (p<0.01, r=0.59) but it did not affect the difficulty of the operation by means of perforation,
conversion rate, and operation time. In addition, wall thickness did not correlate with adhesion formation (p=0.36). Sensitivity and specifity of wall thickness and vascularity were found to be 96.9%, 72.7%, and 68%, 87.2%, respectively. When both diagnostic measurements were taken into account, sensitivity was calculated 69.7% and specificity reached up to 97.6%.
CONCLUSION: Vascularity correlated with adhesion but failed to predict operation difficulty. Specificity of gray-scale sonography could be improved with power Doppler examination; however, desired diagnostic accuracy could not be obtained with only quantitive measurements of sonography.

AMAÇ: Ciddi yanýk travmasý olan hastalarda hastane kaynaklý idrar yolu enfeksiyon sýklýðý ve risk faktörlerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmada Aðustos 2009-Nisan 2012 tarihleri arasýnda Bozyaka Eðitim ve Araþtýrma Hastanesi Yanýk Merkezi’nde %20 ve üzerinde yanýk yaralanmasý nedeni ile tedavi gören hastalarý kapsayacak þekilde geriye dönük olarak deðerlendirme yapýldý. Çalýþmaya 69 hasta alýndý. Çalýþmadaki hastalarýn 30’u erkek (%43.5), 39’u kadýndý (%56.5). Hastalarýn yaþ ortalamasý 40.1±16.7 idi.
BULGULAR: DM, sondalý kalma süresi ve sonda bakýmý ile hastane kaynaklý idrar yolu enfeksiyon arasýnda istatistiksel olarak anlamlý korelasyon saptandý (p<0.005).
SONUÇ: Hastane kaynaklý idrar yolu enfeksiyonlarýýn büyük bir kýsmý üriner kateterizasyonla iliþkilidir. Bu þartlarda takýlan üriner kateterin mümkün olduðunca kýsa sürede sonlandýrýlmasý hastane kaynaklý idrar yolu enfeksiyonu geliþiminin önlenmesi açýsýndan dikkat edilmesi gereken önemli bir noktadýr. Hastanýn sondalý kalmasý zorunlu ise düzenli olarak sonda bakýmýnýn yapýlmasýný önermekteyiz.

BACKGROUND: This study aimed to investigate the prevalence and risk factors for hospital-acquired urinary tract infections in patients with severe burn injuries.
METHODS: In this study, patients treated due to their burn injuries of greater than 20% between August 2009 and April 2012 in Bozyaka Training and Research Hospital Burn Center were assessed retrospectively. Sixty nine patients (30 [43.5%] males, 39 [56.5%] females; mean age 40.1±16.7 years) were included into the study.
RESULTS: DM, duration of the catheter and catheter care showed a statistically significant correlation with hospital-acquired urinary tract infections (p<0.005).
DISCUSSION: A large number of hospital-acquired urinary tract infections are associated with urinary catheterization. In addition, removing urinary catheter within the shortest time possible is another issue to be considered for the prevention of these infections. If the catheter has to remain for a longer time, regular catheter care is recommended.

Sedasyon altýnda redükte edilmiþ nadir bir çift taraflý anteriyor kalça çýkýðý olgusunu sunuyoruz. Kýrk yedi yaþýndaki erkek bir araç tarafýndan çarpýlýp yere düþürüldü. Petidinle kombine titre edilmiþ intravenöz midazolam dozuyla birlikte petidin kullanarak sedasyon altýnda çift taraflý anteriyor kalça kýrýðýný baþarýyla redükte ettik. Manipülasyon yapanýn uyluðunu bir dayanak noktasý olarak kullanýp modifiye Lefkowitz manevrasý uyguladýk. Hasta
travmadan iki ay sonra yük bindirmeye baþladý. Yirmi dört ay sonra ise kalça aðrýsý olmaksýzýn yürüyordu. Literatür gözden geçirildiðinde 12 adet çift taraflý anteriyor kýrýðý olgu sunumu saptadýk. Yalnýzca bir yazar redüksiyon iþlemi için intravenöz sedasyon (propofol) kullandýðýný bildirmiþti. Hiçbir yazar bu amaçla Lefkowitz manevrasý kullandýðýný bildirmemiþti. Sonuçta, modifiye Lefkowitz manevrasýný kullanarak sedasyon altýnda çift taraflý anterior kalça çýkýðýnýn redüksiyonu mümkündür.

A rare case of bilateral anterior hip dislocation reduced under sedation was reported in this study. A 47-year-old man was knocked down by a car and sustained bilateral anterior hip dislocation which was reduced successfully with sedation using titrated dose of intravenous Midazolam in combination with Pethidine. A modified Lefkowitz maneuver using the manipulator’s thigh as a fulcrum was used. Patient started weight bearing in the second month after injury and was walking without any hip pain at the twenty-fourth month
follow-up. Thirteen case reports describing bilateral anterior hip dislocations were found while reviewing the literature and it was noticed that only one author had reported the usage of intravenous sedation (Propofol) for the reduction procedure. However, no author
reported the use of Lefkowitz maneuver for this purpose. Consequently, reduction of a bilateral anterior hip dislocation is possible with sedation using a modified Lefkowitz maneuver.

Karotis patlama sendromu karotis arter ve dallarýnýn yýrtýlmasýna iþaret eder. Karotis patlamasý sendromu tipik olarak baþ veya boyun kanserleri için uygulanan tedavilerin komplikasyonlarý sonucu oluþan tehlikeli bir týbbi acildir. Daha önce baþ veya boyun kanseri öyküsü olmayan ve acil servise aðrýsýz büyümüþ bir boyun kitlesiyle gelen bir hastayý raporluyoruz. Lezyonun görüntülenmesi sýrasýnda kitle büyüyerek akut hava yolu týkanmasýna
neden olmuþ ve hava yolunu korumak için acil krikotirotomi gerekmiþtir. Hastanýn yinelenen kanamalarýný kontrol altýna almak için dört kez endovasküler tedavi uygulanmýþ ve bu tedavi sað orta serebral arter infarktýna baðlý nörolojik komplikasyona neden olmuþtur. Karotis patlama sendromunun klinik belirtileri, deðiþik tedavilerini ve sýk görülen komplikasyonlarýný tartýþtýk.

Carotid blowout syndrome refers to the rupture of the carotid artery and its branches. Carotid blowout syndrome is a dangerous medical emergency typically resulting from complications of treatments for head and neck cancer. A patient without a prior history
of head or neck cancer presented to the emergency department with a painless, enlarging neck mass was reported in this study. The mass progressed to acute airway obstruction during imaging of the lesion and necessitated emergency cricothyrotomy to secure the
airway. The patient underwent four endovascular treatments to manage repeated bleeding thus producing the neurological complication of right middle cerebral artery infarction. Clinical manifestations, varied treatments, and common complications of carotid blowout
syndrome were discussed.

Fournier gangreni genital bölgenin ve perinenin aerobik ve anaerobik bakterilere baðlý olarak geliþen ve nadir görülen nekrotizan fasiitidir. Bu enfeksiyon çoklu organ iþlev bozukluðu ve ölüm gibi ciddi komplikasyonlara yol açmaktadýr. Bu hastalýðýn agresif tedavisi için öncelikli olan tanýnýn erken konmasýdýr. Tedavideki asýl nokta, geniþ doku debridmaný ile birlikte geniþ spektrumlu antibiyoterapinin uygulanmasýdýr. Tedaviye raðmen mortalite yüksek seyretmektedir. Bu olguda, Fournier gangreni tanýsýyla üroloji servisine yatýrýlan yaþlý bir erkek hastaya yönelik hemþirelik yaklaþýmlarý yer almaktadýr.

Fournier’s gangrene is a rare, necrotizing fasciitis of the genitals and perineum caused by a mixture of aerobic and anaerobic microorganisms. This infection leads to complications including multiple organ failure and death. Due to the aggressive nature of this condition,
early diagnosis is crucial. Treatment involves extensive soft tissue debridement and broad-spectrum antibiotics. Despite appropriate therapy, mortality is high. This case report aimed to present nursing approaches towards an elderly male patient referred to the urology service with a diagnosis of Fournier’s gangrene.

Çocukluk çaðý humerus suprakondiler kýrýklarý hem kýrýktan kaynaklanan deformite hem de kýrýk uçlarýnýn keskin yapýsý nedeni sýklýkla nörovasküler komplikasyonlara yol açmaktadýr. Yeterli tedavi edilmedikleri takdirde Volkmann iskemik kontraktürü veya amputasyon gibi katastrofik komplikasyonlara yol açabilmektedirler. Bilgimize göre literatürde ameliyat öncesi dönemde normal nörovasküler muayenesi olup ameliyat sonrasý geç dönemde brakiyal arter trombozu ile birlikte total sinir paralizisi henüz bildirilmemiþtir. Çalýþmamýzda iki yaþ altý aylýk olan çocuk hastada kaymýþ humerus suprakondiler kýrðýnýn ameliyat sonrasý döneminde geliþen brakiyial arter trombozunun embolektomi yapýlarak tedavisini sunmayý amaçladýk.
Total median, ulnar ve radial sinir lezyonlarý, ameliyat sonrasý dördüncü ayda tamamen düzeldi. Sonuç olarak, özellikle ciddi olarak kaymýþ pediatrik humerus suprakondiler kýrýklarýnda ameliyat öncesi dönemde elin dolaþýmý iyi olsa dahi, ameliyat sonrasý dönemde nörovasküler inceleme yakýnen yapýlmalýdýr.

Pediatric supracondylar fractures of the humerus are generally associated with neurovascular complications due to the deformity and sharp nature of bone fragments. When treated inadequately, these injuries may result in catastrophic complications, such as Volkmann’s contracture and amputation. To our knowledge, late onset brachial arterial thrombosis and total temporary peripheral neuropathy after surgery of pediatric supracondylar fracture in the setting of normal preoperative vascular examination has not been reported yet. In this study, a 2-year and 6- month-old girl, who had delayed brachial arterial thrombosis after a displaced humerus supracondylar fracture surgery treated with embolectomy, was reported. Total lesion of median, ulnar and radial nerves completely resolved four months after surgery. Close neurovascular monitoring on the postoperative phase especially in severely displaced supracondylar fractures is strongly emphasized even in the setting of well-perfused hand.