AMAÇ: Eksplosif pulmoner barotravmada vasküler kaçaðýn kritik bir rol oynadýðý kanýtlanmýþtýr. Bu çalýþmada vasküler kaçaðýn bir giderek artan þiddet derecesindeki blast travmasý serisinde þiddet derecesiyle pulmoner vasküler kaçaða iliþkili altyapýsal kanýtlar kantitatif olarak araþtýrýldý.
GEREÇ VE YÖNTEM: Yüz adet erkek beyaz Yeni Zelanda tavþan detonatörden uzaklýklarýna göre beþ gruba randomize edildi (10 cm, 15 cm, 20 cm, 30 cm ve plasebo kontrol). Pulmoner vasküler kaçaðýn miktarý radyoaktif 1251-albümin etiketleme yöntemiyle izlendi. Blast dalgasýnýn neden olduðu patolojik deðiþiklikler ýþýk ve elektron mikroskobuyla incelendi.
BULGULAR: 125I-albüminin kapillerlerden kaçýþ hýzý ve her iki akciðerde rezidüel radyoaktivite detonatörden 10, 15 ve 20 cm mesafede anlamlý derecede artmýþ olmasý bu gruplarda þiddetli derecede vasküler kaçaðýn olduðunu düþündürmektedir. Ultrastrüktürel gözlem 10 ve 15 cm’lik gruplarda akciðer kapillerlerinde ödem ve endotel hücreleri arasýndaki mesafenin açýldýðýný gösterdi.
TARTIÞMA: Primer blast dalgasý akciðer kapillerlerinden kan sýzýntýsýna neden olabilmektedir. Blast dalgasý akciðer kapillerlerinin endotel hücrelerinin þiþmesine neden olabilmekte, endotel hücrelerinin arasýndaki mesafenin artmasý pulmoner vasküler kaçaktan sorumlu olabilmektedir.

BACKGROUND: Vascular leakage has been proven to play a critical role in the incidence and development of explosive pulmonary barotrauma. Quantitatively investigated in the present study was the severity of vascular leakage in a gradient blast injury series, as well as ultrastructural evidence relating to pulmonary vascular leakage.
METHODS: One hundred adult male New Zealand white rabbits were randomly divided into 5 groups according to distance from the detonator (10 cm, 15 cm, 20 cm, 30 cm, and sham control). Value of pulmonary vascular leakage was monitored by a radioactive 125I-albumin labeling method. Pathological changes caused by the blast wave were examined under light and electron microscopes.
RESULTS: Transcapillary escape rate of 125I-albumin and residual radioactivity in both lungs increased significantly at the distances of 10 cm, 15 cm, and 20 cm, suggesting increased severity of vascular leakage in these groups. Ultrastructural observation showed swelling of pulmonary capillary endothelial cells and widened gap between endothelial cells in the 10-cm and 15-cm groups.
CONCLUSION: Primary blast wave can result in pulmonary capillary blood leakage. Blast wave can cause swelling of pulmonary capillary endothelial cells and widened gap between endothelial cells, which may be responsible for pulmonary vascular leakage.

AMAÇ: Bu çalýþma konvansiyonel infrared ýsýtýcýlar kullanýlarak yeni bir yanýk modeli tanýmlanmasý amacýyla gerçekleþtirildi.
GEREÇ VE YÖNTEM: Yirmi bir adet Sprague-Dawley sýçan üç gruba ayrýldý. Sýçanlarýn sýrt derisi zaman ve mesafe deðiþkenleri doðrultusunda; 50 cm 5 dakika (Grup 1), 50 cm 7.5 dakika (Grup 2) ve 50 cm 10 dakika (Grup 3) olacak þekilde infrared ýsýtýcýya maruz býrakýldý. Yanýðýn derecesi ve karakterinin belirlenmesi amacýyla makroskobik ve histopatolojik deðerlendirme yapýldý.
BULGULAR: Birinci grupta yanýk oluþumu izlenmezken, ikinci grupta parsiyel kalýnlýkta, üçüncü grupta ise tam kat yanýk oluþumu izlendi. Ýki ve üçüncü gruplar arasýnda dermal kollajen denatürasonu açýsýndan istatistiksel olarak anlamlý farklýlýklar gözlemlendi. Dermal hasarlanma üçüncü grupta ikinci gruba kýyasla daha derin olduðu gözlemlendi.
TARTIÞMA: Konvansiyonel infrared ýsýtýcýlar kullanýlarak yeni bir yanýk modeli tanýmlanýrken model içerisinde standart deðiþkenlerde ortaya koyuldu. Buna göre 50 cm mesafeden 10 dakika infrared ýsýtýcýya maruz kalýnmasýyla tam kat, ayný mesafeden 7.5 dakika maruz kalýnmasýyla kýsmi kalýnlýkta yanýk modelleri oluþturuldu.

BACKGROUND: This study was undertaken to develop new experimental burn injury model using conventional infrared heaters.
METHODS: 21 Sprague-Dawley rats were divided into 3 groups. Portion of dorsal area was exposed to infrared radiation from distance of 50 cm to create burn injury. Length of exposure to heat for Group 1 was 5 minutes; Group 2 was exposed for 7½ minutes, and Group 3 was exposed for 10 minutes. Macroscopic and histopathological evaluations were utilized to demonstrate depth and characteristics of injury.
RESULTS: There was no burn injury in first group. Group 2 developed partial thickness burn, and result was full thickness burn injury in Group 3. In Groups 2 and 3 there was statistically significant difference in dermal collagen denaturation. Dermal injury depth was statistically significantly higher in Group 3 compared to Group 2.
CONCLUSION: New experimental burn injury model is described using conventional infrared heaters. Standard variables pertaining to model were defined to produce burn injuries at predictable depth: 10 minutes of exposure from 50 cm distance for full thickness burn, and 7½ minutes of exposure from the same distance for partial thickness injury.

AMAÇ: Bu çalýþma, yanýða baðlý olarak geliþen akciðerdeki oksidatif hasara karþý betain tedavisinin olasý koruyucu etkisini tanýmlamak için tasarlandý.
GEREÇ VE YÖNTEM: Yanýk oluþturmak için sýrt derileri traþ edilmiþ Wistar albino türü sýçanlar, eter anestezisi altýnda 10 saniye süreyle 90°C suya tutuldu. Yanýk oluþturulmadan evvel 21 gün süre ile betain 250 mg/kg dozunda oral olarak uygulandý ve yanýk oluþturulduktan sonra tek doz betain uygulamasý yapýldý. Kontrol grubunda ise ayný iþlem uygulandýktan sonra sýrt bölgeleri 10 saniye süreyle 25°C suya tutuldu. Deney sonunda sýçanlar dekapite edildi ve kan numuneleri proinflamatuvar sitokinleri (tümör nekroz faktör- [TNF-] and interlökin 1 beta [IÝL-1]) ve LDH aktivitesini analiz etmek için toplandý. Akciðer doku örnekleri histolojik analizlarin yaný sýra MDA ve GSH seviyelerini, MPO ve Na+, K+-ATPaz aktivitesini belirlemek için alýndý.
BULGULAR: Yanýk hasarý sitokin seviyelerinde ve LDH aktivitesinde önemli derecede artýþa neden oldu. Yanýk hasarýna baðlý olarak akciðer dokularýnda MDA seviyeleri ve MPO aktivitesi yüksek, GSH seviyeleri ile Na+, K+-ATPaz aktivitesi düþük bulundu.
TARTIÞMA: Bu çalýþmanýn bulgularýna göre yanýðýn serum ve dokuda neden olduðu hasarýn betain ile anlamlý olarak azaldýðý saptanmýþtýr.

BACKGROUND: This study was designed to determine possible protective effect of betaine treatment against oxidative injury in pulmonary tissue induced with thermal trauma.
METHODS: Under ether anesthesia, shaved dorsum of Wistar albino rats was exposed to a 90°C water bath for 10 seconds to induce burn injury. Betaine was administered orally (250 mg/kg) for a period of 21 days before burn injury, and single dose of betaine was administered after thermal injury. Control group rats were exposed to 25°C water bath for 10 seconds. Upon conclusion of experiment, rats were decapitated and blood was collected for analysis of pro-inflammatory cytokines and lactate dehydrogenase (LDH) activity. Lung tissue samples were taken to determine malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO), and Na+/K+-ATPase activity, in addition to histological analysis.
RESULTS: Burn injury caused significant increase in both cytokine levels and LDH activity. In lung samples, raised MDA levels, MPO activity, and reduced GSH levels and Na+/K+-ATPase activity were found due to burn injury.
CONCLUSION: Treatment of rats with betaine significantly restored GSH level and Na+/K+-ATPase activity, and decreased MDA level and MPO activity. According to the findings of the present study, betaine significantly diminishes burn-induced damage in tissue.

AMAÇ: Bu çalýþmada, doðal antioksidanlardan olan resveratrol ve kuersetin’in, deneysel spinal kord travmasý oluþturulmuþ sýçanlarda, oksidatif stres ve sekonder doku hasarý üzerine olan etkilerini araþtýrmak amaçlandý.
GEREÇ VE YÖNTEM: Bu deneysel çalýþmada, 42 adet Sprague-Dawley cinsi erkek sýçan kullanýldý. Spinal kord hasarý klip kompresyon metodu kullanýlarak T4-T5 seviyesinden yapýldý. Çalýþma kontrol, travma, travma+çözücü, travma+resveratol, travma+kuersetin ve travma+kombine (resveratrol ve kuersetin) olmak üzere 6 grup üzerinden yürütüldü. Ýþlemden 48 saat sonra tüm sýçanlar sakrafiye edildi. Resveratrol ve kuersetin’in serum ve dokuda total antioksidan kapasite düzeyi ve paraoksonaz enzim aktivitesine ve histopatolojik bulgulara olan etkisi araþtýrýldý.
BULGULAR: Sonuç olarak resveratrol, kuersetin ve kombine tedavi verilen gruplarda TAOK düzeyi ve PON aktivitesi deðerlerinde travma grubuna göre anlamlý bir artma saptandý. Resveratrol ve kuersetin gruplarý arasýnda TAOK düzeyi ve PON aktivitesi açýsýndan anlamlý bir farklýlýk yoktu. Çözücü grubunda TAOK düzeyi ile PON aktivitesi travma grubuna göre anlamlý derecede yüksekti. Histopatolojik incelemede ise sadece çözücü, resveratrol, kuersetin ve kombine tedavi gruplarýnda PMNL infiltrasyonunun azaldýðý görüldü.
TARTIÞMA: Çalýþmamýzdaki biyokimyasal ve histolojik deðerlendirmede resveratrol ve kuersetin uygulamasýnýn spinal kord travmasýnda görülen ikincil hasardan, spinal kordu korumak için kullanýlabileceði sonucuna varýlmýþtýr.

BACKGROUND: The aim of this study was to investigate the effect of natural antioxidants resveratrol and quercetin on oxidative stress and secondary cell damage in rats with acute spinal cord injury.
METHODS: In this experimental study, 42 male Sprague-Dawley rats were used. Spinal cord injury was performed with clip compression method at level of T4-5. The study was conducted using 6 groups: control, trauma, trauma and solvent, trauma and resveratrol, trauma and quercetin, and trauma with combined resveratrol and quercetin. All rats were euthanized 48 hours after the procedure. Effects of resveratrol and quercetin on serum and tissue total antioxidant capacity and paraoxanase activity level were examined.
RESULTS: Compared to trauma group, there was a significant increase in total antioxidant capacity and paraoxanase activity level in resveratrol, quercetin, and combined treatment groups. There was no significant difference between resveratrol and quercetin groups with regard to total antioxidant capacity and paraoxanase activity level. Total antioxidant capacity and paraoxanase activity level were significantly higher in solvent group than trauma group. In histopathological evaluation, there was a decrease in polymorphonuclear leukocyte infiltration in solvent, resveratrol, quercetin, and combined treatment groups.
CONCLUSION: Biochemical and histological staining results of present study showed that resveratrol and quercetin may be effective in preventing secondary damage in spinal cord injury.

AMAÇ: Orbitaiçi yabancý cisim nedeniyle ameliyat edilen hastalarýn klinik özellikleri ve tedavi sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM: On yýllýk bir dönemde orbitaiçi yabancý cisim nedeniyle ameliyat edilen 24 hastanýn týbbi dosyasý gözden geçirildi.
BULGULAR: Yirmi hasta (%83) erkek, dört hasta (%17) kadýndý (ortalama yaþ, 28 yýl; veri aralýðý: 4–69 yýl ). On hasta (%42) travmayý izleyen 48 saat içinde, yedi hasta (%29) üç gün–bir ay içinde ve yedi hasta (%29) bir aydan sonra baþvurdu. Yabancý cisim 19 hastada (%79) inorganik, beþ hastada (%21) organikti. Yabancý cisme eþlik eden majör oküler morbiditeler, orbital sellülit (n=5), travmatik optik nöropati (n=3), göz perforasyonu (n=2) ve rektus kasý kopmasýydý (n=2). Tüm hastalarda yabancý cisim tam olarak çýkartýldý. Ortalama izlem süresi 26 aydý (veri aralýðý: 1 ay–10 yýl).
TARTIÞMA: Orbitaiçi yabancý cisimler sýklýkla inorganik ve metaliktir; genç erkeklerde daha sýk görülür. Orbital sellülit organik yabancý cisimler için tipik sayýlmakla birlikte, lakrimal kese ve paranazal sinüsleri perfore eden metalik yabancý cisimlere baðlý olarak da görülebilir. Orbitaiçi yabancý cisimler, modern orbita cerrahisi yöntemleriyle güvenli bir biçimde çýkartýlabilir.

BACKGROUND: The present study is an evaluation of clinical features and management outcomes of patients operated on for intraorbital foreign bodies (FBs).
METHODS: Medical records of 24 patients who underwent surgery for intraorbital FBs within a 10-year period were reviewed.
RESULTS: Twenty patients (83%) were male and 4 (17%) were female (mean age: 28 years; range: 4-69 years). Ten patients (42%) presented within 48 hours of injury, 7 (29%) within 3 days to 1 month, and 7 (29%) more than 1 month after injury. FBs were inorganic in 19 patients (79%), and organic in 5 (21%). Major ocular morbidities were orbital cellulitis (n=5), traumatic optic neuropathy (n=3), globe perforation (n=2), and rupture of rectus muscle (n=2). FBs could be completely removed in all cases. Mean follow-up time was 26 months (range: 1 month-10 years).
CONCLUSION: Intraorbital FBs are usually inorganic and metallic, and occur more frequently in young males. Orbital cellulitis, considered typical for organic FBs, may also occur with metallic that perforate lacrimal sac or paranasal sinuses. With appropriate caution, intraorbital FBs can be removed safely with current orbitotomy techniques.

AMAÇ: Bu çalýþmanýn amacý penetran keratoplasti sonrasý oluþan travmatik yara ayrýlmasýnýn risklerini ve olasý sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya kliniðimizde 1995–2014 yýllarý arasýnda penetran keratoplasti sonrasý travmatik yara ayrýlmasý geliþen 34 hastanýn 34 gözü dahil edilmiþtir. Hastalarýn kayýtlarý, travmanýn tipi ve zamaný, en iyi düzeltilmiþ görme keskinliði (EÝDGK), baþvuru anýndaki bulgular, uygulanan cerrahi giriþim ve sonuçlarý açýsýndan incelendi.
BULGULAR: Penetran keratoplasti cerrahisi ve travma arasýnda geçen süre bir ay ile 100 ay arasýnda deðiþmekle beraber median 14 aydý. Travma sýrasýndaki median yaþ, 31.5 (5-81) yýldý. Tüm hastalarda yara ayrýlmasý, donör-alýcý ara yüzünde meydana gelmiþti. Hastalarýn %58.8’inde ayrýlmanýn büyüklüðü, altý saat kadraný veya daha geniþti. En sýk travma, parmak veya elle olan künt travmaydý (%35.2). En iyi düzeltilmiþ görme keskinliði median deðeri, travma öncesinde 0.5 logMAR (0.1–3.0), travmadan hemen sonraki muayenede ise 3.0 logMAR (0.7–3.0) idi. Yara ayrýlmasý, tüm hastalarda primer sütürasyon ile tamir edildi. En sýk uygulanan ilave cerrahi prosedür, ön vitrektomiydi (%26.4). Ýki hastada anatomik glob kaybý meydana geldi. Son vizitte, EÝDGK median deðeri 0.7 logMAR (0.1–3.0) idi. Primer sütürasyon sonrasý en sýk rastlanan komplikasyon greft yetmezliðiydi (%23.5). Hastalarýn %67.6’sýnda greft saydamdý.
TARTIÞMA: Travmatik yara ayrýlmasý, penetran keratoplasti sonrasý ortaya çýkabilen en yýkýcý komplikasyonlardandýr. Prognoz, eþlik eden ön ve arka segment hasarlanmasýna baðlýdýr. Bu kötü durumdan korunmak amacýyla penetran kornea nakli geçiren hastalar, cerrahi sonrasý olasý göz travmalarýna karþý uyarýlmalýdýr.

BACKGROUND: The aim of this study was to evaluate risks and consequences of traumatic wound dehiscence after penetrating keratoplasty (PK).
METHODS: Data regarding 34 eyes of 34 patients who were treated for traumatic wound dehiscence after PK between 1995 and 2014 were studied. Patient records were reviewed for type and time of insult, corrected distance visual acuity (CDVA), clinical presentation signs, operative method, and outcome.
RESULTS: The interval between PK and trauma ranged from 1 month to 100 months, with median of 14 months. Median age at trauma was 31.5 years (range: 5–81 years). Wound dehiscence occurred at donor-recipient interface in all patients. In 58.8% of patients, extent of dehiscence was ≥6 clock hours. Most frequent type of trauma was blunt trauma by hand/finger (35.2%). Median CDVA before and just after trauma were 0.5 logMAR (range: 0.1–3.0 logMAR) and 3.0 logMAR (range: 0.7–3.0 logMAR), respectively. Wound dehiscence was managed with primary wound closure in all patients. Most frequent additional surgical procedure was anterior vitrectomy (26.4%). Anatomical globe loss occurred in 2 patients. Median CDVA was 0.7 logMAR (range: 0.1–3.0 logMAR) at final visit. Most common complication after primary suturation was graft failure (23.5%). Graft remained clear in 67.6% of patients.
CONCLUSION: Traumatic wound dehiscence is one of the potentially devastating postoperative complications that can occur following PK. Prognosis depends on existence and severity of additional anterior/posterior segment damage. In order to prevent this catastrophic condition, patients should be warned against ocular trauma after undergoing PK.

AMAÇ: Endoskopik retrograd kolanjiopankreatikografiye (ERKP) baðlý perforasyonlar az görülmelerine karþýlýk yüksek morbidite ve mortalite oranlarýna sahiptir. Bu çalýþmada ERKP’ye baðlý perforasyonlarýn tedavisi ve sonuçlarýmýza ait tecrübelerimizi deðerlendirmeyi ve ilgili literatürün gözden geçirilmesini amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2008 ve Ocak 2015 yýllarý arasýnda Ýzmir Katip Çelebi Üniversitesi, Atatürk Eðitim ve Araþtýrma Hastanesi Endoskopi Ünitesi’nde toplam 9383 ERKP iþlemi yapýldý. Bu hastalarýn 29’unda (%0.33), ERKP’ye baðlý perforasyon tespit edildi ve bu hastalara ait veriler geriye dönük olarak deðerlendirildi.
BULGULAR: Yirmi dokuz hastanýn 18’i kadýn, 11’i erkek hasta olup, ortalama yaþ 70.5 (33–99 yaþlar arasý) idi. Stapfer sýnýflandýrmasýna göre 5 hastada tip 1, 14 hastada tip 2, 7 hastada tip 3 ve 3 hastada da tip 4 perforasyon saptandý. Toplam olarak, 15 hastaya cerrahi tedavi uygulandý; bunlardan 9’u (%60) sorunsuz olarak taburcu edilirken, 6 (%40) hasta ameliyat sonrasý komplikasyonlardan dolayý öldü. Yirmi dokuz hastanýn 7’sinde (%24.1) ise baþlangýçta endoskopik tedavi uygulandý ve bu hastalardan beþi sorunsuz olarak taburcu edildi. Ancak endoskopik tedavi iki hastada baþarýsýz oldu. Peritonit geliþen bu 2 hastadan ilki, cerrahi tedavi sonrasý sorunsuz olarak taburcu edildi. Cerrahi tedaviyi kabul etmeyen diðer hasta ise sepsis nedeni ile öldü. Altý hasta konservatif týbbi tedavi ile baþarýlý bir þekilde tedavi edildi. Peritonit sonrasý geliþen sepsis nedeniyle hayatýný kaybeden 2 hastadan ilkinde hasta ve yakýnlarýnýn cerrahi tedaviyi reddetmesi nedeniyle, diðer hastada ise, anestezinin indüksiyon evresinde ani geliþen kardiyopulmoner arrest sonucu cerrahi tedavi yapýlamadý. Çalýþmamýzda ortalama hastanede kalma süresi 13.2 gün (2–57), ölen hasta sayýsý ise dokuz (%31) idi.
TARTIÞMA: Endoskopik retrograd kolanjiopankreatikografiye baðlý perforasyonlar nadir görülmesine karþýlýk yüksek mortalite oranlarý yol açabilmesi nedeni ile son derece önemli bir klinik durumdur. Erken taný ve tedavi mortalite ve morbidite oranlarýnýn azaltýlmasýnda çok önemlidir. En uygun tedavi yöntemi, hastanýn bireysel özellikleri ve klinik durumu göz önünde bulundurularak verilmelidir.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature.
METHODS: Between January 2008 and January 2015, a total of 9383 ERCPs were performed in endoscopy unit. A total of 29 perforations (0.33%) were identified and retrospectively reviewed.
RESULTS: Of the 29 patients, 18 were female and 11 patients were male, with mean age of 70.5 years (range 33–99 years). According to Stapfer’s classification, the 29 patients with ERCP related perforations included 5 type 1 perforations, 14 type 2 perforations, 7 type 3 perforations, and 3 cases of type 4 perforation. In total, 15 of 29 patients with ERCP perforation were operated on. Nine (60%) of those who underwent surgery were discharged uneventful, but 6 (40%) patients died due to postoperative complications and/or associated comorbidities. Seven (24.1%) of 29 patients had undergone endoscopic treatment and 5 of the 7 were discharged from the hospital without any problems; however, peritonitis occurred in 2 patients whose initial endoscopic treatment failed. The first of these 2 patients underwent surgery and was discharged uneventfully, but second patient, who refused surgery, died due to sepsis. Six patients were successfully treated with conservative management. Surgery could not be performed in the remaining 2 patients, who died of sepsis following peritonitis; 1 refused surgery, the other had sudden cardiopulmonary arrest during induction of general anesthesia. Mean hospital stay was 13.2 days (range: 2–57 days). In all, 9 (31%) patients died during period of the study.
CONCLUSION: ERCP-related perforation is uncommon complication, but an extremely serious condition. Early diagnosis and prompt management are most important to reduce associated significant morbidity and mortality rates. The most appropriate treatment course should be determined on case-by-case basis.

AMAÇ: Akut künt travmatik aortik yaralanmasý ile baþvuran olgularýn geriye dönük olarak incelenmesi ve yatakbaþý akciðer grafisinde muhtemel aortik yaralanmaya ait bulgularýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Beþ yýllýk dönemde 18 yaþ üstü akut travmatik aort transeksiyonu tanýlý hastanýn dosyalarý geriye dönük olarak incelendi. Demografik özellikleri, olayýn niteliði, revise travma skoru, Glaskow koma skalasý, vital bulgularý, fizik muayene bulgularý, biyokimyasal parametreleri, acilde kalýþ süreleri, olgularýn takip sonucu ve yatakbaþý çekilen akciðer grafisi iki acil týp uzmaný ve bir radyolog tarafýndan deðerlendirildi.
BULGULAR: Çalýþmaya 30 olgu alýndý. Yaþ ortalamasý 45.87±16.14 (%70 erkek) ve en sýk nedeni araçiçi trafik kazasý (%53.3) idi. Acil týp uzmanlarý ve radyolog uyumu mediastinal geniþlemesi ve sol seri kot kýrýklarýnda ‘mükemmel-kabul edilebilir’, paraspinal hattýn geniþlemesi ve torasik vertebra kýrýðýnda ‘zayýf’ olarak tespit edildi.
TARTIÞMA: Akut künt travmatik aortik yaralanma primer bakýda fizik muayene ve akciðer grafisi resüsitasyon için fikir verebilir. Ýkincil baký için hastanýn hemodinamik stabilitesi ve yaralanma mekanizmalarý da gözönüne alýnarak uygun görüntüleme stratejileri belirlenmelidir.

BACKGROUND: The purpose of our study was to retrospectively evaluate traumatic aortic transection patients and their bedside plain chest radiographs for signs of aortic injury.
METHODS: Emergency department (ED) patients from a 5-year period with traumatic aortic transection who were over 18 years of age were included in the study. Demographic characteristics, mechanism of trauma, Revised Trauma Score, Glasgow Coma Score, vital signs, physical exam findings, laboratory parameters, length of stay in the ED, and patient outcomes were documented. Bedside plain chest radiograph images were interpreted by 2 emergency medicine specialists and 1 radiologist.
RESULTS: Thirty patients, mean age 45.87±16.14 years (70% male), were enrolled. Most common trauma mechanism was motor vehicle accident (53.3%). Agreement rates between emergency medicine specialists and radiologist were found to be “excellent” and “substantial” in identifying mediastinal widening and multiple left sided rib fractures; and “fair” in identifying widened paraspinal line, and transthoracic vertebral fractures.
CONCLUSION: Though not completely reliable, bedside plain chest radiographs and physical examination findings may be useful in detecting aortic injury during primary survey when the patient is unstable and cannot be sent for chest computerized tomography. Appropriate further imaging studies should be carried out as appropriate based on patient’s hemodynamic status.

AMAÇ: Son yýllarda tüm dünyada olduðu gibi Türkiye’de de obezite çok ciddi bir toplum sorunu olacak þekilde giderek artmaktadýr. Bugüne kadar obezitenin dahili hastalýklarýyla ilgili birçok çalýþma yapýlmasýna raðmen travma hastalarýnda obezitenin prognoz üzerindeki etkisini inceleyen çok az çalýþma mevcuttur. Bu çalýþmada travma hastalarýnda vücut kitle indeksinin (VKÝ) travma þiddeti ve prognoz üzerine etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu ileriye yönelik çalýþmada 01 Haziran 2013 ile 31 Mayýs 2014 tarihleri arasýnda Dicle Üniversitesi Týp Fakültesi Hastanesi Acil Servisi Travma Ünitesi’ne baþvuran 15 yaþ üstü travma hastalarý incelendi. Hastalar maruz kaldýklarý travmanýn þiddetine göre yüksek enerjili travma (YET) ve düþük enerjili travma (DET) olmak üzere iki gruba ayrýldý. Hastalar BMI (kg/m2) deðerlerine göre 4 gruba ayrýldý: Grup I; BMI<25 (normal kilolu grup), Grup II; VKÝ 25–29.9 (kilo fazlalýðý grubu), Grup III; VKÝ 30–34.9 (obez grup), Grup IV; VKÝ ≥35 (morbid obez grup).
BULGULAR: Tüm hastalarýn gruplar arasý farklarý incelendiðinde gruplar arasýnda baþ yaralanmasý, toraks yaralanmasý, ekstremite yaralanmasý, çoklu travma oraný, klinik yatýþ oraný ve mortalite açýsýndan belirgin fark saptandý (p<0.001). Karýn yaralanmasý açýsýndan gruplar arasýnda belirgin bir fark görülmedi (p=0.347).
TARTIÞMA: Travma hastalarýnda VKÝ arttýkça klinik yatýþ oraný, yoðun bakýmda yatýþ süresi, mortalite oraný, multitravma oraný ve ISS skoru artmaktadýr.

BACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients.
METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June 1, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m2). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25–29.9 (overweight). Group III had BMI of 30–34.9 (obese), and Group IV was made up of patients with BMI ≥35 (morbidly obese).
RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347).
CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.

AMAÇ: Ameliyat sonrasý enflamatuvar sitokinlerin serum düzeylerinin cerrahi stresin boyutunu yansýttýðý düþünülür. Sitokin IL-6, sistemik enflamatuvar yanýtýn ve doku hasarýnýn erken bir belirtecidir. Bu çalýþmanýn amacý, açýk ve laparoskopik apendektomi sonrasý serum IL-6 düzeylerini deðerlendirerek bu prosedürlere baðlý geliþen cerrahi stres düzeyini karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Akut apendisit tanýsý almýþ ardarda gelen 200 hastanýn plazmasýnda ameliyat öncesi ve sonrasý IL-6 düzeyleri ölçüldü. Ameliyat öncesi geliþigüzel seçim ile 100 hastaya açýk apendektomi ve 100 hastaya da laparoskopik apendektomi yapýldý.
BULGULAR: Ameliyat öncesi IL-6 konsantrasyonu açýk grupta 65.22±4.76 pg/ml iken laparoskopik grupta ise 65.73±6.34 pg/ml idi (p=0.752). Ameliyat sonrasý düzeyler ise sýrasýyla 105.28±16.14 pg/ml ve 76.11±16.18 pg/ml idi (p<0.05).
TARTIÞMA: Serum IL-6 düzeylerinin daha düþük olmasý laparoskopik cerrahide cerrahi stres düzeyinin daha düþük olmasý ile iliþkilidir. Laparoskopik apendektominin daha hýzlý ameliyat sonrasý iyileþme nedeniyle açýk apenedektomiye göre belirgin avantajý mevcuttur.

BACKGROUND: Postoperative serum inflammatory cytokine levels are thought to reflect the magnitude of surgical stress. Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study evaluated levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures.
METHODS: IL-6 levels were measured pre- and postoperatively in the plasma of 200 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 100 patients underwent open appendectomy, and 100 patients underwent laparoscopic appendectomy.
RESULTS: Preoperative concentrations of IL-6 were 65.22±4.76 pg/mL in the open appendectomy group and 65.73±6.34 pg/mL in the laparoscopic appendectomy group (p=0.752). Postoperative levels were 105.28±16.14 pg/mL and 76.11±16.18 pg/mL, respectively (p<0.05).
CONCLUSION: Lower postoperative serum IL-6 levels suggest that laparoscopic surgery is associated with lower degree of surgical stress. Laparoscopic appendectomy has significant advantage over open appendectomy due to more rapid postoperative recovery.

AMAÇ: Akut apandisitin etiyolojisi nadir olarak gastrointesitinal sistemin parazitik enfeksiyonlarýný içermektedir. Parazitler bazen histopatolojik inceleme sýrasýnda lümen içinde gözlemlenebilmesine raðmen ameliyat öncesi tanýsý zor bir durum olarak kalmaya devam etmektedir. Bu çalýþmanýn amacý, akut apandisitin klinik semptomlarý ile acil servise getirilen ve apendektomi yapýlan hastalarda gaitada gizli kan, intestinal parazitlerin tür ve prevelansýný ileriye yönelik olarak taramaktýr.
GEREÇ VE YÖNTEM: Haziran 2009 ile Aralýk 2014 tarihleri arasýnda apendektomi geçiren 13 yaþ üstü 136 hasta ileriye yönelik olarak ve tüm hastalarýn histopatolojik analiz verileri geriye dönük olarak deðerlendirildi.
BULGULAR: Apendektomi sonrasý histopatolojik incelemede, hastalarýn %75.5 (n=103) akut apandisit (AA), %13.2’si negatif apandisit (normal appendiks, NA) (n=18), %11.1 (n=15) perfore apandisit (PA) idi. Ameliyat öncesi gaita analizinde, tüm hastalarýn %25’inde (n=34) intestinal parazitlerin var olduðu, %14.7’sinde (n=20) gaitada gizli kanýn pozitif olduðu görüldü. Akut apandisit olgularýnýn %9.7’sinde (n=10), PA olgularýnýn %53.3’ünde (n=8) ve NA olgularýnýn %11.1’inde (n=2) gaitada gizli kan pozitifliði tespit edildi ve PA olgularýndaki gaitada gizli kan pozitifliði anlamlý derecede yüksek idi (p<0.001).
TARTIÞMA: Gaitada intestinal parazitler, apandisit ile iliþkili olmayabilir fakat apandisitin patolojik bulgularýna sýklýkla yol açarlar. Gaitada gizli kan pozitifliði apandisit perforasyonu için önemli bir kanýt olabilir.

BACKGROUND: Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy.
METHODS: Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed.
RESULTS: In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (p<0.001).
CONCLUSION: Presence of intestinal parasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

AMAÇ: Kýsmi steril teknik, çocuk suprakondiler humerus kýrýklarýnýn tedavisinde son yýllarda kullanýlýr hale gelmiþtir. Bu çalýþmanýn amacý bu tekniðin suprakondiler humerus kýrýklarýnýn tedavisindeki güvenilirlik ve etkinliðinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Bu çalýþmaya, kýsmi steril teknik kullanýlarak kapalý redüksiyon ve fiksasyon uygulanan 712 hasta dahil edildi. Hastalar ameliyat sonrasý oluþabilecek olan enfeksiyon ve diðer komplikasyonlar açýsýndan deðerlendirildi. Klinik ve radyolojik deðerlendirmeler yapýldý.
BULGULAR: Elli iki hastada (%7.22), aðýzdan antibiyotik tedavisi ve tel dibi bakýmýna cevap veren erken tel çekilmesini (üç hafta öncesi) gerektirmeyen çivi yolu enfeksiyonu izlendi. Derin enfeksiyon ile karþýlaþýlmadý. Redüksiyon kaybý ile 82 hastada (%11.5) karþýlaþýldý. Elli iki tanesi (%7.3) ulnar sinir olmak üzere toplam 59 (%8.3) iyatrojenik sinir yaralanmasý oluþtu. Yirmi dokuz (%4.1) hastada klinik olarak belirgin kubitus varus deformitesi vardý.
TARTIÞMA: Kýsmi steril teknik suprakondiler humerus kýrýklarýnýn tedavisinde etkiliymiþ gibi görünmekteyse de artmýþ tel dibi enfeksiyon oranlarý kaygý vericidir.

BACKGROUND: The purpose of the present study was to evaluate safety and efficiency of the semi-sterile technique used in recent years in treatment of pediatric supracondylar humeral fractures (SHF).
METHODS: Total of 712 patients who were treated for SHF via closed reduction and percutaneous fixation with semi-sterile technique were enrolled in present study. Patients were evaluated for postoperative infection and other complications. Clinical and radiological assessments were also made.
RESULTS: It was found that there were 52 (7.3%) pin tract infections, which responded to oral antibiotic administration and pin care without need for early pin removal (before 3 weeks). There were no deep infections. Loss of reduction was observed in 82 patients (11.5%). There were 59 iatrogenic nerve injuries (8.3%), of which 52 (7.3%) were ulnar palsy. Clinically apparent cubitus varus was observed in 29 (4.1%) patients.
CONCLUSION: Though semi-sterile technique is an effective treatment in closed percutaneous pinning of SHF, increased pin tract infection risk is a matter of concern.

AMAÇ: Suprakondiler humerus kýrýklarý çocukluk döneminin en sýk dirsek kýrýðýdýr. Kapalý redüksiyon ve perkütan çivileme altýn standart tedavi olarak kabul edilir. Bununla beraber bazen açýk redüksiyon gerekebilir. Bu geriye dönük çalýþmamýzýn amacý suprakondiler humerus kýrýklarýnda triseps kasýný kesen posterior ve lateral yaklaþýmlarýn klinik ve fonksiyonel sonuçlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Toplam 38 hasta posterior veya lateral insizyonla ameliyat edildi. Grup 1’de posterior insizyonlu 30 hasta, Grup 2’de lateral insizyonlu sekiz hasta mevcuttu. Kozmetik ve klinik sonuçlarý karþýlaþtýrmak için Flynn kriterleri kullanýldý. Kýrýk kaynamasý AP ve lateral grafilerle deðerlendirildi. Hastalar ve ebeveynlerine dirseðini tam aktif olarak ne kadar sürede hareket ettirebildiði ve tedavi sürecinden tatmin durumlarý sorularak kayýt tutuldu.
BULGULAR: Ortalama kaynama süresi Grup 1 ve Grup 2 için sýrasýyla 44.1 gün ve 46.3 gün, tam veya tama yakýn dirsek hareketlerine kavuþma süresi Grup 1 ve Grup 2 için sýrasýyla atel çýkarýmý sonrasý 57.5 ve 55.7 gün olarak bulundu. Grup 1’deki 30 hastanýn ve ebeveynin 21’i (%70), Grup 2’deki sekiz hastanýn ve ebeveynin altýsý (%75) sonuçtan tam olarak tatmin olduklarýný ifade ettiler. Grup 1’deki 30 hastanýn 21’i (%70), Grup 2’deki sekiz hastanýn ve altýsý (%75) her iki Flynn kriterlerine göre (kozmetik ve fonksiyonel) çok iyi grupta yer aldý.
TARTIÞMA: Pediatrik suprakondiler humerus kýrýklarýnýn tedavisinde kapalý redüksiyon ve perkütan çivilemenin altýn standart tedavi olduðuna inanýyoruz. Bu metodun uygulanamadýðý olgularda trisepsi kesen posterior yaklaþýmýn daha kolay kýrýk redüksiyonu ve muhtemelen daha kýsa ameliyat süresi gibi avantajlarýndan dolayý güvenli ve lateral yaklaþýmla karþýlaþtýrýlabilir olduðunu düþünüyoruz.

BACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and percutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery.
METHODS: A total of 38 patients underwent surgery; Group 1 consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction.
RESULTS: Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group 1 and Group 2, respectively. Twenty-one of 30 (70%) patients (and parents) in Group 1, and 6 of 8 (75%) patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 (70%) patients in Group 1, and 6 of 8 (75%) patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria.
CONCLUSION: In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.

AMAÇ: Bu araþtýrmanýn amacý yanýk hastasýnda sub akut ve kronik dönemde uyku kalitesinin belirlenmesidir.
GEREÇ VE YÖNTEM: Araþtýrma, bir üniversite hastanesinde Ocak 2014–Haziran 2015 tarihleri arasýnda tanýmlayýcý olarak yapýlmýþtýr. Araþtýrmaya 36 hasta dâhil edilmiþtir. Verilerin toplanmasýnda hastalarýn tanýtýcý özelliklerini belirleyen form ve Pittsburgh Uyku Kalitesi Ýndeksi (PUKÝ) kullanýlmýþtýr. Araþtýrmadan elde edilen verilerin analizi için SSPS 22.0 paket programý kullanýlmýþ olup tüm analizlerde istatistiksel önemlilik için p<0.05 kabul edilmiþtir.
BULGULAR: Araþtýrmaya katýlan 36 hastanýn yaþ ortalamasý 26.69±9.63, (yaþ aralýðý 19–60) olup %11.1’i kadýn, %88.9’u erkektir. Hastalarýn %50’sinin yanýk yarasý evde alev yanýðý nedeniyle oluþmuþtur. Yanýða baðlý hastalarýn %52.8’inde komplikasyon geliþmiþtir. Hastalarýn PUKÝ skor ortalamasý 9.30±4.03’tür ve %86.5’inin uyku kalitesi kötüdür. Hastalarýn yoðun bakýmda yatma, eðitim durumu, yanýk alaný yüzdesi, yanýk yaralanmasýnýn üzerinden geçen zaman ve ilaç kullanma (antidepresan, antipsikotik) durumu ile Pittsburgh Uyku Kalitesi ortalamalarý arasýnda istatistiksel olarak anlamlý bir iliþki bulunmuþtur (p<0.05).
SONUÇ: Araþtýrmaya katýlan hastalarýn uyku kalitesinin kötü olduðu deðerlendirilmiþtir. Yanýk yaralanmasý sonrasýnda yeterli uykunun, doðal savunma hücrelerinin iþlevini, protein sentezini ve büyüme hormonu salýnýmýný arttýrarak yanýk yaralarýnýn iyileþmesini saðladýðý bilinmektedir. Bu nedenle hastalarýn uyku kalitesi ve yaþadýklarý uyku problemlerinin bilinmesinin, yanýklý hastalarýn hemþirelik bakýmýnýn geliþmesine katký saðlayacaðý düþünülmektedir.

BACKGROUND: The aim of this study was to determine the sleep quality of patients treated at burn center.
METHODS: The present study is descriptive research conducted between January 2014 and July 2015 at a university hospital. The study included 36 patients. Patient information form and Pittsburgh Sleep Quality Index (PSQI) were used to collect data. SPSS software (version 22.0; SPSS Inc., Chicago, IL, USA) was used for the analysis of the data, and statistical significance was regarded as p<0.05 in all analyses.
RESULTS: The average age of the 36 patients included in the study is 26.69±9.63 years (age range: 19–60 years) and 11.1% are female, while 88.9% are male. Burn injuries of 50% of the patients were due to flash burn that occurred in the house. Complications developed in 52.8% of the patients. PSQI score average of the patients was 9.30±4.03 and 86.5% of them suffer from poor sleep quality. It was found that there was a statistically significant correlation (p<0.05) between Pittsburgh Sleep Quality averages and patient being in the intensive care unit (ICU), education level, percentage of area burned, length of time that had passed since the burn, and medication (antidepressant or antipsychotic).
DISCUSSION: The sleep quality of patients in the study was found to be of poor degree. It is known that after burn injury, sufficient sleep enhances the function of natural defense cells, protein synthesis, and release of growth hormones, thereby healing the burn injuries. Information about patient sleep quality and sleep problems can lead to the development of nursing care for patients suffering from burns.

Splenik damarlarýn arteriyovenöz fistülü (AVF) nadirdir. En çok bir komþu vene mevcut bir splenik arter anevrizmasýnýn spontan rüptürü, travma sonucu veya iyatrojenik psödoanevrizma nedeniyle meydana gelmektedir. Künt abdominal travma bazen dalakta vasküler hasara yol açabilmekte sonuçta AVF oluþmaktadýr. Burada çok þiddetli splenik travmaya maruz kalmýþ yaþlý bir hasta tanýmlanmýþtýr. Arteryel ve venöz fazlý bilgisayarlý tomografik (BT) görüntüler kullanýlarak gerçekleþtirilen üç boyutlu volüm rekonstrüksiyonu posttravmatik AVF erken dönemde tanýmlanmýþtýr.

Arteriovenous fistula (AVF) of splenic vessels is rare. It is most commonly caused by spontaneous rupture of an extant splenic artery aneurysm into an adjacent vein, or by traumatic or iatrogenic pseudoaneurysm. Blunt abdominal trauma can sometimes lead to vascular damage to spleen, resulting in AVF formation. Presently described is case of an elderly patient with high-grade splenic injury. Early post-traumatic AVF was detected by volume-rendered 3D reconstruction using fused arterial and venous phase computed tomography (CT) images.

Özellikle baðýþýklýk sisteminde sorun olan hastalarda ciddi enfeksiyonlara neden olan Aspergillus ailesi nadiren karýniçi enfeksiyonlara da neden olabilmektedir. Dýþ merkezde laparoskopik kolesistektomi ameliyatý olan ve ameliyat sonrasý erken dönemde baþlayarak, giderek artan þiþkinlik, bulantý ve kusma þikayetleri olan hasta ameliyat sonrasý 19. günde akut karýn tanýsý ile kliniðimize sevk edildi. Hasta, safra kaçaðý düþünülerek ameliyat edildi, ancak eksplorasyonda suphepatik alanda bulunan sarý-yeþil renkte yumuþak kitlenin patolojik incelemesinde aspergilloz enfeksiyonuna baðlý fungus topu olduðu anlaþýldý. Ameliyat sonrasý karýn içi aspergillus tanýsý alan 46 yaþýndaki kadýn hasta literatür eþliðinde sunuldu.

Aspergillus fungi can cause serious infections, including intra-abdominal infection, particularly in patients with compromised immune system. Described in the present report is case of 46-year-old female patient who had undergone laparoscopic cholecystectomy (LC) at another healthcare facility. In early postoperative period, she had increasing complaints of swelling, nausea, and vomiting. On postoperative 19th day, she was referred to our clinic with diagnosis of acute abdomen. Surgery was performed with suspected possibility of bile leakage. However, pathological examination of soft, yellow-green mass found in subhepatic space determined it was fungus ball caused by fungi of the genus Aspergillus. Patient was diagnosed postoperative intra-abdominal aspergillosis (IAA).

Lipomlar eriþkinlerde adipöz dokunun en sýk görülen benign tümörleridir. Vücudun heryerinde görülebilmekle beraber, karýn içinde özellikle de preperitoneal bölgede nadiren saptanmaktadýrlar. Genel olarak farklý patolojiler için yapýlan inceleme ve ameliyat esnasýnda rastlantýsal olarak tespit edilmelerine raðmen çok nadir olarak da lipomun kendisi akut karýný taklit eden patolojilere yol açabilmektedir. Bu yazýda, akut apandisiti taklit eden bulgularla acile baþvuran ve laparaskopik eksplorasyonda karýn sað alt kadranda preperitoneal yerleþimli torsiyone olmuþ saplý lipom saptanan 35 yaþýndaki kadýn hasta literatür eþliðinde sunuldu.

Lipoma is the most common benign tumor of adipose tissue. Lipomas can occur almost anywhere in the body, but are rarely found in parietal peritoneum of abdominal wall. Occasionally lipomas are detected incidentally during abdominal surgery for other organ pathologies. Presently described is rare case of torsion of pedunculated lipoma originating in parietal peritoneum of anterior abdominal wall causing abdominal pain that mimicked acute appendicitis in 35-year-old woman.

Nekrotizan fasiit, deri, subkutan dokular ve fasyalarýn ilerleyici nekrozu ile karakterize, yaþamý tehdit eden bir yumuþak doku enfeksiyonudur. Fournier gangreni (FG), perianal ve genital bölgenin tutulduðu nekrotizan fasitin ciddi ve agresif bir þeklidir. Burada anorektal cerrahi sonrasý çevre dokuda yaygýn nekroz geliþen ve septik þoka neden olan iki FG olgusu sunulmuþtur. Olgu 1: Öyküsünde anal darlýk ve duplikasyon yapýlan altý aylýk kýz hasta ateþ, uykuya meyil ve emmeme yakýnmalarý ile baþvurdu. Fizik muayenesinde anal bölgede ekimoz olan hasta septik þok bulgularýyla Yoðun Bakým Ünitesi’ne (YBÜ) alýndý. Uygun antibiyotik tedavisi baþlanan hastanýn on iki saat içerisinde lezyonun nekrotik hale gelmesi üzerine acil cerrahi debridman uygulandý. Kan ve doku kültürleri negatif saptanan hastada baþvurudan itibaren iki ay içerisinde tam iyileþme saptandý. Olgu 2: Dokuz aylýk erkek hasta fistülotomiden sekiz saat sonra dirençli nöbet ve septik þok bulgularý ile YBÜ’ye yatýrýldý. Fizik muayenesinde skrotal, gluteal ve perianal bölgede ödem ve ekimoz gözlendi. Septik þoktaki hastaya temel yaþam desteði verildikten sonra geniþ spektrumlu antibiyotik tedavisi baþlandý ve perianal debridman yapýlarak kolostomi açýldý. Tamamen düzelme hiperbarik oksijen tedavisi sonrasý baþvurunun üçüncü ayýnda saðlandý. Anoraktal cerrahi uygulanan her hasta FG açýsýndan dikkatle izlenmelidir. Erken debridman, uygun antibiyotik tedavisi ve hiperbarik oksijen tedavisi hayat kurtarýcý olabilir.

Necrotizing fasciitis is a life-threatening soft tissue infection characterized by progressive necrosis of the skin, subcutaneous tissues and fascia. Fournier’s gangrene (FG) is a serious and aggressive form of infective necrotizing fasciitis involving perineal region and genitalia. Presently described are 2 pediatric cases of FG with widespread necrosis of surrounding tissue following anorectal surgery, causing severe septic shock. Case 1: Six-month-old female patient with anal stenosis and duplication presented at emergency clinic with fever, somnolence, irritability, and feeding difficulty. Physical examination upon admission to Intensive Care Unit (ICU) with septic shock determined she had ecchymosis in anal region. At 12fth hour after admission, lesion had become necrotic and patient was started on broad-spectrum antibiotics after surgical debridement. Cultures were negative and patient had complete recovery 2 months after admission.
Case 2: Nine-month-old male patient was admitted to ICU for convulsions and sepsis eight hours after fistulectomy. Scrotal, gluteal, and perianal edema and ecchymosis were observed on physical examination. Perianal debridement and colostomy were performed, and patient was given broad-spectrum antibiotics after basic life support strategies for septic shock. Complete recovery was achieved after hyperbaric oxygen treatment for perianal lesion and patient was discharged from the hospital in third month after admission.
After anorectal surgery, every patient should be observed carefully for FG. Early debridement, proper antibiotics, and hyperbaric oxygen treatment can be life-saving.