AMAÇ: Cordycepin’in sýçan modelinde adezyonu önleyip önlemediðini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Her biri 10’ar adet olmak üzere sýçanlar rastgele üç gruba ayrýldý. Kontrol grubu: Laparotomi ile adezyonun olmadýðýný doðruladýk. Adezyon grubu: Çekum abdomenden çýkarýldý ve kuru spanç ile peteþial hemoraji odaklarý oluþana kadar scraping yapýldý. Cordycepin grubu: Ayný cerrahi prosedür adezyon grubunda tanýmlandýðý gibi yapýldý, ancak 10 mg/kg cordycepin intraperitoneal olarak uygulandý. On beþ gün sonra sýçanlar anestezi altýnda kardiyak kan çekme yoluyla sakrifiye edildi. Daha sonra sýçanlar morfolojik ve histopatolojik olarak analiz edildi ve hydroxyproline (OH-p) ve malondialdehyde (MDA) düzeyleri ölçüldü.
BULGULAR: Makroskobik olarak adezyonun Cordycepin grubunda adezyon grubuna göre anlamlý derecede azaldýðý görüldü (p<0.01). Bununla birlikte histopatolojik düzelmede Cordycepin grubunda adezyon grubuna göre anlamlý derecede düzelme görüldü (p<0.05). Kan ve doku OH-p ve MDA düzeyleri kontrol grubuna göre adezyon grubunda daha yüksekti. Bu deðerler Cordycepin grubunda adezyon grubuna göre daha düþüktü. Malondialdehit seviyesi Cordycepin grubunda adezyon grubuna göre istatistiksel olarak anlamlý derecede düþüktü (kan p<0.05, doku p<0.01). Buna karþýlýk yalnýzca doku OH-p düzeyi adezyon grubuna göre Cordycepin grubunda istatistiksel olarak anlamlý derecede düþüktü (p<0.05). Adezyon ve Cordycepin grubunda birer sýçan ameliyat sonrasý kaybedildi.
TARTIÞMA: Cordycepin sýçan abrazyon modelinde adezyonu etkili olarak azalttýðýný tespit ettik. Bu yüzden bu ajan ameliyat sonrasý adezyonu önlemek için deðerli olabilir.

BACKGROUND: The aim of the present study was to investigate whether cordycepin prevented adhesion formation in a rat model.
METHODS: Rats were randomly assigned to 3 groups of 10 rats. Control group: The absence of adhesion was confirmed via laparotomy. Adhesion group: The cecum was removed from the abdomen and scraped with a dry gauze bandage until petechial hemorrhagic foci developed. Cordycepin group: The same surgical procedure was performed as in the adhesion group, and 10 mg/kg cordycepin was administered intraperitoneally. After 15 days, the rats were sacrificed humanely via cardiac blood withdrawal under anesthesia. The rats were then analyzed morphologically and histopathologically, and hydroxyproline (OH-p) and malondialdehyde (MDA) levels were measured.
RESULTS: Macroscopic analysis revealed significantly less adhesion in the cordycepin group than in the adhesion group (p<0.01). Furthermore, significant histopathological improvement was also evident in the cordycepin group compared to the adhesion group (p<0.05). The levels of OH-p and MDA in blood and tissue were higher in the adhesion group than in the control group, and lower in the cordycepin group than the adhesion group. Interestingly, MDA level was significantly lower (blood: p<0.05; tissue: p<0.01) in the cordycepin group than in the adhesion group, whereas only tissue OH-p was significantly lower in the cordycepin group compared with the adhesion group (p<0.05). One rat in both adhesion group and cordycepin group died postoperatively.
CONCLUSION: Results indicated that cordycepin effectively reduced adhesion in a rat abrasion model. Thus, this agent may be valuable to prevent postoperative adhesion.

AMAÇ: Þok, böbrek transplantasyonu, kýsmi nefrektomi, kardiyopulmoner baypas, sepsis gibi çeþitli klinik durumlarda ortaya çýkabilen iskemi reperfüzyon (ÝR) hasarý hastada ciddi organ yetersizliklerine neden olabilmektedir. Ýskemi reperfüzyon hasarýný azaltmak amacýyla kullanýlan yöntemlerden bazýlarý uzak iskemik ön koþullama (UÝÖK) ve farmakolojik koþullamadýr. Bu çalýþmanýn amacý; sýçan renal ÝR modelinde tek taraflý arka ekstremiteye uygulanacak UÝÖK ile farmakolojik koþullama olarak deksmedetomidin kullanýmýnýn etkilerinin karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Dokuz Eylül Üniversitesi Týp Fakültesi Hayvan Deneyleri Yerel Etik Kurulu onayý alýndýktan sonra aðýrlýklarý 250–300 g arasýnda deðiþen 28 adet erkek Wistar albino sýçan her birinde yediþer denek olacak þekilde dört gruba ayrýldý. Tüm gruplara genel anestezi altýnda laparotomi uygulandý ve sol renal pedikül diseke edildi. Grup I (Sham, n=7): Laparatomi sonrasý sol renal pedikül diseke edilip baþka bir giriþim yapýlmadan sýçanlar anestezi altýnda bekletildi. Grup II (ÝR, n=7): Laparotomi sonrasýnda sol böbreðe 45 dakika total iskemi sonrasý dört saat reperfüzyon uygulandý. Grup III (ÝR+ Deksmedetomidin, n=7): Laparotomi sonrasýnda sol böbreðe Ýskemi uygulanýrken reperfüzyonun beþinci dakikasýnda 100 µg/kg deksmedetomidin intraperitoneal verildi. Grup IV (UÝÖK+ÝR, n=7): Anestezi altýnda sol arka bacaða üç döngü 10 dakika iskemi ve 10 dakika reperfüzyon uygulananarak beþ dakika sonra sol böbrekte ÝR oluþturuldu. Tüm gruplarda ratlarýn anestezi süresi eþit tutuldu, histomorfolojik deðerlendirme için sol böbrek çýkarýldýktan sonra sýçanlar sakrifiye edildi.
BULGULAR: Böbrek histomorfolojik hasar toplam skoru Sham grubunda diðer gruplara göre anlamlý olarak düþük bulundu (p<0.01). Ýskemi reperfüzyon grubundaki histomorfolojik hasar toplam skorlarý ÝR+deksmedetomidin ve UÝÖK+ÝR gruplarýndan anlamlý olarak yüksek saptandý (p<0.01). Deksmedetomidin ve UÝÖK gruplarýnýn hasar skorlarý karþýlaþtýrýldýðýnda anlamlý bir fark saptanmadý (p=0.89).
TARTIÞMA: Bu deneysel çalýþmada, sýçan renal ÝR modelinde deksmedetomidin ve UÝÖK’nin ÝR hasarýný histomorfolojik olarak anlamlý düzeyde azalttýðý saptanýrken, ÝR+deksmedetomidin ve UÝÖK+ÝR gruplarý arasýnda anlamlý bir fark bulunmadý.

BACKGROUND: The aim of this study was to evaluate the effects of remote ischemic preconditioning (RIPC) and dexmedetomidine as pharmacological conditioning in a rat renal ischemia/reperfusion (IR) injury model.
METHODS: Total of 28 male Wistar Albino rats weighing 250 to 300 g were divided into 4 equal groups. Group I (Sham; n=7): Laparotomy and renal pedicle dissection were performed, and the rats were observed under anesthesia without any intervention. Group II (IR; n=7): Following laparotomy and 45 minutes of left renal pedicle occlusion, 4 hours of reperfusion was performed. Group III (IR+D; n=7): Following laparotomy and ischemia, dexmedetomidine was administrated intraperitoneally (100 μg/kg) at fifth minute of reperfusion. Group IV (RIPC+IR; n=7): Under anesthesia, 3 cycles of ischemic preconditioning were applied to the left hind leg, and after 5 minutes, renal IR was performed. All rats were sacrificed after the left kidney was processed for conventional histomorphology.
RESULTS: Total histomorphological renal injury score was significantly lower in the Sham group compared with the other groups (p<0.01). Total renal injury score of IR group was significantly higher than IR+D and RIPC+IR groups (p<0.01). There was no significant difference in the total renal injury score between the dexmedetomidine and RIPC groups (p=0.89).
CONCLUSION: In the present study, it was demonstrated histomorphologically that both dexmedetomidine and RIPC decreased renal IR injury significantly. In addition, no significant difference was found between dexmedetomidine and RIPC groups.

AMAÇ: Bu çalýþma, sýçanlarda oluþturulan kontrolsüz hemorajik þok (HÞ) modelinde, soðuk sývý resüsitasyonunun yaþam süresi, kanama miktarý, kanama hýzý, hemodinami, hipotermi, koagülopati, asit-baz dengesi, hematokrit, laktat ve baz defisit üzerine etkilerini, ýlýk sývý resüsitasyonunun etkileriyle karþýlaþtýrmak için planlandý.
GEREÇ VE YÖNTEM: Çalýþmada ketamin ve ksilazinle anestezi altýna alýnan 29 sýçanýn dalaðýnda, vasküler ve parankim yaralanmasý ile HÞ modeli oluþturuldu. Hemorajik þokun 30. dakikasýnda, sýçanlara randomize olarak, 14.5 ml/kg dozunda %0.9 NaCl solüsyonu, 24 ºC sýcaklýkta (Grup 1, n=9) ve 4 ºC sýcaklýkta (Grup 2, n=10) 20 dakika süreyle intravenöz infüze edildi. Grup 1 ve 2’nin tedavi etkinliði, sývý tedavisi uygulanmayan grupla (Grup 3, n=10) karþýlaþtýrýldý. Ýstatistiksel olarak veriler, ortalama±standart sapma olarak hesaplandý. Ýstatistiksel analiz için SPSS for Windows 15.0 programý, Bonferroni düzeltmeli Mann-Whitney U-testi ve Kaplan-Meier prosedürü kullanýldý. P≤0.05 olduðunda, istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Soðuk sývý resüsitasyonu kanama miktarýný, kanama hýzýný, asidozu, hipotermiyi, laktatý, baz defisitini artýrarak ve de kan basýncýný, hematokriti düþürerek yaþam süresini kýsaltmýþtýr.
TARTIÞMA: Travmada sývý resüsitasyonu ile ilgili olarak; hangi sývýnýn, hangi sýcaklýkta, hangi miktarda ve ne kadar sürede verileceðini inceleyen birçok deneysel ve klinik çalýþmalarýn planlanmasýna büyük ihtiyaç olduðu deðerlendirilmiþtir.

BACKGROUND: This study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats.
METHODS: HS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24ºC (Group 1; n=9) or 4ºC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ≤0.05 was considered statistically significant.
RESULTS: Cold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit.
CONCLUSION: There is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration.

AMAÇ: Septik hastalarda sývý yanýtýný tahmin etmek için volüm durumunun hýzlý, doðru ve tekrarlanabilir olarak deðerlendirilmesi çok önemlidir. Spontan soluyan septik hastalarda sývý yanýtýnýn tahmininde inferiyor vena kava kollapsibilite indeksine (IVC-CI) ek olarak internal jugular ven kollapsibilite indeksinin (IJV-CI) etkinliðini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Sonografik inceleme üç aþamada gerçekleþtirildi. USCOM (Ultrasonic Cardiac Output Monitor) sistemiyle hemodinamik verilerle birlikte IVC-CI ve IJV-CI ölçümleri birinci aþamada yarý oturur pozisyonda, ikinci aþamada pasif bacak kaldýrma sonrasýnda (PBK) ve üçüncü aþamada yeniden yarý oturur pozisyona getirildikten sonra ölçüldü. Sývý yanýtý PBK sonrasý kardiyak indeksdeki (CI) deðiþiklikle deðerlendirildi. Hastalar retrospektif olarak iki gruba ayrýldý: PBK sonrasý ΔCI ≥%15 olanlar sývý yanýtlý (R), ΔCI <%15 sývý yanýtsýz olarak kabul edildi.
BULGULAR: Mekanik ventilatör desteði almayan 44 sepsis tanýlý hastada (ortalama yaþ 54.6±16.1 yýl) toplam 132 çift IVK ve IJV kollabsibilite indeksi ölçümü yapýldý. Bu hastalardan 23’ü (%52.2) yanýt alýnan (R) olarak kabul edildi. Sývý yanýtý alýnan hastalarýn IJV-CI ve IVC-CI deðerleri sývý yanýtsýz hastalara göre daha yüksekti (p<0.001). Ýnternal jugular ven kollapsibilite indeksi deðeri %36 yüksek olmasý %78 duyarlýlýk ve %85 özgüllük ile sývý yanýtlýlýðýný tahmin edebilmektedir. Venöz çap ölçümleri için gereken zaman IJV-CI (30 sn), IVC-CI (77.5 sn) karþýlaþtýrýldýðýnda IJV ölçüm süresi anlamlý olarak kýsa bulundu (p<0.001).
TARTIÞMA: Mekanik ventilasyon desteði almayan septik hastalarda sývý yanýtýnýn tahmininde IJV-CI kolay uygulanabilen, invaziv olmayan bir parametredir, IVC-CI yerine kullanýlabilir.

BACKGROUND: Rapid, accurate, and reproducible assessment of intravascular volume status is crucial in order to predict the efficacy of volume expansion in septic patients. The aim of this study was to verify the feasibility and usefulness of the internal jugular vein collapsibility index (IJV-CI) as an adjunct to the inferior vena cava collapsibility index (IVC-CI) to predict fluid responsiveness in spontaneously-breathing patients with sepsis.
METHODS: Three stages of sonographic scanning were performed. Hemodynamic data were collected using the Ultrasonic Cardiac Output Monitor 1A system (Uscom, Ltd., Sydney, NSW, Australia) coupled with paired assessments of IVC-CI and IJV-CI at baseline, after passive leg raise (PLR), and again in semi-recumbent position. Fluid responsiveness was assessed according to changes in the cardiac index (CI) induced by PLR. Patients were retrospectively divided into 2 groups: fluid responder if an increase in CI (ΔCI) ≥15% was obtained after PLR maneuver, and non-responder if ΔCI was <15%.
RESULTS: Total of 132 paired scans of IJV and IVC were completed in 44 patients who presented with sepsis and who were not receiving mechanical ventilation (mean age: 54.6±16.1 years). Of these, 23 (52.2%) were considered to be responders. Responders had higher IJV-CI and IVC-CI before PLR maneuver than non-responders (p<0.001). IJV-CI of more than 36% before PLR maneuver had 78% sensitivity and 85% specificity to predict responder. Furthermore, less time was needed to measure venous diameters for IJV-CI (30 seconds) compared with IVC-CI (77.5 seconds; p<0.001).
CONCLUSION: IJV-CI is a precise, easily acquired, non-invasive parameter of fluid responsiveness in patients with sepsis who are not mechanically ventilated, and it appears to be a reasonable adjunct to IVC-CI.

AMAÇ: Akut mezenter iskemi (AMÝ), tanýsý geç konan ve mortalitesi oldukça yüksek bir hastalýktýr. Mannheim peritonit indeksi (MPÝ) ve trombosit/lenfosit (T/L) oranýnýn akut mezenter iskeminin prognozu üzerine etkisini araþtýrmak.
GEREÇ VE YÖNTEM: Akut mezenter iskemi tanýsý konan 34 hastanýn dosyalarý, Eylül 2014–Nisan 2016 tarihleri arasýnda geriye dönük olarak tarandý. Hastalar hayatýný kaybeden ve kaybetmeyen diye iki gruba ayrýldý. Hastalarýn MPÝ ve T/L oranlarý, demografik verileri, yatýþ süreleri kaydedilip karþýlaþtýrýldý.
BULGULAR: Hastalarýn 19’u erkek (%55.9), 15’i kadýn (%44.1) olarak saptandý. Toplam 15 hasta hayatýný kaybederken (%44.1),19 hasta (%55.9) saðlýklý taburcu edildi. Mannheim periton indekslerine bakýldýðýnda ise hayatýný kaybeden hastalarda ortalama deðer 21.13±7.55 bulunurken, hayatýný kaybetmeyen hastalarda 16.00±5.24 olarak saptandý (p=0.026). Trombosit/lenfosit oranlarýna bakýldýðýnda hayatýný kaybetmeyen grupta 288.48±233.01 saptanýrken hayatýný kaybeden grupta ise 373.82±389.62 olarak bulundu (p=0.045).
TARTIÞMA: Akut mezenter iskemi tablosunda, prognozu ön görmede MPÝ ve T/L oranlarý basit ve güvenilir yöntemlerdir.

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that has a very high mortality rate and for which the diagnosis is frequently delayed. The aim of the present study was to assess the predictive value of the Mannheim Peritonitis Index (MPI) and platelet-to-lymphocyte (P/L) ratio in the prognosis of AMI.
METHODS: The files of 34 patients diagnosed with AMI between September 2014 and April 2016 were retrospectively examined. The patients were divided into 2 groups based on survival. The parameters of MPI and P/L ratio, demographic data, and duration of hospitalization were recorded and compared.
RESULTS: In all, 19 (55.9%) patients were male, and 15 (44.1%) were female. Total of 19 patients (55.9%) were discharged with a complete recovery, while 15 (44.1%) died. MPI mean value was 21.13±7.55 and 16.00±5.24 in those who died and survived, respectively (p=0.026). P/L ratio was 288.48±233.01 and 373.82±389.62 in those who survived and died, respectively (p=0.045).
CONCLUSION: MPI and P/L ratio are simple and reliable methods to predict the prognosis of AMI.

AMAÇ: Özofagusta takýlý kalan disk piller yüksek morbidite ve mortalite riskine sahiptir. Bu çalýþmada, kliniðimizde özofagus yerleþimli disk pil nedeniyle tedavi edilen hastalar sunuldu, erken taný ve tedavinin önemi vurgulandý.
GEREÇ VE YÖNTEM: Ocak 2010–Mayýs 2015 tarihleri arasýnda yabancý cisim yutma nedeniyle baþvuran hastalar geriye dönük olarak incelendi. Özofagusta takýlý kalan piller çalýþmaya dahil edildi. Hastalar yaþ, cinsiyet, baþvuru süresi, baþvuru semptomlarý, pilin yerleþim ve boyutu, uygulanan tedavi ve seyir açýsýndan incelendi.
BULGULAR: Yabancý cisim yutma ile baþvuran 1891 olgunun 71’inde yabancý cisim özofagusta yerleþimliydi. Yetmiþ bir özefageal yabancý cismin sekizi disk pildi (%11.2). Ortalama yaþ 1.7 yýl idi. Baþvuru süresi beþ olguda ilk altý saat, iki olguda 24 saat sonra, bir olguda bir ay sonra idi. Bir hasta dýþýnda hastalarýn tümünde yabancý cisim yutma öyküsü vardý. Tüm hastalarda pil endoskopik yolla çýkartýldý. Üç hastada dilatasyonlara yanýt veren özofageal striktür geliþti.
TARTIÞMA: Özofagusta takýlý kalan disk piller acil olarak tanýnýp çýkartýlmalýdýr. Uzun süren solunum ve gastrointestinal sistem semptomlarý olan hastalarýn ayýrýcý tanýsýnda özofageal yerleþimli disk pil akýlda tutulmalýdýr.

BACKGROUND: Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment.
METHODS: Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed.
RESULTS: Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation.
CONCLUSION: Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.

AMAÇ: Mikrocerrahideki cerrahi ve teknik ilerlemelere raðmen halen parmak amputasyonlarýnýn replantasyonu sonrasýnda tatminkar sonuçlar elde etmek zordur ve baþarý oranlarýný belirleyen birçok faktör mevcuttur. Bu yazýda, replantasyonun baþarýsýný deðiþtirebilecek faktörleri tartýþmak amaçlandý.
GEREÇ VE YÖNTEM: Altmýþ hastada uygulanan 85 parmak replantasyonunun geriye dönük analizi yapýldý. Revaskülarizasyonlar ve metakarpofalangeal eklemin proksimalindeki replantasyonlar çalýþma dýþý býrakýldý. Hastalarýn demografik özellikleri, yaralanma yeri, yaralanma mekanizmasý, amputasyon seviyesi ve baþarý oranlarý deðerlendirildi.
BULGULAR: Ortalama yaþlarý 31 olan 53 erkek ve yedi kadýn hasta çalýþmaya dahil edildi. Ýþaret parmaðý en sýk replante edilen parmaktý (%27). Sol el en sýk etkilenen taraftý (%62). Yaralanma mekanizmasý, replante edilen parmaklarýn %56’sýnda ezilme, %23’ünde giyotin tip, %21’inde ise avülziyondu. Baþarý oranlarý giyotin, ezilme ve avülziyon tipi yaralanmalarda sýrasýyla %81, %53 ve %36 olarak bulundu.
TARTIÞMA: Sonuç olarak, replantasyonlarýn baþarý oranlarýný belirlemede yaralanma tipi ve kiþisel deðiþkenler oldukça önemlidir. Replantasyon cerrahisinin sonuçlarýna etki edebilecek deðiþkenler hakkýnda bilgi sahibi olmak, hasta ve yakýnlarýný doðru bilgilendirme konusunda el cerrahlarýnýn yanýnda acil cerrahi hizmeti veren hekimler için de oldukça yönlendirici olacaktýr.

BACKGROUND: Despite surgical and technical advances in microsurgery, it is still difficult to obtain satisfactory results after replantation of finger amputation. The aim of the present study was to discuss some of the many factors that can affect the success rate of replantation.
METHODS: A retrospective analysis of 60 patients with 85 finger replantations was performed. Revascularizations and replantations proximal to the metacarpophalangeal joint were excluded. Demographic characteristics of the patients, place of injury, mechanism of injury, level of amputation, and success rate were examined.
RESULTS: A total of 53 male and 7 female patients with mean age of 31 years were included in the study. Index finger (27%) was the most commonly replanted digit. Left side was the more affected, with 62%. Mechanism of injury was crush in 56%, guillotine in 23%, and avulsion in 21% of replanted digits. Success rate was 81%, 53%, and 36% in guillotine, crush, and avulsion injuries, respectively.
CONCLUSION: In conclusion, the injury type and personal variables are very important in the rate of replantation success. Knowledge about the effects of different factors on the results of replantation surgery will provide guidance to hand surgeons in order to inform patients and their relatives properly.

AMAÇ: Bu çalýþmada çocuklardaki apandisit ile iskemi modifiye albümin (ÝMA), C-reaktif protein (CRP), eritrosit sedimentasyon hýzý (ESR), beyaz küre sayýsý (WBC), nötrofil lenfosit oraný (NLR), platelet lenfosit oraný (PLR) ve ortalama platelet hacmi (MPV) arasýndaki iliþkinin ortaya konulmasý amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmaya Mayýs 2015 ve Kasým 2015 tarihleri arasýnda hastanemize baþvuran toplam 63 olgu dahil edildi, bunlarýn 30’u apandisit olgusu ve 33’ü saðlýklý kontrol olgu idi. Gruplar yaþ ve cinsiyet açýsýndan benzerdi.
BULGULAR: Apandisitli hastalarda ÝMA, CRP, ESR, WBC, MPV, NLR ve PLR deðerlerinin ölçüldüðü ROC eðrisinin deðerlendirilmesinde, en yüksek eðri altýnda kalan alan (EAA) ÝMA’da (EAA: 0.991) tespit edilirken, onu takip eden EAA deðerleri NLR (EAA: 0.946), CRP (EAA: 0.808), PLR (EAA: 0.779), ESR (EAA: 0.767), WBC (EAA: 0.749) ve MPV (EAA: 0.583) idi.
TARTIÞMA: Bu amaçla apandisit tanýsýnda sýkça kullanýlan yüksek WBC ve CRP düzeyi, sað alt kadran aðrýsý ve USG sonuçlarýna ek olarak NLR, PLR, ÝMA ve ESR deðerlerinin de tanýda kullanýlmasýnýn faydalý olacaðý kanaatindeyiz.

BACKGROUND: The aim of the present study was to determine relationship of ischemia-modified albumin (IMA) level, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) to appendicitis in children.
METHODS: Study included total of 63 patients who presented at hospital between May 2015 and November 2015. Of these, 30 were cases of appendicitis, and 33 were healthy control subjects. The groups were statistically similar in age and gender.
RESULTS: Receiver operating characteristic curve was evaluated for IMA, CRP, ESR, WBC, MPV, NLR, and PLR values in patients with appendicitis, and IMA was determined to have highest area under the curve value (0.991), followed by NLR (0.946), CRP (0.808), PLR (0.779), ESR (0.767), WBC (0.749), and MPV (0.583).
CONCLUSION: Use of NLR, PLR, IMA, and ESR values may be helpful in diagnosis of appendicitis, in addition to WBC and CRP values, lower right quadrant abdominal pain, and ultrasonography signs commonly used.

BACKGROUND: Damage control surgery (DCS) has been a well-established practice in the management of trauma victims for more than 2 decades now. The primary aim of this study was to review and analyze the presentation and outcome of patients with torso trauma who underwent DCS at Level I trauma center.
METHODS: Retrospective study was conducted using database records prospectively maintained over period of 6 years from 2008 through 2013 at an urban Level I trauma center. Data available from hospital medical records were analyzed to study presentation, mechanism of injury, organs injured, associated injuries, and outcome in patients who underwent DCS following torso trauma. Primary outcome measure was survival.
RESULTS: Total of 61 patients were identified who had undergone DCS during the study period. Majority of these patients were males (n=59), had sustained blunt trauma as result of road traffic injury, and had presented with shock (n=49). The 30-day mortality rate was 54%. Mortality was significantly associated with shock (63% cases died; p=0.008), and with Glasgow Coma scale ≤8 (85% died; p=0.001). Injuries significantly associated with high mortality were hepatic injury (n=15; 11 died), major vascular injury (n=10; 3 died), cardiac injury (n=5; 3 died), and pelvic fracture (n=17; 10 died). Re-exploration was required in 28 cases with 13 deaths. Mesh laparostomy was performed in 24 cases, with mortality in 58%.
CONCLUSION: In the absence of more effective alternative, especially at facilities with limited resources, DCS may be appropriate in critically injured patients; however, it continues to be associated with significant morbidity and high mortality, even at tertiary care centers.

AMAÇ: Travmatik ölümler Dünya Saðlýk Örgütü’nün baþlýca ölüm sebepleri listesinde en üst sýralarda yer almaktadýr ve bu ölümlerde mortaliteyi en fazla etkileyen faktörlerden birisi travmanýn þiddetidir. Travma hastalarýnda týbbi giriþimler sýrasýnda kimi yaralanmalar atlanabilmekte ve bu durum týbbi uygulama hatasý iddialarýnýn doðmasýna neden olabilmektedir. Bu çalýþmanýn amacý, travma skorlama sistemlerinin saðlayacaðý yararý ortaya çýkarak týbbi uygulama hatasý iddiasý olan olgularýn deðerlendirilmesine yeni bir bakýþ açýsý getirmektir.
GEREÇ VE YÖNTEM: Olgulara Adli Týp Kurumu Genel Kurulu’nda 2010–2013 yýllarý arasýnda görüþülerek karara baðlanmýþ dosyalar taranarak ulaþýldý. Týbbi uygulama hatasý olan hekimin týbbi kayýtlarý, otopsi ya da son klinik deðerlendirme bulgularý göz önüne alýnarak her birisi için ayrý ayrý yaralanma aðýrlýk sorularý hesaplanarak karþýlaþtýrýldý.
BULGULAR: 2010–2013 yýllarý arasýnda 263 týbbi uygulama hatasý iddiasý dosyasý tartýþýlarak karara baðlanmýþtýr. Bunlardan 25’i hastanýn ölümüyle sonuçlanmýþ olgulardýr. Bu 25 olguda 34 hekim hakkýnda týbbi uygulama hatasý ile iddiasý ortaya atýþmýþtýr. Kurul 12 olguda 14 hekimin týbbi uygulama hatasý olduðu yönünde karar vermiþtir. Hakkýnda iddia olan hekimin tuttuðu týbbi kayýtlarda saptayabilmiþ olduðu travma bulgularý ile otopsi ya da son klinik deðerlendirmede saptanan tüm bulgulara ait Yaralanma Aðýrlýk Skoru ve Yeni-Yaralanma Aðýrlýk Skoru hesaplanarak atlanmýþ ya da gözden kaçýrýlmýþ yaralanmalarýn ölüm üzerindeki etkisi ortaya konabilecektir.
TARTIÞMA: Týbbi uygulama hatasý iddiasý bulunan olgularda travma skorlarýnýn hesaplanmasý tüm dallardan týbbi bilirkiþilikle görevlendirilmiþ uzmanlara ve ayrýca hakimlere, atlanmýþ ya da gözden kaçýrýlmýþ yaralanmalarýn etkilerinin ortaya çýkarýlmasýnda ve hekimin sorumluluðunun yorumlanmasýnda ve olgunun uygulama hatasý olmasaydý yaþayabilme ihtimalinin belirlenmesinde yardýmcý olacaktýr. Tek baþýna karar verdirici bir ölçüt olarak deðil diðer tüm bulgularý destekleyici bir araç olarak kullanýlabilecektir.

BACKGROUND: Traumatic injury is near the top of World Health Organization list of leading causes of death, and one of the major factors affecting mortality is the severity of the trauma. During medical intervention for trauma patients, some injuries may be overlooked, and this misstep may be the basis of a malpractice claim. The objective of this study was to provide a new approach to evaluating medical malpractice cases by discussing the benefits of the use of trauma scores.
METHODS: Cases of alleged malpractice that were discussed and concluded between 2010 and 2013 were selected from the case archive of the General Committee of the Council of Forensic Medicine (GC of CFM). Injury severity scores were calculated from the medical records of accused physicians and from the autopsy or final clinical evaluation records and compared.
RESULTS: Between the years 2010 and 2013, 263 cases of alleged medical malpractice were discussed and concluded by the general committee. Of these, in 25 cases of patient death, the reason for admission to the hospital was traumatic injury. Various surgical specialties were involved. In these 25 cases, 34 physicians were accused of medical malpractice, and the General Committee classified the interventions of 14 physicians in 12 cases as “malpractice.” Missed injuries and unrecognized diagnoses can be established by comparing the Injury Severity Score and New Injury Severity Score values in the findings of accused physicians with the subsequent findings of last evaluation or autopsy.
CONCLUSION: In a medical malpractice case, calculating injury severity scores may assist an expert witness or judge to detect any unseen injuries and to determine the likely survival potential of the patient, but these values do not provide enough information to evaluate all of the evidence or draw conclusions about the entire case. All contributing factors to trauma severity should be considered along with the trauma score and other case factors.

AMAÇ: Asetabulum kýrýklarý sonrasý erken Total Kalça Protezi (TKP) uygulamasýnýn fonksiyonel ve klinik sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2008–Ekim 2013 tarihleri arasýnda asetabulum kýrýðý tanýsýyla erken total kalça protezi uygulanan 17 hastanýn klinik ve radyolojik sonuçlarý deðerlendirildi. On dördü erkek, üçü kadýn olmak üzere, ortalama yaþlarý 52 (29–80) idi. Hastalarýn ortalama takip süresi 48.2 aydýr (24 ay–70 ay). Hastalarýn travmalarý ile operasyonlarý arasýndaki ortalama süre 13 gündür (2 gün–21 gün).
BULGULAR: Hastalarýn fonksiyonel sonuçlarý Harris kalça skoru ile deðerlendirildi. Ortalama Harris kalça skoru 89.6 (70–100) olarak bulundu. On üç (%76) hastada ise mükemmel ve iyi olarak bulundu. On hastanýn yedisi travmadan önce çalýþtýklarý iþe geri döndü. Ortalama iþe dönüþ süresi ise 7.2 ay (1.5 ay–24 ay) idi. Komplikasyon olarak kýsalýk, enfeksiyon, dislokasyon ve heterotopik ossifikasyon görüldü. Enfeksiyon ve dislokasyon nedeniyle iki hastaya revizyon uygulandý. Dokuz (%52.9) hastada Brooker sýnýflamasýna göre heterotopik ossifikasyon tespit edildi.
TARTIÞMA: Asetabulum kýrýklarýndan sonra doðru endikasyon ve doðru hasta seçimi ile yapýlan erken TKP ile aðrýsýz ve fonksiyonel bir kalça eklemi elde edilirken, erken mobilizasyon, erken iþe dönüþ ve tekrar operasyon riskinde azalma avantajlarý olduðu anlaþýlmýþtýr ve kafa travmasý, yüksek enerjili travma ya da ek kas iskelet sistemi yaralanmasýndan biri veya daha fazlasý olan hastalarda heterotopik ossifikasyon profilaksisi akýlda tutulmalýdýr.

BACKGROUND: The aim of this study was to evaluate the functional and clinical results of early total hip arthroplasty performed to treat acetabulum fracture.
METHODS: Evaluation of 17 patients who were diagnosed with acetabulum fracture and treated with early total hip arthroplasty between January 2008 and October 2013 was performed. In all, 14 patients were male, and 3 were female, with mean age of 52 years (range: 29–80 years). Time elapsed between trauma and operation was mean of 13 days (range: 2–21 days). Observation period was average of 48.2 months (range: 24–70 months). Mean Harris Hip Score was 89.6 (range: 70–100).
RESULTS: In 13 patients, score was good or excellent. Total of 7 of 10 patients had returned to their pre-trauma jobs. Mean length of time for return to work was determined to be 7.2 months (range: 1.5–24 months). Of the total, 9 (52.9%) patients were diagnosed with heterotopic ossification according to Brooker Classification.
CONCLUSION: After acetabulum fracture, early total hip arthroplasty with the correct indications and appropriate patient can result in functional, pain-free hip joint with the advantages of early mobilization, early return to work, and decrease in reoperation risk. Heterotopic ossification prophylaxis should be considered in the presence of 1 or more risk factors, such as a head injury, high-energy trauma, or associated musculoskeletal injuries.

AMAÇ: Çalýþmamýzýn amacý, intramedüller çivi ile tedavi edilen fibula kýrýðýnýn eþlik etmediði tibia diafiz kýrýklarý ile fibula kýrýðýnýn eþlik ettiði ayný tip tibia diafiz kýrýklarýnýn cerrahi süre, kaynamama, yanlýþ kaynama ve iyileþme oranlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: 2010–2013 yýllarý arasýnda tibia diafiz kýrýðý tanýsý konulan ve intramedüller çivi ile tedavi edilen 254 hasta geriye dönük olarak incelendi. Çalýþma kriterlerine uyan hastalar iki gruba ayrýldý. Her iki gruptaki hastalar, cerrahi öncesi geçen süre, cerrahi turnike zamaný, kaynama zamanlarý ve son kontrollerindeki tibia varus, valgus, rekurvatum ve antekurvatum deformiteleri açýsýndan karþýlaþtýrýldý.
BULGULAR: Her iki grup arasýnda cerrahi öncesi geçen süre, cerrahi turnike zamaný, kaynama zamanlarý ve son kontrollerindeki tibia varus, valgus, rekurvatum ve antekurvatum deformiteleri açýsýndan istatistiksel olarak anlamlý fark tespit edilmedi.
TARTIÞMA: Ýntramedüller çivi ile tedavi edilen tibia diafizer kýrýklarýnda fibulanýn saðlam olmasý redüksiyon kaybý, kaynamama, yanlýþ kaynama, ve iyileþme oranlarý bakýmýndan bir dezavantaj deðildir.

BACKGROUND: The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary nailing method.
METHODS: Records of 254 patients diagnosed with tibial diaphysis fracture and treated with intramedullary nailing between 2010 and 2013 were examined and 30 patients were included in the study. Group 1 comprised patients with solitary tibial diaphysis fracture, and Group 2 was made up of patients with tibial diaphysis fractures associated with fibula fracture. Patients in both groups were compared in terms of time to surgery, duration of surgical tourniquet, time to union, and varus, valgus, recurvatum, and antecurvatum deformities of the tibia at final follow-up.
RESULTS: No statistically significant difference was found between the 2 groups in time to surgery, duration of surgical tourniquet, time to union, or varus, valgus, recurvatum, and antecurvatum deformities.
CONCLUSION: Results indicated that intact fibula in tibial diaphysis fracture treated with intramedullary nailing was not a disadvantage; it did not affect rate of union or lead to loss of reduction, non-union, or malunion.

This is the first report in the literature to describe removing war-related cardiothoracic shrapnel using video-assisted thoracoscopic surgery (VATS). War blast caused penetrating thoracic and extremity injuries in 30-year-old man. He was referred to our hospital after stabilization. Magnetic resonance imaging was required to evaluate brachial plexus injury. Large, penetrating shrapnel fragment in the right posterior chest wall, retained shrapnel in apex of the right lung, and another fragment in the pericardium were removed using VATS in staged approach. Postoperative period was uneventful. VATS is useful in managing complex, war-related cardiothoracic injuries.

Visseral arter anevrizmalarý (VAA) vasküler patolojiler arasýnda çok nadir görülmektedir. Otopsi çalýþmalarýnda görülme sýklýðý %0.1–%0.2 arasýnda deðiþmektedir. Çoðu olguda semptomsuzdurlar ve komplikasyonlarý sonucu taný alýrlar ya da baþka nedenle yapýlan görüntülemeler sýrasýnda insidental olarak saptanýrlar. Visseral arter anevrizmalarý arasýnda süperiyor mezenterik arter (SMA) uç dal anevrizmalarý %3 oranýnda görülmektedir. Anevrizma rüptürü sonucu intra ve/veya ekstraperitoneal kanamalar hayatý tehdit etmekte ve acil müdahale gerektirmektedir. Bu nedenle taný konulduktan sonra hýzlý bir þeklide cerrahi ya da endovasküler giriþim ile tedavi edilmeleri gerekmektedir. Bu yazýda, karýn aðrýsý, bulantý, kusma nedeni ile baþvuran ve görüntülemelerinde ileokolik arterde anevrizma saptanýp endovasküler giriþim planlandýðý ve hastanede yatýþ sýrasýnda rüptüre olan, acil cerrahi giriþim uygulanan olguyu sunmayý ve literatür taramasý yapmayý amaçladýk.

Visceral artery aneurysm (VAA) is very rare among vascular pathologies. Incidence reported in autopsy series and angiographic studies varies between 0.1% and 0.2%. Most cases are asymptomatic and are diagnosed as result of complications, or incidentally, when imaging is performed for another reason. Three percent of VAAs are superior mesenteric artery (SMA) terminal branch aneurysms. Intra- and/or extraperitoneal bleeding due to ruptured aneurysm is life-threatening condition and requires emergent intervention. Therefore, surgical or endovascular interventional treatment must be performed rapidly after diagnosis. Presently described is case of ileocolic artery aneurysm in a patient admitted with abdominal pain, nausea, and vomiting. Endovascular intervention had been planned; however, during hospitalization, aneurysm ruptured and emergent surgery was performed. Review of the literature is also presented.

Ýlaç baðýmlýlýðý önemli bir sosyal ve týbbi sorundur. Uyuþturucu madde kaçakçýlýðýnda “vücutta depolama” yöntemi sýklýkla kullanýlmaktadýr. Uyuþturucu madde küçük plastik paketler halinde hazýrlandýktan sonra yutulur ya da rektum, vajina gibi doðal vücut kavitelerine yerleþtirilir. Diðer benzer bir durum da uyuþturucu madde paketinin polis baskýný sýrasýnda tutuklanmamak için istemli yutulmasýdýr. Biz burada eroin içeren bir paket yutan ve endoskopik olarak tedavi edilen bir olguyu sunduk. “Vücut Depolayýcýlarý”nýn yuttuðu uyuþturucu paketlerinin tedavisinde, uygun olgularda üst gastrointestinal endoskopi güvenli bir alternatif yöntemdir.

Drug addiction is an important medical and social problem. “Body packing” is frequently used for concealed transportation of illegal drugs. The drug is packed in small plastic packages and swallowed or placed into body cavities, such as the rectum or the vagina. Another aspect is “body stuffing,” in which the drug package is usually hastily swallowed in order to avoid arrest. Presently described is case of a body stuffer who ingested a package of heroin and was successfully treated with upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy is a safe alternative therapeutic option in body stuffers in selected cases.