AMAÇ: Melatoninin iskemi/reperfüzyon hasarýnda (ÝRH) intestinal anastomoz iyileþmesi üzerine etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Otuz Wistar-Albino sýçan üç gruba (Sham, kontrol ve tedavi) ayrýldý. Süperior mezenterik arter (SMA) klemplenip 30 dakika sonrasýnda açýlarak ÝRH oluþturuldu. Sham grubunda sadece SMA manüplasyonu yapýldý. Tedavi grubuna melatonin (10 mg/kg) ve kontrol grubunda salin verildi. Tedavi ve kontrol gruplarýnda ek olarak 1 cm ileal segment rezeke edilerek anostomoz yapýldý. Ameliyat sonrasý yedinci günde anastomotik patlama basýncý, hidroksiprolin seviyeleri, yara iyileþmesinin histolojik göstergeleri ve oksidatif parametrelerin düzeyleri araþtýrýldý. Ýstatistik için tek yönlü varyans analizi ve ki kare testi kullanýldý.
BULGULAR: Melatonin tedavisi patlama basýncýnda anlamlý yüksekliðe yol açtý (sýrasýyla, p=0.027 ve p<0.00). Katalaz ve süperoksit dismütaz enzim seviyeleri sham ve melatonin gruplarýnda en yüksek, kontrol grubunda ise en düþüktü (sýrasýyla, p=0.001 ve p=0.002). Melatonin tedavisi her iki enzim düzeylerinde anlamlý yüksekliðe yol açtý (sýrasýyla, p=0.026 ve p=0.003). Glutatyon peroksidaz ve total glutatyon düzeylerinde tedavi grubunda hafifçe artýþ görülse de bu fark anlamlý deðildi (sýrasýyla, p=0.205 ve 0.216). Fibroblast infiltrasyonu, kapiller formasyon ve epitelizasyon melatoninle tedavi edilen sýçanlarda anlamlý olarak daha iyiydi. Granülosit ve mononükleer infiltrasyon skorlarý tüm gruplarda benzerdi.
TARTIÞMA: Deneysel modelde ÝRH sýrasýnda melatonin uygulamasýnýn intestinal anastomoz iyileþmesi üzerine belirgin olumlu etkileri olduðunu düþünüyoruz.

BACKGROUND: The aim of this study was to investigate the effects of melatonin on intestinal anastomosis after intestinal ischemia/reperfusion injury (IRI).
METHODS: Thirty Wistar albino rats of both sexes were divided into 3 groups: sham, control, and treatment. IRI was performed by clamping the superior mesenteric artery (SMA) for 30 minutes, followed by reperfusion. The sham rats received only manipulation of the SMA. Melatonin (10 mg/kg) was administered to the treatment group, and the control group was given a vehicle injection. Both the treatment group and the control group further underwent ileal resection of a 1-cm segment and anastomosis. On the postoperative seventh day, the anastomotic burst pressure, hydroxyproline level, histological indices of wound healing, and oxidative parameters of catalase (CAT), superoxide dismutase (SOD), total glutathione (T-GSH), and glutathione peroxidase (GSH-Px) levels were measured. A one-way analysis of variance and chi-square test were used for the categorical data.
RESULTS: Melatonin treatment led to a significantly higher burst pressure (p=0.027 and p<0.001, respectively). The 2 antioxidant enzymes, CAT and SOD, were at the highest level in the sham and melatonin groups and the lowest level in the control group (p=0.001 and p=0.002, respectively). Melatonin treatment resulted in a significantly higher level of both enzymes compared with the control group (p=0.026 and 0.003, respectively). The GSHpx and total GSH levels were slightly elevated in the treated rats, but the difference was not statistically significant (p=0.205 and 0.216, respectively). Fibroblast infiltration, capillary formation, and epithelialization were significantly better in the melatonin-treated animals. The granulocyte and mononuclear infiltration scores were similar between all groups.
CONCLUSION: It was concluded that melatonin had marked effects on intestinal anastomotic healing during intestinal IRI.

AMAÇ: Taktiksel ortamda turnike uygulamasý iki þekilde yürütülmüþtür: “kendi kendine yardým” denilen yaralýnýn kendisine turnike uygulamasý ve “arkadaþ yardýmý” denilen bir yardýmcýnýn turnike uygulamasý. Bu çalýþmanýn amacý bir yakýn harp simülasyon ortamýnda turnike kullanýmýnýn kalitesini test etmekti.
GEREÇ VE YÖNTEM: Çalýþmaya 24 “yaralý” ve tüm simülasyon çalýþmasýnda 72 uygulayýcý, altýþarlý 12 bölüm þeklinde katýldý. Turnike uygulamalarýný valide etmek için Yaralýlarýn Taktiksel Savaþ Ortamýnda Tedavisi Komitesi’nin önerilerinden yararlanýlmýþ turnike uygulamasýnýn hemodinamik etkisini deðerlendirmek için Doppler ultrason kullanýldý.
BULGULAR: Sonuçlar 15 uygulayýcýda kan akýmý durdurulmuþ, üç hastada çok az kan akým ve altý kiþide kýsýtlamasýz kan akýmý olduðunu göstermiþtir. Kiþilerin kendine veya baþka biri tarafýndan uygulanan turnike prosedürlerinin kaliteleri arasýnda herhangi bir anlamlý farklýlýk yoktu. Turnike ile koltuk altý arasýndaki ortalama mesafe kendi kendine veya baþkasýnýn uyguladýðý turnikelerde 9.5 cm idi. On altý olguda turnikenin kol dýþýndan baðlandýðý, yalnýzca sekiz olguda doðru biçimde kol içinden baðlandýðý gözlenmiþtir. On sekiz olguda taktiksel ortamda turnike doðru yerleþtirilmemiþ, yalnýzca altý olguda doðru yerleþtirilmiþtir. Ultrasonda negatif akým görülen uygulayýcýlarýn çoðunda DOP de negatifti. Ultrasonda tam kesintisiz akýmýn görüldüðü uygulayýcýlarýn çoðunda pozitif DOP saptanmýþtýr.
TARTIÞMA: Turnikelerin uygulanmasý uzmanlaþmýþ birimlerde bile zorluk yarattýðýndan bu iþlemin uygulanmasýna yönelik düzenli eðitim verilmesi gerekir.

BACKGROUND: Application of a tourniquet in a tactical environment is implemented in two ways: the so-called self-aid, which is the application of a tourniquet by the injured, and the so-called buddy aid, which is the application of a tourniquet by the person provide aid. This study aimed to test the quality of tourniquet use in a simulated situation, close quarter battle.
METHODS: The study involved 24 injured operators and 72 operators in the whole simulation, implying 12 sections of six individuals. To validate the application of tourniquets, the recommendations of the Committee of Tactical Combat Care of the Injured were used, and ultrasound with Doppler function was employed to assess the hemodynamic effect of applying tourniquets.
RESULTS: Native flow was observed in 15 operators; in three people, a trace flow was noticed, whereas in six people, a full flow was observed. No significant difference was found between the qualities of tourniquet application by the operators themselves compared with those of tourniquet application by another person. The median distance of tourniquet application from the armpit was 9.5 cm for self-aid and buddy aid. In 16 participants the outer arrangement of tourniquets was observed, and in only eight participants tourniquets were correctly located on the internal part of the arm. In 18 participants, tourniquets were not correctly prepared for use in the tactical environment, whereas in only six participants, they were correctly prepared. Most operators with a negative ultrasound flow revealed negative distal observed pulse (DOP). Positive DOP occurred in the majority of operators with full ultrasound flow.
CONCLUSION: The application of tourniquets poses a challenge even in case of specialized units; therefore, there is a need to provide regular training for implementing that procedure.

AMAÇ: Eskiden total splenektomi travmatik dalak yaralanmalarýnda tek seçimdi. Ancak modern týpta cerrahidýþý tedavi ve dalaðý koruyucu teknikler tercih edilmektedir. Cerrahýn splenektomi uygulamaya sevk edildiði bazý durumlarda dalaðýn ototransplantasyonu dalak fonksiyonunu koruyabilir. Dalak ototransplantý etkisini en iyi deðerlendirme yönteminin seçimi yýllarca tartýþma konusu olmuþtur. Bu çalýþmada implante edilmiþ dalaðýn fonksiyonunu deðerlendirmede çokça kullanýlan üç testi karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Laparotomi ve splenektomi adayý 10 hasta çalýþma katýlýmcýlarýný oluþturmuþtu. Splenektomi yaptýktan sonra her hastanýn omentum majusu içine beþ dalak parçasý implante ettik. Üç ay sonra implante edilmiþ dalaðýn fonksiyonu nükleer eritrosit sintigrafisi, periferik kanda serum immünoglobülin M (IgM) düzeyif ve Howell-Jolly (HJ) cisimciklerinin varlýðýyla deðerlendirildi.
BULGULAR: Hastalarýn hepsinde periferik kandan yapýlan yayma testi patolojik deðildi. Yalnýzca bir olguda IgM düzeyi normalden düþüktü, baþka birinde sintigrafi nakledilen böbreði göstermemiþti.
TARTIÞMA: Bu testlerin tümünde benzer sonuçlar alýnabilir. Ancak bulunabilirliði, düþük maliyeti ve kolayca uygulanabilirliði nedeniyle periferik kandan yayma preparatýnýn implante edilmiþ dalak fonksiyonunu deðerlendirmede ilk seçenek olduðu düþünülebilir.

BACKGROUND: Historically, total splenectomy was the only choice of treatment for traumatic splenic injuries. However, non-operative management and spleen-preserving surgical techniques are preferred in modern medicine. In some situations in which the surgeon has to perform splenectomy, spleen autotransplant may preserve the splenic function. Selecting the best method for evaluating the splenic autotransplant effect has been debated for several years. In this study, we compared three common tests in evaluating the implanted spleen function.
METHODS: Participants included 10 patients who were candidates for laparotomy and splenectomy. After performing splenectomy, we implanted five pieces of the spleen in the greater omentum of each patient. After 3 months, the implanted spleen function was evaluated by nuclear red blood cell (RBC) scan, serum immunoglobulin (Ig) M level, and presence of Howell–Jolly (HJ) bodies in the peripheral blood smear.
RESULTS: All patients had normal peripheral blood smear. The IgM level was lower than normal in one patient, and scintigraphy did not demonstrate the transplanted spleen in another patient.
CONCLUSION: All these tests may have comparable results, but because of availability and low cost of peripheral blood smear, which is also easily performed, it can be considered as the first option to evaluate the implanted spleen function.

AMAÇ: Yorgunluk ve uykusuzluk doðru karar verme yetisini ve motor becerileri etkileyerek týbbi performansý ve hasta bakým kalitesini düþürebilir. Bu çalýþmanýn amacý, farklý zamanlarda genel anestezi altýnda yapýlan laparoskopik genel cerrahi olgularý ile istenmeyen sonuçlar arasýnda iliþki olup olmadýðýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: Üçüncü düzey bir üniversite hastanesinin acil servisinde 01.01.2016–31.12.2016 tarihleri arasýnda ameliyat edilen tüm laparoskopik kolesistektomi ve apendektomi olgularý çalýþmaya dahil edildi. Ameliyat zamanlarý üçe ayrýldý: 08.01–17.00 arasý (G1: gündüz), 17.01–23.00 arasý (G2: erken mesai sonrasý) ve 23.01–08.00 arasý (G3: gece). Çalýþmaya dahil edilen hastalarýn dosyalarý taranarak ameliyatta ve ameliyat sonrasý dönemlerde anestezi veya cerrahiye ait komplikasyon yaþayýp yaþamadýklarý incelendi.
BULGULAR: Baðýmsýz deðiþkenler olan yandaþ hastalýklar, yaþ, cinsiyet, vücut kitle indeksi, ASA skoru ve ameliyat zamaný ile baðýmlý deðiþken olan ameliyat sýrasýnda komplikasyon sýklýðý arasýndaki iliþki multipl regresyon analizi yapýlarak deðerlendirildi. Gece yapýlan ameliyatlar (p<0.001 OR: 6.7 CI [2.6–16.9]) ve yüksek yaþýn (p=0.004 OR: 1.04 CI [1.01–1.08]) ameliyat sýrasýnda komplikasyon sýklýðý için risk faktörü olduðu saptandý. Ayný deðerlendirme ameliyat sonrasý komplikasyonlar için yapýldýðýnda yukarýdaki baðýmsýz deðiþkenler ile ameliyat sonrasý komplikasyon sýklýðý arasýnda iliþki olmadýðý saptandý.
TARTIÞMA: Gece yapýlan ameliyatlarda ve yaþlý hastalarda ameliyat sýrasýnda komplikasyon riski ciddi morbidite veya mortalite artýþýna neden olmadan artmaktayken ameliyat sonrasý komplikasyon sýklýðýnda artýþa neden olan bir baðýmsýz deðiþken bulunmamýþtýr.

BACKGROUND: Fatigue and sleep deprivation can affect rational decision-making and motor skills, which can decrease medical performance and quality of patient care. The aim of the present study was to investigate the association between times of the day when laparoscopic general surgery under general anesthesia was performed and their adverse outcomes.
METHODS: All laparoscopic cholecystectomies and appendectomies performed at the emergency surgery department of a tertiary university hospital from 01. 01. 2016 to 12. 31. 2016 were included. Operation times were divided into three groups: 08.01–17.00 (G1: daytime), 17.01–23.00 (G2: early after-hours), and 23.01–08.00 (G3: nighttime). The files of the included patients were evaluated for intraoperative and postoperative surgery and anesthesia-related complications.
RESULTS: We used multiple regression analyses of variance with the occurrence of intraoperative complications as a dependent variable and comorbidities, age, gender, body mass index (BMI), ASA score, and operation time group as independent variables. This revealed that nighttime operation (p<0.001; OR, 6.7; CI, 2.6–16.9) and older age (p=0.004; OR, 1.04; CI, 1.01–1.08) were the risk factor for intraoperative complications. The same analysis was performed for determining a risk factor for postoperative complications, and none of the dependent variables were found to be associated with the occurrence of postoperative complications.
CONCLUSION: Nighttime surgery and older patient age increased the risk of intraoperative complications without serious morbidity or mortality, but no association was observed between the independent variables and the occurrence of postoperative complications.

AMAÇ: Yanýk travmasý, etkilenen hastalar üzerinde fiziksel, fizyolojik ve ekonomik yansýmalarý olan ciddi saðlýk problemidir. Bu çalýþma, Türkiye’nin kuzeydoðusunda bulunan ve yaklaþýk dört milyon kiþilik bir nüfusa hitap eden, referans bir yanýk tedavi merkezinin sekiz yýlý aþkýn sürede takip ettiði hastalarýn epidemiyolojik ve demografik özelliklerini sunmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Hastalarýn týbbi dosyalarýndan, hastalarýn demografik özellikleri, yanýk kaynaðý, yanýk mahalli, yanýk yüzey alaný (YYA), yapýlan cerrahi tedavi, hastanede kalýþ süresi ve mortalite oranlarý analiz edildi.
BULGULAR: En sýk yanýk sebebi sýcak sývýlara baðlý haþlanma yanýklarý (2013 olgu, %74.2) idi. Yanýk merkezimizin bulunduðu bölgenin iklim koþullarýna baðlý olarak donma yanýðý 16 (%0.6) olguda gözlemlendi. Yanýk yüzey alanýna göre hastalar gruplandýrýldýðýnda; hastalarýn %88.7’si %0–15, %8.0’i %15–30 ve %3.3’ü ise %30’dan fazla YYA’ya sahipti. En fazla izlenen mikroorganizma Pseudomonas aeruginosa idi. Yedisi çocuk olmak üzere toplam 24 (%0.9) hasta (8 erkek, 16 kadýn) öldü.
TARTIÞMA: Tandýrlarýn kaldýrýlmasý ve yerine yüksekte kurulu olan fýrýnlarýn oluþturulmasý, peynir ve tereyaðý üretiminin daha geliþmiþ þartlarda yapýlmasý ve toplumun yanýk konularý hakkýnda bilgilendirilmesi ile, bu bölgedeki yanýk olgularý büyük oranda azaltýlabilir.

BACKGROUND: Burn trauma is a significant health problem that has physical, psychological, and economic repercussions on affected patients. The aim of this study was to present epidemiological and demographic characteristics of patients treated over an 8-year period at a reference burn treatment center located in the northeast of Turkey and serving a population of approximately four million people.
METHODS: Each patient’s medical record was reviewed, and demographic features, source of burns, place of residence, total body surface area (TBSA), surgical treatment, duration of hospital stay, and mortality rates were analyzed.
RESULTS: The most frequent cause of burn was scalding from hot liquids (2013 cases, 74.2%). Freeze burn was observed in 16 (0.6%) cases due to climatic conditions of the region where our burn center is located. Grouping based on TBSA revealed that 88.7% patients had TBSA of 0%–15%, 8% patients had TBSA of 15%–30%, and 3.3% patients had TBSA ≥ %30.The most common microorganism was Pseudomonas aeruginosa. A total of 24 patients (0.9%; 8 males, 16 females) died, including 7 children and 17 adults.
CONCLUSION: Removal of tandirs and replacement with high ovens, restriction of cheese and butter production under primitive circumstances, encouraging cheese and butter production via dairy farm systems, and raising people’s awareness through training programs could greatly reduce the number of the burn accidents occurring in this region.

AMAÇ: Açýk göz yaralanmasý (AGY) olgularýnýn karakteristiklerini ve kötü görsel prognoz için risk faktörlerini çocuk ve eriþkin yaþ gruplarýnda incelemek.
GEREÇ VE YÖNTEM: En az bir yýlýk takibi olan 294 AGY olgusu çalýþmaya alýndý. Göz travmasý ile ilgili demografik ve klinik özellikler kaydedildi. Olgular yaþlarýna göre çocuk (≤16 yýl) ve eriþkin (>16 yýl) olmak üzere iki gruba ayrýldý.
BULGULAR: Açýk göz yaralanmasýna neden olan kazalara çocuklarýn çoðunlukla ev ortamýnda maruz kaldýðý görülürken eriþkinlerin iþ ortamlarýnda maruz kaldýðý görüldü. Penetran göz yaralanmalarýnýn çocuklarda daha sýk olduðu ve sýklýkla sivri uçlu cisimlerle oluþtuðu saptandý. Her iki grupta da Zon 1 yaralanmalarýn daha sýk olduðu görüldü. Yüksek evre yaralanmalarýn sýklýðýnýn yaþ ile birlikte arttýðý saptandý. Yabancý cisim yaralanmalarý ve birden fazla ameliyat gerekliliði eriþkin grupta daha fazlaydý. Yaþ gruplarý arasýnda oküler travma skoru (OTS) ve görme keskinliði açýsýndan fark yoktu. OTS, birden fazla ameliyat ihtiyacý ile iliþkili bulundu. Eriþkin yaþ grubunda, yaþ, birden fazla ameliyat olmak ve baþlangýç görme keskinliði sonuç görme keskinliði için önemli risk faktörleri olarak bulundu.
TARTIÞMA: Hem AGY nedenleri hem de kötü görsel prognoz için risk faktörleri, eriþkin ve çocuk yaþ gruplarýnda farklýlýklar göstermektedir. Bu farklýlýklarýn bilinmesi önleyici tedbirlerin alýnmasýnda ve morbiditenin azaltýlmasý konusunda önemli olabilir.

BACKGROUND: This study aimed to evaluate 1-year follow-up results of cases that were diagnosed with open globe injury (OGI), to compare trauma-related characteristics between pediatric and adult cases, and to determine risk factors for a poor final visual acuity.
METHODS: This study enrolled 294 cases that met the OGI definition and were followed up for at least 1 year. Demographic and clinical features regarding ocular trauma were recorded. The cases were divided into two groups according to age: pediatric (≤16 years) and adult (>16 years) groups.
RESULTS: Children were exposed to accidents that led to OGI mostly at home, whereas adults were exposed to such accidents mostly in the office. Penetrating injuries were more common in children than in adults, and injuries most commonly occurred owing to spiky objects. Zone I injuries were most frequent in both children and adults. The frequency of high-grade injuries increased with age. Foreign body injuries and multiple surgeries were more common in adults than in children. There was no difference between the two age groups based on ocular trauma score (OTS) and visual acuity. OTS predicted the need for multiple surgeries. In the adult group, age, multiple surgeries, and initial visual acuity were significant risk factors for the final visual acuity that was achieved.
CONCLUSION: OGI causes and risk factors for poor final visual outcomes differ in adults and children. The knowledge of these differences is crucial for taking adequate preventive measures and decreasing morbidity.

AMAÇ: 15 Temmuz 2016 tarihinde Türkiye’de sivil halk ile askerin karþý karþýya geldiði bir darbe giriþimi gerçekleþmiþtir. Bu darbe giriþimi ülkede ciddi yaralanma ve ölümlere neden olmuþtur. Bu çalýþmada, darbe giriþimi esnasýnda Ýstanbul ilindeki tüm hastanelere baþvuran hastalar, saðlýk açýsýndan deðerlendirilmiþ, olayýn doðal afetlerden ve diðer terörist eylemlerden farklarý analiz edilmiþtir.
GEREÇ VE YÖNTEM: Darbe giriþimindeki olaylar nedeniyle maðdur olan 1104 hasta mevcuttur. Bu çalýþmada, 15–16 Temmuz 2016 tarihleri arasýnda Ýstanbul’daki tüm hastanelere (kamu ve özel) baþvuran ve Ýstanbul Ýl Saðlýk Müdürlüðü Kriz Merkezi’nde kayýt altýna alýnan 882 darbe maðduru yaralýnýn demografik ve saðlýk bilgileri analiz edilmiþtir.
BULGULAR: Deðerlendirmeye alýnan 882 hastanýn %97.27’si erkek, %2.73’ü kadýndýr. Hastalarýn yaþ ortalamalarý 34.12’dir. Hastalarýn %82.43’ü kamu hastanelerine, %17.57’si ise özel hastanelere baþvurmuþtur. Toplam ölüm oraný %10.4 olarak bulunurken, kamu hastanelerinde %9.76, özel hastanelerde ise %13.54 olarak bulunmuþtur. Hastalarýn %65.07’si ateþli silah yaralanmasý, %11.11’i darp, %7.7’si tank veya motorlu taþýt yaralanmasý, %5.44’ü delici kesici alet yaralanmasý, %5.32’si yumuþak doku travmasý, %2.83’ü düþme ve yüksekten düþme, %2.15’i diðer nedenlerle, üç hasta da psikiyatrik bozukluklar nedeni ile hastanelere baþvurmuþtur.
TARTIÞMA: 15 Temmuz darbe giriþimindeki hastanelere baþvuran hastalarýn yaralanma ve ölüm nedenleri, doðal afetler ya da terörist eylemlerden farklýdýr. Darbe giriþimindeki yaralanmalar savaþlarda karþýlaþýlabilecek nedenlerle gerçekleþmiþtir. Gene maðdurlarýn savaþlardaki gibi erkek cinsiyet aðýrlýklý olduðu görülmüþtür. Bu çalýþmada ilk 48 saat içinde olan fiziksel yaralanmalar ve sonuçlarý incelenmiþ olup, post travmatik stres bozukluðu açýsýndan uzun dönem çalýþmalar yapýlabilir. Ayrýca, Hastane Afet Planlarý içerisinde darbe gibi çok az görülen toplumsal olaylarla ilgili çalýþmalar da yer almalýdýr.

BACKGROUND: A coup attempt against the government took place in Turkey on July 15, 2016. This attempt caused serious injuries and deaths in the country. In this study, the data of patients referred to all hospitals in Istanbul during the attempt were evaluated, and differences between natural disasters, other terrorist actions, and coup attempts were analyzed.
METHODS: In total, 1104 patients were injured in the abovementioned coup attempt. In this study, the demographic and health information of 882 coup victims who were admitted to all hospitals (state and private) in Istanbul on July 15 and 16, 2016 and registered at the Crisis Center of Istanbul Provincial Health Directorate was analyzed.
RESULTS: Of the 882 patients evaluated, 97.27% were male and 2.73% were female. The mean age of the patients was 34.12 years. Most (82.43%) patients were admitted to state hospitals, and 17.57% were admitted to private hospitals. The total mortality rate due to the abovementioned coup attempt was 10.4% (9.76% in state hospitals and 13.54% in private hospitals). Of the 882 patients evaluated, 65.07% had gunshot injuries, 11.11% had been assaulted, 7.70% had experienced tank/motor vehicle accidents, 5.44% had other penetrating injuries, 5.32% had soft-tissue trauma, 2.83% had experienced falls (including falls from heights), 0.33% had psychiatric disorders, and 2.15% were admitted for other reasons.
CONCLUSION: The patterns of injury and mortality resulting from the July 15, 2016 coup attempt differed from those resulting from natural disasters and terrorist acts and were similar to those encountered during wars: the victims were predominantly male, similar to those in wars. Following a coup attempt, an increase in the number of patients with post-traumatic stress disorder can be expected. Further studies focusing on the incidence of this disorder due to the abovementioned coup attempt in Turkey are needed. Hospital disaster plans need to include information and plans related to terrorist acts, such as coup attempts.

AMAÇ: Bu çalýþmadaki amacýmýz el dorsumundaki defektlerin posteriyor interosseöz arter flebi (PÝA) ve ters akýmlý adipofasyal radial önkol (RRÖF) ile onarým sonuçlarýný kýyaslamaktýr.
GEREÇ VE YÖNTEM: Geriye dönük olarak dizayn edilen bu çalýþmaya 2008–2013 yýllarý arasýnda, PÝA ile (11 hasta) ve RRÖF ile (12 hasta) el dorsumundaki yumuþak doku defektleri onarýlan 23 hasta dahil edildi. Onarým yöntemleri fonksiyonel olarak kol, omuz ve el sorunlarý anketi (DASH) skoru, eklem hareket açýklýðý (ROM) ile; estetik olarak skarýn görünümü ile deðerlendirildi. Ameliyat süreleri, hastanede kalýþ süreleri ve donör alan problemleri kýyaslandý.
BULGULAR: Posteriyor interosseöz arter flebi ve RRÖF arasýnda ROM ve DASH skorlarý ve hastanede kalýþ süresi açýsýndan istatistiksel açýdan fark saptanmadý. Ameliyat süreleri, skar deðerlendirmesi ve donör alan problemleri açýsýndan ise istatistiksel açýdan fark saptandý.
TARTIÞMA: Dorsal el defektlerinde RRÖF sonuçlarý PÝA’dan daha iyidir, ne varki RRÖF elin ana bir arterini sakrifiye etmektedir.

BACKGROUND: Our objective was to compare the outcomes of dorsal hand defect reconstruction using a posterior interosseous artery flap (PIAF) and a reverse adipofascial radial forearm flap (RARFF).
METHODS: From 2008 to 2013, 23 patients who underwent hand soft tissue defect reconstruction with PIAF (11 patients) and RARFF (12 patients) were included in this retrospective study. Reconstruction methods were compared in terms of functionality with disability of the arm, shoulder, and hand (DASH) score and range of motion (ROM) and aesthetically with scar assessment. Operation times, length of hospital stay, and donor site problems were compared.
RESULTS: We found no statistically significant differences between PIAF and RARFF in terms of ROM, DASH score, and length of hospital stay. Statistically significant differences were found in operation time, scar assessment, and donor site problems between PIAF and RARFF patients.
CONCLUSION: RARFF showed better results than PIAF in dorsal hand defects, but in RARFF, the major arteries of the hand are sacrificed.

AMAÇ: Travmatik pulmoner psödokistler künt göðüs travmalarýnýn nadir komplikasyonlarýdýr. Çalýþmamýzýn amacý, bu nadir durumun komplikasyonlarýndan kaçýnmak ve doðru tedavi yaklaþýmýný tespit etmek üzere 15 olgunun radyolojik ve klinik parametrelerle deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Temmuz 2014–Aralýk 2015 tarihleri arasýnda kliniðimizde toraks travmasý nedeniyle takip edilen 185 hastanýn bilgileri ve radyolojik görüntüleri geriye dönük olarak deðerlendirildi.
BULGULAR: Travmatik pulmoner psödokist tespit edilen 15 hastanýn klinik özellikleri ve görüntüleme bulgularý deðerlendirildi. Ortalama yaþ 26.33’dü (1–89 yaþ). On üç olguda etiyolojide trafik kazasý sorumlu iken iki olguda yüksekten düþme sonrasý geliþmiþti. Beþ olguda tüp torakostomi uygulandý. Olgularýn %66’sý komplikasyonsuz iyileþti ve hiçbir olguda torakotomi gereksinimi olmadý. Beþ olgu, eþlik eden toraks dýþý ciddi yaralanmaya baðlý olarak kaybedildi.
TARTIÞMA: Pnömotosel formasyonu akciðer parankiminde meydana gelen ani makaslama gücü etkisiyle parankimde kontüzyon geliþmesi ve kontüzyon alanýndan ani hava çýkýþýyla oluþmaktadýr. Bu hastalarda önerilen tedavi yaklaþýmý konservatif olmakla birlikte kist rüptürüne baðlý komplikasyonlar geliþebilir. Hastalar yakýn takip edilmelidirler ve hayatý tehdit eden komplikasyonlar açýsýndan dikkatli olunmalýdýr.

BACKGROUND: Traumatic pulmonary pseudocysts (TPP) are rare complications of blunt chest trauma. The aim of this study is to increase the understanding of this rare entity with imaging and clinical parameters for preventing complications and determining the correct treatment approach by observing 15 cases.
METHODS: We retrospectively reviewed the medical data and thoracic computed tomography scans of 185 patients who underwent examinations in our department after chest trauma between July 2014 and December 2015.
RESULTS: Fifteen patients had TPPs, and their clinical features and imaging findings were evaluated. Their average age was 26.33 (range, 1–89) years. The cause of TPP was traffic accident in 13 patients and falling from a height in two. Tube thoracostomy was required in five patients. None of the patients required thoracotomy, and 66% of them recovered without any complications. Five patients died because of serious concomitant injuries.
CONCLUSION: Sudden shearing force across the pulmonary parenchyma results in an area of pulmonary contusion and airtransfer from the airway to the contused area, which in turn leads to pneumatocele formation. Conservative treatment is recommended for these patients, but complications can occur because of cyst rupture. Patients should be closely monitored and be made aware of the risk of life-threatening complications.

AMAÇ: Savaþýn deðiþen þartlarý ile maksillofasiyal yaralanmalar daha sýk görülmeye baþlandý. Özellikle kentsel alanlarda, el yapýmý patlayýcý gibi yüksek enerjili patlayýcý cihazlar, uzun namlulu silahlarýn yanýnda sýklýkla kullanýlmaktadýr. Travma hastasýna zamanýnda týbbi ve doðru tepki verebilmek için travma puanlama sistemleri ve çok disiplinli yaklaþým kullanýlmasý önemlidir. Bu çalýþmada, uzun namlulu silahlar ya da yüksek enerjili patlayýcý cihazlar tarafýndan oluþan yaralanmalar arasýnda Askeri Yaralanma Ölçeði (MCIS) ve Askeri Ýþlevsellik Arýzasý Ölçeði (MFIS) karþýlaþtýrýldý ve operasyonel saha hastanesinin deneyimleri paylaþýldý.
GEREÇ VE YÖNTEM: 27 Temmuz 2015 ile 22 Temmuz 2016 tarihleri arasýnda uzun namlulu silah (LBW) ve yüksek enerjili patlayýcýlardan (HEED) kaynaklý maksillofasiyal ve servikal yaralanmalarý sebebi ile operasyon hastanesine baþvuran 84 hastanýn týbbi verileri gözden geçirildi. Tüm hastalar için MCIS ve MFIS skorlarý hesaplandý ve nitelikli hastalarýn kayýtlarý Glasgow Koma Ölçeði (GKS) skorlarý ve hasar alanlarý için deðerlendirildi. Hastalar yaralanmaya neden olan cihaza/silaha göre iki gruba ayrýldý: I. grup LBW ve II. gruptaki HEED olarak belirlendi.
BULGULAR: Hastalarýn tümü erkekti ve yaþ ortalamasý 28.75 idi (20–58). Ortalama GKS skoru 13.4 iken, 16 hastada (%19) 15’ten düþüktü. LBW ve HEED gruplarý arasýnda MCIS skorlarýnda istatistiksel olarak anlamlý farklýlýk yoktu (p=0.206). Ek olarak LBW ve HEED gruplarý arasýnda MFIS skorlarýnda istatistiksel olarak anlamlý farklýlýk yoktu (p=0.238).
TARTIÞMA: Maksillofasiyal ve servikal bölge yaralanmalarý, çoðunlukla kentsel alanlarda bulunan modern çatýþmalara daha çok girmeye baþlamýþtýr. Yüksek enerjili patlayýcý cihazlarýn yol açtýðý yaralanmalar, maksillofasiyal alanda uzun namlulu silahlarýn neden olduðu yaralanmalar kadar morbid ve ölümcüldür. Hýzlý ve kapsamlý müdahale, hayat kurtarýcýdýr ve hastanýn ileri travma tedavisine yardýmcý olur.

BACKGROUND: With the changing conditions of war, maxillofacial injuries are observed more frequently. Particularly in urban areas, high-energy explosive devices (HEEDs), such as improvised explosive devices, are often used alongside long-barreled weapons (LBWs). It is important to use trauma scoring systems and a multidisciplinary approach for medically and accurately responding to the trauma patient in a timely manner. This study aimed to compare the Military Combat Injury Scale (MCIS) and Military Functional Incapacity Scale (MFIS) between injuries sustained by LBWs or HEEDs and to share experiences of an operational field hospital.
METHODS: Medical data of 84 patients admitted to an operational field hospital with maxillofacial and cervical injuries sustained by LBWs and HEEDs between July 27, 2015, and July 22, 2016 were reviewed. MCIS and MFIS scores were calculated for all patients; records of the qualifying patients were studied for the Glasgow Coma Scale (GCS) scores and injury sites. The patients were divided into two groups according to the device/weapon causing the injury: injuries sustained by LBWs in group I and those sustained by HEEDs in group II.
RESULTS: All patients were males, with a mean age of 28.75 (range 20–58) years. The average GCS score was 13.4, but it was lower than 15 in 16 (19%) of the patients. There was no statistically significant difference in MCIS scores between the LBW and HEED groups (p=0.206). In addition, there was no statistically significant difference in MFIS scores between the LBW and HEED groups (p=0.238).
CONCLUSION: Maxillofacial and cervical region injuries are increasing in modern conflicts that are usually located in urban areas. Injuries sustained by HEEDs as well as those sustained by LBWs in the maxillofacial area are morbid and mortal. Rapid and comprehensive intervention is life-saving and helping the patient to further trauma treatment.

AMAÇ: Solid organ yaralanmalarýnda, bütün dünyada standart tedavi yöntemi “nonoperative management”dýr (NOM). Kurþun, trakt boyunca yaydýðý yüksek enerjiden dolayý oluþturmuþ olduðu doku hasarýnýn derinliði öngörülememekte ve içi boþ ogan (ÝBO) yaralanma sýklýðý yüksek olduðundan ateþli silah yaralanmasý (ASY) ile ilgili bir konsensüs bulunmamaktadýr. Bu çalýþmada, karýn bölgesinde ASY olan hastalarýn cerrahi ve NOM kriterlerini ortaya koymayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2010–Nisan 2016 tarihleri arasýnda karnýnda ASY olan hastalar geriye dönük olarak analiz edildi. Hemodinamik instabilitesi olan, seri karýn muayenelerinde peritonit bulgusu devam eden, karýnda serbest havasý olan grup 1 (n=17) operasyona alýndý. NOM ile tedavi edilen olgular ise grup 2 (n=13) idi.
BULGULAR: Grup 1 ile grup 2’yi karþýlaþtýrdýðýmýzda; grup 1’de hemoglobin (Hb) seviyesi ve sistolik kan basýncý istatistiksel olarak düþük iken (p<0.001), yoðun bakýmda kalýþ süresi ve ortalama yaralanma þiddet skoru (ISS) ise istatistiksel olarak yüksek idi (p<0.001). Ayrýca Grup 1’deki olgularýn 10’unda kolon perforasyonu, yedisinde ise ince baðýrsak perforasyonu saptadýk. Grup 2’deki olgularýmýzýn dördünde karaciðer yaralanmasý, birinde dalak, üçünde ise renal yaralanma var iken, beþinde ise parankimatoz organ yaralanmasý ve ÝBO saptamadýk.
TARTIÞMA: Karýnda ASY’lerindeki problem ÝBO yaralanmasý tanýsýndaki zorluklara baðlý olarak tedavinin gecikmesidir. Hemodinamik olarak stabil ve seri karýn muayenelerinde peritonit bulgusu olmayan parankimatoz organ yaralanmalarý NOM olarak tedavi edilebilinir.

BACKGROUND: Non-operative management (NOM) is a standard treatment method for solid organ injuries worldwide. There is no consensus on the management of gunshot wounds (GSW) because of the higher frequency of hollow viscus injuries (HVI) and the unpredictable depth of tissue damage produced by kinetic energy transfer during retardation of the bullet. Here we aimed to re-evaluate indications for surgery and NOM based on our pediatric patients with abdominal GSW.
METHODS: We performed a retrospective analysis of patients evaluated and treated for abdominal GSW at University of Dicle between January 2010 and October 2016. Patients with hemodynamic instability, signs of peritonitis on serial abdominal examination, and free air in the abdomen underwent laparotomy; these were included in group I (n=17). Patients managed non-operatively were included in group II (n=13).
RESULTS: Our statistical analysis showed significantly lower Hb levels and systolic blood pressure levels (p<0.001) and higher pulse rate, higher mean injury severity score, and longer length of stay at intensive care unit in patients in group I than in those in group II (p<0.001). We further detected colon perforation (n=10) and small bowel perforation (n=7) in patients in group I; liver laceration (n=4), splenic injury (n=1), and renal injury (n=3) but no solid organ injury or HVI (n=5) were detected in patients in group II.
CONCLUSION: The major drawback of NOM is the difficulty in diagnosing HVI in abdominal GSW, which may delay treatment. We suggest that patients with solid organ damage who are hemodynamically stable and exhibit no signs of peritonitis upon serial abdominal exam may be treated with NOM.

AMAÇ: Bu çalýþmanýn amacý, retrograd diseksiyondan (RD) fundus-first (FF) tekniðine ya da laporoskopik parsiyel kolesistektomiye (LPK) geçiþin komplikasyonlar, ameliyat süresi ve hastanede kalýþ süresi üzerine etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2010–Aralýk 2014 tarihleri arasýnda laparoskopik kolesistektomi (LK) yapýlan 210 hastanýn týbbi kayýtlarý geriye dönük olarak incelendi. Tüm LK’lere RD yöntemiyle baþlanýldý. Güvenlik penceresinin diseksiyonunda zorluk yaþanmasý durumunda operasyon ilk olarak FF tekniðine geçildi. Fundus-first tekniðinin de güvenli bir kolesistektomi için yetersiz kaldýðý durumlarda ise LPK tercih edildi.
BULGULAR: Laparoskopik kolesistektomi ile baþlanan 210 olgunun 197’si RD ile sonlandýrýldý. On üç olguda diseksiyon sýrasýndaki zorluklar nedeniyle FF tekniði uygulandý. Fundus-first grubunda yedi olguda laparoskopik total kolesistektomi baþarýyla gerçekleþtirildi, geri kalan altý hastada LPK uygulandý. Ameliyat sonrasý RD grubunda üç komplikasyon, LPK grubunda iki komplikasyon saptandý. Tüm olgular deðerlendirildiðinde majör intraoperatif komplikasyon ve peroperatif mortalite görülmedi.
TARTIÞMA: Elektif ve komplikasyonsuz olgularda güvenli posteriyor pencere (güvenlik penceresi) prensibi uygulanmalýdýr. Ancak anatomik belirsizliklerin ön planda olduðu komplike olgularda RD tekniðinde ýsrarcý olmamak ve FF ya da LPK tekniklerinden birini tercih etmek açýk cerrahiye dönme oranlarýný azaltýr ve güvenli bir laporoskopik müdahale yapýlmasýný saðlar.

BACKGROUND: This study aims to evaluate the impact of conversion from retrograde dissection to fundus-first technique (FF) or laparoscopic partial cholecystectomy (LPC) on complication rates, operation time, and duration of hospitalization.
METHODS: The medical records of 210 consecutive patients who underwent laparoscopic cholecystectomy between January 2010 and December 2014 were retrospectively evaluated. All laparoscopic cholecystectomies were initiated with retrograde dissection (RD). In cases of difficulty in dissection of critical view of safety, the operation strategy was first converted to FF and then to LPC when FF was considered insufficient for safe cholecystectomy.
RESULTS: Of the 210 cases, LC was initiated and completed with RD in 197 cases. FF was implemented in 13 cases due to difficulties in dissection. In the FF group, laparoscopic total cholecystectomy was successfully accomplished in seven patients, and LPC was performed in the remaining six cases. Three postoperative complications occurred in the RD group and two in the LPC group. No major intraoperative complications or perioperative mortality occurred in any patients.
CONCLUSION: In elective, noncomplicated cases, the safe posterior window (critical view of safety) principle should be implemented. However, in complicated cases where anatomic uncertainties are dominant, the performance of FF technique or LPC may decrease conversion rates to open surgery and contribute to accomplishing the laparoscopic intervention safely.

Biliyer Fasciola hepatica enfestasyonu, endemik ve non-endemik bölgelerde etiyolojisi bilinmeyen biliyer týkanýklýðýn ayýrýcý tanýsýnda olasý bir sebep olarak düþünülmelidir. Tanýsal deðerlendirme sonrasý safra yollarýnda obstrüksiyon saptanan ortalama yaþlarý 55.8 yýl olan beþ hastaya etiyolojik deðerlendirme ve/veya endoskopik tedavi için endoskopik retrograd kolanjiyopankreatografi uygulandý. Endoskopik sfinkterotomi ve kolanjiyogram, biliyer sistemde safra dolum defektlerini gösterdi. Balon ve sepet kateteri kullanýlarak sýrasýyla iki ve üç hastada Fasciola hepatica parazitleri çýkartýldý. Morbidite veya mortalite görülmedi. Fiziksel ve laboratuvar bulgular 10 gün içinde kademeli azalarak normalleþti. Fasciola hepatica, endemik ve non-endemik bölgelerde etiyolojisi bilinmeyen safra yolu týkanýklýðý ayýrýcý tanýsýnda öncelikle düþünülmelidir. Fasciola hepatica’ya baðlý safra yolu týkanýklýðý olgularýnda endoskopik retrograd kolanjiyopankreatografi standart taný ve/veya tedavi yöntemidir. Parazitin kaygan ve jel benzeri yapýsýndan dolayý, balon kateterin yetersiz kaldýðý durumlarda, yarý-açýk pozisyonda sepet kateterin kullanýlmasý gerekebilir.

In the differential diagnosis of biliary obstruction with unknown etiology, biliary fascioliasis should be considered in endemic and non-endemic regions. After diagnostic evaluation, endoscopic retrograde cholangiopancreatography (ERCP) was performed for etiological evaluation and/or treatment of biliary obstruction in five patients with a mean age of 55.8 years. Endoscopic sphincterotomy and cholangiogram revealed linear filling defects in the biliary system. Fasciola hepatica parasites were extracted using balloon and basket catheters in two and three patients, respectively. No morbidity or mortality was observed. F. hepatica infection should be considered as a differential diagnosis of biliary obstruction with unknown etiology in endemic and non-endemic regions. ERCP can be the standard diagnostic and/or therapeutic procedure in cases of biliary obstruction due to fascioliasis. Due to slippery and gel-like characteristics of the parasite, use of a basket catheter in semi-opened position may be required in case of unsuccessful extraction using a balloon catheter.

Travmatik beyin yaralanmasý sonrasý dural venöz sinüs trombozu (DVST) sýk görülmeyen bir bulgudur. Baþlangýçta taný özellikle üstünde bir kýrýk yoksa sýklýkla atlanabilir. Üstünde kýrýk olmayan pediyatrik DVST çok ender olup literatürde bu tarihe kadar yalnýzca 20 olgu bildirilmiþtir. Burada önemsiz bir düþme ve bir febril epizot öyküsü olan 19 aylýk bir erkek çocuðu sunuyoruz. Bize geldiðinde Glasgow Koma Skalasý skoru (pGKS) E3V4M6 olduðu gibi beynin bilgisayarlý tomografi (BT) taramasý normaldi. Baþlangýçta konservatif tedavi edildi. Ancak bir nöbet sonrasý çekilen müteakip BT taramasý tentoriyumda subaraknoid kanama ve falks hematomunu gösterdi. pGKS’de düþüþle birlikte yinelenen nöbetleri geliþmeye baþlayana kadar konservatif tedaviye devam edildi. Yinelenen BT taramasý masif beyin ödemiyle birlikte süperiyor sagital sinüsün arka yüzünü etkileyen sinüs trombozunu açýða çýkardý. Koagülasyon profili normaldi ve sinüsün üzerinde kýrýk yoktu. Acil bifrontal dekompressif kraniyektomi uygulanmasýna raðmen hasta kurtarýlamadý. Bu olgu sunumu, sinüs tanýsýný atlamamanýn ve atlandýðý takdirde yýkýcý sonuçlara yol açabilen bu patolojinin önemini vurgulamaktadýr.

Dural venous sinus thrombosis (DVST) is an uncommon finding after traumatic brain injury. The diagnosis can often be initially missed, particularly if not associated with an overlying fracture. Pediatric DVST following closed head injury and without an overlying fracture is very rare, with only 20 cases reported in the literature to date. Here we present the case of a 19-month-old boy who presented with a history of trivial fall and an episode of fever. On presentation, the pediatric Glasgow Coma Scale (pGCS) score was E3V4M6, and initial brain computed tomography (CT) was normal. He was initially conservatively managed. However, subsequent CT, taken following an episode of seizure, revealed right tentorial subarachnoid hemorrhage and falx hematoma. Conservative management was continued till he started developing recurrent seizures with a decrease in pGCS scores. Repeat CT revealed sinus thrombosis that involved the posterior aspect of the superior sagittal sinus with a massive brain edema. The coagulation profile was normal, and no fracture overlying the sinus was observed. Although he underwent emergency bifrontal decompressive craniotomy, he did not recover. This study emphasizes on the importance of not missing the diagnosis of sinus thrombosis and the devastating consequences that can occur if it is overlooked.

Künt göðüs travmasý sonrasý koroner arter diseksiyonu ve intramüral hematom seyrek görülen, ancak yaþamý tehdit edici bir komplikasyondur. Koroner intramüral hematomun yayýlmasý ise çok daha seyrek görülür. Otuz bir yaþýndaki erkek yakýndaki bir hastaneye künt göðüs travmasý nedeniyle kabulü sýrasýnda kötüleþen sol göðüs aðrýsý nedeniyle hastanemize sevk edildi. Hasta baþý ekokardiyografisinde sol ventriküler apeks ve ön duvarda akinezi, sol ventrikül anteroseptal duvar ve arka duvarlarýnýn orta-alt bölümlerinde hipokinezi görüldü. Bilgisayarlý tomografi koroner anjiyografi sol ana koroner arter ve proksimal sol ön inen arterde intramüral hematomun varlýðýný gösterdi. Hematomun neden olduðu týkanýklýðý açmak için sol ana koroner arterden proksimal sol sirkumfleks (LCX) artere perkütan koroner giriþim (PKG) ile çýplak metal stent implante edildi. Stentlemeden sonra sol ana koroner arteri baskýlayan hematom LCX artere doðru yer deðiþtirdi. Yine intramüral hematom geliþti ve LCX’e uzandý. Bu týkanýklýðý çözmek için bir ilaç salan stent baþarýyla LCX arter içine implante edildi. Hasta komplikasyonsuz taburcu edildi. Ýzlemin ikinci ayýnda hasta semptomsuzdu ve hastada kardiyovasküler semptomlar nüksetmemiþti. Travma sonrasý geç dönemde oluþan göðüs aðrýsý koroner arter diseksiyonundan kuþkulandýrmalý ve hematomun geniþlemesine karþý dikkatli olunmalýdýr.

Coronary artery dissection and intramural hematoma after blunt chest trauma are rare, but life-threatening, complications. Coronary intramural hematoma extension is even rarer. A 31-year-old man was transferred to our hospital for worsening left chest pain during while he was admitted at a nearby hospital due to blunt chest trauma. Bedside echocardiography showed akinesis of the left ventricular apex and anterior wall as well as hypokinesis of the mid-to-basal anteroseptal wall and mid-to-basal lateral and posterior walls of the left ventricle. Computed tomography coronary angiography revealed intramural hematoma in the left main (LM) coronary and proximal left anterior descending (LAD) arteries. Percutaneous coronary intervention, with bare metal stent implantation from the LM coronary artery to the proximal LAD artery, was performed to treat the occlusion caused by the hematoma. After stenting, the hematoma that compressed the LM coronary artery shifted the left circumflex (LCX) artery, and the intramural hematoma developed and extended to the LCX artery. To resolve this occlusion, a drug-eluting stent was successfully implanted in the LCX artery. The patient was discharged without complications. At 2-month follow-up, he remained asymptomatic, with no recurrence of cardiovascular symptoms. Delayed chest pain after trauma should be suspected during coronary dissection, and on treatment, care must be taken to extend the hematoma.

Yabancý cisimlerle omurilik yaralanmalarý oldukça nadirdir. Bununla beraber patolojik problemlere neden olan spinal kanalýn içindeki cam parçacýklarý çok nadir raporlanmýþtýr. Bu raporda, lomber manyetik rezonans görüntüleme ve bilgisayarlý tomografi kullanýlarak sýrtta laserasyon, bacakta aðrý ve güç kaybý ile gelen ve L2-L3 seviyesinde cam parçacýklarý mevcut hasta sunuldu. L2 total laminektomi ve cam parçacýklarýnýn tamamen çýkartýlmasý sonrasý dura tamir edildi. Takiplerde tam nörolojik iyileþme saptanan hasta taburcu edildi. Bu cam fragmanlarýyla olan spinal yaralanmalarda nöral elemanlarýn erken operatif dekompresyonu seçeneklerden biridir. Cam parçacýklarýyla iliþkili Cauda Equine sendromlu hasta, fonksiyonel olarak iyi bir prognoza kavuþmuþtur.

Penetrating spinal injuries with foreign bodies are exceedingly rare. To date, pathological problems due to glass fragments in the spinal canal have rarely been reported. In this report, the case presenting with a back laceration, leg pain, and leg weakness was found to have glass frag-ments in the spinal canal at the L2-L3 level by lumbar computed tomography and magnetic resonance imaging. After L2 total laminectomy and retrieval of the glass fragments, the dura was re-paired. The patient was discharged from the hospital after complete neurological recovery. In cases of spinal canal injuries due to foreign bodies, early operative decompression of the neural elements is the treatment of choice. Patients with Cauda Equina syndrome due to glass fragments have a good prognosis for functional recovery.

Genital ve perianal yanýklar ciddi ve zorlu uzun dönem komplikasyonlarý ile ortaya çýkabilmektedir. Literatüründe herhangi bir bildirilmiþ yanýk sekeli olarak oluþan kriptorþitizm olgusuyla karþýlaþmadýk. Kriptorþitizminde yanýklarýn rolünü göstermek için, sekiz yaþýnda yaygýn perineal ve inguinal yanýklarý sonucu kriptorþitizm olan çocuk bildirilmiþtir. Azalan skrotal volüm skarlý doku üzerine z-plasti, deri grefti ve inmemiþ testis onarýmý ile gerçekleþtirildi.

Genital and perineal burns are rare and challenging injuries with serious long-term complications. Involvement of the testes is a sign of severity. There is limited knowledge in the literature about the management of complications and testes involvement in genital and perineal burns. In this report, we present the case of an 8-year-old boy with secondary cryptorchidism due to burn contracture who was treated by increasing the scrotal volume by Z-plasties, skin graft, and orchidopexy.