AMAÇ: Testislerdeki iskemi reperfüzyon hasarý üzerine oksitosinin etkilerini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýzda aðýrlýklarý 250–320 gr arasýnda deðiþen toplam 24 adet Wistar-Albino cinsi sýçan kullanýldý. Sýçanlar, sekiz sýçandan oluþan randomize üç gruba ayrýldý. Grup 1 kontrol grubu olarak deðerlendirildi. Grup 2’de önce testis torsiyonu gerçekleþtirildi. Sonrasýnda detorsiyone edilerek reperfüzyon hasarý oluþturuldu. Grup 3’de ise torsiyon ve detorsiyon iþlemlerini takiben reperfüzyondan önce oksitosin uygulandý. Testiküler dokular, Johnsen skorlama sistemi kullanýlarak histolojik ve spermatogenik parametrelere göre deðerlendirildi ve ortalama Johnsen skoru hesaplandý.
BULGULAR: Histolojik test sonuçlarý torsiyon grubu tedavi ve kontrol gruplarýndan istatistiksel olarak anlamlý derecede farklýydý. Oksitosin ile tedavi edilen grup hem kontrol hem de torsiyon gruplarýndan farklýydý (p=0.010 ve p=0.012). Biyokimyasal test sonuçlarý testis torsiyonu oluþturulan grupta süperoksit dismutaz ve glutatyon peroksidaz düzeyleri kontrol grubuna göre istatistiksel olarak anlamlý derecede düþük bulundu (p=0.007 ve p=0.007). Daha sonra oksitosin ile tedavi edilen testiküler torsiyon grubunda malondialdehit ve nitrik oksit düzeyleri yalnýzca testis torsiyonu yapýlan grupla karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý þekilde azaldý (p=0.017 ve p=0.014).
TARTIÞMA: Bu sonuçlara göre, oksitosin klinik uygulamada testiküler torsiyon tedavisinde doku hasarýný en aza indirgemek için alternatif bir ajan olarak düþünülebilir.

BACKGROUND: We aimed to demonstrate the effectiveness of oxytocin on the testes for treating ischemia-reperfusion injury.
METHODS: A total of 24 male Wistar albino rats weighing 250–320 g were used. The rats were randomized into three groups of eight rats. Group 1 was assessed as the control group. In Group 2 rats, testicular torsion was first performed, followed by testicular detorsion to induce reperfusion injury. In Group 3, following testicular torsion and detorsion, oxytocin was administered before inducing reperfusion. Testicular tissues were histologically evaluated, spermatogenic parameters were assessed using the Johnsen scoring system, and the mean Johnsen score was calculated.
RESULTS: Histological tests revealed significantly different results between the testicular torsion group and the oxytocin-treated torsion and control groups as well as between the oxytocin-treated torsion group and the control and testicular torsion groups (p=0.010 and 0.012, respectively). Biochemical test results revealed that superoxide dismutase and glutathione peroxidase levels were significantly lower in Group 2 than in Group 1 (p=0.007 and 0.007, respectively). Malondialdehyde and nitric oxide levels were significantly lower in Group 3 than in Group 2 (p=0.017 and 0.014, respectively).
CONCLUSION: These results indicate that oxytocin can be considered as an alternative agent for treating testicular torsion in clinical practice to minimize tissue damage.

AMAÇ: Karanlýk ortamda düþman ateþi altýnda endotrakeal entübasyon (ETE) prosedürü hastane öncesi travma yaþam desteði prosedürlerinden farklýdýr. Amacýmýz; aydýnlýk odada klasik laringoskop (KL), karanlýk odada modifiye laringoskop (ML) modeli ile ETE prosedürlerinin baþarý, zorluk derecesi ve ETE prosedür süresini ortaya çýkartmaktýr.
GEREÇ VE YÖNTEM: Tüm giriþimler 10 kiþiden oluþan muharip saðlýk personeli tarafýndan yapýldý. Gece koþullarýnda, gece görüþ gözlükleri (GGG) ile ETE prosedürünün gerçekleþtirmek için ML modeli geliþtirdik. Giriþimler; KL kullanýlarak aydýnlatýlmýþ bir alanda ve ML ile GGG kullanýlarak karanlýkta gerçekleþtirildi. Modifiye laringoskop býçaðý aðýz içinde (ML-AÝ+GGG) veya aðýz dýþýnda (ML-AD+GGG) açýlacak þekilde iki ayrý metod þeklinde kullanýldý.
BULGULAR: Uygulayýcýlar tarafýndan aydýnlýk ve karanlýk odada yapýlan ETE giriþimlerinin (Gündüz-KL, ML-AD+GGG, ML-AÝ+GGG) ortalama tamamlanma süreleri sýrasýyla 14.46 sn., 26.9 sn., ve 32.38 sn. olarak saptandý. ML-AD+GGG ve ML-AÝ+GGG, Gündüz-KL’ye göre istatistiksel olarak anlamlý derecede daha uzundu (p<0.05). Modifiye laringoskop-AÝ+GGG, ML-AD+GGG’ye göre göre istatistiksel olarak anlamlý derecede daha uzun bulundu (p<0.05). Bütün ETE giriþimleri %100 baþarýlýydý. Gündüz-KL, ML-AD+GGG ve ML-AÝ+GGG ile karþýlaþtýrýldýðýnda daha kolaydý (p<0.05).
TARTIÞMA: Endotrakeal entübasyon savaþ alanýnda GGG kullanarak karanlýkta uygulanabilir bir prosedürdür. Gece görüþ gözlükleri ile karanlýkta yapýlan týbbi müdahaleler, taktik acil týbbýnda verilen temel eðitimlerin bir parçasý olmalýdýr.

BACKGROUND: Endotracheal intubation (ETI) procedure in the combat area differs from prehospital trauma life support procedures because of the danger of gunfire and the dark environment. We aimed to determine the success, difficulty degree, and duration of ETI procedures with a classical laryngoscope (CL) in a bright room and with a modified laryngoscope (ML) model in a dark room.
METHODS: All interventions were performed by a combatant medical staff of 10 members. We developed an ML model to obtain a tool that can be used in combination with night vision goggles (NVGs) to perform ETI at night. The procedures were performed using a CL with the naked eye in a bright room and using a ML with NVGs in a dark room. The ETI procedure that used the ML was performed by engaging and locking the blade on the handle either in the mouth (ML-IM) or outside of the mouth (ML-OM).
RESULTS: The mean completion times for the ETI procedures, namely Day-CL, ML-OM+NVG, and ML-IM+NVG, performed by the operators were 14.46, 26.9, and 32.38 s, respectively. The ML-OM+NVG and ML-IM+NVG procedures were significantly longer than the Day-CL procedure (p<0.05). The ML-IM+NVG procedure was significantly longer than the ML-OM+NVG procedure (p<0.05). All ETI procedures were found to be 100% successful. The Day-CL procedure was easier than the ML-OM+NVG and ML-IM+NVG procedures (p>0.05).
CONCLUSION: The ETI procedure is applicable using NVGs in dark conditions on the battlefield. Medical interventions performed using NVGs in the dark should be a part of the basic training provided in tactical emergency medicine.

AMAÇ: Abdominal yaralanmalarýn cerrahi dýþý tedavisi (CDT) son 10 yýllarda geniþ kabul görmüþtür. Bu çalýþmada, bölgesel Yunanistan hastanesinde künt abdominal travmada (KAT) CDT etkinliði deðerlendirildi.
GEREÇ VE YÖNTEM: Künt abdominal travma için 2008–2015 arasý hastaneye yatýrýlmýþ hastalarýn tümüne önceden kararlaþtýrýlarak uygulanmýþ tedavi protokollerinin sonuçlarý incelendi. Protokol peritonit belirtileri olmayan hemodinamik açýdan stabil hastalarda CDT’yi önerdi. Demografik özellikler, yaralanmanýn tipi, yaralanmýþ organ(lar), tedavi tipi (cerrahi’ye karþýn cerrahi dýþý) Yaralanma Þiddeti Skoru (YÞS), morbidite, mortalite oranlarý ve saðlýk bakým maliyetleri deðerlendirildi.
BULGULAR: Künt abdominal travma nedeniyle bölümümüze yatýrýlmýþ146 hasta çalýþmaya alýndý. Bunlar arasýnda 49’u ameliyat edilmiþ, 97’sine CDT uygulanmýþtý. Yaralanma Þiddeti Skoru cerrahi grubunda istatistiksel açýdan daha yüksek olmasýna raðmen iki grup arasýnda karaciðer, dalak ve böbreklerdeki yaralanmanýn þiddet derecesi açýsýndan farklýlýk yoktu. Cerrahi dýþý tedavi uygulanan hiçbir olgu için muhtemelen CDT’nin katý dahil edilme kriterleri nedeniyle cerrahi tedaviye geçiþ gerekmemiþti.
TARTIÞMA: Hemodinamik açýdan stabil, fizik muayenesi normal yüksek derecede selektif olgular yaralanmanýn derecesine bakýlmaksýzýn cerrahi dýþý yöntemlerle tedavi edilebilir. Yaralanma Þiddeti Skoru cerrahi tedavi riskine iliþkin baðýmsýz bir risk faktörüdür.

BACKGROUND: The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital.
METHODS: We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated.
RESULTS: One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM.
CONCLUSION: Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.

AMAÇ: suPAR (Soluble urokinase plasminogen activator receptor) enflamasyon düzeyinin tesbitinde kullanýlan yeni bir biyobelirteçtir. Çalýþmamýzýn amacý suPAR düzeylerinin çocuklarda akut apandidsit tanýsýndaki ve akut ve kronik apandisit ayýrýmýndaki yerini tartýþmaktýr.
GEREÇ VE YÖNTEM: Çalýþmamýza 40 komplike apandisit, 40 komplike olmaya apandisit ve 25 kontrol grubu oluþtumak üzere 105 çocuk alýndý. Tüm hastalardan ameliyat öncesinde suPAR, C-reaktif protein, lökosit, nötrofil ve nötrofil yüzdesi bakýlmak üzere kan örnekleri alýndý.
BULGULAR: Apandisitli gruplarda kontrol grubuna göre suPAR, C-reaktif protein, lökosit, nötrofil ve nötrofil yüzdesi anlamlý olarak yüksek bulundu. Komplike apandisitlerde suPAR deðeri anlamlý olarak daha yüksek bulundu (p=0.016).
TARTIÞMA: Çalýþmamýz kan suPAR seviyelerinin akut ve komplike apandisit ayýrýmýnda faydalý olduðunu göstermiþtir.

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is a new biomarker of inflammation level. The aim of the study was to evaluate whether suPAR levels could be useful to detect acute appendicitis and to differentiate uncomplicated appendicitis (UA) from complicated appendicitis (CA).
METHODS: We prospectively studied 105 patients consisting of 40 UA cases, 40 CA cases, and 25 control patients. Blood samples were collected to measure suPAR level, C-reactive protein level, leukocyte counts, neutrophil counts, and neutrophil percentages preoperatively.
RESULTS: Median values of suPAR level, C-reactive protein level, leukocyte counts, neutrophil counts, and neutrophil percentages in UA and CA were significantly higher than control patients. suPAR levels of the UA and CA groups showed a statistically significant difference (p=0.016).
CONCLUSION: The current study demonstrated that serum suPAR concentrations can be helpful in differentiating CA from UA and in diagnosing acute appendicitis.

AMAÇ: Birçok doktor gaz oluþumuyla karakterize sinerjistik nekrotizan selülit hakkýnda az bilgi sahiptir, çalýþmamýzda bu durumu geriye dönük araþtýrdýk.
GEREÇ VE YÖNTEM: Kasým 2006 ile Eylül 2015 arasýnda gaz oluþumuyla karakterize sinerjistik nekrotizan selülit tanýsý konmuþ toplam 30 hasta çalýþmaya alýndý. On dokuz hastaya açýk drenaj uygulandý, 11 hastaya agresif debridman yapýldý. Geriye dönük olarak demografiler, APACHE II skorlarý, patojenlerin kültür sonuçlarý, ameliyat sýrasýnda kanama miktarý, beyaz küreler ve derlenme geriye dönük olarak incelendi.
BULGULAR: Ölüm oranlarý açýk drenaj ve agresif debridman gruplarýnda sýrasýyla %26 ve %73 idi (p=0.023). Tedavi öncesinde iki grup arasýnda APACHE II skorlarý açýsýndan herhangi bir istatistiksel farklýlýk yoktu (16.6±4.5’e karþýn 18.1±7.5, p=0.511). Tedavi sonrasýnda agresif tedavi grubunda APACHE II skoru anlamlý derecede daha yüksek idi (14.2±5.8’e karþýn 20.1±9.1, p=0.038). Tedavi öncesi ve sonrasý arasýnda beyaz küre sayýsýnda istatistiksel farklýlýk yoktu (13.49±5.05×109 hücre/L’e karþýn 17.46±6.94×109 hücre/L, p=0.082; 10.37±3.54×109 hücre /L ve 15.47±7.51×109 hücre /L, p=0.055). Ameliyat sýrasýnda kanama agresif debridman grubunda anlamlý derecede daha fazla idi (315±112 ml’ye karþýn 105±45 ml, p=0.000).
TARTIÞMA: Sinerjistik nekrotizan selülit tedavisi için hasta kabulden sonra olabildiðince en kýsa sürede açýk drenaj yapýlacak en önemli giriþimdir.

BACKGROUND: As many doctors know little about gas-forming synergistic necrotizing cellulitis, we retrospectively explored it in our study.
METHODS: Totally, 30 patients diagnosed with gas-forming synergistic necrotizing cellulitis between November 2006 and September 2015 were included. They were divided into two groups: open drainage group (19 patients) and aggressive debridement group (11 patients). Retrospectively analyzed data comprised demographic characteristics, APACHE II scores, pathogen culture results, bleeding amount during the operation, white blood cell count, length of hospital stay and recovery.
RESULTS: The mortality rate was 26% in the open drainage group and 73% in the aggressive debridement group (p=0.023). There was no statistical difference in the APACHE II score before treatment between the open drainageand aggressive debridement groups (16.6±4.5 vs 18.1±7.5, p=0.511). The APACHE II score was significantly higher after treatment in the aggressive debridement group (14.2±5.8 score vs 20.1±9.1, p=0.038). There were no statistical differences in the white blood count cell before and after treatment (13.49 × 109±5.05×109 cells/L vs 17.46×109±6.94×109 cells/L, p=0.082; 10.37×109±3.54×109 cells/L vs 15.47×109±7.51×109 cells/L, p=0.055; respectively). The bleeding amount during the operation was significantly more in the aggressive debridement group (315±112 ml vs 105±45 ml, p<0.001.
CONCLUSION: For treating gas-forming synergistic necrotizing cellulitis, performing open drainage as early as possible isthe most important procedure after admission.

AMAÇ: Türkiye’deki acil týp hekimleri, beyin cerrahlarý ve radyologlarýn, minör kafa travmasýnda (MKT) bilgisayarlý tomografi (BT) kullanýmý ile ilgili tutum ve davranýþlarýný belirlemektir.
GEREÇ VE YÖNTEM: Çalýþma acil týp hekimleri, beyin cerrahlarý ve radyologlara anket formu uygulanarak gerçekleþtirildi.
BULGULAR: Ankete 201 acil týp hekimi, 179 beyin cerrahý ve 227 radyolog dahil olmak üzere toplam 607 katýlýmcý yanýt verdi. Minör kafa travmasýnda beyin BT kurallarý ile ilgili genel farkýndalýk oraný %31 olarak bulundu. Katýlýmcýlarýn %27.3’ü kurallarý uyguladýðýný bildirdi. Kurallarýn farkýndalýðý ve kullanýmý acil týp hekimi grubunda en belirgin iken en düþük oranlar radyologlar grubunda gözlendi (p<0.01). Acil týp hekimlerinin MKT’de beyin BT kurallarýný kullanmalarýný engelleyen baþlýca etkenler; mediko legal kaygý (%73.6), hastalarýn ve/veya hasta yakýnlarýnýn beklentileri (%72.6) ve zaman kýsýtlamalarý (%44.3) idi. Beyin cerrahlarýnýn belirttikleri baþta gelen faktörler; mediko legal kaygý (%60.9) ve hasta ve/veya hasta yakýnlarýnýn beklentileri (%46.4) idi. Radyologlar tarafýndan belirtilen baþlýca etken “karar verme sürecinde danýþýlmamaktadýr” (%65.6) idi.
TARTIÞMA: Çalýþmamýzýn sonuçlarý, Türkiye’de birçok hekimin MKT’de beyin BT kurallarý ile ilgili olumlu tutumlarý olmadýðýný göstermektedir. Mediko legal kaygý, hastanýn ve/veya hasta yakýnlarýnýn beklentileri, zaman kýsýtlamalarý, BT’nin yaygýnlýðý ve týbbi görüntülemede radyasyondan korunma veya hasta radyasyon dozu konularýnda eðitim yetersizliði bu uygulama þekli için ortak nedenler olarak tanýmlanmaktadýr.

BACKGROUND: We aimed to determine the attitudes and practices of emergency physicians (EPs), neurosurgeons, and radiologists in Turkey regarding computed tomography (CT) use for adults with minor head injury (MHI).
METHODS: This cross-sectional study was conducted between August 2015 and October 2016 after obtaining the approval of the institutional ethical committee. The purpose of this study was disclosed to the participants prior to beginning the survey. The study was performed conducting a questionnaire via e-mail on three groups of participants including EPs, neurosurgeons, and radiologists. Participants comprised academic staff at university hospitals as well as department chiefs, specialists, and residents working at university, government, and private hospitals, all of whom are in charge of evaluating MHI patients.
RESULTS: A total of 607 participants including 201 (33.1%) EPs, 179 (29.5%) neurosurgeons, and 227 (37.4%) radiologists responded to the survey; 31% of the participants reported awareness and 27.3% reported use of head CT rules in MHI. Awareness and use of the rules were most prominent in EPs group, while the lowest rates were observed in radiologists group (p<0.01). The leading factors inhibiting the use of head CT rules in MHI stated by EPs were medicolegal anxiety (73.6%), expectations of patients and/or patient relatives (72.6%), and time constraints (44.3%). The leading factors stated by neurosurgeons were medicolegal anxiety (60.9%) and expectations of patient and/or patient relatives (46.4%); “not being consulted in the decision-making process to obtain CT in MHI” (65.6%) and medicolegal anxiety (49.8%) were the leading factors stated by radiologists.
CONCLUSION: The results of our study show that many physicians in Turkey do not have favorable attitudes regarding head CT rules in MHI. Medicolegal anxiety, expectations of patient and/or patient relatives, time constraints, wide availability of CT, and lack of adequate education on radiation protection or on patient dose from imaging are the common reasons for this practice pattern.

AMAÇ: Yoðun olarak özçekim ve bunlarý sosyal medyada paylaþmak ya da bununla iliþkili davranýþlar, özellikle gençler arasýnda giderek artmaktadýr. Bu durum özçekim nedenli travmalara yol açabilir. Bu klinik çalýþmayý, özçekim iliþkili yaralanma ve ölümlere dikkat çekmek için gerçekleþtirdik.
GEREÇ VE YÖNTEM: Çalýþmamýzda medya kaynaklarýnda rapor edilen 111 özçekim olayý veya kazasý ile iliþkili 159 olgu deðerlendirildi. Özçekimle iliþkili yaralanma ve ölümlerin nedenleri ile birlikte kurbanlarýn vital bulgularý, demografileri, ritmisiteleri, tercihler, olay veya kaza tipleri, risk faktörleri ve etkilenen vücut bölgeleri deðerlendirildi.
BULGULAR: Özçekim kurbanlarýnýn birçoðunun öðrenci olduðu belirlendi. Özçekim iliþkili yaralanma ve ölümler en sýk Hindistan, ABD ve Rusya’dan bildirilmiþti. Kurbanlarýn en sýk poz tercihi uçurum kenarý idi. En sýk rapor edilen kaza tipi yüksekten zemine düþme idi. Özçekim iliþkili yaralanma ve ölümlerde en sýk etkilenen çoklu vücut bölgesi idi. En sýk saptanan ölüm nedeni multitravma ve suda boðulma idi.
TARTIÞMA: Özçekim iliþkili yaralanma ve ölümler son yýllarda giderek artmaktadýr. Özellikle ergenler ve genç yetiþkinler tehlikeli özçekim açýsýndan yüksek risk taþýrlar. Bu nedenle özçekim iliþkili yaralanma ve ölümleri azaltmak için bilinçlendirme yapýlmalýdýr.

BACKGROUND: The incidence of taking selfies and sharing them on social media as well as selfie-related behaviors is increasing, particularly among young people, possible leading to selfie-related trauma. Therefore, we performed this clinical study to draw attention to selfie-related injuries and deaths.
METHODS: We analyzed 159 selfie victims from 111 events or accidents, which were reported in the media sources. We evaluated vital results, demography, rhythmicity, preferences, event or accident types, selfie-related risk factors, affected body regions of victims with causes of injury, and death.
RESULTS: We found that the majority of selfie victims were students. Selfie-related injuries and deaths were reported most frequently in India, the US, and Russia. The most preferred site of taking selfies was the edge of the cliff. The most frequently reported event or accident type was falling from a height. Mostly multiple body parts were affected in selfie-related injuries and deaths. The most frequent causes of selfie-related deaths were multitrauma and drowning.
CONCLUSION: Selfie-related injuries and deaths have increased in the past years. Particularly, teenagers and young adults are at high risk for selfie-related traumas and deaths; therefore, drastic measures should be taken to reduce their incidence.

AMAÇ: Hastane acil servisleri hem travmatik hem de travmatik kökenli olmayan acil dental durumlarla karþý karþýya gelirler. Öte yandan literatür, týp uzmanlarý arasýnda travmatik dental yaralanmalarýnýn (TDY) yönetimi konusunda bilgi eksiklikleri bulunduðunu ileri sürmektedir. Bu çalýþmanýn amacý, Ýstanbul acil cerrahi doktorlarýnýn TDY’nin tedavisine yönelik bilgi ve tutumlarýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: Anketler acil servis yöneticilerine ve doktorlara daðýtýldý. Anket, özellikleri ve dental travma yönetimi konusundaki bilgilerini deðerlendiren sorularý içermekteydi.
BULGULAR: Toplamda 126 anketin (13’ü acil sevis yöneticisi, 113 doktor) geri dönüþü olmuþ ve deðerlendirme kapsamýna alýnmýþtýr. Acil çalýþanlarýnýn kron kýrýklarý ve avülsiyon konusundaki uygun tedavi bilgi düzeyleri genelde iyi düzeyde olmasýna karþýn (p=0.221), lüksasyon yaralanmalarda konusundaki bilgileri yetersizdi (p=0.0001). Doktorlar kalýcý diþler konusunda süt diþlerine oranla daha iyi bir bilgi düzeyine sahiplerdi (p=0.027).
TARTIÞMA: Bu çalýþmadan elde edilen bulgulara dayanarak, hastanelerde özellikle doktorlar arasýnda TDY yönetimini iyileþtirmek için eðitim, izleme, kaynaklarýn daha iyi kullanýlabilirliði ve disiplinler arasý uyum eksikliðinin deðerlendirilmesi gereklidir.

BACKGROUND: Hospital emergency departments (EDs) are confronted with managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests inadequate knowledge of the management of traumatic dental injuries (TDIs) among medical professionals. The aim of this study was to investigate the knowledge and attitudes regarding management of TDIs among Istanbul ED physicians.
METHODS: Surveys were distributed to emergency departments (ED) directors and their physicians. The survey contained questions about their characteristics and tested their knowledge of managing dental trauma.
RESULTS: A total of 126 surveys (13 ED directors and 113 physicians) were returned and included in the analysis. ED physician’s knowledge of the appropriate management of crown fractures and avulsion was generally good (p=0.221), but poor for luxation injuries (p=0.0001). Physicians were more likely to have a better knowledge about permanent teeth than about primary teeth (p=0.027).
CONCLUSION: Education, monitoring, improved availability of resources, and disciplinary measures in cases of poor compliance are necessary to improve TDI management in hospitals, especially among physicians.

AMAÇ: Çocuklar duvarlara, merdivenlere ve korkuluklara týrmanmaya meraklýdýr. Bu durum düþme sonucu travmalarý da artýrmaktadýr. Çalýþmamýzda korkuluk demiri ile üst ekstremite penetran yaralanmasý olan çocuk hastalarýmýzdaki tecrübelerimizi paylaþmayý ve çocuklardaki bu tip yaralanma riskine dikkat çekmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýzda ortalama yaþý 8.8 olan beþ erkek çocuk dâhil edildi. Saplanmýþ olan korkuluk demirleri ameliyathanede çýkartýldý.
BULGULAR: Eksplorasyon sonucu yaralandýðý tespit edilen yapýlar (fleksör digitorum profundus tendonu, A4 pulleyi, distal interfalangeal eklem volar plak, radial dijital sinir, ulnar dijital sinir ve radial dijital arter) hemen onarýldý.
TARTIÞMA: Korkuluk demiri yaralanmalarý, ameliyathanede eksplorasyon gerektirmekte ve önemli yapýlarýn yaralanmasýna neden olabilmektedir. Özellikle erkek çocuklarý risk altýndadýr ve ebeveynler bu açýdan dikkatli olmalýdýr. Korkuluk demirlerinin kullanýmýnda standart bir hukuki düzenleme olmasý gerektiðini düþünmekteyiz. Bu çalýþmayý, olasý yaralanmalar açýsýndan toplumun, olasý hukuki sonuçlarý açýsýndan da kullanan kurumlarýn ve kiþilerin dikkatine sunuyoruz.

BACKGROUND: Children have a curiosity for climbing walls, stairs, and railings and have an increased risk of falling. Here, we report our experience with railings causing injuries by penetrating the upper extremities, and aim to call attention to spiked railing injuries in children.
METHODS: We report on five children with a mean age of 8.8. All of the children were male. The penetrating railing parts were removed in a surgical room.
RESULTS: The injured structures repaired immediately were as follows: flexor digitorum profundus tendon, A4 pulley, volar plate of the distal interphalangeal joint, radial digital nerve, ulnar digital artery, and radial digital artery.
CONCLUSION: Spiked railings can lead to significant injury that requires further exploration. Boys particularly are at risk, and parents should be alert regarding these type of injuries. We recommend a standard regulation for fence erection, and we wish to warn owners of this type of fence regarding probable legal sanctions.

AMAÇ: Mavi Kod, hastanelerde kalp ve solunum arrestine yanýt vermek üzere geliþtirilmiþ acil çaðrý sistemidir. Ancak, literatürde Mavi Kod iþlemlerinde mortaliteyi öngörmek için bir skor sistemi geliþtirilmemiþtir. Bu çalýþmada Mavi Kod ile deðerlendirilen hastalarda mortalite tahmininde hesaplanan APACHE II ve PRISM skorlarýnýn etkinliðinin araþtýrýlmasý ve Mavi Kod çaðrýlarýnýn geriye dönük analizi amaçlandý.
GEREÇ VE YÖNTEM: Hastanemizde 2009 ile 2013 yýllarý arasýnda Mavi Kod ekibi tarafýndan deðerlendirilen 1195 hasta geriye dönük olarak incelendi. Hastalara ait demografik veriler, taný ve iliþkili bölümler, Mavi Kod nedenleri, kardiyopulmoner resüsitasyon süresi, APACHE II ve PRISM skorlarý ile hesaplanan mortalite ve gerçekleþen mortalite deðerleri hastane veritabaný ile Mavi Kod Bildirim Formlarýndan geriye dönük olarak kayýt edildi.
BULGULAR: Mavi Kod çaðrýlarýnda gerçek mortalite ile APACHE II ve PRISM skorlarý tarafýndan hesaplanan beklenen mortalite arasýnda tüm yaþ gruplarýnda anlamlý fark vardý (p<0.05). Gerçek mortalite oraný beklenen mortaliteden anlamlý derecede daha düþüktü.
TARTIÞMA: Mevcut parametrelerle APACHE ve PRISM skorlarý, Mavi Kod iþlemlerinde mortalitenin öngörülmesine yardýmcý olmayacaktýr. Bu yüzden, farklý parametrelerin kullanýldýðý yeni skor sistemlerine gereksinim vardýr.

BACKGROUND: Code blue (CB) is an emergency call system developed to respond to cardiac and respiratory arrest in hospitals. However, in literature, no scoring system has been reported that can predict mortality in CB procedures. In this study, we aimed to investigate the effectiveness of estimated APACHE II and PRISM scores in the prediction of mortality in patients assessed using CB to retrospectively analyze CB calls.
METHODS: We retrospectively examined 1195 patients who were evaluated by the CB team at our hospital between 2009 and 2013. The demographic data of the patients, diagnosis and relevant de-partments, reasons for CB, cardiopulmonary resuscitation duration, mortality calculated from the APACHE II and PRISM scores, and the actual mortality rates were retrospectively record-ed from CB notification forms and the hospital database.
RESULTS: In all age groups, there was a significant difference between actual mortality rate and the expected mortality rate as estimated using APACHE II and PRISM scores in CB calls (p<0.05). The actual mortality rate was significantly lower than the expected mortality.
CONCLUSION: APACHE and PRISM scores with the available parameters will not help predict mortality in CB procedures. Therefore, novels scoring systems using different parameters are needed.

AMAÇ: Bu çalýþmanýn amacý deplase eklem içi kalkaneus kýrýklarýnýn tedavisinde uyguladýðýmýz anatomik lateral çerçeve plak sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya 13 hastanýn (3 kadýn, 10 erkek, ortalama yaþ: 37.5) 14 deplase eklem içi kýrýðý olan hasta alýndý. Tüm hastalara geniþletilmiþ lateral yaklaþým uygulandý ve eklem hattý redükte edildikten sonra otogreft kullanýlarak desteklendi. Daha sonra da anatomik lateral çerçeve plak ile tespit edildi. Ameliyattan sonra tüm hastalara atel uygulandý. Ameliyattan sonra hastalara 6–8. haftalarda kontrollü, 12. haftadan sonra ise tam yük verdirildi.
BULGULAR: Hastalarýn ortalama takip süresi 28 aydý. Kýrýklarýn sýnýflamasý Sanders sistemine göre yapýldý. Hastalarýn klinik skorlamalarý AOFAS, Creighton-Nebreska ve Maryland skorlama sistemleri kullanýlarak yapýldý. Hastalarýn bu skor sistemlerine göre ortalamasý sýrasý ile 83.7, 75.7, 88.5 olarak bulundu.
TARTIÞMA: Çalýþmamýzda deplase eklem içi kalkaneus kýrýðý olan hastalarda kullandýðýmýz anatomik lateral çerçeve plak tasarýmýmýzýn sonuçlarýný tanýmladýk. Kullandýðýmýz plaðýn kalkaneusun lateral yüzüne anatomik olarak oturmasýyla hem klinik hem de radyolojik olarak yeterli ve tatmin edici sonuçlar elde ettik.

BACKGROUND: The present study evaluated the results obtained from the anatomical lateral frame plate treatment of displaced intraarticular calcaneus fractures.
METHODS: Overall, 14 displaced intraarticular fractures of 13 patients (3 females, 10 males; Mean age, 37.5 years) were included in the present study. Surgery was performed using widened lateral approach and supported by auto grafts following joint line reduction in all patients. They were then fixated by anatomical lateral frame plate. All the joints were stabilized by casting after the operation. All patients were prescribed controlled and full weight bearing at 6–8th and 12th weeks, respectively.
RESULTS: Mean follow-up of patients was 28 months. The fractures were classified according to Sanders system. Clinical scoring of the patients was performed according to American Orthopaedic Foot and Ankle Society, Creighton-Nebraska, and Maryland systems. According to these systems, the mean scores of the patients were 83.7, 75.7, and 88.5 respectively.
CONCLUSION: In the present study, we have defined the results of anatomical lateral frame plate treatment in patients with displaced intraarticular calcaneus fractures. We have obtained clinically and radiologically satisfactory results with the anatomical compatibility of plate to the lateral surface of the calcaneus.

AMAÇ: Çalýþmada AO tip 13C humerus distal kýrýklarýnda olekranon osteotomisi ile birlikte açýk redüksiyon ve internal tespit yapýlan hastalarýn fonksiyonel ve klinik sonuçlarýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: AO Tip 13C distal humerus kýrýðý tanýsý mevcut olan ve cerrahisi yapýlan 39 hasta (ortalama yaþ, 44.7; Erkek, %56.4) geriye dönük olarak deðerlendirildi. Hastalarýn demografik verileri, týbbi öyküleri, radyolojik ve fonksiyonel sonuçlarý kayýt altýna alýndý. Hastalarýn fonksiyonel sonuçlarý Mayo Dirsek Performans Puanlama Sistemi’ne (MEPI) göre deðerlendirildi.
BULGULAR: Ortalama dirsek fleksiyon derecesi 102.2 (60–120 derece) ve ortalama ekstansiyon kaybý derecesi 11.4 (0–25 derece) olarak hesaplandý. Mayo Dirsek Performans Puanlama skorlama sistemine göre yedi hastada mükemmel, 12 hastada iyi, 13 hastada orta ve 7 hastada kötü sonuç elde edildi. Tüm hastalarda ameliyat sonrasý altýncý ayda radyolojik olarak kaynama görüldü. Tip 13C3 kýrýklarda tip 13C1 ve 13C2’ye göre daha fazla ekstansiyon kaybý, daha düþük fleksiyon derecesi ve daha düþük ortalama MEPI skoru tespit edildi. Fonksiyonel sonuçlara bakýldýðýnda olekranon fiksasyon yönteminin (tansiyon bant ve kanüle vida) anlamlý farklýlýk yaratmadýðý tespit edildi.
TARTIÞMA: AO tip 13C1 ve tip 13C2 kýrýklarýn klinik ve fonksiyonel sonuçlarýnýn AO tip 13C3 kýrýklara göre daha iyi olduðu ve iki farklý olekranon fiksasyon yönteminde fonksiyonel sonuçlarýn deðiþmediði görüldü.

BACKGROUND: To investigate the outcomes of patients undergoing open reduction and internal fixation with olecranon osteotomy due to AO type13C fractures of the distal humerus.
METHODS: Data of 39 patients (mean age, 44.7 years; males, 56.4%) undergoing surgery with the diagnosis of AO type 13C distal humeral fractures were retrospectively evaluated. Patients’ demographic characteristics, medical history, and radiological and functional outcomes were recorded. The patients were evaluated at the final follow-up according to the Mayo Elbow Performance Index (MEPI).
RESULTS: The mean degrees of flexion and extension loss were 102.2 degrees (range, 60–120 degrees) and 11.4 degrees (range, 0–25 degrees), respectively, at the final follow-up. According to the MEPI score, outcomes were excellent in seven, good in 12, fair in 13, and poor in seven patients. All patients achieved a radiological union of the fracture site within the first postoperative six months. It was found that the loss of extension was more severe, the range of flexion was decreased, and the mean MEPI score was lower in the patients with type C3 fractures than in those with type C1 and type C2 fractures. No significant difference was determined between fixation techniques (tension band vs. cannulated screw) regarding the functional outcomes.
CONCLUSION: Our results revealed better prognosis in AO type C1 and type C2 fractures than in AO type C3 fractures and no different effects of two fixation techniques in olecranon osteotomy on the outcomes.

AMAÇ: AO tipleri A1.2 ve A1.3 kýrýklarýnýn rotasyonel instabil olduðu düþünülmesine raðmen, dinamik kalça vidasý ile tespitten sonra stabil olmadýklarý ortaya çýkmýþtýr. Bu nedenle bu kýrýklarýn rotasyonel instabil kýrýklar gibi tedavi edilmesi gerektiðini varsaymaktayýz.
GEREÇ VE YÖNTEM: AO tip A1, A2 and B2.1 kýrýklarý olan 83 kýrýklýk bir seri DKV/DRV ile tedavi edildikten sonra 24 ay izlendi. Ameliyattan hemen sonra, redüksiyonun ve fiksasyonun yeterliliði, altýncý aylarda veya kýrýklar iyileþtiðinde ise kýrýk bölgesindeki çökme deðerlendirildi. Varsayýmýmýzýn uygulanabilirliðini araþtýrmak için kýrýklar iki gruba ayrýldý: Kaçýnýlmaz olarak instabil kýrýk grubu (KÝKG) AO tip A1.1, A2.1,2,3 ve B2.1 kýrýklarý, potansiyel olarak instabil kýrýk grubu (PÝKG) AO tip A1.2 ve A1.3 kýrýklarý içermekteydi. Sonuçlar istatistiksel açýdan analiz edildi.
BULGULAR: Yetmiþ yedi kýrýkta yeterli redüksiyon ve 71’inde yeterli fiksasyon saðlandý. Kýrýklarýn tümü ortalama 13.5 haftada iyileþti ve kýrýk bölgesinde ortalama 5.8 mm’lik çökme (kolaps) oluþtu. Altmýþ altý hastada her iki alt ekstremite eþitlendi, 80 hastada kalça hareket erimi diðer saðlam kalçanýn hareket erimine kavuþtu. Bir AO tip A1.2’li hasta yeniden ameliyata alýndý. Sonuçlarýn karþýlaþtýrýlmasýna göre KÝKG ile PÝKG arasýnda önemsiz farklýlýklar vardý.
TARTIÞMA: DKV/DRS ile femurun proksimal ucunun anatomik özellikleri orijinal haline getirilmiþ ve takip dönemi sýrasýnda bu durum korunmuþtur. KÝKG ile PÝKG sonuçlarý arasýnda önemsiz farklýlýklar, rotasyonel instabil kýrýklara AO tip A1.2 ve A1.3 kýrýklarýn da ilavesi akla yakýndýr.

BACKGROUND: It was thought that the AO types A1.2 and A1.3 fractures are rotationally stable; however, it revealed instability when fixed using the dynamic hip screw. Therefore, we hypothesized that these fractures should be treated as rotationally unstable.
METHODS: A series of 83 fractures of the AO types A1, A2, and B2.1 were treated using dynamic hip screw with derotation screw (DHS/DRS) composite and then prospectively followed for 24 months. Adequacy of reduction and fixation were immediately assessed after surgery, and fracture collapse was assessed at six months or when fractures healed. To investigate the feasibility of our hypothesis, fractures were classified into two groups: 1) the inevitably unstable group (IUG) included the AO types A1.1, A2.1, A2.2, A2.3, and B2.1 fractures and 2) the potentially unstable group (PUG) included the AO types A1.2 and A1.3 fractures. The results were statistically analyzed.
RESULTS: Adequate reduction was achieved in 77 and adequate fixation in 71 fractures. All fractures healed in a mean time of 13.5 weeks, and the amount of the fracture collapse averaged 5.8 mm. Equalization of the lower limbs was achieved in 66 patients, and hip motion range equalized the healthy contralateral in 80 patients. Re-operation was performed in one case with AO type A1.2. Comparison of IUG and PUG using the outcomes revealed insignificant differences.
CONCLUSION: Using the DHS/DRS composite, anatomical features of the proximal femoral end were restored and maintained during the follow-up period. Insignificant differences between outcomes of IGU and PGU render the addition of the AO types A1.2 and A1.3 to the rotationally unstable fractures reasonable.

Künt travmaya baðlý eviserasyon son derece nadirdir. Yirmi aylýk erkek çocukta künt travma sonrasý mide, ince ve kalýn baðýrsakta eviserasyonu tanýmladýk. Acil laparotomi ve cerrahi onarým yapýlmýþtý. Mezenterde küçük bir delikten baþka bir yaralanma yoktu. Baðýrsaklar karýn boþluðuna drene edildi ve cilt kapatýldý. Hasta iyileþti.

Blunt traumatic evisceration is extremely rare. We describe the case of a 20-month-old boy with stomach and small and large intestine evisceration after blunt trauma. Immediate laparotomy and surgical repair were performed. There was no injury, other than a small hole in the mesentery. The bowels were drained into the abdominal cavity, and the skin was closed. The patient recovered well.

Akut apandisit, acil cerrahi gerektiren en yaygýn akut karýn aðrýsý nedenlerinden biridir. Apendiksin varyasyonel anatomik lokalizasyonlarýndan dolayý olgularýn yaklaþýk üçte birinde farklý bir kadranda aðrý olabilir. Akut apandisit, sitüs inversus totalis (SIT), Midgut malrotasyon (MM) gibi birkaç doðuþtan anomali dýþýnda sol alt kadran aðrýsýnda nadiren akla gelir. Midgut malrotasyon nadir bir doðuþtan anomali olup superior mezenterik damarlarýn etrafýnda rotasyon veya baðýrsaklarýn fiksasyonu hatasýndan kaynaklanýr ve baðýrsaðýn inkomplet rotasyonu veya nonrotasyonu anlamýna gelir. Burada sol alt kadran aðrýsý ile baþvuran ve akut perfore apandisit tanýsý alan intestinal nonrotasyonlu bir olgu sunuldu. Klinisyenler intestinal nonrotasyonun sol alt kadran aðrýsý ile prezente olan akut apandisit ile komplike olabileceðini bilmeli, sol alt kadran lokalizasyonlu apandisitlerde intestinal nonrotasyon akla gelmelidir.

Acute appendicitis is the most common cause of acute abdominal pain, requiring emergency surgery. Approximately one third of cases have pain unexcepted location due to its various anatomical location. Acute appendicitis is a very rare cause of left lower quadrant pain; if it occurs, a few congenital anomalies should be considered such as Situs Inversus totalis and Midgut Malrotation (MM). MM is a rare congenital anomaly; it occurs due to error in process of rotation or fixation of intestines around the superior mesenteric vessels and it refers to nonrotation or incomplete rotation of intestines. Here we report a case who presented with left lower abdominal pain and was diagnosed with acute perforated appendicitis with intestinal nonrotation. Clinicians should be aware that intestinal nonrotation may be presented with left lower quadrant pain and complicated by acute appendicitis.

Vasküler kapatma cihazý, endovasküler giriþimsel iþlemler sonrasýnda hemostazý saðlamak amacýyla sýklýkla kullanýlmaktadýr. Bu cihazlar, ponksiyon yerinde hýzlý bir hemostaz saðlamasýnýn yaný sýra, hastanýn erken mobilizasyonuna ve kliniðin iþ yükünün azalmasýna da olanak saðlamaktadýr. Ancak nadir de olsa iþleme baðlý komplikasyonlar bildirilmiþtir. Bu yazýda, vasküler kapatma cihazý kullanýmý sonrasýnda ani baþlayan ve cerrahi giriþim gerektiren iki akut arter týkanýklýðý olgusu paylaþýldý.

Vascular closure devices are frequently used after percutaneous arterial interventions to achieve hemostasis at the puncture site and facilitate early ambulation. Occasionally, complications have been reported with closure devices, such as hematoma, infection, arteriovenous fistula, pseudoaneurysm, and ischemia. This is a report of 2 cases of severe, acute-onset arterial occlusion and critical limb ischemia, one of which occurred in the upper limb following the use of a vascular closure device, and the required surgical treatment.