AMAÇ: Günümüzde, taný yöntemlerindeki, cerrahi tekniklerdeki, antibiyoterapi ve yoðun bakým ünitelerindeki ilerlemeler, þiddetli sekonder peritonitin mortalitesini azaltmasýna raðmen, mortalite hala kabul edilemeyecek kadar yüksektir. Peritonit kaynaðýný ortadan kaldýrmak için cerrahýn kapatma, dýþa alma ve rezeksiyon gibi çeþitli seçenekleri vardýr. Bu yöntemlerin hangisinin uygulanacaðý cerrahýn tercihine ve hastanýn durumuna baðlýdýr. Bu çalýþmanýn amacý peritoneal temizleme yöntemleri arasýnda yer alan kuru temizleme (izotonikle ýslatýlýp sýkýlmýþ gazlý bezler=kuru temizlik) ile izotonikle peritoneal lavaj yöntemini karþýlaþtýrýlarak bakteriyel translokasyon oranlarýný belirlemektir.
GEREÇ VE YÖNTEM: Sham, kontrol, kuru temizlik ve izotonikle temizlik grubu olarak toplam 64 sýçan üzerinde çalýþma yapýldý. Sham grubunda sadece laparotomi, kontrol grubuna çekal baðlama ve delme iþlemi uygulandý. Diðer iki gruba baðlama ve delme iþlemi sonrasý birinde kuru temizlik diðerinde izotonikle temizleme iþlemi yapýldý. Sakrifiksayon sonrasý karaciðer, dalak ve mezodan elde edilen örnekler aerobik ve anaerobik ortamlarda kültüre alýndý.
BULGULAR: Karaciðer, dalak ve mezo örneklerinin kültür sonuçlarýnda aerob bakteri ölçümlerinde kuru temizlikle izotonik grubu arasýndaki deðerlendirmede anlamlý fark bulunmasýna raðmen anaerob bakterilerde ise anlamlý fark saptanmadý.
TARTIÞMA: Yaptýðýmýz çalýþmaya göre karýniçi enfeksiyonlarýn tedavisinde, karýn temizliði açýsýndan ýslatýlýp sýkýlmýþ gazlý bezle yapýlan temizlik serum fizyolojikle yapýlan temizliðe göre aerobik bakteriler açýsýndan daha efektif olduðu söylenebilir. Anaerob bakteriler açýsýndan her iki yöntem arasýnda fark görülememektedir.

BACKGROUND: Currently, all progress in diagnostic techniques, surgical techniques, antibiotherapy, and intensive care units is accompanied by a decrease in the mortality due to severe secondary peritonitis; however, the rate is still unacceptably high. To remove the source of peritonitis, a surgeon has several options, such as closure, exclusion, and resection, depending on the preference of the surgeon and the condition of the patient. The aim of this study is to determine the rates of bacterial translocation by comparing the dry cleaning method (gauze squeezed with saline) and peritoneal lavage method (cleaning with saline), which are among the peritoneal cleaning methods.
METHODS: A total of 64 rats were studied as sham, control, dry cleaning, and saline cleaning groups. Only laparotomy was performed in the sham group, and cecal ligation puncture was performed in the control group. After ligation puncture operations in the other two groups, one of them was subjected to dry cleaning and the other to isotonic cleaning. The samples obtained from the liver, spleen, and mesothelium were sacrificed and cultured under aerobic and anaerobic environments.
RESULTS: There was no significant difference in the anaerobic bacterial counts, although there was a significant difference in the results of the aerobic bacterial counts in liver, spleen, and mesothelium samples on comparing the dry cleaning and saline cleaning groups.
CONCLUSION: According to our study, the cleaning of intraabdominal infections with dry gauze is more effective than the cleaning with physiological saline for the elimination of aerobic bacteria. There is no difference observed with respect to the anaerobic bacterial counts.

AMAÇ: Travma yoðun immünolojik iþlev bozukluðuyla iliþkilidir. Bu durum hastalarý enfeksiyonlara ve olumsuz sonuçlara yatkýnlaþtýrýr. Beta-glukan antimikrobiyal immün yanýtýn baþlamasýyla iliþkilendirilmiþtir. Bu çalýþma kritik çoklu travma hastalarýnda β-glukan içeren enteral diyetin serum IL-12 ve yüksek derecede duyarlý C-reaktif protein (hs-CRP) düzeyleri, enfeksiyon oluþumu ve klinik sonuçlar üzerine etkilerini deðerlendirme amaçlanmýþtýr.
GEREÇ VE YÖNTEM: En az 10 gün enteral beslenmesi gereken 40 çoklu travma hastasý giriþim grubu (n=20) veya plasebo grubuna (n=20) randomize edildi. Giriþim grubuna 3 g β-glukan içeren yüksek proteinli enteral diyet, kontrol grubuna ise benzer bir diyet ve plasebo olarak 3 g maltodekstrin verildi. Baþlangýçta (0. gün), 10. ve 21. günde serum IL-12 ve hs-CRP düzeyleri ölçüldü.
BULGULAR: Kontrol grubuna göre beta-glukan grubu 21. günde anlamlý derecede daha yüksek serum IL-12 düzeyleri sergiledi. Beta-glukan grubunda enfeksiyon sýklýðý ve mekanik ventilasyon süresi anlamlý derecede daha düþüktü. SOFA (Sequential Organ Failure Assessment, Ardýþýk Organ Yetersizliði Deðerlendirme) skorunda β-glukan grubu lehine anlamlý derecede olumlu bir farklýlýk mevcuttu. Ýki grup arasýnda serum hs-CRP düzeyleri, yoðun bakým ünitesinde kalýþ süresi, enfeksiyon oluþumu ve mortalite oranlarý arasýnda herhangi bir farklýlýk saptanmadý.
TARTIÞMA: Beta-glukan kritik çoklu travma hastalarda serum IL-12 düzeylerini yükseltebilir, mekanik ventilasyon süresini kýsaltabilir ve organ yetersizliðini
hafifletebilir.

BACKGROUND: Trauma is associated with a profound immunological dysfunction. This predisposes patients to infections and adverse outcomes. β-glucan has been implicated in the initiation of anti-microbial immune response. The present study aimed to evaluate the effects of an enteral diet containing β-glucan on serum levels of IL-12 and highly-sensitive C-reactive protein (hs-CRP), occurrence of infection, and clinical outcomes in critically ill multiple-trauma patients.
METHODS: Forty multiple-trauma patients requiring enteral nutrition for at least 10 days were randomly assigned to the intervention group (n=20) or the placebo group (n=20). The intervention group received a high-protein enteral diet providing 3 g β-glucan, and the control group received a similar diet, except for 3 g of maltodextrin as a placebo. Serum levels of IL-12 and hs-CRP were measured on days 0, 10, and 21.
RESULTS: The β-glucan group showed significantly higher serum levels of IL-12 on day 21 compared to the control group. Infection frequency and duration of mechanical ventilation were significantly lower in the β-glucan group. A significant difference was found in the Sequential Organ Failure Assessment (SOFA) score in favor of the β-glucan group. No difference was found in the serum levels of hs-CRP, length of ICU stay, occurrence of infection, and mortality rates between the two groups.
CONCLUSION: β-glucan may increase serum levels of IL-12, shorten the duration of mechanical ventilation, and reduce organ failure in critically ill multiple-trauma patients.

AMAÇ: Bu bibliyometrik çalýþmada, travmatoloji alanýndaki en sýk alýntýlanan 100 makalenin çok yönlü analizini yapmayý amaçladýk.
GEREÇ VE YÖNTEM: Biz bu çalýþmada, Web of Science ve PubMed’teki veri tabanlarýndan elde ettiðimiz, 1975 ile 2017 yýllarý arasýnda yayýnlanmýþ 56.980 travma makalesi içinden en çok alýntýlanan ilk 100’ünü alýntýlanma sayýlarýna ve yayýn yýllarýna, köken aldýðý ülkelere ve kurum veya organizasyonlarýna, en sýk tercih edilen konularýna, fonlanma durumlarýna, makale tiplerine ve kanýt düzeylerine göre analiz ettik.
BULGULAR: Travmatoloji alanýnda en sýk alýntýlanan 100 makaledeki toplam yazar sayýsýný 649 ve yazar sayýsý ortalamasýný 6.49±5.46 (daðýlým: 1–32), toplam çalýþma grubu sayýsýný 8 ve eþlik eden çalýþmacý sayýsýný ise 1241 olarak saptadýk. Amerika Birleþik Devletleri, yayýnlarda en sýk yer alan ülke ve kurum ya da organizasyon olma ve bilimsel aktivitede sunulan makale sayýsý bakýmlarýndan ilk sýrada idi. En çok alýntýlanan 100 makalenin 70’inin, geliþmiþ ülkelerdeki fon desteði veren kuruluþlar tarafýndan desteklendiðini belirledik. Travmatoloji ile ilgili en çok alýntýlanan 100 makalede en sýk tercih edilen ilk üç konu baþlýðýný santral sinir sistemi travmasý (21 makale), majör travma-kanama kanama kontrolü-transfüzyon-erken koagülopati (18 makale) ve travma bakýmý ve sistemleri (8 makale) olarak saptadýk. En sýk alýntýlanan 100 travmatoloji makalesinin kanýt ortalamasý 2.45±1.05 (daðýlým: 1–4) idi. Ayrýca biz en çok alýntýlanan 100 makalenin 66’sýnýn etki faktörü 2.6 daha yüksek olan bilimsel dergilerde (daðýlým: 2.648–72.406) yayýnlandýðýný belirledik. Araþtýrmacýlar tarafýndan en sýk tercih edilen çalýþma tipinin klinik araþtýrma (92 makale) ve çalýþma alt tipinin ise karþýlaþtýrmalý ileriye yönelik çalýþmalar (27 makale) olduðunu saptadýk. Travmatolojideki klasik makalelerin kanýt gruplarýnýn daðýlýmlarýný ise sýrasýyla B (54 makale), A (26 makale) ve C (20 makale) olarak belirledik.
TARTIÞMA: Makalelerin bilimsel deðerini saptamadaki bazý eksikliklerine raðmen travmatoloji alanýndaki klasik makalelerin alýntýlanma analizleri, önemli akademik katkýlar saðlayabilir.

BACKGROUND: In this bibliometric study, we aimed to conduct multi-dimensional citation analysis of the top 100 cited articles in traumatology.
METHODS: We analyzed the top 100 cited articles among 56.980 trauma articles published between 1975 and 2017, which we obtained from databases in Web of Science and PubMed based on their citation rates and publication years, countries of origin, institutions or organizations, the most common subjects, funding status, article types, and levels of evidence.
RESULTS: In the top 100 cited articles, the number of total authors was 649 and average authorship was 6.49±5.46 (1–32); group author or study group number was eight, and the number of total collaborators was 1241. USA was the top country in terms of country of origin and institutions or organizations and also the number of proceedings papers in scientific activities. We found that 70 of the top 100 cited articles were supported by funding agencies in developed countries. In the present study, the three most common subjects were central nervous system trauma (21 articles), major trauma–hemorrhage–bleeding control–transfusion–early coagulopathy (18 articles), and trauma care and systems (eight articles), respectively. The average level of evidence of the top 100 cited articles was 2.45±1.05 (range: 1–4). We also found that 66 of the 100 most frequently cited articles in traumatology were published in scientific journals that had an impact factor of ≥2.6 (range: 2.648–72.406). We found that the most commonly preferred article type by authors is clinical research (92 articles) and sub-type is prospective comparative studies (27 articles). Evidence groups of classical papers in traumatology were B (54 articles), A (26 articles), and C (20 articles), respectively.
CONCLUSION: Despite some flaws in determining the scientific values of articles, citation analysis of classical papers in traumatology can provide important scientific contributions.

AMAÇ: Mesleksel el yaralanmalarýnýn kapsamýna raðmen el yaralanmalarýný korunmasýna iliþkin yetkin kýlavuzlar mevcut olmadýðý gibi Güney Çin veya diðer geliþmekte olan alanlarda akut mesleksel el yaralanmalarýnýn epidemiyolojisi az sayýda çalýþmada araþtýrýlmýþtýr. Bu çalýþmada Güney Çin Foshan ilindeki acil servislerde tedavi edilmiþ akut mesleksel el yaralanmalarýnýn epidemiyolojisini araþtýrdýk ve geliþmekte olan benzer alanlarda koruyucu stratejilere iliþkin veriler saðladýk.
GEREÇ VE YÖNTEM: Foshan ilinde beþ büyük hastanenin acil bölümlerinde ileriye yönelik ve çok merkezli çalýþma tasarlanýp yürütüldü. Bu çalýþmada verileri toplamak için özellikle tasarlanmýþ bir adsýz anket formu kullanýldý.
BULGULAR: Akut mesleksel el yaralanmasý olan toplam 2142 denek bir yýllýk çalýþma dönemi içinde anket formlarýný doldurmuþtur. Mesleksel el yaralanmalarýnýn çoðuna makineler neden olmuþtu. El yaralanmasýnýn tipi ve yaralanmanýn yeri yaþ farklýlýklarýyla deðil cinsiyet ve iþin kategorisiyle iliþkiliydi. Acil servislere en çok Temmuz ve Aðustos 2010 aylarýnda en az Ocak ve Þubat 2010 aylarýnda hasta kabulü olmuþtur.
TARTIÞMA: Epidemiyolojik veriler akut mesleksel el yaralanmalara ait bilgimizi artýrmakta ve gelecekte mesleksel el yaralanmalarýnýn engellenmesi ve tedavisinde rol oynayabilir.

BACKGROUND: Despite the magnitude of occupational hand injuries, there are no authoritative guidelines for hand injury prevention, and little research has been done to investigate the epidemiology of acute occupational hand injuries in South China or other developing areas. In this study, the epidemiology of acute occupational hand injuries treated in emergency departments (EDs) in Foshan City, South China, was examined and data were supplied to assist with preventive strategies in similar developing regions.
METHODS: A multicenter study was prospectively designed and conducted in 5 large hospital EDs in Foshan City from July 2010 to June 2011. An anonymous questionnaire was designed specifically to collect the data for this study.
RESULTS: A total of 2142 patients with acute occupational hand injury completed the questionnaire within the 1-year study period. Results indicated that most occupational hand injuries were caused by machinery. Hand injury type and site of the injury did not correspond to age, but were related to gender and job category. July and August 2010 were the peak periods of admission to EDs, while January and February 2010 were the trough periods.
CONCLUSION: Epidemiological data enhance our knowledge of acute occupational hand injuries and could play a role in the prevention and treatment of future occupational hand injuries.

AMAÇ: Geliþen teknolojik imkanlar ve bunlara kolay ulaþým ile birlikte akut apandisit hastalarýnýn tanýsýnda hemen her hastada kullanýlan ultrasonografi (USG) -özellikle klinik þüphede kalýnan hastalarda- bilgisayarlý tomografi (BT) ile desteklenmektedir. Biz bu çalýþmada özellikle Alvarado skorlamasý ve US sonuçlarý göz önüne alýnarak akut apandisit tanýsýnda kullanýlan BT’nin ne kadar etkin kullanýldýðýný araþtýrmayý hedefledik.
GEREÇ VE YÖNTEM: Mayýs 2013 ve Þubat 2016 tarihleri arasýnda acil serviste deðerlendirilerek tedavisi düzenlenen akut apandisit hastalarý etik kurul onaylý veriler analiz edilerek geriye dönük tarandý. Ameliyat öncesi BT kullanýlan hastalar çalýþmaya alýndý. Hastalarýn demografi verileri, Alvarado skorlarý, USG ve BT raporlarý, BT istenen bölüm (acil servis-cerrahi), ameliyat notlarý ve patoloji sonuçlarý kayýt edildi.
BULGULAR: Çalýþma sürecinde tedavi edilen 811 akut apandisit hastasýndan 208’ine (%25) BT çekildiði saptandý. Hastalarýn hepsine en az bir kez USG yapýlmýþtý ve %53’ünde (n=112) USG negatif idi. Alvarado skorlarý ortalama 5±1.5 (daðýlým: 3–8) idi. Bilgisayarlý tomografi istemlerinin %42’si acil hekimleri tarafýndan %57’si cerrahlar tarafýndan istenmiþti. Acil servis ve cerrahi branþlarýnýn BT istemi yaptýklarý hastalarýn ortalama Alvarado skorlarý sýrasýyla 4.7 ve 5.6 olarak bulundu (p=0.013). Apendiks patolojisi normal saptanan (n=29, %14) hastalarda negatif BT oraný anlamlý yüksek (p=0.042); yaþ ve Alvarado skoru anlamlý düþük (sýrasýyla, p=0.015 ve 0.037) saptandý.
TARTIÞMA: Alvarado skorunun BT çekilen hastalarýn çoðunda 5–8 arasýnda olmasý ve çoðunlukla USG negatif hastalarda olmak üzere %25 oranýnda uygulanmasý ameliyat öncesi BT’nin apandisit tanýsýnda etkin kullanýldýðý lehine yorumlanabilir. Bu sonuçlar ýþýðýnda çalýþmamýzdaki negatif apendektomi oranlarý göz önüne alýndýðýnda BT’nin daha etkin kullanýmýný saðlamak için ileri çalýþmalara ihtiyaç vardýr.

BACKGROUND: Technological developments support using ultrasonography (US) in all patients, if available, and advanced diagnostic methods such as abdominal computed tomography (CT) in case of clinical suspicion during diagnostic process of acute appendicitis. We aimed to investigate whether CT was appropriately and efficiently used in the diagnosis of acute appendicitis.
METHODS: Between May 2013 and February 2016, 811 patients who underwent appendectomy were retrospectively reviewed from an IRB-approved database, and those who underwent a preoperative CT were enrolled into the study. Results of Alvarado scores and US were recorded in addition to which clinic requested the CT (general surgery or emergency department).
RESULTS: The frequency of CT use in the diagnostic process was 25% (n=208/811). Ultrasound was negative for appendicitis in 53% of these patients. The mean Alvarado score was 5±1.5 (range: 3–8). General surgeons requested 57% of CTs. Alvarado scores were significantly higher in patients whose CT was requested by general surgery than in those whose CT was requested by the emergency clinic (5.6 vs. 4.7, p=0.013). Regarding histopathological results, age and Alvarado scores were significantly lower (p=0.015 and 0.037, respectively), whereas the frequency of negative CT was significantly higher (p=0.042) in those with negative appendectomy (n=29, 14%).
CONCLUSION: Most patients who underwent CT in the diagnostic process had an Alvarado score between 5 and 8 and negative ultrasound for appendicitis preoperatively. These findings may provide efficient use of CT in the diagnosis of appendicitis with an acceptable rate of 25% compared with the findings in current literature. However, further research is needed to ensure more efficient use of CT because negative appendectomy has been a concern in our series despite promising results of this study.

AMAÇ: Günümüzde, kafa içi basýncýn (KÝB) belirlenmesinde, optik sinir kýlýfý çapý (OSKÇ) ölçümlerinden faydalanýlabileceði belirtilmektedir. KÝB artýþý, intrakraniyal yaralanmalarýn doðal bir sonucudur. Bu çalýþmada, çok kesitli bilgisayarlý beyin tomografisindeki, pozitif intrakraniyal bulgular ve OSKÇ geniþlemesi arasýndaki iliþki deðerlendirildi.
GEREÇ VE YÖNTEM: Toplam 161 hastanýn çok kesitli BT görüntüleri geriye dönük incelendi. Ölçümler, kesitlerde optik sinirin en geniþ görüldüðü bölge beþ kez büyütülerek yapýldý.
BULGULAR: Çok kesitli beyin tomografisi görüntülerinde, 54 hastada kafa içi hasar tespit edilirken, 107 hastada edilmedi. Pozitif tomografi bulgularý ile OSKÇ artýþý arasýnda anlamlý iliþki olduðu belirlendi, 5.60±0.75 mm ve 5.35±0.75 mm (p=0.038). ROC eðrisinin altýnda kalan alan, 0.600 (%95 güven aralýðýnda 0.508–0.692; p<0.039). OSKÇ eþik deðeri ≥5 mm, duyarlýlýk %80, özgüllük %36 olarak belirlendi.
TARTIÞMA: Bu çalýþma, çok kesitli tomografilerde incelenen kafa içi hasar ile OSKÇ artýþý arasýnda anlamlý ancak zayýf bir iliþki olduðunu gösterdi. Beyinde ciddi yapýsal deðiþikliklere ve kanamaya yol açacak travmalar, optik sinirin geniþlemesi üzerinde ancak sýnýrlý bir etkiye sahiptir.

BACKGROUND: Currently, the measurement of optic nerve sheath diameter (ONSD) has been offered as a possible indicator of
intracranial pressure (ICP). Increased ICP is observed during intracranial injury. The objective of this study was to evaluate the relationship
between increased ONSD and positive intracranial findings from multislice computed tomography (CT) of the brain.
METHODS: In total, CT scans of 161 patients were retrospectively reviewed. The image that showed the largest ONSD was magnified
five times.
RESULTS: The CT scan revealed intracranial lesions in 54 patients and no intracranial lesions in 107 patients. A significant relationship
was observed between positive CT findings and increased ONSD: 5.60±0.75 mm vs. 5.35±0.75 mm (p=0.038). The area under the
receiver operating characteristic curve was 0.600 (95% confidence interval, 0.508–0.692; p<0.039). A cut-off value of ≥5.0 mm had a
sensitivity and specificity of 80% and 36%, respectively.
CONCLUSION: This study demonstrated a significant yet poor relationship between intracranial injury and increased ONSD from
the multislice CT scan. Severe structural changes in the brain and trauma that causes bleeding have only limited effects on the extension
of the optic nerve.

AMAÇ: Ciddi abdominal sepsis ve abdominal kompartman sendromu geliþen hastalarda günümüzde uygulanan en önemli tedavi yöntemi abdomenin geçici karýn kapama yöntemleri ile kapatýldýðý açýk karýn (AK) uygulamasýdýr. Bu amaçla kullanýlan baþlýca yöntemler Vacum Asisted Closure Method (VACM) ve non-vacum asisted closure (NVACM) teknikleridir. Bu çalýþmada farklý karýn kapama yöntemlerinin morbidite ve mortalite üzerine olan etkileri incelendi.
GEREÇ VE YÖNTEM: Çalýþmada 2013–2016 yýllarý arasýnda AK uygulanan hastalarýn geçici karýn kapama yöntemleri geriye dönük olarak incelendi.
VACM ile NVACM uygulanan hastalarýn AK etiyopatolojisi, mortalite tahmin skorlarý, nihai karýn kapama süresi ve yöntemleri, hastanede yatýþ süresi, geliþen komplikasyon (enteroatmosferik fistül, mesh enfeksiyonu, insizyonel herni) ve mortalite oranlarý belirlenerek karþýlaþtýrýldý.
BULGULAR: Bu çalýþmaya VACM (n=65) ve NVACM (n=58) uygulanan 123 hasta dahil edildi. Gruplarýn (VACM ve NVACM) yaþ, cinsiyet ve etiyopatogenezleri arasýnda fark yoktu (p>0.05). Tedavi döneminde ortalama APACHE 4 ve MODS skorlarý sýrasýyla 47/63 ve 11/14’tü (p<0.05). Gruplarýn yoðun bakým ünitesi ve hastanede ortalama yatýþ süreleri sýrasýyla 11/16 ve 22/28 gündü (p<0.05). Apse, koleksiyon geliþme oraný sýrasýyla %46.2 ve %77.6 idi (p<0.05). Enteroatmosferik fistül geliþme oraný sýrasýyla %15.4 ve %56.9’du. Ortalama karýn kapama zamaný sýrasýyla 13 ve 17 gündü (p<0.05). VACM grubunda 18 (%28), NVACM grubunda 32 (%55) hasta kaybedildi (p<0.05).
TARTIÞMA: Açýk karýn uygulanan hastalarda geçici karýn kapama yöntemi olan VACM diðer yöntemlere göre daha düþük komplikasyon ve mortalite oranýna sahiptir. Ayrýca hastanede yatýþ süresi daha kýsadýr. Açýk karýn tedavisinde etkili ve güvenli bir uygulama yöntemidir.

BACKGROUND: Open abdomen (OA) in which the abdomen is closed with temporary abdominal closure methods is the most effective in patients who develop severe abdominal sepsis or abdominal compartment syndrome. Major techniques used are Vacuum- Assisted Closure Method (VACM) and non-vacuum assisted closure method (NVACM). In the present study, the effects of different abdominal closure methods on morbidity and mortality were evaluated.
METHODS: In the study, the temporary abdominal closure methods of the patients with OA during 2013–2016 were studied retrospectively. OA etiopathologies, mortality prediction scores, final abdominal closure periods and methods, hospitalization periods, complications (enteroatmospheric fistula, mesh infection, and incisional hernia), and mortality rates of patients who underwent VACM and NVACM were determined and compared.
RESULTS: The present study included 123 patients who underwent VACM (n=65) and NVACM (n=58). There was no difference between the groups in terms of age, gender, and etiopathogenesis (p>0.05). The mean APACHE 4 and Multiple Organ Dysfunction Score (MODS) scores in the VACM/NVACM groups in treatment period were 47/63 and 11/14, respectively (p<0.05). The mean intensive care and hospitalization periods in the VACM/NVACM groups were 11/16 (days) and 22/28 (days), respectively (p<0.05). The collection and abscess development rates in the VACM and NVACM groups were 46.2% and 77.6%, respectively (p<0.05). The rate of enteroatmospheric fistula (EAF) development in the VACM and NVACM groups were 15.4% and 56.9%, respectively (p<0.05). The mean abdominal closure times in the VACM and NVACM groups were 13 and 17 days, respectively (p<0.05). Mortality rate in the VACM and NVACM groups were 18% (n=18) and 55% (n=32), respectively (p<0.05).
CONCLUSION: In patients with OA, the temporary abdominal closure technique VACM has lower complication and mortality
rates and shorter hospitalization period than other methods. Therefore, it is an effective and safe method for the treatment of OA.

AMAÇ: Akut pankreatit (AP), erken taný ve tedavi gerektiren bir karýn aðrýsý nedenidir. Hastalarda prognozu öngörmede kullanýlan birçok skorlama sistemi acil servis gibi az sayýda veri ve hýzlý karar verme gerekliliði olan alanlarda kullanýþlý deðildir. Son dönemde HAPS (Harmless Acute Pancreatitis Score) prognoz tahmin sisteminin güvenilir olduðunu söyleyen çalýþmalar yapýlmýþtýr. Bu çalýþmanýn amacý, acil serviste AP tanýsý koyulan hastalarda erken dönemde prognozu tahmin etmede HAPS’nin deðerliliðini saptamaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada, acil serviste akut pankreatit tanýsý alan 16 yaþ üstü hastalar geriye dönük olarak incelendi. Çalýþmaya 69’u (%47.9) erkek, 75’i (%52.1) kadýn, yaþ ortalamasý 58.7±15.4 olan 144 hasta alýndý. Hastalarýn arþiv dosyalarýndan bilgilerine ulaþýldý. HAPS’nin hafif seyirli pankreatit olgularýný saptamadaki baþarýsý test edildi. Hastalarýn Ranson skorlarý da hesaplanarak HAPS ile uyumluluðu karþýlaþtýrýldý.
BULGULAR: HAPS ile pankreatit prognozunu tahmin etme arasýndaki iliþki anlamlý bulundu (p=0.008). HAPS spesifitesi %81, pozitif prediktif deðeri %96, odds oraný 5.57 (1.51–20.50, p=0.009) olarak hesaplandý. Ranson skorlarýna göre bakýldýðýnda ise istatistiksel anlamlý fark saptanmadý. HAPS ile Ranson skorlarýnýn uyumluluðu için hesaplanan kappa deðeri 0.15 – zayýf uyumluluk olarak bulundu.
TARTIÞMA: HAPS acil servise baþvuran ve klinik olarak hafif seyredecek pankreatit hastalarýný tespit etmede, basit ve kolay uygulanabilir deðerli bir skorlama sistemi olabilir. HAPS-0 olan hastalarda, agresif tedavi giriþimlerine ve erken dönemde ileri görüntüleme incelemelerine ihtiyaç yoktur.

BACKGROUND: Acute pancreatitis (AP) is a common abdominal disorder, which requires early diagnosis and treatment. Several prognostic scoring systems introduced to clinical practice are not suitable in emergency department (ED) because these require much time and complex parameters. Recently, the harmless acute pancreatitis score (HAPS) has been introduced to identify AP with a nonsevere course. The aim of this study was to determine the utility of HAPS in predicting the severity of AP.
METHODS: All patients aged >16 years who were diagnosed as AP in ED were enrolled in this retrospective study. The study included 144 patients with a mean age of 58.7±15.4 years, and 69 (47.9%) of them were males and 75 (52.1%) were females. Patient data were collected from hospital database. The utility of HAPS was analyzed and compared using the Ranson’s score.
RESULTS: HAPS was statistically significant for predicting mild disease (p=0.008) and has demonstrated a specificity of 81%, a positive predictive value (PPV) of 96%, and an odds ratio of 5.57 (1.51–20.50). The predictability of Ranson’s scores was not significant. The measure of agreement (κ) between the two scores was 0.15, indicating a low agreement.
CONCLUSION: HAPS is a simple and useful scoring algorithm to predict the non-severe course of AP in ED. HAPS-0 patients did not require early aggressive treatments and advanced radiological screening tools during the early stages of the disease.

AMAÇ: Gebelik sürecinde olan fizyolojik deðiþiklikler akut apandisit semptom bulgular ile benzerlik gösterdiði için tanýyý zorlaþtýrmaktadýr. Bu sebeple gebelik süresince tanýya yardýmcý olabilecek özgün radyolojik ve laboratuvar testleri yoktur. Bu çalýþmada amacýmýz gebelik trimesterlerine göre laboratuvar ve radyolojik testlerin hangi evrede daha etkili olduðunu araþtýrmaktýr.
GEREÇ VE YÖNTEM: 2012–2017 yýllarý arasýnda kliniðimizde ameliyat edilen ve patoloji raporlarýyla onaylý akut apandisit tanýsý alan gebe hastalarýn laboratuvar verilerinden nötrofil lenfosit oraný (NLO), platelet lenfosit oraný (PLO) analiz edilerek gebeliðin hangi evrelerinde daha anlamlý olduðu araþtýrýldý.
BULGULAR: Ortalama yaþ 25 (19–38) yýl. Ortalama gebelik haftasý 17 (6–31) ortalama lenfosit sayýsý 12.4 (6.3–22.4) hücre/m3 ultrasonografi %60 hastada apandisit ile uyumlu bulgular saptandý. Lenfosit sayýlarý, C-reaktif protein deðerleri, nötrofil sayýlarý ve ultrasonografi deðerleri açýsýndan 1. tirmester (grup 1) ve 2 ve 3 üncü trimester (grup 2) hastalar arasýnda anlamlý bir fark saptanmadý (p>0.05). Lenfosit sayýsý grup 2’de belirgin düþük izlendi (p>0.05). Nötrofil lenfosit oraný ve PLO oranlarý grup 2’de belirgin yüksek izlendi (p<0.05).
TARTIÞMA: Gebelik süresince önemli laboratuvar deðiþiklikleri olmaktadýr. Nötrofil lenfosit oraný ve PLO akut apandisit deðerlendirmesinde ve gebeliðin evresine göre tanýya kolay ulaþmak için önem kazanmaktadýr.

BACKGROUND: Normal physiologic changes during pregnancy result in similar laboratory and symptomatology changes as those during acute appendicitis (AA), making the diagnosis extremely difficult. The aim of the present study was to analyze the efficacy of conventional laboratory and radiologic tests in the diagnosis of AA according to different stages of pregnancy.
METHODS: Twenty-five pregnant patients with pathologically confirmed AA operated at our department between 2012 and 2017 were retrospectively analyzed in terms of changes in conventional laboratory parameters as well as neutrophil-to lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios to aid the diagnosis of AA according to different stages of pregnancy.
RESULTS: There were no significant changes in C-reactive protein levels, leukocyte and neutrophil counts, and accuracy of ultrasonography between patients in the first (group 1) and second + third trimesters (group 2) (p>0.05). Lymphocyte count was significantly lower (p>0.05), whereas NLR and PLR were significantly higher in group 2 (p<0.05).
CONCLUSION: Laboratory values change significantly during pregnancy, and NLR and PLR seems to be valuable tools for evaluating AA in a stage-specific manner in pregnant patients.

AMAÇ: Postsplenektomi sepsis hiposplenizm geliþen hastalarda 50 kat artan ciddi bir enfeksiyondur. Bu çalýþmanýn amacý travmatik dalak yaralanmalarýndan sonra aþýlama rehberlerine ne kadar uyulduðunun tespit edilmesidir.
GEREÇ VE YÖNTEM: Mayýs 2012–Mart 2016 tarihleri arasýnda karýn travmasý sebebiyle total splenektomi yapýlan hastalar çalýþmaya dahil edildi. Hastlarýn klinik, labaratuvar ve patoloji verileri kaydedildi. Taburculuk öncesi, sonrasý ve de nihai aþýlanma oranlarý ayrý ayrý belirlendi.
BULGULAR: Yirmi yedi hastaya total splenektomi yapýlmýþtý. Taburculuk öncesi, sonrasý ve nihai aþýlama oranlarý sýrasýyla þu þekildeydi: Her üç aþýnýn yapýlma oraný 0 (%0), 0 (%0) ve 8 (%18.5) idi. Hiç aþýlama yapýlmama oranlarý ise 13 (%48.2), 11 (%40.8) ve 9 (%33.4) idi. Postsplenektomi sepsis geliþmesi açýsýndan 17 hastanýn verisi mevcuttu. Ortanca takip süresi 17.8 (4.4–41.2) aydý ve hiçbir olguda postsplenektomi sepsis geliþmedi.
TARTIÞMA: Aþýlama rehberlerine uyum düþük seyretmektedir. Aþýlama takip sistemi kurulmasý ve aþýlama rehberlerine daha fazla uyum saðlanmasý postsplenektomi sepsis gibi ciddi enfeksiyonlarý önleyecektir.

BACKGROUND: The occurrence of a serious infection called overwhelming post-splenectomy infection (OPSI) increases more than 50 times in patients who have hyposplenia. The aim of this study was to investigate the adherence to vaccination recommendations after traumatic splenic injury.
METHODS: We identified patients who underwent total splenectomy due to abdominal trauma between May 2012 and March 2016. We recorded the clinical, laboratory, and pathological features of the patients. We calculated the vaccination proportions before discharge, after discharge, and final.
RESULTS: Twenty-seven patients underwent total splenectomy. For the vaccination status before discharge, after discharge, and final, the number of patients who received all the three vaccinations were 0 (0%), 0 (0%), and 8 (18.5%) and those who received none were 13 (48.2%), 11 (40.8%), and 9 (33.4%), respectively. The data of 17 patients were available for developing OPSI. The median follow-up time was 17.8 (4.4–41.2) months, and no OPSI cases were observed.
CONCLUSION: Adherence to vaccination recommendations remains still low. Establishing a vaccination tracking system and following vaccination recommendations will be helpful to prevent serious infections, such as OPSI, after traumatic splenectomy.

AMAÇ: Bir ilçe devlet hastanesine baþvuran ýsýrma ve sokma olgularýnýn daðýlýmý ve akrep sokmalarýnda ve yýlan ýsýrmalarýnda antivenom kullanýmýnýn deðerlendirilmesi.
GEREÇ VE YÖNTEM: Devlet hastanesine 2014 yýlý içerisinde bildirilen ýsýrma-sokma olgularýnýn demografik özellikleri, ýsýrma sokma etkeni, mevsim, baþvuru sýrasýnda klinik bulgularýn ciddiyeti, akrep sokmalarýnda ve yýlan ýsýrmalarýnda antivenom kullanýmý geriye yönelik olarak deðerlendirildi. Ýstatistiksel analizde ki-kare testi kullanýldý.
BULGULAR: Tüm olgular arasýnda, ýsýrma ve sokmalarýn oraný %0.5 idi. Akrep sokma olgularý, hastane baþvurularýn yarýsýndan fazlasýný (%54.2) oluþtururken, akrep sokmalarýný, arý sokmalarý (%30.8) ve yýlan ýsýrmalarý (%5.5) izliyordu. Semptomsuz hastalarda, gereksiz antihistaminik uygulamasý istatistiksel olarak anlamlý oranda yüksekti (p=0.00006). Akrep sokmalarýnda ve yýlan ýsýrmalarýnda, sistemik ya da lokal endikasyon olmamasýna raðmen antivenom kullanýmý anlamlý oranda yüksekti (p<0.0001, χ2=80.595).
TARTIÞMA: Çalýþmamýzda, akrep sokmalarýnda ve yýlan ýsýrmalarýnda, endikasyon olmadýðý durumlarda da antivenom kullanýldýðýný saptadýk. Bu nedenle, ýsýrma sokma olgularýnýn yönetiminde, birinci basamakta çalýþan pratisyen hekimlere güncel kýlavuzlar ve kaynaklar eþliðinde bilgilendirme amaçlý eðitimler verilmelidir.

BACKGROUND: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases.
METHODS: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis.
RESULTS: Bite and sting cases comprised 0.5% of all the patients reporting to the hospital’s emergency department, with scorpion sting cases comprising almost half (54.2%) of these hospital presentations, followed by Hymenoptera (bee and wasp) sting (30.8%) and snake bite (5.5%) cases. Unnecessary antihistamine administration was found to be significantly high in asymptomatic patients (p=0.00006). Furthermore, antivenom use was found to be significantly high in patients with scorpion sting and snake bite despite the absence of systemic or local indications (p<0.0001, χ2=80.595).
CONCLUSION: The study results showed that antivenom was used in scorpion sting and snake bite cases even when it was not indicated. Therefore, primary practitioners should be provided training for management of envenomation cases and should be made aware of the updated guidelines and references to raise their knowledge levels.

AMAÇ: Ultrason (US) invaziv olmayan, kolaylýkla eriþilebilir ve ucuz bir yöntemdir. Ýnferiyor vena kava (IVC) çapý ve solunumsal deðiþkenliði hemodinamik durumun iyi bir göstergesi olarak bildirilmiþtir. Ancak, IVC temelli parametrelerin sývý ve kanama durumunu belirleme gücü yönünden son çalýþmalar birbiriyle tutarsýzdýr.
GEREÇ VE YÖNTEM: Bu acil servise baþvuran hastalarda gerçekleþtirilen gözlemsel bir çalýþmadýr. IVC ve aorta çaplarý hastalarýn ilk baþvurusunda US ve bilgisayarlý tomografi (BT) ile ölçülmüþtür. Bu ölçümlerin ve bu ölçümlerden köken alan parametrelerin ilk yaþamsal bulgular ile kanama ve þokun laboratuvar belirteçleriyle korelasyonu deðerlendirilmiþtir. Ayrýca US ve BT ölçümlerinin tutarlýlýðý Bland-Altman analiziyle incelenmiþtir.
BULGULAR: Çalýþmanýn son örneklemi 140 hasta olup, ortalama yaþ 38 yýl, erkek oraný %79.3’dür. Ýnferiyor vena kava ve aorta çaplarý yaþamsal bulgular ile kanama ve þok belirteçleri ile, US ya da BT ile ölçülmesinden baðýmsýz þekilde klinik olarak anlamlý bir korelasyonu tespit edilmemiþtir. Ultrason ve BT ile ölçülen IVC çaplarýnýn birbiri ike tutarlýlýðý ve korelasyonu yüksektir.
TARTIÞMA: Travma hastalarýnýn deðerlendirmesinde tek sefer ve ilk baþvuruda ölçülen IVC ve aort parametrelerinin deðeri sorgulanmalýdýr. Ancak, takip esnasýnda bu parametrelerdeki deðiþimin deðeri yapýlacak ilerki çalýþmalarda yeniden deðerlendirilmelidir.

BACKGROUND: Ultrasonography (US) is noninvasive, readily available, and cheap. The diameter of inferior vena cava (dIVC) and its respiratory variation were proposed as a good surrogate of the hemodynamic state. However, recent studies have shown conflicting results, and the value of IVC-derived parameters in the estimation of fluid status and hemorrhage remains unclear.
METHODS: This was an observational study of trauma patients who presented to emergency department. dIVC and aorta diameter (dAorta) were measured at the initial US and CT in all patients. The correlation of these measurements and all parameters derived from those measurements along with the initial vital signs and laboratory values of hemorrhage (hemoglobin, hematocrit) and shock (lactate, base excess) were assessed. US and CT values were also compared for accuracy using Bland–Altman analysis.
RESULTS: The final study population was 140, with a mean age of 38 years and 79.3% were male. dIVC and dAorta did not have any clinically significant correlation with any of the vital signs or laboratory values of hemorrhage or shock when measured by US or CT. A good and significant correlation was observed between dIVC and dAorta measured by US and CT.
CONCLUSION: The value of an initial and single measurement of IVC and aorta parameters in the evaluation of trauma patients should be questioned. However, the change in the measured parameters may be of value and should be investigated in further studies.

AMAÇ: Radius baþý ön kol rotasyonel stabilitesi ve dirsek valgus stresine dayanma açýsýndan önemlidir. Radius baþý eriþkinlerdeki en sýk dirsek kýrýðýdýr. Kýrýðýn derecesine göre farklý tedavi yöntemleri tanýmlanmýþtýr. Bununla birlikte, tip III kýrýklarýn tedavisi tartýþmalýdýr. Bu çalýþmanýn amacý ileri derecede parçalý Mason tip III radius baþý kýrýklarýnýn baþ rezeksiyonu veya protez ile tedavi sonuçlarýnýn araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Radius baþý rezeksiyonu (n=7) veya radius baþý protezi (n=7) ile tedavi edilmiþ parçalý Mason tip III kýrýðý çok merkezli ve geriye dönük olarak deðerlendirildi. Klinik sonuçlarý deðerlendirmede DASH (Disabilities of the Arm, Shoulder and Hand) ve Mayo dirsek-el bileði skorlarý kullanýldý. Kavrama kuvvetini deðerlendirmede hidrolik el dinomometresi kullanýldý; kavrama kuvveti her iki taraf ekstremite için üçer kez tekrarlanýp ortalamasý alýndý. Kavrama kuvveti saðlam tarafa göre yüzde olarak hesaplandý.
BULGULAR: Rezeksiyon ve protez yapýlan hastalarda ortalama fonksiyonel sonuçlar sýrasý ile DASH skoru için 25.8 ve 17.2; Mayo dirsek skoru için 74 ve 84.1; Mayo el bileði skoru için 84 ve 92.5 bulundu. Maksimum kavrama kuvvetleri ise rezeksiyon grubu için %48.8, protez grubu için ise %77.8 oldu. Ortalama eklem hareket açýklýðý rezeksiyon ve protez yapýlan gruplarda sýrasý ile fleksiyon, 112.14° ve 104.29°; ekstansiyon -10.00° ve -25.00°; pronasyon, 70.00° ve 47.86°; supinasyon, 70.00° ve 52.14° bulundu.
TARTIÞMA: Radius baþý rezeksiyonu yapýlan hastalarda eklem hareket açýklýðý kýsýtlanmýþ bununla beraber fonksiyonel sonuçlar ve kavrama kuvveti radius protezi ile tedavi edilen hastalarda daha iyi olmuþtur. Bu sonuçlar ileri derecede parçalý Mason tip III radius baþý kýrýklarýnýn tedavisinde radius baþý protezi uygulamasýnýn hasta memnuniyeti ve fonksiyonel sonuçlar açýsýndan rezeksiyona göre daha iyi olduðunu desteklemektedir.

BACKGROUND: The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis.
METHODS: Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side.
RESULTS: Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, −10.00° and −25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°.
CONCLUSION: Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.

AMAÇ: Farklý nedenlerle meydana gelen geniþ saçlý deri defektlerinin onarýmýnda çoðunlukla serbest doku nakilleri gerekmektedir. Bu çalýþmanýn amacý serbest anterolateral uyluk flebi ile onarým uygulanmýþ geniþ saçlý deri defekti olan olgulardaki deneyimlerimizi gözden geçirmek ve paylaþmaktýr.
GEREÇ VE YÖNTEM: 2007 ile 2015 yýllarý arasýnda geniþ saçlý deri defekti olan, defekt onarýmýnda anterolateral serbest uyluk flebi kullanýlan olgularýn týbbi kayýtlarý geriye dönük olarak tarandý. Ortalama yaþý 44 olan on bir hasta bu çalýþmaya dahil edildi.
BULGULAR: Saçlý derideki geniþ defekti onarmak için; geniþliði 7 ile 14 cm, uzunluðu ise 10 ile 34 cm arasýnda deðiþen on bir serbest anterolateral uyluk flebi kullanýldý. Hiçbir hastada flep kaybý gözlenmedi.
TARTIÞMA: Saçlý deri onarýmýnda kullanýlabilecek pek çok serbest flep seçeneði bulunmaktadýr. Serbest anterolateral uyluk flebi diðer serbest flep seçeneklerine olan üstünlüðü, güvenilirliði ve avantajlarý nedeniyle geniþ saçlý deri defekti olan olgularda ilk seçenek olarak deðerlendirilebilir.

BACKGROUND: Extensive scalp defects caused by various etiologies often require free-tissue transfer. We aimed to review our experience in the reconstruction of extensive scalp defects with free anterolateral flaps.
METHODS: A retrospective analysis was performed on all patients with extensive scalp defects that were reconstructed with free anterolateral thigh flaps from November 2007 to April 2015. Eleven patients with a mean age of 44 years were included in this study.
RESULTS: Eleven free-tissue transfers were used to reconstruct the extensive scalp defects. The flaps were 7–14 cm in width and 10–34 cm in length.
CONCLUSION: Microvascular free-tissue transfer is the mainstay for the treatment of extensive scalp defects. We recommend anterolateral thigh free flap use for challenging and complex cases, given the method’s numerous advantages, including reliability and safety.

AMAÇ: Pelvisin bölgesel anatomisi ve genellikle yüksek derecede parçalý kýrýðýn eþlik ettiði kýrýk konfigürasyonunun karmaþýklýðý nedeniyle asetabulumun her iki kolonun kýrýklarýnda tatminkâr bir redüksiyon ve fiksasyon elde etmek sýklýkla zordur. Bu yazýda, ameliyat öncesi planlamayý kolaylaþtýrmak, kýrýk redüksiyon iþlemini simüle etmek ve asetabulumun her iki kolonunun kýrýklarý için tespit plaklarýný önceden biçimlendirmek amacýyla üç boyutlu (3D) hastaya özgü pelvisin bilgisayarda oluþturulmuþ bir modelinin kullanýmý sunuldu.
GEREÇ VE YÖNTEM: Bilgisayarlý tomografi görüntülerini girdi olarak kullanýp oluþturulan birleþtirmeli yýðma modellemesi ile yazýcýda 3 boyutlu kalýp gerçekleþtirildi. Asetabulumun her iki kolonunda kýrýklarý olan ortalama 41.4 yaþýndaki beþ hastanýn cerrahi ve klinik sonuçlarý deðerlendirildi. Malta kriterleri kullanýlarak kýrýk redüksiyonunun durumu sýnýflandýrýlmýþ, modifiye edilmiþ Merle d’Aubigne skoru kullanarak fonksiyonel sonuç deðerlendirildi.
BULGULAR: Redüksiyon dört hastada mükemmel ve bir hastada iyi olarak sýnýflandýrýlmýþ ve son izlemde hastalarýn hepsinde iyi fonksiyonel sonuçlar gerçekleþtirilmiþtir. Ortalama insizyon uzunluðu 6.9 cm ve ortalama cerrahi süresi 124 dakika idi.
TARTIÞMA: Asetabulumun her iki kolon kýrýðýnýn cerrahi tedavisinde yazýcýyla 3 boyutlu sanal modellemeyi baþarýyla uygulayarak cerrahi sonuçlarý iyileþtirdik, iyi-mükemmel redüksiyon ve orta vadede iyi fonksiyonel sonuçlar elde ettik.

BACKGROUND: It is often difficult to achieve satisfactory reduction and fixation of both-column acetabular fractures owing to the complexity of the regional anatomy of the pelvis and the fracture configuration, which is commonly associated with a high degree of comminution. Herein, we describe the use of a three-dimensional (3D) patient-specific printed model of the pelvis to facilitate preoperative planning, simulate the fracture reduction procedure, and pre-contour the fixation plates for treating both-column acetabular fractures.
METHODS: The 3D-printed model was constructed using a fused deposition modeling method with computed tomography images as inputs. Operative and clinical outcomes were evaluated for 5 patients with both-column acetabular fractures (mean age: 41.4 years). The status of fracture reduction was classified using the Matta criteria, and the functional outcome was assessed using the modified Merle d’Aubigne score.
RESULTS: Reduction was classified as excellent in 4 patients and good in 1 patient, and good functional outcomes were achieved in all patients at the final follow-up. The average incision length was 6.9 cm with an average operative time of 124 min.
CONCLUSION: We successfully applied 3D printing for the surgical management of both-column acetabular fractures, thereby improving surgical outcomes while achieving good-to-excellent reduction and good medium-term functional outcomes.

Morgagni hernisi (MH) kasýn kostal ve sternal bölümleri arasýnda diyafragmanýn ön yüzünde çok seyrek saptanan doðuþtan bir defekttir. En sýk görülen defekt doðuþtan diyafragma hernisi %90 oranýnda Bochdalek tipidir. MH’leri tüm diyafragmatik hernilerin aþaðý yukarý %90’ýný oluþturur. MH’lerin çoðu çocuklarda bulunur ve onarýlýr, ancak %5’i eriþkinlerdedir. Burada, enkansere ve strangüle MH ile eþ zamanlý karaciðer ve enine kolon düþüklüðü olan ve karýn aðrýsý ve intestinal obstrüksiyon semptomlarýyla hastanemize kabul edilmiþ 77 yaþýndaki bir erkek hastayý sunuyoruz.

Morgagni hernia (MH) is a very rare congenital defect found in the anterior aspect of the diaphragm between the costal and sternal portions of the muscle. The most common defect is congenital diaphragmatic hernia, 90% of which are Bochdalek type. MHs account for approximately 3% of all diaphragmatic hernias. Most MHs are found and repaired in children, but 5% are found in adults. Here, we present the case of an incarcerated and strangulated MH with synchronous prolapse of the liver and transverse colon in a 77-year-old man who was admitted to our hospital for abdominal pain and symptoms of intestinal obstruction.