AMAÇ: Vasküler defektlerin onarýmý sonrasýnda kullanýlan ven greftinin iskemi ve reperfüzyon hasarý sonrasý reaktif oksijen radikalleri oluþarak endotelyal dokuya, vasküler düz kaslara etki ederek intimal hiperplaziye neden olmaktadýr. Tempol serbest radikalleri tutarak biyolojik memeranlarda stabilizasyon saðlamaktadýr. Bu çalýþmada femoral arter defektlerinin ven grefti ile onarýldýðý sýçanlarda Tempol’ün intimal hiperplazi ve serbest oksijen radikallerinin düzeyleri deðerlendirildi.
GEREÇ VE YÖNTEM: Sýçanlarýn femoral arterlerinde bir defekt oluþturularak oluþan defekt ayný taraftan ven grefti alýnarak onarýldý. Sýçanlar iki gruba ayrýldý. Yirmi sekiz gün boyunca hergün intraperitoneal olarak Tempol verilenler grup T ve serum fizyolojik verilenler grup C olarak adlandýrýldý. Deney sonunda kan ve vasküler doku örnekleri alýndý.
BULGULAR: Ven greftleri hematoksilen-eozin ve Verhoeff’in elastin boyasý ile deðerlendirildi. Gruplar intimal hiperplazi ve media tabakasýndaki kalýnlýklarý bakýmýndan karþýlaþtýrýldýðýnda istatistiksel olarak belirgin fark olduðu tespit edildi (p<0.01).
TARTIÞMA: Bu çalýþmada serbest radikal tutucu Tempol’ün erken dönemde geliþen intimal hiperplaziyi engellediði gösterildi. Tempol’ün bu etkiyi media tabakasý ve ven endoteline zararlý serbest oksijen radikallerinin düzeyini azaltarak ve anti-oksidan ürünlerin seviyesini arttýrarak ve muhtemelen bu etkiler sonucu polimorf nükleer lökositlerin infiltrasyonunu engelleyerek gerçekleþtirdiði düþünülmektedir.

BACKGROUND: Reversed vein grafting exposes the vessel to a period of ischemia, reperfusion and subsequent reactive oxygen species, which may damage endothelial tissue, smooth muscle cell proliferation and later the development of intimal hyperplasia. Tempol is a free radical scavenger that permeates biological membranes. This study investigates the effects of a free radical scavenger (Tempol) on intimal hyperplasia of femoral vein grafts and the level of reactive oxygen species in rats.
METHODS: Arterial defects created in the femoral artery of rats were repaired with ipsilateral femoral vein grafts. Tempol was administered to group T and saline to group C on a daily basis for a period of 28 days. Blood samples were measured.
RESULTS: The veins were stained with H&E and Verhoeff’s elastic stains. Binary comparison revealed a statistically significant difference for intimal and medial thicknesses (p<0.01).
CONCLUSION: This study found that a free radical scavenger (Tempol) prevents the early development of intimal hyperplasia, most probably by inhibiting the infiltration of polymorph nuclear monocytes (PNM), with evidence of increased levels of antioxidant products and decreased levels of free oxygen radicals.

AMAÇ: Çalýþmamýzda deneysel peritonit oluþturulan sýçanlarýnda, periton sývýsýnýn bazý gram negatif ve Candida albicans üzerine olan etkisi araþtýrýldý. Çalýþmanýn temel amacý karýn içi enfeksiyonlara neden olan mikroorganizmalar üzerine periton sývýsýnýn etkisini anlamaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmada 250-300 g aðýrlýðýnda 20 erkek Spraque-Dawley sýçaný kullanýldý. Sýçanlar rastgele 10 hayvandan oluþan iki gruba ayrýldý. Ameliyat prosedürleri steril koþullar altýnda yapýldý. Grup I’de kontrol laparotomisi yapýldý. Grup II’de çekumun distal kýsmý baðlandý ve çekum perforasyonu yapýldý. Deneklerden 2. ve 4. saatte anestezi altýnda laparotomi yapýlarak peritoneal sývý örnekleri Pasteur pipet kullanýlarak alýndý.
BULGULAR: Periton sývýsý, C. freundii, P. Mirabilis ve E. aerogenes’e etkisizdi. Sekiz saat boyunca K. pneumoniae üremesini engelledi, ayrýca 24 saat sonra alýnan pasajlarda büyüme önemli ölçüde arttýðý görüldü. C. Albicans üremesi ise 4 ve 8 saat sonra alýnan pasajlarda azaldý ve 24 saat sonra ise arttý. E. coli ve P. aeroginosa kolonilerinin sayýsýnýn 2 saat sonraki alýnan pasajlarda artmadýðý ve üreme olmadýðý saptandý.
TARTIÞMA: E. coli ve P. aeruginosa’nýn çoðalan koloni sayýlarý 2 saat sonra azaldý ve sonraki kültürlerde çoðalma yoktu. Periton sývýsý, uygun koþullar altýnda bakterisidal bir etki gösterir. Karýn içi enfeksiyonlarda ana patojen olan E. coli’ye karþý peritoneal bakterisidial etkinlik göstermektedir.

BACKGROUND: In our study, the effects of peritoneal fluid on some Gram-negative and Candida albicans in experimental peritonitis rats were studied. The primary objective of the present study was to understand the effect of peritoneal fluid on microorganisms causing intra-abdominal infections.
METHODS: Twenty male Sprague–Dawley rats weighing between 250 and 300 g were used in the study. The rats were randomly divided into two groups consisting of 10 animals. The operative procedures were performed under sterile conditions. In group I, sham laparotomy was done. In group II, the distal part of the cecum was ligated, and cecum perforation was performed. Peritoneal fluid samples at baseline and 2 and 4 h were extracted using a Pasteur pipette during laparotomy under anesthesia.
RESULTS: Peritoneal fluid was ineffective on Citrobacter freundii, Proteus mirabilis, and Enterobacter aerogenes. It inhibited the growth of Klebsiella pneumoniae for 8 h. However, growth was significantly increased in the passages obtained after 24 h. The growth of C. albicans decreased in the passages that were extracted after 4 and 8 h and increased in the passages obtained after 24 h (p<0.05). It was found that the number of Escherichia coli and Pseudomonas aeruginosa colonies that were grown in 2 h decreased, and no growth was detected in the passages obtained after 2 h (p<0.05).
CONCLUSION: Proliferating colony counts of E. coli and P. aeruginosa decreased after 2 h, and there was no proliferation in subsequent cultures. Peritoneal fluid exhibits a bactericidal effect under appropriate conditions. It also exhibits peritoneal bactericidal activity against E. coli, the major pathogen in intra-abdominal infections.

AMAÇ: Bu çalýþmada, etkili bir antioksidan ve antienflamatuvar ilaç olan kalsiyum dobesilatýn (CaDob) deneysel karaciðer iskemi-reperfüzyon hasarý (IRI) modelinde koruyucu etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Kýrk sýçan dört gruba ayrýldý. Grup 1’de (sham), sadece hepatik pedikül mobilize edildi. Grup 2’de (kontrol), hepatik pedikül 60 dk klemplendikten sonra 90 dakika süreyle reperfüze edildi. Grup 1 ve 2’de ek bir tedavi uygulanmadý. Grup 3’te (ameliyat sürecinde CaDob), operasyondan iki saat önce 100 mg/kg CaDob verildi, 60 dakika iskemi sonrasý 90 dakika boyunca reperfüze edildi. Grup 4’te (ameliyat öncesi CaDob), operasyondan önceki 10 gün boyunca 100 mg/kg/gün CaDob verildikten sonra, hepatik pedikül 60 dakika boyunca klemplendi ve 90 dakika süreyle reperfüze edildi. Ýþlemlerin sonunda biyokimyasal ve histopatolojik deðerlendirme için kan ve karaciðer dokusu örnekleri alýndý.
BULGULAR: Ameliyat öncesi ve ameliyat sürecinde tedavi gruplarýnda karaciðer fonksiyon testleri ve doku oksidatif stres parametreleri kontrol grubuna göre anlamlý olarak düþüktü. Ayrýca, kontrol grubundaki histopatolojik hasarýn, hem ameliyat sürecinde hem de ameliyat öncesi tedavi gruplarýnda anlamlý düzeyde azaldýðý saptandý.
TARTIÞMA: Kalsiyum dobesilat, antioksidan ve antienflamatuvar etkileriyle iliþkili olarak önemli bir hepatoprotektif etki göstermiþtir.

BACKGROUND: This study investigates the protective effect of calcium dobesilate (CaDob), an effective antioxidant and anti-inflammatory drug, on experimental liver ischemia-reperfusion injury (IRI).
METHODS: Forty rats were divided into four groups. In Group 1, (sham), only hepatic pedicle was induced. In Group 2 (control), hepatic pedicle was reperfused for 90 min after being clamped for 60 min. No treatment was given in Group 1 and 2. In Group 3 (perioperative CaDob), 100 mg/kg CaDob was given 2 hours prior to the operation in which hepatic pedicle was reperfused for 90 min following a 60-min clamp. In Group 4 (preoperative CaDob), after 100 mg/kg/day CaDob was given for 10 days before the operation, hepatic pedicle was clamped for 60 min and reperfused for 90 minutes. At the end of these procedures, blood and liver tissue samples were collected for biochemical and histopathological assessment.
RESULTS: Liver function tests and tissue oxidative stress parameters were significantly lower in the preoperative and perioperative treatment groups than the control group. Furthermore, it was observed that histopathological injury in the control group significantly decreased in both perioperative and preoperative treatment groups.
CONCLUSION: Calcium dobesilate demonstrated a significant hepatoprotective effect in terms of its antioxidant and anti-inflammatory effects.

AMAÇ: Ýntestinal iskemi-reperfüzyon (IIR) hasarý çoklu organ yetersizliði ve ölüme yol açabilir. Bu çalýþmanýn amacý, intestinal iskemide reperfüzyon öncesi uygulanan pentoksifilin ve iloprostun etkilerini araþtýrmaktýr.
GEREÇ VE YÖNTEM: 25–300 gr agýrlýðýnda 25 Wistar-Albino cinsi sýçan, her bir grupta beþ sýçan olacak þekilde beþ gruba ayrýldý: Kontrol grubu (n=5), sham grubu (n=5 IR yok), IR grubu (n=5, 45 dk iskemi 120 dk reperfüzyon), IR+Ptx grubu (n=5, 45 dk iskemiyi takiben 50 mg/kg intraperitoneal pentoksifilin ve 120 dk reperfüzyon), IR+IL (n=5, 45 dk iskemiyi takiben 2 mcg/kg intraperitoneal iloprost ve 120 dk reperfüzyon). Deney sonunda ileum örnekleri hemotoksilen-eosin ile boyandý ve histopatolojik olarak Chiu skorlamasýna göre deðerlendirildi. Izometrik kasýlma –gevþeme cevaplarý organ banyosu kullanýlarak kaydedildi.
BULGULAR: Pentoksifilin histopatoljik ve kasýlma –gevþeme cevaplarý açýsýndan anlamlý düzelme saðladý. Ýloprost reperfüzyon hasarýný düzeltmesine raðmen bu düzelme istatistiksel olarak anlamlý deðildi.
TARTIÞMA: Bulgularýmýza göre pentoksifilin incebaðýrsak iskemi-reperfüzyon hasarýndan korumada ümit verici olabilir. Öte yandan, iloprost için daha ileri klinik ve deneysel çalýþmalara gereksinim duyulmaktadýr.

BACKGROUND: Intestinal ischemia-reperfusion (I/R) injury can lead to multiple organ failure and death. The aim of this study was to investigate the effects of pentoxifylline and iloprost administered before reperfusion in intestinal ischemia.
METHODS: In total, 25 male Wistar Albino rats weighing 250–300 g were divided into five groups each comprising five subjects: control group (n=5), sham group (n=5, no I/R), I/R group (n=5, 45 min ischemia, and 120 min reperfusion), I/R + pentoxifylline group (n=5, 45 min ischemia following intraperitoneal 50 mg/kg pentoxifylline and 120 min reperfusion), and I/R + iloprast group (n=5, 45 min ischemia followed by intraperitoneal 2 mcg /kg iloprost and 120 min reperfusion). At the end of the experiment, ileum specimens were stained using hematoxylin-eosin and histopathologically evaluated using the Chiu score. Isometric contraction–relaxation responses were recorded using organ baths for contraction–relaxation responses.
RESULTS: Pentoxifylline provided a significant improvement in response to histopathological and contraction–relaxation responses. Although iloprost provided recovery in reperfusion injury, it was not statistically significant.
CONCLUSION: Our findings demonstrate that pentoxifylline may be promising in preventing small bowel ischemia-reperfusion injury. We concluded that further clinical and experimental studies for iloprost are needed.

AMAÇ: Yara iyileþmesi etkisiyle, kitosan kaplý ipliklerin baðýrsak anastomozu gücü üzerine uygulanabilir olmasýný araþtýrdýk.
GEREÇ VE YÖNTEM: Vikril ve PDS iplikler %2 kitosanla kaplandý. Laparatomi birinci gruba uygulanýrken, kitosan ikici grupta periton boþluðuna uygulandý. Takibinde sýrasýyla vikril, PDS, kitosan kaplý vikril ve kitosan kaplý PDS iplikler kolon anastomozunda kullanýldý. Yedinci ve 14. günlerde her gruptan sekiz sýçan sakrifiye edilerek incelemesi yapýldý.
BULGULAR: Kitosan ve kontrol grubunun adezyon deðeri iplik gruplarýna göre anlamlý olarak daha düþük saptandý (p<0.05). Kitosan kaplý vikril grubunun 14. günde vaskülarizasyon deðeri, kitosan kaplý PDS iplik grubuna göre anlamlý olarak daha az olduðu belirlendi (p=0.038). Kitosan kaplý vikrilin 14. gücünde, anastomoz vaskülarizasyonu ve fibroblast hücreleri üzerinde vikril ve kitosan kaplý PDS göre etkisi daha düþük bulundu (p<0.05). Kitosan kaplý vikrilin 14. ve yedinci günündeki in vitro mukavemet gücü vikrilden daha yüksek olmasýna raðmen (p<0.05), in vivo farklýlýk görülmedi. The PDS-kitosan’ýn mukavemet gücü in vivo yedinci günde, PDS’den daha az olarak saptandý (p<0.05).
TARTIÞMA: Kitosan ile kaplama, anastomoz gücünü ve adezyon etkisini hafif oranda in vitro vikril ve in vivo PDS üzerinde arttýrdý.

BACKGROUND: We evaluated the feasibility of chitosan-coated sutures for intestinal anastomosis strength through wound-healing effect.
METHODS: Vicryl and PDS sutures were coated with 2% chitosan. While laparotomy was applied to the first group, chitosan was applied in the peritoneal cavity in the second group. Then the following materials were applied to colon anastomosis, in order: Vicryl, PDS, chitosan-coated Vicryl, and chitosan-coated PDS sutures. On the 7th and 14th days, eight rats from each group were euthanized.
RESULTS: The adhesion scores of chitosan and control groups were lower than the suture groups. The vascularization of Vicryl–chitosan was lower than PDS–chitosan on the 14th day (p=0.038). Fibroblast cells and vascularization of anastomosis with chitosan-coated Vicryl were lower than Vicryl and chitosan-coated PDS on the 14th day (p<0.05). The tensile strength of Vicryl–chitosan increased more than Vicryl in vitro (p<0.05) on the 14th and 7th days, but there was no difference in vivo. The tensile strength of PDS–chitosan decreased more than PDS on the 7th day in vivo (p<0.05).
CONCLUSION: The chitosan-coating effect on the adhesion and reinforcement of anastomosis in some parts of Vicryl in vitro and PDS in vivo was slightly improved.

AMAÇ: Bu çalýþmada, amacýmýz negatif basýnçlý yara terapisinin (NBYT) akut yanýklarýn tedavisindeki sonuçlarý ve etkinliðinin araþtýrýlmasýydý.
GEREÇ VE YÖNTEM: Bu çalýþmaya, Ocak 2014 ile Aralýk 2015 tarihleri arasýnda Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi Yanýk Merkezi’nde yanýk yarasý sebebiyle NBYT uygulanan hastalar dâhil edildi. Hasta verileri ileriye yönelik olarak tutulan bir veritabaný kullanýlarak geriye dönük olarak toplandý. Olgularýn; yaþ, cinsiyet, yanýk etiyolojileri, yara lokalizasyonlarý, VAC uygulama süreleri, genel tedavi süreleri, yara kapatma teknikleri geriye dönük olarak deðerlendirildi.
BULGULAR: Çalýþmaya alýnan toplam 35 olgunun 32’si (%91.6) erkek, üçü (%8.4) kadýndý. Hastalarýn genel yaþ ortalamalarý 49.5±16 (13–79) idi. Etiyolojik faktörler sýrasýyla 19 (%54.3) olguda elektrik çarpmasý, yedi (%20) olguda temas yanýðý, altý (%17.2) olguda alev yanýðý, üç (%8.6) olguda sýcak su þeklindeydi. Uygulama yapýlan yaralarýn tümünde yanýklar 3. veya 4. derece idi. NBYT uygulama süremiz en az üç, en çok 16 gün olmak üzere ortalama 10.1±3.9 gündü. Hastalarýn hiçbirinde uygulamaya baðlý komplikasyon geliþmedi. Bir hastamýzda standart basýnçta uygulama sýrasýnda lokal aðrý geliþmesi üzerine uygulamaya düþük basýnç ile (75 mmHg) devam edilerek basýnç kademeli olarak artýrýldý. Uygulama sonucu tüm hastalarýn yara alanlarýnda küçülme, granülasyon dokusunda ve kanlanmada artma, ödem ve yara sekresyonunda azalma gözlemlendi. Hastalarýn hiçbirinde uygulama bölgesinde bakteriyal üreme tespit edilmedi. Tüm hastalarýn yaralarý cerrahiye uygun olarak deðerlendirilerek ortalama 11.2±3.7 günün sonunda greft veya flep yöntemlerinin biri kullanýlarak kapatýldý. Hastalarýn hiçbirinde greft ya da flebe sekonder komplikasyon görülmedi. Hastalar ameliyat sonrasý ortalama 6.7±2.1 (5–9 gün) günde taburcu edildi.
TARTIÞMA: Çalýþmamýzýn bulgularý ýþýðýnda, NBYT’nin iyileþmesi zor, derin, tendon ve kemik ekspoze olmuþ yanýklarda yaranýn kýsa sürede greft ya da flepler ile kapatýlmasýna olanak vererek, pansuman sayýsýný ve hastanede yatýþ süresini azaltabilecek yardýmcý bir tedavi seçeneði olabileceði söylenebilir. Ancak, halen daha literatürde NBYT’nin yanýkta kullanýmý ile ilgili kanýt düzeyi yüksek ileriye yönelik, randomize, kontrollü çalýþma eksikliðinin de mevcut olduðu vurgulanmalýdýr.

BACKGROUND: The aim of the present study was to evaluate the outcomes and efficacy of negative pressure wound therapy in the management of acute burns.
METHODS: Patients with acute burns who have received negative pressure wound therapy at the Dr. Lutfi Kýrdar Kartal Research and Training Hospital Tertiary Burn Care Center between January 2014 and December 2015 were included in the study. Patient data were retrospectively reviewed by analyzing data from our prospective patient database.
RESULTS: A total of 38 patients were evaluated for the study. Three patients were excluded due to mortality prior to the completion of the treatment course. There were 32 (91.6%) male and 3 (8.4%) female patients. The mean age of the patients was 49.5±16 years. The etiological factors included electrical burn injury in 19 (54.3%), chemical burn injury in 7 (20%), flame burn injury in 6 (17.2%), and hot water burns in 3 (8.4%) patients. The severity of the burns was grade 3 or 4 in all of the patients included in the study. The mean duration of negative pressure wound therapy was 10.1±3.9 days. There were no procedure-related complications throughout the duration of the study. During the standard application of the device, one patient experienced local pain; therefore, low pressure (75 mmHg) was applied during therapy, and pressure was steadily increased. As a result of the application of this therapy, a decrease in the surface area, edema, and secretion of the wound and an increase in the granulation tissue and perfusion of the wound were observed in all treated patients. Wound cultures revealed no bacterial growth in any of the patients. The mean duration of surgical wound closure was 11.2±3.7 days. No complication was observed related to wound closure. The mean duration of hospital discharge in the postoperative period was 6.7±2.1 days.
CONCLUSION: Well-designed, randomized control studies showing the efficacy of negative pressure wound therapy in patients with burns are lacking. The results of the present study showed that negative pressure wound therapy may reduce the number of wound debridement sessions, time of wound closure, and hospitalization in major burn injuries exposing the underlying tendons and bones.

AMAÇ: Terapotik hipoterminin, elektif cerrahi uygulanan hastalarda yara yeri enfeksiyonu ve ameliyat sonrasý aðrýya etkili olduðu bilinse de, acil laparatomi uygulanan hastalardaki etkisi net bilinmemektedir. Çalýþmada hipotezimiz terapotik hipoterminin açýk acil abdominal cerrahi uygulanan hastalarda yüzeyel cerrahi alan enfeksiyonu ve ameliyat sonrasý aðrýyý azaltacaðýdýr.
GEREÇ VE YÖNTEM: 2016–2017 tarihleri arasýnda acil abdominal cerrahi uygulanan hastalar bilgisayar aracýlýðýyla randomize edilerek hastalarýn yarýsýna ameliyat sonrasý birinci saat içinde steril buz kompres ile lokal soðutma, diðer yarýsýna klasik steril kompres uygulanarak gruplandýrýldý. Gruplarýn yaþ, cinsiyet, primer taný, kesi boyutu, yara tipi, boyutu ve cerrahi süre belirlenerek karþýlaþtýrýldý. Ameliyat sonrasý 48 saat boyunca her üç saatte bir vizüel aðrý skorlarý ile bu dönemlerdeki analjezik gereksinimi belirlenerek gruplar karþýlaþtýrýldý. Tüm hastalardan ameliyat öncesi ve sonrasý beþinci günde kan alýnarak, C-reaktif protein, beyaz küre, albumin, serum total antioksidan status, total oksidan status seviyeleri ölçüldü, oksidatif stres indeksi hesaplanarak gruplar karþýlaþtýrýldý. Gruplarda geliþen yüzeyel cerrahi alan enfeksiyonu karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet, primer taný, kesi boyutu, yara tipi, boyutu ve cerrahi süre açýsýndan anlamlý fark yoktu (p>0.05). Gruplar arasýnda vizüel aðrý skorlarý açýsýndan istatiksel açýdan anlamlý fark olmamakla birlikte (p>0.05) steril buz kompres uygulanan grupta analjezik ihtiyacý daha azdý (p<0.05). Ameliyat öncesi lökosit sayýsý, albumin, C-reaktif protein, serum total antioksidan status, total oksidan status ve oksidatif stres indeksi açýsýndan fark yoktu (p>0.05). Ameliyat sonrasý beþinci günde gruplar arasýnda serum total antioksidan status düzeyi steril buz kompres uygulanan grupta belirgin olarak artmýþtý ve oksidatif stres indeksi belirgin olarak azalmýþtý (p<0.05). Yüzeyel cerrahi alan enfeksiyonu steril buz kompres uygulanan grupta belirgin olarak daha azdý (p<0.05).
TARTIÞMA: Terapotik hipotermi/lokal soðutma, acil açýk abdominal cerrahi uygulanan hastalarda ameliyat sonrasý dönemde analjezik ihtiyacýný azaltmaktadýr. Ayrýca yüzeyel cerrahi alan enfeksiyonunun geliþmesini önlemektedir. Bu etkileri serum total antioksidan status seviyesini arttýrarak oksidatif stres indeksini azaltarak gerçekleþtirmektedir.

BACKGROUND: Although therapeutic hypothermia has been shown to be effective on surgical site infection and postoperative pain in patients undergoing elective surgery, its exact effect on emergency laparotomy remains unclear. In this study, we aimed to investigate the effect of therapeutic hypothermia on superficial surgical site infection and postoperative pain in patients undergoing urgent open abdominal surgery.
METHODS: The study included 100 patients who underwent emergency open abdominal surgery from 01/01/2016 to 01/01/2017. The patients were randomly divided into two groups: therapeutic hypothermia, group I underwent cold therapy with local sterile frozen ice compress; and control group II, underwent conventional sterile compress. Age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery were compared between the groups. Visual analog scale scores were determined every 3 hours, and the requirement for analgesics was assessed for each patient within 48 hours postoperatively. Both before and after 5 days of laparotomy, c-reactive protein (CRP), white blood cell count (WBC), albumin, serum total antioxidant status, and total oxidant status levels were measured, and oxidative stress index was calculated for each patient. The rates of superficial surgical site infection were compared between both groups.
RESULTS: The two groups were similar in terms of age, gender, primary pathology diagnosis, size of incision, wound type and size, and duration of surgery (p>0.05). Although no significant difference was found between the groups with regards to visual analog scale scores (p>0.05), requirement for analgesics was lower in the group I compared to that in the control group (p<0.05). No significant difference was found between the groups in terms of preoperative WBC, albumin, CRP, serum total antioxidant status, total oxidant status, and oxidative stress index (OSI) levels (p>0.05). At postoperative day 5, serum total antioxidant status level was significantly higher, and OSI level was significantly lower in the group I compared to the respective levels in the control group (p<0.05). Moreover, the superficial surgical site infection rate was significantly lower in the group I (p<0.05).
CONCLUSION: In patients undergoing urgent open abdominal surgery, therapeutic hypothermia led to lower requirement for analgesics and lower superficial surgical site infection rates in the early postoperative period. We consider that therapeutic hypothermia exerts this effect by elevating the serum total antioxidant status level, and decreasing the effects of inflammatory mediators and OSI.

AMAÇ: Akut apandisit (AA) gebelik döneminde obstetrik ve jinekolojik patolojilerden sonra en sýk acil cerrahi gerektiren durumdur. Gebe hastalarda AA tanýsýnýn hýzlý ve doðru konulmasý maternal ve fetal morbite/mortalite oranlarýný azaltýr. Bu çalýþma, hemogramýn gebelik döneminde AA tanýsý koymadaki önemini irdelemektedir.
GEREÇ VE YÖNTEM: Ordu veya Ondokuz Mayýs Üniversitesi Týp Fakültesi Hastanesi’nde Ocak 2007–Aralýk 2017 yýllarý arasýnda AA nedeniyle ameliyat edilen 47 gebe hasta ile 47 saðlýklý gebe hastanýn hemogram parametrelerinden beyaz kan hücresi (WBC) sayýsý, nötrofil sayýsý, lenfosit sayýsý, platelet sayýsý, nötrofil/lenfosit oraný (NLO), platelet/lenfosit oraný (PLO), mean platelet volüm (MPV) ve kýrmýzý hücre daðýtým geniþliði (RDW) deðerleri kýyaslandý. Ameliyat edilen hastalar, patoloji sonucu apandisit olanlar Grup A normal olanlar ise Grup B olarak ikiye ayrýldý ve kontrol grubu ile kýyaslandý.
BULGULAR: Grup A hastalarýnýn WBC sayýsý, nötrofil sayýsý, ortalama NLO ve PLO deðerleri Grup B ve kontrol hastalarýndan anlamlý olarak yüksek tespit edildi (p<0.001). Lenfosit sayýsý ortalamasýnýn Grup A hastalarýnda diðer gruplardan anlamlý olarak düþük olduðu görüldü (p<0.001). MPV, RDW ve ortalama platelet sayýsý açýsýndan gruplar arasýnda anlamlý bir farklýlýk yoktu (p>0.05). WBC sayýsý, nötrofil sayýsý, NLO, PLO ve lenfosit sayýsý için kestirim deðerleri sýrasýyla >10300, >7950, >5.50, >155.2 ve ≤1330 olarak alýndýðýnda sensivite oranlarý sýrasýyla %72.5, %80, %90, %77.5 ve %85 olarak gözlenirken spesifite oranlarý ise sýrasýyla %72.3, %79.7, %89.4, %74.5 ve %82.5 olarak tespit edildi.
TARTIÞMA: Akut apandisit tanýsý olan gebe kadýnlarda WBC sayýsý, nötrofil sayýsý, NLO ve PLO deðerleri kontrol grubu ve apandisit þüphesi nedeniyle ameliyat edilen hastalardan istatistiksel olarak anlamlý olacak þekilde yüksek bulunurken lenfosit sayýsý ise düþük bulunmuþtur. Gebe kadýnlarda AA tanýsý koymak için anamnez, fizik muayene ve görüntüleme yöntemleri ile birlikte hemogram parametreleride göz önünde bulundurulmalýdýr.

BACKGROUND: Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy.
METHODS: Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group.
RESULTS: The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC, neutrophil count, NLR, PLR, and lymphocyte counts were set to >10300, >7950, >5.50, >155.2, and ≤1330, respectively, the sensitivity rates were 72.5%, 80%, 90%, 77.5% and 85%, whereas specificity rates were 72.3%, 79.7%, 89.4%, 74.5%, and 82.5%, respectively.
CONCLUSION: When comparing pregnant women diagnosed with AA to patients operated for suspected AA and healthy pregnant women, the WBC and neutrophil count and NLR and PLR values were found to be significantly higher, whereas lymphocyte counts were lower. In addition to medical history, physical examination and imaging techniques, hemogram parameters should be considered to diagnose AA in pregnant women.

AMAÇ: Çalýþmamýzda amacýmýz akut apandisit nedeniyle laparoskopik apendektomi (LA) uygulanan hastalarda açýk apendektomiye (AA) konversiyona neden olan faktörleri incelenmektir. Ameliyat öncesi laboratuvar bulgularýndan C-reaktif protein (CRP) ve nötrofil yüzdelerinin konversiyona etkisini incelemek ve bu deðerler için kesim deðeri belirlemektir.
GEREÇ VE YÖNTEM: Merkezimizde, Ocak 2011–Ocak 2017 yýllarý arasýnda akut apandisit nedeniyle LA uygulanan hastalarýn dosya bilgileri geriye dönük olarak incelendi. Ameliyat öncesi American Society of Anesthesiology skoru, Alvorado skoru, beyaz küre sayýsý, CRP düzeyi ve nötrofil yüzdesi deðerlendirildi.
BULGULAR: Akut apandisit ön tanýsýyla 394 hastaya LA uygulandý. On yedi (%4.31) hastada AA’ya konversiyon tespit edildi. C-reaktif protein deðeri için 108.5 mg/L ve üstü deðerler; nötrofil yüzdesi için %81.5 ve üstü deðerlerde LA’dan AA’ya konversiyonun istatistiksel olarak anlamlý olduðu görüldü.
TARTIÞMA: Akut apandisit nedeniyle LA uygulanan hastalarda erkek cinsiyet, yaþ, nötrofil yüzdesi ve CRP deðerinin yüksek olmasý LA’dan AA’ya konversiyonda risk faktörü olduðu görülmüþtür.

BACKGROUND: In this study, we aimed to investigate the factors causing conversion from laparoscopic appendectomy (LA) to open appendectomy (OA) in patients with acute appendicitis and to investigate the role of preoperative C reactive protein (CRP) and neutrophil ratio in this conversion and determine a cut-off point for these parameters.
METHODS: Records of patients who underwent LA due to acute appendicitis at our general surgery department between January 2011 and January 2017 were retrospectively evaluated. The preoperative American Society of Anesthesiology (ASA) scores, Alvarado scores, white blood cell count, C-reactive protein level, and neutrophil ratio were evaluated.
RESULTS: LA was performed in 394 patients with an initial diagnosis of acute appendicitis. A conversion to OA (cOA) was performed in 17 patients (4.31%). A CRP value of ≥108.5 mg/L and a neutrophil ratio of ≥81.5% were found to be statistically significant for the cOA (p<0.001).
CONCLUSION: Our study results showed that male gender, age, elevated neutrophil ratio, and CRP value were the main risk factors for cOA in patients who were scheduled for LA due to acute appendicitis.

AMAÇ: Çalýþmamýzýn amacý immatür granülosit sayýsý (IGS) ve yüzdesinin (IG%) hem akut apandisit tanýsýnda hem de basit apandisit (BA) ile komplike apandisiti (KA) ayýrmadaki etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma apendektomi yapýlan 438 eriþkin hasta üzerinde yapýldý. Hastalarýn demografik verileri, beyaz küre (BK) sayýmý, nötrofil/lenfosit oraný (NLO), IGS ve IG%’si, ameliyat bulgularý ve patoloji sonuçlarý geriye dönük olarak deðerlendirildi. Hastalar patoloji raporlarýna göre akut apandisit (AA) ve normal apendiks (NA) olarak, akut apandisitler de ameliyattaki bulgulara göre BA ve KA olarak gruplara ayrýldý.
BULGULAR: Beyaz küre, NLO, IGS, IG% akut apandisit tanýsýnda anlamlý parametrelerdi. Bu parametrelerin arasýnda IGS’nin AUROC, duyarlýlýk ve özgüllük deðerleri diðerlerinden daha yüksek idi. IGC için AUROC; 0.795, duyarlýlýk: %55.5, özgüllük: %96.1 idi. Tüm parametreler komplike apandisit tanýsýnda da anlamlý idi ancak IG%’nin komplike apandisit tanýsýndaki deðeri diðer parametrelerden daha güçlü idi (AUROC: 0.979, duyarlýlýk: %94.4, özgüllük: %97.9 idi.
TARTIÞMA: Ýmmatür granülosit hem akut apandisit tanýsý koymada, hem de basit ve komplike apandisiti ayýrmada hýzlý, kolay ulaþýlabilir ve güvenilir bir parametredir.

BACKGROUND: The aim of this study was to investigate the effectiveness of the immature granulocyte (IG) count (IGC) and percentage (IG%) in both diagnosing acute appendicitis (AA) and discriminating between simple appendicitis (SA) and complicated appendicitis (CA).
METHODS: This study was carried out using the data of 438 adult patients who underwent an appendectomy. Demographic details, the preoperative white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), IGC and IG%, operation findings, and pathology results were assessed retrospectively. The patients were grouped as AA and normal appendix (NA) according to the pathology reports, and the AA cases were subdivided into SA and CA groups according to the intraoperative findings.
RESULTS: WBC, NLR, IGC, and IG% were significant parameters in the diagnosis of AA. The area under the receiver operating characteristic curve (AUROC: 0.795), sensitivity (55.5%) and specificity (96.1%) values of IGC were higher than the other parameters. All of the parameters were also significant for a CA diagnosis; however, the value of IG% in a CA diagnosis was stronger than the other parameters (IG% AUROC: 0.979, sensitivity: 94.4%, specificity: 97.9%).
CONCLUSION: The IG value is a fast, easily available, and reliable parameter in both diagnosing AA and discriminating between SA and CA.

AMAÇ: Hekim ile hastasý arasýndaki iliþkinin temeli vekâlet sözleþmesi hükümlerine tabidir. Gerçekleþtirdiði riskli bir ameliyat esnasýnda þiddetli bir doðal afet (deprem) meydana gelmesi gibi mücbir durumlarda, hekimin takýnacaðý tutum ve bu eylemi sonucunda hukuki ve etik açýdan sorumluluðu tartýþmalýdýr. Bu çalýþmada ilgili meslek gruplarýnýn bu konu hakkýnda görüþlerinin ortaya konulmasý ve bu konunun etik ve yasal zeminde tartýþýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu çalýþma kapsamýnda oluþturulan anket formlarý, Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi’nde görevli 121 hekim ve Ýstanbul Barosu’na kayýtlý 86 avukat olmak üzere toplam 207 gönüllü katýlýmcý tarafýndan dolduruldu. Anketlere verilen yanýtlar bilgisayar ortamýnda SPSS 21.0 programý kullanýlarak tanýmlayýcý istatistik ve grafik analizi ile deðerlendirildi.
BULGULAR: Katýlýmcýlarýn %76.8’i, hekimin þiddetli bir doðal afet esnasýnda kendi can güvenliðini düþünerek hastayý terk etmesinin etik açýdan sorun teþkil ettiðini belirtti. Ancak %68.1’i bu davranýþýndan dolayý hekimin herhangi bir cezai yaptýrým ile karþýlaþmayacaðý yönünde görüþ bildirdi. Anketi dolduran iki meslek grubunun yanýtlarý ayrý ayrý deðerlendirildiðinde; hekimlerin %26.4’ü, avukatlarýn ise %39.5’i söz konusu fiilin hukuki ve cezai sorumluluðunun bulunduðunu belirtti.
TARTIÞMA: Bu çalýþma sonucunda her iki meslek grubunun birbirleri arasýnda ve kendi içinde bu konu hakkýnda tam bir görüþ birliði içinde bulunmadýklarý saptandý. Her iki meslek grubunun birlikte bulunduðu toplantýlarda konunun tartýþýlmasý ve doðru bir zemine oturtulmasý gerektiði sonucuna varýldý.

BACKGROUND: The relationship between the physician and the patient is based on the provisions of the proxy agreement. The attitude of the physician and the legal and ethical responsibilities of this attitude in an event of force majeure, such as severe natural disaster (earthquake), during a risky operation should be discussed. The aim of the present study was to present the opinions of the related professions about the subject and to discuss the subject on an ethical and legal ground.
METHODS: A total of 207 volunteers including 121 physicians working at the Cerrahpasa Faculty of Medicine at Istanbul University and 86 lawyers registered at the Istanbul Bar Association completed the questionnaires. Statistical analysis of data acquired from the questionnaires was performed using SPSS 21.0.
RESULTS: Of the participants, 76.8% stated that abandoning the patient by the physician considering his/her own safety during a severe natural disaster is ethically problematic. However, 68.1% of the participants stated that physicians would not be facing any criminal sanctions in response to his/her attitude. When the answers from both occupational groups were compared separately, it was found that 26.4% of the physicians and 39.5% of the lawyers stated that the act in question has both legal and ethical liability.
CONCLUSION: In the present study, no complete consensus was observed either between or within two occupational groups. It was concluded that the meetings in which the subject is discussed and is based on a concrete ground by both occupational groups should be held.

AMAÇ: Bu çalýþmada vücut kitle indeksi (VKÝ) ve Travma Derecesi Skorlama Sistemi’nin yüksekten düþme nedeniyle ameliyat edilen hastalarýn mortalite oranlarý üzerindeki rolü araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, Ocak 2008 ile Aralýk 2016 tarihleri arasýnda yüksekten düþme nedeniyle baþvuran ve ameliyat edilen, çoklu travmalý 45 ardýþýk eriþkin hastayý içermiþtir. Hastalar mortalite ve yaþayan gruplarýna ayrýlmýþtýr (n=10, n=35, sýrasýyla). Gruplar yaþ, cinsiyet, kilo, düþme nedeni, düþme yüksekliði, düþme yeri, VKÝ, Travma Skorlarý (Injury Severity Score [ISS], New Injury Severity Score [NISS], Glasgow Coma Scale [GCS], Abbreviated Injury Score [AIS], Revised Trauma Score [RTS]), hastanede kalýþ süresi ve ameliyat sonrasý komplikasyonlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Her iki grup arasýnda yaþ, cinsiyet, boy veya düþme nedeni açýsýndan istatistiksel olarak anlamlý fark bulunmazken (p>0.05), kilo ve VKÝ deðerleri açýsýndan istatistiksel olarak anlamlý fark saptandý (p<0.01). Gruplar arasýnda hastanede kalýþ süresi ve ameliyat sonrasý komplikasyonlar açýsýndan (p<0.01), ISS, NISS, GCS, AIS ve RTS skorlarý açýsýndan istatistiksel olarak anlamlý fark saptandý (p<0.05).
TARTIÞMA: Bu çalýþmada, yüksekten düþme sonucu travma ile baþvuran hastalarýn vücut aðýrlýðý ve VKÝ’nin mortalite üzerine etkisi objektif olarak gösterilmiþtir.

BACKGROUND: The aim of the present study was to investigate the role of body mass index (BMI) and trauma severity score systems on the mortality rates of patients undergoing surgery due to falls from height.
METHODS: This retrospective study included 45 consecutive adult patients with multitrauma who were admitted and operated on due to a fall from height between January 2008 and December 2016. Patients were divided into mortality and recovery groups (n=10 and n=35, respectively). The groups were compared in terms of age, gender, weight, cause of the fall, height of the fall, location of the fall, BMI, trauma scores (Injury Severity Score [ISS], New Injury Severity Score [NISS], Glasgow Coma Scale [GCS], Abbreviated Injury Score [AIS], Revised Trauma Score [RTS]), hospital stay, and postoperative complications.
RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, and height or cause of the fall (p>0.05), whereas there was a statistically significant difference with respect to weight and BMI values (p<0.01). A statistically significant difference was determined between the groups in terms of hospital stay and postoperative complications (p<0.01) and ISS, NISS, GCS, AIS, and RTS scores (p<0.05).
CONCLUSION: The effect of weight and BMI on the mortality rate of patients presenting with trauma as a result of a fall from height was objectively demonstrated in the present study.

AMAÇ: Terörizmin koþullarý deðiþtikçe, özellikle kentsel alanlarda, el yapýmý patlayýcýlar gibi yüksek enerjili patlayýcý maddeler sýklýkla kullanýlmaktadýr. Bu travmalar özellikle maksillofasiyal bölgeyi etkiler ve genellikle otolojik problemler yaratýrlar. Bu çalýþma, yüksek enerjili patlamayla iliþkili yaralanmalara maruz kalan hastalarýn otolojik þikayetlerini, otoskopik ve auriküler muayene ve diyapozon testlerini deðerlendirmeyi ve otolojik deðerlendirme skorlarýna dayanarak el yapýmý patlayýcýlar (ÝED) ve rokete (PM) baðlý yaralanan travma hastalarý arasýnda bir karþýlaþtýrma yapmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: 27 Temmuz 2015 ile 22 Temmuz 2016 tarihleri arasýnda el yapýmý patlayýcý EYP ve roket PM nedeniyle yaralanan ve operasyonel saha hastanesi acil servisine baþvuran 241 hastanýn týbbi verileri gözden geçirildi. Tüm hastalar için iþitme bozukluðu, kulak çýnlamasý þikayetleri, otolojik muayene, aurikuler bölgede muayene ve diyapozon testleri yapýldý ve otolojik problemi olan hastalarýn (n=86) otolojik deðerlendirme skoru kayýtlarý deðerlendirildi. Hastalar yaralanmaya neden olan cihaza göre iki gruba ayrýldý: Grup I’de ÝED, grup II’de PM’ler.
BULGULAR: Ýki yüz kýrk bir savaþçý, yüksek enerjili patlayýcýlarla yaralanmýþtý. Tüm hastalar erkekti ve yaþ ortalamasý 30.2 idi (aralýk 20–54). Ýki yüz kýrk birinden 86’sýnda iþitme þikayeti mevcuttu. Bunlarýn 50’sinin ÝED tarafýndan yaralanmasý ve 36’sý PM tarafýndan yaralanmýþtý. Seksen altý hastanýn 18’inde travmatik timpanik membran perforasyonu vardý ve altý hasta ÝED, 12 hasta PM nedeniyle yaralanmýþtý. Seksen altý hastanýn 68’inde sensorinöral iþitme kaybý vardý ve bu hastalarýn 44’ünde ÝED yaralanmasý ve 24’ünde PM yaralanmasý vardý. Otolojik deðerlendirme skoruna göre ÝED ve PM gruplarý arasýnda istatistiksel olarak anlamlý farklýlýk vardý (p=0.044).
TARTIÞMA: Bu çalýþma, roket yaralanmalarýnýn insan kulaðýnda daha büyük bir etkiye neden olabileceðini ve travma hastalarý arasýnda el yapýmý patlayýcýlara göre daha þiddetli otolojik bulgular yarattýðýný gösterdi. Operasyonel saha hastanesi gibi acil müdahale alanlarýnda otolojik yaralanmaya maruz kalan hastalarýn erken ve doðru deðerlendirilmesi ve uygun tedavisi çok önemlidir.

BACKGROUND: With the changing conditions of terrorism, particularly in urban areas, high-energy explosive devices such as improvised explosive devices (IEDs) and projectile missiles (PMs) are frequently used. Traumas caused by these devices particularly affect the maxillofacial region and typically lead to otologic problems. In this study, we aimed to evaluate otologic complaints, otoscopic and auricular examinations, and tuning-fork tests of patients who were exposed to high-energy blast-related injuries and perform a comparison between trauma patients injured by IEDs and PMs.
METHODS: The medical data of patients admitted to an operational field hospital emergency room with injuries related to high-energy explosive devices such as IEDs and PMs between July 27, 2015 and July 22, 2016 was reviewed. The hearing impairment, tinnitus, otologic examination, auricular region examination, and tuning-fork tests of all patients were evaluated. The otologic evaluation records of the patients (n=86) were evaluated using a scoring system established by the authors. The patients were categorized into two groups according to the device causing the injury: IEDs in group I and PMs in group II.
RESULTS: A total of 241 combatants were injured by high-energy explosive devices. All patients were male with a mean age of 30.2 years (range, 20–54). Of these, 86 had hearing impairments that were detected by tuning-fork tests. Of those, 50 were injured by IEDs and 36 by PMs. Of the 86 patients, 18 had traumatic tympanic membrane perforation, and of those, 6 patients were injured by IEDs and 12 by PMs. Further, 68 of the 86 patients had sensorineural hearing loss, and of those, 44 were injured by IEDs and 24 by PMs. There was a statistically significant difference between the IED and PM groups according to otologic evaluation score (p=0.044).
CONCLUSION: This study demonstrates that PMs can have a large impact on the human ear and may cause more severe otologic manifestations among combatants than those caused by IEDs. The early and accurate evaluation of patients exposed to high-energy explosive devices in an operational field is important for the appropriate management of these patients.

AMAÇ: Bu çalýþmada, elektrik yanýklarýnda kullandýðýmýz negatif basýnçlý yara tedavisinin (NBYT) klinik etkinliðini ve güvenilirliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþma, hastanemizin yanýk merkezinde ileriye yönelik olarak tutulan veri tabaný kullanýlarak geriye dönük olarak yapýldý. Aðustos 2008 ile Aralýk 2012 tarihleri arasýnda merkezimizde NBYT uygulanan elektrik yanýklý hastalar ardýþýk olarak çalýþmaya dahil edildi. Çalýþmamýzdaki tedavi sonuçlarý, tedavi endikasyonlarý ve hedefleri dikkate alýnarak baþarýlý veya baþarýsýz olarak deðerlendirildi.
BULGULAR: Çalýþmamýzda toplam 39 hasta analiz edildi. Otuz altýsý erkekti (%92.3). Ortalama yaþ 34.9±9.8 (daðýlým 17–63) idi. Çalýþmamýzdaki hastalarýn çoðunluðu (%92.3) yüksek voltaja maruz kalmýþtý. Ortalama TBSA 19.3±9.8 (daðýlým 4–44) idi, altý hastada (%15.4) TBSA %30’un üzerindeydi. Otuz bir hastada (%79.5) 3. derece yanýk, sekiz hastada (% 20.5) 4. derece yanýk vardý. Çalýþmamýzda, NBYT endikasyonlarý; 27 hastada (%69.2) granülasyonun standart pansumanlar ile elde edilemeyeceði kemik ve/veya tendon içeren erken greftleme ve flap uygulamalarý için yeterli destek dokusu olmayan derin yaralanmalar, sekiz hastada (%20.5) greft fiksasyonu, dört hastada (%10.3) ise primer greft kaybýný takiben sekonder grefti desteklemek þeklindeydi. Çalýþmamýzda NBYT’nin endikasyon ve tedavi hedeflerine göre genel baþarý oraný %90.7 olarak tespit edildi.
TARTIÞMA: Sonuçlarýmýz, NBYT uygulamasýnýn ciddi elektrik yanýklarýnda kullanýlan geleneksel konvansiyonel tedavilere katkýda bulunabileceðini göstermektedir.

BACKGROUND: In this study, we aimed to evaluate the clinical efficacy and safety of negative-pressure wound therapy (NPWT) in the treatment of the patients with electrical burns.
METHODS: This study was retrospectively performed using a database placed prospectively in the burn center of our hospital. All consecutive patients with electrical burns treated using NPWT at our center between August 2008 and December 2012 were included. The treatment results in our study were grouped as successful or unsuccessful considering the treatment objectives in accordance with therapy indications.
RESULTS: In total, 39 patients were included in our study; of them, 36 (92.3%) were men. The average age was 34.9±9.8 years (range, 17–63 years). The majority of the patients in our study (92.3%) had been exposed to high voltage electricity. The mean total burned body surface area (TBSA) was 19.3±9.8 (range, 4–44). Six patients (15.4%) had TBSAs ≥30%, 31 (79.5%) had third degree burns, and 8 (20.5%) had fourth degree burns. In our study, indications of NPWT included bone and/or tendon exposed deep wounds that are not suitable for early grafting or flap applications owing to the lack of supporting tissue in 27 (69.2%) patients, graft fixation in 8 (20.5%) patients, and secondary grafting following graft loss in 4 (10.3%) patients. The general success rate of NPWT was 90.7% according to indications and treatment objectives in our study.
CONCLUSION: In the light of our results, NPWT may contribute to the present conventional treatments used in severe electrical burns.

AMAÇ: Parmak ucu amputasyonlarýnda replantasyon altýn standarttýr. Repozisyon flebi, replantasyonun uygulanamadýðý durumlarda parmak uzunluðunu, týrnak kompleksini ve parmak ucu duyusunu korumak amacýyla yapýlan, týrnak-kemik kompleksinin serbest greft olarak kullanýlmasý ve flep ile örtülmesi esasýna dayanan bir yöntemdir. Bu çalýþmada parmak ucu amputasyonlarýnda yapýlan replantasyonlar ile repozisyon flebi uygulanan hastalarýnýn uzun dönem sonuçlarýnýn deðerlendirilmesini karþýlaþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþmaya 2., 3. ve 4. parmakta Foucher sýnýflamasýna göre zone 2 ve zone 3 parmak ucu ampütasyonu nedeniyle baþvuran ve replantasyon yapýlmýþ 35 hasta, repozisyon flebi uygulanmýþ 28 hasta dahil edildi. Bütün hastalar ortalama 13 ay (9–23 ay) takip edildi. Bütün hastalar statik ve dinamik iki nokta testi, Semmes-Weinstein monofilaman testi, soðuk intoleransý ve verici saha nöroma geliþimi açýsýndan deðerlendirildi.
BULGULAR: Replantasyon yapýlan beþ hastada iþlem baþarýsýz oldu. Bu hastalarýn hepsinde nekrotik dokular uzaklaþtýrýldýktan sonra lokal flep ile onarým yapýldý. Repozisyon flebi uygulanan iki hastanýn flep kenarlarýnda ayrýlma oldu ve pansuman ile takip sonrasý sekonder iyileþme gözlendi.
TARTIÞMA: Repozisyon flebi mikrocerrahi uygulanamayan durumlarda ve uygun seçilmiþ hastalarda, parmak ucu uzunluðunu ve duyusunu koruyan, hastanýn gündelik yaþamýna bir an önce dönmesini saðlayan bir yöntemdir ve parmak ucu onarýmlarýnda diðer yöntemlere iyi bir alternatif olabilir.

BACKGROUND: Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures.
METHODS: Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2nd, 3rd, and 4th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9–23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes–Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site.
RESULTS: In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures.
CONCLUSION: Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

AMAÇ: Nondeplase skafoid kýrýklarýn tedavisinde alçý süresi ile ilgili çeliþkili sonuçlar bulunmaktadýr. Bu çalýþmanýn amacý, nondeplase skafoid kýrýklarýn tedavisinde iyileþme sürecini deðerlendirmek ve bilgisayarlý tomografinin (BT) alçý süresinin kýsaltýlmasýndaki rolünü belirlemekti.
GEREÇ VE YÖNTEM: Ocak 2012 ile Ocak 2014 arasýnda nondisplase skafoid kýrýðý tanýsý alan 42 hasta deðerlendirildi. Kýrýklar anatomik yerleþim yerleri ve yer deðiþtirme derecelerine göre sýnýflandýrýldý. Kýrýklar, nondeplase olduklarý BT ile doðrulandýktan sonra baþparmaðý içeren kýsa kol alçýya alýndý. Radyolojik deðerlendirme iki hafta aralýklar ile iki planlý grafiler kullanýlarak yapýldý. Yaralanmanýn dördüncü haftasýnda BT taramasýnda kemik iyileþmesine göre kaynama ve kaynamama gruplarýna ayrýldýlar. Kaynama grubundaki hastalarýn alçýlarý çýkarýldý.
BULGULAR: Anatomik yerleþim açýsýndan sekiz hasta distal, 30’u bel bölgesi, dördü proksimal kýrýk olarak sýnýflandýrýldý. Ortalama yaþý 31.95±13.11 olan 42 hastanýn 41’inde kýrýk iyileþmesi tespit edildi ve dördüncü hafta sonunda alçý çýkarýldý. Hastalar dördüncü haftanýn sonunda kýrýk iyileþmesi bakýmýndan kaynama ve kaynamama olmak üzere iki gruba ayrýldý. Translasyon derecesi, kontakt yüzey oraný ve yer deðiþtirme durumu açýsýndan gruplar arasýnda istatistiksel olarak anlamlý farklýlýklar vardý (sýrasýyla, p=0.001, p=0.001 ve p=0.001).
TARTIÞMA: Nondeplase skafoid kýrýklarýnýn alçýyla takibinde BT ile yüksek kaynama oranlarýnýn saptanmasý uzun süreli alçý tedavisinin gerekli olmadýðýný göstermiþtir.

BACKGROUND: There are conflicting results regarding the duration of the plaster treatment of nondisplaced scaphoid fractures. The aim of the present study was to evaluate the healing process and to determine the role of computed tomography (CT) on shortening the duration of plaster treatment of nondisplaced scaphoid fractures.
METHODS: A total of 42 patients diagnosed with nondisplaced scaphoid fractures between January 2012 and January 2014 were investigated. Fractures were classified according to anatomical locations and displacement degree. Fractures were short-arm plastered enclosing thumb after non-displacement was confirmed by CT. Radiological evaluation was performed using two-planned radiographs at 2-week intervals. Patients were divided into two groups as union and non-union according to their bone healing in the CT scan at week 4 of the fracture. The cast was removed in the union group.
RESULTS: Regarding anatomical location, 8 patients were classified as distal, 30 were waist region, and 4 were proximal fractures. Among 42 patients with a mean age of 31.95±13.11 years, the union was determined in 41 patients, and the plasters were removed at the end of 4 weeks. Patients were divided into two groups, non-union and union, in terms of fracture healing at the end of 4 weeks. There were highly statistically significant differences between the groups regarding translation degree, contact surface rates, and displacement status (p=0.001, p=0.001, and p=0.001, respectively).
CONCLUSION: It has been shown that determination of high union rates in CT accomplishes the non-requirement of long-term plaster treatment in patients with nondisplaced scaphoid fractures after follow-up with plasters.

AMAÇ: Önkol kýrýklarý çocuk kýrýklarýnýn yaklaþýk %40’ýný oluþturur. Genel olarak dirsek 90˚ fleksiyonda alçýlama yapýlarak konservatif olarak tedavi edilir. Tedavinin baþarýsý redüksiyonun doðru pozisyonda korunmasýna ve alçýlamayý zamanýnda sonlandýrmaya baðlýdýr. Baþarýsýzlýk, yani alçý içerisinde açýlanma oluþma riski, alçý içindeki harekete baðlýdýr. Bu çalýþmanýn amacý, redüksiyon kaybýný iþaret eden “Cast Index” (CI) ve “Three Point Index” (TPI) ölçümünün çocuklarýn önkol orta 1/3 kýrýklarýnda uygulanabilirliðinin araþtýrýlmasýdýr. Hipotezimiz kýrýk redüksiyonu sonrasý ödemin azalmasý ve alçýnýn deforme olmasý nedeniyle, alçý içerisinde harekete baðlý kaymayý iþaret eden TPI ve CI’inin takipler sýrasýnda bakýlmasý gereken parametreler olduðudur.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük olarak planlandý. 2014 yýlý Mart–Eylül aylarý arasýnda acil polikliniðimizde 1/3 orta önkol diyafiz kýrýðý kapalý redüksiyon ve uzun kol alçý tespiti ile tedavi edilen 48 olgu çalýþmaya dahil edildi. Hastalarýn yaþlarý beþ ile 14 (8.15±3.19) arasýnda deðiþmekte idi. Sadece radiusu veya sadece ulnasý kýrýk olanlar, açýk kýrýklar, ek kýrýðý ya da sistemik hastalýðý (kemik metabolizma hastalýðý, vb) olanlar, geliþ grafisinde ulna ve radiusta 10°’den az kýrýk açýlanmasý olanlar ve uygun takibi yapýlamayan hastalar çalýþmadan çýkarýldý. “Picture Archiving Communication Systems” (PACS) üzerinde anteroposterior (AP) ve lateral grafilerde TPI ve CI hesaplandý.
BULGULAR: Anteroposterior planda redüksiyon sonrasý yapýlan TPI ölçümlerine göre, redüksiyondan 10 gün sonra yapýlan TPI ölçümlerinde saptanan artýþlar istatistiksel olarak anlamlý idi (p<0.01). Ancak AP planda redüksiyon kaybý olanlar ile olmayanlarýn redüksiyon sonrasý TPI ölçümleri arasýnda istatistiksel olarak anlamlý farklýlýk bulunmadý (p>0.05). Redüksiyon kaybý olanlar ile olmayanlarýn AP planda CI ölçümleri arasýnda da istatistiksel olarak anlamlý farklýlýk yoktu (p>0.05).
TARTIÞMA: Redüksiyondan 15. günde ölçülen TPI deðerlerinde redüksiyon sonrasý TPI deðerlerine göre anlamlý artýþ olmasýna raðmen, redüksiyon kaybý olanlar ile olmayanlar arasýnda anlamlý fark sadece lateral TPI’de gösterildi.

BACKGROUND: Forearm fractures constitute approximately 40% of all pediatric fractures. Generally, in conservative treatment,a plaster cast is applied with the elbow in 90° flexion. Success of the treatment depends on theprevention of the reduction in the correct position and suitable duration of the plaster cast. Failure, or the risk of angulation within the cast, is associated with movement within the cast. The aim of this study was to evaluate the applicability of the Cast Index (CI) and Three-Point Index (TPI) measurements, which indicate the loss of reduction, in pediatric mid-third forearm fractures. The hypothesis of the study was that as edema decreases and deformity of the plaster cast occurs after fracture reduction, TPI and CI should be examined during follow-up, as they indicate shifting due to movement within the plaster cast.
METHODS: This retrospective study included a total of 48 patients, who were treated with closed reduction and long-arm plaster cast for a mid-third forearm diaphyseal fracture at our Emergency Polyclinic between March and September 2014. The mean age of the patients was 8.15±3.19 years (range, 5–14 years). Patients were excluded from the study if they had isolated radial or ulnar fracture, open fractures, concomitant fracture or systemic disease (bone metabolism disease, etc), and <10° fracture angulation in the ulna and radius on the initial radiograph and if they did not followup. TPI and CI values were calculated on anterioposterior (AP) and lateral radiographs in the Picture Archiving Communication Systems.
RESULTS: In the AP plane, compared with TPI values after reduction, statistically significant increases were observed in TPI values 10 days after reduction (p<0.01). However, no significant difference was observed between those with and without reduction loss in TPI values in the AP plane (p>0.05). Although there was a statistically significant increase in TPI values 15 daysafter reduction compared with the values immediately after reduction, a significant difference between those with and without reduction loss was observed only on lateral TPI.
CONCLUSION: In cases of pediatric forearm diaphyseal fracture, ulnar TPI examined in the lateral plane can be used in monitoring the fracture in a plaster cast applied after the reduction.

AMAÇ: Çalýþmamýzýn amacý; sýçanlarda deneysel olarak oluþturulan siyatik sinir yaralanmasý ve uç-uca anastomoz yapýlmasý modelinde gabapentinin koruyucu etkilerini belirleyerek sinir yaralanmasýna baðlý morbiditeyi en aza indirmek ve bu konudaki klinik çalýþmalara yön vermektir.
GEREÇ VE YÖNTEM: Çalýþmamýzda 40 adet yetiþkin, erkek, Sprague-Dawley cinsi sýçanlar; rastgele I: Sadece cerrahiye maruz kalan, II: siyatik sinirleri düzgün bir þekilde kesilip tekrar uç-uca anastomoz yapýlan ve ek herhangi bir iþlem yapýlmayan, III: anastomoz yapýlýp tek doz 30 mg/kg gabapentin verilen, IV: anastomoz yapýlýp üç gün 30 mg/kg gabapentin verilen, V: anastomoz yapýlýp yedi gün 30 mg/kg gabapentin verilen olmak üzere beþ gruba ayrýldý. Cerrahi iþlemden 60 gün sonra yüksek doz tiyopental (50 mg/kg) ile deney sonlandýrýldý. Tüm hayvanlarýn sað siyatik sinirleri alýndý ve elde edilen kesitler immünohistopatolojik olarak incelendi.
BULGULAR: Ýmmünohistokimyasal özellikler ve Schwann hücre proliferasyonu kontrol grubunda, diðer gruplara kýyasla istatistiksel olarak anlamlý daha az oranda saptandý. Ýkili gruplar arasýnda ise Grup 3’de 5’e oranla daha fazla hücre proliferasyonu görüldü. Grup 4’deki immünohistokimyasal deðiþiklikler Grup 3’e göre anlamlý oranda az saptandý. Ayrýca axonal dejenerasyon da Grup 4’de Grup 3’e oranla daha fazla bulundu.
TARTIÞMA: Gabapentin, histopatolojik olarak periferik sinir yaralanmasýnda nöroprotektif özelliði ile nörolojik düzelmeyi teþvik eder. Çalýþmamýzýn sonuçlarýnda, gabapentinin, periferik sinir hasarý sonrasýnda primer cerrahi tedaviye ek tamamlayýcý bir tedavi olarak kullanýlabilirliðini göstermektedir.

BACKGROUND: The aim of our study is to minimize the morbidity related to nerve injury by determining the protective effects of gabapentin in experimental sciatic nerve injury and end-to-end anastomosis model in rats and to guide clinical studies on this subject.
METHODS: In our study, 40 adult male Sprague–Dawley rats were randomly divided into the following five groups: I: Only surgical intervention was applied; II: The sciatic nerve was cut properly and was repaired by end-to-end anastomosis. No additional procedure was performed; III: A single dose of gabapentin at 30 mg/kg was given after anastomosis; IV: 30 mg/kg gabapentin was given for 3 days after anastomosis; and V: 30 mg/kg gabapentin was given for 7 days after anastomosis. The experiment was terminated with high-dose thiopental (50 mg/kg) 60 days after the surgical intervention. The right sciatic nerve was taken from all animals. The obtained sections were examined immunohistopathologically.
RESULTS: Immunohistochemical properties and Schwann cell proliferation were found to be statistically significantly lower in the control group than in the other groups. Schwann cell proliferation was higher in Group 3 than in Group 5. Immunohistochemical changes were significantly lower in Group 4 than in Group 3. Axonal degeneration was also higher in Group 4 than in Group 3.
CONCLUSION: Gabapentin promotes neurological recovery histopathologically in peripheral nerve injury due to its neuroprotective properties. Our study results show that gabapentin can be used as an adjunctive therapy to primary surgical treatment after peripheral nerve injury.

Amaç: Walled-off pankreatik nekrozda (WOPN) morbiditeye eden risk faktörlerini deðerlendirmek ve endoskopik nekrozektomiye dirençli hastalarda sürekli postoperatif lavajýn etkilerini ortaya koymayý planladýk.
Materyal ve Metot: Bu çalýþmaya hastanemizde cerrahi tedavi veya endoskopik nekrozektomi yapýlan 28 WOPN’ lu hastanýn 19’u kabul edildi ve hastalar iki gruba ayrýldý; ilk akut pankreatit (AP) tanýsý konulduðu zaman (grup 1, n= 19), operasyon veya endoskopik nekrozektomi yapýlan zamana kadar (grup 2, n= 19). Hastalar demografik özellikleri, operasyon bulgularý ve komplikasyonlarý açýsýndan karþýlaþtýrýldý.
Sonuçlar: Hastalar hastanede kalýþ süresi ve komplikasyon arasýnda, yaþ, VKÝ (Vücut kitle indeksi), WOPN çapý, ASA skoru (American Society of Anesthesiologists), Ranson kriteri, operasyon zamaný, ilk baþvuradan operasyon veya endoskopik nekrozektomi yapýlan zamana kadar deðerlendirildiðinde istatistiksel farklýlýk yoktu (P>0.05). Endoskopik nekrozektomi yapýldýkça komplikasyon sayýsý azalmaktaydý (B=-0.626, 95% CI: -0.956 - -0.296 ve P<0.001), ayrýca ilk baþvurudaki nötrofil lenfosit oraný (NLR) düzeyi arttýkça komplikasyon sayýsý artmaktaydý (B=0.032, 95% CI: 0.009 - 0.055 ve P=0.01). Kültürde üreme (B=0.669, 95% CI: 0.365 - 0.973 ve P<0.001) ve erkek cinsiyet (B=0.484, 95% CI: 0.190 - 0.778 veP=0.003) hastanede kalýþ süresini arttýran risk faktörüydü.
Sonuç: Sürekli postoperatif lavaj WOPN’ da etkili ve güvenli bir cerrahi tedavi yöntemidir. Ayrýca, kültürde üreme, erkek cinsiyet, yüksek NLR düzeyi, yetersiz veya ulaþýlamayan endoskopik nekrozektomi kötü prognoza etki eden risk faktörleridir.

BACKGROUND: The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach.
METHODS: The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications.
RESULTS: No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson’s criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009–0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365–0.973; p<0.001), (B=0.484, 95% CI: 0.190–0.778; p=0.003), respectively.
CONCLUSION: CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.

Akciðer aþýrý derecede hasarlandýðýnda ve konvansiyonel tedavi baþarýsýz olduðunda venovenöz ekstrakorporeal membran oksijenizasyonu (VV-ECMO) kritik rol oynar. ECMO dokunun yeterince oksijenlenmesine ve akciðerin toparlanmasýna olanak saðlar. Tedavi sýrasýnda sistemik antikoagülasyon uygulandýðýndan kanama riski olan hastalarda ECMO kontrendike olmayý sürdürmektedir. Yirmi altý yaþýnda kadýn hasta gelmeden bir saat önce trafik kazasý nedeniyle politravma geçirmiþ. Basit torasik radyografi ve bilgisayarlý tomografi sað akciðer atelektazisiyle birlikte geniþ bir sað hemopnömotoraks ve sað akciðerde ciddi kontüzyonun varlýðýný gösterdi. ECMO desteði altýnda baþarýyla sað alt lob çýkartýldý. Hemorajik þoklu politravma hastalarýnda kontrendike olmasýna raðmen kanama iyice kontrol altýna alýnmýþsa ECMO uygulamasý mümkün olabilir. Hasta önemli bir komplikasyon olmaksýzýn taburcu edilmiþtir.

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) plays a crucial role when the lung is extensively damaged and when conventional management has failed. ECMO provides adequate tissue oxygenation and an opportunity for lung recovery. However, ECMO remains contraindicated in patients with a risk of bleeding because of systemic anticoagulation during the treatment. A 26-year-old female experienced polytrauma due to a traffic accident 1 h before arrival. Simple chest radiography and chest computed tomography showed a large right hemopneumothorax with atelectasis of the right lung and severe contusion of the left lung. Heparin-free VV-ECMO was applied peripherally via both femoral veins. Under the ECMO support, right lower lobectomy was successfully performed. Although contraindicated in polytraumatic patients with hemorrhagic shock, surgical repair with the application of ECMO may be feasible if bleeding is well controlled. The patient was discharged without significant complications.