AMAÇ: Karýn içi yapýþýklýklar halen önemli bir sorundur. Bakteriyel dekontaminasyon saðlanmasýyla karýn içi yapýþýklýklarýn azalacaðý düþünülmektedir. Geçmiþte çeþitli antibiyotikler septik karýnda adezyon formasyonunun önlenmesi için kullanýlmýþtýr. Bu çalýþmanýn amacý çekal ligasyon ve puncture yöntemi ile sepsis modeli oluþturulan sýçanlarda ertapenem etkinliðinin gösterilmesidir.
GEREÇ VE YÖNTEM: Çalýþmada aðýrlýklarý 200–250 gr arasýnda deðiþen, erkek cinsi, 28 adet Wistar cinsi sýçan kullanýldý. Sýçanlar rastgele dört gruba ayrýldý. Tüm gruplarda çekal ligasyon ve puncture yöntemiyle bakteriyel peritonit oluþturuldu. Grup 1 sham grubu olarak kabul edildi; grup 2’ye serum fizyolojik (SF), grup 3’e ertapenem tek doz, grup 4’e ertapenem her gün günde bir doz intraperitoneal yolla verildi. Cerrahiden yedi gün sonra karýn içi yapýþýklýklar deðerlendirildi, histopatolojik inceleme yapýldý, elde edilen asitesten mikrobiyolojik inceleme yapýldý. Sýçanlardan alýnan kan örneklerinden TNF-α bakýldý.
BULGULAR: Ertapenem uygulamasý ile adezyon skoru anlamlý derecede azaldý (p<0.001) ve fibrozis skorlarý anlamlý derecede düþük olarak bulundu (p=0.005). Tüm gruplar arasýnda, antibiyotik uygulamasý ile koloni sayýsýndaki azalma arasýndaki iliþki anlamlý bulunmadý (p=0.109). Tek doz ertapenem verilen grup ile multipl (çok doz) ertapenem verilen grup arasýnda istatistiksel olarak fark saptanmadý (p=1).
TARTIÞMA: Bu veriler ýþýðýnda septik karýnda, ertapenemle peritoneal lavajýn adezyonu önlemede etkin olduðu görülmektedir. Tek doz ile çok doz antibiyotik uygulamasý sonunda adezyon skorlarýnda fark saptanmadýðýndan operasyon sonrasý tek doz uygulamanýn yeterli olabileceði düþünülmektedir. Sonuçlarýn bir klinik çalýþmada deðerlendirilmesi gerektiði düþünülmektedir.

BACKGROUND: Intra-abdominal adhesions are still a major problem which is expected to be reduced by the provision of bacterial decontamination. Various antibiotics have been used to prevent the formation of adhesion in the septic abdomen. This study aims to investigate the efficacy of ertapenem in sepsis of rats induced by cecal ligation and puncture.
METHODS: Twenty-eight Wistar rats were divided into four groups randomly. In all groups, bacterial peritonitis was created by cecal ligation and puncture method. Group 1 was considered as sham group. Groups 2, 3 and 4 were given, respectively, saline, a single dose of ertapenem and a dose of ertapenem intraperitoneally every day. Intra-abdominal adhesions were assessed seven days after surgery by histopathological examination. Microbiological examination was performed through the ascites obtained. TNF-α was measured from blood taken from rats.
RESULTS: Adhesion score decreased significantly by the application of ertapenem (p<0.001) and fibrosis scores were found to be significantly lower (p=0.005). Among all groups, the relationship between the decrease in the number of colonies and antibiotics application was not statistically significant (p=0.109). No statistically significant difference was found between the group given a single dose of ertapenem and the group given multiple ertapenem (p=1).
CONCLUSION: Peritoneal lavage with ertapenem appears to be effective in preventing the adhesion in the septic abdomen. As no difference was detected at the end of a single dose and multiple-dose administration of antibiotics in the adhesion scores, a single dose after surgery seems to be enough. The findings suggest that the results should be evaluated in a clinical trial.

AMAÇ: Pulmoner kontüzyon (PC), akciðer hasarý ve enflamasyon ile karakterize, hayatý tehdit eden önemli bir klinik durumdur. Kafeik asit fenetil ester (CAPE), güçlü antioksidan ve anti-enflamatuvar etkileri olan biyolojik bir ajandýr. Bu çalýþmada, CAPE’nin deneysel PC modelinde doku hasarý, nükleer faktör kappa-beta (Nf-κβ) aktivitesi, indüklenebilir nitrik oksit sentaz (iNOS) sentezi ve pulmoner apoptozis üzerindeki etkileri araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmada 40 yetiþkin Wistar albino sýçaný kullanýldý ve dört gruba ayrýldý: Kontrol, PC, PC + CAPE ve CAPE. CAPE, PC oluþumunu takiben yedi gün boyunca intraperitonal olarak uygulandý (dimetil sülfoksit içinde çözülmüþ 10 umol/kg). Akciðer dokusunda ýslak/kuru aðýrlýk oraný belirlendi. Pulmoner doku hematoksilen-eosin ve masson trikrom histokimyasal boyamasý ile ve taramalý elektron mikroskobu ile incelendi. Akciðerlerdeki Nf-κβ ve iNOS aktiviteleri indirekt immünhistokimyasal yöntemle belirlendi. Pulmoner apoptozis, TUNEL yöntemi ile tespit edildi.
BULGULAR: Pulmoner kontüzyon grubunda artmýþ lökosit infiltrasyon skoru, pulmoner ödem, alveoler hasar ve artmýþ Nf-κβ ve iNOS aktiviteleri tespit edildi. CAPE uygulamasý Nf-κβ ve iNOS aktivitelerini ve pulmoner apoptozu azaltmaktadýr.
TARTIÞMA: Çalýþmanýn sonuçlarý, CAPE’nin Nf-κβ ve iNOS enflamatuvar mediatörlerini baskýlayarak doku hasarýný engellediðini ettiðini açýkça göstermektedir. Ayrýca, CAPE’nin akciðer dokusunda koruyucu olduðunu ve terapötik bir ajan olarak kullanýlabileceðini göstermektedir.

BACKGROUND: Pulmonary contusion (PC) is an important life-threatening clinical condition characterized by lung injury and inflammation. Caffeic acid phenethyl ester (CAPE) is a biological agent with potent antioxidant and anti-inflammatory effects. This study aimed to investigate the potential effects of CAPE on tissue damage, nuclear factor kappa-beta (Nf-κβ) activity, inducible nitric oxide synthase (iNOS) synthesis, and pulmonary apoptosis in an experimental PC model.
METHODS: Forty adult Wistar albino rats were used in this study and divided into four groups as follows: control, PC, PC + CAPE, and CAPE. CAPE was administered intraperitoneally for seven days following PC formation (10 µmol/kg, dissolved in dimethyl sulfoxide). Wet/dry weight ratio in lung tissue was determined. The pulmonary tissue was examined using hematoxylin–eosin and Masson’s trichrome histochemical staining and also by scanning electron microscopy. Nf-κβ and iNOS activities in the lungs were determined by the indirect immunohistochemical method. Pulmonary apoptosis was detected by the TUNEL method.
RESULTS: Increased leukocyte infiltration score, pulmonary edema, alveolar damage, and increased Nf-κβ and iNOS activities were determined in the PC group. CAPE administration inhibited Nf-κβ and iNOS activities and pulmonary apoptosis.
CONCLUSION: In this study, the findings showed that CAPE inhibited tissue damage by suppressing inflammatory mediators of Nf-κβ and iNOS activities. Also, CAPE was found to be protective in the lung tissue and could be used as a therapeutic agent.

AMAÇ: Bu ileriye yönelik randomize çalýþmanýn amacý; akut kolesistitli (AK) hastalarda, hemen yapýlan laparoskopik kolesistektomi (LK) ameliyatý ile medikal tedavi altýnda geçiktirilerek yapýlan LK ameliyatýnýn sonuçlarýný kýyaslamaktýr. Ayrýca ameliyat öncesi serumda bakýlan oksidatif stres belirteçleri ile komplikasyon oranlarý arasýndaki ilgiyi ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu çalýþmaya AK tanýlý 64 hasta dahil edildi ve hastalar rastgele iki gruba ayýrýldý. Grup 1’deki (n=32) hastalara hemen LK uygulanýrken, grup 2’deki (n=32) hastalara medikal tedaviyi takiben geciktirilmiþ LK uygulandý. Tüm hastalar ilk yatýþlarýnda ameliyat edildi.
BULGULAR: Her iki grup arasýnda, komplikasyon, konversiyon oranlarý ve operasyon süreleri açýsýndan istatistiksel anlamlý fark yoktur (p>0.05). Ameliyat sonrasý hastanede yatýþ süresi grup 1’de istatistiksel olarak anlamlý oranda daha kýsa olarak belirlendi (1.75 ve 2.93 gün; p=0.024). Sadece total antioksidan durumu (TAS) belirteci, grup 1’de anlamlý olarak yüksek çýkmýþ (p=0.017) fakat bu durum komplikasyon oranlarý ile korele bulunmamýþtýr.
TARTIÞMA: Akut kolesistitli hastalarda, semptomlarýn baþlangýcýndan itibaren 72 saatten fazla zaman geçmesine raðmen, ilk baþvuruda kolesistektomi güvenli bulunmuþtur. Operasyon öncesi serum oksidatif stres belirteçleri ile komplikasyon oranlarý arasýnda korelasyon kurulamamýþtýr.

BACKGROUND: This prospective randomized study aims to compare outcomes between immediate laparoscopic cholecystectomy (LC) and same admission delayed LC in patients with acute cholecystitis and also to investigate the relation between oxidative stress markers and complication rates in the patients with AC.
METHODS: This study included 64 patients with AC who were randomly divided into two groups. Patients in Group 1 (n=32) were immediately administered LC, while in Group 2 (n=32) patients underwent transient LC following medical treatment. All patients were operated on their first hospitalization.
RESULTS: No statistically significant differences were observed between the groups for the comparison of complications, conversion rates, or operation durations (p>0.05). The length of postoperative hospital stay was found to be significantly shorter in group 1 compared to group 2 (1.75 vs 2.93 days; p=0.024). Only the total antioxidant status result was significantly higher in group 1 (p=0.017), but the finding was not correlated with complications.
CONCLUSION: LC for AC was performed during the first admission was found to be safe, even beyond 72 hours following symptom onset. Pre-operative oxidative stress markers did not correlate with the complication rates.

AMAÇ: Çalýþmamýzda giriþimsel sedasyon ve analjezi uygulanan hastalarda sedasyon derinliðini takip etmede EEG monitörizasyonu (Bispectral Index™, BIS) ile ‘Ramsey Sedasyon Skalasý’nýn (RSS) uyumluluðunu ve geliþebilecek komplikasyonlarý tanýmada kullanýlabilirliðini belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmamýzda olgularýn belirli aralýklarla BIS ve RSS deðerleri, geliþen komplikasyonlar ve yapýlan müdahaleler deðerlendirildi. BIS ve RSS deðerlerinin uyumluluðu deðerlendirildi. Komplikasyon görülen, görülmeyen olgularýn BIS deðerleri karþýlaþtýrýldý.
BULGULAR: Tüm zaman dilimlerindeki BIS ve RSS deðerlerinin ortalamalarý karþýlaþtýrýldýðýnda aralarýnda yüksek derecede korelasyon saptandý (r=-0.989, p<0.001). Komplikasyon görülen olgularda 15. dk’daki BIS deðerleri arasýnda istatistiksel anlamlý bir fark vardý (p=0.018). Olgular BIS deðeri <70 ve ≥70 olarak iki gruba ayrýldý. BIS <70 olan grupta daha fazla komplikasyon görüldü (p=0.037).
TARTIÞMA: Çalýþmamýzda RSS ve BIS monitörizasyonu aralarýnda yüksek derecede korelasyon saptandý. BIS monitörizasyonu, GSA takibinde rutin ve kiþi baðýmlý klinik skalalara alternatif, objektif bir monitörizasyon yöntemi olarak güvenle kullanýlabilir ve komplikasyonlarý erken tanýmada öncül bir gösterge olabilir.

BACKGROUND: This study aimed to investigate the compliance between electroencephalogram monitoring (Bispectral Index, BIS) and Ramsay Sedation Scale (RSS) to measure the depth of sedation in patients who underwent procedural sedation and analgesia (PSA) in an emergency department. This study also aimed to investigate the usefulness of this compliance for early diagnosis of complications.
METHODS: A total of 54 consecutive patients during PSA in the emergency department were included in this study. The BIS and RSS scores at regular intervals and also all complications and interventions of these patients were evaluated. The compliance between the BIS and the RSS score was evaluated. The BIS scores of cases with complication and without complication were compared.
RESULTS: The BIS and RSS scores exhibited a high correlation was detected between the average BIS and RSS scores at each time interval (r=-0.989, p<0.001). The BIS scores of the complicated and uncomplicated cases were different at 15 min after the procedure (p=0.019). The cases were divided into two groups according to the BIS scores <70 and ≥70; complication rates were higher in the BIS score <70 group during the procedure (p=0.037).
CONCLUSION: In our study, a high correlation was detected between BIS monitoring and RSS scores. BIS monitoring for PSA can be used as a full-time, objective, and an alternative technique for person-dependent clinical scales and also as an indicator for early diagnosis of complications.

AMAÇ: Akut pankreatit (AP), acil serviste sýk görülen bir enflamatuvar hastalýktýr. Bu çalýþmanýn amacý, acil servise baþvuru sýrasýnda biliyer ve non-biliyer AP’li hafif ve þiddetli AP hastalarýnda C-reaktif protein (CRP) ve hematolojik parametrelerin rolünü deðerlendirmektir.
GEREÇ VE YÖNTEM: Kontrol grubu olarak 100 hasta ve acil serviste AP tanýsý alan 168 hasta çalýþmaya dahil edildi. Kontrol grubunun ve AP hastalarýn demografik bilgileri (yaþ, cinsiyet), amilaz, lipaz, CRP, hematolojik parametreler (beyaz kan hücresi sayýmý [WBC], ortalama trombosit hacmi [MPV], kýrmýzý hücre daðýlým geniþliði [RDW], trombosit sayýmý [PLT], nötrofil-lenfosit oraný [NLR]) kaydedildi ve karþýlaþtýrýldý. Hastalar, AP etiyolojisine göre biliyer ve nonbiliyer grup olarak ayrýldý. Hastalýðýn þiddetine göre, hafif ve þiddetli AP olarak iki grup oluþturuldu, ayný parametreler deðerlendirildi.
BULGULAR: Hasta ve kontrol grubu arasýnda WBC, CRP, NLR, MPV ve PLT deðerleri arasýnda anlamlý fark bulundu (p<0.001). Ranson ve APECHE II skorlamasý WBC, CRP ve NLR ile korele idi. Hafif ve þiddetli AP gruplarý arasýnda, hastanede yatýþ süresi, CRP, WBC ve NLR deðerleri arasýnda istatistiksel olarak anlamlý bir fark vardý (CRP için p=0.003, diðerleri için p<0.001). Ciddi AP’de NLR’nin kestirim deðeri 8.05, sensitivite %93.48, spesifite %86.89 ve AUC: 0.937 olarak bulundu (p<0.001).
TARTIÞMA: Beyaz kan hücresi sayýmý, CRP ve NLR gibi parametrelerin acil serviste diðer diagnostik ve prognostik araçlarla birlikte kullanýlmasý, baþvuru ve prognoz sýrasýnda klinisyenlere kolaylýk saðlayabilir.

BACKGROUND: Acute pancreatitis (AP) is a common inflammatory disease in the emergency department (ED). This study aims to assess the role of CRP and hematologic parameters in mild/severe AP patients and biliary/nonbiliary AP at the time of admission to the ED.
METHODS: 168 patients who were diagnosed as AP in the ED, and as a control group, 100 patients were included in this study. At the time of application to the ED, the demographic information (age, sex) and the amylase, lipase, CRP, hematological parameters (WBC, MPV, RDW, PLT, NLR) of all patients and the control group were recorded and compared. According to the etiology of the patients, the patients were divided into biliary and nonbilary AP groups and according to the severity, they were divided into mild and severe AP groups, then, the same parameters were evaluated.
RESULTS: Significant differences were found out between WBC, CRP, NLR, MPV and PLT values between patient and the control group (p<0.001). The length of hospitalization and the parameters were not significant between the biliary and the nonbiliary group. Ranson and APACHE II scores were correlated with WBC, CRP and NLR. There was a statistically significant difference between the mild and severe AP groups in terms of duration of the hospital stay, CRP, WBC and NLR values (p=0.003 for CRP, p<0.001 for the others). In severe AP, the cut-off value of NLR was found to be 8.05, sensitivity %93.48, specificity %86.89 and AUC 0.937 (p<0.001).
CONCLUSION: The use of parameters, such as WBC, CRP, and NLR, in combination with other diagnostic and prognostic tools in emergency service can provide convenience to clinicians at the time of admission and prognosis.

AMAÇ: Bu çalýþma, majör yanýklý hastalarda erken dönem fizyoterapinin biyokimyasal parametreler üzerine etkisini araþtýrmak amacýyla planlandý.
GEREÇ VE YÖNTEM: Çalýþmaya, yaþlarý 21–47 arasýnda deðiþen 10 kadýn (%50), 10 erkek (%50) toplam 20 hasta alýndý. Çalýþmaya alýnan hastalar, tedavi ve kontrol gurubu olmak üzere iki gruba ayrýldý. Tedavi grubundaki hastalar, hastaneye yattýklarý ilk günden itibaren rutin tedavilerine (týbbi, cerrahi vs.) ek olarak haftada dört gün olmak üzere fizyoterapi programýna alýndý. Fizyoterapi programý; erken mobilizasyon ve ambulasyon eðitimi, pulmoner fizyoterapi, aktif ve pasif normal eklem hareketi egzersizleri gibi parametreleri içermekteydi. Tedavi günleri salý, çarþamba, perþembe ve cuma günü olarak belirlendi. Pazartesi ameliyat günü olduðundan hastalara tedavi yapýlamadý. Kontrol grubu, çeþitli nedenlerden dolayý fizyoterapi alamayan hastalardan oluþturuldu. Çalýþmaya dahil edilen tüm hastalarýn hastaneye yatýþlarýndan itibaren altý hafta boyunca haftalýk olarak deðerlendirmeleri yapýldý. Deðerlendirmede demografik bilgiler, yanýk hasarýnýn özellikleri, C-reaktif protein, fibronektin, transferrin ve prealbumin gibi parametrelere bakýldý.
BULGULAR: Çalýþmadan elde edilen sonuçlara bakýldýðýnda; tüm biyokimyasal parametrelerde tedavi grubu lehine anlamlý olduðu gözlendi (p<0.05). Prealbuminde tedavi grubunda ikinci haftadan itibaren anlamlý bir yükselme görüldü (p<0.05). Fibronektinde de tedavi grubunda dördüncü haftadan itibaren anlamlý bir artýþ gözlendi (p<0.05).
TARTIÞMA: Erken fizyoterapi yanýk tedavisinin önemli bir parçasýdýr. Majör yanýk sonrasý görülen hipermetabolik cevabýn etikisinin azaltýlmasýnda, erken dönem fizyoterapinin etkili olabileceði görüþündeyiz. Ancak çok merkezli ve daha geniþ çalýþmalara ihtiyaç vardýr.

BACKGROUND: This study sets out to investigate the effects of early physiotherapy on biochemical parameters in major burn patients.
METHODS: Ten women (50%) and 10 men (50%) aged 21–47 years old were included in this study. Participants were divided into two groups: the first group was the treatment group and the second group was the control group. In the treatment group, patients were admitted to the physiotherapy programme from the first day they have been hospitalised, in addition to their routine treatment (e.g. medical, surgery), for four days per week. The physiotherapy programme consisted of parameters, such as early mobilisation and ambulatory training, chest physiotherapy, and both active and passive normal joint movement exercises. The days of treatment were determined as of Tuesday, Wednesday, Thursday and Friday. Patients could not be treated on a Monday because that was surgery day. The control group consisted of patients who could not receive physiotherapy due to various reasons. All patients included in this study were evaluated weekly for six weeks after admission to the hospital. Parameters, such as demographic information, characteristics of burn injury, C-reactive protein, fibronectin, transferrin and prealbumin, were evaluated.
RESULTS: When the results obtained in this study were considered, there was a significant difference in favour of the treatment group for all biochemical parameters (p<0.05). From the second week, a significant increase was observed in prealbumin values in the treatment group (p<0.05). A significant increase was observed in fibronectin after the fourth week (p<0.05).
CONCLUSION: We believe that early physiotherapy should be included in the treatment in major burns. Early physiotherapy may reduce the effects of hypermetabolic response after major burns. There is a need for multi-centered and broader studies.

AMAÇ: Acil servise sað alt kadran aðrýsý ile baþvuran eriþkin hastalarda serum ürokinaz-tipi plazminojen aktivatör reseptörü (uPAR) düzeylerini ölçmek ve bu parametrenin akut apandisit (AA) tanýsýnda bir biyokimyasal belirteç olup olamayacaðýný araþtýrmayý planladýk.
GEREÇ VE YÖNTEM: Çalýþmaya Mayýs 2018–Aralýk 2018 tarihleri arasýnda acil servise baþvuran ve AA tanýsý konularak ameliyat edilen 18 yaþ ve üzeri hastalar dahil edildi. Çalýþmaya AA (Grup A) ile uyumlu cerrahi patoloji sonuçlarý olan 84 hasta, AA (Grup B) ile uyumlu olmayan cerrahi patoloji sonuçlarý olan 26 hasta ve 55 saðlýklý kontrol grubu dahil edildi. Hastalardan baþvuru anýnda alýnan venöz kan örneklerinden serum uPAR seviyeleri ölçüldü.
BULGULAR: Grup A’da ortalama uPAR düzeyleri 4.53±3.47 ng/mL, Grup B’de 1.13±1.63 ng/mL ve kontrol grubunda 0.80±1.21 ng/mL idi. Grup A hastalarýn serum uPAR düzeyinin Grup B ve kontrol gruplarýn serum uPAR düzeyleri ile karþýlaþtýrýlmasýnda istatiksel olarak anlamlý fark bulundu (p<0.05).
TARTIÞMA: uPAR, AA hastalarýnda kontrol grubu ve cerrahi olarak AA dýþý patoloji saptanan hastalara göre anlamlý olarak yüksek bulundu. Serum uPAR deðerleri eriþkin hastalarda AA tanýsýnda yardýmcý tetkik olarak kullanýlabilir.

BACKGROUND: To measure serum uPAR levels in patients operated with a preliminary diagnosis of acute appendicitis (AA) and to investigate whether these parameters can be used as a biochemical marker in the diagnosis of AA.
METHODS: Patients aged 18 or over, presenting to the emergency department between May and December 2018 and operated with a diagnosis of AA were enrolled. This study included 84 patients with surgical pathology results compatible with AA (Group A), 26 patients with surgical pathology results were not compatible with AA (Group B) and 55 healthy control groups. Serum uPAR levels were measured from venous blood samples taken at admission.
RESULTS: Mean uPAR levels were 4.53±3.47 ng/mL in the Group A, 1.13±1.63 ng/mL in the Group B and 0.80±1.21 ng/mL in the control group. Serum uPAR levels differed statistically significantly from Group A in Group B and the control group, (p<0.05).
CONCLUSION: uPAR was found to be significantly higher in the AA patients compared to the control group and patients with surgically determined non-AA pathologies. uPAR can be used as an aid in the diagnosis of acute appendicitis.

AMAÇ: Motosiklet kullanýmýnýn neden olduðu ispitli tekerlek yaralanmasýnýn görülme sýklýðý artmaktadýr. Bu yaralanmalar küçük yumuþak doku laserasyonundan yoðun ezilme yaralanmalarýna kadar uzanýr. Bu çalýþmanýn amacý ispitli tekerlek yaralanmalarýnýn mekanizmasýný, özelliklerini, insidansýný ve tedavisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çocuk cerrahisi acil servisinde Ocak 2014–Aralýk 2017 tarihleri arasýnda baþvuran, ispitli tekerlek yaralanmalarý ile baþvuran tüm çocuklarýn verileri analiz edildi. Tedavi planýyla birlikte yaralanma insidansý, mekanizmasý ve özellikleri kaydedildi. Takipteki hastalar deðerlendirilerek sonuç deðerlendirildi.
BULGULAR: Çalýþmaya alýnan toplam hasta sayýsý 120, yaralanmanýn insidansý ise %21.7 idi. Yaþ ortalamasý 8.03±2.28 yýl idi. Yüz bir adet yaralý erkek hasta mevcuttu. Hastalar ve yolcular motosiklete ata biner gibi oturuyorlardý. Hastalarýn çoðu ayakkabý giyiyordu ve esasen sað ayaðýn arka kýsmý yaralanmýþtý. Elli beþ (%45.8) hastada ikinci ve 55 (%45.8) hastada üçüncü derece yaralanma görüldü. Yirmi yedi hastada (%22.5) flep kullanýlmasý gerekti. Tüm hastalar ayaktan takip edildi.
TARTIÞMA: Bu tuzaklanma yaralanmalarýnýn insidansýnýn arttýðýna dikkat çekmekle birlikte farklý tedavi teknikleri kullanarak hastalarýmýzda tatmin edici sonuçlar aldýk. Bu kadar feci yaralanmalarý önlemek için güvenlik protokollerinin uygulanmasýný öneriyoruz.

BACKGROUND: The incidence of motorcycle-induced spoke wheel injury is on the rise in our set up. These injuries range from minor soft tissue laceration to extensive crush injuries. This study aimed to evaluate the mechanism, characteristics, incidence and management of wheel spoke injuries.
METHODS: Data of all children admitted to Pediatric Surgery Emergency from January 2014 to December 2017, presenting with wheel spoke injuries were analyzed. Incidence, mechanism and characteristics of injury, along with management plan, were noted. The outcomes were assessed by evaluating patients in follow up.
RESULTS: Total study patients were 120, with an incidence of 21.7%. Mean age was 8.03±2.28 years. There were 101male patients and nine female patients. All patients were passengers and were sitting astride. Most of the patients were wearing shoes, and hindfoot area of the right foot was mainly involved. Grade 2 injury was seen in 55 (45.8%) and Grade 3 in 55 (45.8%) patients. Flap was needed in 27(22.5%) patients. All patients were mobile at the time of the follow-up.
CONCLUSION: We noted the rising incidence of entrapment injuries; however, we had a satisfactory outcome in our patients using different management techniques. We recommend the implementation of safety protocols to avoid such catastrophic injuries.

AMAÇ: Fournier gangreni (FG) günlük üroloji pratiðinde çok nadir görülen bir hastalýktýr. Týbbi geliþmelere raðmen, FG’de mortalite hala yüksektir. Ýlave giriþimlerin ve mortalitenin düþürülmesi için erken taný çok önemlidir. Bu çalýþmada, on yýl süresince iki merkezde izlenen FG’li hastalarýn özelliklerini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Fournier gangrenli hastalarýn týbbi kayýtlarý geriye dönük gözden geçirildi. Hastalarýn özellikleri, etken patojenler, laboratuvar bulgularý ve tedavi yaklaþýmlarý deðerlendirildi.
BULGULAR: Ocak 2008–Þubat 2018 tarihleri arasýnda baþvuran 35’i erkek ve biri kadýn olmak üzere toplam 36 FG olgusu çalýþmaya alýndý. Hastalarýn yaþ ortalamasý 59.27±12.91 idi. Hastanede kalýþ süresi ortalama 19±10.44 gündü. En sýk predispozan faktör 28 hastada bulunan diyabetes mellitus idi. Ýki hastada prostat kanseri ve bir hastada kronik lenfoblastik lösemi olmak üzere üç hastada malignite saptandý. Ýki hastada karaciðer sirozu ve bir hastada da Behçet hastalýðý ve sedef hastalýðý vardý. Dokuz hastanýn yara kültüründen mikrobiyolojik etken izole edilmiþtir. Acil cerrahi debridman sonrasý nitrofurazone (Furacin) ile günlük pansuman yapýldý. Gerektiðinde ilave debridman gerçekleþtirildi. On hastaya orþiektomi uygulandý, bunlardan ikisi iki taraflý orþiektomi idi. Bir hasta hastaneye baþvurusunun yedinci gününde sepsis nedeniyle kaybedildi.
TARTIÞMA: Fournier gangreni yüksek mortalite oraný ile hayatý tehdit edici bir ürolojik acildir. Geniþ spektrumlu antibiyotikler ve acil cerrahi müdahale mortaliteyi önlemektedir.

BACKGROUND: Fournier’s gangrene (FG) is a very rare disease in daily urological practice. Despite medical improvements, mortality in FG is still high. Early diagnosis is very important to reduce additional instrumentations and mortality. In this study, we aimed to present the characteristics of the patients with Fournier’s gangrene followed in two centers during ten years period.
METHODS: The medical records of patients with FG were reviewed retrospectively. The patient characteristics, causative pathogens, laboratory findings and treatment modalities were evaluated.
RESULTS: A total of 36 FG cases admitted between January 2008 and February 2018 were included in this study, consisting of 35 male patients, and one female patient with a mean age of 59.27±12.91 years. The mean duration of hospital stay was 19±10.44 days. The most common predisposing factor was diabetes mellitus, which was found in 28 patients. Malignancy was detected in three patients; prostate cancer in two patients and chronic lymphoblastic leukemia in one patient. Two patients had liver cirrhosis, and one patient had Behcet’s disease and psoriasis. The microbiological agent was isolated from a wound culture in nine patients. After urgent surgical debridement, daily dressing with nitrofurazone (Furacin) was done. Additional debridement was conducted when necessary. Orchiectomy was performed in 10 patients; two of them underwent bilateral orchiectomy. One patient died because of sepsis on the seventh day of hospital admission.
CONCLUSION: FG is a life-threatening urological emergency with a high mortality rate. Treatment with broad-spectrum antibiotics and urgent surgery is pivotal for the prevention of mortality.

AMAÇ: Bu çalýþmada metilprednizolonun torakolomber bileþke (T10-L1) kýrýklarý ile beraber spinal kord yaralanmasý olan hastalarda nörolojik sonuçlarýna etkisi deðerlendirildi.
GEREÇ VE YÖNTEM: Eylül 2008–Ocak 2015 aylarý arasýnda torakolomber bileþke kýrýðý nedeniyle ameliyat ettiðimiz 182 hastanýn bilgileri geriye dönük olarak deðerlendirildi. Hastalar iki gruba ayrýldý. Grup 1; erken cerrahi ile beraber metilprednizolon tedavisi uygulanan grup iken, Grup 2; metilprednizolon tedavisi verilmeyen sadece erken cerrahi uygulanan gruptu. Hastalarýn ilk baþvuruda ve son muayene kayýtlarýna göre motor indeks skorlarý Amerikan Spinal Yaralanma Birliði (ASIA) skalasýna göre deðerlendirildi. Sonuçlar istatistiki olarak karþýlaþtýrýldý.
BULGULAR: Grup 1’de ortalama takip süresi 14.4±1.4 iken Grup 2’de 13.6±1.7 idi. Hastalarýn baþlangýçta ve son muayene kayýtlarýnda ASIA skorlarý benzerdi (p>0.05). Komplikasyon oraný ise Grup 1’de belirgin þekilde yüksekti (p<0.05).
TARTIÞMA: Bulgularýmýza göre spinal kord yaralanmasý olan hastalarda steroidin nörolojik sonuçlar üzerine belirgin faydalý etkisi yoktur ve yan etkisiyle komplikasyon oranýný arttýrmaktadýr.

BACKGROUND: In this study, we aim to evaluate the potential effects of methylprednisolone on the neurological outcome of spinal cord injury (SCI) patients with thoracolumbar junction (T10-L1) spine fractures.
METHODS: The data from 182 SCI patients who sustained a thoracolumbar junction spine fracture were operated by us between September 2008 to January 2015 were analysed retrospectively. The patients were divided into two groups: Group 1 underwent methylprednisolone treatment in conjunction with early surgical intervention, while group 2 underwent only early surgical intervention without methylprednisolone treatment. American Spinal Injury Association (ASIA) motor index scores of the patients were evaluated and compared with statistical methods at admission and at the first-year follow-up.
RESULTS: The main follow-up period was 14.4±1.4 months in group 1 and 13.6±1.7 months in group 2. Initial and last follow-up ASIA scores of the patients were similar between groups (p>0.05), but the complication rate was significantly high in group 1 (p<0.05).
CONCLUSION: The findings showed that steroids have no significant beneficial effects on the neurological outcome but have significant side effects and leads to increased complication rate in SCI patients.

AMAÇ: Pelvik yaralanmalarýn büyük çoðunluðu yaþamý tehdit etmemesine raðmen, iliþkili yaralanmalarýn heterojen doðasý sebebiyle, açýklýða kavuþmasýna ihtiyaç vardýr. Bu çalýþmanýn amacý, kapalý pelvik travmalý hastalarda iliþkili pelvik ve ekstra pelvik organ yaralanmalarýný araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, acil servise pelvik kýrýk tanýsý ile baþvuran 471 eriþkin hasta ile yapýldý. Kýrýk tipi, eþlik eden viseral organ yaralanmalarý, demografik veriler, operasyon þekli, mortalite oranlarý kaydedildi ve istatistiksel olarak analiz edildi.
BULGULAR: AO sýnýflamasýna göre genel cerrahi kliniði veya diðer cerrahi klinikler tarafýndan yapýlan operasyonlarýn oraný istatistiksel olarak farklýlýk göstermemiþtir (p=0.118). A0-A2, A3 ve B1 kýrýk tiplerinde, genel cerrahi kliniðinin operasyon oraný anlamlý bir farklýlýk göstermemiþtir. Bununla birlikte, ekstrapelvik cerrahi geçiren hastalarýn çoðu AO A2 ve A3 gibi hafif þiddetteki pelvik travmalý hastalardý. Toplamda 31 hasta hayatýný kaybetti, bunlarýn 17’si AO-A2 tipi kýrýðý olan hastalardý. Ortopedi dýþý ameliyat olanlar ile normal abdominal ultrasonografi sonuçlarý arasýnda anlamlý bir fark olduðu saptandý (p<0.001). Yapýlan tüm tip ameliyatlar ve normal abdominal bilgisayarlý tomografi sonuçlarý arasýnda (p=0.215) anlamlý bir fark yoktu.
TARTIÞMA: Pelvis kýrýðý olan hastalarýn yönetiminde, türüne ya da evresine bakýlmaksýzýn, iliþkili yaralanmalarýn gözden kaçýrýlmamasýna dikkat edilmelidir. Hastanýn hemodinamik durumu stabilize edildikten sonra erken kan ve görüntüleme testleri yapýlmalýdýr.

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures.
METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically.
RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215).
CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient’s hemodynamic status is stabilized.

AMAÇ: Pnömomediastinum (PM) mediastende hava varlýðýný tanýmlayan terimdir. Ayrýca mediastinal anfizem olarakta tanýmlanmýþtýr. PM, spontan PM (SPM) ve sekonder PM (ScPM) olarak adlandýrýlan iki alt gruba ayrýlýr.
GEREÇ VE YÖNTEM: Þubat 2010 ve Temmuz 2018 arasýnda taný konulan PM’nin karþýlaþtýrmalý geriye dönük bir çalýþmasý sunuldu. Kýrk hasta karþýlaþtýrýldý. Hasta öyküsü, fiziksel özellikleri, semptomlarý, muayene bulgularý, hastanede kalýþ süresi, tedavileri, klinik süreci, nüks ve komplikasyonlarý ile ilgili klinik veriler dikkatli bir þekilde araþtýrýldý. SPM, travmatik PM (TPM) ve iyatrojenik PM (IPM) olan hastalar karþýlaþtýrýldý.
BULGULAR: SPM 14 hastada (%35) tespit edildi. ScPM grubunda; 16 hastada (%40) TPM, 10 hastada (%25) iyatrojenik PM tespit edildi. SPM grubunda en sýk bildirilen semptomlar göðüs aðrýsý, dispne, subkütanöz amfizem ve öksürük idi. Tanýyý doðrulamak ve olasý bulgularý deðerlendirmek için tüm hastalara BT uygulandý. Tüm hastalara mediastiniti önlemek için profilaktik antibiyotik reçete edildi.
TARTIÞMA: Bu çalýþmanýn temel amacý, travma ve travma dýþý hastalardaki PM’lerin klinik farklýlýklarýný ve yönetimini deðerlendirmektir. Pnömomediastinumun klinik spektrumu, benign mediastinal anfizemden mediastinal yapýlarýn perforasyonu nedeniyle ölümcül bir mediastinite kadar deðiþebilir. Birçok çalýþmada sadece SPM pek çok açýdan deðerlendirilmiþtir, ancak travmatik ve travmatik olmayan PM’lerin deðerlendirmesini ve yönetimini karþýlaþtýran daha az çalýþma vardýr. Sadece toraks bölgesine sýnýrlý travma geçiren ve görüntüleme çalýþmalarýnda mediastinal organ hasarý olmadýðý gösterilen TPM’li hastalar, mediastinal organ yaralanmasýna sahip olmayan SPM hastalar gibi takip ve tedavi edilebilir.

BACKGROUND: Pneumomediastinum (PM) is the term which defines the presence of air in the mediastinum. PM has also been described as mediastinal emphysema. PM is divided into two subgroups called as Spontaneous PM (SPM) and Secondary PM (ScPM).
METHODS: A retrospective comparative study of the PM diagnosed between February 2010 and July 2018 is presented. Forty patients were compared. Clinical data on patient history, physical characteristics, symptoms, findings of examinations, length of the hospital stay, treatments, clinical time course, recurrence and complications were investigated carefully. Patients with SPM, Traumatic PM (TPM) and Iatrogenic PM (IPM) were compared.
RESULTS: SPM was identified in 14 patients (35%). In ScPM group, TPM was identified in 16 patients (40%), and IPM was identified in 10 patients (25%). On the SPM group, the most frequently reported symptoms were chest pain, dyspnea, subcutaneous emphysema and cough. CT was performed to all patients to confirm the diagnosis and to assess the possible findings. All patients prescribed prophylactic antibiotics to prevent mediastinitis.
CONCLUSION: The present study aimed to evaluate the clinical differences and managements of PMs in trauma and non-trauma patients. The clinical spectrum of pneumomediastinum may vary from benign mediastinal emphysema to a fatal mediastinitis due to perforation of mediastinal structures. In most series, only the SPM was evaluated in many aspects, but there are fewer studies comparing the evaluation and management of traumatic and non-traumatic PMs. The patients with TPM who have limited trauma to the thorax and who do not have mediastinal organ injury in their imaging studies can be followed up and treated like SPM patients who do not have mediastinal organ injury, and both have good clinical course.

AMAÇ: Bu çalýþmanýn temel amacý, fitobezoarýn neden olduðuý ileus ile ilgili klinik sonuçlara dayanan tedavi stratejilerini tartýþmaktýr.
GEREÇ VE YÖNTEM: Aralýk 2012 ve Aralýk 2018 yýllarý arasýnda fitobezoar tanýsý alan toplam 25 hasta geriye dönük olarak deðerlendirildi. Farklý seviyelerde gastrointestinal (GI) týkanýklýða yol açmýþ fitobezoarlara baðlý akut mekanik baðýrsak obstrüksiyonu olan hastalar çalýþmaya alýndý. Hastalarýn klinik verileri (klinik bulgular, laboratuvar sonuçlarý, radyolojik deðerlendirmeler, tedavi yöntemleri) deðerlendildi.
BULGULAR: Çalýþmaya 25 hasta dahil edildi. Yirmi beþ hastanýn 13’ü kadýndý (%52). Ortanca yaþ 60 (31–84) yýldý ve toplam ortanca kalýþ süresi yedi (2–28) gündü. On üç hastada (%72) geçirilmiþ abdominal cerrahi olduðu tespit edildi. Ýki hasta (%8) konservatif olarak takip edildi, 20 (%80) hastaya cerrahi müdahale gerekti. Bir hastaya (%4) önceki endoskopik giriþim ile parçalanan bezoar parçalarý yüzünden oluþan distal ileal obstrüksiyon nedeniyle cerrahi giriþim uygulandý. Ameliyat sonrasý dönemde hastalarýn üçünde cerrahi alan enfeksiyonu, yara ayrýlmasý ve ameliyat sonrasý ileus gibi komplikasyonlar geliþtiði saptandý. Sadece milking yapýlan grup ile gastrotomi/enterotomi gruplarý arasýnda hastanede yatýþ süresi ve ameliyat sonrasý komplikasyonlar açýsýndan fark olmadýðý saptandý. Bir hasta ameliyat sonrasý 13. günde çoklu organ yetersizliði nedeniyle öldü. Mortalite oraný %4 olarak saptandý.
TARTIÞMA: Fitobezoar kaynaklý akut mekanik baðýrsak týkanýklýðý ile baþvuran seçilmiþ olgularda konservatif yaklaþým uygulanarak, önemli cerrahi müdahale gerekmeksizin uygun klinik iyileþme saðlanabilir. Ancak konservatif tedaviye yanýt alýnamayan olgularda cerrahi tedavi mutlaka göz önünde bulundurulmalýdýr. Enterotomi yapýlan baðýrsak segmentinin dikkatlice seçilmesi güvenli cerrahi için önemlidir.

BACKGROUND: This study aims to discuss management strategies regarding phytobezoar induced ileus based upon clinical results.
METHODS: In the present study, between December 2012 and December 2018, a total of 25 patients who were diagnosed with phytobezoar were evaluated retrospectively. Patients who had acute mechanical intestinal obstruction due to phytobezoars at different segments of gastrointestinal (GI) tract were included in this study. The clinical data (such as clinical findings, laboratory results, radiological evaluations, treatment methods) of the patients were examined.
RESULTS: Twenty five patients were included in this study. Of the 25 patients, 13 were women (52%). The median age was 60 (31–84) years, and the overall median length of the stay was 7 (2–28) days. Previous abdominal surgery had been recorded for 13 patients (72%). Two patients (8%) were followed up conservatively, whereas 20 (80%) patients had needed surgical intervention. One (4%) patient underwent surgery for distal ileal obstruction due to the pieces of bezoar that crumbled with previous endoscopic intervention. Three of the patients had complications, such as surgical site infection, wound dehiscence and paralytic ileus in the postoperative period. There were no differences between milking and gastrotomy/enterotomy groups according to the length of stay and postoperative complications. One patient died on the 13th postoperative day due to multi-organ failure. The mortality rate was 4%.
CONCLUSION: Phytobezoars, which are common with many other different surgical entities, can be located at any segment of the gastrointestinal tract and may cause obstruction, strangulation and/or even perforation. Contrast-enhanced CT scan must be performed in case of suspicion and to rule out any other causes of acute mechanical intestinal obstruction. Conservative and endoscopic procedures may be useful for selected patients, but the surgical treatment may be needed for the vast majority of the patients with phytobezoar. The surgery is safe for phytobezoar if the enterotomy site is chosen wisely.

AMAÇ: Bu çalýþmanýn amacý, kliniðimizde akut apandisit tanýsýyla apendektomi yapýlan ve histopatolojik inceleme sonucunda apendiks karsinoid tümörü tespit edilen hastalara ait verilerimizi sunmaktýr.
GEREÇ VE YÖNTEM: Ocak 1999–Eylül 2018 tarihleri arasýnda akut apandisit ön tanýsý ile apendektomi yapýlan hastalar içinden histopatolojik olarak apendiks karsinoid tümörü tespit edilen hastalarýn sonuçlarý geriye dönük olarak incelendi.
BULGULAR: Bu tarihler arasýnda toplam 2778 hastaya akut apandisit tanýsý ile apendektomi yapýldý. On iki (%0.43) hastada apendiks karsinoid tümörü tespit edildi. Dört (%33.3) hasta erkek, sekiz (%66.7) hasta ise kadýndý. Medyan yaþ 37.5 yýl (21–60) idi. Medyan tümör çapý 0.7 cm (0.1–2.5) idi. Hiçbir hastada perfore apandisit gözlenmedi. On bir (%91.7) hastaya sadece apendektomi yapýlýrken, bir (%8.3) hastaya sað hemikolektomi yapýldý. Medyan takip süresi 41.5 ay (22–49) olup hiçbir hastada nüks izlenmedi.
TARTIÞMA: Apendiks karsinoid tümörleri oldukça nadir görülürler. Genellikle semptomsuz seyreder. Taný çoðunlukla akut apandisit nedeniyle apendektomi yapýldýktan sonra histopatolojik incelenme sonucu, insidental olarak konulur. Apendiks karsinoid tümörlerinin tedavisi tümör boyutu, yerleþim yeri, lenfovasküler ve mezoapendiks invasyon varlýðý, mitotik aktivasyon oraný ve Ki67 seviyesi ile doðrudan iliþkili olduðundan patoloji sonuçlarýnýn takip edilmesi son derece önemlidir.

BACKGROUND: We aim to present the data of patients who underwent appendectomy due to acute appendicitis, and incidental carcinoid tumor was detected on pathology.
METHODS: Retrospective analysis of the patient charts between January 1999 and September 2018 were performed.
RESULTS: 2778 appendectomy was performed due to acute appendicitis. Appendiceal carcinoid tumor was detected in 12 (0.43%) patients. Eight patients were (66.7%) female. Median age 37.5 years (range: 21–60). The median tumor size was 0.7 cm (range: 0.1–2.5). No perforation was detected. Eleven patients underwent appendectomy, and one patient had right hemicolectomy. The median follow-up period was 41.5 months (range: 22–49). There were no recurrences.
CONCLUSION: Appendix carcinoid tumors are quite rare, usually asymptomatic and diagnosed incidentally on histopathological examination after appendectomy. The treatment of carcinoid tumors of the appendix is directly related to the tumor size, localization, presence of lymphovascular and mesoappendix invasion, mitotic activation rate and level of Ki67. Thus, it is important to follow the histopathological results after appendectomy. The prognosis of appendix carcinoid tumors is very good if the appendix is non-perforated.

AMAÇ: Yüksek enerjili travmalar dünya çapýnda yaygýn karþýlaþýlan olaylardýr. Politravma olgularýnda gözden kaçan boyun kýrýklarýnýn oraný da yüksektir. Daha önce yapýlan çalýþmalar artiküler (eklem içi) kalça patolojilerinin, özellikle de boyun kýrýklarýnýn femoral þaft kýrýklarý ile iliþkili olduðunu göstermiþtir. Bu çalýþmanýn amacý travmatik femoral þaft kýrýðýný takiben eklem içi kalça patolojisi olgularýný tanýmlamaktýr. Bu çalýþmanýn araþtýrma sorusu “Femur þaft kýrýklarýndan sonra femur boynu kýrýlmayan hastalarýn kalça eklemlerinde ne oluyor?” dur.
GEREÇ VE YÖNTEM: Femur þaft kýrýðý tanýsý konan ve ameliyat edilen hastalar (intramedüller fiksasyon veya plak uygulamasý) çalýþmaya alýndý. En az altý ay takip edilen ve desteksiz baðýmsýz yürüme yeteneðine sahip hastalar AO/OTA kýrýk sýnýflamasýna göre gruplandýrýldý. Hastalara derin anterior kasýk aðrýsý soruldu ve belirtilen þikayetleri olan hastalar aranarak fizik muayene ve kalça görüntüleme (X-ray ve manyetik rezonans artrografi [MRA]) yapýldý.
BULGULAR: Ýki hastada labral yýrtýk tespit edildi. MRA ile femur boynu osseöz bump 16 kalçadan üçünde bulundu. Gluteal tendinosis veya gözyaþý ve herniasyon pit (çukurunun) varlýðýnýn deðerlendirilmesi, 16 kalçadan üçünde tespit edilmiþtir. Bir hastada osteofit varlýðý belirlendi. MRA ile, 16 kalçadan üçünde birden fazla tipte intra-artiküler (eklem içi) patoloji tanýmlandý. Femur boynu osseöz bumpý olan iki hastaya da herniasyon pit olarak ek kalça patolojisi tanýsý konuldu.
TARTIÞMA: Femur þaft kýrýðý öyküsü olan hastalarda kasýk önü aðrýsý her zaman implantlarla iliþkili deðildir. Ortopedik cerrahlar, þiddetli alt ekstremite travmasý sonrasý kalýcý kalça aðrýsý olan hastalarda eklem içi kalça patolojilerinden þüphelenmelidirler.

BACKGROUND: High-energy traumas are common occurrences worldwide. The rate of overlooked neck fractures in polytrauma cases is also high. Previous studies have shown that articular hip pathologies, particularly neck fractures, are associated with fractures of the femoral shaft. This study sets out to describe cases of intra-articular hip pathology following traumatic femoral shaft fracture. Thus, the present study aims to investigate the relationship between ipsilateral hip pain and femoral shaft fractures.
METHODS: Patients who were diagnosed with a fracture of the femur shaft and who were operated on (intramedullary fixation or plate) were included in this study. Patients with pathologic fractures, femoral neck fractures, femoral intertrochanteric fractures, or pelvic fractures were excluded. Patients with at least six months of follow-up and who were capable of independent walking without support were grouped according to AO/OTA fracture classification. Patients were questioned for deep anterior groin pain, and physical examination tests and hip imaging (X-ray and MR arthrography) were performed by calling patients with the indicated complaints.
RESULTS: The presence of labral tears were noted in two patients. The incidence of osseous bump of the femoral neck identified by MR arthrography (MRA) was found in three of 16 hips. Assessment of the presence of gluteal tendinosis or tear and herniation pit identified three of 16 hips. The presence of osteophytes was noted in one patient. MRA identified three of 16 hips with more than one type of intra-articular pathology. Two patients with an osseous bump of the femoral neck were also diagnosed with additional hip pathology as herniation pit.
CONCLUSION: Anterior groin pain in patients with a history of femoral shaft fracture is not always related to implants. Orthopedic surgeons should become suspicious in cases of intra-articular hip pathology in patients who have persistent hip pain after severe lower extremity trauma.

AMAÇ: Bu araþtýrma, aðýr yanýk hastalarýnýn tedavisinde deri eþdeðeri, Nevelia®’nýn etkinliðini ve güvenliðini geriye dönük olarak deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Mayýs 2017–Mayýs 2018 tarihleri arasýnda çalýþmamýza 20 aðýr yanýklý hasta alýndý. Eskarektomiden sonra yara tedavi protokolü iki aþamalý bir prosedürle uygulandý. Deri eþdeðeri implantasyonunu kýsmi kalýnlýkta deri grefti takip etti. Ameliyat ihtiyacý, komplikasyonlar, hastanede kalýþ süresi ve genel saðkalým analiz edildi.
BULGULAR: Yaþ ortalamasý 40.1±4 (18–86), kadýn/erkek: 5/15 idi. Ortalama yanma yüzey alaný %50.1±2 (daðýlým, 25–96) idi. Yanýk travmalarýnýn ve yandaþ hastalýklarýnýn ciddiyeti nedeniyle iki hasta kaybedildi. Olgularda greft, Nevelia®’uygulamasýndan ortalama 21.2 gün sonra yapýldý. Nevelia® kaynaklý herhangi bir komplikasyon geliþmedi. Hastalar ortalama 55.2±4 günde taburcu edildi.
TARTIÞMA: Bu çalýþma Nevelia®’nýn düþük komplikasyon oranlarý ve kýsa hastanede yatýþ süresi ile aðýr yanýk hastalarýnda güvenli ve etkili bir þekilde kullanýlabileceðini göstermiþtir.

BACKGROUND: This research aims to retrospectively evaluate the effectiveness and safety of dermal substitute (DS), Nevelia®, for the treatment of severely burned patients.
METHODS: Twenty severely burned patients were enrolled in this study between May 2017 and May 2018. After escharotomy of the wound, the treatment protocol was applied following a two-step procedure –DS implantation followed by split-thickness skin graft (STSG) application. Need for surgery, complications, hospitalisation duration and overall survival were analysed.
RESULTS: Mean age was 40.1±4 (18–86) years old; female/male: 5/15. Mean burn surface area was 50.1%±2 (25–96). Two patients died under hospital treatment due to the severity of their burn trauma and comorbidities. For the rest of the cases, STSG was performed after Nevelia® at mean 21.2 days. No complications due to Nevelia® were detected. The patients were discharged with a mean total recovery of 55.2±4 days.
CONCLUSION: This study showed that Nevelia® can be used safely and effectively in severely burned patients with low complication rates and short hospital stay.

Kaza sonucu oluþmayan yaralanma (KSOY) dünya ölçeðinde sýk görülmeyen bir sorun olup bebeklerde önemli morbidite ve mortaliteye yol açmaktadýr. Klinik öyküyle uyumlu olmayan retina veya subdural kanamalarýn veya ensefalopatinin varlýðý yüksek olasýlýkla KSOY’yi düþündürür. Bu çalýþmada acil servise çok hýzlý baþlangýçlý yinelenen generalize tonik-klonik nöbetlerle gelen üç aylýk bir bebeði raporluyoruz. Travma öyküsü veya dýþardan görünür belirti yoktu. Kýz bebekte iki taraflý subdural kanamalar ve atipik tek taraflý iskemik retinopati saptanmýþtýr. Retinal fotokoagülasyon uygulamasý sonucu vitröz ve retina kanamalarýnýn kaybolduðu görülmüþtür. Ancak bu gözde görme pek geri dönmemiþtir. Bulgular, intrakranyal kanama ve tek taraflý retina kanamalarý olan bebeklerde yüksek olasýlýkla KSOY’den kuþkulanýlmasý gerektiðini göstermiþtir.

Non-accidental injury (NAI) is not an uncommon problem worldwide, which leads to significant morbidity and mortality in infants. The presence of retinal or subdural haemorrhages, or encephalopathy with injuries inconsistent with the clinical history is highly suggestive of NAI. In this study, we report on a case of a a 3-month-old infant who presented to the casualty department with a very sudden onset of recurrent generalised tonic-clonic seizures. There was no history of trauma or visible external signs. She was found to have bilateral subdural haemorrhages and atypical unilateral ischaemic retinopathy. Retinal photocoagulation was performed with subsequent resolution of vitreous and retinal haemorrhages. However, visual recovery in that eye remained poor. The findings showed that a high index of suspicion of NAI is required in infants with intracranial haemorrhage and unilateral retinal haemorrhages.

Heterotopik mezenterik ve/veya omental ossifikasyon, karýn boþluðunda görülen kemik benzeri bir lezyondur. Bu nadir rastlanan klinik tablonun etiyolojisi belirsizdir, ancak bu hastalarýn çoðunda künt veya penetran abdominal travma veya cerrahi komplikasyonlar nedeniyle çoklu cerrahi giriþim öyküsü vardýr. Ýntraabdominal heterotopik ossifikasyon semptomsuz olabileceði gibi baðýrsak týkanýklýðý semptomlarýna veya baðýrsak perforasyonu gibi ciddi bir komplikasyona neden olabilir. Kemikleþme benzeri oluþumlar, nadir görülmesi nedeniyle, bazen gözden kaçabilmekte ya da yanlýþ teþhis edilerek intraabdominal malignite veya opak kaçaðý ile karýþtýrýlabilmektedir. Bu sebeple cerrahlar, bu olaðandýþý tabloyu özellikle daha önceden geçirilmiþ bir abdominal cerrahi öyküsü olan hastalarda akýllarýnda bulundurmalýdýr. Bu yazýda, ateþli silah yaralanmasý nedeniyle çok sayýda abdominal cerrahi iþlem geçiren 41 yaþýnda bir erkek hastada rastlantýsal olarak karþýlaþýlan heterotopik mezenterik ve omental ossifikasyon olgusunu sunuyoruz.

Heterotopic mesenteric and/or omental ossification is an uncommon bone-like lesion located inside the abdominal cavity. Its etiology is unclear, but most of the patients with this rare disease had a history of a blunt or penetrating abdominal trauma or multiple surgical operations owing to surgical complications. Heterotopic mesenteric and/or omental ossification may be asymptomatic or may present with symptoms of bowel obstruction or cause a severe complication, such as bowel perforation. Due to its rarity, intra-abdominal ossification may sometimes be overlooked or misdiagnosed. However, the surgeon should be aware of this unusual condition, particularly in patients with a previous surgical history. In this study, we present a case of heterotopic mesenteric and omental ossification incidentally found in a 41-year-old man with multiple abdominal surgical operations because of a gunshot injury.