Yoðun bakýmdaki hastanýn kompleks tedavi süreci, ciddi oranda verilere baðýmlý durumlar nedeniyle dikkatle izlenmelidir. Yoðun bakým hekimliði, diðer branþlara oranla sayýlarla çok daha fazla iç içe olmayý gerektirdiðinden, bu verilerdeki ufak hatalar dahi hastalar üzerinde ciddi hasarlar býrakabilecek önemli hatalara sebep olabilmektedir. Týbbi kayýtlarýn elle tutulmasý hataya eðilimi arttýrdýðý gibi hem bu kayýtlarý tutan hemþireler hem de verileri analiz eden hekimler için anlamlý ölçüde zaman alan bir durumdur. Bu durum hastalýk sürecinin karmaþýklaþmasý ve yatýþ süresinin uzadýðý durumlarda çok daha belirgin hale gelmektedir. ENIAC (Electronic Numerical Integrator and Computer) isimli ilk bilgisayarýn 1946’da ortaya çýkmasýnýn ardýndan bilgisayarlarý týp pratiðine entegre etmeye yönelik birçok giriþim olmuþtur ve son yýllarda da yoðun bakým yazýlýmlarýnýn ortaya çýkýþýna þahit olmaktayýz. Bu yazýlýmlar týbbi kayýtlarýn doðruluðunu ve kalitesini arttýrma ve medikal hatalarýn görülme sýklýðýný azaltma potansiyeline sahip olduklarý gibi elektronik karar desteði sunmakta; kalite kontrol ve performans deðerlendirmesi gibi alanlar için de araçlar içermektedirler. Daha da önemlisi, bu sistemler hastanýn anlýk durumunu deðerlendirme gayretindeki hekimlere farklý bakýþ açýlarýyla yaklaþabilmesi yönünde bir ortam sunabilirler. Günümüze kadar yoðun bakým yazýlýmlarýnýn kullanýmý, yüksek finansal maliyetler ve diðer bir takým faktörler nedeniyle kýsýtlý kalmýþtýr. Günümüzde her ne kadar teknolojik yönden ileri bir konumda olsak dahi bir yoðun bakým yazýlýmýnýn etkin bir þekilde kullanýma sunulmasý zorlu ve düzgün planlanmadýðý takdirde anlamlý gecikmelere, ek finansal maliyetlere, ekip içerisinde kabulleniþe yönelik zorluklara ve hatta tamamen baþarýsýzlýða mahkum bir süreçtir. Bu yazýda, yoðun bakým yazýlýmlarýnýn geçmiþini, günümüzdeki halini ve geleceðini deðerlendirdiðimiz gibi bu yazýlýmlara geçiþ sürecinde kendi yaþadýðýmýz deneyimleri de paylaþacaðýz.

In the continuum of the complex therapy process of a critically ill patient, the intensive care unit (ICU) period must be followed very meticulously because of the extremely data-intensive circumstances. Intensive care medicine is a lot more reliant on “numbers” than most of the other medical disciplines, and minor errors in the records may lead to wrong decisions, which may cause major harm to the patient. Manual records are prone to errors, inaccuracies and are time-consuming for both nurses maintaining them and physicians trying to interpret them, especially in patients with complex pathologies and long-term stays. Since the introduction of the first general-purpose computer, ENIAC (Electronic Numerical Integrator and Computer) in 1946, there have been attempts to integrate computers into medicine and in the last decades, we are witnessing the emergence of intensive care information systems (ICIS). ICIS has the potential to increase the quality and accuracy of the medical records, while also decreasing the incidence of medical errors. They present electronic decision support and tools for quality control and performance evaluation. More importantly, they allow a medium where the physician can easily assess the current condition of the patient from different perspectives. So far, the usage of ICIS has been limited due to high costs and some other factors. Although we are in a technologically advanced position today, it is still a challenge to implement an ICIS successfully. If not planned properly, it is a process prone to significant delays in time, additional costs, poor acceptance by the staff and even total failure. In this study, we are going to evaluate the past, present and future of intensive care information systems and share our experiences in implementing them.

AMAÇ: Sepsis, enfeksiyona karþý konaðýn göstermiþ olduðu disregüle yanýta baðlý geliþen hayatý tehdit edici bir organ disfonksiyonu olarak tanýmlanabilir. Sepsiste, koagülasyon kaskatý aktive olur ve denge prokoagülan tarafa doðru kayar. Protein C’nin sepsis tedavisinde kullanýmýný araþtýran yakýn tarihli çalýþmalar mevcuttur. Ayrýca diðer bir terapötik ajan olan triiyodotironin hakkýnda da çalýþmalar yapýlmýþtýr.
GEREÇ VE YÖNTEM: Çalýþmamýzda sepsis oluþturulmuþ sýçanlarda geç dönemde tek doz aktive protein C ve triiyodotironin uygulamasýnýn etkileri karþýlaþtýrýldý. Uygulama sonrasý 24. saatte lökosit, platelet, hemoglobin ve antitrombin-III konsantrasyonlarý ile ince baðýrsak, karaciðer ve akciðerdeki histopatolojik deðiþiklikler deðerlendirildi.
BULGULAR: Intraperitoneal tek doz rekombinant insan APC (aktive protein C) uygulamasýnýn geç fazda hematolojik parametrelerde küratif etkileri olduðu ve baþta akciðer olmak üzere hepatik ve ince barsak dokusunda da anlamlý terapötik etkilerinin olabileceði görülmüþtür. Triiyodotironin ise sepsis tedaivisnde kullanýlabilecek önemli bir terapötik ajan olarak deðerlendirildi.
TARTIÞMA: Çalýþmamýzda T3 hormonunun özellikle akciðer dokusu olmak üzerre karaciðer ve ince baðýrsak dokusu üzerinde sepsis baðlý hasarý sýnýrladýðý veya azalttýðý gözlenmiþtir. Triiyodotironin daha az maliyet ve kanama riskiyle sepsis tedavisinde APC’ye iyi bir alternatif olabileceði kanaatinedeyiz.

BACKGROUND: Sepsis can be defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. In sepsis, the coagulation cascade is activated and the balance shifts to the procoagulant side. Recently, the use of protein C is proposed for the treatment of sepsis. Another therapeutic agent that has been intensively studied is tri-iodothyronine.
METHODS: This study aimed to compare the effects of activated protein C and tri-iodothyronine, which are administered at a single dose to sepsis-induced rats at the late phase. Leukocyte, platelet, hemoglobin and antithrombin-III concentrations and histopathological changes in the small intestine, liver and lung were evaluated at 24 hours.
RESULTS: Single-dose intraperitoneal recombinant human APC (activated protein C) has a partial curative effect on hematological parameters in the late phase, while it is possible to state that it has significant therapeutic effects on hepatic and intestinal tissues, but more remarkably on the lung tissue. Tri-iodothyronine is also considered to be used for the treatment and has a strong potential to be a therapeutic agent.
CONCLUSION: We observed that the T3 hormone has significantly limited and reduced the sepsis-related damage to hepatic and intestinal tissues, but especially the lung tissue. Tri-iodothyronine can be a good alternative to APC, which is partially allowed due to high cost and complication of bleeding in the treatment of sepsis.

AMAÇ: Diz fleksiyon ve ekstansiyon pozisyonundayken, medial ve lateral menisküslerin anterior, orta ve posterior boynuz yýrtýklarýnýn içten-dýþa onarým tekniði sýrasýnda tamir edilmesi için iðnelerin peroneal ve safen sinire milimetre cinsinden yakýnlýðýný ölçerek güvenli, riskli ve yüksek riskli bölgeleri belirlemektir.
GEREÇ VE YÖNTEM: Ýlk olarak, 10 kadavra dizinde her iki (lateral ve medial) menisküste longitudinal yýrtýk simülasyonu ile menisküsün anterior, korpus ve posterior olarak bölündüðü kadavra çalýþmasý yapýldý. Bir sonraki aþama, diz 90° fleksiyonda ve tam ekstansiyondayken menisküsün simüle yýrtýklarýnýn dikilmesini içeriyordu. Son olarak, anterior, gövde ve posterior meniskal yýrtýklar boyunca yerleþtirilen K-teli çýkýþ noktasýnýn yukarýda bahsedilen sinirlerden uzaklýðý bir dijital kumpas ile ölçülmüþtür.
BULGULAR: Her iki menisküsün gövde ve anterior boynuz yýrtýklarýnýn tamiri sýrasýnda K-teli çýkýþ noktalarý ile nörovasküler yapýlar arasýndaki mesafe çok uzak olarak kabul edildi ve dahil edilmedi. Ancak, iyatrojenik sinir hasarý riskinden kaçýnmak için daha yakýn arka menisküs ölçümleri yapýldý. Lateral menisküs posterior yýrtýðý için ölçülen mesafeler 90° fleksiyonda 11±5.2 mm ve ekstansiyonda 8±4.5 mm iken, medial menisküs için 90° fleksiyonda 17.3±5.7 mm ve ekstansiyonda 13.7±4.7 mm olarak kaydedildi. Bu deðiþkenler baðýmlý örneklem t-testi kullanýlarak deðerlendirildi ve istatistiksel olarak anlamlý fark bulunamadý.
TARTIÞMA: Sonuçlarýmýz diz fleksiyondayken içten-dýþa tekniðinin posterior menisküs yýrtýklarýnda bile güvenli olduðunu göstermektedir. Bununla birlikte, güvenlik mesafesi dizin daha yüksek fleksiyon dereceleri ile arttýrýlabilir. Son olarak, arka menisküs yýrtýk tamirinde, bu bölgedeki sinir hasar riskini önlemek için diz fleksiyonda iken retraktör yardýmlý mini açýk tekniðini veya tamamen içeriden dikiþ tekniðini öneriyoruz. Her ne kadar birçok cerrahýn arka menisküs yýrtýklarýnda içten-dýþa tekniðini tercih etmediði bilinmesine raðmen, diz 90°’den daha fazla fleksiyonda iken retraktör yardýmlý mini açýk teknik kullanýlarak her iki menisküsün içten-dýþa arka menisküs tamiri tamamen içeriden dikiþ tekniði kadar güvenlidir.

BACKGROUND: In this study, we aim to assess the safe, risky and high-risky zones by measuring the proximity of the needles to the peroneal and saphenous nerves in millimeters for the repair of tears of the anterior, middle and posterior horns of the medial and lateral menisci at flexion and extension position during inside-out repair technique.
METHODS: First, a cadaveric study was conducted on 10 cadaver knees in which both (lateral and medial) menisci were divided into anterior, corpus and posterior with the longitudinal tear simulating in each section. The next phase involved the suture of the simulated tears of the menisci while the knee was at 90° of flexion and full extension. Finally, the distance from the exit points of the K-wire being inserted through meniscal anterior, corpus and posterior tears to the aforementioned nerves was measured with a digital caliper.
RESULTS: The distance between K-wire exit points and neurovascular structures concerning corpus and anterior horn tear repair of both menisci were considered far away and not included. However, closer posterior menisci measurements were taken to avoid the risk of iatrogenic nerve injury. The measured distances for lateral meniscus posterior tears were recorded 11±5.2 mm at 90° of flexion and 8±4.5 mm at extension, whereas those recorded 17.3±5.7 mm at 90° of flexion and 13.7±4.7 mm at extension for medial meniscus. These variables were evaluated statistically using a paired t-test; the mean of t value was not considered statistically significant.
CONCLUSION: Our results show that the inside-out technique at knee flexion is safe even in the posterior meniscus tears. However, safety distance can be increased with the higher flexion degrees of the knee. Lastly, in posterior meniscal tear repair, we recommend either retractor assisted mini-open technique at knee flexion, or all-inside suture technique, to avoid nerve injury risk in this zone. Although many surgeons do not prefer inside-out techniques for posterior menisci tears, inside-out posterior meniscal repair of both menisci is as safe as an all-inside technique using retractor assisted mini-open technique with the knee at higher than 90° flexion.

AMAÇ: Karýniçi hipertansiyon (KH) risk faktörü olan kritik hastalarda akut böbrek hasarýnýn (AKI) en sýk nedenlerinden biridir. Bu çalýþmada abdominal perfüzyon basýncý (APP) ile Doppler temelli renal rezistif indeks (RRI) ile gösterilen AKI arasýndaki iliþkiyi saptamayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya KH için risk faktörü taþýyan ve mekanik ventilasyon desteði altýnda 18 yaþýndan büyük 38 hasta alýndý. Tüm ölçümler ve elde edilen parametreler renal disfonksiyona göre iki gruba ayrýldý (Grup I; RRI <0.72 ve Grup II; RRI >0.72).
BULGULAR: Gruplarýn ortalama karýniçi basýnçlarý (IAB) Grup I’de (11.5±6.9 mmHg, n=35) ve Grup II’de (13.5±5.8, n=33) benzerdi. APP; Grup I’de (81.2±13.6) Group II’ye göre (66.4±9.5) daha yüksekti (p<0.001). RRI’ya göre renal perfüzyondaki bozulma APP’nin (≤72 mmHg) belirlemdeki duyarlýlýðý %76 ve seçiciliði %71’dir. ROC eðrisi altýnda kalan alan 0.802’dir (p<0.001).
TARTIÞMA: Çalýþmamýzýn sonuçlarý APP ≤72 mmHg eþik deðerinde RRI’nýn anlamlý þekilde arttýðýný ve bunun da renal perfüzyonun bozulmasýný öngörebileceðini göstermiþtir.

BACKGROUND: Intra-abdominal hypertension (IAH) is a frequent cause of acute kidney injury (AKI) among critically ill patients who have risk factors. This study aimed to determine the relation between Abdominal Perfusion Pressure (APP) and AKI showed by the Doppler-based renal resistive index (RRI).
METHODS: In this study, 38 patients older than 18 years old who received mechanical ventilation and had risk factors for the development of IAH were prospectively studied. All measurements and parameters were divided into two groups according to renal dysfunction (Group I: RRI <0.72 vs Group II: RRI >0.72).
RESULTS: The mean IAPs were not significant between the groups, 11.5±6.9 mm Hg in Group I (n=35) and 13.5±5.8 in Group II (n=33), respectively. APPs were statistically higher in Group I (81.2±13.6) than Group II (66.4±9.5) (p<0.001). The AUC for the association between APP at RRI >0.72 was 0.802 (p<0.001), with the APP ≤72 mmHg having a sensitivity of the 76% (95% CI 58–89%) and a specificity of 71% (95% CI 54–85%).
CONCLUSION: Our findings suggest that an APP with a threshold of ≤72 mmHg is associated with a significant increase in renal RRI, which may be predictive of worsening of renal perfusion.

AMAÇ: Travmatik diyafragma rüptürleri (TDR) nadir görülür. Genellikle akut dönemde morbiditeye neden olmazlar, ancak klinik taný konulamayan tüm TDR’ler geç dönemde herniasyon, strangülasyon, pnömoni, plevral effüzyon, ampiyem, kalp tamponadý ve solunum bozukluklarý gibi morbidite ve mortalitesi yüksek klinik durumlara neden olabilir. Bu çalýþmada travmatik diyafragma rüptürünün epidemiyolojisi, klinik özellikleri, taný, tedavi yöntemleri ve mortalite üzerine etkili faktörleri deðerlendirildi.
GEREÇ VE YÖNTEM: Ocak 2012-Aralýk 2017 tarihleri arasýnda kliniðimizde travmatik diyafragma yaralanmasý nedeni ile ameliyat edilen hastalarýn kayýtlarý geriye dönük olarak incelendi. Travmatik diyafragma rüptürü nedeni ile ameliyat edilen hastalarýn; yaþ, cins, yaralanma þekli, operasyon öncesi muayene bulgularý, laboratuvar tetkikleri, görüntüleme yöntemleri, taný konulma zamanlarý, ameliyat bulgularý, eþlik eden diðer organ yaranlamalarý, yapýlan ameliyatlar, hastane kalýþ süreleri, ameliyat sonrasý dönemde geliþen mortalite ve morbiditeler Abbreviated Injury Scale (AIS) ve Injury Severty Score’larý (ISS) incelendi.
BULGULAR: Ocak 2012–Aralýk 2017 tarihleri arasýnda kliniðimizde torakoabdominal travma nedeniyle 1066 hasta ameliyat edildi ve bu hastalardan 45’ine diyafragma rüptürü tanýsý konuldu. 45 hastanýn 32’sinde penetran travma (7 ateþli silah 25 delici kesici alet yaralanmasý), 9’unda künt travma ve 4 hastada ise kariniçi kitle nedeniyle ameliyat edildiði sýrada oluþan iyatrojenik yaralanma nedenli diyafragma rüptürü geliþtiði görüldü. Travmatik diyafragma rüptürüne en sýk eþlik eden yaralanmalar sýrasýyla hemopnömotoraks (%70), karaciðer (%43), dalak (%32), kolon (%20), mide (%17), ve kot fraktürü (%15) yaralanmalarýydý. Mortalite toplamda yedi (%17) hastada görüldü; beþ hasta hemorajik þok nedeniyle intraoperatif veya ameliyat sonrasý erken saatlerde kaybedilirken, iki hasta yoðun bakým takiplerinde çoklu organ yetersizliði nedeniyle kaybedildi.
TARTIÞMA: Yüksek enerjili künt ve penetran torako-abdominal travmalarda diyafragma rüptüründen þüphelenmek gerekir. Mortalite üzerine etkili faktörler AIS, ISS, eþlik eden organ yaralanmasý sayýsý ve pnömo-hemotoraks birlikteliði olarak bulundu.

BACKGROUND: Traumatic diaphragm ruptures (TDR) are rarely seen. Although TDR does not cause morbidity in the acute period, undiagnosed TDR may cause clinical states, such as herniation, strangulation, pneumonia, pleural effusion, empyema, and cardiac tamponade, which have high morbidity and mortality rates in the late period. This study aims to evaluate the epidemiology, clinical characteristics, diagnosis and treatment methods of TDR encountered in thoracoabdominal trauma and to identify the factors affecting mortality.

METHODS: A retrospective examination was carried out on the patients who were operated in our clinic because of traumatic diaphragm injury between January 2012 and December 2017. Each patient operated because traumatic diaphragm injury was evaluated in respect of age, gender, manner of injury, preoperative examination findings, laboratory test results, imaging methods, time of diagnosis, operation findings, concomitant injuries to other organs, operations performed, length of stay in hospital, the development of postoperative morbidity and mortality, and the calculated Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS).

RESULTS: Between January 2012 and December 2017, a total of 1066 patients were operated in our clinic because of thoracoabdominal trauma, and of 1066 patients, 45 of the patients were determined with TDR. Of the 45 patients, surgery was applied because of penetrating trauma in 32 cases (7 firearms injuries, 25 penetrating cutting injuries), blunt trauma in nine cases, and in four cases, diaphragm rupture was seen to have developed associated with iatrogenic injury during an operation. The most common injuries concomitant to traumatic diaphragm rupture were hemopneumothorax (70%), liver (43%), spleen (32%), colon (20%), stomach (17%) injuries and rib fractures (15%), respectively. Mortality developed in seven (17%) patients; five patients were lost because of hemorrhagic shock intraoperatively or in the early postoperative hours, and two because of multiorgan failure during follow-up in the intensive care unit.

CONCLUSION: In high energy blunt and penetrating thoracoabdominal traumas, diaphragm injuries should be suspected. Factors affecting mortality were found to be the AISS, ISS, number of concomitant organ injuries and the combination with pneumohemothorax.

AMAÇ: Literatürde nadir görülen bir akut karýn veya baðýrsak týkanýklýðý nedeni, abdominal koza sendromu sklerozan peritonit veya sklerozan enkapsüle peritonit olarak tanýmlanmaktadýr. Abdominal koza, karýn organlarýnýn lifli bir zar ile tamamen veya kýsmen sarýlmasý ile karakterizedir. Genellikle genç kadýnlarda görülmesine raðmen etiyoloji bilinmemektedir. Taný genellikle laparotomi sýrasýnda yapýlýr. Bu yazýda, operasyon sýrasýnda abdominal koza tanýsý almýþ yedi hasta sunuldu.
GEREÇ VE YÖNTEM: Hastanemiz genel cerrahi kliniðinde Ocak 2012 ile Kasým 2018 tarihleri arasýnda karýn aðrýsý ve/veya baðýrsak týkanýklýðý nedeniyle laparotomi yapýlan ve ameliyat sýrasýnda abdominal koza tanýsý alan hastalarýn kayýtlarý geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, altta yatan etiyolojik faktörler, cerrahi iþlemler, bulgularý ve takipleri kaydedildi.
BULGULAR: Abdominal koza nedeniyle ameliyat edilen 7 hastadan dördü erkek, 3’ü kadýndý. Ortanca yaþ erkeklerde 61 (57-63), kadýnlarda 39.6 (28-49) idi. Akut karýn veya ileus tanýsý ile altý hasta acil durumlarda ameliyat edildi. Elektif koþullarda karýn içi kitle tanýsý alan bir hasta ameliyat edildi. Yedi hastadan beþinde, ince baðýrsaklarýn tamamý bir fibrokollajen kapsül ile kaplýyken, 2 hastada baðýrsaklar kýsmen fibrokollajen kapsül ile kýsmen sarýldý. Hastalarýn dördünde altta yatan hastalýk yoktu, bir tanesinde Ailesel Akdeniz Ateþi (AAA), birinde endometriozis, birisinde beta-bloker kullanýmý vardý. Ameliyat sýrasýnda ince baðýrsak nekrozu ve septik peritonit saptanan hasta 6 gün sonra kaybedildi. Diðer hastalarýn takibinde komplikasyon görülmedi ve hiçbir hasta nüks nedeniyle tekrar ameliyat edilmedi.
TARTIÞMA: Abdominal koza, akut karýn veya baðýrsak týkanmasý gibi nedenlerle ameliyat edilen hastalarda genellikle ameliyat sýrasýnda teþhis edilen bir durumdur. Geç taný konulan olgularda ince baðýrsak nekrozu ve septik komplikasyonlar nedeniyle ölüm görülebilir. Preoperatif tanýda yüksek klinik þüphe ve radyolojik görüntüleme önemlidir. Tedavi, fibrokollajen membranýn eksizyonu ve adezyolizisdir.

BACKGROUND: A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation.
METHODS: The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded.
RESULTS: Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57–63) years in male and 39.6 (28–49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence.
CONCLUSION: Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.

AMAÇ: Peptik ülser perforasyonunda (PÜP) açýk veya laparoskopik Graham omentopeksi sýklýkla uygulanan tedavi þeklidir. Özellikle omentum rezeksiyon öyküsü olan hastalarda uygulanmanýn teknik zorluðu, PÜP’de falsiform ligament kullanýmýna yol açmýþ olup bazý çalýþmalarda omentopeksi’den daha avantajlý bir teknik olabileceði bildirilmiþtir. Bu çalýþmada, PÜP onarýmýnda falsiformopeksi veya omentopeksi uygulanan hastalarýmýzýn geriye dönük sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: 1999–2018 yýllarý arasýnda PÜP nedeniyle takip ve tedavi edilen 303 hasta çalýþmaya alýndý. Malignite, gastrik rezeksiyon, definitif ülser cerrahisi, laparoskopik cerrahi ve ameliyat dýþý tedavi alan hastalar çalýþma dýþý býrakýldý. Kalan hastalara ometopeksi veya falsiformopeksi uygulandý. Bu iki teknik ameliyatta ve amaliyat sonrasý sonuçlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Falsiformopeksi (n=46) ve omentopeksi (n=243) gruplarý benzer demografik özelliklere sahipti, ancak ASA skorlarý falsiformopeksi grubunda daha düþüktü. Ülser boyutu ve lokalizasyonu, operasyon süresi açýsýndan gruplar arasýnda fark saptanmadý. Genel postoperatif morbidite ve mortalite açýsýndan gruplar arasýnda anlamlý fark yoktu. Bununla birlikte, omentopeksi grubunda atelektazi daha sýk görülürken, peksi baþarýsýzlýðý falsiformopeksi grubunda daha sýktý (%2.6 ve %8.7, p=0.04).
TARTIÞMA: Falsiformopeksi, omentumu kullanmanýn mümkün olmadýðý durumlarda kullanýlabilecek alternatif bir tekniktir. PÜP onarýmý için omentopeksi’den daha üstün deðildir.

BACKGROUND: Open or laparoscopic Graham’s omentopexy is frequently used in the treatment of peptic ulcer perforation (PUP). The technical difficulty of applying the omental plug, especially in patients with previous omentum resection, has led to the use of falciform ligament for the PUP, and some studies have reported that PUP may even be a more advantageous technique than omentopexy. Here, in this study, we aimed to compare the retrospective results of patients who underwent falciformopexy or omentopexy for PUP.
METHODS: Between 1999 and 2018, 303 patients who were followed-up and treated for PUP were included in this study. Patients who had malignancy, gastric resection, definitive ulcer surgery, laparoscopic surgery and nonoperative treatment were excluded from this study. In the remaining patients, either open ometopexy or falciformopexy were applied based on the surgeon’s choice. These two techniques were compared for intraoperative and postoperative outcomes.
RESULTS: Falciformopexy (n=46) and omentopexy (n=243) groups had similar demographics, but ASA scores were lower in the falciformopexy group. For ulcer size and localization, duration of operation, no difference was found between the groups. There was no significant difference between the groups concerning general postoperative morbidity and mortality. However, atelectasis was more frequently observed in the omentopexy group, whereas the pexia failure was more frequent in the falciformopexy group (2.6% and 8.7%, p=0.04).
CONCLUSION: Falciformopexy is an alternative technique that can be used in situations where it is not possible to use the omentum. Falciformopexy is not superior to omentopexy for the repair of the PUP.

AMAÇ: Perforasyon, peptik ülserin nadir bir komplikasyonudur. Peptik ülser perforasyonunun yaygýn kabul gören tedavisi cerrahi olmakla birlikte, ameliyatsýz tedavi seçilmiþ hastalarda bir seçenek olabilir. Bu çalýþmada, peptik ülser perforasyonunda ameliyatsýz tedavi tecrübemizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2012 ile Eylül 2017 tarihleri arasýnda peptik ülser perforasyonu tanýsýyla kliniðimizde tedavi edilen hastalara ait veriler geriye dönük olarak deðerlendirildi. Taný, fizik muayene ve radyoloji bulgularý ile kondu. Ameliyatsýz tedavi, vital parametreleri normal olup, fizik muayenede yaygýn peritonit bulgularý olmayan seçilmiþ hastalara aydýnlatýlmýþ onamdan sonra uygulandý. Hastalarýn tamamýnda aðýzdan gýda ve sývý alýmý durduruldu, intravenöz sývý, antibiyotik ve pantoprazol baþlandý.
BULGULAR: Çalýþma süresince 41 hasta kliniðimize peptik ülser perforasyonu tanýsý ile yatýrýlarak tedavi edildi. Bu hastalarýn 35’i ameliyat edilirken altýsý konservatif olarak takip edildi. Hastalarýn tamamýnda, fizik muayenede karýn üst kadranlarda periton irritasyon semptom ve bulgularý vardý. Hiçbirinde yaygýn peritonit mevcut deðildi. Hastalarýn tamamýna direkt karýn grafisi ve tomografi çekildi. Ameliyatsýz tedavi grubundaki hastalarýn hiçbirine takip süresince cerrahi veya giriþimsel radyolojik bir iþlem yapma gerekliliði oluþmadý. Bu gruptaki hastalarda ortanca hastanede kalýþ süresi dört gündü. Hastalarýn tamamý sorunsuz olarak taburcu edildi.
TARTIÞMA: Peptik ülser perforasyonlu hastalarýn çoðunda standart tedavi halen cerrahidir. Ameliyatsýz tedavi, vital parametreleri normal olan ve karýn muayenesinde yaygýn peritonit bulgularý olmayan seçilmiþ hastalarda bir tedavi seçeceði olarak akýlda bulundurulmalýdýr. Bu þekilde, gereksiz yere cerrahi yapmaktan ve cerrahinin olasý morbidite ve mortalitesinden kaçýnmak mümkün olabilir.

BACKGROUND: Perforation is a rare complication of peptic ulcer. Although the most widely accepted treatment for peptic ulcer perforation is surgery, non-operative treatment can be an option in selected patients. In this study, we aimed to present our non-surgical treatment experience in peptic ulcer perforation.
METHODS: In this study, the data of the patients who were treated due to peptic ulcer perforation between January 2012 and September 2017 in our clinic were retrospectively reviewed. The diagnosis was reached by physical examination and radiologic findings. After obtaining the informed consent from the patients, non-operative treatment was performed to the selected patients who had normal vital parameters and did not have findings of generalized peritonitis in the abdominal examination. Oral food and fluid intake were stopped and intravenous fluid, antibiotics and pantoprazole were administered to all patients in this study.
RESULTS: A total of 41 patients were treated due to the diagnosis of peptic ulcer perforation in our clinic during the study period. Out of 41 patients, while 35 of the patients were operated, six of them were treated non-operatively. There were peritoneal irritation signs and symptoms in the upper quadrants on physical examination in all of the patients. None of them had generalized peritonitis. Abdominal X-ray and computed tomography were obtained from all of the patients. None of the patients in the non-operative group underwent any interventional procedure or surgery during the follow-up period. The median length of hospital stay was four days in this group. All of the patients were discharged uneventfully.
CONCLUSION: Standard treatment of peptic ulcer perforation in most of the patients is still surgical repair. Non-surgical treatment should be kept in mind as an option in the selected patients who had normal vital parameters and did not have any findings of generalized peritonitis in the abdominal examination. In this way, it may be possible to avoid unnecessary surgery and reduce the possible morbidity and mortality associated with the operation.

AMAÇ: Kolorektal kanserin (KRK) tedavisinde tanýda gecikme önemli bir sorun olmaya devam etmektedir. Birçok olgu akut baðýrsak obstrüksiyonu ya da perforasyonundan ötürü acil cerrahi müdehaleyi gerektirir. Bu geriye dönük çalýþma akut obstrüksiyon ya da peforasyon için acil cerrahi müdehaleye maruz kalan KRK'li hastalarýn saðkalýmý, erken ameliyat sonrasý sonuçlarý, tedavileri ve klinik durumlarýný deðerlendirmeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM: 2012–2017 yýllarý arasýnda toplam 612 hasta KRK nedeniyle ameliyat edildi. Bu hastalar içinde acil müdehale gerektiren 179 hasta yaþ, cinsiyet, komorbidite, fizyolojik durum, cerrahi endikasyon, tümör lokalizasyonu, tümör evresi, perioperatif kan transfüzyon oraný, cerrahi müdehale þekli ve hastanede kalma ve ameliyat geriye dönük olarak deðerlendirildi.
BULGULAR: Toplamda 152 (%85) hastada tam obstrüksiyon, 27 hastada (%15) perforasyon vardý. Majör ameliyat sonrasý komplikasyon hastalarýn neredeyse yarýsýnda gözlendi. Genel mortalite oraný %12 (22 hasta) idi. Obstrüksiyon nedeniyle ameliyat edilen hastalarýn %12'sinde (18 hasta), perforasyon nedeniyle ameliyat edilen hastalarýn ise %15'inde (4 hasta) mortalite geliþti. Peroperatuvar kan transfüzyonu ve yüksek ASA skoru majör komplikasyonu öngören baðýmsýz prognostik faktörler olarak tespit edilirken, ileri yaþ ve peroperatuvar kan transfüzyonu mortaliteyi öngören baðýmsýz risk faktörü olarak bulundu.
TARTIÞMA: Baþka çalýþmalarda da görüldüðü üzere, bizim yazýmýzda da acil cerrahi giriþim gerektiren KRK hastalarýnda yüksek oranda peroperatuvar morbidite ve mortaliteye rastladýk. Tarama programlarý yardýmýyla erken taný ve tedavi bu hastalýkta yaþam kurtarýcý rol oynamaktadýr.

BACKGROUND: Late diagnosis continues to be a significant problem in the treatment of colorectal cancer (CRC). Most cases require emergency surgical intervention due to acute intestinal obstruction or perforation. This retrospective study was formed from an assessment of the clinical presentation, treatment, early results, and survival of patients with CRC undergoing emergency surgery for acute obstruction or perforation.
METHODS: Between 2012 and 2017, 612 patients underwent surgery for CRC. In all, 179 patients who required emergency treatment were retrospectively evaluated according to age, gender, significant comorbidities, physiological status, surgical indications, tumor location, tumor stage, perioperative blood transfusion rate, type of surgery, and the length of the operation and hospitalization.
RESULTS: In total, 152 (85%) patients had a complete obstruction and 27 (15%) patients had a perforation. A major postoperative complication was identified nearly in half of the patients. The overall mortality rate was 12% (22 patients). Mortality was seen in 12% (18 patients) cases received surgery due to obstruction and in 15% (four patients) cases received surgery due to perforation. Perioperative blood transfusion and a high Acute Physiology and Chronic Health Evaluation II score were independent factors that predicted a major complication. Advanced age and perioperative blood transfusion were statistically independent prognostic factors for mortality.
CONCLUSION: Consisted with the findings of studies in the literature, the results of this study also revealed a high perioperative morbidity and mortality rate in patients with CRC who required urgent surgery. Our findings suggest that early detection and treatment of CRC with screening programs can be life-saving.

AMAÇ: Üst ekstremitenin kompleks anatomik ve fonksiyonel yapýsý, bu bölgeye ait kompleks defektlerin onarýmýnýn rekonstrüktif cerrahlar için zor bir iþlem olmasýna neden olmaktadýr. Bu rekonstrüksiyonda kompozit dokularý içeren lokal ve bölgesel flep seçenekleri kýsýtlýdýr. Bu çalýþmadaki amaç; posteriyor interosseöz flebinin (PÝO) klinik pratikte çok yönlü kullanýlabilirliðini vurgulamak ve kompleks üst ekstremite defektlerinde iyi bir seçenek olduðunu belirtmektir.
GEREÇ VE YÖNTEM: Çalýþmada üst ekstremite defekti mevcut 18'i erkek, 7'si kadýn toplam 25 hastaya, 26 PÝO flebi uygulandý. Baþlýca etyolojik faktörler, yanýk kontraktürü, trafik kazasý, ateþli silah yaralanmasý ve akut yanýk yaralanmasý idi. 22 flep fasyokutanöz kaldýrýlrken, 4 flep osteofasyokutanöz þekilde kaldýrýlarak metakarp defektlerine uygulandý. Pediküllü transfer edilen 25 flebin, 23'ü ters, 2'si ise düz akýmlý idi. Bir flep ise serbest flep olarak transfer edildi.
BULGULAR: Ortalama takip süresi 14 ay idi. Parsiyel nekroz ve sekonder iyileþme ile düzelen 1 flep hariç geri kalan fleplerin tamamý bütünüyle sorunsuz iyileþti. Tüm hastalar geç postoperatif dönemde günlük iþlerini sürdürebilecek temel fonksiyonlarý kazandýlar. Hastalar ve/veya anne babalarý postoperatif fonksiyonel ve estetik geliþimden memnun kaldýlar.
TARTIÞMA: PIO flebinin birçok avantajý, üst ekstremite kompleks defektlerinde kullanýlabilir olmasýný saðlamaktadýr. Akým yönünün deðiþtirilebilirliði ve içeriðinin zenginleþtirilebilmesi sayesinde çok yönlü olarak kullanýlabilir.

BACKGROUND: Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented “in a single study” with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted.
METHODS: We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap.
RESULTS: The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/or their parents were satisfied with the postoperative functional and aesthetic improvements.
CONCLUSION: Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

AMAÇ: Bifosfonatlar osteoporozlu hastalarda kýrýk geliþimini önlemek için sýklýkla kullanýlan ilaçlardýr. Ancak bifosfonat kullanýmý nadiren de olsa atipik femur kýrýklarýna yol açabilir. Sunulan çalýþma cerrahi olarak tedavi edilen bifosfonatla iliþkili atipik femur kýrýklarýnýn klinik ve radyolojik özellikleri ile tedavi sonuçlarýný sunmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2009 ile Aralýk 2017 tarihleri arasýnda atipik femur kýrýðý tanýsýyla ameliyat edilmiþ olan ve bifosfonat kullanma öyküsü olan hastalar geriye dönük olarak incelendi. Çalýþmaya Amerikan Kemik ve Mineral Araþtýrma Topluluðu (American Society for Bone and Mineral Research) tarafýnca tanýmlanmýþ olan atipik femur kýrýðý kriterlerini karþýlayan hastalar dahil edildi. Dahil edilen hastalarýn kýrýklarýnýn radyolojik özellikleri, kullanýlan bifosfonat ve kullaným süresi, prodromal klinik ve radyolojik bulgularýn varlýðý deðerlendirildi. Tedavi sonrasý sonuç deðerlendirmesi ise klinik deðerlendirme, radyolojik kaynama durumu ve mobilizasyon durumuna göre gerçekleþtirildi.
BULGULAR: Çalýþmaya 19 hasta dahil edildi. Hastalarýn ortalama yaþý 69.6 yýl (aralýk: 60.8-85.1) ve ortalama takip süresi 33.8 yýldý (aralýk: 13-104). Ortalama bifosfonat kullaným süresi 8.65 yýl (aralýk: 3-18) yýl olarak bulundu. 4 hastada bilateral kýrýk mevcuttu. Çalýþmada incelenen 23 kýrýktan 8 tanesi subtrokanterik, 15 tanesi ise diafizer yerleþimliydi. 21 kýrýk intramedüller çivi ile, 1 kýrýk kilitli kompresyon plaðý ile ve 1 kýrýk da proksimal femur çivisi ile tedavi edilmiþti. 15 kýrýkta ilk 6 ay içinde kaynama gözlendi. 4 kýrýkta kaynama gecikmesi ve 4 kýrýkta kaynamama tespit edildi. Ortalama kaynama süresi 5.1 ay (aralýk: 2-9) olarak bulundu. Toplam 7 hastanýn operasyon sonrasýnda preoperatif mobilizasyon durumunu koruðu gözlenirken 12 hastanýn mobilizasyon durumunda kýrýk sonrasýnda gerileme olduðu görüldü.
TARTIÞMA: Bu çalýþmanýn bulgularý atipik femur kýrýklarýnýn prodromal bulgularý olabileceðini ve bu kýrýklarýn yüksek komplikasyon ve kaynamama oranlarý ile iliþkili olduðunu göstermektedir.

BACKGROUND: Atypical femur fracture is a rare complication of bisphosphonate treatment, which is widely used for the prevention of osteoporotic fractures. This study aims to report clinical and radiological features and outcomes of surgically treated atypical femur fractures related to bisphosphonates.
METHODS: We retrospectively reviewed patients with the diagnosis of atypical femur fracture who were under bisphosphonate treatment and who were surgically treated in our clinic between January 2009 and December 2017. Patients who met the atypical femur fracture criteria defined by the American Society for Bone and Mineral Research were included in this study. Radiological features of the fractures, bisphosphonate treatment and duration, prodromal clinical and radiological findings were evaluated. Outcome measures included perioperative results, clinical and radiological outcomes and mobilization status.
RESULTS: In this study, 19 patients were enrolled. Mean age of the patients was 69.6 years (range: 60.8-85.1) and the mean follow-up was 33.8 months (range: 13-104). Mean bisphosphonate use duration was 8.65 years (range: 3-18). Four patients had bilateral fractures. Eight of 23 fractures were subtrochanteric and 15 were diaphyseal. Twenty-one fractures were treated with an intramedullary nail, one fracture with a locked compression plate and one fracture with cephalomedullary nail. Union was observed in 15 fractures within the first six months. There was a delayed union in four fractures and non-union in four fractures. Mean union time was 5.1 months (range: 2-9). While seven patients preserved their preoperative mobilization status, 12 patients showed regression after the fracture.
CONCLUSION: This study suggests that atypical femur fractures may have prodromal signs and that their management is complex due to high complication and nonunion rates.

AMAÇ: Kasýk fýtýðý popülasyonun %3–8’ini etkiler. Femoral herniler nadiren görülmekle birlikte genellikle acil cerrahi müdehale gerektirir ve sýklýkla baðýrsak rezeksiyonu gerekebilmektedir. Bu çalýþmanýn amacý, acil veya efektif koþullar altýnda farklý teknikler kullanarak femoral herni olgularýnýn cerrahi sonuçlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Nisan 2013 ile Kasým 2017 arasýnda, Ýstanbul’daki iki üniversite hastanesinin genel cerrahi kliniklerinin acil servisine 52 femoral herni olgusu baþvurdu. Femoral herni tanýsý ile ameliyat edilen tüm hastalarýn týbbi dosyalarý geriye dönük olarak incelendi. Demografik veriler, taraf bilgisi, kesenin içeriði, cerrahi teknik, hastanede kalýþ süresi, son polikliniðe göre rekürrens ve komplikasyonlar geriye dönük olarak incelendi.
BULGULAR: Olgularýn cinsiyet daðýlýmý %88.5 (n=46) idi, kadýn %11.5 (n=6) idi. Ortalama yaþ 62.9±16.49 yýl (31–91 yýl) idi. Ýki grup arasýnda fýtýk tarafýna göre anlamlý fark yoktu (p=0.282). Elektif olgularýn 13’ü (%52) açýk teknikle, 12’si (%48) laparoskopik teknikle ameliyat edildi.
TARTIÞMA: Cerrahi tekniklerin ve sonuçlarýn karþýlaþtýrýlmasý için, geniþ tabanlý cerrahi teknikleri standart hale getirmek için ileriye yönelik randomize çalýþmalar tasarlanmalýdýr.

BACKGROUND: Inguinal hernia affects 3–8% of the population. Femoral hernias are only a small number of groin hernias; however, femoral hernias are very important because these operations are generally emergency procedures, and bowel resections are frequently necessary. This study aims to compare surgical outcomes of patients with femoral hernias using different techniques under emergency or elective conditions.
METHODS: Between April 2013 and November 2017, 52 patients with femoral hernias were admitted to the emergency department of the General Surgery Clinics at two university hospitals in Istanbul. The medical files of all the patients who underwent surgery with a diagnosis of a femoral hernia were retrospectively evaluated. The demographic data, hernia side information, sac contents, surgical technique, length of hospital stay, recurrence according to the last outpatient clinic and complications were retrospectively analyzed.
RESULTS: The sex distribution of the cases was as follows: 88.5% (n=46) of the patients were female, and 11.5% (n=6) were male. The mean age was 62.9±16.49 years (31–91 years). There were no significant differences between the two groups, according to the hernia side (p=0.282). Thirteen of the elective cases (52%) were operated using open techniques, and 12 cases (48%) were operated using laparoscopic techniques.
CONCLUSION: For the comparison of surgical techniques and outcomes, prospective randomized studies should be designed to standardize broad-based surgical techniques.

AMAÇ: Bu çalýþmada kliniðimizde çift ya da tek endoloop kullanýlarak laparoskopik apendektomi yapýlan hastalarýmýzýn sonuçlarýný literatür eþliðinde geriye dönük olarak deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmaya 137 erkek (%54.6) ve 114 kadýn (%45.4) olmak üzere tek cerrah tarafýndan ameliyat edilen toplam 251 hasta katýldý. Hastalarýn 107’si tek endoloop yönteminin kullanýldýðý grup I, 144’ü çift endoloop yönteminin kullanýldýðý grup II idi. Hastalarýn yaþ cinsiyet, ameliyat süresi, hastanede yatma süresi, patoloji bulgularý, perioperatif apendiks bulgularý, perioperatif batýn bulgularý, ameliyat sonrasý yatýþ gereken komplikasyonlar, ameliyat sonrasý operasyon gereken komplikasyonlar ve yara yeri enfeksiyonuna bakýldý. Komplikasyonlar istatistiksel olarak incelendi.
BULGULAR: Her iki grup arasýnda demografik özellikler, perioperatif ameliyat bulgularý, patoloji bulgularý, ameliyat sonrasý bulgular ve hastanede yatýþ süreleri arasýnda anlamlý fark izlenmedi. Ameliyat süreleri grup I’de (54.9±16,1) grup II’den (61.2±18,8) daha kýsa bulundu. Tekrar yatýþ gerektiren komplikasyonlar grup I’de (%1,9; n=2) grup II’den (%9; n=13) anlamlý olarak az bulundu (p=0.018). Tekrar ameliyat gereken komplikasyon grup I’de olmadý. Grup II’de dört hastada (%2.8) oldu, Ýstatistiksel olarak anlamlý fark bulunmadý. Yara yeri enfeksiyonu grup I (%7.5 n=8) ile grup II (%4.9 n=7) arasýnda anlamlý fark izlenmedi.
TARTIÞMA: Çift endoloop kullanmak ameliyat sonrasý komlikasyonlarý azaltmamakla birlikte ameliyat maliyetini artýrmakta ve ameliyat süresini uzatmaktadýr. Laparoskopik apendektomide loop kullanýmýnda tek loop kullanmanýn daha uygun olacaðý kanaatindeyiz.

BACKGROUND: In this study, using single or double endoloops, with reference to the literature, we aimed to retrospectively assess the results for patients in our clinic who underwent a laparoscopic appendectomy.
METHODS: This study included 251 patients who were operated on by a single surgeon; 137 of the patients were male (54.6%) and 114 were female (45.4%). Patients were divided into two groups based on the type of endoloop procedure that was used. Group 1 included 107 patients for whom a single endoloop was used. Group II included 144 patients for whom double endoloop was used. Age, sex, duration of operation, length of hospital stay, pathological findings, perioperative appendix findings, perioperative abdominal findings, post-operative complications requiring hospitalization and wound infections were assessed for each patient. Patients were also assessed statistically for complications.
RESULTS: There were no significant differences in the demographic characteristics, perioperative surgery findings, pathological findings or duration of hospital stays between the two groups of the patients. However, the duration of operation was shorter in Group I (54.9±16.1 min) as compared to Group II (61.2±18.8 min). The incidence of complications requiring rehospitalization was statistically significantly lower in Group I (1.9%; n=2) as compared to Group II (9%; n=13) (p=0.018). There were no complications requiring re-operation for patients in Group I. In Group II, four patients (2.8%) required re-operation; however, this difference was not statistically significant. Concerning wound infection, there was also no significant difference between Group I (7.5% n=8) and Group II (4.9% n=7).
CONCLUSION: Using a double endoloop does not decrease the risk of post-operative complications, but it does increase the cost and the duration of the operation. We have concluded that using a single endoloop in a laparoscopic appendectomy may be more appropriate.

AMAÇ: Bu çalýþmada, kafa travmalý olgularýn tüm vücut bilgisayarlý tomografi (TVBT) ile deðerlendirilip, hastalarda eþlik edebilecek diðer vücut yaralanmalarýnýn tespiti için TVBT’nin ne kadar gerekli olduðu ortaya konmaya çalýþýldý.
GEREÇ VE YÖNTEM: Çalýþmamýza 2012–2016 tarihleri arasýnda hastanemiz acil servisine kafa travmasý sonrasýnda baþvurmuþ, beyin tomografisinde (BT) lezyon saptanmýþ, ek muayene bulgusu olmayan ve TVBT çekilmiþ 198 hasta alýndý. Geriye dönük olarak yapýlan çalýþmada hastalarýn yaþ, cinsiyet, beyin BT’deki lezyonun tipi, Glaskow Koma Skalasý (GKS) deðerleri ve TVBT bulgularý incelendi.
BULGULAR: Hastalarýn %85.4’ü erkek olup, yaþ ortalamasý 25.7 yýldý. En sýk saptanan kraniyal BT bulgusu kýrýk, takiben parankimal kanamaydý. Hastalarýn %67’sinin GKS’si 8’in altýndaydý. Hastalarýn 78’inde (%39.4) ek travma saptandý. En sýk saptanan ek lezyon toraksta kontüzyondu. BT’de belirlenen servikal yaralanmasý olan hastalarýn yaþ ortancalarý anlamlý olarak yüksekti (p<0.05). Kraniyal kýrýk ve yabancý cisim sýklýðý ile toraks yaralanmasý arasýnda anlamlýlýk tespit edildi (p<0.05). Beyin BT’de kontüzyon saptanan hastalarda servikal yaralanma sýklýðý anlamlý olarak yüksekti (p<0.05). TVBT’de ek lezyon varlýðý ile kýrýk sýklýðý anlamlý olarak yüksekti (p<0.05). Diðer kraniyal lezyonlar ve ek yaralanma bölgesi arasýnda iliþki saptanmadý (p>0.05).
TARTIÞMA: Literatürde TVBT’lerin deðerlendirildiði çalýþma sayýsý çoktur. Ancak, çalýþmamýz kafa travmasý olan ve vücudunda ek lezyon olmayýp TVBT’deki bulgularýn deðerlendirildiði ilk çalýþmadýr. Klinik deðerlendirilmesi tam yapýlamayan hastalarda TVBT çekimi önerilmelidir. TVBT baþta toraks içi lezyonlar olmak üzere, birçok patolojinin tanýsýnda önemli bir taný aracýdýr.

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT.
METHODS: In our study, we included 198 patients, who were referred to our hospital’s emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients’ age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined.
RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients’ GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05).
CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.

Non-travmatik ve altta yatan tümör olmayan rektum perforasyonlarý oldukça nadir olgulardýr. Refleksiyon altýnda olan alt ve orta rektum perforasyonlarý batýn içi apse veya enflamasyona neden olmadýkça semptomsuz olarak seyredebilir. Biz bu olgumuzda anüsten ince baðýrsak prolapsusu ile acil cerrahi kliniðine baþvuran bir hastayý sunmayý amaçladýk.

Non-traumatic rectum perforation is rarely seen if there is no underlying tumor formation. The perforations in the middle and lower parts of the rectum that are under the peritoneal reflex are asymptomatic unless there is intraabdominal infection or inflammation. In this study, we aim to present a patient who referred to the emergency surgery clinic with the small bowel prolapse from the anus.

Penetran keratoplasti (PK) sonrasý glop rüptürü önemli bir ameliyat sonrasý komplikasyonudur. PK sonrasý kornea yarasý normal kornea dokusunun saðlamlýðýna hiçbir zaman eriþemediðinden, künt travma sonrasýnda glop rüptürü kornea da alýcý-donör yataðýnda gerçekleþir. Biz PK’li hastada künt travmaya baðlý skleral rüptürü geliþen bir hastayý sunduk. Altmýþ yaþýnda kadýn hasta sol gözünde künt travmaya baðlý görme kaybý, kýzarýklýk ve aðrý ile baþvurdu. Ön segment muayenesinde total hifema, yaygýn subkonjonktival hemoraji ve kapaklarda ekimoz mevcuttu. Donör kornea saðlamdý. Sað göz de PK’li, kornea saydam, sklera mavi renkte idi. Limbusa 2 mm mesafede üst kadranda saat 3’ten 9’a kadar uzanan skleral rüptür cerrahi sýrasýnda saptandý. Hastanýn öyküsünde sistemik hipertansiyon dýþýnda baþka bir hastalýðý yoktu. Mavi skleraya neden olan hastalýklarýn ayýrýcý tanýsý yapýldý. Ayrýntýlý öyküde hasta çocukluk döneminde ciddi alerjik göz hastalýðý yaþadýðýný belirtti. Vernal keratokonjonktivite baðlý geliþen komplikasyon tanýsý kondu. PK’li ve mavi skleralý hasta da künt travmaya baðlý kapalý sklera perforasyonu geliþebileceði akýlda bulundurulmalýdýr.

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o’clock to 9 o’clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.