Mezenterik iskemi farklý klinikle seyreden bir çok etyoloji neticesinde geliþebilir. Sebep ne olursa olsun mezenter iskemi sonucu geliþen patofizyolojik mekanizmalardan biri de bakteriyel translokasyondur. Çalýþmamýzda sýçanlarda seftriaksonun mezenterik iskemi modelindeki bakteriyel translokasyon üzerine etkisini araþtýrdýk. Sýçanlara seftriakson (25 mg/kg im) enjekte edildikten yarým saat sonra superior mezenterik arter baðlanarak iskemi oluþturuldu. Daha sonra mezenter lenf bezlerinden, akciðerden, karaciðerden, sistemik ve portal kandan kültürler alýnarak enterik mikroorganizmalar açýsýndan kalitatif olarak deðerlendirildi.

Mesenteric ischemia may result from a wide range of pathological processes, each having different clinical features. Regardless of etiology, one of the pathophysiologic mechanisms that develop as a result of mesenteric ischemia is bacterial translocation. In this study, we evaluated the effect of ceftriaxon on bacterial translocation of enteric organisms in animal models of mesenteric ischemia was formed as a result of ligating superior mesenteric artery. Qualitative cultures of blood, liver, lungs and mesenteric lymph nodes have been taken.

Ýskemiye maruz kalan organlarda, reperfüzyon sonrasý görülen hasarýn (I-R hasarý) ortaya çýkmasýnda nötrofiller önemli rol oynamaktadýr. Nötrofil aracýlýðýyla geliþen I-R hasarý önlemek amacýyla, deneysel koþullarda, çeþitli maddelerin yaný sýra siklosporin A (CsA) ve FK506 gibi immünosupresif ajanlar da kullanýlmýþtýr. Ancak immünosupresiflerin nötrofiller üzerindeki etki mekanizmalarý henüz tam olarak anlaþýlamamýþtýr. Hipovolemik þok oluþturulan sýçanlarda, nötrofil aracýlýðýyla oluþan I-R hasarýna CsA'nýn etkilerini araþtýrmayý amaçladýk. Çalýþmamýzda, her biri 10 diþi Wistar albino sýçan içeren 4 grup oluþturuldu. G1: Kontrol, G2: Þok, G3: Þok+Reperfüzyon, G4: CsA. Þok oluþturmak için, deneklerden femoral ven yoluyla yaklaþýk 2,5 ml kan alýndý. Reperfüzyon gruplarýnda, alýnan kan 20 dk sonra ayný yoldan reperfüze edildi. G4'te, reperfüzyondan 5 dk önce IV20 mg/kg CsA verildi. Postop 24.cü saatte sakrifiye edilen deneklerde plazmada malonildialdehit (MDA); karaciðer, akciðer, ince barsak ve böbreklerde ise MDA ve miyeloperoksidaz (MPO) ölçümü ve nötrofil sayýmý yapýldý. I-R sonrasý plazma ve tüm dokularda artan MDA deðerleri, CsA verildikten sonra normale inmiþtir. Bu bulgular, I-R hasarýnda serbest oksijen radikallerinin (SOR) rolünü göstermektedir. Ancak, MPO deðerleri CsA verilmesi ile sadece ince barsakta normale inmiþtir. CsA'nýn nötrofil infiltrasyonunu azaltýcý etkileri de yine ince barsak ve böbrekte görülmüþtür. Sonuç olarak, CsA tedavisinin I-R hasarýný azaltýcý yönde etkiye sahip olduðu saptanmýþtýr. Ancak bu etkinin, en azýndan karaciðer ve akciðerde, nötrofil infiltrasyonunu azaltmak yoluyla olmadýðýný düþünmekteyiz. CsA'nýn dozu arttýrýldýðý taktirde, bu etki belki tüm dokularda yaygýnlaþabilir. CsA'nýn I-R hasarýndaki etki mekanizmasýnýn tam olarak anlaþýlabilmesi için yeni araþtýrmalara ihtiyaç vardýr.

Neutrophils are an important factor in the organ injury associated with ischemia and reperfusion (I-R). In experimental conditions, besides many chemicals, immunosuppressive agents like cyclosporineA (CsA) and FK 506 were also used to prevent I-R injury. But effect of immunosuppressives on neutrophils still remains unclear. We designed an experimental study to investigate the role of CsA in organ injury after hemorrhagic shock and reperfusion in rats. Forty Wistar albino rats were divided into 4 groups. G 1: Control, G2: Shock, G3: Shock + Reperfusion, G4: CsA. Shock was induced by with drawing of 2,5 ml blood viafemoralvein. The shed blood was then reinfused after 20 min in reperfusion groups. In G4, CsA (20 mg/kg) was given by a single IV injection just before (5 min) the perfusion. Rats were sacrified24 hours after operation. Plasma malondialdehyde (MDA) levels of all groups and, MDA and myeloperoxidase (MPO) levels of liver, lung, small bowel and kidney were measured. In addition, neutrophil counts were obtained from all organs. After I-R, MDA levels of plasma and all organs increased and then returned to normal by CsA administration. This observations revealed the role of free oxygene radicals in I-R injury. But CsA-induced MPO decrease was obtained in only small bowel. In addition, reduction in neutrophil infiltration by CsA was seen in small bowel and kidney. We concluded that, CsA has a beneficial effect on I-R-induced organ injury. But, at least in liver and lung, these results couldn't attributed to reduced neutrophil infiltration. However, increase of CsA dose may cause widespread reduction in neutrophil counts. Further investigations are necessary to clarify the exact role of CsA on I-R injury.

Otobüs ve kamyon þoförlerinin ilkyardým konusundaki bilgi tutum ve davranýþlarýný deðerlendirmek amacýyla yapýlan bu çalýþmada 37 otobüs ve 47 kamyon þoförü olmak üzere 84 þoföre anket uygulanmýþtýr. Araþtýrma grubuna alýnan þoförlerin büyük çoðunluðunun suni solunum uygulama, kapalý kalp masajý uygulama, kýrýklar, kanama, delici karýn yaralanmalarý, yanma ve donma gibi durumlarda ne yapacaklarýný yeterince bilmedikleri saptanmýþtýr. Çalýþma süresi 10 yýldan daha az olanlarýn ilkyardým konusundaki bilgileri meslekte 10 yýldan uzun süredir çalýþanlara göre daha yüksektir. Þoförlerin % 70.07 ilk yardým eðitimi almadan ehliyet almýþtýr. Araçlarýn % 90.5' inde ilk yardým çantasý bulunmaktadýr. Þoförlerin % 8.3'ü ilk yardým konusundaki bilgilerinin yeterli olduðuna, % 40.5'i kýsmen yeterli ve % 51.2'si ise yetersiz olduðuna inanmaktadýr. Þoförlerin % 64.3'ü ilkyardým konusunda yapýlacak olan eðitime katýlmak istemektedirler. Sonuç olarak trafik kazalarýna baðlý ölüm insidansýný azaltmak için: þoförler baþta olmak üzere herkes ilkyardým konusunda eðitilmelidir. Her düzeydeki eðitim kurumlarýnýn programlarýnda kazalarý önleme ve ilkyardým konusundaki derslere yer verilmelidir. Televizyon ve radyo baþta olmak üzere toplu iletiþim araçlarýnda eðitim programlarýna daha fazla zaman ayrýlmalýdýr.

This study has been carried out to evaluate the knowledge, attitude, and behaviour of bus and lorry drivers on first aid. Questionnaire was given to 84 drivers (37 bus drivers, 47 lorry drivers). It has been found out that the great majority of the study group did not know what to do in cases of respiratory problems, bleeding, penetrating abdominal injuries, fractures, burns and freezing. The knowledge of the drivers who have been working for 10 years and less was found to be more than the drivers who have been working for mere than 10 years. 70% of the drivers had a drivers license without training on first aid. It was found that 90.5% of the vehicles had a first aid bag. Among the drivers in the study group, 8.3 % believed that their knowledge on firs aid was sufficient, 40.5 % of them believed that their knowledge was partially sufficient, and 51.1% of them believed that their knowledge was not sufficient. 64.3 % of the drivers said they would be willing to attend a training programme on the first aid. It can be concluded that all people, particularly drivers at first, must be trained on the first aid to reduce incidence of deaths related to traffic accidents. Lectures on first aid and prevention of accidents must be included in curricumulus of training and education instutions of various levels. Press organs such as TV and radio must allocate more time and opportunities for training of people on these subjects.

Günümüzün geliþen teknolojisi ile birlikte yüksek enerjili travma sýklýðý ve buna koþut olarak geliþen vertebral kolon yaralanmalarý önemli ölçüde artmýþtýr. Konservatif tedavinin sonuçlarýnýn yeterli oranda tatminkar olmamasý, instabil torakal ve lomber vertebral kýrýklarýn yeterli stabilizasyonu, daha hýzlý rehabilitasyon, daha kolay bakým ve komplikasyonlarýn azaltýlmasý için daha radikal cerrahi yaklaþýmlarýn yapýlmasý gerektiði özellikle son 15 yýlda yoðunlaþmýþtýr. Bu çalýþmada; torakolomber travmalý 14 hasta deðerlendirilmiþtir. Hastalarýn klinik tablosu Frankel, travma biyomekaniði Denis sýnýflamasýna göre deðerlendirilmiþtir. Hastalara cerrahi tedavi olarak Sine transpediküler vida tekniði, 2 hastaya rod-kanca sistemi ile posterior stabilizasyon, 2'sine anterior enstrümentasyon, 2'sine de anterior ve posterior stabilizasyon yöntemleri uygulanmýþtýr. Ayrýca hastalarýn 8'ine total laminektomi, 2'sine korpektomi yapýlmýþtýr. Hastalar postoperatif üçüncü gün torakolomber korse ile mobilize edilmiþtir. Bu çalýþmada torakolomber travmalarda, travma biyomekaniðine göre uygulanan çeþitli stabilizasyon yöntemleri tartýþýlmýþtýr.

Injuries of columna vertebralis had increased together with high energy traumas related with advanced technology. Because of unsatisfactory results of conservative therapies and for rapid rehabilitation aggresive surgical procedures have been widely accepted in last fifteen years. In this study, 14 cases with thoracolumbar traumas were reported. The clinical status of the patients have been according to Frankel classification. Biomechanics of trauma was classified according to Denis classification. For posterior stabilization we applied pedicle screw plating in 8 patients, rod-hook system in 2 patients classified. For anterior stabilization we used anterior instrumentation in 2 cases and we also used combined techniques together with anterior-posterior stabilization in 2 patients. In addition, we performed total laminectomy in 8 patients and corpectomy in 2 cases. All the patients have been mobilized with thoracolumbar brace after 3 days postoperatively in this manuscript. We discussed various techniques of stabilization in thoraco-lumbar injuries according to trauma biomechanics.

Bu çalýþmada ölümcül olabilen Fournier gangreni hakkýnda literatürü kendimizin tedavi ettiði 18 hasta ile birlikte tekrar gözden geçirdik. Kliniðimizde tedavi edilen 18 fournier gangrenli hastanýn týbbi kayýtlarý kullanýldý. 10 hastada predispozan faktör olarak diabet saptandý. 17 hastada geniþ debridman, 3 hastada sekonder sütürasyon ve 3 hastada sekonder olarak plastik cerrahi giriþimler gerekti. 16 hastada iyileþme saðlandý. Erken taný, predispozan faktörlerin göz önünde bulundurulmasý, geniþ spektrumlu antibiyotik tedavisi ve geniþ cerrahi debridmanla Fournier gangreni kolaylýkla tedavi edilebilir bir hastalýktýr.

In this study we reviewed the related literature about Fournier s gangrene with 18 patients admitted to our clinic with this entity. The records of Ý 8 patients with Fournier gangrene treated in our clinic were retrospectively reviewed. Diabetes mellitus was a predisposing factor in 10 patients. Extensive debridments were made to 17 patients, seconder suturing to three patients whereas 3 patients required secondary reconstructive surgery. 16 patients recovered primarily. With early diagnosis, treating predisposing factors, broad spectrum antibiotic therapy and extensive surgical debridment, Fournier's gangrene, a lethal disease, can easily be managed.

Ý.Ü. Ýstanbul Týp Fakültesi Travma ve Acil Cerrahi Birimine Ocak 1991 -Aralýk 1995 tarihleri arasýnda baþvuran 70 servikal omur yaralanmalý (SOY) olgu gözden geçirildi. Olgularýn %57si araç kazasýna, %21'i düþmeye baðlý oluþmuþtur. Hastalarýn tamamýnda çekilen direkt grafilere ilave olarak, % 80 bilgisayarlý tomografi (BT) ve %10 (manyetik rezonans görüntüleme MRG) tetkikleri yapýldý. Vakalarýn %92.8'inde konservatif tedavi, %7.1'inde cerrahi giriþim uygulandý. Hastalarýn %55.7'si taburcu olurken, %15.7si kaybedilmiþ, %28.5'inin tedavileri diðer kliniklerde sürdürülmüþtür. SOY'larý yüksek oranda mortalite ve morbiditeye sebep olduðu için, politravmatize hastalarýn solunum ve dolaþým kontrolünü takiben ayrýntýlý nörolojik muayene yapýlmalý ve görüntüleme metodlarý ile aksi ispatlanýncaya kadar SOY var gibi düþünülmelidir.

We evaluated Cervical Spine Injuries (QSI) of 70 patients admitted to Trauma and Emergency Surgical Unit at Istanbul Medical School between January 1991-December 1995. The cause of injury was motor vehicle accident in (57%) and fall in (21 %). In addition to plain cervical radiography performed in all patients, computerized Tomography (80 %) and Magnetic Resonance Imaging (MRI) (10%) were performed. Conservative treatment was performed in 92.8 % and surgical treatment to 7.1% of the cases. Of the total 70 patients, 38 (55,7 %) were discharged, 10 (5.7 %) were lost and 22 were referred to other clinics for treatment. Because CSI cause high mortality and morbidity patients with multiple trauma should undergo a complete neurological examination following stabilization of the respiratory and hemodynamic status and CSI should be considered unless otherwise is proven by radiological methods.

Posttravmatik leptomeningeal kistler (PTLMK), kafatasýnýn diastatik kýrýklarýnýn nadir bir komplikasyonudur. Genellikle çocuklarda ve parietal bölgede görülür. Oluþmasý için kýrýk altýndaki duranýn da yýrtýlmasý zorunludur. Beyin pulsasyonu ve oluþmuþ leptomeningeal kist zamanla kýrýk hattýnda açýlmaya yol açar. Klinik bulgular çocukluk ve eriþkin yaþ grubunda birbirinden farklýdýr. Tedavi cerrahi düzeltmedir. Çalýþmada son 4 yýl içinde tedavi edilen PTLMK'li 7 olgu sunulmaktadýr. Olgularýn 5'i çocukluk, 2'si eriþkin yaþ grubundadýr. Tüm olgularda öyküde yüksekten düþme saptanmýþ ve PTLMK tümünde 20 gün-20 yýl arasýnda geliþmiþtir. Çocuk olgular kafada þekil bozukluðu, eriþkinler ise nöbet ve baþ aðrýsý yakýnmalarý ile baþvurmuþlardýr. Olgular cerrahi olarak tedavi edilmiþtir.

Posttraumatic leptomeningeal cysts are rare complications of diastatic skull fracture, occurring almost in childhood and parietal region. Disruption of the underlying dura is necessary in pathogenesis. The normal growth of the brain, cerebral pulsations and cystic lesion cause to enlargement of the fracture edges. Surgical repair is the treatment of choice. In the last 4 years, we have managed 7 cases of growing skull fracture. All patients had a history of falling from a height. The time interval between the trauma and presentation was variable between 20 days to 20 years. The most common clinical feature was local swelling in children, while seizure and atypical headache in adults. Dural repair and cranioplasty was performed in all patients.

Ülkemizde yaþlý nüfus giderek artmaktadýr. Yaþlýlarda travma nedenleri ve travmaya verilen cevap diðer yaþ gruplarýna göre farklýlýk göstermektedir. Ocak 1997 ile Haziran 1998 tarihleri arasýnda hastanemize travma nedeni ile baþvuran hastalarýn dosya kayýtlarý incelendi. Hastalar erken yaþlý grubu (55-64yaþ arasý), ileri yaþlý grubu (65 yaþ ve yukarýsý) olmak üzere iki gruba ayrýldý. Ayrýca 35-44 yaþ arasý hastalar kontrol grubu olarak çalýþmaya dahil edildi. Bu tarihler arasýnda travma nedeni ile baþvuran 9450 hastanýn %5,5'i 55 yaþ ve yukarýsýnda idi. En sýk travma bölgesi her üç grupta da kafa idi. En sýk travma nedeni ise kontrol ve erken yaþlý gruplarýnda trafik kazasý iken ileri yaþlý grubunda "düþme idi. Ortalama Travma Þiddet Skorlarý kontrol, erken yaþlý ve ileri yaþlý gruplarýnda sýrasýyla 9, 9, 16 olarak bulundu. Ortalama hastanede yatma süreleri, kontrol, erken yaþlý ve ileri yaþlý gruplarýnda sýrasýyla 5, 7, 9 gün olarak bulundu. Kontrol grubunda mortalite %5,9 iken, erken yaþlý grubunda %10,7, ileri yaþlý grubunda ise %23,7 idi. Sonuç olarak yaþlý hastalarýn fizyolojik rezervlerinin daha az olmasý ve travmaya gösterdikleri metabolik ve endokrin cevabýn yetersiz olmasý, travma sonrasý hayatta kalma þanslarýný azaltmýþ olabilir.

Elderly population is increasing every year in our country. Reasons of trauma and response to trauma changes with age. Files of the patients who applied to our hospital for trauma between January 1997 and June 1998 have been examined. Patients were divided into two groups: Those who are 55 to 64years old and those who are 65years old and over. In addition, patients of 35 to 44 years have been included in the study as control group. 5.5% of 9450 patients who were admitted to the hospital for trauma were 55 years old and over. The most frequent trauma was head trauma in each of the 3 groups. While most frequent trauma reason was traffic accident in control and early elderly group, in the late elderly it was fall. Average ISS in control, early elderly and late elderly groups have been found 9,9 and 16 respectively. Average hospitalization periods in control, early elderly and late elderly groups have been founds 5,7,9 days, respectively. While mortality was 5.9% in control group, it was 10.7% in early elderly group, and 23.7% in the late elderly group. As a conclusion, the fact that elderly patients physiological reserves are less and their insufficient metabolic and endocrine response to trauma might have reduced their survival chance after trauma.

Akut karýn aðrýlý olgularda düz karýn grafisinin tanýsal deðerini, asistan ve radyolog ve genel cerrahi uzmaný deðerlendirmesi arasýndaki farký saptamak için prospektif bir çalýþma yapýlmýþtýr. Akut karýn aðrýsýyla Ýlk ve Acil Yardým anabilim dalýna baþvuran 88 olgu çalýþmaya alýndý. Tüm olgulara rutin olarak ayakta düz karýn grafisi çekildi. Ýlk aþamada olgu ve grafisi asistanlarca, daha sonra radyolog ve genel cerrahça deðerlendirildi. Grafiler 4 grupta incelendi, a) tanýya katkýsý yok, b) tanýya yardýmcý, c) taný koydurucu, d) yanlýþ taný. Klinik tanýlar 7 gruptaydý, a) akut apandisit (25 hasta) b) ileus (13 hasta) c) akut kolesistit (12 hasta) d) non-spesifik karýn aðrýsý (18 hasta) e) ürolitiazis (5 hasta) f) perforasyon (4 hasta) g) deðiþik tanýlar (11 hasta). Asistan deðerlendirmesinde grafilerin %73'ü tanýya katkýsý yok, %21 tanýya yardýmcý, %3,4 taný koydurucu olarak deðerlendirildi. Radyolog ve genel cerrahi deðerlendirmesinde ayný oranlar sýrasýyla % 75, %19, %6.8 olarak bulundu. Sonuçlarýmýz akut karýn aðrýlý olgularýn %75'inde direkt karýn grafisinin tanýya katkýsý olmadýðýný göstermektedir. Yanlýzca asistanlarýn deðerlendirilmesinde ise radyolog ve genel cerrahýn birlikte deðerlendirmesi kadar doðru oranlar bulunmuþtur.

A prospective study was performed on patient with abdominal pain to evaluate of plain abdominal radiographs and to determine the differences of registrar and radiologist and general surgeon in diagnosis. Eighty eight patients with acute abdominal pain who admitted to department of emergency medicine were evaluated. The plain abdominal radiography were obtained in all of them. In first step, case and radiograph were evaluated by registrar and later, radiologist and surgeon assessment was done. Radiograph was classified by the authors into one of the following groups a) of no help in diagnosis b) diagnostic c) of help in diagnosis and d) wrong diagnosis. Seven acute abdominal conditions were considered a) acute appendicitis (25 patients) b) intestinal obstruction (13 patients) c) acute cholecystitis (18 patients) d) non-spesific abdominal pain (11 patients) e) urolithiazis (5 patients) f)perforation (4 patients) g) miscellaneous diagnosis (11 patients). In registrar evaluation radiograph were no help diagnosis in 73 percent of cases, help diagnosis in 21 percent of cases, helpful in 3.4 percent. This assessment had became respectively 75,19,68, percent in radiologist and surgeon evaluation. Our results suggest that for the 75 percent of all patients with acute abdominal pain there is little value in taking a plain abdominal radiograph. Registrar had assessment as right as radiologist and surgeon assessment.

Spondiloptosis, spondilolistesisin en ileri þeklidir ve subaksiyal servikal bölgede çok nadirdir. Literatürde günümüze kadar servikal spondiloptosis'li sadece 2 olgu bildirilmiþtir. Bu çalýþmada, travma sonrasý C3-4 mesafesinde spondiloptosis geliþmiþ, nörolojik bulgusu olmayan 67 yaþýnda bir erkek olgu sunulmaktadýr. Olgu anterior ve posterior kombine cerrahi yaklaþýmla tedavi edilerek 3 ay halofiksasyon ortezi ile tespit edilmiþ ve takibinde füzyon saðlanmýþtýr.

Clivus fractures are classified in three groups as longitudinal, transverse and oblique types according to CT appearance. Due to advance in high resolution CT techniques, they can be easily diagnosed. It is known that in these kind of fractures, complication, morbidity and mortality rates are high. In this manuscript, a case of transverse fracture of dims caused by falling a heavy object of 500 kg, over the patient's head will be reported.

Trans cranial perforating injuries are uncommon. Recently we treated a 14 year old boy, who sustained a trans cranial spanner injury. The patient was admitted to our emergency department without any neurological dysfunction. He was operated urgently and the spanner was removed. During the hospital stay and in his follow-up of 18 months he did not develop any complication. In this study we presented the case and discussed the topic in the view of recent literature.

Paraözefageal fýtýklar genelde ileri yaþlarda ortaya çýkan, bazen hayatý tehdit edebilen olgulardýr. Gastrik volvulusa neden olmalarý dolayýsýyla cerrahi olanak tedavileri gerekir. Bu çalýþmanýn amacý, cerrahi tamir yöntemlerini gözden geçirmek ve Akut Karýn sendromu belirtileriyle kliniðimize müracaat eden bir olguyu incelemektir. Cerrahi yaklaþýmda seçilecek olan yöntem mevcut cerrahi metodlarýn birini seçmekten çok hastanýn aperatif ve medikal bulgularýna dayandýrýlmýþ, hastaya özgün bir yöntem olmalýdýr.

Currently, diagnostic and therapeutic intravascular approach increased with some complications behind. Complications like hemorrhagia, pseudoanerysms and arteriovenous fistula could be noticed after the procedure. We had operated a 3 years old patient who had pseudoaneurysm of subclavian artery 3 weeks after subclavian vein hemodialysis catheter access trial. Expetielfy after proximal vascular approach surgeon could meet complication especially hemorrhagia which may cause mortality. Patients with hemorrhagical problems should be followed up for complications desalted above and early surgical intervention may be life saving.