Spinal travmalarda sekonder hasarýn bir dizi biyokimyasal reaksiyon sonucu oluþtuðu bilinmektedir. Yapýlan çeþitli çalýþmalarda bu reaksiyon zincirini durdurmaya yönelik birçok farmakolojik ajan denenmiþtir. Bu çalýþmada beyinde N-metil-D-aspartat reseptör antagonisti olarak etki yapan magnezyum sülfat kullanýldý. Magnezyum sülfat klinikte eklampsi ve tetanusda kullanýlan bir ilaçtýr. Tavþanlarda aðýrlýk düþürme yöntemiyle oluþturulan medulla spinalis travmasýndan sonra oluþan nöronal doku hasarý ve bunun sonucu olarak geliþen nörolojik bozukluðunda magnezyum sülfat ile histopatolojik %20, klinik %26 düzelme saðlanmýþtýr.

It is known that secondary injury following spinal trauma develops as a result of a series of biochemical reactions. Several pharmachological agents have been used to break this reaction chain. Magnesium sulphate which acts as a N-methyl-D-aspartate receptor antagonist in the brain was used in this study. At present magnesium sulphate is being used in the treatment of eclampsia and tetanus. In this study, usage of magnesium sulphate resulted in 20% histopathological and 26% clinical improvement of the neurological deterioration which develops as a result of weight drop technic trauma of medulla spinalis and consequent neuronal injury in the rabbits.

Spinal travmalarda medulla spinalisteki sekonder hasarýn bir dizi biyokimyasal reaksiyon sonucu oluþtuðu bilinmektedir. Yapýlan çeþitli çalýþmalarda bu reaksiyon zincirini durdurmaya yönelik birçok farmakolojik ajan denenmiþtir. Bu çalýþma aðýrlýk düþürülerek oluþturulan tavþan deneysel medulla spinalis modeli üzerinde yapýldý. Daha önceki yýllarda antienflamatuar teoriden yola çýkýlarak nonstereoidal antienflamatuar ilaçlar medulla spinalis travmalarýnda kullanýlmýþ ve kýsmen faydalý olduklarý görülmüþtür. Bu çalýþmada kullandýðýmýz diklofenak sodyum bu ilaçlara göre daha lipofilik ve santral sinir sistemine daha kolay geçebilmektedir. Bu çalýþmanýn amacý medulla spinalis travmasýndan sonra oluþan nöronal doku hasarýný ve bunun sonucu olarak geliþen nörolojik bozukluðun diklofenak sodyum ile ne kadar düzeldiðini araþtýrmaktýr. Sonuç olarak bu çalýþmada diklofenak sodyumun tavþanda aðýrlýk düþürme yöntemiyle oluþturulan deneysel spinal kord travmasýnda nörolojik defisitlerde %15,i oranýnda iyileþme saðladýðý görüldü. Diklofenak sodyum ile % 27.75 oranýnda histopatolojik düzelme saðlandýðý gözlendi.

Secondary medulla spinalis injuries after spinal trauma is the result of many biochemical reactions. In the recent studies, many pharmalogical agents was used for the prevent of these reaction chains. Non-steroidal antienflamatuary drugs used in and showed that particulary usefull in the experimental spinal cord injury model. Diclophenac sodium, a non-steroidal antienflamatuary drug is known that more lypophilic and penetrable to central nervous system than others was used in our study for the preventing of secondary biochemical cord injuries in the experimental rabbit weight dropped-spinal cord injury model. The aim of this study is the investigation of the ameliorative effect of diclophenac sodium in the neurological deterioration due to spinal cord injuries. In our study, the neurological recovery is 15.6% and histopathological recovery is 27.75%, these results are significant statistically as compared with untreated controls.

Her yýl ülkemizde 7000-10000 arasý kiþi trafik kazalarýndan ölmekte, bir çok insanda düþme, darp, iþ kazalarý ve ateþli silah yaralanmalarý gibi travmalardan kaybedilmektedir. Sakat kalanlarýn sayýsý ve travmalarýn sebep olduðu ekonomik kayýp miktarý tam olarak bilinmese de çok yüksek orandadýr. Bu nedenle travmanýn sadece tedavi edilmesi gereken bir hastalýk olarak görülmesi doðru deðildir. Travma sosyoekonomik öneme sahip bir halk saðlýðý sorunudur. Travma cerrahisi yanýnda, halk saðlýðý bölümlerinin de içinde bulunduðu ekipler tarafýndan koruyucu ve tedavi edici önlemler beraber deðerlendirilmelidir.

Every year 7000-10000 people die due to traffic accidents and many others die due to falls, gun shot wounds, and professional injuries. Trauma causes not only a high morbidity and mortality rate but also a high socioeconomic loss. Therefore trauma must not be thought only as a disease but it must be handled as a social problem which should be evaluated by trauma and public health clinics together. In this study we retrospectively analysed the trauma patients who were admitted to the Emergency Clinic of the Van Yüzüncü Yýl University.

Ocak 1991 ile Aðustos 1997 tarihleri arasýnda Taksim Devlet Hastanesi Acil Polikliniðine baþvuran batýna penetran yaralanmalý 163 hasta retrospektiv olarak incelendiler. Ýncelenen 163 penetran batýn yaralanma olgularý arasýnda 13'ünde laparotomide büyük damar yaralanmasý tesbit edildi. Travma þekli, baþvurma anýndaki kan basýncý, transfüzyon sayýsý ile yaralanan organlar yönünden deðerlendirildiler. Aorta (%38) ile Vena Cava inferior (%23) en sýk yaralanan damarlardýr. Aort yaralanmalarýnda % 100, genel olarak %38.5 mortalite tesbit edilmiþtir. Hastanede ortalama yatýþ süresi 13 gündür. Ameliyat edilen hastalar arasýnda yaþama oraný %61.5 olup, 4 hasta (% 30.7) peroperatifex olmuþtur.

One hundred sixty three cases, who were operated for penetrating abdominal trauma between January 1991 and August 1997 were reviewed. These cases were evaluated for the type of trauma, admisition blood pressure .unit of blood transfused and number of injured organs. Thirteen of them had major abdominal injury. Aort (38%) and vena cava inferior(23%) were most frequently injured vessels. Aortic injury had a mortality rate of 100%. Overall mortality rate was 38,5%. Median hospital stay was 13 days. 61,5% of patient operated on were a live, while 4 patients (%30,7) died during operation.

Çocuklarda maksillofasiyal kemiklerin kýrýlma sýklýðý yetiþkinlere göre daha azdýr. Mandibula en sýk etkilenen bölgeler baþýnda gelmektedir. Çocuklarda mandibula fraktürlerinin tedavileri yetiþkinlere göre bazý farklýlýklar göstermektedir. Bu hastalarda uygulanan tedavinin daimi diþ germlerini zedelememesi ve çocuðun çene geliþimini etkilememesi gereklidir. Bu olgu sunusunda, yaþlarý 6-12 arasýnda deðiþen 7 mandibula kýrýðý olgusu sunulmuþtur. Olgular Gunning tip splint ile tedavi edilmiþlerdir. Hastalarýn yaþ, cinsiyet, etyolojileri deðerlendirilmiþ ve diðer tedavi seçenekleri tartýþýlmýþtýr. Gunning tip splint ile tedavi edilen hastalarýn splintleri iyi talere ettikleri ve komplikasyonsuz iyileþmenin saðlandýðý görülmüþtür. Bu yaþ grubu hastalarda splint uygulamasýnýn iyi bir tedavi seçeneði olabileceði düþünülmektedir.

The probability of maxillofacial bone fractures in children is less than that of adults. Mandibula is one of the most effected sites in children. The treatment of mandibular fractures in children shows some variations than that of adults. The treatment chosen for these patients should neither be harmful for the germs of the permanent teeth nor the development of the jaws. In this study, 7 mandibular fracture cases aging between 6-12 is presented. The treatment was carried on by Gunning types splint. Age, sex, etiologies of the patients were evaluated and other treatment alternatives were discussed. Cases treated will Gunning type splint showed good toleration for the splints and healing without complications was observed in the cases. Therefore, we believe that treatment of mandibular fractures in children by splint application would be a reasonable treatment choice.

Karýn içi damar yaralanmalarý sýklýkla delici ve kesici aletlerle olmakta, nadir de olsa künt travmalarý takibinde yaralanmalar meydana gelmektedir. Künt travmalar sonucu oluþmuþ damar yaralanmalarýna ait az sayýda yayýn vardýr. Geniþ bir yelpazeyi daðýlan künt travmalar da oluþan damar yaralanmalarýnýn sýklýðý bilinmemektedir. Beþ yýlý aþkýn süre içinde künt travmalar sonucu karýn içi damarlarda yaralanma oluþmuþ 27 hastanýn geriye dönük olarak týbbi dosyalarý tarandý. Bu yaralanmalarýn %93'ü (25/27) motorlu araç kazasýydý. Hastalarýn acil merkezimize geliþteki ortalama kan basýnçlarý 88/26 mm Hg'idi. Yaralanma ciddiyet skorlarý ortalamasý (ISS) 28±8.2 puan olan hastalarýn, 19'sunda arterial, 17 sinde venöz yaralanma mevcuttu. 26 hastada (%96) damar yaralanmalarýna, diðer karýn içi organ yaralanmalarý eþlik ediyordu. Arter yaralanmalarý için primer onarým ve ligasyon, venöz yaralanmalar için ise kompresyon, ligasyon ve/veya primer onanýn uygulandý. Kaba mortalite oraný %l 9 olarak bulundu. Arter yaralanmalarýnýn tek baþýna bulunduðu grupta ölüm yokken, mortalite venöz yaralanmalarý olan grupta 33% (5 hasta) olarak bulundu (p<0.05). Nadir de olsa künt batýn travmalarý sonucu batýn içi damar yaratanýndan oluþmaktadýr. Eþlik eden organ yaralanmalarýný takiben hemodinamik deðiþikler oluþmakta ve tüm müdahalelere raðmen yüksek mortalite ve morbiditiye neden olmaktadýr. Büyük ven yaralanmalarý ise yüksek olan mortaliteyi daha da arttýrmaktadýr. Bu nedenle hemodinamik olarak stabil olmayan hastalar resüsitasyon uygulandýktan sonra acil operasyona alýnmalý ve damar yaralanmasý yönünden dikkatli olunmalýdýr.

Abdominal vascular trauma is predominantly penetrating in nature with blunt injuries occurring less frequently. The various specific types of blunt abdominal vascular trauma have been individually reported, however, the wide spectrum of vascular pathology possible with blunt injury is relatively unknown. Over a five year period, 27 patients who sustained blunt abdominal vascular injury were identified. The injury was motor vehicle related in 25/27 (93%). Mean blood pressure on admission was 88/26 mm Hg and mean Injury Severity Score (ISS) was 28±8.2. In 27 patients, there was 19 arterial and 17 venous injuries diagnosed. Significant associated injuries were present in 26/27 (96%) patients. When arterial and venous injuries were compared, surgical treatment of arterial injuries more frequently required grafting or ligation, in contrast to venous injuries usually required ligation, packing, or primary repair. Overall morbidity (56%) was significantly greater in the group with venous injury (92% vs 46%, p<0.05). The overall mortality rate was 19%. There was no death in the group with major arterial injuries, while five patients (33%) with major venous injuries died (p< 0.05). Blunt abdominal vascular trauma is a rare entity with a wide spectrum of vascular injuries possible. Hypotension and associated visceral injuries are often present. Major venous injuries present acutely and despite heroic measures, continue to have a higher morbidity and mortality. Aggressive resuscitation should be followed by early surgical intervention keyed by a high index of suspicion.

Orbita tabaný onarýmý otojen yada alloplastik materyallerle yapýlmaktadýr. Bu çalýþmada 8 hastanýn deðiþik travmalara baðlý olarak meydana gelmiþ orbita tabaný kayýplarýnýn onarýmýnda poröz polietilen kullanýldý. Ortalama 14 aylýk takip süresinden sonra sonuçlar deðerlendirildi. Enfeksiyon ve implant yer deðiþtirmesi gibi komplikasyonlar görülmedi. Poröz polietilen'in enfeksiyon riski, donör bölge morbiditesi ve implant kaymasý gibi problemler olmadan orbita onarýmýnda kullanýlabilecek uygun bir materyal olduðunu düþünüyoruz.

Reconstruction of the orbital floor has been performing by either otogenous or alloplastic materials. In this study porous polyethylene sheet was used for orbital reconstruction in 8 patients with various traumatic defects of the orbital floor. The results were evaluated at the end of 14 months period of mean follow-up. Complications such as infection, displacement of the implant were not observed. Porous polyethylene is suitable and it can be used safely and effectively for orbital reconstruction without the risk of infection, donor site morbidity and implant displacement.

Ocak 1998-Eylül 1998 tarihleri arasýnda birimimize getirilen, 85 künt travmalý, þuuru kapalý, hemodinamisi stabil hasta çalýþma grubuna alýnmýþtýr. Travma nedenleri 44'ünde trafik kazasý, 38'inde düþme, 3'ünde darptýr. Bu hastalarýn hiçbirine karýn travmasýnýn teþhisi amacý ile peritoneal lavaj yapýlmamýþ, hastalar hemodinamik durumlarý ile takip edilmiþtir. Hastalarýn 74'ü þifa ile taburcu olurken, 11'i kaybedilmiþtir. Ülkemizde yaygýn olarak hekimler þuuru kapalý travmatik hastalarda karýn travmasýnýn teþhisinde hemodinamik deðerlendirmeyi dikkate almadan yardýmcý taný yöntemlerine müracaat etmektedir. Biz bu çalýþmamýzda þuuru kapalý travmatik hastalarda hemodinamik stabilite varlýðýnda invaziv bir yöntem olan DPL'nin yaygýn kullanýmýn uygun olmadýðý görüþüne vardýk. Çalýþma grubumuzdaki 85 hastanýn takibinde bir sorun yaþanmamasý da bu görüþümüzü desteklemektedir. Sonuç olarak künt travmalý, þuuru kapalý hastalarýn karýn travmasýnýn deðerlendirilmesinde hemodinamik izlem güvenli bir yöntemdir. Yardýmcý taný yöntemi gerektiðinde kullanýlmasý gereken ilk taný yöntemi USG olmalýdýr.

We have evaluated 85 blunt traumatized, hemodynamically stable, unconscious patients who admitted to our emergency surgery department, between January 1998-September 1998. The reasons for trauma are traffic accidents in 44, fall in 38, hitting in 3. None of these patients underwent peritoneal lavage, but were followed up with their hemodinamic parameters. While 74 of them were discharged with complete healing, 11 of them died. The doctors in our country usually use other diagnostic tools to evaluate the presence of abdominal trauma in blunt traumatized, unconscious patients without considering the hemodynamic parameters. In this study we showed that DPI which is an invasive method is not necessary to use so frequently in the hemodynamically stable, unconscious patient with multitrauma. In conclusion, we say that the evaluation and follow up of abdominal injury with the hemodynamic parameters, in a blunt traumatized and unconscious patient is a reliable method. If necessary the first tool to be used in diagnosis should be ultrasonography.

Nekrotizan yumuþak doku enfeksiyonu (NYDE) tanýsý ile kliniðimizde Mayýs 1988 ile Aralýk 1998 tarihleri arasýnda tedavi edilen 11 hastanýn hastane kayýtlarý retrospektif olarak incelendi. Hastalardan 2'si kadýn 9'u erkekti. Hastalýðýn en sýk saptandýðý yer perianal bölge (7 hastada, %63), en sýk yandaþ hastalýk ise Diabet Mellitus (DM) (6 hasta, %55.5) olarak bulundu. Tüm hastalara ortalama 5.1 (3-7) kez cerrahi debridman uygulandý. Mortalite oraný %18.1 (2 hasta) olarak bulundu. Hastalarýn yaþ ve cinsiyeti, baþvuru anýndaki klinik ve laboratuvar parametreleri, yandaþ hastalýklarýn varlýðý, enfeksiyon lokalizasyonunun ve cerrahi tedavi zamanlamasýnýn morbidite ve mortalite üzerine olan etkisi deðerlendirildi. Enfeksiyon lokalizasyonu ve geniþliðinin, bakteriyemi varlýðýnýn, hastanýn diabetinin olmasýnýn ve uzamýþ inmobilizasyonun morbidite ve mortaliteyi etkilediði sonucuna varýldý.

A retrospective review of the medical records of 11 patients between the years May 1988-June 1998 with the diagnosis of necrotizing fasciitis was performed. There were 2 females, and 9 males. Diabetes mellitus was the most common concomitant disease (6 patients, 55.5%), and the most common sites of origin of infection were the perineum (7 patients, 63 %). The mean number of surgical debridements were 5.1 (3-7). The mortality rate was 18.1% (2 patients). Age and sex of the patients, the presence of concomitant diseases, localization of the infection, timing of the surgery on the morbidity and mortality was evaluated. We conclude that extent and localization of the infection, presence of diabetes mellitus, presence of bacteriemia and prolonged immobilization influence the morbidity and mortality.

Amaç: Bu çalýþmanýn amacý geriatrik travma olgularýnda mortalite ve morbiditeye etki eden faktörlerin ortaya konmasýdýr. Metod: 318yaþlý çoklu yaralanmalý olgu; yaralanma mekanizmasýnýn, altta yatan hastalýðýn, Yaralanma Aðýrlýðý Skorunun (ISS), Düzeltilmiþ Travma Skorunun (RTS) sonuca etkisi bakýmýndan incelenmiþtir. Bulgular: Yaþýn mortalite ve komplikasyon oranýna etki etmediði, ancak sekeli etkilediði belirlenmiþtir. Ölüme en çok neden olan yaralanma mekanizmasýnýn düþme olduðu saptanmýþtýr. Kardiyovasküler hastalýk dýþýndaki altta yatan hastalýklarýn varlýðý mortalite, komplikasyon oranýný ve hastanede kalýþ sürelerini etkilemediði saptanmýþtýr. Komplikasyon geliþiminin sekeli, yoðun bakýmda ve hastanede kalýþ süresini artýrdýðý gözlenmiþtir. Takip edilebilen 133 hastanýn %57.9'unda sekel bulunmuþtur. ISS ve RTS mortaliteyi belirlemede önemli bulunurken; BS ayný zamanda sekeli belirlemek açýsýndan da önemli bulunmuþtur. Mekanik ventilasyon ve kan transfüzyonu yapýlanlarda mortalitenin arttýðý gözlenmiþtir.Sonuç: ISS, RTS, yaralanma mekanizmasý (düþmeler), baþvuru sýrasýnda þok varlýðý, kafa travmasý, transfüzyon ve mekanik ventilasyon mortaliteyi artýrmaktadýr. Ýleri yaþ, komplikasyon geliþimi ve ISS ise sekel riskini belirlemede önemli bulunurken, hastanede kalýþ süresi uzunluðu yalnýzca komplikasyon geliþimi ile iliþkili bulunmuþtur.

Aim: To evaluate the factors effecting morbidity and mortality in geriatric trauma patients. Method: 318 elderly patients with multiple injuries were evaluated to analyse the effects of injury mechanism, preexisting disease, Injury Severity Score (ISS), Revised Trauma Score (RTS) on outcome. Results: Age was not found to be a factor on mortality and complication, while it increased disability. Falls were the mechanism mostly associated with the mortality. We found that preexisting chronic illnesses other than cardiovascular diseases were not significantly related to mortality, complication and hospital stay. Complication increased disability, ICU stay and hospital stay. Disability was found in 57.9% of the 133 patients followed. ISS and RTS were predictors of survival and ISS was also a good predictor of disability. The mortality increased with blood transfusion and mechanical ventilation. Conclusion: ISS, RTS, injury mechanism (falls), shock at the admission, head injury, transfusion and mechanical ventilation significantly predict mortality. Age, complication and ISS are related to disability. Complication is the only factor related to a prolonged hospital stay.

Bu prospektif çalýþma kapalý kafa travmalý olgularda koagulasyon bozukluklarýnýn derecesi ile prognozu arasýndaki iliþkinin ortaya konulmasý için planlandý. 55 olgu Glasgow Koma Skalasý (GKS) skoruna göre 3 gruba ayrýldýlar: Grup 1 (GKS skoru 13-151, Grup 2 (GKS skoru 8-12), Grup 3 (GKS skoru 3-7). Koagulasyon testleri (trombosit sayýsý, protrombin zamaný, aktif parsiyel tromboplastin zamaný, fibrinojen, öglobulin yýkým zamaný, fibrin yýkým ürünleri (FYÜ), D-Dimer, antitrombin III) ve bilgisayarlý tomografi tetkiki tüm hastalarda yapýldý. Kan örnekleri travma sonrasý 6 ve 24. saatlerde, 3 ve 7. günlerde alýndý. Cerrahi giriþim yapýlan olgularda, cerrahinin hemen öncesi ve sonrasý ve anestezi indüksiyonu sýrasýnda ek kan örnekleri alýndý. Grup I'de tüm koagulasyon testleri normaldi. Grup 2 ve 3'de FYÜ ve D-Dimer seviyeleri önemli derecede yüksek, antitrombin III seviyeleri düþüktü. Bu deðerler hastanýn prognozuna göre deðiþim gösterdi. FYÜ, D-Dimer ve antitrombin III ün künt kafa travmalý olgularýn prognoz tahmininde önemli olduklarý saptandý.

The present prospective study was undertaken to evaluate the relationship between degree of coagulopathy and prognosis after closed head injury. 55 patients were divided into three groups according to Glasgow Coma Scale (GCS) score: Group 1 (GCS score 13-15), Group 2 (GCS score 8-12), Group 3 (GCS score 3-7). Coagulation studies (platelet count), prothrombin time, activated partial thromboplastin time, fibrinojen, euglobulin lizis time, fibrin degradation products (FDP), D-Dimer, antitrombin III) and computed tomography scan examinations were performed in all patients. Blood samples were taken in 6 hours, 24 hours, 3 days and 7 days after injury. In the operated patients, additional samples were collected immediately before and after surgery and during induction of anesthesia. In the group 1, all coagulation parameters were normal. In the group 2 and 3, FDP and D-dimer levels were abnormally higher and also antitrombin III level was significantly lower in the patients in group 2 and 3(p< 0.01). FDP, D-dimer and antitrombin III had an important value in estimation of prognosis in patient with blunt head injury.

1987-1998 yýllarý arasýnda fizik travmayla baþvuran 40'ý kýz, 100'ü erkek olmak üzere toplam 140 olgu, Anabilim Dalýmýzda yatýrýlarak saðaltýlmaya çalýþýldý. Yanýklar ve cerrahi hatalar bu serinin dýþýnda tutuldu. Baþvuran hastalar 1, 2., ve 3. aþama travma merkezi olarak "Pediatrik Travma Skorlamasý", "Glasgow Koma Skalasý" ve 3 yaþ altý çocuklarda "Çocuklarda Koma Skalasý uygulanarak prospektif amaçla prognostik olarak deðerlendirildi. Kanamanýn sürmesi, atlanabilen ilk taný ve komplikasyonlarýn oluþmasý yönünden nörolojik deðerlendirme ve triaj amaçlý skorlama erken uyarý niteliðinde bulundu.

A total of 140 children (100 male and 40 female) with physical trauma were admitted to Department of Pediatric Surgery, between 1987 and 1998. Burns and surgical faults were excluded. Patients were evaluated prospectively on the base of "Pediatric Trauma, Glasgow Coma and Pediatric Coma Scores" as primary, secondary and tertiary trauma centers. Data shows that, neurologic evaluation and scoring for triage help as an early warning method for the detection of further bleeding, missed diagnosis and other complications.

Temporoparietal-galeal flep travmaya baðlý kontrakte soket ve periorbital deformite rekonstrüksiyonunda iyi vaskülarize bir doku saðlamasý açýsýndan güvenilir bir fleptir.Bu çalýþmada minimal donor morbiditeye yol açarak temporoparietal fasyal flebi uyguladýðýmýz 5 hastayý sunmaktayýz.

Temporoparietal-galeal flap provides a reliable source of pliable, well vascularized local tissue capable of reconstructing contracted eye socket and periorbital deformities due to trauma. We present five patients whom we applied temporoparietal fascial flap successfully with minimal donor morbidity. The results were quite satisfactory.

Kliniðimizde Eylül 1995 ve Kasým 1997 yýllarý arasýnda 19 femur intertrokanterik kýrýklý hastaya Leinbach hemiprotez uygulandý. Hastalardan ikisi erkek (%10.5), 17"si kadýndýr (%89.5). Ortalama yaþ 81.8'dir (yaþ daðýlýmý 70-95). On dokuz hastanýn 14'ünde (%73.6) kalkarda kýrýk saptandý. Tüm ameliyatlar spinal anestezi yardýmý ile yapýldý. Ameliyat sonrasý birinci günde hastalarýn hepsi yataklarýnda oturtuldu; dren alýnmasýndan sonra yürüteç yardýmý ile tam yük vererek yürütüldü. Hastanede kalýþ süresi ortalama 22 gün, takip süresi ortalama 19 aydýr. Ýki hastanýn kardiak nedenlerle, iki hastanýn da kýrýk sonrasý geliþen düþkünlük dolayýsýyla ex olduðu hasta yakýnlarýndan öðrenildi. Ýki hasta, halen hayatta olmalarýna raðmen ameliyat sonrasý geçirmiþ olduklarý nörolojik problemler nedeniyle hemiplejik olduklarýndan son kontrole gelemediler. Hastalarýn fonksiyonel deðerlendirilmesi Merle d'Aubigne kriterlerine göre yapýldý. Bu kriterlere göre 1 hastada çok iyi (%5.2), 7 hastada iyi (%36.8), 5 hastada orta (%26.3), 6 hastada kötü (%3 1.5) sonuç elde edildi. On üç hastanýn (%68.4) yürüyebildikleri ve günlük iþlerini yapabildikleri saptandý. Takip süresi içinde radyolojik olarak deðerlendirilen 13 hastanýn hiçbirinde stemde gevþeme, dislokasyon ve asetabuluma protrüzyon saptanmadý. Ýleri derecede yaþlý ve osteoporotik hastalarýn intertrokanterik femur kýrýklarýnda tedavide amaç, hastanýn erken mobilizasyon ve günlük hayatýna en kýsa sürede dönebilmesidir. Bu amaca yönelik tedavide Leinbach tip hemiprotezlerin uygulanabileceði görülmüþtür.

We employed Leinbach prosthesis in 19 patients with intertrochanteric hip fractures between September 1995 and November 1997. Of these, two patients (10.5%) were men and 17 (89.5%) were women (age range 70-95 years, mean age 81.8years). In calcar femoris fractures were detected in 14 patients (73,6 %) All operations were performed under spinal anesthesia. The patients achieved sitting position in bed on the postoperative first day; full weight-bearing position with an aid of walkers was obtained after the removal of the drainage. Mean hospital stay was 22 days with a mean follow-up of 19 months. According to the account given by patients' relatives, two patients died from cardiac causes and another two from debilitating conditions developed after fractures. Two patients, although they were alive, were not available for follow-up because of hemiplegic conditions caused by postoperative neurologic problems. Merle d' Aubigne functional hip scores were used for evaluation of the patients. 1 patient (5.2%) was classified excellent, 7 patients (36.8%) were good, 5 patients (26.3%) were fair and 6 patients (31.5%) were poor. Thirteen patients (68.4%) achieved walking and implementation of daily activities. Radiologic examinations did not show loosening of the stem, dislocation, and acetabular protrusion. The object of treatment in elderly and osteoporotic patients with intertrochanteric hip fractures is to achieve early mobilization and rapid restoration of daily activities. Leinbach prosthesis appears to be appropriate for intertrochanteric hip fractures.

Yumuþak doku içindeki yabancý cisimler özellikle radyoopak deðilse oldukça zor çýkarýlýrlar. Radyoopak olanlarda bile lokalizasyon oldukça zor olur. Ýyi lokalize edilmeden yapýlan insizyonlar uzun süren baþarýsýz müdahalelerle sonuçlanabilir. Acil servise yabancý cisim batmasý þikayetiyle baþvuran 53 hasta incelendi. Bunlardan yabancý cisimleri radyoopak olan 15'i çalýþmamýzý oluþturdu. Hastalara iki yönlü direk radyografi çekildi. Yabancý cisim olduðu ve bunun da radyoopak olduðu tespit edildikten sonra yabancý cismi en iyi lokalize edecek þekilde enjektör ucu ile iþaretleme yapýldý. Tekrar iki yönlü radyografi alýndý. Grafiler eþliðinde yabancý cisim arandý ve çýkarýldý. Daha sonra dokular anatomik katlara uygun olarak kapatýldý. Tekrar kontrol grafisi çekildi. Hasta bir hafta sonra kontrole çaðrýldý. Yöntemi uyguladýðýmýz 15 vakanýn 13'ündeyabancý cisim iðne idi. Yabancý cisimlerin 7'si el, 4'ü ayakta idi. Diðerleri vücudun çeþitli yerlerinde idi. 14 vakada yabancý cisimler baþarý ile çýkarýldý. Sonuç olarak; Özellikle skopi imkanlarýnýn olmadýðý yerlerde ve acil servis þartlarýnda stereotaksik yöntemle yabancý cisim çýkarýlmasý ekonomik ve kolay bir yöntemdir. Ýþlemi yapan doktorun radyasyona maruz kalmamasý bir diðer önemli avantajýdýr. Ameliyathane þartlarýna, özel ekip ve ekipmana gerek kalmadan radyoopak yabancý cisimler bu yöntemle çýkarýlabilir.

Removal of foreign bodies in soft tissue is not an easy process. Those which are not radiopaque may make the removal procedure more difficult. Incisions which are made without determining the site of the foreign body properly may result in unsuccessful interventions. In this study we used 'Stereotaxy' method to remove radiopaque foreign bodies from the soft tissues. This approach does not require any specialised team or equipment. 53 patients who visited our emergency department for the foreign bodies embedded in the soft tissues were investigated. 15 patients who had radiopaque foreign bodies in the soft tissues were included in the study. Two-view plain radiographies were obtained first. An injector needle was used to mark the site of the foreign body considering the x-ray appearance of the radiopaque foreign body. After marking the site, x-rays were obtained again. The foreign bodies were removed using the guideness of these radiographs. Control radiographies were obtained following the removal procedure. The patients were asked to apply to the hospital one week later for control examination. This method was applied in the 15 cases. The foreign body was pin in the 13 cases. 7 of the foreign bodies were embedded in the soft tissues of the hand, 4 in the soft tissues of the foot. The remaining ones were in the other parts of the body. The foreign bodies were successfully removed in the 14 cases. Foreign bodies embedded in the soft tissues may cause inflammation, infection and toxic and allergic reactions. The accurate determination of the site of a foreign body embedded in the soft tissue is difficult. Superficial markers, multidimensioned radiographies, grills, fluoroscopy and stereotaxic instruments can be used in determining the localisation of the foreign body. As a result, stereotaxy is a cheap and easy method especially in emergency departments and in clinics where scopy is not present. The foreign bodies can be removed using this method without needing specialised team and equipment and operating-room conditions.

Pulmonary pseudocysts are lesions which develop rarely after blunt non-penetrating thoracic trauma, and heal spontaneously within 1-4 months without requiring a specific treatment History of thoracic trauma together with chest X-rays revealing cavitary lesion usually lead to the diagnosis. In some of the cases the presence of pulmonary contusion and hematoma may hide the cystic lesion. Computed tomography plays an important role in the early diagnosis of the lesions. In this case report a case of pulmonary pseudocyst is presented of which the diagnosis was made by computed tomography and required surgical treatment since there was no spontaneous resorption.

Diagnosis, management and postoperative care of duodenal injuries are difficult, especially when the duodenum was injured by blunt trauma. Injury to adjacent organs commonly accompanies duodenal trauma. Here we present a male patient, who suffered from a blunt trauma leading to complex-isolated duodenal rupture and was managed by means of primary repair with retrograde duodenostomy. In this regard, we also discussed diagnostic modalities, causes of delayed diagnosis and management of duodenal injuries and reviewed literature.

Tracheobronchial injuries are rarely seen. Injury in the bronchus is closed by mucus plug it prevented the diagnose in early hospitalization period. The patient who was discharged following blunt chest trauma was rehospitalized for atelectasia was operated with the diagnosis of right bronchial rupture.

Oesophageal perforation, is a rare condition, can be caused by external trauma, or instrumentation, or foreign body. A spontaneous form of the rupture is named as Boerhaave syndrome. Because of the protected location of oesophagus, its perforation is generally associated with other organ injuries. Conservative therapy is one of the modalities treatment is proposed. In these papers, a patient with a traumatic oesophageal perforation is reported. He is treated by conservative therapy and additional irrigation that haven't been found in the literature. The patient is cured without any complication.