Bu çalýþmada Þýrnak Askeri Hastanesinde Ocak 1997 ile Temmuz 1999 tarihleri arasýnda yüksek enerjili ateþli silahlarla ve mayýna basma sonucu meydana gelen, acil olarak ameliyata alýnan ekstremite yaralanmalarý retrospektif olarak deðerlendirildi. Toplam 236 olgunun 147'si (%62.3) alt ekstremite yaralanmasý 89'u (%37.7) üst ekstremite yaralanmasýydý. En sýk görülen yaralanmalar üst ekstremitede el; alt ekstremitede ayak yaralanmasý þeklindeydi. En dramatik yaralanmalar anti tank mayýnla tuzaklanmýþ, anti personel mayýna basma sonucu meydana gelirken; kaþarlanmanýn yeri ve þiddeti ateþli silahýn cinsine, gücüne, þahsýn yaralanma anýndaki pozisyonuna ve ateþli silahtan olan uzaklýðýna baðlý olarak deðiþmekteydi.

Hospital records of patients who had extremity injuries caused by high energy gunshots and land-mines and treated in Þýrnak Military Hospital between January 1997 and July 1999 were reviewed retrospectively. Among 236 cases 147 (62.3%) had lover extremity wounds and 89 (37.7%) had upper extremity wounds. The most frequently injured part was hands for the upper extremity and feet for the lower extremity. The most dramatic wounds were caused by slapping on anti personnel mines trapped with anti tank mines. The localization and the extension of the wounds worries with type and power of the gun, the position of the victim at the time of explosion and the distance between the victim and the gun.

Peptik ülser perforasyonu nedeni ile 1983-1998 yýllarý arasýnda ameliyat edilen 248 hastanýn kayýtlarý retrospektif olarak incelendi. Hastalarýn 112'sinde (%45.1) kronik, 34'ünde (%13.7) akut ülser hikayesi varken, 102 hastada (%41.2) ülser hikayesi yoktu. Hastalarýn 228'inde (%92.0) duodenal, 9'unda (%3.6) jukstapilorik, 6'sýnda (%2.4) marjinal, 5'inde (%2.0) antral ülser mevcuttu. Hastalarýn 42'si (%16.9) semptomlarýn baþlamasýndan sonraki ilk 12 saat içinde hastaneye müracaat ederken 206'sý (%83.1) 12 saatten sonra (12 saat-6 gün) müracaat etti. Ýntraabdominal sepsis olan 126 hasta (%50.8) ile ciddi yandaþ hastalýðý olan 32 hastaya (%12.9) basit kapama+omentoplasti yapýlýrken, 32 hastaya (%12.9) bilateral trunkal vagotomi (BTV) + piloroplasti, 34 hastaya (%13.7) basit kapama + omentoplasti + BTV + gastroenterostomi, 21 hastaya (%8.5) basit kapama + omentoplasti +proksimal gastrik vagotomi (PGV), 3 hastaya (%1.2) BTV + antrektomi yapýldý. Definitif iþlem yapýlmayan hastalara H2 reseptör blokerleri veya proton pompa inhibitörleri verildi. Endoskopik kontrole 193 hasta (%77.8) geldi. Definitif iþlem yapýlýp kontrole gelen 53 hastanýn 2'sinde (%3.8) nüks tespit edildi ve bu hastalara medikal tedavi uygulandý. Definitif iþlem yapýlmayýp kontrole gelen 140 hastanýn 34'ünde (%24.3 nüks tespit edildi. Bu hastalarýn 2'sine definitif iþlem olarak PGV yapýlýrken diðerlerine medikal tedavi uygulandý. Nüks oraný definitif iþlem yapýlmayan hastalarda definitif iþlem yapýlanlardan anlamlý derecede yüksek olarak bulundu (p<0.01)

Two hundred forty-eight patients were operated for perforated peptic ulcer between 1983 and 1998. Of the patients 112 (45.1%) had chronic, 34 (13.7%) had acute ulcer history and 102 (41.2 %) had no ulcer history. Of the patients 228 (92.0%) had duodenal, 9 (3.6%) had juxtapyloric, 6 (2.4%) had marginal, and 5 (2.0%) had antral ulcer. Forty two patients (16.9%) admitted within 12 hours and 206 patients (83.1%) between 12 hours and six days after perforation. Simple closure and omental patch was performed in 32 patients (12.9%) who had severe concomitant illness and 126 (50.8%) intraabdominal sepsis, truncal vagotomi + pyloroplasty in 32 (12.9%), simple closure + omental patch + truncal vagotomi + gdstroenterostomy in 34 (13.7%), simple closures omental patch + pariatal cell vagotomy in 21 (8.5%), truncal vagotomi + antrectomy in 3 (1.2%). Patients who didn't have definitive procedure received H2 receptor blockers or proton pomp inhibitors. One hundred ninety-three patients (77.8%) underwent endoscopic control. Two of 53 patients with definitive procedure (3.8%) and 34 of 140 patients (24.3%) with simple closure had recurrence. Two patients in simple closure group underwent pariatal cell vagotomy, the others received medical treatment. The recurrence rate was significantly higher in simple closure group (p<0.01).

Trafik kazalarý her yaþ grubundan insaný etkileyen önemli bir halk saðlýðý sorunudur. Bu çalýþmada amaç; trafik kazalarýnýn hangi þartlarda daha fazla olduðunu; kazalarýn gün ay ve yýl içindeki daðýlýmlarýný tespit etmek, ayrýca kazaya neden olan diðer etkenleri belirlemektir. Çalýþma, Erciyes Üniversitesi Týp Fakültesi Acil Polikliniði'nde yapýldý. 1998 yýlý içindeki 12 aylýk zaman periyodunda acil polikliniðe 31.550 hasta müracaat etti. Bunlarýn 7098'i (%22) trafik kazasý idi. 7098 hastadan %10 sistematik örneklem ile tespit edilen 710 hasta çalýþmaya alýndý. Çalýþmaya alýnan hastalarýn 504'ü erkek (%7l), 206'sý kadýn (%29) olup yaþ ortalamasý 26.0 (1-85) olarak bulundu. Trafik kazalarý gün içinde saat 12.00-18.00 arasýnda, hafta sonlarý ve mayýs-haziran aylarýnda artmaktadýr. Kazalarýn oluþ þekli þehir içi ve þehir dýþý yollarda aynýdýr ancak þehir içi trafik kazalarýnda yayaya çarpma oraný yüksektir. En çok kaza yapan araç otomobil olmasýna raðmen mortalitesi en yüksek araç kazasý otobüs, minibüs ve motosiklettir. Hastalarýn %80.5'inin ilk tedavi yeri üniversite hastanesi olmuþtur. Acile trafik kazasý nedeni ile getirilen hastalarýn 619'u (%87.1) geçici travma tanýsý almýþ ve tedavilerinden sonra þifa ile taburcu edilmiþlerdir. 52 hasta (%7.3) ise kaybedilmiþtir. Kazalarýn oluþ yeri, zamaný, kazaya karýþan araçlar ve kaza sonrasý hastaya yapýlan týbbi tedavinin kalitesi hastanýn morbimortalitesini önemli derecede etkiler.

Traffic accidents, which influence to every age group people, are an important public health. This study to determine which condition it has happened more, which days, months and years it has happened, what things have caused to happen traffic accidents. The study was made in Erciyes University Medical School Emergency Department. 31550 patients applied to emergency department in a period of twelve months in 1998. 7098 (22%) cases of these were traffic accidents. It has done on 710 patients who have been brought to emergency by traffic accidents, and 10% systematic sampling of 7098 people. 504 (71%) of patients were male, 206 (29%) of them were female, the average age was 26.0 (min-max: 1-85). It was observed that traffic accidents occurred during peak times 1200-1800 p.m. The number of traffic accidents was higher during the weekends and in may and June than other times. All the accidents occurred in the same way both within and outside urban area. But the drivers hit the pedestrians more in the urban area. Although it has been seen 'the cars' in the accidents the most. The most mortality has been occurred in bus, minibus and motorbike accidents. The first treatment place of the casualties of 80.5% was at university emergency department. 619 all of the casualties who were admitted the university emergency department was simple injured. They all left the hospital with cure. 52 of casualties lost their life. As a result, some risk factors increase incidence of traffic accidents. Considering these risk factors in taking measures is of great importance in prevention of traffic accidents. Morbidity and mortality are affected by place where accidents occur, time of accident, properties of motor vehicles, and quality of medical care performed following the incident.

1995- 1998 yýllarý arasýnda kliniðimize baþvuran kraniyal ateþli silah yaralanmalý 21, vaka yaþ, cinsiyet, kraniyal yaralanmanýn þekli, giriþ Glaskow Koma Skalasý (GKS), tedavi ve mortalite yönünden analiz edildi. Hastalarýn yaþlarý 9-24 arasýndaydý. 19'u erkek, 2'si kadýndý. Kraniyal ateþli silah yaralanmalarýnýn nedenleri arasýnda ilk sýrayý terör nedeniyle silahlý çatýþma alýyordu. Hastalarýn tamamýna düz grafi ve bilgisayarlý tomografi (BT) tetkiki yapýldý. 9 olguda intraserebral, 4 olguda subdural, 1 olguda intraventriküler, 1 olguda epidural hematom saptandý. 9 olguda yaralanmaya sebebiyet veren þarapnel parçasý veya kurþunun intrakraniyal harabiyet sonrasý kraniumda sabit kaldýðý görüldü. Giriþ GKS 3-5 arasýndaki hastalar tüm tedaviye raðmen eksitus oldu. GKS göre 11-15 arasýndakiler in tedavileri þifayla sonuçlandý. Olgularýn 15'ine cerrahi tedavi uygulandý. Cerrahi uygulanan hastalarda lasere dokular debride edildi ve dekompresyon gerektiren patoloji varsa- tedavi edildi. 3 olguda' postoperatif dönemde BOS fistülü geliþti reoperasyon ile dura onarýmý yapýldý. Olgularýn giriþ GKS puaný, BT ile ayrýntýlý deðerlendirme ve acil cerrahi, lasere dokularýn geniþliði ve lokalizasyonu ile postoperatif komplikasyonlarýn morbidite ve mortalite üzerine etkisi tartýþýldý.

21 patients with gunshot wounds were retrospectively evaluated. They were 19 male and 2 female, age range was 9-24. All of the patients underwent a plain x-ray and computed tomography evaluation. 9 patients had intracerebral hematoma, 4 had subdural hematoma, 1 had epidural hematoma and 1 had intraventricular hematoma. 9 patients were observed to have bullet in the cranium. All the patients with glascow coma scale 3-5 at the admittance died. 15 patients underwent surgical treatment. 3 patients had cerebrospinal fluid fistula postoperatively and underwent reoperation. Extensivity of the lacereted brain, localization of the lesion and the glascow coma scale at the admittance affect the outcome in gunshot wounds.

Travmatik korpus kallozum (KK) lezyonlarýnýn saptanmasýnda MRG ve bilgisayarlý tomografinin (BT) taný deðerinin belirlenmesi ve lezyonlarýn özelliklerinin saptanmasý. Olgular ve Yöntem: Acil polikliniðine getirilen, Glasgow Koma Skalasý (GKS) skoru 12 ve altýnda olan ve erken dönemde hem BT, hem MRG yapýlmýþ olan 49 olguda KK lezyonlarýnýn varlýðý ve özellikleri retrospektif olarak deðerlendirildi. Bulgular: Olgularýn 20'sinde (%40.8) toplam 31 KK lezyonu saptandý. MRG'de. lezyon saptanan 20 hastanýn sadece 7'sinde lezyonlar BT'de görüldü. MRG'de lezyonlarýn büyük bir kýsmý nonhemorajik (%87) olduðu halde, BT'de saptanan 7 lezyonun üçü nonhemorajikti (%42.8). 20 hastanýn 7'sinde (%35) lezyonlar sadece spleniumda yerleþmiþti. Diðer olgularda spleniumla birlikte ya da tek baþýna KK ön bölümünde lezyon vardý. KK lezyonlu hastalarda ventrikül içi kanama ile DAH'ýn diðer komponentlerinden olan beyin sapý ve subkortikal ak madde lezyonlarýnýn bulunma olasýlýðý KK lezyonu olmayan hastalara göre yüksekti, ancak farklar anlamlý deðildi. Sonuç: Travmatik KK lezyonlarý orta-aðýr kafa travmalý hastalarda sýk görülür. Lezyonlarýn çoðu spleniumda yerleþir ve nonhemorajiktir. Travmatik KK lezyonlarýnýn saptanmasýnda MRG'nin taný deðeri BT'den çok daha yüksektir.

Aim: To determine the diagnostic values of magnetic resonance imaging and computed tomography and characteristics of the lesions in traumatic lesions of the corpus callosum. Cases and methods: In 49 cases with traumatic lesions of the corpus callosum whose Glasgow Coma Scale (GCS) scores were 12 or under, presence and characteristics of the lesions of corpus callosum were evaluated retrospectively. All of the cases had both of MRI and CT scans at early posttraumatic periods. Results: In 20 patients (40.8%) there were 31 lesions. There were lesions in only 7 of 20 patients that had lesions in MRI. Despite most of lesions (87%) were nonhemorrhagic in MRI, 3 of 7 lesions (42.8%) were nonhemorrhagic in CT. Lesions were limited to the splenium in 7 of 20 patients (35%). In other cases there were lesions at anterior regions of corpus callosum with or without splenial lesions. There were more lesions of brain stem and subcortical white matter in patients with corpus callosum trauma than ones without, but differences were not statistically significant. Conclusions: Traumatic lesions of the corpus callosum are frequently seen in moderate and severe head injury. Most of the lesions are nonhemorrhagic and localized in splenium. The diagnostic value of MRI is rather high than of CT in traumatic lesions of corpus callosum.

Travmaya baðlý yaralanmalar hakkýnda ülkemizin epidemiyolojik verilerine katkýda bulunmak amacýyla Dokuz Eylül Üniversitesi Hastanesi Acil Servisine 1.1.1997 ve 30.6.1997 tarihleri arasýnda baþvuran eriþkin travma hastalarý retrospektif olarak incelendi. Ýncelenen 1063 hastanýn 626'sý erkek (%59), 437'si kadýn (%41) ve hastalarýn yaþ ortalamalarý 40.6±18'di. En sýk yaralanma nedeni (%43.5) düþme idi. Yetmiþbeþ hastada düzeltilmiþ travma skoru < 12 bulundu. Hastalarýn %90.8'inin ambulans dýþýndaki bir araçla acil servise getirildiði saptandý. Hastalarýn 13'ü (%1.2) öldü, 872 hasta (%82) acil servisten taburcu oldu, 118'i (%11.1) hastaneye yatýrýldý, 73'ü (%6.9) baþka bir saðlýk kuruluþuna sevk edildi. Altmýþbeþ yaþýn üzerindeki hastalarýn ve penetran travmalý hastalarýn hastaneye yatýþlarý daha fazla idi (sýrasýyla p=0.001, p=0.003). Penetran travmalý hastalarda aperatif giriþim ve ölüm daha fazlaydý (sýrasýyla p=0.000, p=0.009).

We have evaluated retrospectively adult trauma patients admitted to the Dokuz Eylül University Hospital Emergency Department (ED) between 1.1.1997 - 30.6.1997 by the aim of contributing epidemiological data about trauma related injuries of Turkey. Among the 1063 study patients, 626 patients were male, 437 patients were female and mean age of the patients was 40.6 ± 18. The most common causes of injury was fall. The revised trauma score lesser than 12 was 75 patients. It has been determined that 90.8% of the patients were brought to ED by the vehicles other than the ambulance. Among all patients, 872 patients (82%) were discharged from ED, 118 patients (11.1%) were admitted, 73 patients (6.9%) were referred to another hospitals and 13 patients (1.2%) were died. We have determined the significantly increased hospital admission rate in the subgrups of the penetrating trauma patients, patients older than 65 years old (p=0.001 and 0.003, respectively) and the significantly increased operative intervention and death in penetrating trauma patients (p=0.000 and 0.009, respectively).

Trakeobronþiyal yaralanmalar ender görülmelerine karþýn yaþamý tehdit edici niteliktedir. Baþarýlý bir taný ve tedavi için kuþku düzeyinin yüksek olmasý gerekir. Bu yazýda, geçen 10 yýlý kapsayan süre içinde künt göðüs travmasýna baðlý trakeobronþiyal yaralanma nedeniyle tedavi edilen yedi olgu gözden geçirildi. Klinik kuþkunun ardýndan yapýlan bronkoskopi ile kesin taný kondu. Yaralanmalarýn çoðu, sað bronþ sisteminde lokalize olup (beþ hasta), sadece bir olguda sol bronþiyal sistem ve bir olguda da trakea yerleþimli idi. Büyük oranda primer tamir uygulandý (beþ hasta), iki hastada lobektomi gerekli oldu. Postoperative mortalite görülmedi, ancak bir olguda ampiyem, iki olguda onarým hattýnda kýsmi stenoz olmak üzere toplam üç olguda komplikasyon geliþti.

The tracheobronchial injuries are seldom, but life threatening. Their successful diagnosis and treatment require a high level of suspicion. In this report, we reviewed our experience with seven patients with tracheobronchial injuries due to blunt thoracic trauma, treated over the past 10 years. Definitive diagnosis was recognized with bronchoscopy after clinical suspicion. Most injuries were located in the right bonchial tree (five patients), whereas only one patient had an injury located in the left bronchial tree and one in trachea. The majority of the injuries were repaired primarily (five patients) and two required lobectomy. There were no postoperative mortality: but three postoperative complications were noted; one empyema and two partial stenoses on the repair line.

Barsak týkanmalarý acil cerrahi giriþim gerektiren önemli patolojilerdendir. Tedavisinde seçilecek cerrahi yöntem, giriþim için geçen süre ve tekrarýnýn önlenmesi gibi sorunlar güncelliðini korumaktadýr. Etyolojide geliþmiþ ülkelerde postoperatif yapýþýklýklar ön sýrada iken geliþmekte olan ülkelerde boðulmuþ fýtýklar ön plandadýr. Bu çalýþmada 1993-1999 yýllarý arasýnda kliniðimizde mekanik barsak týkanmasý tanýsý ile opere edilen 147 olgudan 80 boðulmuþ karýn duvarý fýtýðý retrospektif olarak deðerlendirildi. 80 olgunun 50'si (%62.5) erkek, 30'u (%37.5) kadýn ortalama yaþ 59 (4-94) idi. Ýnguinal herni 49 vaka ile en sýk sebepti. Fýtýk kesesi içinde en sýk ince barsaklar tespit edildi. Olgulardan 14'üne(%17,5) fýtýk onarýmý dýþýnda ek cerrahi giriþim uygulandý. Toplam morbiditemiz %22.5 mortalitemiz %7.5 olarak tespit edildi. Barsak týkanýklýðý bulgularý ile baþvuran hastalarda fýtýk noktalarý dikkatle muayene edilmelidir. Acil giriþimlerde morbidite ve mortalite oranlarý yüksek olduðundan karýn duvarý fýtýðý saptanan hastalara elektif cerrahi giriþim uygulanmalýdýr.

Mechanical intestinal obstructions form important part of pathologies those necessitates emergent surgical intervention. Length of time between symptoms and surgery, preference of surgical procedure and prevention of recurrence are still under discussion. While the most frequent etiological factor is postoperative adhesions in developed countries, strangulated hernias are more common in developing countries. In this study, among 147 cases operated on with the diagnosis of mechanical intestinal obstruction between 1993-1999, 80 strangulate were 50 males (%62,5) and 30 females (%37,5). Mean age was 59 years (range 4-94). The most frequent type of hernia was inguinal hernia and observed in 49 cases. Small intestine was detected most frequently in hernia sac. In 14 cases (%17,5), beside hernia repair, additional surgical interventions were performed. Total morbidity was %22,5 and mortality was %7,5. Patients with mechanical intestinal obstruction should be evaluated for abdominal wall hernias because of high incidence of tried surgical intervention have high morbidity and mortality rates, elective surgery should be recommended when abdominal wall hernia is diagnosed.

Çalýþmada künt vücut travmalarýný takiben nadiren ortaya çýkan üreteropelvik bileþke yaralanmalarýnda radyolojik deðerlendirme aþamalarý ve klinik tedavi yaklaþýmlarýnýn incelenmesi amaçlandý ve 1995-2000 Ocak arasýnda GATA Üroloji AD, Fýrat Üniversitesi Týp Fakültesi Araþtýrma Hastanesi Üroloji AD, Elazýð Asker Hastanesi Üroloji Servisine baþvuran, künt batýn travmalarý olan hastalardan üreteropelvik bileþkenin tek baþýna yaralandýðý 8 hasta yer aldý. Vakalar 1 çocuk (12 yaþlarýnda) ve 7 eriþkin hastayý içeriyordu (1 kadýn, 6 erkek, 18-62 yaþ arasý). Hastalarda tanýda abdominopelvik USG(Ultrasonografi), IVP (Ýntravenöz Pyelografi), abdominopelvik CT(Bilgisayarlý Tomografi) ve retrograd-antegrad pyelografi kullanýldý. Hastalar perkütan nefrostomi, antegrad ve retrograd double j kateter uygulamalarý ve rekonstriktif açýk cerrahi uygulamalarý ile tedavi edildiler. Hastalarda extravazasyonun ortadan kalkmasý ve üreteropelvik geçiþin saðlanmasý ile tam tedavi saðlandý.

The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laseration due to blunt body trauma. In this study there are eight patients with isolated UP J laseration, admitted to Gulhane Military Medicine Academy, Fýrat University Medical Faculty Urology department, and Elazýð Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG (Ultrasonography), IVP(Intravenous Pyelograpy), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.

10 yýllýk bir periyot içerisinde 19 iatrojenik üreler travmalý olgunun tedavisi yapýldý. Jinekolojik operasyonlar %52.6 ile en sýk 1 travmaya neden olan cerrahi giriþimlerdi. Altý olgunun teþhisi operasyon anýnda, 13 olgunun teþhisi ise operasyondan sonra 14-180. günler arasýnda konuldu. Operasyon sýrasýnda üreler travmasý belirlenen 6 olgunun 5'i baþarýlý bir þekilde tedavi edilirken 1 olguya nefrektomi yapýldý. Geç taný konulan 13 olgunun 7'sine perkütan nefrostomi ile baþlangýç tedavisi yapýldý. Diðer 5 olgunun 2'sine üreteroneosistostomi, 1'ine üreteroüreterostomi ve 1'ine ise üreterolizis yapýldý. Üç olguda operasyon sonrasý takiplerde üreteral darlýk belirledik. Bu olgularda endoürolojik yaklaþým ile tedavi saðlandý. Sonuçta iatrojenik üreter travmalarýnýn operasyon anýnda tanýsý ve tedavisi önemliyken, geç dönemde taný konulan iyatrojenik üreteral travmalý olgularda ilk tedavi seçeneði olarak perkütan nefrostomi önermekteyiz.

We treated 19 patients with iatrogenic ureteral injuries during a 10- year period. Gynecologiacal operations were the most common surgical procedures (52.6%). The diagnosis of ureteral injury was made immediately in 6 patients and was delayed 14 to 180 days in 13. Five of the 6 injuries recognized during the operation were repaired successfully at the time of injury; one patient resulted a nephrectomy. Seven of the lately recognized 13 patients were treated with percutaneous nephrostomy and the first treatment. The two patients were made ureteroneocystostomy, one was made ureteroureterostomy and one had ureterolysis in the other five patients. We observed ureteral stenosis in the three patients after the operation follow ups. The treatment was achieved with the endourological approach at these patients. Finally, we recommend percutaneous nephrostomy as a first treatment choice in the lately recognized iatrogenic ureteral injuries, while the immediate diagnosis and treatment of iatrogenic üreteral injuries, are severely important.

Ocak 1998'den itibaren kliniðimizde, künt dalak yaralanmalý seçilmiþ çocuk ve eriþkin olgularda non-operatif tedavi yöntemini tercih ediyoruz. Ocak 1998-Mayýs 2000 tarihleri arasýnda künt dalak yaralanmasý nedeniyle kliniðimize baþvuran 26 olgudan 20'sine, yaralanma derecesi ve yaþ sýnýrlamasý dikkate alýnmaksýzýn hemodinamik stabiliteyi esas alan non-operatif tedavi protokolümüzü uyguladýk. Non-operatif tedavi uygulanan hastalara tanýsal amaçlý bilgisayarlý tomografi (BT) çekildi. Künt dalak yaralanmasý olan hastalarýmýzdaki non-operatif tedavi oraný %76.9' dur (çocuk hastalarda; %83.3, eriþkin hastalarda: %71.4). Non-operatif tedavi uygulanan olgularýmýzda komplikasyon ve mortalite gözlenmedi. Preoperatif deðerlendirme sonucu acil cerrahi giriþim uygulanan 6 hastada yandaþ yaralanmalar mevcuttu. Operatif ve non-operatif tedavi uygulanan gruplar arasýnda yaþ açýsýndan anlamlý bir fark bulunmadý (p=0.421). Ameliyat edilen hastalardaki ortalama aperatif dalak yaralanma derecesi 3 iken, non-operatif tedavi uygulanan hastalardaki BT ile deðerlendirilen ortalama dalak yaralanma derecesi 2.6 idi (p=0.572). Hastanede kalýþ süresi aperatif grupta 7.6, non-operatif grupta 8.6 gün idi (p=0.572). Operatif tedavi uygulanan hastalardaki ortalama kan transfüzyonu 1.1 ünite iken, non-operatif tedavi uygulanan hastalarda 0.6 ünite idi (p=0.453). Sonuçlarýmýza göre, yaralanmanýn bilgisayarlý tomografi ile derecelendirilmesi ve yaþ sýnýrlamasý dikkate alýnmaksýzýn, non-operatif tedavi uygulanacak hastalarýn seçiminde hemodinamik stabilite esastýr.

Since January 1998, non-operative management of blunt splenic trauma has become the preferred method for the selected paediatric and adult patients in our clinic. Of the 26 patients who were admitted to our clinic because of blunt splenic trauma between January 1998 and May 2000, 20 were elected for non-operative management according to our protocol which was primarily based on hemodynamic status regardless of the age and grading of the injury. Diagnostic computed tomography (CT) was obtained in the patients with non-operative management. Non-operative management rate was 76.9% for patients with blunt splenic trauma (83.3% and 71.4% for the paediatric and adult patients, respectively). All of these cases were managed conservatively without any complication and no mortality was observed. Six patients required emergent surgical exploration based on preoperative evaluation. In all of these 6 cases, associated injuries were present. No significant differences were found with regard to the age of operative and non-operative management groups (p=0.421). The mean operative splenic injury grade was 3 in the patients who underwent surgery, and the mean injury grade based on CT scan was 2.6 in the patients who were managed conservatively (p=0.572). The mean duration of hospitalisation in the patients with operative and non-operative management groups were 7.6 and 8.6 days, respectively (p=0.572). The mean unit of blood transfusion in the patients with operative and non-operative management groups were 1.1 and 0.6, respectively (p=0.453). Our data revealed that hemodynamic stability is the most important factor which could effect the selection of patients for non-operative management outcome regardless of the patient age and computed tomography scan grading of the injury.

Yoðun bakým ünitesinde enteral beslenme esnasýnda regürjitasyon ve buna baðlý aspirasyon pnömonileri ile sýkça karþýlaþýlmaktadýr. Perkutan endoskopik gastrostomi (PEG) uygulamasý bu riski azaltarak hastanede kalýþ süresini kýsaltmasý, ayrýca hastaya bakým kolaylýðý getirmesinden dolayý sýkça tercih edilir bir çözüm olmuþtur. Çalýþmamýzda 1997-98 yýllarýnda ünitemizde PEG yöntemi ile enteral beslenme uygulanmýþ 31 hastada, uygulamanýn nasogastrik beslenmeye göre aspirasyon ve trakeal aspiratta üreme sýklýðýna etkisini araþtýrdýk. Uzun süren koma veya diðer sebeplerle oral beslenemeyecek ve enteral beslenmesi gerekli olacak olgulara PEG uygulandý. Yaþ ortalamalarý 60.5(19.4 olan hastalarýmýzýn aspirasyon deðerlendirmeleri klinik izleme göre yapýldý. PEG öncesi aspirasyon ve buna baðlý beslenmenin kesilmesi hasta baþýna ortalama 1.57 ((1.43) defa olmuþken, PEG sonrasý bu deðerin 0.67 ((0.73) deðerine gerilediði görüldü. Ayný þekilde PEG öncesi trakeal aspiratta üreme ortalama 3.14 ((1.95) defa olmuþken PEG, sonrasý bu deðer l.52 ((1.47)'ye gerilemiþtir (p=0,0019).

Aspiration pneumonia due to gastroesephageal reflux is a frequent complication in ICU. The most commonly chosen method for long-term enteral access is gastrostomy and this method also reduces the risk of aspiration and shortens the hospital stay. We evaluated 31 patients in whom PEG was performed between 1997-98 in our unit. Indication of PEG was long-term ICU stay and coma which necessitate long term enteral nutrition. Mean age of our patients were 60.5 (19.4). We evaluated the aspiration by clinical inspection. Aspiration and interruption of feeding was observed 1.57 (1.43) times before PEG and 0.67 (0.73) times after PEG. Further more positive tracheal aspirate culture were seen 3.14 (1.95) times before PEG and 1.52 (1.47) times after PEG.

Cerrahi explorasyonu takiben üreter travmasý ve ürinoma oluþumu gözden kaçýrýlan 12 hasta evalüe edildiler. Ateþ, halsizlik, titreme nöbetleri ve lökositoz geç dönemde ortaya çýkan semptom ve bulgulardý. Kontrastlý Abdomino pelvik tomagrafi tüm hastalarda ürinomayý ortaya çýkardý. Hematüri hastalarýn 6'sýnda mevcuttu. 6 hastaya ÝVP ile taný konulamadý. Perkütan Nefrostomi cerrahiyi takiben geç dönem üreter yaralanmasý ve ürinoma oluþumu tespit edilen hastalarda ilk basamak tedavi yöntemi oldu. Ürinoma perkütan boþaltýldý. Böylece ciddi bir ateþli silah yaralanmasý ve explarasyonu takiben hastayý erken bir ikinci operasyondan koruduk. Bu hastalarda intraoperatif aðýr kanama varlýðýndan dolayý hýzlý explorasyon zorunluluðunu, kolon yaralanmasýndan dolayý olan kötü yara iyileþmesini ve yüksek hýzlý merminin blast etkisinin geç dönemde oluþturduðu doku nekrozunu sonradan ortaya çýkan ürinoma ve üreter yaralanmasýnýn nedeni olarak düþündük. 8 hasta nefrostomi ile tam tedavi elde edildi. Ortalama takip süresi 3 aydý. 2 hastada psoas hitch + üreteroneosistostomi, 1'inde boariflep+ psoas hitch + üreteroneosistostomi ve bir hastada üreteroüreterostomi yapýldý. Bu 4 hastada rekonstroksiyonun nedeni üreteral fistülün devamý ve uzun dar üreter seçmenlidir. Sonuç olarak perkütan nefrostomi ve drenajýn böyle yaralanmalar sonrasýnda ilk tedavi basamaðý olabileceði düþünüldü. Geç dönemde gerekirse rekonstrüksiyon uygulanmasý ikinci basamaktýr.

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malasia, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionaly, Urinoma is dranied percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrosthomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary-flep and ureteroneocystostomy and at one ureterouretenostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous draniage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

Aralýk 1994 ve Nisan 2000 tarihleri arasýnda kliniðimize göðüs travmasý nedeniyle yatýrýlan hastalarýn kayýtlarý gözden geçirildi. 126 hastanýn 113'ü (%89.7) erkek, yaþ aralýðý 7-96 arasýnda olup ortalamasý 35.3 idi. Bütün göðüs travmalý hastalarda en sýk görülen neden 48 olgu (%38) ile trafik kazasý olup künt travmalý 73 olgu (%57.9) vardý. 36 olgu politravmalý idi. Hemo ve/veya pnömotoraks en sýk görülen göðüs yaralanmasý idi (%85.7). Kot fraktürleri 47 olguda vardý (%36.2'sinde 3 kottan daha fazlasýnda fraktür vardý). 4 hastada yelken göðüs ve 5'inde de göðüs duvarý defekti saptandý. Yine 6 hastada pulmoner kontüzyon ve 8'inde de intraparankimal hematom vardý. Plevral drenaj 106 olguda uygulandý (8'i bilateral) ve torakotomi 11'inde endike idi (6 olgu acil). Mortalite %6.9 olup (n: 8), 4'ü politravmalý gruba aitti. Mortalite büyük ölçüde politravma ile ilgilidir. Göðüs travmalý hastalarda yoðun bakým þartlarýnda hýzlý, etkin taný ve tedavi yaklaþýmý, morbidite ve mortalitenin azaltýlmasýnda önemli noktalardan birisini oluþturmaktadýr.

To evaluate our experience in chest trauma we review the records of the patients admitted for chest trauma to our service between December 1994 and April 2000. There were 126 patients (113 males, 89.7%), with an age range of 7 to 96 years (mean 35.3). The most frequent cause of chest injury were traffic accidents 48 cases (38%) and 73 cases (57.9%) were victims of blunt trauma. In 36 cases there was a politrauma. Hemo and/or pneumothorax represented the most common thoracic injury (85.7%). Rib fractures were present in 47 cases (36.2 % with more than 3 rib fractures). Four patients sustained flail chest and 5 defect of thoracic wall. Six patients were pulmonary contusion and 8 intraparenchymal haematom. Pleural drainage was performed in 106 cases (8 cases bilateral) and thoracotomy was indicated in 11 (6 cases emergency). Mortality was 6.9% (n: 8), of which 4 belonged to politrauma group. Mortality is directly related with politrauma. In the patients of the chest trauma, agressive diagnostic and therapeutic approaches in association with intensive care follow-up remains one of the most important points to decrease mortality and morbidity rate.

Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition for both mother and fetus. In this article, we reported two cases suffered from acute pancreatitis and hyperlipidemia; 24 -year old pregnant women and 40 year old non-pregnant women. The risks of the pregnancy in this situation were also discussed.

Ascariazis, sanitasyon koþullarýnýn uygun olmadýðý yerlerde özellikle çocuklar ve gençlerde yaygýn olarak rastlanan bir helmintik enfestasyondur. Aðýz yoluyla alýnan parazit yumurtalarýndan, ince barsakta çýkan lavralar kan ve lenf dolaþýmýyla akciðerlere gelir. Alveol duvarýný aþarak siliyer hareketlerle hipofarinkse gelen lavralar yutkunmakla tekrar gastrointestinal sisteme döner ve eriþkin hale gelir. En sýk jejenum ve proksimal ileumda yaþarlar. Olgularýn çoðu asemptomatik olurken, bazen karaciðer abselerine, akciðerde Löffler sendromu'na, bilier ve intestinal obstrüksiyonla seyreden hastalýklara sebep olabilirler. Nadiren ince barsaklardaki Ascaris lumbricoides (AL) peritona geçerek granülomatöz peritonit meydana getirebilir. Bu çalýþmada 8 aylýk gebe bir kadýnda gastrointestinal sistemde herhangi bir perforasyon odaðý olmadan görülen bir peritoneal ascariazis olgusu, bebeðin yaþamýný kaybetmesi ve annenin hayatýný tehdit etmesi nedeniyle sunulmuþ ve granülomatöz peritonit literatür ýþýðý altýnda irdelenmiþtir.

Ascaris Lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.