Bu çalýþmada, 54 adet Sprague-Dawley cinsi rat üzerinde intraabdominal sepsis oluþturularak, Granülosit Koloni Sümük Edici Faktör (G-CSF) ve Granülosit-Makrofaj Koloni Stimule Edici Faktör (GM-CSF)gibi hemapoietik büyüme faktörlerinin saðkalým, periferik kan tablosu ve makrofaj fagositik aktivitesi üzerine olan etkileri araþtýrýldý. Çalýþmanýn ilk aþamasýnda; her birinde 7'þer denek bulunan 3 grup ile baþlandý. Her bir deneðe çekal ligasyon ve delme (ÇLD) uygulanarak sepsis oluþturuldu. Kontrol grubuna; 2x0.2 cc % 5 dextroze SC enjekte edildi. G-CSF grubuna; 2x 1 g G-CSF 0,2 cc %5 Dextroz içinde SC enjekte edildi. GM-CSF grubuna; 1x2 g GM-CSF 0,2 cc %5 Dextroz içinde SC enjekte edildi. Bu 3 grupta kriter olarak 7 günlük saðkalým dikkate alýndý. Çalýþmanýn ikinci bölümünde ise, her birinde 11 denek bulunan 3 grup kullanýldý. Ayný iþlemler bu gruplara da uygulandý. Postoperatif 24 ve 72. saatlerde lökosit sayýsý, periferik yayma ve 72. saatte peritoneal ve alveoler makrofajlara bakýldý. G-CSF verilen rotlarda, kontrol grubuna göre anlamlý derecede nötrojilik lökositoz geliþti (p < 0.001). Buna karþýn, peritoneal ve alveoler makrofajlarýn fagositik aktivitelerinde bir deðiþim olmadý. GM-CSF ise sepsiste lökosit sayýsýný deðiþtirmeksizin makrofajlarýn fagositik aktivitesi üzerine pozitif etki gösterip, periferik kanda nötrofili, monositoz ve lenfositopeniye yol açtý. G-CSF, GM-CSF ve kontrol grubunda 7. günde sað kalým oraný sýrasýyla %71.4, %28.5 ve %42.8 bulundu. Sonuç olarak sepsis yerleþtikten sonra G-CSF uygulanýmý, periton makrofajlarýnýn fagositik aktivitesini etkilememesine karþýn, periferik kan nötrofillerinde ve ortalama saðkalýmda artýþ meydana getirmiþtir. GM-CSF ün sepsisli organizmaya uygulanmasý ile uyarýlan makrofajlarýn fagositik yeteneklerinin ve nötrofil fraksiyonunun arttýðý, ancak sað kalýmýn olumsuz yönde etkilendiði görüldü.

In this experimental study, consist of 54 Sprague-Dawley rats, we tried to observe the effectiveness of haemopoietic growth factors such as G-CSF and GM-CSF in treatment of sepsis and see if they have any effects on phagocytic activity of macrophages when are administered after establishment of sepsis. In first phase of this study, twenty one rats were randomly divided into three groups of 7 animals each. Cecal ligation and perforation were carried out in each rat and sepsis made up. The Control group received 2x0.2 cc%5 dextrose injection subcutaneous (SC).. The G-CSF group received 2x 1g G-CSF with 0,2 cc %5 dextrose SC. The GM-CSF received 1x2 g GM-CSF with 0,2 cc %5 dextrose SC. Seventh day survival was considered as criterion in the three groups. In second phase of this study, thirty three rats were randomly divided into three groups of 1 animals each. The same procedures were carried out also in these groups. Leukocyte counts and peripheric spread were aralyzed in postoperative 24th and 72th hours, alveolar and peritoneal macrophages were investigated in postoperative 72th hour. There was significantly neutrophilic leukocytosis in the G-CSF group according to the control group. Nevertheless, there was no change in the phagocytic activity of alveolar and peritoneal macrophages. GM-CSF brought about positive effect of phagocytic activity of macrophages without change of leucocyte count in the sepsis, but it caused neutrophili, monocytosis and lymphocytopenia. The seventh day survival rates in control, G-CSF, GM-CSF groups were as; 42.8 %, 71.4 %, 28.5 % respectively. As a result, we saw that G-CSF has no effect on the phagocytic activity of macrophages, while increases the survival by enhancing the count and probably the function of neutrophils. GM-CSF fails to increase survival while effects the phagocytic activities of macrophages positively and enhances the peripheral neutrophil and monosit counts without changing the total number of leukocytes.

Anastomoz kaçaklarý, özellikle acil kolorektal cerrahide, hastanede kalýþ süresi ve mortaliteyi önemli oranda artýran bir komplikasyondur. Bu nedenle dokularýn biyolojik yapýþmasýný kolaylaþtýracak bir faktör kullanarak anastomoz ayrýlmasýný önlemeyi planladýk. Bu amaçla 48 adet, Sprague-Dawley cinsi erkek sýçan ile her biri 12 denekten oluþan 4 grup oluþturuldu. Tüm gruplara inen kolonda kolokolik anastomoz, ikinci ve dördüncü gruplara ek olarak anastomoz etrafýna fibrin yapýþtýrýcý uygulandý. Üçüncü ve dördüncü gruplarda ise bu iþlemlerden önce peritonit oluþturuldu. Anastomoz patlama basýncý ölçümleri ve histopatolojik deðerlendirmede peritonitti deneklerde kolokolik anastomoz iyileþmesinin bozulduðu gözlenirken fibrin doku yapýþtýrýcý uygulanmasý ile hem normal karýnda hem de peritonit varlýðýnda, anastomoz güvenliðinin ve iyileþmenin pozitif yönde etkilendiði saptandý.

Leakage from a colonic anastomosis remains a major complication of surgery for colon emergencies and is associated with a significant increase in postoperatif hospital stay and mortality rate. The purpose of our study was to investigate whether fibrin sealant, a well known tissue adhesive, will augment healing of bowel anastomosis in an experimental peritonitis model. Forty-eight male Sprague-Dawley rats were randomized into four groups. All rats underwent conventional sutured colo-colic anastomosis. The rats in group 3 and 4 had been exposed peritonitis before that procedure. In groups 2 and 4 fibrin sealant was added to the suture line. The measurements of bursting pressure and histopathological evaluations of suture lines revealed that peritonitis was deleterious to healing of colonic anastomosis. It was also seen that fibrin sealant augments healing of colonic anastomosis both in normal and peritonitis models.

Genç nüfus popülasyonunda önde gelen ölüm nedenlerinden olan travma, son dokuz yýllýk travmalý olgu kayýtlarýmýz retrospektif incelenerek gözden geçirildi. 1.7.1990-11.4.1999 tarihleri arasýnda travma nedeniyle kliniðimize yatýrýlan 212 olgudan 190'ý (%89.6) ameliyat edilip 22' sine (%10.4) seçici gözlem uygulandý. Olgulardan 36' sý kadýn (%17), 176'sý (%83) erkekti. Yaþ ortalamasý 32.4(16-81) olarak bulundu. Olgulardan 93' ü (%43.9) trafik kazasýna (TK), 56' sý (%26.4) kesid-delici alet yaralanmasýna (KDAY), 33' ü (%15.6) ateþli silah yaralanmasýna (ASY), 30' u (% 14.1) künt travmaya maruz kalmýþtý. Taný, TK (%95.1) ve künt travmada (%76.9) çoðunlukla diagnostik peritoneal lavaj (DPI), ASY da fizik muayene (%59.4), KDAY da ise fizik muayene ve lokal yara eksplorasyonu (%77.5) ile konuldu. TK ve künt travma olgularýnda en fazla yaralanan organ dalak (%51.4), penetran travmalarda ise ince barsaklardý (%35.8). Negatif laparotomi oranýmýz literatürden fazla olup 47 olgu (%24.7) negatif eksplorasyon olarak deðerlendirildi. Negatif laparotomi ile en fazla KDAY h olgularda (%49) karþýlaþýldý. Ancak seçici gözlem uygulanan 22 olgunun 17' si (%77.3) son iki yýl içindeydi ve son iki yýl içinde 6 olgu negatif laparotomi olarak deðerlendirildi. Son iki yýlda ki olgularýmýz göz önüne alýndýðýnda negatif laparotomi oranýmýz % 14 bulundu ve önceki yýllara göre düþüþ gösterdiði görüldü. Mortalite ve morbidite oranýmýz kabul edilebilir düzeydedir.

Trauma is one of the major cause of death in the young population. The patients treated due to trauma were evaluated retrospectively during the last nine years. 212 cases with trauma were hospitalised in our clinic, between 1.7.1990-11.4.1999. 190 189.6%) of them were operated and 22 (10.4%) of them were observed selectively. 36 (17%) of the cases were female and 176 (83%) of them were male. The mean age was 32.4 (16-81). 93 (43%) of them were hospitalized following traffic accidents; 56 (26.4%) of them stab wounds, 33 (15.6%) of them gunshots and 30 (14.1%) of them blunt trauma. The diagnose was done through the diagnostic peritoneal lavage 95.1% of the traffic accident cases. The diagnose was performed through diagnostic peritoneal lavage 76.9% of the after blunt trauma cases. After gunshots the diagnose was done by 59.4% of the cases with physical examination. Local lesion exploration helped us to establish the diagnose 51.4% of the stab wound cases. The most frequent organ injury following traffic accidents is splenic injury and injury of small intestine following penetrating trauma. The amount of our negative laparotomy was more than in literature and 47 (24.7%) cases were accepted as negative exploration. Negative laparotomy was seen mostly by stabwounds (49%). 17 (77.3%) of the 22 cases observed selectively were the cases of the last two years. In the recent two years the amount our negative laparotomy was six and our negative laparotomy ratio is 14%. Our mortality and the morbidity rates were at the acceptable level.

Karýn ameliyat yaralarýnýn postoperatif dönemde açýlmasý erken relaparotomi nedenlerinin baþýnda gelmektedir.Yüksek mortalite nedeniyle dikkatler medikal ve cerrahi profilaksi üzerine yoðunlaþmýþtýr. Profilaksinin yöneleceði risk faktörlerinin iyi bilinmesi gerektiðinden araþtýrmamýzda keþi ayrýlmasýna katkýda bulunan faktörlerin aydýnlatýlmasý hedeflenmiþtir. Bu amaçla son 25yýllýk dönemde rastladýðýmýz majör karýn ameliyatlý 38 abdominal evisserasyon olgusunun hastane kayýtlarý retrospektif olarak incelendi. Evisserasyon oraný %0.92'dir. Olgularýn %76'sý erkek, %79'u 50 yaþ üzerinde, ve ortalama yaþ 58'dir. Primer ameliyatlarýn %61'i acil endikasyonludur. Ameliyat gerektiren primer patolojiler incelendiðinde malign tümör (%21), infeksiyöz hastalýklar (%21) ve barsak týkanmalarý (%18), obstrüktif ikter (%16) ön plandadýr. Postoperatif dönemde en sýk karþýlaþýlan yandaþ komplikasyon olarak yan enfeksiyonu ve entero-kutan veya biliyer fistül geliþimi saptanmýþtýr. Olgularýn %44'ünde belirgin bölgesel ve yerel infeksiyon vardýr. Olgularýn %79'unda eviserasyona neden olan iki veya daha çok risk faktörü vardýr. Evisserasyon olgularýmýzda mortalite %37'dir. Sonuçta ileri yaþ ile birlikte, malignite, obstrüktifikter, septik patolojiler, karýn içi basýnç artýþý yaratan patolojilerin mevcudiyeti; yara enfeksiyonu ve fistül geliþimi gibi komplikasyonlar; evisserasyon geliþmesinde etkili olumsuz faktörler olarak bulunmuþtur. Yandaþ sorunlar ve esas cerrahi patoloji nedeniyle yüksek riskli olgularda postoperatif eviserasyon geliþimi yüksek mortaliteye neden olmaktadýr.

Disruption of abdominal surgical wounds is one of the common causes of early re-laparotomy. Because of high mortality, medical and surgical preventive measures are essantial in primary peri-operative period. Good knowledge of risk factors is mandatory for prophylaxis. In this study we aimed to elucidate some factors contributing to disruption of incisions. In a period of the last 25 years hospital records of 38 cases of abdominal evisceration following major abdominal surgery were analysed retrospectively. Disruption rate is found as 0.92%. Seventy-six percent of 38 patients are men with a mean age of 58 years, and 79% over 50 years of age. Sixty-one percent of primary operations were performed under emergency conditions. Malignant tumours(21%), infectious diseases(21%) and intestinal obstructions(8%) and obstructive jaundice (16%) were the most common primary pathologies as indications of surgery. Wound infection, entero-cutaneous and bilious fistula formation were found as causes affecting wound healing in the postoperative period. Obvious regional and local severe infection is present in 44% of the cases. Two or more factors are contributing to evisceration in great majority (79%) of patients. Mortality was 37% after re-laparotomy for surgical correction of evisceration by support of retention sutures or synthetic mesh. In conclusion, advanced age, The presence of malignancies, jaundice, intraperitoneal infections, disease increasing intraabdominal pressure, and postoperative wound infection and fistula formation were found as factors affecting wound healing process, and leading to evisceration. Early re-laparotomy for correction of evisceration and evisceration itself causes high mortality rate in high risk patients due to primary pathologies and preexisting co-morbid conditions.

Peritonit ve intra-abdominal sepsisli hastalara uygulanacak tedavi seçeneklerinin belirlenmesi ve tedaviye yanýtýn tahmin edilmesi, her dönemde ilgili hekimlerin baþlýca amaçlarýndan birisi olmuþtur. Ancak bugüne kadar bu amaçlarla önerilen skorlaný sistemleri beklentilere tam anlamýyla yanýt verememiþtir. Son 20 yýlda önerilen skorlama sistemlerinden Mannheim Peritonit Ýndeksi(MPÝ), uygulama kolaylýðý ve etkinliði ile oldukça ön plana çýkmýþtýr. Bu skorlama sisteminin deðerlendirilmesi amacýyla 1995-1999 yýllarý arasýnda Ege ve Dokuz Eylül Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dallarýnda deðiþik etiyolojilere baðlý peritonit ve intra-abdominal sepsisli 325 olgu retrospektif olarak hastane kayýtlarýndan incelenmiþtir. Hastalarýn 258'i(%79.4) þifa veya selah ile taburcu edilmiþken, 67'si (%20.6) ise kaybedilmiþtir. Ölen hastalarýn tümünde MPI skoru 26 ve üstündedir. Bu hastalarda ortalama deðer 30.23 7.05 iken, þifa veya selah ile taburcu edilenlerde deðer ortalamasý 18.55 6.67 olmuþtur. Tek tek ele alýndýðýnda, MPI'inde belirleyici olan risk faktörleri ile eksitus olanlar ve olmayanlar bakýmýndan kestirimde bulunma oranlan arasýnda anlamlý farklýlýk saptanmýþtýr. Sonuç olarak MPI'nin, peritonit veya intra-abdominal sepsis durumlarýnda prognozu belirleyici etkin bir skorlama sistemi olduðu kanýsýna varýldý.

Classificiation of patients regarding to outcome in early periods of peritonitis or intra-abdominal sepsis, has always been a primary goal of intensive care physicians. In order to predict outcome, a wide variety of scoring systems have been proposed. Mannheim Peritonitis Index (MPI) is one of the most effective scoring systems and its predictive value has been shown previously. Three hundred and twenty five patients that were admitted to Emergency Services in both Ege and Dokuz Eylül University Hospital between 1995 and 1999, have been evaluated retrospectively by using patient records. Among them, 258 patients (79.4%) have been discharged in well condition and 67 patients died (20.6%). In the latter, MPI scores were always equal or more than 26. Mean MPI scores were 30,23 7,05 and 18,55 6,67 in exitus group and discharged group respectively. When all descriptive factors in MPI have been evaluated separately, every predictor was revealed statistically significant differences between exitus and discharged groups. It has been concluded that MPI is effective scoring system in terms of predicting final outcome in patients with peritonitis and intraabdominal sepsis.

Nekrotizan pankreatit (NP), akut pankreatitin en þiddetli formudur ve yüksek morbidite ve mortaliteye sahiptir. Bu retrospektif çalýþmada, Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde Þubat 1993-Temmuz 2000 tarihleri arasýnda ameliyat edilen 11 hastanýn (17 erkek, 5 kadýn, yaþ ortalamasý 52.714) verilerini deðerlendirerek, kliniðimizin deneyimini aktarmak ve NP olgularýndaki cerrahi tedavisinde morbidite ve mortaliteye etki eden faktörleri tanýmlamayý amaçladýk. Hastalarýn tamamýnda preoperatif taný ve laparatomi endikasyonu klinik bulgulara (akut batýn ve eþlik eden sepsis, septik þok veya organ yetmezliði varlýðý) ek olarak abdominal Bilgisayarlý Tomografi ile konuldu ve çalýþmaya laparotomide pankreatik ve peripankreatik nekroz varlýðý ispatlanan olgular dahil edildi. Hastalarýn demografik verileri, klinik bulgularý, baþvuru anýndaki APACHE-II skoru, çoklu organ yetmezliði (ÇOY) ve lokorejyonel komplikasyonlarýn (IRK) morbidite ve mortalite ile olan iliþkisi araþtýrýldý. Ýstatistiksel yöntem olarak Fisher'in kesin Ki-kare testi kullanýldý ve p<0.05 deðeri anlamlý olarak kabul edildi. Yirmi-iki hastaya toplam 97 (1-23, ortalama 4.44.9) cerrahi giriþim uygulandý. Toplam 17 hastada (%77) LRK komplikasyon görüldü. En sýk geliþen komplikasyon intra-abdominal abse idi (15 hasta). Lokorejyonel komplikasyon geliþimi ile uzamýþ hastanede yatýþ süresi ve artmýþ cerrahi giriþim sayýsý arasýndaki iliþki anlamlý bulundu (p>0.05). Sekiz hasta (%36) eksitus oldu. Baþvuru anýndaki APACHE-II skoru 10 ve altýnda olan 7 hastada mortalite görülmedi. APACHE-II skorunun 10'nun üzerinde olduðu 15 hastadan 8'i öldü. Toplam 7 (%32) hastada çoklu organ yetmezliði geliþti ve bu hastalarýn 6'sý (%86) eksitus olurken, bu oran çoklu organ yetmezliði geliþmeyen hastalarda %13 olarak bulundu. Baþvuru anýndaki yüksek (> 10) APACHE-II skoru (p=0.02) ve tedavi sýrasýnda geliþen ÇOY(p = 0.002) ile mortalite arasýndaki anlamlý bulundu. Sonuç olarak NP'in cerrahi tedavisinde, baþvuru anýndaki APACHE-II skorunun > 10 olmasý ve hastanýn takibi sýrasýnda ÇOY geliþiminin mortaliteye etkili olabileceði, buna karþýn LRK geliþiminin hastanede kalýþ süresi ve cerrahi giriþim sayýsýný arttýrdýðý halde mortaliteyi etkilemediði sonucuna varýldý.

Necrotizing Pancreatitis is the most severe form of acute pancreatitis with a high morbidity and mortality rates. In this retrospective study we report our experience with 22 patients (17 men, 5 women with a mean age of 52.714) who operated at Akdeniz University School of Medicine Department of General Surgery, from February 1993 to July 2000 and define the factors affecting the morbidity and mortality in surgical treatment of NP. Diagnosis of NP and decision of laparotomy was performed by clinical findings and contrast-enhanced abdominal computed tomography (CT). The patients with pancreatic and peripancreatic necrosis confirmed intraoperatively included to the study. All patients had required intensive care therapy. The relationship between mortality / morbidity and with demographic and clinical data of patients, APACHE II score, presence of multiple organ dysfunction (MOD), and local-regional complications (IRC) was examined. The Fischer Chi-Square test was used to evaluate statistical significance and p < 0.05 was accepted as meaningful. The mean number of reoperations were 4.44.9 (1 to 23). Local-regional complications were observed in 17 (77%) patients and mostly consisted of intra-abdominal abscess (15 patients). The overall hospital mortality rate was 36% (8 of 22 patients died). In the 7 patients with low APACHE-II score on admission (< or = 10) no mortality was encountered. Eight of 15 patients with high APACHE-II score (> 10) on admission were died. Multiple-organ dysfunction developed in 7 (32%) patients and 6 (86%) of them died. Two of the 15 patients (13%) died without MOD. In conclusion, poor outcome was associated with high APACHE-II score (> 10) on admission (p = 0.02), and progression of MOD (p=0.002) during the treatment. Local-regional complications increase the hospital stay and frequency of surgical interventions but these complications do not effect the mortality in negative manner in the surgical treatment of NP.

Bu çalýþmada, kliniðimizde, son on yýlda ürogenital sistem travmasý nedeniyle hospitalize edilerek tedavisi ve takibi yapýlan 34 pediyatrik hasta retrospektif olarak deðerlendirildi. Hastalarýn 6'sý (9617.6) kýz, 28'i (9682.4) erkek olup, yaþ ortalamasý 10.1 yýl (2.5-17 yýl) idi. Hastalardaki yaralanma nedenleri 24 hastada (%70.6) trafik kazalarý, 9'u nda (%26.4) yüksekten düþme, 1'inde (%3) ateþli silah yaralanmasý idi. Hastalarýn 13'ünde (%38.2) böbrek, 13'ünde (%38.2) üretra, 4'ünde (%11.7) mesane, 3'ünde (%8.8) testis, 1'inde(%2.9) penis yaralanmasý mevcuttu. Hastalar taburcu edildikten sonra takip süresi ortalama 11.2 ay (6-12 ay) idi. Komplikasyonlar, üretra yaralanmasý olan 2 hastada üretral darlýk, mesane yaralanmasý olan l hastada mesane boynunda darlýk idi. Sonuç olarak çalýþmamýzdaki çocuklarda genitoüriner sistem travmalarý literatürle benzer olarak en sýk künt travmalar þeklinde, trafik kazalarý ve düþmeler sonucunda olup, erkeklerde kýzlara oranla daha fazla idi. Çalýþmamýzdaki en sýk yaralanan organlar böbrek ve daha sonra üretra ve mesane olup, yaralanma sonrasý komplikasyonlar nadir idi. Bununla birlikte pediyatrik hastalarda takibin önemli olduðu akýlda bulundurulmalýdýr.

In the present study, 34 pediatric patients who were hospitalized and maintained with urogenital trauma in our department last ten years, were reviewed, retrospectively. Six of them (17.6%) were girls and 28 (82.4%) were boys, and the mean age was 10.1 years (ranged between 2.5-17 years). The causes of injuries were traffic accident in 24 cases (70.6%), full from a height in 9 cases (26.4%) and gun-shot in one case (3%). Traumas involving the kidney, urethra, bladder and, testis were encountered in 13 (38.2%), 13 (38.2%), 4 (11.7%), 3 (8.8%) and 1 (2.9%), respectively. The mean duration of follow up was 11.2 months (6-12 months). The encountered complications were urethral stricture in 2 cases with urethral trauma and bladder neck stricture in 1 case with bladder trauma. In conclusion, the most common pediatric genito-urinary injuries we observed in this study, were blunt trauma resulted from traffic accidents and falls, and were more frequent in boys similar to the literature. The most common injured organs were kidney, urethra and bladder and the complications were rare. But the importance of follow up in pediatric patients should be kept in mind.

1994-2000 yýllarý arasýnda Turgut Özal Týp Merkezi Göðüs Kalp ve Damar Cerrahisi Kliniðinde 60 damar yaralanmasý vakasý görülmüþtür. Olgularýn 48'i erkek (%80), 12'si kadýn (%20) olup yaþlarý 5-70 (ortalama 28.9) arasýndaydý. Olgularýn yaralanma nedenleri; 34'ü (56.6) kesici-delici alet, 14'ü (%23.3) ateþli silah, beþi (%8.3) iatrojenik ve yedisinin (%11.6) künt travma sonucu olduðu belirlenmiþtir. Olgularýn 45'inde (%75) tam kesi, 14'ünde (%23.3) parsiyel kesi, birinde (%1.6) psödoanevrizma mevcuttu. Yaralanmalar 34 hastada (%56.6) üst ekstremitede, 26 hastada (%43.4) alt ekstremitede idi. Damar yaralanmalarýnýn lokalizasyonu sýklýk sýrasýna göre; femoral arter 12 olgu (%20), radial arter 10 olgu (%16.6), popliteal arter 10 olgu (%16.6), brakial arter dokuz olgu (%15), aksiller arter dokuz olgu (% 15), ulnar arter altý olgu (%10), tibialis posterior arter üç olgu (965) ve tibialis anterior arter bir olgu (%1.6) þeklinde idi. Olgularýn dokuzunda (%15) yandaþ ven yaralanmasý, 10 olguda (9616.6) ise sinir yaralanmasý vardý. Hastalarýn hastaneye ortalama varýþ süreleri 3 saat 30 dakika idi. Ortalama 95 dakika sonra revaskülarizasyon için operasyona alýndýlar. Cerrahi metod olarak vakalarda; 27 (%45) otojen safen ven interpozisyonu, 19 (%31.6) rezeksiyon + uç uca anastomoz, 10 (%16.6) lateral tamir, üç (% 3.2) sentetik greft ve bir (%1.6) ligasyon uygulandý. Serimizde ekstremite kurtarýlma oranýmýz % 98.2 dýr. Hastalarýn hastanede ortalama kalýþ süreleri 14.4 gündü. Hastalarýmýzýn hastanede kalýþ süresi içerisinde mortalite görülmedi.

Between 1994-2000, 60 peripheral vascular injuries were admitted to the Turgut Özal Medical Center Thoracic and Cardiovascular Surgery Clinic. Fourty eight (80 %) of patients were male, twelve (20 %) were female and their age ranged from 5 to 70 years (mean 28.9 years). The causes of injuries were related to penetrating device in 34 (56.6%), gun shots in 14 (23.3 %), blunt trauma in seven (11.6%) and iatrogenic causes in five(8.3 96). Total laceration, partial laceration and pseudoaneurysm were observed in 45 (75%), 14(23.3%) and one(1.6%) respectively. The localization of injuries were the upper limbs in 34(56.6%) and the lower limbs in 26 (414 %). The vascular injury localizations in order of frequency were femoral artery in 12 cases (20.75 %), radial artery in ten cases (17 %), popliteal artery in ten cases (15%), brachial artery in nine cases (15%), axillary artery in nine cases (13.2 %), ulnar artery in six cases (11.3%) and tibial artery in four cases( 7.4 %). There were nearby venous injuries in nine patients (15 %) and neural injuries in ten patients(16.6%). The patients' mean admission time to the hospital was 3 hours and 30 minutes and mean operation time for revascularization was within 95 minutes. The operative techniques were otogenous saphenous vein graft interposition in 27 cases (45 %), resection and end-to-end anastomosis in 19 cases (31.6%), lateral repair in ten cases (16.6%), synthetic graft insertion in three cases (4.8%) and ligation in one case(1.6%). Our success rate was 98.2 % in salvaging the limbs. Mean lenght of hospital stay was 14.4 days. Mortality was not observed during the hospital stay.

Vücudun en büyük sesamoid kemiði olan patellanýn kýrýklarý tüm iskelet yaralanmalarýnýn % 1 'ini oluþturmaktadýr. Parçalý patella kýrýklarýnýn tedavisinde parsiyel patellektomi önerilmektedir. Kliniðimizde 1986-1997 yýllarý arasýnda parçalý patella kýrýðý nedeniyle parsiyel patellektomi yapýlan 25 olgudan takibi yapýlabilen 18 hasta retrospektif olarak deðerlendirildi. Olgularýn 5'i (%27.8) bayan, 13'ü (%72.2) erkekti. Oluþ mekanizmasýna göre; hastalarýn 11'i (%61) trafik kazasý, 4'ü (%22) yüksekten düþme, 2'si (%11) ateþli silah aralanmasý, 1'i (%6) ise göçük altýnda kalma idi. Ortalama yaþ 34.3'tü (13-65). Olgulardan 10'unda (%55) sol, 8'inde (%45) sað dize parsiyel patellektomi uygulandý. Ek patoloji 10 (%56) olguda saptandý. Ortalama 5,2 (3-11) yýl takip edilebilen olgularýn tümünde iyileþme tam olarak görüldü. Sonuçlar Noyes tarafýndan geliþtirilen Cincinnatti diz skoruna göre 5 (%30) hasta mükemmel, 8 (%42) hasta iyi, 3 (%17) hasta orta, 2 (%11) hastada kötü olarak deðerlendirildi. Parsiyel patellektomi, parçalý patella kýrýklarýnda tedavi seçeneðidir. Ýleriki yýllarda görülen pateller eklem yüzeyinde geniþleme ve ekstansör mekanizma içinde kompansatuar olarak geliþen ossifikasyon, osteoartroz gibi deðerlendirilebilir, ancak bunun olgularýmýzýn diz eklemi fonksiyonlarýnda önemli bir kayýp meydana getirmediði görüldü.

The fracture of the biggest sesamoid bone patella is encountered at a rate of 1 % of all skeletal injuries. Partial patellectomy is advised in the treatment of comminuted fractures of patella. In this retrospective study, we evaluated 18 of25 patients who had partial patellectomy in our clinic between 1986-1997. Five patients were female (%27.8) and 13 were male (%72.2). The mechanisms of injuries were as follows: 11 (%61) motor vehicle accidents; 4 (%22) falls from flat-roofed house;2(%11) gunshot; and 1 (%5) subsidence. The mean age of the patients was 34.3 (range,13-65). Ten left (%55) and eight right (%45) partial patellectomy were performed. Ten (%55) patients had also additional pathologies. The median follow-up time was 5.2 years (range, 2-11 years). Patients were very well in the last follow-up. According to Cincinnati Knee Score, which was improved by Noyes, 5 patients (%30) had excellent, 8 (%42) good 3(%17) moderate and 2 (%11) bad results. In conclusion, In the following years, enlargement in patellar articular surface and ossification, which is developed compansatuarly in the extensor mechanism may be detected and mis evaluated as osteoarthrosis. Hence, We determined that they hand not restricted knee joint functions in our cases.

Bu çalýþmada konservatif olarak tedavi edilen çocuk femur cisim kýrýklarýnda rotasyonal deformitelerin hangi sýklýkta ve büyüklükte görüldüðü fizik muayene bulgularý ve ayak geliþme açýsýnýn ölçülmesiyle tesbit edilmeye çalýþýlmýþ ve bunlarýn klinik sonuçlarý deðerlendirilmiþtir. Atatürk Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý'nda 1992-1999yýllarý arasýnda traksiyon ve pelvipedal alçý ile tedavi edilen 82 femur cisim kýrýktý çocuktan kontrolleri yapýlabilen ve tek taraflý kýrýk olan 50'si çalýþmaya dahil edilmiþtir. Yaþlarý 4 gün -13yýl (ortalama 4.2 yýl) olan olgularýn 11'i (%22) kýz, 39'u (%78) erkektir. Traksiyonda kalma süresi 10-25 (ortalama 18.1)gün, alçýda kalma süresi ise 20 gün 12 hafta arasýnda ortalama 8.4 haftadýr. Olgular 5 ay ile 6yýl arasýnda, ortalama 3.5yýl takip edilmiþlerdir. Ayak geliþme açýsý; 21 olguda (%42) ortalama 2.1° artmýþ, 26 olguda (%52) ortalama 4.9° azalmýþtýr. Ayak geliþme açýsýndaki deðiþiklik takip süresi 1 yýlýn altýnda olanlarda, büyük çocuklarda ve kýrýk yeri proksimalde olanlarda daha fazladýr (p< 0.01). Ancak son kontrollerinde hiçbir hastanýn ve ebeveyninin þikayeti yoktur, fizik muayene bulgularý ve yürüyüþ muayeneleri normaldir. Bu çalýþmanýn sonucunda çocuk femur cisim kýrýklarýnýn konservatif tedavisinden sonra sorun yaratan ve tedavi gerektiren rotasyonal deformitelerin alýþýlmýþ bir komplikasyon olmadýðý kanaatine varýlmýþtýr.

In this study, it was tried to determine the frequency and violence of rotational deformities and evaluated their clinical results by the physical examination findings and the foot-progression angle in children's femoral shaft fractures that were applied the conservative treatment. In the Department of Orthopaedics and Traumatology of Atatürk University Medical School, between 1992-1999 years, of 82 children who were treated with traction and spica cast, 50 who could be done control and had unilateral fracture were included into this study. Of these cases, l 1 (22%) were females and 39 (78%) males. The average age was 4.2 years, ranging from 4 days to 13 years. The traction period was 10-25 (average 18.1) days, and the cast period was from 20 days to 12 weeks (average 8.4 weeks). The cases were followed up with an average period of 3.5 years (5 months-6 years). The foot-progression angle increased in 21 cases (42%) as average 2.1 ° and decreased in 26 cases (52%) as average 4.9°. The change amount in angle was excessive in the elder children, the proximal femoral fractures and the cases whose the follow-up was smaller than 1 years (p < 0.01). However, in the final control, none of the cases and their parents had complaint, and physical and walking examinations were normal. In the result of this study, it was concluded that the rotational deformities that were symptomatic and required treatment were not the common complication after the conservative treatment in children's femoral shaft fractures.

61 yaþýnda 69 kg. aðýrlýðýnda erkek hasta obstrüktif sarýlýk düþünülerek 1.Cerrahi Kliniði'ne sevk edilmiþ. Sýrt aðrýsý, iþtahsýzlýk ve sarýlýk þikayeti nedeniyle bir hafta dahiliye kliniðinde tetkik edilen hastada alkol kullanma öyküsü bulunmuyor. Fizik muayenede batýn sað üst kadran palpasyonla aðrýlý, safra kesesi hidropik olarak palpe ediliyor. Üst batýn tomografide pankreas baþýnda 22 mm. çapýnda düzgün kontürlü kist mevcut. Hastaya exploratris laparotomi planlandý. Peroperatif yapýlan kist aspirasyonunda kist hidatiðin laminar membraný ile karþýlaþýlýnca pankreas baþýndaki lezyonun kist hidatik olduðuna karar verildi. Kolesistektomi, koledokoduodenostomi, parsiyel kistektomi ve kapitonaj uygulandý. Hasta postoperatif dönem sonrasý 800 mg/gün Albendazol baþlanýlarak taburcu edildi.

The patient (male; age = 69) was referred to the Department of 1 st Surgery upon suspicion of obstructive jaundice. He was admitted to the Department of Internal Medicine with back pain, loss of apetite, and jaundice and some laboratory tests were performed. He has no history of alcohol use. During his physical examination, pain was noted in the upper right quadrant and the gall bladder was palpable and hydropic. A 22 mm. cystic structure with smooth contours was detected in the abdominal CT scan. An exploratory laparatomy was planned. During the perioperative cyst aspiration, the laminar membrane of hydatic cyst led to the probable diagnosis of hydatic cyst. Cholecystectomy, choledocoduodenostomy, partial cystectomy and capitonage was performed. The patient was started on 800 mg/day albendazole during postoperative period and then was discharged.

Although echinococcal disease is common in some parts of the world isolated renal involvement is rare. We present a single muse of a renal hydatid cyst in a patient with situs inversus totalis.

Penetrating cardiac injury (PCI) frequently cause hemorrhage and cardiac tamponade. However peripheral embolization is very rare. In this manuscript one of the rare case of bullet embolism in the right external iliac artery, which occurred after cardiac gunshot wound is reported under the light of the literature.

Acil servise ulaþabilen Künt travmatik aort yaralanmasý olgularý oldukça enderdir. Bu hastalarýn genellikle multipl travmaya maruz kalmýþ olmasý taný ve tedavilerini daha komplike hale getirir. Bu tanýnýn akla getirilmesi, teþhis için ilk basamaklardan biridir. Bu nedenle, multitravmalý tüm hastalarda künt aort yaralanmasý olasýlýðý daima düþünülmelidir. Bu olgu sunumu, künt kafa travmasý, intraabdominal kanama nedeniyle öncellikle laparotomi yapýlan ve daha sonra peroperatuvar künt aort yaralanmasý da tanýsý konan bir travma hastasýnda geç tanýnýn nedenlerini tartýþmak üzere yapýlmýþtýr.

The patients with blunt aortic injury who reach the emergency department alive are very rare. These patients are often multiple injured which complicates their diagnosis and treatment. To remind diagnosis of blunt aortic injury is the first step of accurate diagnosis. Therefore, the possibility of a blunt aortic injury should be considered in all patients who are multiply injured. The presented case is initially operated on blunt head trauma, and intraabdominal bleeding afterwards blunt aortic injury diagnosed lately in peroperatively. Based on this experience, we have discussed the causes of late diagnosis.