Review article
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AIMS: In this study. the effect of an extra-lung sepsis model on lung histopathology is evaluated.
METHODOLOGY: In this study 20 Wistar-Albino rats were used. Following the ether anesthesia laparotomy was done. Caecum was ligated by a silk thread and was perforated by 18 gauge needle. It is squeezed untill feces emerged. Abdominal wall is closed. By this method peritoneal sepsis was perfor/ned. The rats are divided into two groups (n: 1 0). 0.5 ml of serum physiologic is applied to the control group, and imipenem is applied to the antibiotic group as 15 mg/kg/ tid. 48 hours later rats were sacrificied by extreme ether anesthesia.Relaparatomy was done and diaphragm was open. Multiple biopsies were made from the lung. Biopsy materials was cultured and examined histopathologically.
RESULTS: In control group; rats died in 48 hours (%100),but antibiotic group were alive (%0). The results of lung biopsy cultures are; in all rats in control group, Escherichia coli (E. coli) and Bacteriodes fragilis (B.fragilis) were cultured (% 100). Whereas in antibiotic group there is no bacteria cultured (p< 0.001). Histopathologic results are: in control group there was wide spread edema and congestion and inflammatory reaction. In antibiotic group there was slight edema, congestion and inflammatory reaction.
CONCLUSION: In septic condition sings of adult respiratory distress syndrome occurs. Large spectrum antibiotics can prevent nd bacterial translocation in lungs and could minimize the lung injury.

BACKGROUND: Surgical stress induces hormonal and cytokine responses proportional to the extent of the injury. Perioperative administration of cyclo-oxygenase inhibitors reduces cytokine production and nitrogen losses. The objective of this study is to evaluate clinically the metabolic and hormonal effects of ibuprofen which is cyclooxigenase inhibitor on surgical stress.
METHODS: A prospective clinic study was performed in 20 patients who undergone thyroidectomy. Patients were randomly divided I two groups as ibuprofen group (n= 10) and control group (n= 10). In the ibuprofen group, pills containing ibuprofen (400 mg) were administered orally 12 and 2 hours before surgery, and every 8 hours until the third postoperative day. In the both groups, blood samples
were collected 24 and 2 hours before surgery and I, 4, 6, 24, 48, and 72 hours after skin incision for glucose, CRp; leukocytes, ACTH, cortisol determinations.
RESULTS: When preoperative values were compared with postoperative values, surgical stress caused significantly changes on the all parameters in the both groups. The highest levels of ACTH and cortisol were at 1st and 6th hours respectively. In both groups, plasma cortisol levels remained elevatedfor 3 days, whereas plasma ACTH levels returned to the basal level at 1 day. In the ibuprofen group, the levels of ACTH and cortisol were significantly less than those of control group (p < 0.00 1 and p < 0.00 1). In the ibuprofen group glucose level (p< 0.00 1) and count leukocyte (p< 0.00 1) increased mildly. The level of CRP increased gradually after first day and were high until 3th days (p < o. 0 1). In the ibuprofen group the fever increased smaller (p < O. 0 1).
CONCLUSION: In conclusion, in perioperative period pretreatment with ibuprofen is able to reduce the neuroendocrine and humoral responses, but it can not completely suppress. Our present study suggests that ibuprofen may be useful in decreasing the surgical stress response in the serious patients.

BACKGROUND: The purpose of this study was to assess the effects of abdominal compartment syndrome (ACS) on the kidneys.
METHODS: Intra abdominal pressures (lAP) were indirectly measured through urinary bladdel: The patients were categorised into four groups according to lAP levels. Serum urea and creatinin levels and lAP were measured once a day. Abdominal decompression was planned according to lAP as well as clinical assessment.
RESULTS: The number of patients in this study was 25. Serum urea and creatinin levels were highest in the group IV (group in which abdominal pressure was above 31cmH2O) (t> O.05). Five of the 25 patients were died and anuria developed in these five patients before death. In three offive patients abdominal decompression operations were performed.
CONCLUSION: IAH is an unusual and often lethal syndrome. The most important treatment is abdominal decompression and we conclude that it should be done in patients with lAP 30 cmH2O or above to protect renalfunction.

BACKGROUND: The aim of this study is to compare the results of jejunal and gastric nutrition in the ICU.
METHODS: Caloric intake and nutritional complications were recordedfor ten days period in patients receiving gastric (n =21) and jejunal (n=22)feeding.
RESULTS: Caloric requirements were reached on the 3rd day of nutrition in 86% of jejunal and 28% of gastric feeding patients (pO.OOl). In jejunal group, delivered calorie/goal calorie ratio was found 15-20% higher than the gastric group. Serum albumin, J triglyceride. cholesterol levels and nitrogen balance did not show significant differences between groups. Vomiting (pO.Ol) and colouring of tracheal aspirates (pO.05) were more frequent in gastric group, however positive tracheal culture frequency did not differ between the groups.
CONCLUSION: It is concluded that higher caloric intakes could be tolerated earlier in patients receiving jejunal feeding.

BACKGROUND: Our aim is to determine the relationship between free oxygen radicals and tissue destruction in Acute abdomen patients.
METHODS: In this study, direct determination offree oxygen radicals is succeeded by measuring the Malonedealdehyde level (MDA), which is the last product of lipid peroxidation in the peritoneal fluid of acute abdomen patients. Forty patients are included in the study of whom thirty patients were the study group and ten were taken as the control group. MDA levels of both groups and the differences between daily MDA levels of each group are compared statistically by using one way Annova, student t test and student Newman Keulstest respectively.
RESULTS: There was statistical significant difference between study and control group (p<0,05). Also there was significant difference between MDA levels of infected, non-infected and control groups (pCONCLUSION: In this study we proved the high MDA levels in the peritonealfluid of Infected Acute Abdomen patients. This result is meaningful/for the diagnose and following of these patients.

BACKGROUND: The aim of this study is evaluate the percutaneous endoscopic gastrostomy (PEG) and its complications in order to provide enteral nutrition support for a long time period.
METHODS: PEG tube was applied to 15 patients aged between 18-95 years, who could not feed orally prohylactic antibiotic didnt use to any patient. After 8 hours hungry PEG was applied by using pull technique and the results were evaluated prospectively.
RESULTS: PEG was successfully done in 14 patients. Gastric juice drainage at the sides of the tube were seen in two patients, and PEG was pulled out in one of them.
CONCLUSION: PEG is the route of choice for a long lived enteral nutrition, because it cdry be applied without general anesthesia, easy to apply, patients can startfeeding in a short time period, need shorter hospital stay, can be changed easily, cost effective and has a low rate of mortality and morbidity.

BACKGROUND: In this study; we aimed to analyze traffic accident cases applying to the emergency department of the hospital of the Cumhuriyet University according to their age, sex, their position during crash, the place and time of the accident, the time to reachi, hospital, the type of veicle and their lesion forms.
METHODS: The hospital files of cases applying to the,emergency department of the hospital of the Cumhuriyet University for traffic accidents, between 01 January 31 December 1998, were InvestIgated retrospectIvely.
RESULTS: Of the cases, most (44.52 %) were in the 1-25 age group, 41 % was pedestrian. Of the accidents, 81.29 % was at the inner' part of the city. 44.03 % occurred in the summer and 39.83 % occurred at 12-18 hours, 44.52 % reached to hospital in thefirst houl: The vehicle type in 60.80 % of the cases was automobile, 14.28 % of the cases involved in alcohol. The blunt injuries were seen usually; 47.50 % of which was present in the head-neck region. 257 cases (41.45 %) were hospitalized. 23 cases (3.71 %) died because of traffic accidents.
CONCLUSION: The similar studies in literature were examined. The factors causing the traffic accident and the problems resulting from traffic accident were pointed out. The treatment manner in the traffic accident cases was suggested.

BACKGROUND: The results of the eight patients who admitted to emergency room with tibial plateau fractures and treated with Ifizarov technique, were retrospective evaluated both clinically and radiologically.
METHODS: Seven (87%) men and one (13%) woman ranging in age from 23 to 38, were Bvaluated. All the cases were between type IV to VI according to Hohl classification preoperatively. Closed indirect reduction by ligamentotaxis was attempted in all fractures, no open technique was performed.
RESULTS: Three (38%) cases had open fractures (type I according to Gustilo- Andersen Classification) preoperatively. Six (75%) traffic accident and two (25%) fallingfrom a height were detected as etiology. The cases, whose average follow up was 14 (6- 28) months, were evaluated according to Iowa knee score scale and seven (87%) cases were good and excellent. Both clinical and radiological solid fusion were obtained in all cases after removing the frame. Although all the cases had minimal to moderate pin tract infection, all were resolved with dressing and oral antibiotherapy without removing the wires.
CONCLUSION: Closed reduction with Ifizarov technique is appropriate for treatment of plateau tibia fractures with minimal morbidity.

AIMS: Geograpbical differences between cases of colonic obstructions affect clinical course and outcome of patients. We aimed to establish regional clinical differences between patients with colonic obstructionfrom eastern and western regions of Turkey.
METHODS: We retrospectively analysed 224 patients with colonic obstruction who were surgically treated in two hospital situated in Istanbul from western and in Van from eastern regions of Turkey. Tbis analysis was made in respect of demograpbic features, causes of obstruction and location in the colon, complicated obstructions, postoperative clinical course and mortality.
RESULTS: Men constituted 71.4% of patients with a mean age of 55.5 years. Obstruction site was the left colon in 82.5% and the sigmoid in 66% of patients from western region, and 91.7% (p=0.03), and 85% (p=0.007) respectivelyofthosesfrom eastern region. The leading causes of obstruction were obstructive cancer (52.5%) in istanbul and volvulus (80.2%) Van respectively (p< 0.001). The colonic obstruction was complicated in 22% of patients. The rate of complicated obstruction was 17.5% and 26.4% (p=0.07) in Van..espectively. The overall postoperative mortality was found as 12.9%. The mortality being 8.6% in simple obstruction raised to 28% (p=0.008) in complicated patients.
CONCLUSION: We found significant differences in colonic obstruction cases between eastern and western parts of Turkey. The incidence of complicated obstruction is bigher in eastern region. A considerable mortality arises in surgically treated patients with colonic obstruction. Postoperative mortality was significantly elevated in cases of obstruction complicated by strangulation, necrosis, and perforation.

BACKGROUND: Abdominal tuberculosis (tbc) is still a medical problem in developing countries. Since it imitates many abdominal diseases, diagnosis can be easily missed unless the disease is suspected.
METHODS: The aim of this study to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 121 patients with intestinal and peritoneal tbc. The diagnosis was made by histopathological examination of biopsy material and isolation of mycobacterium bacillus in cultures or smears ofascidic fluid.
RESULTS: The diagnosis was confirmed with laparotomy in 102, laparoscopy in 4, colonoscopy in 6, and percutaneous aspiration in 9 patients. There were intestinal tbc in 67 (55.3%) patients and peritoneal tbc in 54 (44.6%). Intestinal involvement was commonly located at ileocecal area. Anti tuberculous chemotherapy was started and avoided from extensive resection in surgical treatment. There were a total of 87 complications in 52 patients (42.9%) at the postoperative period. Wound infection was the most frequent complication. Overall mortality rate was 13.2%. The mortality rate in emergency operation was 20.5% while 3.4% in elective conditions. There were no morbidity and mortality in patients whose diagnosis were made by conservative procedures.
CONCLUSION: Laparoscopic endoscopic and percutaneous aspiration procedures are useful for diagnosis in the selected cases of intestinal and peritoneal tbc. Laparotomy should be performed only when complication develops or diagnosis is uncertain. Extensive resection should be avoided in surgical treatment of intestinal tbc. Early diagnosis and treatment will decreas the complications that can be develop during the progress of the disease and consequently the mortality rates.

AIMS: lnthis study we discussed retrospectively secondary peritonitis patients, surgical treatment modalities and their effectiveness in our clinic.
Materials&METHODOLOGY: 91 patients were operated due to diffuse peritonitis between December 1998 through July 200 1 in our clinic were analysed by age, sex, etiology of peritonitis, treatment modalities, morbidity and mortality.
RESULTS: 32 patients were female (35.2%) and 59 patients were male (64.8 %). The median age was 40.4. The most common etiologic factor for secondary peritonitis is peptic ulcus perforation (38.4%).23 cases (25.2%) had the diagnosis only by physical examination and laboratory assesment. The other cases diagnosed with roentgenographic evaluation. In the first operation, the aim was the source control and eradication. In 3 cases, planned re-laparotomy "staged abdominal repair" (STAR) were perfom1ed. Conservative treatment modality was perfonned for 8 cases. The median hospital stay for the patients were 7.4 day. Morbidity was encountered in 13 (13.6%) and mortality was encountered in2 (2.1%).
CONCLUSION: Source control must be the primary aim of the first operation for secondary peritonitis patients. If there is an uncertinity for source control, STAR procedure shold be the choice of the treatment modality for decrease morbidity and mortality.

Acute aortic transection after blunt trauma is a clinical situation, with a high mortality. When the other system injuries are predominant, the diagnosis could be possible only if it would be considered. These type of cases are usually die. The survivors are generally the cases of whom be diagnosed incidentally. Two cases who were admitted to our clinic due to falling down (suicide attempt) were diagnosed as aortic transection and were immediately operated. End to end greft interpositions were perfom1ed by 'lsing left atrio-femoral bypass in one patient and femoro-femoral bypass in the othel: Systemic examinations of all the patients who are referred to the hospital after blunt trauma should be done completely and the physician should be alarmed for possible aortic transection or dissection.

Some arterial aneurysms rupture can be seen during pregnancy. Howevet; spontan rupture oflumbal arter in a or arteries are very rare. In that manuscript: we presented a 22 year old female with 8 month pregnant operated peripheral hospital for suspicion of
-placenta decolmant. When the fetot heart sounds were missed, patient had been transported to our hospital. We reoperated her emergently. We found out the spontan rupture oflumbal artery.

Posttraumatic radioulnar synostosis may occur after fracture of both bones in the forearm. Distal Location of the syonstosis is reported to be the rarest form. We presented a child with traumatic distal radial epiphyseal arrest in association with distal radioulnar synostosis, whisch is a very rare instance. Excision of the synostosis, muscular interposition, Sauve-Kapandji procedure, and distal ulnar epiphysiodesis provided a succesful result.

Trauma of the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Wounded extremity can be saved by replantation of the amputated parts. Replantation of traumatic amputations can be perfon11ed with reasonable success at a regional medical center when experienced surgeons, appropriate and experienced equipment, and skilled ancillary care are available. Successful replantation significantly reduces the morbidity of upper extremity amputations. We presented one case that. 9 year-old, was bridged to our hospital because of total arm amputation after sustained during use of a lawn movel: His arm was saved by urgency surgery.