Background: The aim of this study is to evaluate the value ofTc-99 HMP AO cerebral SPECT imaging to confirm brain death in patients with complex spinal automatism.
Methods: Fifteen patients (8 female, 7 male) aged between 1,5-48 years showing spinal movements within 24-72 hours after brain death were examined with Tc-99 HMPAO cerebral SPECT.
Results: All patients demonstrated empty skull on Tc-99 HMPAO images and no contradictory case was ob- served between standard clinical criteria and SPECT study.
Conclusion: Non-invasive brain SPECT study is valuable to diagnose and confirm brain death with spinal automatism in adults and children.

Background: This study was peiformed to evaluate the results of massive lower gastrointestinal bleeding in the elderly patients.
Methods: The data of patients older than 60 years with massive lowergastrointestinal bleeding were retrospectively analyzed between January 1999 and March 2002.
r Results: There were 14 (52%) males and 13 (48%), females with mean age of70.2 years (range 60 to 88).Twenty patients were diagnosed with colonoscopy. Angiography was employed in six, sintigraphy in three and r- enteroclysis in two patients. Colonic diverticulosis was the leading etiologic factor (48%). Mean comorbidity and hospital stay were 1.59 and 6.7 days, respectively. Conservative treatment were performed in eighteen, band JCC, ligation in three, surgery in five and embolization in two patients. Mortality rate was 26%. Mortality was high it in patients who had a lower initial diastolic pressure and required more transfusions (p: 0.006 and p: 0.025, res pectively )
Conclusion: Massive lower gastrointestinal system bleeding in the elderly with comorbidities is associated with higher rate ofmortality. Surgery in these patients has high mortality rates. Endoscopic and conservative diagnosis and treatment methods should be the firts choice in the elderly.

AMAÇ: Karýna penetre kesici delici alet yaralanmalarýnda selektif tedavi sonuçlarýmýzý sunmaktýr. GEREÇ-YÖNTEM: Aralýk 1997 ile Þubat 2001 tarihleri arasýnda karýna penetre kesici delici alet yaralanmasý nedeniyle baþvuran 175 hastanýn 61'i (%34.9 Grup I) hemen ameliyat edilirken 114'ü (%65.1 Grup II) seçici olarak tedavi edilmiþtir. BULGULAR: Gruplar arasý gereksiz laparotomiye maruz kalan olgu sayýlarý, morbidite oraný ve hastanede kalýþ süresi karþýlaþtýrýldýðýnda seçici yaklaþýlan gruplarda gereksiz laparotomi (X2=6.7, p=0,03), morbidite (X2-15.4, p<0.001), hastanede kalýþ süresi (F=54, p<0.0001) istatistiksel olarak anlamlý derecede azalmaktadýr. SONUÇ: Karýna penetre kesici delici alet yaralanmalarýnda seçici yaklaþým güvenli bir yöntemdir. Bu yöntemle gereksiz laparotomiler büyük ölçüde önlenmekte ve buna baðlý olarak morbidite oranlarý ve hastanede kalýþ süreleri anlamlý olarak azalmaktadýr.

BACKGROUND: To present the results of the selective treatment on the penetrating stab wound to the abdomen METHODS: From December 1997 to February 2001, 175 patients had penetrating stab wound injuries to the abdomen. Of the 175 patients, 61 (34.9%) in Group I were taken to the operating room urgently, 114 (65.1%) in Group II were treated selectively. RESULTS: It is evident that the rate of unnecessary laparotomies (X2=6.7, p=0.03), morbidity rate (X2=15.4, p<0.001), and hospital stay (F=54, p<0.0001) in the selectively treated group decrease significantly when compared with the non-selective group. CONCLUSION: Selective approach to the penetrating stab wounds to the abdomen is a safe method. Furthermore, this method obviates most of the unnecessary laparotomies. For this reason, morbidity rate and hospitalization decrease significantly.

Introduction: Burnout has been defined as a syndrome of emotional exhaustion, depersonalization, and 1 reduced personal accomplishment. The syndrome have been Iinked to high Ievels of absenteeism from work among professionals group.
Methods: We studied on 22 emergency service and 22 other health staff working at our Hospital. We investigated on health workers with burnout symptoms by the protocol was self-reported (using a poll). AIso we used, Maslach Burnout Inventory in order to obtain as valid data as possible to assess the level of burnout.
Result: 45.3% showed high Ievels of burnout on emotional exhaustion subscale, 32.~% on depersonalizaion subscale and 28.1% on personal accomplýshment. Seven (31.82%) have been determmed to be under serýous. stress based on the investigation in emergency services; where as 2 (9.09%) in other health services workers as well (t=1.903; p< 0.05 ).
Conclusion: Burnout symptoms were more Iikely to occur in the emergency personals than the other health service workers. Sharing experiences with family and friends and with other health staff who understand what health staffs do best, prevents burnout syndrome.

Background: Trauma is a leading cause ofmorbidity and mortality for childhood and young adults. Fa/ls are the most common mechanism. for injury children. Aim of this study is to determine the epidemiology and clinical features of falls among children.
Methods: We retrospectively analysed children under 14 years of age sustainedfromfa/ls admitted to the our emergency service between January 1997- June 2001.
Results: A total of 1039 children were admitted during the study period. Fa/ls comprised 38% these admissions, and 47% of falls were from balconies.252 patients were male and 141 patients were female. Mean age was 5.23. 62.3 % of children were under the 5 years old. Major injuries included head trauma (57%) extremity trauma ( 16%), and abdominal trauma (11%). Mean ISS score was 9.16 and 32% of children had an, 1SS score was 9,16. Overall mortality rate was 2.23 %.
Conclusion: Althoughfa/ls are the significant cause of childhood injury, these injuries are rarely fatal. Most, common type ofinjury is head trauma. ISS, age, and height are significantly associated with mortality.

Background: We investigated the levels of IL-I, IL-2, IL-4, IL-6, IL-I0 and IL-12 in serum of the children with trauma and its relation with the severity of trauma.
Methods: We included 45 children with moderate or severe multipl trauma and 21 healthy children for control group to our study. The serum IL-I, IL-2, IL-4, IL-6, IL-IO and IL-12 were measured by micro ELISA.
Results: Wefound a statistically significant difference between the serum values of IL-l, IL-4, 1 L-6, IL-I0 in the children with trauma and healthy control group. A similar difference was also observed between the control group and the trauma group with injury severity score (ISS) £30 and also ISS 3 32. Serum values of IL-2 and IL-12 did not show significant difference between the groups. We detected a positive correlation between ISS and IL-l, IL-6, IL-I0 and IL-I2 (respectively r = 0,602, p = 0,000; r = 0,391, p = 0,008; r = 0,399, p = 0,007; r = 0,475, p = 0,001 ).
Conclusion: These results point out that serum IL-6, IL-I0, IL-12 and especially IL-l has a close relationship with the severity of the tissue damage after trauma.

Background: ln this study, we compare the outcome of conservative management by closed reduction andfigure of eight bandage in cases of midclavicular fractures with previously published results of other treatment methods.
Methods: In our department between 1997-2002, 37 cases ofmidclavicular fractures having undergone conservative treatment were evaluated.
Results: 26 patients (70.2%) were male and the remaining 11 (29.8%) female. The average age was 34.3 years (range; 9 to 65). The claviclefractures were classified according to the Allman classification and allfractures were in group 1. After reduction, afigure ofeight bandage was applied. The meanfollow-up period was 29.8 months (range; 6 to 48). All thefractures showed a complete union but one case (2.7%). 1n 16.2% ofthe cases minor cosmetic problems were observed.
Conclusions: We conclude that conservative treatment is the preferredmethod oftreatment in cases ofmid- clavicular fractures, unless there is an absolute indicationfor surgical therapy. This approach is easily applicable, cost effective and has fewer complications.
Key Words: Midclavicular fracture, conservative treatment, closed reduction,figure of eight bandage.

Background: The results of intra-articular comminuted distal humeral fractures, which have been treated by open reduction and dual plate fixation, are compared in this study with previously published results.
Methods: At Uludag University Faculty of Medicine Department of Orthopaedics and Traumatology, hetween 1995 and 2002, the results of 20 cases were evaluated in patients with intra-articular comminuted distal humer- alfractures, who had been treated by open reduction and internaljýxation.
Results: Eleven (55%) cases were male, nine (45%) werefemale and mean age was 40.6 (range; 18 to 76). All fractures were C3 type according to AO/ASIF classifýcation. Eight (40%) cases were openfractures and of these, six ( 30% ) were type 3A and 2 ( 1 0% ) were type 3B on the Gustilo-Anderson classifýcation. All the fractures were jýxed with dual plate after open reduction. In 25% ~f the cases, superficial wound infection was observed and in 5% heterotopic ossification.
Conclusion: In adult distal humeral. fractures of type C3, stabilization by dual plate, following open reduction and early commencement of joint movements, hasfewer complications and should he the preferred method of treatment.
Key W ords: Distal humeral, fracture, intra-articular, dual plate. fixation.

Background: The aim of this study is to stage pancreatic injury and to assess the appropriate surgical approach. Trauma leading to pancreatic injury, factors responsiblejor the mortality and complication rates are evaluated and compared with the literature.
Methods: Records of20 patients with pancreatic injuries treated at the Emergency Surgical Unit of Research Hospital between January 1997 to October 2001 were retrospectively evaluated.
Results: In this series 20 per cent of the mortality occurred within the first 48 hours. The faltor responsible for the mortality in these patients was major bleeding; related to major vascular, hepatic, splenic, renal or thoracic injuries. Late mortality was seen in 3 patients (15 per cent) due to sepsis, respiratory insufficiency or ARDS. ln the literature mortality rate is between 5 to 30 per cent and morbidity rate is 30 to 64 per cent. In this series, these percentages were 35 per cent and 43 per cent respectively.
Conclusion: The surgical therapy should be tailored up to the presence of ductal injury and the extent and anatomicallocalization of the injured segment. In principle the control of bleeding and contamination, and application of the appropriate surgical treatment can lower the morbidity and mortality.

The factors effecting mortality in complicated emergency cases who were transfe1fred to our centre after being operated.
Background: To find out the deficiencies related in education and experience of surgeons about the surgical treatment of emergency patients, and to investigate their effects on mortality.
Methods: The records of214 patients, who were transferred to our department after being operated with the diagnosis of abdominal trauma or acute abdomen in last 7 years, were reviewed.
Results: Total mortality rate was 34.1%.1t was seen that 14.5% in patients who underwent efficient surgical treatment and 42.1 % in patients whose treatment was inefficient.
Conclusion: In centre when intensive care unit does not exist, immediately transportation of emergency operated patients with high risk will decrease morbidity and mortality rates. Participation of the surgeons who deal with emergency surgery to the postgraduating courses adapting their experiences to the current improvements has also importance.

A 67 year-old woman with recurrent multinodular goiter was admitted for býlateral near total thyroidectomy. On the postoperative period, a turbid j1uid came from suction drain which was due to an esophageal perforation. Esophagoscopy and contrast computerized tomography revealed a peiforation in the upper third part ofthe.j esophagus. Fo!lowing nonoperative treatment by restricting oral intake, parenteral administration of antibiotics, and parenteral nutritionfor 10 days, the patient has recovered and was discharged without any sequela. We discussed the cause of perforation according to the possible reasons frequently seen in the literature. Among iatrogenic reasons, unsuccessful intubation trials were more common than neck surgery.

Behçet' s Disease (BD ) is a complex multisystemic disease, which is characterized by recurrent oral and genital aphteous ulcers and iritis in which vasculitis cqn also be one of the possible clinical manifestations. A thirty seven year-old female patient with incomplete BD was admitted to emergency service, with intra-abdominal hemorrhage more severe than that would be expected, with the degree of related trauma. We decided to manage the pdt.ient c;o1ýservatively, observing vital signs, haemogram, computed tomography (CT) and angiography instead. Subcapsular hemotomas were detected in the right and left lobes of the liver. No data was encountered in the literature and textbooks referring to liver trauma with BD, except a case of fatal hemobilia. H ere in we present a liver trauma case with hemorrhage and hepatic fragility due to vasculitis in Behçet' s disease and review the literature.

A 26 year old women with a history of drug intoxication was taken to intensive care unit and had an ischemic, hand injury due to insufficient collateral j1ow after placement of a radial artery catheter. Ischemic hand injury 1 occurred 36 hours after the cannulation. The patient hadfingers gangrene in spite of the removal of the catheter, elevation and heating of the hand, systemic anticoagulation therapy, stellate ganglion blockade, and peripheral circulatory regulator therapy. Any evidence of hand ischemia after radial artery cannulation should be aggressively investigated and promptly treated in order to prevent morbidity and necrosis of the hand.
Key Words: Radial artery cannulation, Ischemic hand injury.

It is difficult to decide replantation or revascularization in partial or total amputations proximal to the wrist. Important point is the expected functional result and/ or protection of sensibility.
Crush type partial or total amputations have poor prognosis. In addition to the vascular injury there are also broad cutaneous and muscular injury which have a potential risk for necrosis and infection. And this may threat the patient's life.
In this case report, as two major nerves seemed intact, arterial reconstruction by a vein graft 22 cm. long and protection of important structures such as vein graft, nerves and bone which were exposed after debridement was perforrmed by pedicled latissimus dorsi muscle flap in an above-elbow partial amputation caused by crush injury, and succesjul result was obtained.
Key Words: Major limb amputation, revascularization, vein graft, pedicled muscle flap.