AMAÇ: Travmatik beyin yaralanmasý önemli bir problem olmasýna raðmen, tanýda yardýmcý olan yaygýn kullanýmlý bir nöro-biyobelirteç yoktur. Bu çalýþma, S100B ve prion protein (PrPC) düzeylerini travmatik beyin yaralanmasý oluþturulan sýçanlarda deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: On beþ albino cinsi sýçan; sham (1), kontrol (6) ve travma (8) olarak üç gruba ayrýldý. Travmatik beyin yaralanmasý modifiye serbest düþme modeli ile oluþturuldu. S100B, PrPC düzeyleri ELISA yöntemi ile ölçüldü. Beyin örnekleri patolojik inceleme için çýkarýldý.
BULGULAR: Serum S100B ve PrPc düzeyleri travma grubunda, travmadan sonraki 2. ve 24. saatlerde yüksek bulundu (sýrasýyla, p<0.002, p<0.002). Ayrýca travma grubundan alýnan beyin örneklerinde histopatolojik yaralanma skoru yüksek bulundu. Sadece serum PrPc düzeyleri ile çýkarýlan beyin dokusundaki yaralanma skoru arasýnda pozitif korelasyon vardý (p=0.039, r= 0.731). ROC analizi ile iki parametre incelendiðinde travmatik beyin yaralanmasýnýn tanýsýnda sensitivite ve spesifitesi ayný bulundu.
TARTIÞMA: S100B ve PrPc düzeyleri bizim deneysel modelimizde tanýda iyi sensitiviteye sahiplerdi. PrPc travmatik beyin yaralanmasý ile gelen hastalarda güvenilir bir belirteç olarak kullanýlabilir. Bu biyo-belirteçin tanýsal deðerini gösterecek klinik çalýþmalara ihtiyaç vardýr.

BACKGROUND: Although traumatic brain injury (TBI) is an important problem, there has been no widespread utilization of neuro-biomarkers to aid the diagnosis of TBI. This study was conducted to evaluate serum S100B and prion protein (PrPC) levels in rats with TBI.
METHODS: In this study, 15 albino rats were categorized into three groups as follows: sham-operated (1), control (6) and trauma (8) groups. The TBI model was based on the modified free falling model. S100B, PrPC levels were measured using ELISA. Brain specimens were obtained for the pathological examination.
RESULTS: Serum S100B and PrPC levels were found to increase in T group at both 2h and 24h after trauma (p<0.002, p<0.002, respectively). We also found higher histopathological injury scores of brain tissues in the T group. Only a positive correlation was found between serum PrPC levels and the extent of brain injury (p=0.039, r=0.731). Using ROC analysis, among the two serum markers investigated, both of them revealed the same sensitivity and specificity for diagnosing TBI.
CONCLUSION: The changes in serum S100B and PrPC levels showed good sensitivity in our experimental model. Therefore, PrPC could be helpful in the early prognostic prediction in patients with TBI. Further studies are needed to test our findings in humans following TBI (penetrating bodies, blunt trauma) to definitively acknowledge it as a reliable biomarker and its subsequent diagnostic utility.

AMAÇ: Özbekistan Cumhuriyeti’nin baþkenti olan Taþkent þehri, 2016 yýlýnda ambulans hizmetlerinin kalitesini yükseltmek için Koreli acil servis doktorlarýyla ortak bir proje baþlatmýþtýr. Taþkent’teki ambulans hizmeti, çok sayýda çaðrýyý iþleme koymakta zorluklarla yüz yüze gelmekte olup hastane öncesi ileri acil hasta bakýmý saðlamada kadrolarý yeterince yetkin deðildir. Ambulans personeli için uygun kapasite geliþtirme eðitim programý tasarlamak için, Taþkent’teki mevcut ambulans hizmetini kaynaklar ve personel yeterliliði açýsýndan incelendi.
GEREÇ VE YÖNTEM: Ambulans personeli yapýlandýrýlmýþ anket çalýþmasýna ve katýlmýþ önceden geçerliliði onaylanmýþ yazýlý teste katýldý. Ýstatistikler ve diðer bilgiler Özbekistan Saðlýk Bakanlýðý tarafýndan saðlandý.
BULGULAR: Çalýþmaya 98 ambulans personeli katýldý, yarýdan fazlasý (%53.1) doktordu. Ambulansta ortalama hizmet süresi 8.71±6.9 yýldý. Ambulansta, resüsitasyon için büyük hacimli sývýlar haricinde kritik hasta tedavisi için enjektabl formlarý da içeren yeterli miktarda stoklanmýþ ilaç bulunmaktadýr. Ambulanslarýn sadece yüzde 19 ile 52’sinde gerekli monitörizasyon cihazlarý bulunuyordu. Temel prosedürlere iliþkin yeterlilik %60’tan daha yüksek düzeyde olmasýna raðmen, ancak defibrilasyon gibi kritik hasta bakým becerileri %18 kadar düþük oranda bulundý. Yazýlý teste yalnýzca %41.1 oranýnda doðru yanýt verilmiþ olmasýna raðmen Kore ambulans personeli için validasyon testinde doðru yanýt oraný %60’dan yüksekti. Ambulans personeli için gerekli görülen geleneksel hastane öncesi bilgi ve beceri setinin testte marjinal düzeyde olduðu tespit edildi.
TARTIÞMA: Özbekistan’ýn Taþkent’teki ambulans personeli yetersiz týbbi bilgi ve klinik karar verme yeteneklerine sahipti. Bu çalýþmada elde edilen bulgular ýþýðýnda Taþkent’teki ambulans personeli için eðitim programý geliþtirilmelidir.

BACKGROUND: The Tashkent city, the capital of the republic of Uzbekistan, started joint project with Korean emergency physicians to improve the quality of their ambulance services in 2016. Ambulance service in Tashkent city has been facing challenges in processing a large number of calls, and low competency of their staff in providing advanced prehospital emergency care. To design an appropriate capacity building training program for ambulance staff, we analyzed the current ambulance service in Tashkent concerning resources and competency of the staff.
METHODS: In this study, ambulance staff participated in the constructed survey and pre-validated written test. Statistics and other information were provided by the Ministry of Health of Uzbekistan.
RESULTS: Ninety-eight ambulance staff were participated in this study, and more than half (53.1%) of the participants were physicians. The average years of service in the ambulance were 8.71±6.9 years. In the ambulance, drugs were stocked in enough quantity include injections for critical care, except large volume fluids for resuscitation. Only 19 to 52 percent of the ambulances were equipped with essential monitoring devices. Competency for the basic procedure was surveyed higher than 60%, but critical care skills, such as defibrillation, were as low as 18%. The written test resulted in only 41.1% correct answer rate, though it was higher than 60% in the validation test for Korean ambulance staff. Conventional prehospital knowledge and skillset deemed to be essential for ambulance staff were found to be marginal in the test.
CONCLUSION: The ambulance staff in Tashkent, Uzbekistan found to have insufficient medical knowledge and clinical decision-making abilities. Training program for ambulance staff in Tashkent should be developed on the basis of the findings in this study.

AMAÇ: Deksmedetomidin (DEX) uygulamasýnýn travmatik beyin hasarýnda (TBH) enflamasyonu, artan baðýrsak mukoza hasarýný ve baðýrsak geçirgenliðini etkileme durumu araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmamýzda deðerlendirdiðimiz hayvanlar kontrol grubu (Grup 1, n=10), travma grubu (Grup 2, n=10) ve travma + deksmetetomdin grubu (Grup 3, n=10) olmak üzere üç gruba randomize edildi. Kontrol grubuna travma uygulanmazken, Grup 2 ve 3’deki sýçanlarýn hepsine ayný yöntemle kafa travmasý uygulandý. Grup 3’deki sýçanlara ek olarak intraperitoneal DEX uygulamasý yapýldý. Sistemik ve lokal enflamasyonu deðerlendirmek için travmadan 6 saat sonra baðýrsak TNF-a, serum TNF-a, IL-6, IL-1b, D-laktat düzeyleri ölçüldü. Mukoza hasarýný deðerlendirmek için 6. saatte terminal ileumun histopatolojik incelemesi yapýldý. Ýntestinal geçirgenliði deðerlendirmek için ise proksimal ve distal uçlarýndan baðlanan 5 cm’lik ileum segmentine enjekte edilen dekstranýn 30. dakikada kardiyak ponksiyonla alýnan kandaki düzeyi ölçüldü.
BULGULAR: Grup 3’te ölçülen baðýrsak TNF-a (p=0.003), serum TNF-a (p=0.009), IL-6 (p=0.002), IL-1b (p=0.001), D-laktat düzeyleri (p=0.046), Grup 2’ye göre anlamlý ölçüde düþük saptandý. Grup 3’te kanda ölçülen dekstran düzeyi Grup 2’ye göre anlamlý düzeyde düþük gözlendi (p<0.001). Baðýrsaklarýn histopatolojik incelemesinde ise; Grup 1’deki sýçanlarýn ileumunda hasar yok, Grup 2’deki sýçanlarýn ileumunda; villus atrofisi ve mukozal hasar, Grup 3’dekilerin ise Grup 2’ye göre anlamlý derecede iyileþme olduðu gözlendi.
TARTIÞMA: Çalýþmamýzda DEX’in TBI kaynaklý artan enflamasyonu, baðýrsak mukoza hasarýný ve baðýrsak geçirgenliðini azalttýðý görüldü. Bu sonuçlar, DEX’in, TBH sonrasý enflamatuvar yanýtlarý modüle ederek baðýrsak dokusuna verilen hasarý iyileþtirebileceðini göstermiþtir.

BACKGROUND: This study aims to investigate whether or not dexmedetomidine (DEX) application affects inflammation, increased intestinal mucosa damage and intestinal permeability in traumatic brain injury (TBI).
METHODS: The rats included in our study were randomized into three groups as the control group (Group 1, n=10), trauma group (Group 2, n=10) and the trauma+dexmedetomidine group (Group 3, n=10). While trauma was not induced in the control group, head trauma was induced in all rats in Groups 2 and 3 with the same method. The rats in Group 3 additionally received the DEX application. Intestinal THF-a, serum TNF-a, IL-6, IL-1b and D-lactate levels were measured six hours post-trauma to assess systemic and local infection. Histopathological evaluation of the terminal ileum was performed at the 6th hour to assess mucosal damage. Intestinal permeability was evaluated by measuring the level of dextran injected into the 5-cm ileum segment adhered to the proximal and distal edges at the 30th minute in the blood taken by cardiac puncture.
RESULTS: Intestinal TNF-a (p=0.003), serum TNF-a (p=0.009), IL-6 (p=0.002), IL-1b (p=0.001), and D-lactate levels measured in Group 3 (p=0.046) were significantly lower than those measured in Group 2. Dextran level measured in blood in Group 3 was observed significantly lower than that of Group 2 (p<0.001). Histopathological evaluation of the intestines revealed no injuries in the ileum of the rats in Group 1, injury in the ileum, villus atrophy and mucosal damage in the rats in Group 2, and a significant recovery was observed in Group 3 in comparison to Group 2.
CONCLUSION: It was seen in our study that DEX reduced TBI-induced increased inflammation, intestinal mucosa damage and intestinal permeability. These results suggest that DEX may ameliorate the damage done to the intestinal tissue by modulating post-TBI inflammatory responses.

AMAÇ: Biz bu çalýþmada, pentraxin-3’ün akut apandisit için tanýsal performansýný ve perforasyon için prediktif performansýný, beyaz küre sayýsý, yüksek duyarlýklý C-reaktif protein ve interlökin-6 ile karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Ýleriye yönelik metodolojik türde olan bu çalýþmada, pentraxin-3, beyaz küre sayýsý, yüksek duyarlýklý C-reaktif protein ve interlökin-6’nýn akut apandisit için tanýsal performansý ve akut apandisitli hastalarda perforasyon için prediktif performansý karþýlaþtýrýldý. Kontrol grubunu, inguinal herni tanýsý alan ve kliniðimize elektif cerrahi için baþvuran hastalardan oluþturuldu. Tanýsal doðruluk ve prediktif gücünün karþýlaþtýrmasýnda “receiver operating characteristics’ analizi kullanýldý.
BULGULAR: Serum pentraxin-3 düzeyi >3.67 ng/mL olmasý, akut apandisit tanýsý için %95.5 sensitivite ve %100.0 spesifisiteye sahipken eðri altýndaki alan %0.993 (%95 CI 0.967–1.000) olarak bulundu. Ayrýca pentraxin-3 düzeyi >9.56 ng/mL olmasý, perfore akut apandisit prediksiyonu için %92.9 sensitivite ve %87.1 spesifisiteye sahipken, eðri altýndaki alan 0.820 (%95 CI 0.736–0.886) olarak bulundu.
TARTIÞMA: Pentraxin-3’ün akut apandisit için tanýsal performansý ve perforasyon için prediktif gücü beyaz küre sayýsý, yüksek duyarlýklý C-reaktif protein ve interlökin-6’ya göre yüksek bulunmuþtur.

BACKGROUND: In this study, we aimed to investigate the diagnostic performance of pentraxin-3 for acute appendicitis, and the predictive performance for perforation in patients with acute appendicitis, compared with white blood cell count, high-sensitivity C-reactive protein and interleukin-6 (IL-6).
METHODS: This study was a prospective methodological study, in which we studied the accuracies of the serum levels of pentraxin-3, white blood cell count, interleukin-6 and high-sensitivity C-reactive protein in estimating acute appendicitis, and in estimating perforation in patients with acute appendicitis. We designed the control group with the patients diagnosed inguinal hernia and admitted for elective surgery. Receiver operating characteristics analysis was used to compare the diagnostic accuracies and predictive performances.
RESULTS: Receiver operating characteristics analysis revealed that the Pentraxin-3 level >3.67 ng/mL showed the sensitivity of 95.5% and specificity of 100.0% for diagnosing acute appendicitis, with an area under the curve of 0.993 (95% CI 0.967–1.000). Also, the Pentraxin-3 level >9.56 ng/mL showed the sensitivity of 92.9%, and the specificity of 87.1% for the prediction of the perforation, with an area under the curve of 0.820 (95% CI 0.736–0.886).
CONCLUSION: The diagnostic performance of Pentraxin-3 for acute appendicitis and the predictive performance for perforation were higher than white blood cell count, high-sensitivity C-reactive protein and interleukin-6.

AMAÇ: Ameliyat sonrasý erken dönemde kognitif bozukluk yaþlý popülâsyonda sýk görülür. Anestezi yönetimi ameliyat sonrasý kognitif düþüþü etkileyebilir. Etkin analjezi, erken derlenme ve stres yanýtýn modülasyonu nöroaksiyel bloklarýn avantajlarýdýr. Bu çalýþmanýn amacý, genel anestezi ve epidural analjezi ile kombine edilen genel anestezinin postoperatif kognitif bozukluk (PKB) için etkisini karþýlaþtýrmaktýr. Hipotezimiz genel anestezi (GA) ile birlikte nöroaksiyel bloðun, PKB önlenmesinde olumlu bir etkisi olacaðýydý.
GEREÇ VE YÖNTEM: Kalp cerrahisi dýþýnda operasyona gelen 60 yaþýn üstündeki hastalar bu ileriye yönelik randomize çalýþmaya dâhil edildi ve hastalar iki gruba ayrýldý. Birinci gruptaki hastalara (GI) GA uygulandý; ikinci grupta (GII) ise epidural analjezi ile GA kombine edildi. Hastalarýn kognitif fonksiyonlarý, nöropsikolojik test bataryasý kullanýlarak ameliyattan bir hafta önce ve bir hafta sonra deðerlendirildi. PKD, iki veya daha fazla testte bazal deðerden bir standart sapma düþüþ olarak tanýmlandý.
BULGULAR: Çalýþmayý toplam 116 hasta tamamladý. GI’de GII’den anlamlý olarak yüksek olan maksimum aðrý skorlarý hariç (sýrasýyla, 4.9±2.8’e karþýlýk 1.7±1.7; p<0.001) demografik ve operatif veriler gruplar arasýnda benzerdi. PKD insidansýnda gruplar arasýnda fark saptanmadý (GI’de %26 ve GII’de %24). Bellek performansý, görsel mekânsal fonksiyonlar ve dil beceri testleri GII’de GI’e göre anlamlý olarak yüksek bulundu.
TARTIÞMA: Genel anestezi ve genel anestezi ile kombine epidural analjezi, abdominal cerrahi geçiren yaþlý hastalarda benzer PKD insidansý ile sonuçlandý. Bununla birlikte, kombine anestezi grubunda hafýza, dil becerileri ve görsel mekânsal fonksiyonlarýn daha iyi korunduðu görüldü. Etkin aðrý kontrolü bazý alanlarda kognitif iþlevlerin korunmasýnda katký saðlayabilir durmaktadýr.

BACKGROUND: Cognitive dysfunction in the early postoperative course is common for the elderly population. Anesthetic management may affect postoperative cognitive decline. Effective analgesia, early recovery and modulation of the stress response are advantages of neuraxial blocks. This study aims to compare the effects of general anesthesia and the combination of general anesthesia with epidural analgesia for postoperative cognitive dysfunction (POCD). We hypothesized that neuraxial block combined with general anesthesia (GA) would have a favorable influence on POCD prevention.
METHODS: Patients above 60 years undergoing non-cardiac surgery were included in this randomized, prospective study and randomized into two groups. Patients in the first group (GI) were treated under GA, whereas in the second group (GII), epidural analgesia was combined with GA. Patients’ cognitive function was assessed before and one week after surgery using a neuropsychological test battery. POCD was defined as a drop of one standard deviation from baseline on two or more tests.
RESULTS: A total of 116 patients were allocated for the final analysis. Demographic and operative data were similar between groups, except maximum pain scores, which were significantly higher in GI than GII (4.9±2.8 vs. 1.7±1.7; p<0.001, respectively). The incidence of POCD was comparable between groups (26% in GI and 24% in GII). Memory performance, visuospatial functions, and language skills tests were significantly higher in GII compared to GI.
CONCLUSION: General anesthesia and epidural analgesia combined with general anesthesia resulted in similar POCD in elderly patients undergoing abdominal surgery. However, in combined anesthesia group memory, language skills and visuospatial functions appeared to be better preserved. Effective pain control might contribute to preventing cognitive decline in some domains.

AMAÇ: Akut pankreatit (AP) karýn aðrýsý nedeniyle acil serviste sýklýkla görülen bir hastalýktýr. Bu çalýþma AP tanýsý konulan hastalarda, kanda tiyol-disülfit parametrelerinin ölçümü ve diðer kan parametreleri ile iliþkisinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmaya acil servise baþvuran 56 (%56) hasta ve 44 (%44) saðlýklý gönüllü olmak üzere toplam 100 örnek alýndý. Hastalardan geliþ anýnda detaylý kan örnekleri alýndý. Akut pankreatit tanýsý konan hastalarýn baþvurusu sýrasýnda ki venöz kan örneklerinden Erel ve Neþelioðlu tarafýndan geliþtirilen yepyeni bir yöntemle serumda tiyol-disülfide düzeyi çalýþýldý. Veriler bilgisayar ortamýnda deðerlendirildi.
BULGULAR: Akut pankreatitin etiyolojisi 41 hastada (%73.2) safra taþý, bir hastada (%1.7) hipertrigliseridemi, dört hastada (% 7.1) alkol kullanýmý ve 10 hastada (%17.8) idiyopatik idi. Kan tiyol düzeyleri düþük iken, disülfide düzeyleri anlamlý derecede yüksekti. Diðer kan parametreleri olan amilaz, lipaz, NLR (nötrofil lenfosit oraný) ile tiyol-disülfide dengesi parametreleri arasýnda istatistiki açýdan anlamlý fark bulunamadý.
TARTIÞMA: Akut pankreatit de patogenezde tiyol-disülfit dengesinin bozulmasý rol oynayabilir. AP’de kanda tiyol düzeyi azaldýðýndan bu tiyol eksikliðini tamamlayýcý tedavilerin verilmesi hastalýðýn iyileþmesine katkýda bulunabilir.

BACKGROUND: Acute pancreatitis is a common disease seen in emergency departments because of abdominal pain. The present study aims to evaluate the relation between measurements of thiol-disulfide parameters in patients diagnosed with acute pancreatitis and other blood parameters.
METHODS: A total of 56 (56%) patients, who were admitted to the emergency department, and 44 (44%) healthy volunteers participated in this study. A total of 100 samples were taken from the participants. Detailed blood samples were taken from the patients at the time of arrival at the hospital. The thiol-disulfide level in serum was examined using a brand new method that was developed by Erel and Neþelioðlu in the venous blood samples of the patients who were diagnosed with acute pancreatitis during the admission. The data were evaluated in the computer medium.
RESULTS: Gallstones were defined as the etiology of AP in 41 patients (73.2%); in one patient, hypertriglyceridemia (1.7%); in four patients, alcohol use (7.1%), and idiopathic 10 patients (17.8%). While the blood thiol levels were low, the disulfide levels were high at a significant level. No statistically significant relations were detected between the amylase, lipase, neutrophil lymphocyte ratio (NLR), which are other blood parameters, and thiol-disulfide balance parameters.
CONCLUSION: The disruption of the thiol-disulfide balance may play a role in the pathogenesis of acute pancreatitis. In acute pancreatitis, since the thiol level is decreased in the blood, administration of the complementary therapies for this thiol deficiency may contribute to the treatment of the disease.

AMAÇ: Bu çalýþmanýn amacý, acil servisimizde deðerlendirilen künt ve penetran karýn travmalarý ve bunlara yönelik gerçekleþtirilen tedavi yaklaþýmlarý ile mortalite için risk faktörlerini incelemektir.
GEREÇ VE YÖNTEM: Ocak 2009–Nisan 2019 tarihleri arasýnda acil servisimize baþvuran ve travma nedeniyle cerrahi konsültasyonu yapýlan 664 hasta çalýþma için deðerlendirildi. Baþvuru anýnda gerçekleþen ölümler, verileri eksik olan hastalar ve karýn travmasý saptanmayan hastalar çalýþmaya dahil edilmedi. Çalýþmaya abdominal travmalý 113 hasta alýndý. Demografik, klinik, prognostik ve mortalite ile iliþkili faktörler geriye dönük olarak incelendi.
BULGULAR: Hastalardaki yaþ ortalamasý 36.08±16.1 yýldý. Bunlardan 90’ý erkekti. Seksen hastada (%70.8) künt karýn travmasýnýn (KKT) mevcut olduðu gözlendi. Yimi sekiz hastada (%24.7) izole karaciðer ve iki hastada (%1.7) dalak yaralanmasý vardý. Kombine karaciðer ve dalak yaralanmasýnýn iki hastada (%1.7) görüldü. Yirmi iki (%19.4) hastada mortalite geliþti. Mortalite nedenlerini geri dönüþümsüz hemorajik þok (%40.9) ve merkezi sinir sistemi (%13.6) yaralanmalarý oluþturmaktaydý. KKT mortal seyreden grupta ana yaralanma mekanizmasýný oluþturmaktaydý (%86.4 ve %67, p<0.001). Retroperitoneal yaralanma sýklýðý mortal seyreden hastalarda anlamlý olarak daha yüksekti (%50 ve %50, %16, p<0.001). Mortal seyreden hastalarda ekstra abdominal yaralanma sýklýðý daha yüksekti (%49 ve %68.1; p=0.047). Yatýþ sýrasýndaki ortalama arter basýncý mortal seyreden hastalarýnda anlamlý olarak düþük bulundu (67±26.8 mmHg ve 84.3±17 mmHg; p=0.02). Mortal seyreden hastalarda transfüze edilen eritrosit miktarý daha fazlaydý (8.8±8.6 ve 3.3±5.9 ünite; p=0.047). Ortalama uluslararasý normalleþtirilmiþ oraný (INR) mortal seyreden hastalarda anlamlý derecede yüksekti (4.3±7.1 ve 2.7±4; p=0.016). Mortal seyreden hastalarda ortalama laktat dehidrogenaz daha yüksekti (1685.7±333.82 ve 675.8±565.3 IU/mL; p<0.001). Ortalama alanin amino transferaz (ALT) düzeyi mortal seyreden hastalarda anlamlý olarak daha yüksekti (430±619 ve 244±448 IU/mL; p<0.001). Mortal seyreden hastalarda ortalama alkalen fosfataz (ALP) düzeyi daha yüksekti (76.9±72.8 ve 67.3±27.8 IU/mL; p=0.003). Retroperitoneal yaralanma ve ALT >519 IU/mL varlýðýnýn mortalite açýsýndan baðýmsýz risk faktörleri olduklarý bulundu.
TARTIÞMA: Mortal seyreden hasta grubunda bazý laboratuvar deðiþkenlerinin arttýðýný ve bunlarýn travmanýn ciddiyeti ile ilgili olduðu görüldü. Retroperitoneal yaralanma ve artmýþ ALT düzeyleri mortalite açýsýndan baðýmsýz risk faktörü olup, bu bulgu çalýþmanýn en önemli bulgusu olarak karþýmýza çýkmaktadýr. Mevcut çalýþma bulgularýmýz travma hastalarýnýn deðerlendirilmesinde diðer merkezlere rehberlik edebileceði ve yüksek riskli gruplarý tanýmlamada da kullanýlabilir.

BACKGROUND: The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergency department, the treatment approaches and risk factors of mortality.
METHODS: Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for trauma between January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department were evaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed.
RESULTS: The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had blunt abdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality were an irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury in patients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients with mortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus 49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHg versus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus 3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus 2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL; p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL; p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003). The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality.
CONCLUSION: We have found certain laboratory variables to increase in patients with mortality. These are related to the severity of trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study. Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.

AMAÇ: Abdominal duvar hematomlarýnýn insidansý, klinik uygulamada antikoagülan ve antiplatelet ilaçlarýn kullanýlmasýndan sonra artmýþtýr. Bu hastalar genellikle yaþlýdýr ve birden fazla komorbiditeye sahiptirler. Çoðu spontan hematom kendini kýsýtlama eðilimindedir ve yakýn takip ile konservatif tedavi genellikle yeterlidir ancak cerrahi, kritik olarak karar verilmesi gereken bir seçenektir. Gereksiz cerrahi müdahaleler durumu daha da kötüleþtirebilir. Bu çalýþmanýn amacý, antikoagülan/antiplatelet tedavi altýndaki ve spontan abdominal duvar hematomlarý olan hastalarýn sonuçlarýný cerrahi perspektiften incelemektir.
GEREÇ VE YÖNTEM: Bu çalýþma, Ocak 2016 ve Eylül 2018 yýllarý arasýnda antikoagülan/antiplatelet tedavi gören ve spontan abdomen ve abdominal duvar hematomu nedeniyle genel cerrahi kliniðimize baþvuran 43 hastanýn týbbi kayýtlarýnýn gözden geçirildiði geriye dönük bir çalýþmadýr.
BULGULAR: Olgularýn birçoðu karýn aðrýsý ile baþvurdu. Bu hastalarýn 30’u kadýndý (%69.7). Yaþ ortalamasý 69.32 idi. Hastalarýn yarýsýndan fazlasý (%58.1) acil servisten refere edildi. Olgularýn tamamý çeþitli nedenlerle antikoagülan ve antiplatelet tedavi altýndaydý. Belirti ve semptomlarýn izlenmesi ve laboratuvar testlerinin deðerlendirilmesinden sonra 30 hastaya (%69.7) baþlangýç testi olarak bilgisayarlý tomografik görüntüleme uygulandý. USG ve MRI kullanýlan diðer yöntemlerdi. En sýk rastlanan taný rektus kýlýf hematomuydu (n=16; %37.2) ve bunu sýrasýyla baðýrsak ve kolon duvarý, lombar, psoas, pelvik ve retroperitoneal hematom izledi. Kýrk üç hastadan 39’una (%90.6) konservatif tedavi uygulandý ve iki hastaya transkateter arteriyel embolizasyon uygulandý. Tanýdan sonraki birinci ve 11. günde iki hasta (%4.6) hayatýný kaybetti. Tedavi için cerrahi uygulama gerekmedi.
TARTIÞMA: Erken taný, riskli hastalarýn hastaneye yatýrýlmasý, hemodinamik parametrelerin yakýn takibi, konservatif tedaviye yanýt verme ve minimal invaziv yöntemler tedavide önemli noktalardýr. Konservatif bakým ilk tedavi seçeneðidir ancak hemodinamik stabil olmayan hastalarda her zaman cerrahi akýlda tutulmalýdýr.

BACKGROUND: The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tend to limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Unnecessary surgical interventions could worsen the situation. The present study aims to analyze the results of patients under anticoagulant/antiplatelet treatment and with spontaneous abdominal wall hematomas from surgeons’ perspective.
METHODS: This is a retrospective study that the medical records of 43 patients who were under anticoagulant/antiplatelet therapy and consulted our general surgery clinic because of the spontaneous abdomen and abdominal wall hematoma between January-2016 and September-2018 were reviewed.
RESULTS: The findings showed that most of the cases were presented with abdominal pain. Thirty of these patients were female (69.7%). The mean age was 69.32 years. More than half of the patients (58.1%) were referred from the emergency department. All of the cases were under anticoagulant and antiplatelet treatment for several reasons. With presenting signs and symptoms and after evaluation of laboratory tests, computed tomography was performed to 30 patients (69.7%) as an initial test. USG and MRI were the other methods used. The most common diagnosis was rectus sheath hematoma (n=16; 37.2%) and followed by intestinal and colon wall, lumbar, psoas, pelvic and retroperitoneal hematoma in decreasing order. Among 43 patients, 39 patients (90.6%) followed with conservative treatment and two patients were treated with transcatheter arterial embolization. Two patients (4.6%) were died on day 1 and 11 after diagnosis. No surgery needed for all patients.
CONCLUSION: Early recognition, hospitalization of risky patients, close follow-up of hemodynamic parameters, patients’ response to conservative treatment and minimal invasive methods are key points. Conservative care is the choice of treatment, but surgery must always keep in mind in hemodynamic unstable patients.

AMAÇ: Son yýllarda birçok yayýnda, kolorektal kanser (KRK) cerrahisinde onkolojik prensiplerin önemi vurgulanmaktadýr. Acil ameliyalatlarýn yüksek morbidite ve mortalite oranlarýna sahip olduðu bilinmekle birlikte, onkolojik prensipleri saðlamadaki yeterliliði ve prognozu hala tartýþmalýdýr. Bu çalýþmanýn amacý, acil ve elektif cerrahi rezeksiyon yapýlan KRK hastalarýnýn klinikopatolojik özelliklerini karþýlaþtýrmak, onkolojik ilkelere uygunluðunu ve kýsa/uzun dönem sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kolorektal kanser tanýsýyla ameliyat edilen 564 hasta çalýþmaya alýndý. Hastalar ameliyat koþuluna göre acil (Grup 1) ve elektif (Grup 2) olmak üzere iki gruba ayrýldý. Hastalarýn demografik, klinikopatolojik özellikleri, prognostik faktörleri ve saðkalýmlarý geriye dönük olarak deðerlendirildi.
BULGULAR: Grup 1’de 104 (%18.4), grup 2’de 460 (%81.6) hasta vardý. Hastalarýn %61.2’si erkek ve yaþ ortalamasý 64.27 idi. Gruplar arasý yaþ daðýlýmý, tümör lokalizasyonu, uygulanan cerrahi prosedür, T- N sýnýflamasý, AJCC evresi, müsin alt tipi, lenfovasküler ve perinöral invazyonu mevcudiyeti açýsýndan istatistiksel önemli farklýlýklar mevcut idi. Ortalama tümör çapý 5.23±3.48 cm idi. Gruplar arasý, low anterior rezeksiyon yapýlan hastalar haricinde, disseke edilen lenf nodu yeterliliði açýsýndan farklýlýk yok idi. Ortalama saðkalým süresi 475.212 gün ve ortanca saðkalým süresi 376 gündü. Hastalýksýz ve genel saðkalým oranlarý grup 2’de daha yüksek idi.
TARTIÞMA: Acil þartlarda ameliyat edilen KRK hastalarý, uygun onkolojik rezeksiyon uygulanmasýna raðmen, elektif þartlara göre daha kötü kýsa ve uzun dönem sonuçlara sahipti. Bu nedenle, acil cerrahi oranlarýný azaltmak için kolorektal kanser tarama programlarýnýn yaygýnlýðýnýn artýrýlmasý gerektiðini düþünüyoruz.

BACKGROUND: In recent years, the importance of oncologic principles in colorectal cancer (CRC) surgery has been emphasized in many studies. Although emergency surgery is related to high morbidity and mortality rates, their adequacy and prognosis in maintaining oncologic principles are still controversial. This study aims to compare the clinicopathological features of CRC patients who underwent emergency and elective surgical resection and also to evaluate their compatibility with oncologic principles and to evaluate their short/long term results.
METHODS: Of the patients who underwent surgery for CRC, 564 were included in this study. The patients were divided into two groups according to their surgical conditions as an emergency (Group 1) and elective (Group 2). Demographics, clinicopathological features, prognostic factors and survival rates of the patients were evaluated retrospectively.
RESULTS: There were 104 (18.4%) patients in group 1 and 460 (81.6%) patients in group 2. 61.2% of the patients were male and the mean age was 64.27. There were statistically significant differences between the groups in age distribution, tumor localization, surgical procedures, T- N classification, AJCC stage, presence of mucinous subtype, lymphovascular and perineural invasion. The mean tumor diameter was 5.23±3.48 cm. There was no difference between the groups concerning the adequacy of lymph node harvest, except in patients who underwent low anterior resection. The mean survival time was 475.212 days, and the median survival time was 376 days. The disease-free and overall survival rates were higher in group 2.
CONCLUSION: Despite the appropriate oncologic resection, CRC patients operated under emergency conditions had worse short-term and long-term results than the CRC patients operated under elective conditions. Thus, we believe that the prevalence of colorectal cancer screening programs should be increased to reduce the rate of emergency surgery.

AMAÇ: Akut apandisit (AA) hastalarýnýn %18 ile %34’ü komplike apandisit tanýsý almýþtýr. AA’nýn en önemli komplikasyonu perforasyondur. Perforasyon morbidite ve mortaliteyi arttýrýr. Bu çalýþmada temel enflamatuvar belirteçlerin perfore AA tanýsýndaki rolünü araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Akdeniz Üniversitesi Týp Fakültesi’nde; Ocak 2014–Ekim 2019 ve Aralýk 2017–Ekim 2019 tarihleri arasýnda Ýstinye Üniversitesi Týp Fakültesi Hastanesi’nde AA tanýsý ile apendektomi yapýlan hastalarýn retrospektif dosya incelemesi yapýldý. Kaydedilen belirteçler aþaðýdaki gibiydi: lökosit sayýsý, nötrofil, lenfosit, trombosit sayýmý, C-reaktif protein, ortalama trombosit hacmi, kýrmýzý hücre daðýlým geniþliði ve eozinofiller. Aþaðýdaki üç oranýn üretilmesi için hematolojik endeksler çalýþtýrýldý; beyaz küre nötrofil oraný, trombosit lenfosit oraný ve nötrofil lenfosit oraný.
BULGULAR: Akut apandisit tanýsý olan toplam 536 hasta ameliyat edildi. Bu hastalarýn 344’ü (%64.1) erkek ve 192’si (%35.9) kadýn idi. Hastalarýn yaþ ortalamasý 36.7±16.2 (15–88) idi. Perfore AA olan 94 (%17.5) ve perfore olmayan AA olan 442 (%82.5) hasta vardý. C-reaktif protein (AUC: 0.81, p<0.001), perfore ve perfore olmayan grubun ayýrt edilmesinde en doðru belirteç olarak tespit edildi.
TARTIÞMA: Yüksek CRP seviyesi, enflamatuvar hastalýklarýn çoðunda spesifik olmayan bir enflamatuvar belirteçtir, bu nedenle yüksek CRP seviyesi, perfore AA’nýn tanýsýnda bir tamamlayýcý olarak kullanýlabilir.

BACKGROUND: Between 18% and 34% of acute appendicitis (AA) patients may have complicated appendicitis. Perforation is the most important complication of AA. Perforation increases morbidity and mortality. In this study, we aimed to investigate the role of basic inflammatory markers in the diagnosis of perforated AA.
METHODS: A retrospective chart review was conducted of patients who underwent appendectomy with a diagnosis of AA between January 2014 and October 2019 at Akdeniz University Faculty of Medicine; and between December 2017 and October 2019 at Istinye University Faculty of Medicine Hospital. Markers recorded were as follows: white blood cell count, neutrophils, lymphocytes, platelets, c-reactive protein, mean platelet volume, red cell distribution width and eosinophils. Hematological indices were combined to generate the following three ratios: white cell neutrophil ratio, platelet lymphocyte ratio and neutrophil-lymphocyte ratio.
RESULTS: A total of 536 patients with a diagnosis of AA underwent an operation. There were 344 (64.1%) male patients and 192 (35.9%) female patients. The mean age of the patients was 36.7±16.2 (15-88) years. There were 94 (17.5%) patients with perforated AA and 442 (82.5%) patients with non-perforated AA. C-reactive protein (AUC: 0.81, p<0.001) was the most accurate markers in distinguishing the perforated and non-perforated group.
CONCLUSION: Elevated CRP level is a nonspecific inflammatory marker in most of the inflammatory diseases. A high CRP level can, therefore, be used as a supplement in the diagnosis of perforated AA.

AMAÇ: Türkiye, bombalama ve ateþli silah eylemleri gibi terörist saldýrýlarýndan kaynaklanan askeri ve sivil kitlesel yaralanmalar konusunda deneyimli bir ülkedir. Bu çalýþmada, 15 Temmuz 2016’da gerçekleþen darbe giriþiminde, ön planda ateþli silah yaralanmalarý nedeniyle hastanemize baþvuran hastalarýn ve hasta akýþýnýn özelliklerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu tanýmlayýcý, geriye dönük çalýþmamýza 15 Temmuz 2016 tarihinde darbe giriþimi sýrasýnda yaralanan ve acil servisimize baþvuran toplam 50 hasta alýndý. Hastalarýn demografik özellikleri, anatomik yaralanma bölgeleri, ameliyat sonrasý klinik sonuçlarý ve hastanede yatýþ özellikleri araþtýrýldý. Yaralanma þiddetini ölçmek için Glasgow Koma Skoru (GCS), Travma ve Yaralanma Þiddet Skoru (TRISS), Kýsaltýlmýþ Yaralanma Skoru (AIS), Düzeltilmiþ Travma Skoru (RTS) ve Yaralanma Þiddet Skoru (ISS) kullanýldý.
BULGULAR: Hastalarýn tamamýna yakýný erkekti (49: 1). En sýk yaralanma, ekstremite yaralanmasýydý (%53). Acil servisten taburcu edilen hastalar ile hastaneye yatýrýlan hastalarýn RTS, GCS ve TRISS skorlarý ortalamalarý arasýnda istatistiksel anlamlý bir fark saptanmazken (p>0.05), ISS skoru hastanede yatanlarda daha yüksek saptandý (p<0.001). Takip ve/veya cerrahi giriþim nedeniyle hastaneye yatýrýlan toplam 33 (%66) hastanýn beþi (%10) 14 günden uzun süre hastanede takip edildi. Acil serviste 12 personelin çalýþtýðý ilk dönemde ISS skor ortalamasý 5.75±8.26 olan sekiz hasta baþvurdu. Bu hastalarýn üçü (%37.5) hastaneye yatýrýldý. Ýki saat içinde acil servise gönüllü olarak 63 saðlýk çalýþaný ulaþtý. Acilde 75 personelin çalýþtýðý dönemde ISS skor ortalamasý 7.76±8.29 olan 42 hasta baþvurdu. Otuz hastanýn yatýþý yapýldý (%71.4). Ýlk ve ikinci grubun hastanede yatýþ süreleri (HYS), sýrasýyla 11.19±12.32 gün ve 9.16±9.21gün olarak saptandý. Personel sayýsýnýn artmasýyla HYS’de azalma görüldü ancak bu azalma istatistiksel olarak anlamlý deðildi (p=0.725).
TARTIÞMA: Her afetin yönetimi kendine özgüdür. Ateþli silah yaralanmasý hazýrlýklarýnda hastanenin yüklenme kapasitesine ve hastalarýn hastanede uzamýþ yatýþ süresine odaklanýlmalýdýr. Çalýþmamýzda, gönüllü personellerin acil servise ulaþmasý ile birlikte ISS skorlarý yüksek olan yaralýlarýn hastanede kalýþ sürelerinin kýsaldýðý tespit edilmiþtir. Kitlesel olaylarda, acil saðlýk hizmetlerinin standart operasyonel prosedür eðitimi almýþ gönüllülerle artacaðýna inanýyoruz. Hastane afet planlarý, sadece acil servisler için deðil tüm hastane için yeniden düzenlenmelidir.

BACKGROUND: Turkey is an experienced country for both military and civilian mass casualties that arise from explosions and shootings by various terrorist groups. In this study, we aimed to investigate the characteristics of patient flow admitted to our hospital caused by primarily gunshot wounds during the coup attempts on the 15th of July.
METHODS: This descriptive, retrospective study included a total of 50 patients who were injured during a coup attempt on the date of July 15, 2016, and admitted to our emergency department (ED). Demographic characteristics, anatomical injury sites, postoperative clinical outcomes, and hospitalization settings were recorded. The Glasgow Coma Scale (GCS), Trauma and Injury Severity Score (TRISS), Abbreviated Injury Scale (AIS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) were used to measure the severity of injuries.
RESULTS: A total of 63 medical personnel voluntarily reached the ED within two hours. Extremity injuries were the most common injuries. The mean RTS, GCS, and TRISS scores did not differ significantly between the patients discharged from the ED and the patients who were hospitalized (p>0.05). However, there was a statistically significant difference in the ISS scores (p<0.001, independent t-test). There was no statistically significant difference in the GCS and RTS scores between the discharged and hospitalized patients, although the ISS scores were higher in hospitalized patients (p>0.05 and p<0.001, respectively). A total of 33 patients (66%) were admitted to the hospital for follow-up and/or surgical intervention. Five (10%) of the patients were hospitalized for more than 14 days.
CONCLUSION: The management of each disaster is unique. Armed conflicts result in gunshot wounds, and preparations must be focused on surge capacity and a prolonged hospital stay of the patients. In our study, the length of stay in the hospital decreased after the arrival of volunteer staff to the ED, but we should note that the ISS increased. Hospital disaster plans should be reorganized not only for ED but also for the whole hospital.

AMAÇ: Ateþli silah yaralanmalarý, ciddi morbidite ve mortaliteye neden olan ve acil týp ve adli týp ile ilgili kriminal olaylardýr. Çalýþmamýzýn amacý, ateþli silah yaralanmalarý nedeniyle acil servislere baþvuran olgularýn yara özelliklerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Saðlýk Bilimleri Üniversitesi Ýzmir Bozyaka Eðitim ve Araþtýrma Hastanesi Acil Servisi’ne ateþli silah yaralanmasý nedeniyle baþvuran 18 yaþ ve üzeri 213 olgu çalýþmaya alýndý.
BULGULAR: Ýncelenen 213 olgunun 182’si (%85.4) erkekti. Olgularýn yaþlarý 18–78 yaþ arasý deðiþmekte olup yaþ ortalamasý 33.2±12.6 olarak bulundu. Yaralanmalarýn en sýk Nisan (n=28, %13.2) ve Mayýs (n=25, %11.6) aylarýnda meydana geldiði tespit edildi. Ýki yüz on üç olgunun 194’ünün (%91.1) hastanedeki tedavileri tamamlandýktan sonra taburcu edildiði, 19 olgunun (%8.9) ise tüm giriþimlere raðmen öldüðü belirlendi.
TARTIÞMA: Çalýþmamýz Türkiye’deki ateþli silah yaralanma patern ve sonuçlarý hakkýnda önemli bir kesit sunmakta, ancak bölgesel veriler içermektedir. Bu konuda ülke genelini kapsayan çok merkezli ve multidisipliner çalýþmalarýn literatüre ciddi katkýda bulunacaðý düþünülmektedir.

BACKGROUND: Firearm injuries are criminal events that may cause severe morbidity and mortality and concerned with Emergency Medicine and Forensic Medicine. The present study aims to evaluate the wound characteristics of the cases who presented to emergency services due to firearm injuries.
METHODS: In this study, 213 patients who were 18 years of age or older who applied to the Saðlýk Bilimleri University Bozyaka Training and Research Hospital Emergency Service with gunshot injury were included.
RESULTS: Of the 213 cases examined, 182 (85.4%) were male. The ages of the cases ranged from 18 to 78 years, and the mean age was found as 33.2±12.6. The most common months were April (n=28, 13.2%) and May (n=25, 11.6%). The findings showed that 194 (91.1%) of 213 patients were discharged after completing the treatment in the hospital, and 19 patients (8.9%) died despite all interventions.
CONCLUSION: Our study presents an important cross-section of the gunshot injury patterns and their consequences in Turkey, but it contains regional data. In this regard, multicentre and multidisciplinary studies covering the country, in general, are considered to be a significant contribution to the literature.

AMAÇ: Travmatik diyafragma rüptürü (TDR) olan hastalarda mortalite ile iliþkili faktörleri irdelemektir.
GEREÇ VE YÖNTEM: Ocak 2010 ile Haziran 2018 tarihleri arasýnda künt ve penetran torakoabdominal yaralanma nedeniyle ameliyata alýnýp peroperatif diyafragma yaralanmasý tespit edilen hastalar geriye dönük olarak deðerlendirildi. Hastalarýn demografik özellikleri, travmanýn tipi, lokalizasyonu, iliþkili organ yaralanmasý varlýðý, ek organ yaralanmasý sayýsý, hastanýn geliþ anýndaki tansiyon durumu, ameliyata alýnma zamaný, operasyon þekli, diyafragma onarým þekli, terapötik yaklaþým türü, komlikasyonlar ve Yaralanma Þiddet Skorlarý (ISS) deðerlendirildi.
BULGULAR: Çalýþmaya 92 hasta alýndý. Mortalite oraný %15.2 idi. Yaralanmanýn þekli %77.2 penetran travma ile idi. Ýliþkili organ yaralanmasý en fazla karaciðer olup mortaliteyi arttýrýcý faktör olarak anlamlýydý (p=0.020). Diyafragma tamiri yapýlan hastalarda mortalite yapýlmayanlara göre anlamlýydý (p=0.003). En sýk komplikasyon atelektazi idi. TDR olan hastalarýn ISS’nin 24 ve üzerinde olmasý mortalite ile ilþkili baðýmsýz bir risk faktörü olarak tespit edildi (p=0.003).
TARTIÞMA: Travmatik diyafragma rüptürü sýklýkla diðer organlar ile birliktelik gösterip özellikle karaciðer yaralanmasýnýn eþlik ettiði durumlarda mortalite anlamlý derecede artmaktadýr. Ayrýca ISS’nin 24 ve üzerinde olmasý mortalite ile ilþkili baðýmsýz bir risk faktörü olarak tespit edilmiþtir. Mortaliteyi belirleyen asýl sebep ek organ yaralanmalarý olduðu için diyafragma yaralanmasý olan hastalarda bu durum göz ardý edilmemesi kanýsýndayýz.

BACKGROUND: This study aims to investigate the factors associated with mortality in patients with traumatic diaphragmatic rupture (TDR).
METHODS: The records of patients who were operated on at a single hospital with the indication of blunt or penetrating thoracoabdominal injuries between January 2010 and June 2018 and who were perioperatively diagnosed with a diaphragmatic injury were evaluated retrospectively. The details of demographic characteristics, the type and localization of the trauma, presence and number of associated organ injuries, vital signs at admission, time from admission until surgery, type of operation, type of diaphragmatic repair, therapeutic approach, complications and Injury Severity Score (ISS) were analyzed.
RESULTS: A total of 92 patients were included in this study. The mortality rate throughout the postoperative period was 15.2%. A penetrating injury was detected in 77.2% of the patients. Associated organ injury was most frequently in the liver, which was significant as a factor that increased mortality (p=0.020). The mortality rate was significantly lower among patients who underwent repair of diaphragmatic rupture when compared with untreated patients (p=0.003). Atelectasis was the most common complication. An ISS ≥24 points in patients with TDR was found to be an independent risk factor associated with mortality (p=0.003).
CONCLUSION: Other organs are frequently involved in cases of TDR, and mortality increased significantly in cases with associated liver injury. An ISS of ≥24 was determined to be an independent risk factor associated with mortality. Since the main determinant of mortality was the presence or absence of additional organ injuries, it is important that this should be taken into consideration in these patients.

AMAÇ: Akut mezenterik iskemi (AMÝ) baðýrsaklarý besleyen mezenterik damarlarýn obstrüksiyonuyla baðýrsaklarda iskemiye neden olan, mortalite oraný %80’i bulan hastalýk grubudur. Ýnsidansý 100.000’de kiþi baþýna 0.63’tür. Saðkalým için erken taný ve tedavi çok önemlidir. AMÝ’nin farklý tip ve aþamalarýný yansýtabilen ideal bir biobelirteç yoktur. Çalýþmamýzda AMÝ tanýsýyla ameliyat edilen hastalarda ameliyat öncesi aþamada L-laktat, D-dimer, lökosit, C-reaktif protein (CRP) ve nötrofil/lenfosit oranýnýn (NLO) prediktif ve prognostik önemi araþtýrýldý.
GEREÇ VE YÖNTEM: Bu çalýþmada 2015–2019 tarihleri arasýnda AMÝ tanýsý ile ameliyat edilen 44 hasta incelendi. Çalýþmaya alýnan hastalarýn demografik, klinik, radyolojik, laboratuvar, cerrahi bulgularý dahil edildi. Hastalar etiyolojik olarak AMÝ grubuna göre gruplandýrýldý. Bu hastalarýn L-laktat, D-dimer, CRP, lökosit, NLO seviyeleri belirlendi. AMÝ gruplarýna göre istatiksel analiz yapýldý.
BULGULAR: Çalýþmaya alýnan 44 hastanýn yaþ ortalamasý 67.7 yýl, kadýn erkek oraný 0.76 idi. Tomografi bulgularýna göre hastalarýn %31.8’inde (n=14) mezenter arter embolisi, %29.5’inde (n=13) mezenter arter trombüsü, %25 (n=11) hastada mezenter ven trombüsü, %13.6’sýnda (n=6) non-oklüsiv mezenter iskemi saptandý. AMÝ tipleriyle karþýlaþtýrýldýðýnda D-dimer ve CRP testleri diðer markýrlara göre anlamlý þekilde farklý bulundu. Toplam yatýþ süresi ile L-laktat (p=0.047) ve CRP (p=0.045) ile anlamlý bir korelasyon saptandý. Yapýlan analizlerde tüm AMÝ tiplerinde mezenter iskemi tanýsýnda kullanýlabilecek ortak biyobelirteç CRP olmuþtur.
TARTIÞMA: Ameliyat öncesi özellikle CRP düzeyinin AMÝ tanýsýnda, alt tipini belirlemede ve klinik seyrini belirlemede etkin þekilde kullanýlabilir. Ancak L-laktat, D-dimer, lökosit ve nötrofil/lenfosit oranlarýnýn tüm AMÝ alt tiplerinin tanýsýný koymada etkinliði yoktur.

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI.
METHODS: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups.
RESULTS: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types.
CONCLUSION: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.

AMAÇ: Ekstremite Hasarlanmasý Þiddet Skoru, travma sonrasý ekstremite ampütasyonu için bir karar verme aracýdýr. Üst ekstremitenin travma sonrasý fonksiyonel eksikliklerini ölçmek için Kol, Omuz ve El Yetersizlikleri Anketi geliþtirilmiþtir. Bu çalýþma bu iki deðerlendirme arasýndaki korelasyonu belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu çalýþmada, 2005–2014 yýllarý arasýnda iki merkezde vasküler rekonstrüksiyon ile tedavi edilen üst ekstremite yaralanmasý olan tüm hastalar geriye dönük olarak gözden geçirildi. Her katýlýmcý için ilgili Ekstremite Hasarlanmasý Þiddet Skoru hesaplandý. Hastalar takip muayenesi ve Kol, Omuz ve El Skoru Yetersizliklerinin deðerlendirilmesi için geri çaðrýldý.
BULGULAR: Bu çalýþmada 14 hasta dahil edilme kriterlerini karþýlamýþtýr. Ortalama toplam Ekstremite Hasarlanmasý Þiddet Skoru 5.9 ve Kol, Omuz ve El Yetersizlik Skoru 30 puan idi. Bu deðerlendirmeler arasýnda istatistiksel olarak anlamlý bir iliþki yoktu (Spearman sýralamasý korelasyon katsayýsý: 0.49, p=0.075).
TARTIÞMA: Kol, Omuz ve El Yetersizlikleri Skoru Ekstremite Harabiyeti Þiddet Skoruyla korelasyon göstermemiþtir.

BACKGROUND: The Mangled Extremity Severity Score is a decision-making tool for limb amputation after trauma. The Disabilities of the Arm, Shoulder and Hand questionnaire was developed to quantify posttraumatic functional deficits of the upper extremity. This study aims to determine the correlation between these two assessments.
METHODS: In this study, a retrospective review of all patients with upper extremity injuries who had been treated with vascular reconstruction at two centres between 2005 and 2014 was performed. The respective Mangled Extremity Severity Score was calculated for each participant. Patients were recalled for follow-up examination and assessment of the Disabilities of the Arm, Shoulder and Hand Score.
RESULTS: In this study, 14 patients met the inclusion criteria. The mean total Mangled Extremity Severity Score was 5.9 and the mean total Disabilities of the Arm, Shoulder and Hand Score was 30 points. There was no statistically significant correlation between these assessments (Spearman’s rank correlation coefficient: 0.49, p=0.075).
CONCLUSION: The Disabilities of the Arm, Shoulder and Hand Score did not correlate significantly with the Mangled Extremity Severity Score.

AMAÇ: Safra fistülü, karaciðer ve safra yolu ameliyatlarýnda en sýk görülen komplikasyonlardan biridir. Endoskopik retrograd kolanjiyopankreatografi (ERCP) biliyer fistüllerde taný ve tedavi amaçlý kullanýlýr. ERCP’nin biliyer fistüllerin taný ve tedavisinde katkýsýný analiz etmeyi amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya Ocak 2012–Aralýk 2017 tarihleri arasýnda karaciðer ve safra yolu ameliyatlarýný takiben geliþen safra fistüllerinde ERCP uygulanan hastalar dahil edildi. Hastalarýn demografik özellikleri, cerrahi prosedür, safra fistül lokalizasyonu, safra yolu yaralanmasýnýn sýnýflandýrýlmasý ve ERCP baþarýsý geriye dönük olarak deðerlendirildi.
BULGULAR: Toplam 90 hastaya (37 erkek ve 53 kadýn) biliyer fistül tanýsý ile ERCP uygulandý. ERCP ile 87 hastada ortak safra kanalý (CBD) kanülasyonu saðlandý. Beþ hastada, safra yollarýnýn proksimal kýsmý görüntülenemedi ve ortak safra kanalýnýn tam kat yaralanmasý düþünüldü. ERCP’de, 44 hastada sistik kanal, sekiz hastada ortak safra kanalý, dört hastada karaciðer yataðý, iki hastada hepatik kanal bifürkasyon, yedi hastada sað hepatik kanal ve iki hastada sol hepatik kanal düzeyinde kontrast ekstravazasyonu tespit edildi.
TARTIÞMA: Endoskopik retrograd kolanjiyopankreatografi biliyer hastalýklarýn taný ve tedavisinde etkili bir yöntemdir. ERCP ile taný konabilen ve tedavi edilebilen ameliyat sonrasý biliyer fistüllerin tedavisi hastalarý morbidite, mortalite ve cerrahi maliyetlerinden kurtarýr.

BACKGROUND: Biliary fistula is one of the most common complications of liver and biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) is used for the diagnosis and treatment of biliary fistulas. In this study, we aimed to analyze the contribution of ERCP in this regard.
METHODS: Patients who underwent ERCP for biliary fistulas following liver and biliary tract surgery between January 2012 and December 2017 were included in this study. The demographic characteristics of the patient, surgical procedure, localization of the biliary fistula, classification of biliary duct injury, and success of ERCP were retrospectively evaluated.
RESULTS: In total, 90 patients (37 male and 53 female) with a diagnosis of biliary fistula underwent ERCP. Common biliary duct (CBD) cannulation was achieved in 87 patients using ERCP. In five patients, the proximal part of the biliary tract was not visualized, and complete injury of CBD was considered. In ERCP, contrast extravasation was detected in the cystic duct in 44 patients: CBD, eight patients; liver bed, four patients; hepatic duct bifurcation, two patients; the right hepatic canal, seven patients; and the left hepatic canal, two patients.
CONCLUSION: ERCP is an effective method for the diagnosis and treatment of biliary diseases. The diagnosis and treatment of postoperative biliary fistulas with ERCP reduces surgery cost, morbidity, and mortality.

AMAÇ: Kalça kýrýðý yaþlý hastalarda þiddetli aðrýya neden olan yaygýn bir klinik problemdir. Bununla birlikte kýrýk oluþumunu takip eden þiddetli aðrý mental rahatsýzlýklar ve deliryum geliþimine neden olabilir. IL-6 ve IL-8 ile birlikte olan nöroinflamatuvar yanýtýn deliryum patofizyolojisi ile iliþkili olduðu gösterilmiþtir. Bu çalýþmadaki primer hipotezimiz ameliyat öncesi femoral sinir bloðunun trokanterik femur kýrýklarýnda parasetamole göre daha etkin aðrý tedavisi saðlayacaðýdýr. Sekonder hipotezimiz IL-6 ve IL-8 düzeylerinin femoral sinir bloðu yapýlanlarda daha düþük olacaðýdýr. Üçüncü hipotezimiz ise ameliyat sonrasý deliryum insidansýnýn femoral sinir bloðu uygulananlarda düþük olma durumudur.
GEREÇ VE YÖNTEM: Hastane acil servisine femur kýrýðý nedeniyle baþvuran 65 yaþ üzeri ASA II-IV hastalar çalýþmaya dahil edildi. “Deliryum önleme tablosu”ndaki öneriler tüm hastalara baþvuru anýndan itibaren uygulandý. Ýlk gruba sekiz saatte bir 15 mg/kg parasetamol intravenöz olarak verildi. Ýkinci gruba femoral sinir blokajý uygulandý ve kateter yerleþtirildi. Ardýndan 0.5 mL/kg bupivakain %0.25 her sekiz saatte bir kateter yoluyla verildi. Her iki grupta aðrý skorlarý ilk analjezik uygulandýktan dört saat sonra kaydedildi. Bütün hastlar 48 saat içerisinde spinal anestezi altýnda ameliyat edildi. Spinal anestezi sýrasýnda verilen pozisyona baðlý aðrý skorlarý kaydedildi ve 2 mL beyin omurilik sývýsý (BOS) örneði tüm hastalardan IL-6 ve IL-8 sitokinleri analizi için alýndý.
BULGULAR: Ameliyat öncesi ilk aðrý tedavisi sonrasý dördüncü saatteki ve rejyonal anestezi için verilen pozisyon aðrýsý belirgin olarak femoral sinir blok grubunda düþüktü. IL-8 düzeyleri femoral sinir blok grubunda belirgin olarak düþük iken IL-6 düzeyleri benzerdi. Deliryum insidansý femoral sinir blok grubunda daha azken istatistiksel farklýlýk yoktu.
TARTIÞMA: Femoral sinir bloðu ameliyat öncesi aðrý tedavisinde ve rejyonal anestezi sýrasýndaki pozisyon aðrýsýný önlemede üstündür. Ortalama IL-8 düzeyi femoral sinir blokajý uygulanan hastalarda daha düþüktür. Deliryum insidansý her iki grupta benzerdir.

BACKGROUND: Hip fracture is a common clinical problem which causes severe pain in geriatric patients. However, severe pain following fracture may bring on mental disorders and delirium. A neuroinflammatory response with IL-6 and IL-8 has been shown to be associated with the pathophysiology of delirium. In this study, our primary hypothesis is that preoperative femoral nerve block (FNB) intervention in geriatric patients will more effectively attenuate pain following trochanteric femur fracture than the preoperative paracetamol application. Our secondary hypothesis is that interleukin levels (IL-6, IL-8) in cerebrospinal fluid (CSF) will be lower in the femoral nerve block group than the paracetamol group. Our tertiary hypothesis is that the incidence of postoperative delirium will be lower in the femoral nerve block group.
METHODS: The patients over 65 years of age with ASA status II-IV and admitted to the Emergency Service for femur fracture were included in this study. Recommendations of the “delirium prevention table” were applied to all of the patients at arrival. In the first group, 15 mg/kg paracetamol was administered intravenously every eight hours. In the second group, femoral nerve blockage was performed, and a catheter was placed. Then, 0.5 mL/kg bupivacaine 0.25% was applied every eight hours. In both groups, pain scores four hours after interventions were recorded. All patients were operated within 48 hours under spinal anesthesia. During spinal anesthesia, 2 mL of CSF samples were taken from all patients for analysis of IL-6 and IL-8 cytokines, and pain scores during positioning were recorded.
RESULTS: VAS scores four hours after the first preoperative pain treatment and during the positioning for regional anesthesia were significantly lower in the femoral nerve block group. IL-8 levels are significantly lower in the femoral nerve block group but not in IL-6 levels. The incidence of delirium was less in the femoral nerve block group, but the difference was not statistically significant.
CONCLUSION: The femoral nerve block was more effective in preoperative pain management of trochanteric femur fracture and preventing pain during regional anesthesia application. The mean IL-8 level was lower in the femoral nerve block group when compared to the paracetamol group. There is no difference in the postoperative delirium incidence between groups.

AMAÇ: Bu tek merkezli, geriye dönük çalýþma, el fleksör tendon onarýmý geçiren hastalarýn sosyodemografik, yaralanma özelliklerini ve toplam kayýp iþ günlerini analiz etmeyi ve reoperasyonu öngören faktörleri tanýmlamayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Ocak 2013–Aralýk 2016 tarihleri arasýnda erken rehabilitasyona tabi, dört geçiþli modifiye Kessler kor dikiþ kullanýlarak yapýlan el fleksör tendon onarýmlarý dahil edildi. Bu çalýþmada deðerlendirilen deðiþkenler; hasta sosyodemografik ve yaralanma özellikleri, kayýp iþ günü sayýsý ve rüptür ve/veya adezyon oluþumu nedeniyle yapýlan reoperasyonlardý. Yaralanma ciddiyeti, Modifiye El Yaralanmasý Ciddiyet Skorlamasý (MEYCS) kullanýlarak belirlendi. Reoperasyonun öngörücülerini belirlemek için ikili lojistik regresyon analizi yapýldý.k için ikili lojistik regresyon analizi BULGULAR: Toplam 329 tendon yaralanmasý geçirmiþ 194 hasta çalýþmaya dahil edildi. Katýlýmcýlar genç (ortalama yaþ, 31.8), çoðunlukla erkek (%79.4) ve mavi yakalý çalýþanlardý (%50.0). Hastalarýn çoðu dominant elin tek parmaðýný etkileyen zon 2 yaralanmasýna sahipti. Ortalama MEYCS deðeri 46.6 ve iþe geri dönüþ süresi 114.0 gündü. Toplam 37 (%19.1) hastaya rüptür ve/veya adezyon oluþumu nedeniyle reoperasyon gerekti. Sigara içimi, zon 2 yaralanmasý ve yüksek MEYCS deðeri, reoperasyonun negatif belirleyicileriydi.
TARTIÞMA: Reoperasyon ihtiyacýný en aza indirmek için, cerrahlar ve rehabilitasyon ekibi, bölge 2 yaralanmasý, yüksek MEYCS deðerleri ve sigara içme öyküsü olan hastalara özel dikkat göstermelidir.

BACKGROUND: This single-center, retrospective study aims to analyze the sociodemographic, injury characteristics, and the total number of lost working days of patients undergoing hand flexor tendon repair and to identify factors predicting reoperation.
METHODS: Hand flexor tendon repairs conducted using a four-strand modified Kessler core suture with early rehabilitation from January 2013 to December 2016 were included in this study. The variables evaluated in this study were patient sociodemographic and injury characteristics, number of lost working days, and reoperations because of rupture and/or adhesion formation. Injury severity was determined using Modified Hand Injury Severity Scoring (MHISS). Binary logistic regression analysis was conducted to identify the predictors of reoperation.
RESULTS: A total of 194 patients were included in this study, who had experienced 329 tendon injuries. Participants were young (mean age, 31.8), mostly male (79.4%), and mostly blue-collar workers (50.0%). Most patients had a zone 2 injury affecting a single digit of the dominant hand. The mean MHISS value was 46.6, and the mean time to return to work was 114.0 days. A total of 37 (19.1%) patients required reoperation because of rupture and/or adhesion formation. Smoking, zone 2 injury, and high MHISS value were negative predictors of reoperation.
CONCLUSION: To minimize the need for reoperation, surgeons and rehabilitation teams should take special care of patients with zone 2 injuries, high MHISS values, and smoking history.

AMAÇ: Ýþ ile ilgili el amputasyonlarý tek baþlarýna hayatý tehdit edici deðildir. Ancak fonksiyonel sekellerine ek olarak oluþturduðu sosyal ve pikolojik sorunlar kiþinin yaþam kalitesini olumsuz yönde etkiler.
GEREÇ VE YÖNTEM: 2007–2015 yýllarý arasýnda, 14 kiþi üst ekstremite majör ampütasyonu ile acile baþvurdu. Tüm olgular erkekti (ortalama 29.6 [22–45] yaþ). Çok seviyeli ezilme yaralanmasý olan üç olgu hariç 11 olguya replantasyon uygulandý.
BULGULAR: Tüm replantasyonlarda baþarý saðlandý. Önkol seviyesinden replantasyon yapýlan iki ve distal kol seviyesinden replantasyon yapýlan bir olguya ameliyat sonrasý ek giriþimler uygulandý. Ameliyat sonrasý fonksiyonel sonuçlar deðerlendirildi. Hastanýn genel memnuniyeti, fleksör ve ekstansör hareket seviyeleri, her parmaðýn aktif hareket derecesi, baþparmak opozisyon derecesi, el bileði ve dirsek eklemlerinin aktif hareketleri, medyan ve ulnar sinir traselerinde duyusal iyileþmesinýn sonuçlarý, replante edilen elin ve/veya önkolun tüm günlük görevleri yerine getirebilirliði incelendi. Sonuçlar, el replantasyonlarýnda tatminkardý, ancak, proksimal önkol ve distal kol seviyesinde replantasyon yapýlan dört olguda özellikle unlar sinir fonksiyonlarýnda distal motor minör fonksiyon sekelleri ile karþýlaþýldý. Diðer hastalarda mükemmele yakýn sonuçlar alýndý.
TARTIÞMA: Geliþmiþ protez seçenekleri, kadavralardan replantasyon olanaklarýna raðmen, doðal ekstremitenin replantasyonu, ampute hastalar için hala en uygun tedavi yöntemidir. Bununla birlikte cerrahlar, nihai amacýn sadece canlý dokuyu replante etmek deðil, fonksiyon ve görünümü iyileþtirerek yaþam kalitesini korumak olduðunu kabul etmelidir.

BACKGROUND: Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of upper extremity amputation, disfigurements frequently cause psychological and social debilitations.
METHODS: Between 2007–2015, fourteen cases were admitted to emergency with total major amputation of the upper extremity. All cases were male (22–45 years of age. Mean age: 29.6). Replantation was applied to all except three cases with multileveled crush injuries.
RESULTS: All replantations were successful. Additional interventions were needed in four cases with replantation at elbow level and replantation at the distal arm level. The postoperative functional results were evaluated. The patient’s overall satisfaction, the recovery of flexor and extensor mobility, the extent of the active motion of digits, the recovery of thumb opposition, active movements of wrist and elbow joints, recovery of sensitivity in the median and ulnar nerve, the ability of the surviving hand and/or forearm to perform daily works are all evaluated. The results were satisfactory in hand replantations. However, some ulnar nerve distal motor problems were encountered in three cases with replantation at elbow level, and one case with replantation at the distal arm level with a crush injury, acceptable and excellent results were obtained in other cases.
CONCLUSION: Despite the availability of prostheses, cadaveric upper extremity replantations, replantation of the native extremity is still the most appropriate treatment for amputated cases. However, surgeons should realize that the ultimate goal is not merely to save the viability of the extremity through replantation, but rather to preserve the life quality by improving the function.

AMAÇ: Bu çalýþmanýn amacý deplase asetubulum kýrýklarýnýn cerrahi tedavisinde anteriyor-intra pelvik (AÝP) yaklaþýmla açýk redüksiyon ve içten tespitin etkinliðini, orta dönem klinik ve radyolojik sonuçlarýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: Deplase asetabulum kýrýðý tanýsýyla baþvuran hastalardan AÝP yaklaþým ile açýk yerleþtirme ve içten tespit uygulanan 12 hasta geriye dönük olarak incelendi. Hastalar, kýrýk tipi, ek yaralanma varlýðý, ameliyata kadar geçen süre, ek cerrahi giriþim ihtiyacý, perioperatif komplikasyonlar, radyografik ve fonksiyonel sonuçlar açýsýndan deðerlendirildi.
BULGULAR: Erkek/kadýn oraný 1/2 idi. Ortalama yaþ 40.5±16.2 (16-64) yýldý. Ortalama takip süresi 59.8±32.2 (12–124) aydý. Yedi hastada çift kolon, üç hastada anteriyor kolon+posteriyor hemitransvers, bir hastada transvers+posterior duvar ve bir hastada anteriyor kolon kýrýk paterni mevcuttu. Hastalar, ortalama 6.6±4.4’üncü (2–16) günde ameliyat edildi. Amaliyat sýrasýnda kan transfüzyonu ortalama 830 (300–2000) mL idi. Sekiz hastada ameliyatta ve ameliyat sonrasý komplikasyonlar gözlemlendi. Ortalama Merle d’Aubigné and Postel skoru 14.5±2.7 (10–18) idi. Anatomik redüksiyon elde edilen altý olguda mükemmel/iyi fonksiyonel ve radyolojik sonuç gözlemlendi. Anatomik olmayan redüksiyon elde edilen üç hastada orta dönemde post-travmatik kalça artrozu geliþti ve total kalça replasmaný ile tedavi edildi.
TARTIÞMA: AÝP yaklaþým, asetabulumun deplase anteriyor duvar/kolon ve özellikle çift kolon kýrýklarýnýn cerrahi tedavisinde yeterli açýlýmý saðlar. Klinik sonuçlar, redüksiyon kalitesiyle doðrudan iliþkilidir. Anatomik olmayan redüksiyon elde edilen hastalarda orta-dönemde kalça eklem artrozu açýsýndan dikkatli olunmalýdýr.

BACKGROUND: This study aims to evaluate the radiological and clinical mid-term results of the patients with displaced acetabular fractures surgically treated with open reduction and internal fixation using an anterior intra-pelvic approach (AIP).
METHODS: In this study, we retrospectively reviewed 12 patients with displaced acetabular fractures treated surgically via the AIP approach. Patients were analyzed for Letournel’s acetabular fracture classification, associated injuries, time to surgery, additional surgical procedures needed, perioperative and postoperative complications, radiologic and functional results.
RESULTS: Of the 12 patients, the male/female ratio was 1/2; the mean age was 40.5±16.2 (16–64) years. The mean follow-up time was 59.8±32.2 (12–124) months. Seven patients had both column fractures, three patients had anterior column + posterior hemitransverse fractures, one patient had transverse + posterior wall and one patient had anterior column fracture. The mean time to surgery was 6.6±4.4 (2–16) days. The mean intraoperative blood transfusion was 830 (300–2000) ml. Intra-operative and post-operative complications were noted in eight patients. The mean Merle d’Aubigné and Postel score was 14.5±2.7 (10–18). Six patients with an anatomical reduction of the fracture showed excellent/good functional and radiologic outcomes. Three patients with a non-anatomic reduction developed post-traumatic arthrosis that was treated with total hip arthroplasty.
CONCLUSION: AIP approach provides a satisfactory exposure for the surgical treatment of displaced anterior wall/column and both column acetabular fractures. Clinical outcome is directly related to the reduction quality. Patients with poor reduction are most likely to develop mid-term complications, such as hip joint arthrosis.

AMAÇ: Literatürde, deplase mediyal epikondil kýrýklarýnýn cerrahi tedavisinde hangi tip tespit materyalinin kullanýlacaðýna karar vermenin ardýnda yatan gerekçe yeterince araþtýrýlmamýþtýr. Çalýþmamýzda, deplase mediyal epikondil kýrýðý olan çocuklarda Kirschner teli (K-teli) veya kanüllü vida ile internal tespitin uzun dönem klinik ve radyografik sonuçlarýný karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: 5 mm’den daha fazla yer deðiþtirmiþ mediyal epikondil kýrýklarý için cerrahi tedavi uygulanmýþ toplam 42 çocuk iki gruba ayrýldý. Grup A, K-telleri ile internal tespit uygulanmýþ 22 çocuk içerirken, grup B kanüllü vida ile tespit uygulanmýþ 20 çocuktan oluþuyordu. Ortalama yaþ grup A’da 9 yýl (ortanca, 10.5; aralýk, 6–14) iken, grup B’de 15 yýldý (16, 10–17). Toplam takip süresi 10 (ortanca, 10; aralýk, 5–15) yýl olarak hesaplandý. Hastalarýn klinik sonuçlarýný deðerlendirmek için, son takipteki dirsek hareket açýklýðýna (ROM) ek olarak Mayo Dirsek Performans Skorlarý (MEPS) kullanýldý. Radyografik deðerlendirme sýrasýnda, son takip radyografileri üzerinde epikondil kýrýðýna ikincil olasý deformiteler incelendi.
BULGULAR: Ortalama MEPS, A ve B gruplarýnda sýrasýyla 95 (ortanca, 95; aralýk, 85–100) ve 93 (94, 85–100) olarak tespit edildi (p=0.18). ROM’da anlamlý bir fark gözlenmedi (p=0.43). Radyografik incelemede her gruptan birer hasta fibröz kaynama saptanýrken, her gruptan birer hastada hipoplazi mevcuttu. Deformite ve tespit tipi arasýnda anlamlý iliþki saptanmadý (p=0.34, χ2 testi).
TARTIÞMA: Deplase mediyal epikondil kýrýklarýnýn cerrahi tedavisinde, iskelet olgunluðuna yakýn çocuklar için vida ile tespit, daha küçük çocuklar için iki adet K-teli ile internal tespit düþük morbidite ve radyografik deformite oranlarý ile uzun süreli takiplerde olumlu klinik ve radyolojik sonuçlar saðlayabilir.

BACKGROUND: The rationale behind the decision-making on which type of fixation to use in displaced medial epicondyle fractures is not well elucidated. This study aims to compare the long-term clinical and radiographic outcomes of internal fixation with either Kirschner wires (K-wires) or cannulated screws in children with displaced medial epicondyle fractures.
METHODS: In this study, 42 consecutive children who underwent surgical treatment for medial epicondyle fractures displaced more than 5 mm were categorized into two groups as follows: group A, 22 children undergoing fixation with K-wires and group B, 20 children undergoing fixation with a screw. The mean age was nine (median, 10.5; range, 6–14) years in group A and 15 (16, 10–17) in group B. The overall follow-up was 10 (median, 10; range, 5–15) years. To assess patients’ clinical outcomes, the Mayo Elbow Performance Scores (MEPS) were used in addition to the elbow range of motion (ROM) at the last follow-up. During the radiographic assessment, possible deformities secondary to the epicondyle fracture were examined on final follow-up radiographs.
RESULTS: The main MEPS were 95 (median, 95; range, 85–100) and 93 (94, 85–100) in groups A and B, respectively (p=0.18). In ROM, no significant differences were observed (p=0.43). In the radiographic assessment, one patient from each group developed a fibrous union, and one from each group had hypoplasia. There was no significant relationship between the deformity and fixation type (p=0.34, χ2 test).
CONCLUSION: Two smooth K-wires for younger children and screw fixation for children near skeletal maturity may provide favorable clinical and radiological outcomes at long-term follow-up, with low morbidity and radiographic deformity.

Castleman hastalýðý, lenfoproliferatif bir hastalýktýr ve ince baðýrsakta görülmesi nadirdir. Bu çalýþmada, terminal ileum tutulumuna baðlý mekanik baðýrsak týkanýklýðýna neden olan bir Castleman hastalýðý olgusu sunuldu. Daha önce geçirilmiþ karýn cerrahisi öyküsü olmayan 50 yaþýnda erkek hasta, mekanik baðýrsak týkanýklýðý bulgularý ve semptomlarý ile hastaneye baþvurdu. Muayene ve abdominal bilgisayarlý tomografi ile mekanik intestinal obstrüksiyon tanýsý konuldu ve median insizyon ile acil cerrahi giriþim yapýldý. Abdominal eksplorasyonda, distal ince baðýrsak mezenterini ve ileoçekal valvi tutan tümör benzeri kitlesel lezyonun intestinal obstrüksiyona neden olduðu görüldü. Ýleoçekal rezeksiyon ve ileokolik anastomoz yapýldý. Castleman hastalýðý nadir görülen bir durumdur. Görüntülemede ya da ameliyat sýrasýnda büyümüþ lenf bezlerine eþlik eden distal ileumda kitle benzeri görünüm tespit edilmesi durumunda mekanik baðýrsak týkanýklýðýnýn ayýrýcý tanýsýnda akýlda bulundurulmalýdýr.

Castleman’s disease (CD) is a lymphoproliferative disorder and the occurrence of CD in the small bowel is rare. In this study, we present one case of CD causing mechanical intestinal obstruction due to involvement of terminal ileum. A 50-year-old man was admitted to the hospital with signs and symptoms of mechanical intestinal obstruction without history previous surgery. After examination and obtaining abdominal computed tomography, diagnosis of mechanical intestinal obstruction was reached and emergency surgery was performed with a median incision. On abdominal exploration a tumor like mass that also held distal small intestine mesentery, and ileocecal valve causing complet intestinal obstruction was observed. Ileocecal resection and ileocolonic anastomosis were performed. CD is a rare entity and should be kept in mind during the differential diagnosis of mechanical intestinal obstruction provided that wall thickening in terminal ileum mimicking mass, and accompanying enlargement mesenteric lymph nodes observed during preoperative investigations or intraoperative exploration.

Endometriozis, üreme çaðý kadýnlarda görülen, endometrium dokusunun uterus dýþýnda yer almasý ile kendini gösteren bir hastalýktýr. Kolonik endometriozis menstrüal siklusla iliþkili pelvik aðrý, disparoni, tenesmus ve aðrýlý dýþkýlama þikayetleri ile ortaya çýkabildiði gibi, nadiren akut mekanik intestinal obstrüksiyona (AMÝO) da yol açabilmektedir. Literatürde %3–37 oranýnda gastrointestinal yerleþim bildirilmiþ olup bu olgularýn da %7–23’ünde AMIO kliniði bildirilmiþtir. Literatürde kolon malignitesini taklit eden sigmoid endometriozise baðlý az sayýda mekanik obstrüksiyon olgusu bulunmaktadýr. Biz de kolonik endometriozise ikincil olarak geliþen AMÝO saptanan 40 yaþýndaki kadýn hastayý literatür eþliðinde sunmayý amaçladýk. Hartmann prosedürü uygulanan ve cerrahi tam iyileþme ile taburcu edilen hastada patolojik incelemede endometriozis tespit edildi. Ameliyat sonrasý 6. ayda kolostomi kapatýlmasý ve kendi isteðiyle bilateral ooferektomi operasyonu uygulanan hastanýn takipleri devam etmektedir. Endometriozis tüm organlarý tutabilen jinekolojik bir hastalýk olup gastrointestinal yerleþimi AMÝO etiyolojisinde özellikle reprodüktif dönemdeki kadýn hastalarda akýlda tutulmalý ve iliþkili semptomlar sorgulanmalýdýr.

Endometriosis is a disease seen in women at reproductive age, characterized by extrauterine localization of endometrial tissue. Colonic endometriosis rarely causes acute mechanical intestinal obstruction (AMIO). It may also be presented with pelvic pain, dyspareunia, tenesmus, painful defecation related to the menstrual cycle. In the literature, 3-37% of the gastrointestinal location was reported and AMIO was observed in 7-23% of these cases. There are only few cases of mechanical obstruction related to sigmoid endometriosis mimicking colon malignancy. In this study, we aim to report a case of a 40-year-old patient with AMIO developed secondary to colonic endometriosis in light of the literature. The patient was discharged with full surgical recovery after the Hartmann procedure was performed, and the pathological diagnosis was reached as endometriosis. At the post-operative sixth-month colostomy, closure and bilateral oophorectomy were performed with the patient’s will. The patient was discharged with surgical recovery and is still being regularly followed up. Endometriosis is a gynecological disease that may occur in all organ systems even though the most common location is the overs. Gastrointestinal located endometriosis should, therefore, be kept in mind in the etiology of AMIO in women at reproductive age and the related symptoms should be questioned in differential diagnosis.