Çalýþmamýzda 1989-1994 yýllarý arasýnda birimimize baþvurup gastrointestinal sistem yaralanmasý saptanarak ameliyat edilen 250 hasta deðerlendirildi. Olgularýn 180'inde penetran, 70'inde ise künt travma saptandý. Penetran travmalar içinde býçaklanma ve kurþunlanma, künt travmalarda da trafik kazalarýnýn ilk sýrayý aldýðý gözlendi. En sýk yaralanan organlar olarak sýrasýyla ince barsaklar, kolon ve mide saptandý. Karaciðer yaralanmalarý, eþlik eden organ travmalarý içinde ilk sýrayý almakta ve dalak ile kafa travmalarý bunlarý izlemekteydi. Hastalarýn birimimize büyük bir oranda (%88) travmayý takip eden ilk bir saatte getirildikleri görüldü. Taný yöntemleri içinde peritoneal lavajýn ilk sýrayý aldýðý, görüntüleme yöntemlerinin de (Ultrasonografi, Bilgisayarlý Tomografi) büyük bir oranda kullanýldýðý tespit edildi. Laparoskopinin de özellikle son bir yýlda yaygýn olarak kullanýldýðý izlendi. Serimizde morbidite oraný %17,6, mortalite oraný ise %12 idi. Majör ölüm sebepleri içinde ek travmalar ilk sýrayý almaktaydý.

250 patients with gastrointestinal tract trauma, who underwent surgery between the years 1989'and 1994 were evaluated in this study. 180 of the trauma cases were penetrating, and 70 were blunt. Main causes of penetrating trauma were: stabbing and shot-gun wounds. The main cause for blunt trauma were traffic accidents. Major injured organs were: small intestine, colon, and stomach. Major concomitant organ injuries were: liver, spleen, and head; respectively. 88% of the patients were transported to our center within the first hour following trauma. Peritoneal lavage remained in the first setting, among diagnostic methods. Ultrasound and CT were the major screening methods. Diagnostic laparoscopy was favored during the last year. The overall morbidity and mortality rates were 17.6% and 12%, respectively. Concomitant trauma constituted the major death cause.

Bu prospektif çalýþmada 1990-1994 yýllarý arasýnda Ýstanbul Týp Fakültesi Acil Cerrahi Biriminde tedavileri yapýlan 25 damar lezyonuyla komplike alt ekstremite travmasý olgusu incelenmiþtir. Çalýþmanýn amacý bu tür komplike yaralanmalarda prognozu daha önceden belirleyecek bir puanlama sistemi kullanýp, bu puanlama sistemi sayesinde tedaviden yarar görmeyecek hastalarýn önceden belirlenmesi ve ileride gerekli olacak amputasyonun erken dönemde yapýlabilmesini saðlamaktýr. Bu amaçla Johansen ve arkadaþlarýnýn önerdiði puanlama yöntemi kullanýlmýþtýr. Çalýþma sonucunda skoru 7 ve üzerinde olan hastalarda yüksek oranlarda amputasyon gerektiði gösterilmiþtir. (p<0.001).

In this study between years 1990 and 1994, 25 combined lower extremity vascular and orthopedic trauma patients were examined retrospectively. The aim of the study is to determine some factors which show the prognosis of the patients. By a score system, the patients, who would not get benefit from the treatment, will be determined previously, and their limb amputation would be performed without spend more time. As a result, we saw that in the patients whose score is 7 or over 7; amputation will be needed. (p<0.001).

Taksim Hastanesi I. Cerrahi Kliniðinde, Mayýs 1990'da, I Cerrahi ve Radyoloji Kliniklerinin iþbirliði ile baþlanan, prospektif bir çalýþma çerçevesinde, BT ve US ile lokalizasyonu ve özellikleri belirlenen, 22 intraabdominal abseli hasta araþtýrma kapsamýna alýndý. Abse formasyonuna göre basit ve komplike olmak üzere iki gruba ayrýlan hastalarýn 7'sine radyolojik giriþim, 15'ine ise aperatif giriþim uygulandý. Hastalarýn prognostiði APACHE II skor sistemi ile deðerlendirildi. Basit abseli hastalarda radyolojik giriþimle arasýnda istatistiki anlamlý bir fark gözlenmedi (0.1

22 patients with radiologically proven (CT, US) intraabdominal abscess were prospectively evaluated within the context of a dual treatment protocol allowing the patient cither to a radiologically controlled catcheter drainage or classical open operative abscess drainage. The trial was conducted between may 1990 and december 1994 in the First Surgical and Radiology Clinics of the Taksim Hospital. Patients were categorised as having simple or complicated intraabdominal abscess formation. 7 patients received radiologically assisted puncture and drainage, whereas 15 were primarily operated for abscess drainage. Prognostic evaluations were done with APACHE II scoring system. The results of surgical and radiological procedures were not statistically different in cases with simple intraabdominal abscess (0.1

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Diagnostik periton lavajý ve ultrasonografi künt karýn travmalý olgularýn tanýsýnda yaygýn olarak kullanýlan iki taný yöntemidir. Ocak 1991-Ocak 1994 tarihleri arasýnda künt karýn travmasý nedeniyle kliniðimize getirilen ve þüpheli karýn bulgularý olan 31 olguda (25 erkek, 6 kadýn) DPL ve USG'nin tanýdaki yerini karþýlaþtýran bir çalýþma yapýlmýþtýr. Tüm olgular ilk deðerlendirmede hemodinamik olarak stabildi. Yaþ ortalamasý 31.4 idi. Künt karýn travmasýnýn en sýk nedeni 27 (%87.1) olguda görülen trafik kazasý idi. Karýnda hassasiyet ve defans en çok saptanan fizik muayene bulgularý idi. Olgulara önce ultrasonografi (USG) ve sonrada diyagnostik periton lavajý (DPL) yapýldý. Elde edilen sonuçlara göre 31 olgunun 26'sý (%84) ameliyat edilmiþ, 5 olgu ise yakýn takibe alýnmýþtýr. Ameliyat bulgularý ve takip sonuçlarýna göre DPL ile 25 olguda (%80) doðru pozitif, 5 olguda (%16) doðru negatif ve 1 olguda da (%3.2) yanlýþ pozitif sonuç bulunmuþtur. USG'de ise 24 olguda (%77.4) doðru pozitif, 3 olguda (%9.67) doðru negatif, 3 olguda yanlýþ pozitif ve l olguda da yanlýþ negatif sonuçlar elde edilmiþtir. Duyarlýlýk, seçicilik ve doðruluk oranlarý DPL için sýrasýyla %100, %83.3 ve %96.7, USG için ise %96, %50 ve %87 olarak bulunmuþtur. Sonuç olarak diagnostik periton lavajý künt karýn travmalý olgularýn tanýsýnda ultrasonografiden daha üstün görülmektedir.

Diagnostic peritoneal lavage and ultrasonography are widely used two methods in the diagnosis of blunt abdominal trauma. 31 (25 male, 6 female) patients admitted to our clinic due to blunt abdominal trauma who had abdominal signs between the period of January 1991 and January 1994. The value of USG and DPL was compared in the diagnosis of blunt abdominal trauma. All patients were hemodynamically stable when first seen at the emergency department. Mean age was 31.4. The most frequent cause of blunt abdominal trauma was traffic accident which was seen in 27 (%87.1) patients. The signs most often seen were abdominal pain and defense musculare during palpation. Firstly USG was done to all patients and then DPL. According to results 26 patients (%84) were operated and 5 cases (%16) were closely observed. At the end of the period of operation and observation DPL was found true positive in 25 cases (%80.6), true negative in 5 cases (%16) and false positive in 1 case (%3.2). USG was true positive in 24 cases (%77.4), true negative in 3 cases (%9.7), false positive in 3 cases and false negative in 3 cases. Sensitivity, specificity and accuracy rate were found %100, %83,3 and %96.7 for DPL and %96, %50 and %87 for USG respectively. In conclusion, diagnostic peritoneal lavage was found more valuable than ultrasonography in the diagnosis of the blunt abdominal trauma.

Karýn travmasý nedeniyle 7 yýllýk bir period içinde laparotomi yaptýðýmýz 274 hasta retrospektif olarak gözden geçirildi. En yaygýn travma sebebi araç içi ve dýþý trafik kazalarý (%50.3), operasyon için en yaygýn endikasyon peritoneal lavaj (%50.4) ve sok bulgularý (%28.9)'dýr. Kunt travmaya en çok maruz kalan organ dalak (%48.8), delici-kesici alet ve ateþli silahlarla en fazla yaralanan organ ince barsaklar (%32., %36)'dýr. Künt travmalarda negatif laparatomi oraný %2.4 iken, delici-kesici alet yaralanmalarýnda %20.4 ve ateþli silah yaralanmalarýnda %8'dir. Künt travmalarýn mortalitesi %16.9, delici-kesici alet travmalarýnýn %1.2, ateþli silah yaralanmalarýnýn %12 'dir.

We reviewed 274 patients retrospectively for a 7 years period that we made laparotomy for abdominal trauma. The most trauma cause was motor vehicle accident (50.3%) and the indications for operation were peritoneal lavage (50.4%) and shock (28.9%). The most commonly injured organ by blunt trauma was spleen (48.8%); in the penetrating trauma (32.6%) and the stab wounds (36%) was small intestine. The false laparotomy rate for blunt trauma was 2.4%, while for stab wounds it was 20.4%, and for shotgun wounds 8%. The mortality rate for blunt trauma was 16.9%, for stab wounds 1.2% and f or shotgun wounds 12%.

Tanýsý geç koyulmuþ 2 strangule diafragma hernisi olgusu irdelendi. 17 yýl ve 6 ay sonra herniasyon geliþenlerde çeþitli komplikasyonlar gözlendi. Diyafragma rüptürünün tanýnmasýndaki güçlük ve tanýdaki gecikmeler yaþamý olumsuz yönde etkilemektedir. Hatýra gelmedikçe ve özel teknikler uygulanmadýkça taný koymak zor olmaktadýr. Bu nedenle þüpheli durumlarda mutlaka diyafragma rüptürü olasýlýðýnýn düþünülmesi ve ileri tetkiklerin yapýlmasýnýn faydalý olacaðý kanýsýndayýz.

In this case report, we want to present two patients with strangulated hernia, which retained silent for. a long period. Consequently a developing strangulated hernia would make the situation even more complicated. To effect the morbidity and the mortabidity and the mortality rates positively in the patients who have thoracic trauma, silent ruptures of the diaphragm must be considered.

Havalý silah yaralanmalarý, Türkiye'de 1992 yýlýndan itibaren görülmeye baþlandý. Havalý silahlar ile yaralanmalar nadir olup, genellikle aðýr ciddi tablolar oluþturmadan seyrederler. Mermi çekirdeði ya da saçma tanesi göz bölgesine isabet ederse cildi ve orbitanýn duvarýný delip geçebilir ve sonuçta deðiþik derecelerde görme kaybý oluþabilir. Bu yazýda, sol gözü perfore ederek kafa boþluðuna giren ve beynin sol lobus temporalisinde kalan bir havalý silah saçma tanesi yaralanmasý olgusu sunulmuþtur.

Injuries from air guns have been seen in Turkey since 1992. Although air gun injuries are rare and generally not serious, if the pellet hits the eye region, it can penetrate the skin and the wall of the orbit. So visional loss may occur at different degrees on victim. In this paper, a case of air gun injury, which perforated the left eye and rested in lobus temporalis of cerebrum, is reported.

Haseki Hastanesi Cerrahi Kliniðinde 1990-1994 yýlarý arasýnda penetran batýn yaralanmasý nedeniyle 56 hastaya eksploratris laparotomi yapýlmýþtýr. Bunlardan 21 olgu (%37) negatif laparotomi ile sonuçlanmýþtýr. Penetran karýn yaralanmalarýnda negatif laparotomi oranýnýn yüksek olmasý, bu vakalarda seçici davranýlmasý gerektiðini düþündürmektedir.

In Haseki Hospital, Department of General Surgery, laparotomy were performed between the years 1990-1994 for 56 penetrating abdominal wound. 21 cases (%37) were negative laparotomies. Since the ratio of negative laparatomies in stab wounds of the abdomen is too high, it has been thought that, the indications for exploration in these cases must be reviewed as has been proposed by many authors and a more selective approach must be made.

Acil Laparoskopi (AL) akut karýn tanýsýnda ve abdominal travmanýn deðerlendirilmesinde yararlý bir yöntem olabilir. 15 ay içinde 20 hastaya acil laparoskopi uyguladýk. 14 hastada AL endikasyonu sað alt kadran aðrýsý (SAKA), altý hastada ise künt karýn travmasý idi. 14 hastanýn beþinde AL ile akut apandisit tanýsý kondu ve hepsine laparoskopik appendektomi yapýldý. Yapýþýklýklar nedeniyle taný konulamayan bir hastaya konvansiyonel appendektomi uygulandý. 8 hastada SAKA nedeni jinekolojikti ve bunlardan yalnýzca bir tanesine dýþ gebelik nedeniyle cerrahi giriþimde bulunuldu. 6 hastada AL endikasyonu kunt karýn travmasý idi hepsinde de ayný zamanda kafa travmasý, dördünde ise açýklanamayan hipotansiyon vardý. Hipotansiyon nedeni olarak iki hastada AL ile karýn içi kanama saptandý ve laparotomiye geçildi. Birinde dalak rüptürü, diðerinde geniþleyen bir retroperitoneal hematom mevcuttu. Yirmi hastadan yalnýz bir tanesinde AL diyagnostik olamadý. Bu hastada da eski laparatomiye ikincil karýn içi yapýþýklýklar vardý. Böylece, bu seride, AL ile %95 oranýnda doðru taný konulmuþ oldu. Serideki tek komplikasyon da taný konamayan ve konvansiyonel appendektomiye giden hastanýn trokar yerindeki yara enfeksiyonu idi. Sonuç olarak, AL sað alt kadran aðrýsýnýn ayýrýcý tanýsýna, multipl travmalý hastada tedavi önceliðinin saptanmasýna, gereksiz, laparatomilerin önlenmesine ve taný için cerrahýn baþkalarýna baðlý kalmamasýna yardým eden bir uygulama olarak deðerlendirilebilir.

Diagnostic laparoscopy (DL) can be employed in emergency conditions either to assess the patient with abdominal trauma or in abdominal diagnostic dilemma. We performed 20 urgent of emergent DL in a period of 15 months. The indication of DL was right lower quadrant pain (RLQP) in 15 and blunt abdominal trauma in 6 patients. Appendicitis was diagnosed in five of the fourteen patients who had undergone DL for RLQP. Laparoscopic appendectomy was done in all five and conventional appendectomy (due to multiple adhesions from previous surgery) was done in one patient. In 8 patients, the origin of the RLQP was gynecological and only one patient who had tubal pregnancy needed surgical intervention. Emergent DL was performed in six patients who had. blunt abdominal trauma. All six had concomitant head injury and four of these had, in addition, unexplained hypotension. Two of these patients had blood in the abdomen and underwent laparotomy, one retroperitoneal hematoma. In one patient with RLQP laparoscopy was not diagnostic due to multiple abdominal adhesions from previous surgery. In this series DL was successful in establishing a definite diagnosis in 19/20 (95%) of the cases. Only one complication was encountered in these 20 patients and it was a wound infection at the trocar site in a patient who underwent appendectomy for a perforated appendix. In conclusion, emergency DL can diagnose dilemmas, establishes priority of treatment in the multiple injured patient and eliminates unnecessary laparatomies and expensive and time consuming laboratory examinations.

Fýrat Üniversitesi Týp Fakültesi Genel Cerrahi Kliniði'nde 1990-1994 yýllarý arasýnda sigmoid kolon volvulusu tanýsý konarak gangren belirtisi bulunmayan 34 hastaya rektosigmoidoskopik detorsiyon uygulandý. 21 hastada (%61,7) basarý saðlandý. 13 hastada (%38,3) baþarý saðlanamadý. Baþarýlý olunan grupta ise 3 hastada ilk 3 günde nüks geliþti. Basarý saðlanamayan grupta nüks eden 3 hasta ve baþarýlý grupta operasyonu kabul eden 6 hasta elektif þartlarda opere edildi. Operasyonu kabul etmeyen 12 hastanýn 3'ünde geç dönemde nüks geliþti. Sonuçlarýmýz gangren gözlenmeyen sigmoid kolon volvulusu vakalarýnda endoskopik detorsiyon denenmesi gerektiðini ve baþarýlý olgularda elektif þartlarda operasyon uygulanmasýnýn mortalite ve morbiditeyi düþüreceðini desteklemiþtir.

This report discusses 34 patients with non-gangrenous sigmoid volvulus attempted sigmoidoscopic decompression in University of Fýrat Faculty of Medicine Department of General Surgery between 1990 and 1994. Decompression procedures were successful in 21 patients (%61,7). In 3 of these patients early recurrences were occurred in 72 hours and was managed endoscopically. 12 patients did not undergo surgery and 3 of these patients had late recurrent volvulus and was managed endoscopically. Elective resection was performed in 9 patients. Endoscopic attemps at decompression were unsuccessful in 13 patients. Emergency resection was required in these patients. We conclude that elective operation that was performed after successful endoscopic decompression would decrease mortality and morbidity rates.

Penetran gluteal travma giderek artan sýklýkta rastlanmasýna raðmen literatürde yeterli olarak yer almýþ bir konu deðildir. Bu çalýþmada gluteal bölgenin minör yaralanmasý ile seyreden 4 vaka incelenmiþtir. Bu olgulardan ikisi superior gluteal ikisi ise inferior gluteal arterleri tutmuþtur. Hastalarýn ikisi hemorajik þokta idi. Resüsitasyonu takiben hastalarda kanama tamponman ile kontrol altýna alýnmýþtýr. Hastalara daha sonra anjiografik tetkik yapýlmýþ ve kanayan damarlar fibrin ile embolize edilmiþtir. Embolizasyon sonrasý yapýlan anjiografi anevrizma ve besleyen damarlarýn tam olarak týkandýðýný göstermiþtir. Sonuç olarak gluteal bölgenin kontrol edilemeyen kanamalarýnda anjiografik embolizasyonun güvenli ve sýklýkla definitif bir tedavi metodu olduðuna inanýyoruz.

Penetrating gluteal trauma, although increasingly common, has not been widely discussed in the surgical literature. Four cases of life-threatening sequelae of relatively minor penetrating injuries of the gluteal region, involving the superior gluteal (two cases), and inferior gluteal (two cases) arteries, are reported. Two of the patients were in hemorragic shock. After being resuscitated, the bleeding could be controlled by packing in all patients. Thereafter, angiographic assessment was used in these cases and the bleeding vessels were embolized with fibrin. Angiography after embolization showed complete occlusion of the aneurysms and their feeding vessels. We believe that the advent of angiographic embolization offers the opportunity for safe definitive treatment.

Mezenter iskeminin erken taný ve tedavisi halen problem olmaya devam etmektedir. Bu çalýþma mezenter iskeminin erken teþhisinde serum fosfor deðerlerinin rolünü saptamak ve ayrýca mezenter iskemide bakteriyel translokasyonu araþtýrmak için yapýldý. 250-300gr. aðýrlýðýnda Wistar Albino erkek sýçan kullanýldý. Mezenter arter baðlandýktan sonra 0-2-3-4-6 saatlik, onar adetlik beþ gruba ayrýlan sýçanlarda relaparotomi ile sistemik, portal kan, mezenter lenf ganglionu ve terminal ileum örnekleri alýndý. Mezenter iskemide serum fosfor seviyesinde artýþ ve bakteriyel translokasyon olduðu yönünde bulgular gözlendi.

Early diagnosis and treatment of mesenteric ischemia are still significant problems. The changes in the serum phosphorus level and the bacterial translocation rate were investigated in a rat model of mesenteric ischemia. (Superior mesenteric artery ligation). The animals were sacrificed 0,2,3,4 and 6 hours after ligation. The serum phosphorus level and the bacterial translocation rate were increased in this model.

Bu çalýþmada 5 yýllýk bir dönemde (1990-1995) SSK Okmeydaný Hastanesinde opere edilen 303 duodenal-ülser perforasyonu olgusu klinik bulgularý ve cerrahi tedavileri açýsýndan incelenmiþtir. Elektif ameliyatlarýn yýllar içerisinde daha az yapýlmaya baþlandýðý saptanmýþtýr. H2 reseptör blokeri ve hidrojen proton pompa inhibitörleri gibi etkili ilaçlarýn kullanýlmasý duodenal ülser perforasyonu sonrasý primer kapama yönteminin cerrahlar tarafýndan daha sýk kullanýlmasýna neden olacaktýr.

In this study, clinical and surgical treatment of 303 cases of perforated duodenal ulcer were evaluated during a period of 5 years (1990-1995). As a result, we can state that surgeons less often prefer acid-decreasing surgical procedures in the surgical treatment of patients after closure of perforated duodenal ulcer. The effect of H2 antagonists and proton inhibitors may explain why mostly simple closure for perforated duodenal ulcers is preferred by the surgeons.

Yanýklý hastalarda hücresel ve hümoral immun fonksiyonlarda birtakým defektler tesbit edilmiþtir. Keza ciddi termal yaralanma sonucu enterik bakterilerin mezenter lenf bezleri ve uzak organlara translokasyon oluþturduðu gözlenmiþ ve translokasyon ile yanýk mortalitesi arasýnda iliþki gözlenmiþtir. Bu bulgulara dayanarak lökositlerin fonksiyonlarýný arttýrýcý bir ilaç olan Granülosit Koloni Stimulan Faktör'ün (G-CSF) bakteriyel translokasyona etkisi araþtýrýldý. 24 adet 250gr erkek Wistar Albino rata %30 haþlanma yanýðý ve 1x10³ koloni oluþturan ünite (cfu) Pseudomonas Aeruginosa ile enfeksiyon oluþturuldu. Kontrol grubuna (12 adet), yanýktan 2 gün önce baþlayarak %5 Dextroz, tedavi grubuna (12 adet) ise 100mg/kg dozda recombinant human G-CSF (Nuepogen-Roche) günde tek doz. subkutan uygulandý. Yanýk sonrasý 4. gün raflarda mezenter lenf ganglionlarý (MLG), karaciðer ve dalaða translokasyon araþtýrýldý. Kontrol grubunda MLG'da (5/12p<0.01), karaciðerde (6/12p<0.01) ve dalakta (6/12p<0.01) translokasyon oluþtu. MLG'deki translokasyon miktarý kontrol grubunda 986 349 cfu/1 gr tedavi grubunda 371 151 cfu/gr (p<0.05) bulundu. G-CSF'nin yanýk ve infeksiyona baðlý bakteriyel translokasyonu anlamlý derecede azalttýðý tesbit edilmiþtir.

Certain defects of cellular and humoral immunity have been established in burn patients. Likewise translocation of enteric bacteria to mezenteric lymph nodes and to distant organs has been observed following serious thermal injury and this translocation has shown relationship with burn mortality. Bearing this factors in mind effects of Granulocyte Colony Stimulating Factor (G-CSF), a leukocyte function improving drug on bacterial translocation has been investigated. 24 Wistar Albino rats weighing 250gr have been scalded 30% and the lesion infected by 1x103 cfu Pseudomonas Aeruginosa. The control group (n-12) has been treated with 5% Dextroz solution subcutaneously starting two days preburn, and the study group (n-12) with 100ug/kg human G-CSF (Neupogen - Roche) subcutaneously. On the 4th post burn day translocation to mesenteric lymph nodes (MLN), liver and spleen has been investigated. Translocation in the control group was 12/12 in MLN, 12/12 in liver an 12/12 in spleen where as in the study group the values were 5/12 in MLN (p<0.01), 6/12 in liver (p<0.01) and 6/12 in spleen (p<0.01). Translocation values in MLN were 986 349 cfu/gr (p<0.05) in the study group. It has been observed that G-CSF is significantly effective in reducing bacterial translocation due to burn injury infection.

1990-1994 yýllarý arasýnda, 4 yýl süresince kliniðimizde tedavi gören 19 generalize tetanoz olgusu gözden geçirildi. Yaþ ortalamalarý 48±16 olan hastalarýn tümü basit yaralanmalar sonucu hastalýða yakalanmýþlardý. Aðrý, trismus, ense sertliði, yutma güçlüðü en sýk rastlanan baþlangýç bulgularýydý. Bunlardan ortalama 24 saat sonra adele spasmlarýda tabloya eklenmiþti. Mekanik ventilasyon, MgSO4 ile sedasyon ve supportif tedavi uygulanan hasta grubumuzda mortalite oraný %63 olarak saptanmýþtýr.

19 generalized tetanus cases that have been treated between 1990-1944 in HNH Reanimation Clinic are reviewed. The patients with an average age of 48+18 had tetanus due to simple wounds. Pain, trismus, neck stiffness, disphagia were the initial symptoms encountered. After 24 hours muscle spasms were seen. Treatment was carried out with mechanical ventilation, MgSO4 sedation and supportive therapy in our clinic and our mortality rate was63%.

Þiþli Etfal Hastanesi acil cerrahi biriminde tedavi edilen künt travma ile oluþmuþ midtorasik trakeobronþial rüptür olgusu. Travmanýn yeri ve mekanizmanýn nadir oluþu nedeniyle, bu konudaki literatürüde gözden geçirerek sunmaya çalýþtýk. Künt toraks travmasýný takiben oluþan pnömotoraksýn tüp drenajla düzeltilemediði durumlarda trakeabronþial rüptür olasýlýðýnýn düþünülmesi gerektiði ve taný gecikmesinin ölümcül olabileceði vurgulandý.

Midthorasic tracheobronchial rupture case caused by blunt injury, treated at the emergency ward of Þiþli Etfal Hospital Because of the location of the injury and the rarity of the mechanism, we try to present the case by summarizing the relevant literature. After blunt thorax injury, failure of the lung to expand after thoracostomy tube insertion should suggest tracheobronchial rupture and delay in diagnoses can be fatal.

Uludað Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Kliniðinde tedavi edilen 42 femur cisim kýrýklý hastada, diðer vücut bölümlerine ait yaralanmalarýn sýklýðý araþtýrýldý. Olgularýn yaþ ortalamasý 32.3, kýrýklarýn ise 32'sinin erkeklerde (%76.20), 10'unun kadýnlarda (%23.80) olduðu görüldü. Çalýþmamýzda %85.71 oranýnda trafik kazalarýnýn bu yaralanmalara neden olduðu, femur cisim kýrýklarýyla birlikte diðer vücut bölümlerine ait toplam yaralanma oranýn %73.80 ve bunlarýn içinde baþ bölgesinin %35.72, batýnýn ise %16.66 gibi yüksek oranlarda yaralandýklarý saptandý. Femur cisim kýrýklarý ile birlikte diðer vücut bölgelerindeki ciddi ve aðýr komplikasyonlu yaralanmalarýn sýklýðýnýn bilinmesi, multitravmalý hastalarda kýrýðýn yanýþým bu yaralanmalarýn erken taný ve tedavisinin gerekliliði ortaya koymaktadýr.

Forty-two patients with femoral shaft fractures treated in the University of Uludað Medical School. Orthopaedics and Traumatology Department were evaluated for associated injuries. Thirty-two (76.20%) patients were men and ten (23.80%) were women with an average age of 32 years. The major cause of the injuries were traffic accidents (85.71%). Seventy four percent of these patients had associated injuries. Majority of them were head (35.72%) and abdominal (16.66) injuries. In conclusion, keeping in mind of the associated injuries, patients with femoral shaft fractures should be carefully evaluated and treated.

Orbitanýn penetran yaralanmalarý önemle ele alýnmasý gereken durumlardýr. Orbitayý penetre olmuþ yabancý cisimler görme kaybý ve enükleasyona sebep olabilmeklerinden dikkatlice araþtýrýlmalýdýr. Bu amaçla konvansiyonel radyolojik tetkiklerden manyetik rezonans tetkiklerine kadar geniþ bir görüntüleme yelpazesi mevcuttur. Burada kliniðimizde teþhisi ve tedavisi yapýlan bir intraorbital yabancý cisim olgusu sunulmaktadýr.

Attention should be made on penetrating injuries of the orbit. Forcing bodies, that can cause vision loss and even enucleation, should be detected carefully. Different imaging techniques, ranging from conventional radiographs to magnetic resonance imaging should be used. In this paper, we report an orbitocranial penetration case. Diagnosis, evaluation of the patient and treatment are diseased in this case report.

Ankara Dr.M.Ülker Acil Yardým ve Travmatoloji Hastanesi acil servisine 1 Nisan 1994 ile 31 Aralýk 1994 tarihleri arasýnda kafa travmasý hikayesi ile baþvuran 791 hastadan ekstremite lezyonu bulunan 179 hastanýn ayrýntýlý demografi ve klinik özelliklerini içeren bir inceleme yapýlmýþtýr. Ekstremite veya vertebral kolona ait lezyonu bulunan hastalarýn kimlik bilgileri, travma nedenleri, alkol ve ilaç kullanmýþ olup olmamalarý gibi anamnez ile ilgili bilgilerin yanýsýra, acile ilk baþvuru anýndaki vital bulgularý, nörolojik muayene bulgularý, Glaskow koma skalasýna göre puanlarý, ek travmatik patolojileri ayrýntýlý olarak deðerlendirilmiþ ve kaydedilmiþtir. Daha sonraki kýrýk lokalizasyon ve özellikleri dikkate alýnarak ek bir inceleme yapýlmýþtýr.

During the period from 1st of April to 31st of December 1994, we had examined the demographic data's and clinical aspect of 791 patients in Ankara Dr. M.Ülker Emergency and Traumatology Hospital, Emergency department that were an suffering from head injuries and 179 of those had an extremities problems. All identity knowledge's, causes of injuries and whetner the patients had used alcohol or drug was noted. Besides vital functions of patients at first arrival to the emergency department, neurologic examination, scores of Glasgow coma scales, and other pathologies were added to the forms. Additionally, patients who had extremity problems and vertebrae's fractures were examined again and classified related to the localization of the fractures.

Bu retrospektif çalýþma 1989-1995 yýllarý arasýndaki 7 yýllýk dönemde Ýstanbul Týp Fakültesi Acil cerrahi Birimine kabul edilen 985 olguyu içermektedir. Hastalarýn 689'u erkek, 296'sý bayan idi (ortalama yaþ: 22,4). Ortalama yanýk sahasý geniþliði total vücut yüzeyinin %19 (minör yanýklarda: %16, majör yanýklarda: %55) dur. En sýk etyolojik neden kaynak sývý ile haþlanma (%54) olup, olaylarýn %72'si evde meydana gelmiþtir. Hastalarýn %58'i 0-14 y aþ grubundadýr. Ortalama mortalite %19 olup, bu rakam minör yanýklar için %1.5, majör yanýklar için %45.5'dur. Bu çalýþmadan ehle edilen epidemiyolojik veriler vakalarýn büyük bir kýsmýnýn ana-babalarýn ve okul çaðý çocuklarýnýn eðitimi ile önlenebileceðini göstermektedir. Cerrah, mortalitenin düþürülebilmesi için, yanýk geniþliði, derinliði ve hastanýn yaþý gibi çok önemli faktörleri dikkate almalýdýr.

This is a retrospective study of 985 patients with burn injuries admitted to the Emergency Surgery Department of Istanbul Medical School during a period of 7 years (1989-1995). There were 689 males and 296 females (mean age 22.4). The mean burn extent was 19 percent of the total body surface (16%in minor burns, 55%in major burns) and the most common cause was in the group of 0-14 years. Patient mortality was 1,5 %in minor burns, 45,5% in major burns, a great number of these cases could be prevented by the education of parents and school children. Burn extent, its depth and patient age are the factors on which the surgeon's attention should concentrate in the immediate treatment of burn victims in order to decrease the mortality.

1990-1994 yýllarý arasýnda Haseki Hastanesi'nde cerrahi tedavi uygulanan üst Gastrointestinal Kanamalý 58 olgu retrospektif incelendi. Bulgu ve sonuçlar literatürdekilerle karþýlaþtýrýlarak deðerlendirildi. Yaþlýlarda, gecikmiþ olgularda ve yeterince resüsite edilmeden ameliyata alýnanlarda mortalitenin daha yüksek olduðu gözlendi.

58 cases with upper gastrointestinal haemorrhage treated surgically at Haseki Hospital from 1990 through 1994 have been investigated being compared with datas in recent literature. Mortality was observed to be higher in patients who are old, delayed and not resuscitated adequately.

Yüz kýrýklarýnýn çok parçalý yaygýn kýrýklarý iyi bir zamanlama ile doðru tedavi edilemediklerinde bir çok problemi de beraberinde getirirler. Kraniofasial cerrahide kullanýlan tekniklerin yüz kýrýklarý tedavisinde de kullanýlmasýyla ve yüz yaralanmalarý tedavisinde yeni bir dönem baþlamýþtýr. Yaralanmadan sonra erken olarak yapýlan ilk giriþimde tüm travmatik patolojilerin onarýmý planlanmaktadýr. Bu amaçla; "multitravmatize hastalarda dahi mümkün olan en erken sürede kýrýk parçalarýn açýk redüksiyonu, bu parçalarýn rijid fiksasyon yöntemleriyle tespiti, gerekli durumlarda kemik greftlerinin kullanýmý ve tek seansta onarým" yaygýnlaþan tedavi yaklaþýmýdýr. Kliniðimizde, yeni yapýlanma dönemini kapsayan, son 3 yýllýk süre içinde tedavi edilen, aðýr ve yaygýn yüz kemikleri kýrýklarý olan 10 hastada uygulanan teþhis ve tedavi yöntemlerinin aktarýldýðý bu çalýþmada kullanýlan yöntemlerin avantaj ve dezavantajlarý sunulmaktadýr. Rijid fiksasyon yöntemleriyle yüzün projeksiyonu ve üç düzlemde anatomik onarýmý tam olarak elde edilebilmekte ve fonksiyonel onarým baþarýlý olarak yapýlabilmektedir. Böylece estetik olarak da iyi sonuçlar elde edilmekte ve gerçekten zor olan ikincil giriþimlere gerek kalmamaktadýr.

Many problems have been appeared if severe panfacial fractures are not treated in proper timing and good reconstructive techniques. The use of craniofacial surgical techniques in facial fractures and immediate surgical intervention are purposed for the reconstruction of seven the most complicated injuries. According to this approach; the facial injuries are repaired immediately or within the first few days even in multitraumatized patients whenever possible. It is a common approach today to treat the facial injuries in one stage by open reduction and rigid fixation, and if necessary by using bone grafts. In this study, the techniques of diagnosis and treatment of 10 patients with panfacial injury who were admitted to emergency for last 3 years agter reorganization of the unit were presented including advantages and disadvantages of the used methods. Three dimensional and functional reconstruction have been obtained by using rigid fixation successfully. This approach results in good appearance aesthetically and prevents late interventions for secondary deformities which are extremely difficult to treat later adequately.