Travma dýþarýdan saldýrýlarýn neden olduðu doku hasarýdýr. Nörohümoral ve fizyolojik iþlevlerden oluþan stres cevap travmatik hasardan sonra tedavi edilmemiþ organizmanýn yaþama þansýnýn artmasýna neden olur. Hasardan sonra yetersiz aðrý kontrolunun sekeli fizyolojik olmaktan uzaktýr. Kronik nöropatik aðrý travmanýn sýk rastlanan bir sekelidir. Travma ve yanýk kurbanlarýnýn aðrý tedavileri hemodinamik deðiþiklikler ve solunum depresyonu korkusu nedeni ile genellikle yetersizdir. Aðrýnýn erken ve hatta preemptif tedavisinin sonraki analjezik ihtiyacýný azalttýðý gösterilmiþtir. Aðrý tedavisinde her hastanýn ihtiyaçlarý farklý olacaðýndan analjezi indüksiyonu dikkatli olarak, ideali yakýn monitorizasyon altýnda titre edilerek yapýlmalýdýr. Travma ve yanýk aðrýsýnýn tedavisinde farmakoterapi ve giriþimsel yöntemler geniþ bir çeþitlilikte kullanýlabilmektedir.

Trauma is tissue damage caused by an extrinsic force. The stress response comprises an activation of neurohumoral and physiologic process that would lead to improved survivability of an untreated organism following a traumatic injury. The sequelae of inadequate pain control following an injury are more than physiological. Chronic neuropathic pain is a frequent sequelae of trauma. Trauma and burn victims usually have poor pain management, because of the fear of hemodynamic alterations and respiratory depression. Early or even preemptive treatment of pain have been shown to reduce analgesic requirements over time. Individual patients will have widely variant requirements for pain medications, so induction of analgesia must be carefully adjusted, ideally in a closely monitored environment. Pharmacotherapy and interventional methods can be used in a wide variety for the management of pain in trauma and burns.

AMAÇ: Bu çalýþmada temizlik amaçlý yaygýn olarak kullanýlan %45 nitrik asit (NHO3) ve %18’lik hidroklorik asidin (HCl) lokal ve sistemik etkileri belirlemeyi amaçladýk.
GEREÇ-YÖNTEM: Bu ileriye dönük, deneysel ve plasebo kontrollü çalýþma Akdeniz Üniversitesi hayvan laboratuvarýnda gerçekleþtirildi. %45’lik NHO3 ile %18’lik HCl plasebo ile karþýlaþtýrýldý. Solüsyonlar her biri 10 sýçandan oluþan 3 gruba aðýzdan verildi. Solüsyonlar verilmeden önceki ve sonraki pH ve kalsiyum deðerleri ölçülerek, meydana gelen metabolik deðiþiklikler izlendi. Ayrýca patolojik deðiþiklikler ile ölüm oranlarý da kaydedildi.
BULGULAR: Solüsyonlarýn verilmesinden 30 dakika sonra yapýlan ölçümlerde, HCl (Ca artýþý için p=0.007, pH’deki azalma için p=0.023) ve NHO3 (Ca artýþý için p=0.006, pH’deki azalma için p=0.001) grubunda kalsiyum seviyelerinde anlamlý olarak artýþ, pH seviyelerinde ise azalma saptandý. Ayrýca, Ca ve pH deðerlerinde deðiþiklikler açýsýndan üç grup ANOVA ile karþýlaþtýrýldýðýnda istatiksel olarak anlamlý fark bulundu. Yapýlan çoklu karþýlaþtýrmada farkýn kontrol grubundan kaynaklandýðý saptandý. Mide ve özofagusun patolojik incelemesinde gruplar arasýnda anlamlý fark bulunurken (p=0.009 (Ö) ve p=0.016 (M)), farkýn yine kontrol grubundan kaynaklandýðý saptandý (p=0.543 (Ö), p=0.244 (M) NHO3 vs HCL). Otuzuncu dakikadaki ölüm oranlarý NHO3 grubunda %20, HCl grubunda %60 ve kontrol grubunda ise %0 idi.
SONUÇ: NHO3 ve HCl alýmlarý sonrasý ciddi metabolik ve hafif lokal patolojik deðiþiklikler olabilir. Bu maddelerin alýmlarý sonrasý oluþan ölümleri engellemek için yeni çalýþmalara ihtiyaç vardýr; halk saðlýðý önlemlerinin arttýrýlmasý gerekir.

BACKGROUND: We aimed to determine the local and systemic effects of widely available household cleaners, namely 45% nitric acid (NHO3), and 18% hydrochloric acid (HCl), in a rat model.
METHODS: This prospective, experimental, placebo-controlled trial was carried out in the Animal Research Laboratory of Akdeniz University hospital. Commonly available solution of 45% NHO3 and 18% HCl were tested against normal saline. Each solution was administrated orally to groups consisting of ten rats. The metabolic changes were determined by measuring the pH and calcium (Ca) levels before and after the administration of solutions. In addition, the pathological changes and mortality rates were determined for each group.
RESULTS: There was a statistically significant increase in the post-ingestion (30 minutes later) Ca levels and a decrease in the post-ingestion pH levels after the administration of test solution in the NHO3 (p=0.006 for Ca increase, p=0.001 for pH decrease) and HCl (p=0.007 for Ca increase, p=0.023 for pH decrease) groups. There was also a statistically significant difference between groups for Ca increase (p=0.000) and pH decrease (p=0.006). In post hoc analysis, the difference between the groups was found to be originated from the placebo group. In the pathological evaluation of esophagus and stomach, there was a statistically significant difference between groups (p=0.009 (E) and p=0.016 (S)) and the difference was found to be originated from the control group (p=0.543 (E), p=0.244 (S) for NHO3 and HCl). The 30-minute mortality rates were 0,2 in the NHO3 group, 0,6 in the HCl group and 0 in the control group.
CONCLUSION: Serious metabolic and mild local pathological changes can occur after the ingestion of household NHO3 and HCl solutions. Further studies should be performed to elucidate the causes of death following oral ingestion of these compounds and appropriate public health warnings should be taken.

AMAÇ: Bu çalýþmada hipotansif sýçan modelinde düþük doz dopamin infüzyonunun böbrek koruyucu etkisi araþtýrýldý.
GEREÇ-YÖNTEM: Çalýþmada kontrol, hipotansiyon, dopamin ve dopamin+hipotansiyon gruplarýna ayrýlan Wistar cinsi 40 sýçan kullanýldý. Hipotansiyon yaratmak için sodium nitroprussid infüzyonu kullanýldý ve iki saatlik çalýþma süresince kan ve idrar örnekleri toplandý.
BULGULAR: Hipotansiyon grubunda kan üre nitrojen düzeyinin çalýþmanýn birinci saatinde anlamlý derecede yükseldiði, fakat çalýþma süresinin sonunda bu farkýn kaybolduðu gözlendi. Dopamin infüzyonunun kreatinin ve potasyum klirensine etkisi gözlenmedi. Sadece dopamin verilen sýçanlarda natriürez gözlenmezken, dopamin verilen hipotansif sýçanlarda idrar sodyum atýlýmýnýn anlamlý derecede arttýðý saptandý.
SONUÇ: Düþük doz dopamin infüzyonunun farmakolojik olarak oluþturulan hipotansiyonun erken safhasýndaki kan üre nitrojen yükselmesine karþý engelleyici etki gösterdiði saptandý.

BACKGROUND: The aim of this study was to investigate the effect of low-dose dopamine on markers of the renal functions in a rat model of hypotension.
METHODS: Forty Wistar rats were divided into control, hypotension, dopamine, and hypotension+dopamine groups. Hypotension was achieved by sodium-nitroprusside infusion. Samples were drawn for analysis during the two-hour study period.
RESULTS: Blood urea nitrogen levels were significantly increased in hypotension group during the early phase but this difference disappeared at the end of the second hour. Dopamine infusion had no effect on creatinine and potassium clearance. Despite the significance of improved sodium clearance in the hypotensive rats treated with dopamine, natriuresis did not occurred in the dopamine-only group.
CONCLUSION: It can be stated that low dose dopamine infusion at a rate of 0.5 µg kg-1 min-1 has a short-term preventive action against the increase of blood urea nitrogen during the early phase of pharmacologically induced hypotension.

AMAÇ: Travma nedeniyle hayatýný kaybeden olgularýn Acil Cerrahi ve Travma Merkezine (ACTM) geliþteki Yaralanma Aðýrlýk Skoru (YAS) ile otopsi esnasýndaki YAS karþýlaþtýrýldý. Yaralanma Aðýrlýk Skoru 14 puanýn altýnda (önlenebilir ölümler olarak tanýmlanan) olgular araþtýrýlarak sonuçlarýn diðer ülkelerdeki verilerle karþýlaþtýrýlmasý amaçlandý.
GEREÇ-YÖNTEM: Çalýþma 1 Ocak 2000 ile 31 Aralýk 2002 tarihleri arasýnda Ýstanbul Týp Fakültesi ACTM ile Adli Týp Kurumu’nda gerçekleþtirildi. Üç yýllýk bir dönemde travma nedeniyle ölen ve otopsisi yapýlabilen 160 olgu incelendi.
BULGULAR: Otopsi sýrasýnda saptanan YAS deðeri 14’ün altýnda olan (önlenebilir ölüm) olgularýnýn oraný %3 (n=4), YAS deðeri 16-66 olan (önlenmesi muhtemel ölüm) olgularýn oraný %96, YAS deðeri 75 olan (ölümün önlenemez olduðu) olgu oraný %1 (n=1) olarak bulundu. Acil Cerrahi ve Travma Merkezine geliþlerde ise bu oranlar; YAS deðeri 14’ün altýnda olan %12 (n=19), YAS deðeri 16-66 olan %68 (n=109), YAS deðeri 75 olan %20 (n=32) idi. Otopsi sýrasýnda hesaplanan YAS deðeri ile ACTM’ye geliþlerinde saptanan YAS deðerleri arasýnda zayýf da olsa bir ilinti saptandý (r=0.16; p=0.04).
SONUÇ: Travmalý hastalarda YAS deðerlendirmesinin kullanýlmasýnda birtakým güçlükler vardýr. Ölüme katkýsý olan alkol, ilaç kullanýmý gebelik gibi fizyolojik deðiþiklikler YAS’da gösterilmemektedir. YAS’ýn güncellenerek geliþtirilmesi gereklidir. Bu sayede kliniklerin bakým kalitesinin deðerlendirilmesi ve travma merkezlerinin standardizasyonu daha doðru yapýlabilir.

BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.
BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.

AMAÇ: Bu çalýþmada 2005 yýlý 8. Ankara Aciller Toplantýsý’na katýlan ve Ankara’daki çeþitli acil servislerde çalýþan toplam 52 hekimin resüsitatif torakotomi (RT) giriþimi ile ilgili görüþleri belirlenmeye çalýþýldý.
GEREÇ-YÖNTEM: Hekimlerin RT giriþimine dair görüþlerine yönelik 14 soru içeren anket formu hazýrlandý. Anketörler formlarý tek baþlarýna yanýtlama yöntemi ile doldurdular. Verilerin analizinde Student t-testi ve ANOVA yöntemleri kullanýldý.
BULGULAR: Ankete katýlan hekimlerin RT’nin %65,4 acil serviste yapýlmasý gerektiði, %69,23 uzman hekimler tarafýndan yapýlmasý gerektiði; ancak endikasyon kesin olduðunda herkesin deneyimli olmak koþulu ile yapabileceði görüþünde olduklarý ve katýlýmcýlarýn %96,15’inin mezuniyet sonrasý eðitim kurslarý kapsamýnda eðitim almak istedikleri saptandý.
SONUÇ: Týp eðitimlerimizde resüsitatif torakotomiye ait teorik ve pratik eðitim politikasý yeniden gözden geçirilmelidir. Acil servislerde bu konuda ciddi organizasyonlara gidilmesi, resüsitatif torakotomi iþleminin deneyimli kiþiler tarafýndan uygulanmasý, endikasyonlarýnýn çok iyi belirlenmesi ve acil servis çalýþanlarý hekimlere mezuniyet sonrasý eðitim kurslarý düzenlenerek öðretilmesi gerekir.

BACKGROUND: The aim of this study was to define the opinions of 52 emergency physicians working in different ERs in Ankara and participated in the 8th Ankara Emergency Meeting 2005, on resuscitative thoracotomy (RT).
METHODS: A questionnaire form containing 14 questions was designed for the opinions of physicians on RT. Responders filled in the forms through answering the questions by themselves. Data were analyzed using Student’s t-test and ANOVA.
RESULTS: The survey concluded three common points: 1. Resuscitative thoracotomy should be performed in the emergency rooms (65,4%), 2. It should be performed by specialists however; it is a procedure which can and should be conducted by every experienced emergency physician easily when the indications are clear (69,23%). 3. Majority of the responders stated that they would like to get a post-education courses on this subject (96,15%).
CONCLUSION: Theoretical and practical policies of our medical education on RT should be revised. Emergency rooms should be equipped for this intervention. Resuscitative thoracotomy should be applied by the experienced people, indications should be clarified well and emergency physicians should be trained on resuscitative thoracotomy by regular post-graduation courses.

AMAÇ: Parçalý intraartiküler distal radius kýrýklarýnda voler plaklama ile tedavi edilen yetiþkin hastalarýn orta dönem takip sonuçlarý sunuldu.
GEREÇ-YÖNTEM: 1999-2003 yýllarý arasýnda parçalý intraartiküler distal radius kýrýðý nedeniyle ameliyat edilen eriþkin hastalardan 23 tanesine açýk redüksiyon ve voler plaklama uygulandý. Düzenli takipleri yapýlan 19 hasta (11 kadýn, 8 erkek; ort. yaþ 34; daðýlým 22-54) çalýþmaya dahil edildi. Yaralanma çoðu hastada sadece tek el bileðiyle sýnýrlýydý (7 dominant - 12 nondominant). Hastalarýn ameliyat öncesi deðerlendirmeleri hikaye, fizik muayene ve radyolojik incelemeleri (direkt grafiler, bilgisayarlý tomografi) içerdi. AO/ASIF kriterlerine göre hastalarýn 7’si tip B [B1 (1); B2(3); B3(3)], kalan 12’si ise tip C [C1(7); C2(5)] þeklinde sýnýflandý. Cerrahi prosedür voler yaklaþýmla, plak ve vidalar kullanýlarak internal fiksasyon uygulamasýný içerdi. Ameliyat sonrasý erken dönemde hareket açýklýðý egzersizlerine baþlandý. Hastalar klinik ve radyolojik olarak ortalama 28 ay (13 - 47 ay) takip edildi. Komplikasyonlar kaydedildi.
BULGULAR: Tüm hastalarda kaynama saðlandý. Radyografik parametreler; radyal yükseklik, radyal inklinasyon, voler eðim, ve eklem yüzey uyumsuzluklarý ameliyatla birlikte düzeltilerek son takiplere kadar korundu. Gartland ve Werley skorlamasýna göre hastalarýn 9’unda (%47) mükemmel, 7’sinde (%37) iyi ve 3’ünde de (%16) orta sonuçlar alýndý. Üç hastada yara sorunlarý ve bir hastada uzun süreli skar hassasiyeti geliþmesi dýþýnda ameliyat sýrasýnda ve ameliyat sonrasý baþka komplikasyonla karþýlaþýlmadý.
SONUÇ: Voler yaklaþýmla plaklama, intraartiküler distal radius kýrýklarýnýn tedavisinde, distal fragmanýn deplasman yönüne bakýlmaksýzýn, güvenilir ve etkili bir yöntemdir.

BACKGROUND: We herein present the mid-term results of the adult patients with communited intra-articular fractures of the distal radius who were treated by palmar plating.
METHODS: Between 1999 and 2003, open reduction and palmar plating were performed in 23 of the patients who had surgical treatment for comminuted intra-articular fractures of the distal radius. Nineteen patients (11 females, 8 males; mean age 34; range 22 to 54 years) with regular follow-up were included in the study. In the majority of patients only one wrist was involved (7 dominant - 12 nondominant). Preoperative evaluation included patient’s history, physical examination, and radiological studies (plain radiographs, computed tomography). The patients were classified according to AO classification as 7 type B [B1 (1); B2 (3); B3 (3)] and 12 type C [C1 (7); C2 (5)]. The surgical procedure included internal fixation by using plates and screws with palmar approach. Range of motion exercises were started immediately after the operations. The patients were followed clinically and radiographically, with an average follow-up time of 28 months (range, 13-47 months). Complications were recorded.
RESULTS: Union was achieved in all patients. Radiographic parameters including the radial height, radial inclination, palmar tilt, and articular congruency have been corrected in the operation and remained unchanged until the last follow-up. According to the Gartland and Werley’s classification, there were 9 (47%) excellent, 7 (37%) good, and 3 (16%) fair results. No perioperative and postoperative complications were recorded, except for three wound problems and one prolonged scar tenderness.
CONCLUSION: Palmar plating is a safe and effective treatment for comminuted intraarticular fractures of the distal radius, regardless of direction of displacement of the distal fragment.

AMAÇ: Bu çalýþmada maksillofasiyal travmalý hastalara yaklaþým, uygulanan tedavi þekli ve karþýlaþýlan sorunlar ele alýndý.
GEREÇ-YÖNTEM: 1992-2004 tarihleri arasýnda kliniðimize baþvuran, klinik ve radyolojik olarak maksillofasiyal kemiklerden en az birinde kýrýk saptanan 602 hastanýn (486 erkek; 116 kadýn; ort. yaþ 28,4±15,2; daðýlým 1-80) dosyasý incelendi. Hastalarýn travma etyolojileri, kýrýk lokalizasyonlarý, yaþ ve cinsiyete göre daðýlýmlarý, tedavi öncesi geçen süre, uygulanan tedavi biçimi ve ameliyat sonrasý komplikasyonlar deðerlendirildi.
BULGULAR: Hastalarýn; %42,7’sinde mandibula kýrýðý, %25,9’unda nazal kýrýk, %11’inde maksilla kýrýðý, %5,6’sýnda zigoma kýrýðý, %5,3’ünde multipl yüz kýrýklarý, %4,8’inde ‘blow-out’ kýrýðý ve %4,7’sinde frontal sinüs kýrýðý saptandý. Üç yüz kýrkaltý (%57) olguya açýk redüksiyon ve mini plakla fiksasyon, 256 (%43) olguya ise kapalý redüksiyon uygulandý. Ameliyat sonrasý dönemde 51 (%8,3) hastada komplikasyon meydana geldi.
SONUÇ: Bazý komplikasyonlara neden olmasýna raðmen; güçlü bir fiksasyon saðlamasý, kolay uygulanabilir olmasý, estetik ve kozmetik sonuçlarý iyi olmasý nedeniyle, maksillofasiyal travma tedavisinde açýk redüksiyon ve mini plakla fiksasyon tercih edilebilir bir tedavi yöntemidir.

BACKGROUND: The approach and type of management along with the common complications in maxillofacial trauma were evaluated in this study.
METHODS: Medical records of 602 patients (486 males; 116 females; mean age 28,4±15,2; range 1 to 80 years) with maxillofacial fractures, admitted to the Department of Otolaryngology between 1992 and 2004, were evaluated in this study. Maxillofacial fracture was diagnosed by clinical and radiological findings. Sex and age distribution of patients, etiology of trauma, localization of the fractures, treatment modalities, time to treatment after the trauma and postoperative complications were recorded.
RESULTS: There were 257 (42,7%) mandible, 156 (25,9%) nose, 66 (11%) maxillary, 34 (5,6%) zygoma, 32 (5,3%) multiple facial, 29 (4,8%) blow-out and 28 (4,7%) frontal sinus fractures. While 256 (43%) patients underwent closed reduction, 346 (57%) patients were treated by open reduction. Postoperative complications were seen in 8,3% (51) of patients.
CONCLUSION: Although associated with some complications, open reduction and miniplate fixation should be the preferred treatment option, since it provides a powerful fixation, is easy to perform, and has better esthetic and cosmetic results.

AMAÇ: Penetran kolon yaralanmalý olgularda morbidite ve mortaliteye etkili faktörler araþtýrýldý.
GEREÇ-YÖNTEM: Kýrk iki olgu (37 erkek, 5 kadýn; ort. yaþ 30,1; daðýlým 14-63) yaþ, cinsiyet, penetran travmanýn türü, kolonda yaralanma yeri, kolon yaralanmasýnýn þiddeti, ek organ yaralanmasý, yaralanmadan ameliyata kadar geçen süre, hemodinamik durum, kan transfüzyonu, fekal kontaminasyon, cerrahi iþlem, ameliyat sonrasý komplikasyon ve mortalite açýsýndan incelendi.
BULGULAR: Olgularýn 28’inde (%67) kesici delici alet yaralanmasý, 14’ünde (%33) ateþli silah yaralanmasý vardý. Kolon yaralanma þiddeti skoru ortalamasý 2,1 idi. Abdominal Travma Ýndeksi (ATÝ) deðeri ortalama 17,2 olup, sekiz olguda (%19) 25’in üzerindeydi. On bir olguda (%26) baþvuru anýnda þok tablosu vardý; on altý olguya (%38) kan transfüzyonu yapýldý. Yirmi bir olguda karýn içi hemoraji vardý ve bu durum on bir olguda (%26) 500 ml’nin üzerinde idi. Olgularýn 36’sýna (%86) primer tamir, altýsýna (%14) stomalý ameliyatlar uygulandý. Morbidite ve mortalite oranlarý sýrasýyla %41 ve %10 bulundu.
SONUÇ: Abdominal Travma Ýndeksi deðerinin 25 ve üstünde olmasýnýn morbiditeyi artýrdýðý; baþvuru anýnda þok tablosu, ameliyatta karýn içi serbest kan miktarýnýn 500 ml’den fazla olmasý, üç ünite ve daha fazla kan transfüzyonu yapýlmasýnýn da mortaliteyi anlamlý olarak artýrdýðý bulundu. Hemodinamisi stabil ve ATÝ skoru 25’in altýnda olan penetran kolon yaralanmalý hastalarda primer onarým güvenle uygulanabilir.

BACKGROUND: In this study, the factors that effect the morbidity and mortality in patients with penetrating colonic injuries were evaluated.
METHODS: Fourty-two patients (37 males, 5 females; mean age 30,1; range 14 to 63 years) with penetrating colonic trauma were evaluated according to age, gender, type of penetrating trauma, location and severity of the colonic injury, associated injury, interval between the trauma and the definitive operation, hemodynamic status, blood transfusion requirement, fecal contamination, surgical procedure, postoperative complication and mortality.
RESULTS: Type of the penetrating trauma was stab injury in twenty-eight (67%) patients, and gunshot injury in fourteen (33%) patients. The mean Colon Injury Severity Score was 2,1. The mean Abdominal Trauma Index (ATI) was 17,2 and it was over than 25 in eight (19%) patients. The symptoms of shock were present in eleven (26%) patients at admission. Blood transfusions were applied in sixteen (38%) patients. In twenty-one patients intraabdominal bleeding was observed and it was more than 500 mL in eleven (26%) patients. Primary repair was performed in 36 (86%) of the 42 patients and colostomy was performed in six (14%) patients. Morbidity and mortality rates were 41% and 10% respectively.
CONCLUSION: It was found that morbidity rates were increased in patients with ATI score higher than 25, and mortality rates were increased in patients presenting shock at admission, with the amount of intraabdominal blood more than 500 mL, and who needed three or more units of blood transfusion. The primary repair of the penetrating colon trauma can be performed confidently in the hemodynamicaly stable patients with ATI score less than 25.

AMAÇ: Bu çalýþma yaþlý travma hastalarýnda demografik ve klinik özellikleri saptamak, mortalite ve morbiditeye etkili faktörleri incelemek ve ülkemizdeki travma verilerine katkýda bulunmak amacýyla yapýlmýþtýr.
GEREÇ-YÖNTEM: Retrospektif olarak 65 yaþ ve üstü 371 olgunun týbbi kayýtlarý incelenmiþtir. Olgular, yaþ, cinsiyet, travma mekanizmasý, yaralanma bölgeleri, prognoz, travma skorlarý ( GKS (Glasgow koma skoru, RTS ( eriþkin travma skoru), ISS (yaralanma þiddet skoru) açýsýndan analiz edilmiþtir.
BULGULAR: Çalýþma süresi boyunca acil servisimize toplam 187.326 hasta baþvurmuþtur. Bu hastalarýn 9520 tanesi travma olgusudur. Tüm travma olgularýnýn ise 371 tanesi 65 yaþ ve üstü yaþ grubuna dahildir. Olgularýn yaþ ortalamasý 71.9’dur. Olgularýn % 62.3’ü erkek, % 37.7’ si ise kadýndýr. Ortalama travma skorlarý ise sýrasýyla GKS: 13.6, RTS: 11.3 ve ISS: 9.3’dür. Toplam 213 hasta yatýrýlarak tedavi görmüþtür ve ortalama yatýþ süresi 7.9 gündür. 66 olgu ise acil servisten taburcu edilmiþtir.Mortalite oraný % 10.2 (38/371). Yaralanma mekanizmasý, yaralanma þiddeti ve yaþýn mortaliteyi etkileyen faktörler olduðu saptanmýþtýr (p< 0.001). Yaralanma bölgesi açýsýndan kafa travmasý ve ekstremite travmasýnýn ayný sýklýkta olduðu (% 36.4), toraks travmasýnýn ise ikinci sýrayý aldýðý (% 18) görülmüþtür. Kafa travmasý ve abdominal travmanýn ölen olgularda anlamlý olarak sýk görüldüðü tespit edilmiþtir (p< 0.001, p= 0.02)
SONUÇ: Yaralanma þiddeti ve yaþ mortaliteyi belirleyen önemli faktörlerdir. Ayrýca araç dýþý motorlu taþýt kazalarý diðer travma mekanizmalarýna göre daha yüksek mortaliteye sahiptir. Son olarak yaþlý olgularda yaralanmaya en çok maruz kalan bölgeler kafa ve ekstremitelerdir.

BACKGROUND: The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and morbidity and to make a contribution to the national trauma data,
METHODS: We retrospectively investigated the medical records of three hundred seventy-one trauma patients (231 males (62,3%); 140 females (37,7%); mean age 71,9), aged 65 and older presenting to our hospital. Patients’ census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), RTS (Adult Trauma Score), ISS (Injury Severity Score)), sites of injury were analyzed.
RESULTS: During the study period 187.326 patients were admitted to our emergency department (ED). A total of 9.520 patients were trauma patients. There were 371 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,6, 11,3, and 9,3 respectively. A total of 213 patients were hospitalized. Mean length of stay was 7,9 days. Sixty-six patients were discharged from the ED. Mortality rate was 10,2% (38/371). The mechanism of injury, injury severity, increasing age were predictors of mortality (p<0.001). Major injuries included head trauma (36,4%), extremity trauma (36,4%), and thoracic trauma (18%). Head trauma and abdominal trauma were significantly more frequent in the nonsurvivors (p<0.001 and p=0.02 respectively).
CONCLUSION: Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities.

AMAÇ: Türkiye’de demiryolu taþýmacýlýðý ile iliþkili kazalar sonucunda, yýlda taþýnan 100 milyon yolcu baþýna 150-200 ölüm gerçekleþmektedir. Bu çalýþmada amacý demiryolu taþýmacýlýðý sýrasýnda gerçekleþen ölüm ve yaralanmalarýn epidemiyolojik analizi yapýldý.
GEREÇ-YÖNTEM: Türkiye’de Ocak 1997-Aralýk 2003 tarihleri arasýnda gerçekleþen yaralanma ve ölümlü demiryolu kazalarýna ait bilgiler geriye dönük olarak incelendi.
BULGULAR: Demiryolu ile iliþkili kaza ve olaylar yýllýk 100 milyon yolcu baþýna 213,3 ölüme neden olmaktadýr. Tren-yaya çarpýþmalarý en fazla sayýda mortaliteye, hemzemin geçit kazalarý en fazla sayýda yaralanmaya neden olmuþtur. Ýntihar amacý ile tren yollarýnýn kullanýlmasý demiryollarýnda en yüksek mortalite oranýna sahip olaylardýr. Ölüm ve yaralanmalarýn büyük çoðunluðu erkek cinsiyette ve 25-60 yaþ grubunda görülmüþtür. En fazla ölüm ve yaralanma yaz döneminde meydana gelmiþtir.
SONUÇ: Demiryolu taþýmacýlýðýnda güvenliði arttýrýcý önlemlerin alýnmasý gerekmektedir. Bu önlemlerin baþýnda yayalarýn demiryoluna girmemesini saðlayacak önlemler ve hemzemin geçitlerin durumunun iyileþtirilmesi gelmektedir.

BACKGROUND: Railway related accidents and incidents account for 150-200 deaths per 100 million passengers annually in Turkey. The aim of this study was to evaluate the epidemiological aspects of these casualties.
METHODS: The data about railway related casualties between January 1997 and December 2003 were retrospectively analyzed in Turkey.
RESULTS: Railway related accidents and incidents resulted in 213,3 deaths per year per 100 million passengers during the study period. Train-pedestrian accidents caused highest number of mortality and level crossing accidents caused highest numbers of casualty. Furthermore, suicide attempts had highest mortality ratio in railway related accidents. The majority of the fatalities and injuries occured in males for every type of incident and most of the injuries have taken place in the 25-60 age group. Summer time was the season with the highest number of fatalities and injuries.
CONCLUSION: Measures should be taken to improve railway safety. These include prevention of direct exposure of pedestrians to the railway tracts and conditioning the level crossings.

Sentetik greft kullanýlan periferik damar ameliyatlarýndan sonra greft enfeksiyonlarý görülebilir. Ateþli silahlý yaralanmasýndan sonra sentetik greftle femoro-femoral baypas yapýlan ve geniþ doku defekti bulunan bir hasta kliniðimize kabul edildi. Distal pedal nabýzlar palpe edilebiliyordu. Beþinci günde hastada greft bölgesinde kanama oldu ve hasta acil olarak ameliyata alýndý. Ýlk olarak enfekte greft materyeli çýkarýldý. Daha sonra lomber insizyonla eksternal iliyak artere PTFE greftin proksimal anastomozu yapýldý. Krista iliyaka süperiyorun mediyalinden ve inguinal ligamentin altýndan bir tünel oluþturuldu. Enfekte alaný dýþarýda býrakacak þekilde sartorius kasýnýn arkasýndan, PTFE greft bu tünelden geçirildi ve süperfisiyal femoral artere anastomoz edildi. Kontrol anjiyografisinde anostomozlarýn açýk olduðu gözlendi. Geniþ doku kayýplarýnýn bulunduðu greft enfeksiyonlarýnda alternatif bir giriþim olarak retro-sartorius baypas baþarýyla uygulanabilir bir seçenektir.

Graft infections can be seen after the peripheric vascular operations using synthetic graft. The patient who had femoro-femoral bypass with synthetic graft after a gunshot wound admitted to our department with graft infection and wide tissue loss. The distal pedal pulses were palpable. At the fifth day, the patient had a bleeding on the graft site and underwent emergency operation. Firstly the infected graft material was excised. Then the proximal end of the PTFE graft anastomosed to the external iliac artery with the lomber incision. A tunnel was formed just medial to the superior crista iliaca and under the inguinal ligament. The PTFE graft was passed through this tunnel excluding the infected area behind sartorius muscle and anastomosed to superficial femoral artery. Control angiography revealed that anastomoses were patent. At the graft infections which are especially with wide tissue loss, the retro-sartorious bypass surgery can be performed successfully as an alternative procedure.

Yedi yaþýnda erkek çocuk, sol gözüne sanayi tipi dikiþ makinesi iðnesinin batmasý þikayeti ile acil servise getirildi. Dikiþ iðnesi sol orbitadan girerek sfenoid kemiði delmiþ ve sol temporal lobun dura yapraklarý içine uzanmaktaydý. Cerrahi tedavi uygulanan olguda ameliyat sonrasý dönemde komplikasyon oluþmadý. Orbitadan girerek beyine kadar uzanan penetran yabancý cisimler intraserebral hematom, beyin apsesi, menenjit, beyin omurilik sývýsý (BOS) fistülü, proptosis, diplopi, orbital sellülit ve periorbital apse gibi komplikasyonlara neden olabilirler. Bu komplikasyonlarý önlemek için penetran transorbital uzanýmlý yabancý cisimler cerrahi yaklaþýmla çýkartýlmalýdýr.

We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications.

Kaza ile oluþan ciddi hipotermi (merkezi vücut ýsýsýnýn 28 °C’nin altýnda olmasý) yüksek mortalite ile iliþkili medikal, acil ve hayatý tehdit eden bir durumdur. Prognoz, altta yatan hastalýða, ileri veya çok genç yaþa, tedaviye dek geçen süreye, hemodinamik bozukluðun derecesine ve özellikle aktif içten ve dýþtan yeniden ýsýtmayý içeren tedavi yöntemlerine baðlýdýr. Bu yazýda; sokakta bulunan, donma nedeni ile hastanemize getirilen ciddi hipotermisi olan 70 yaþýnda bir erkek hasta sunuldu. Tüm resüsitasyon çabalarýna ve ýsýtma yöntemlerine raðmen kaybedilen bu olgu, hipotermi tedavisi üzerine yapýlan son tartýþmalara, resüsitasyon çabalarýna ve olasý komplikasyonlara deðinmek amacý ile sunuldu.

Severe accidental hypothermia (core body temperature of less than 28 °C) is a life threatening state and a medical emergency associated with a high mortality rate. The prognosis depends on underlying diseases, advanced or very early age, the duration prior to treatment, the degree of hemodynamic deterioration, and especially, the methods of treatment, including active external or internal rewarming. We report a 70-year-old male patient with severe accidental hypothermia (core temperature 28 °C). The homeless man was found in the street. He died, in spite of all resuscitation efforts and rewarming methods. In this case report reviews the epidemiology, pathophysiology, clinical presentation, and treatment of accidental hypothermia.

Yað embolizmi sendromu (YES) özellikle uzun kemik kýrýklarýnda geliþen bir travmatoloji komplikasyonudur. Yað embolisine baðlý klinik tablo sýklýkla belirgin olmayabilir ve belirtiler deðiþiklik gösterdiði için, rutin laboratuvar ve radyografik taný yöntemi olmadýðýndan taný zor koyulmaktadýr. Klasik olarak, YES uzun kemik kýrýðýndan 24 ile 48 saat sonra oluþan solunum sýkýntýsý, þuur deðiþiklikleri ve peteþiyal döküntüler triadý ile ortaya çýkar.
Bu çalýþmada, travmatik YES geliþen 16 yaþýndaki kýz çocuðu sunuldu. Olguda travmatik yað embolisi tanýsý, temel olarak mevcut klinik deðiþiklikler, radyolojik ve laboratuvar bulgularýnýn yaný sýra geliþen arteriyel hipoksemiye neden olabilecek bozukluklarýn yokluðunun gösterilmesi ile konuldu. Yoðun bakým servisine alýnan hasta pozitif end-ekspiratuvar basýnç ile uygulanan ventilatör ve destek tedavisi sonucu durumundaki düzelme ile açýk redüksiyon ve internal fiksasyon yapýlmak üzere taburcu edildi.

Fat embolism syndrome (FES) is a known complication of traumatology, especially in long bone fractures. Fat embolic events are most often clinically insignificant and difficult to recognize since clinical manifestations are varied and there is no routine laboratory or radiographic diagnostic tool. Classically, FES presents with the triad of pulmonary distress, mental status changes, and petechial rash 24 to 48 hours after long-bone fracture. We report the intensive care management of a 16-year-old female patient who developed traumatic fat embolism syndrome. Traumatic fat embolism was diagnosed, based on suggestive clinical manifestations, radiographic and laboratory findings and confirmed by the demonstration of arterial hypoxemia in the absence of other disorders. Admission to the intensive care unit, mechanical ventilatory support with positive end-expiratory pressure and supportive therapy leaded to the patient's improvement and she was discharged with planned open reduction and internal fixation.