AMAÇ
Trombositce zengin plazma (TZP), kemik iyileþmesine katkýda bulunmak üzere uygulanmýþ ve kemik yenilenmesine yönelik yeni bir materyal olarak geliþtirilmiþtir. Bu çalýþmada tavþanlarda, kemik iliði kaynaklý stromal hücreler (KÝKSH) vermek ve kritik kemik iliði hasarlarýný düzeltmek için kemik dokularýný yenilemek üzere TZP taþýyýcýlýðýnýn fizibilitesinin incelenmesi amaçlandý.
GEREÇ VE YÖNTEM
On sekiz tavþanýn kafatasýna ciddi ölçüde hasar verildi ve bunlar deðiþik kompozitlerle tedavi edildi: KÝKSH/TZP (n=6); otojen partiküler kansellöz kemik grubu (n=6) ve tek baþýna TZP grubu (n=6). Hasarlar, ameliyattan sonra 12. haftada gros gözlem, radyografik, histolojik ve mekanik incelemelerle deðerlendirildi.
BULGULAR
Kemik hasarý tamirinin tek baþýna TZP grubunda en az düzeyde olduðunu, KÝKSH/TZP grubu ile partiküler kansellöz kemik grubunda anlamlý yeni kemik oluþumu gözlenebileceðini, radyoopasite alanýnýn KÝKSH/TZP grubunda otojen partiküler kansellöz kemik grubundakinin (radyoopasite alanýnda %82.4) %76.5’i oranýnda kazanýldýðýný, planlanarak düzenlenmiþ kemiðin kompresif gücünün KÝKSH/TZP grubunda otojen partiküler kansellöz kemik grubundakinin %71’i oranýnda kazanýldýðýný gösterdi (p<0.05).
SONUÇ
TZP jelden salýverilen KÝKSH’lerin, baðýþýklýk sistemi normal olan hayvanlarda kemik hasarýný tamir edebileceðini ve KÝKSH/TZP grubundaki planlanarak düzenlenmiþ kemiðin kritik ölçüdeki hasarýnýn tamirinde otojen partiküler kansellöz kemik grubundaki ile karþýlaþtýrýlabilir olduðunu göstermiþtir.

BACKGROUND
Platelet-rich plasma (PRP) has been applied to promote bone healing and developed as a novel material for bone regeneration. This study aimed to investigate the feasibility of PRP carrier to deliver bone marrow derived stromal cells (BMSCs) and regenerate bone tissues to reconstruct critical bone defects in rabbits.
METHODS
Critical sized defect were made on eighteen rabbits’ crania and treated by different composites: BMSCs/PRP (n=6); Autogenous particulate cancellous bone group (n=6) and PRP alone group (n=6). The defects were evaluated by gross observation, radiographic examination, histological examination, and mechanical examination at 12 weeks postoperatively.
RESULTS
The results showed that repair of bone defect was the least in PRP alone group, and significant new bone formation could be observed in BMSCs/PRP group and particulate cancellous bone group, radiopacity area in BMSCs/PRP group attained 76.5%, which was in the same range of that in autogenous particulate cancellous bone group (82.4% in radiopacity area), compressive strength of engineered bone in BMSCs/PRP group attained 71% of that in autogenous particulate cancellous bone group (p<0.05).
CONCLUSION
These data implicated that BMSCs delivered from PRP gel can repair bony defect in immunocompetent animals, and the tissue engineered bone in BMSCs/PRP group is comparable to autogenous particulate cancellous bone group for the repair of critical-sized bone defect.

AMAÇ
Bu çalýþmanýn amacý, sýçanlarda akut stres gastritis geliþmesinde düþük serum tiroit hormon düzeylerinin etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM
Altmýþ eriþkin Sprague-Dawley cinsi sýçan onarlý altý gruba ayrýldý: Kontrol grubu, cerrahi tiroidektomi grubu, stres grubu, cerrahi tiroidektomi + stres grubu, cerrahi tiroidektomi + T4 + stress grubu ve cerrahi tiroidektomi + T3 + stres grubu. Gastrik mukoza hasarýnýn sayý ve büyüklüðü milimetrik asetat kaðýdý kullanýlarak 3,5 kez büyütülmüþ fotoðraf üzerinde belirlendi.
BULGULAR
Sadece stres altýnda olan sýçanlar (grup III) ile karþýlaþtýrýldýðýnda cerrahi tiroidektomi + stres grubunda (grup IV) akut stres gastriti, belirgin olarak artmýþtý (stres gastriti skorlarý; grup IV: 44, grup III: 16, p<0,001). Grup IV’teki sýçanlarla karþýlaþtýrýldýðýnda stres gastriti skorunun grup VI’da belirgin olarak azaldýðý gözlendi (stres gastriti skorlarý; grup VI: 10, grup IV: 44, p<0,001).
SONUÇ
Sýçanlarda düþük serum tiroit hormon düzeyleri stres gastritinin geliþmesini artýrmakta ve bu etki, tiroit hormon replasman tedavisi ile önlenebilmektedir.

BACKGROUND
The aim of this study was to investigate the effect of low circulating thyroid hormone levels on the development of acute stress gastritis in rats.
METHODS
Sixty adult Sprague-Dawley rats were divided into six groups: Control group, surgically thyroidectomized group, stressed group, surgically thyroidectomized + stressed group, surgically thyroidectomized + T4 + stressed group, and surgically thyroidectomized + T3 + stressed group. Damage to the gastric mucosa was studied using millimetric acetate papers on photographs enlarged 3.5 times and the number and the size of the lesions was recorded.
RESULTS
Acute stress gastritis was significantly increased in stress + surgically thyroidectomized rats as compared to rats that were only put under stress (group III) (stress gastritis scores; group IV: 44, group III: 16, p<0.001). The stress gastritis score in group VI was significantly decreased compared to rats in group IV (stress gastritis scores; group VI: 10, group IV: 44, p<0.001).
CONCLUSION
Low circulating thyroid hormone levels in rats increased the development of stress gastritis. This effect could be prevented by thyroid hormone replacement therapy.

AMAÇ
Hava temasý tendonlarda canlý-dýþý (in vitro) ortamda matriks sentezini ve hücre ilerlemesini azaltabilir ve hatta önleyebilir. Bu çalýþmanýn amacý, dehidrasyon ve irigasyonun Aþil tendon iyileþmesi üzerine etkisinin canlý-içi (in vivo) hayvan modeli üzerinde gösterilmesidir.
GEREÇ VE YÖNTEM
Kýrk beþ adet Sprague-Dawley cinsi sýçanýn Aþil tenotomisi yapýldý. Kontrol grubunda, tendon hemen dikildi. Diðer iki grubun cilt ve cilt altý dokularý ekarte edilerek Aþil tendonlarýnýn doðrudan hava ile temasý saðlandý. Bu gruplardan birine irigasyon uygulanýrken diðerine uygulanmadý. 60 dakikalýk hava temasýný takiben, her iki grubunda tendonlarý kontrol grubuna da yapýldýðý gibi dikilerek yaralarý kapatýldý. Operasyon sonrasý 28. günde sýçanlar öldürüldü. Aþil tendonlarý parçalara ayrýlarak histolojik ve biyomekanik incelemelere alýndý.
BULGULAR
Hava temasý saðlanan gruplarýn histolojik incelemesinde, tendonun çevre dokulara yapýþmasýyla birlikte yoðun fibröz doku oluþumu olduðu görüldü. Ýrige edilmeyen ve edilen her iki deney grubunda da yüksek oranda damarsallaþma ve enflamatuvar reaksiyon saptandý. Biyomekanik çalýþma da, hava temasýna uðrayan tendonlarda kontrol grubuna göre daha yüksek gerilme gücü buna karþýn daha düþük bükülebilme olduðu görüldü.
SONUÇ
Hava temasý fibroz doku ve yapýþýklýk oluþumuna sebebiyet vererek iyileþme kalitesini düþürmektedir. Ýrigasyon, bu istenmeyen etkileri ortadan kaldýrmamaktadýr. Buna raðmen gerilme kuvveti hava temasýndan etkilenmemektedir.

BACKGROUND
Air exposure is a factor that inhibits in vitro cellular proliferation and matrix synthesis in tendons. Aim of this experimental study was to evaluate effect of dehydration and irrigation on healing of Achilles tendon.
METHODS
Achilles tenotomy was done in forty-five Sprague-Dawley rats. In control group, tendon was sutured immediately. In the remaining two groups, the Achilles tendons were allowed to direct exposure of air. Irrigation of Achilles tendon was performed in one of exposed groups, while irrigation was not done in other group. After 60 minutes, tendons of both groups were sutured same as control group. Rats were sacrificed at postoperative day 28. Achilles tendons were dissected and histological and biomechanical evaluations were performed.
RESULTS
Histological evaluation revealed intense fibrosis formation with adhesion of tendon to surrounding tissues in the air exposed groups. The quantity of angiogenesis and inflammatory reaction were also higher in experimental groups regardless of irrigation. Air exposed tendons had higher tensile strength however lower stiffness than control group in biomechanical evaluation.
CONCLUSION
Air exposure decreases quality of healing by increasing fibrosis and adherence formation. These negative effects of exposure to air were not counteracted by irrigation. However, air exposure didn’t affect tensile strength of the healing.

AMAÇ
Bu çalýþma, yoðun bakým ünitesine (YBÜ) yatýrýlan travma hastalarýndaki entübasyon gereksinimi (EG), mekanik vantilasyon gereksinimi (MVG) ve mekanik vantilasyon süresinin öngörülmesine iliþkin, yaralanma þiddeti ölçeði (ISS) ve yeni yaralanma þiddeti ölçeði (NISS) sistemlerinin doðruluðunu onaylamaktadýr.
GEREÇ VE YÖNTEM
Bu prospektif kohort çalýþmaya 110 travma hastasý dahil edildi. ISS ve NISS ile ilgili öngörme kesinlikleri, YBÜ yatýrýlma prosedürü lojistik regresyon modeline iliþkin Kabul Eden Operatör Karakteristiði (ROC) eðrileri ve Hosmer-Lemeshow (H-L) istatistikleri kullanýlarak karþýlaþtýrýldý.
BULGULAR
EG öngörüsüne iliþkin en iyi kesilme noktalarý, ISS için 22 ve NISS için 27 oldu. Pozitif öngörme deðeri, NISS’de %91,6, ISS’de %87,8 idi. Youden indeksi, NISS için 0,47, ISS için 0,57 seviyesinde en iyi kesilme noktalarýna sahip oldu. ROC eðrisi altýnda kalan alan, NISS’de 0,79, ISS’de 0,86 oldu. Youden indeksi ve ROC eðrisi altýnda kalan alan anlamýnda, NISS ile ISS arasýnda istatistiksel farklýlýk olduðu saptandý (p<0,05). MVG’nin öngörülmesine iliþkin olarak, NISS, ISS’ye göre ROC eðrisi altýnda kalan alanda ve Youden indeksinde daha iyi sonuçlar verdi (p<0,05).
SONUÇ
EG veya MVG’nin öngörülmesi ile ilgili olarak, NISS, ISS’ye göre daha yüksek doðruluða sahiptir.

BACKGROUND
This study validates the accuracy of the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) systems for prediction of need intubatin (NI), need mechanical ventilation (NMV), and duration of mechanical ventilation (DMV) in intensive care unit (ICU) trauma patient admissions.
METHODS
One-hundred ten trauma patients were included in this prospective cohort study. The predictive accuracies of the ISS and the NISS were compared using Receiver Operator Characteristic (ROC) curves and Hosmer-Lemeshow (H-L) statistics for the logistic regression model of ICU admission.
RESULTS
For prediction of NI, the best cut-off points were 22 for ISS and 27 for NISS. The positive prediction value was 91.6% in NISS and 87.8% in ISS. The Youden index had best cut-off points at 0.47 for NISS and 0.57 for ISS. The area under Receiver Operating Characteristic (ROC) curve was 0.79 in the ISS and 0.86 in the ISS. There were statistical differences among NISS with ISS in terms of Youden index and the area under the ROC curve (p<0.05). For the prediction of NMV, NISS yielded significantly better results in the area under the ROC curve and Youden index than those of ISS (p<0.05).
CONCLUSION
For prediction of NI or NMV, the NISS has better accuracy than ISS.

AMAÇ
Nonspesifik karýn aðrýlý hastalarýn ayrýmýnda, hastalýk hikayesi, klinik bulgular, basit laboratuvar deðerlendirmelerinin tanýsal deðerini belirlemek ve bu hastalarýn uzun süreli takiplerini analiz etmektir.
GEREÇ VE YÖNTEM
Uludað Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý Acil Servisi’nde Kasým 2001 ile Kasým 2002 tarihleri arasýnda prospektif gözlem çalýþmasý gerçekleþtirildi. Altý yüz on karýn aðrýlý hasta, spesifik karýn aðrýsý (501 hasta) ve nonspesifik karýn aðrýsý (109 hasta) olarak gruplandýrýldý. Nonspesifik karýn aðrýlý hastalar 24 saat sonra takip deðerlendirmesi için çaðrýldýlar; 8., 15., 30. günler ile 1 yýl sonunda olmak üzere 4 takip görüþmesi için tekrar çaðrýldýlar. Ýki grubun bulgularý arasýnda istatistiksel deðerlendirme yapýldý.
BULGULAR
Lojistik regresyon analizinde daha önce benzer bir aðrý hikayesi varlýðý (odds oraný 1,88; p=0,009), bulantý (odds oraný 0,46; p=0,001), defans (odds oraný 0,24; p=0,024), ateþ ≤36,6°C (odds oraný 1,66; p=0,037), lökosit sayýmý ≤8700 (odds oraný 1,85; p=0,011), yaþ ≤39 (odds oraný 1,85; p=0,018), solunum hýzý ≤15 (odds ratio 3,19; p=0,00) anlamlý baðýmsýz tanýsal faktörlerdi. Bir yýllýk takip sürecinde hiçbir malinite saptanmadý.
SONUÇ
Acil servise akut karýn aðrýsý nedeniyle baþvuran olgularda baþvuru esnasýnda daha önce benzer bir aðrý hikayesi, bulantý, defans, ateþ >36,6°C, lökosit sayýmý >8700, yaþ >39, solunum hýzý >15 olan ve taburculuk sonrasý 24 saatte kalýcý-devamlý aðrýsý olan hastalarda spesifik bir neden olasýlýðý yüksektir.

BACKGROUND
The aims of this study were to determine the diagnostic value of elements of the disease history, the clinical findings and basic laboratory examinations in differential diagnosis of the patients with nonspecific abdominal pain and to analyze the long-term survey of these patients.
METHODS
A prospective observational study was performed at the Department of General Surgery Medicine Faculty of Uludag University between November 2001 to November 2002. Based on the diagnosis reasons for abdominal pain, 610 patients were classified as being of specific abdominal pain (n=501) versus nonspecific abdominal pain (n=109). Patients with nonspecific abdominal pain were invited to a follow-up examination 24 hours later and 4 follow-up interviews were conducted on days 8, 15, 30 and at the end of 1 year. Statistical analyses were performed between findings of two groups.
RESULTS
In logistic regression analysis, presence of a history of similar pain (odds ratio 1.88; p=0.009), nausea (odds ratio 0.46; p=0.001), rigidity (odds ratio 0.24; p=0.024), fever ≤36.6°C (odds ratio 1.66; p=0.037), leukocyte count ≤8700 (odds ratio 1.85; p=0.011), age ≤39 years (odds ratio 1.85; p=0.018), respiratory rate ≤15 (odds ratio 3.19; p=0.00..) were significantly independent diagnostic factors. There was no malignancy during one-year follow-up period.
CONCLUSION
The possibility of a specific cause is higher in patients with history of a similar pain, nausea, rigidity, fever >36.6°C, leukocyte count >8700, age >39 years, respiratory rate >15 in admission and persistent pain 24 hours after discharge.

AMAÇ
Motorlu araç kazalarýnda yaralanan travmalý hastalarla ilgili hastane mortalitesi tahminleri deðerlendirildi.
GEREÇ VE YÖNTEM
Yunanistan’ýn Girit kentinde 1. basamak travma merkezi olan Herakleion Üniversitesi Hastanesi’nin travma kayýtlarý deðerlendirilerek, 1997 ile 2000 yýllarý arasýnda motorlu araç kazasý nedeniyle yatýrýlan eriþkin 730 travma hastasý ardýþýk olarak çalýþmaya dahil edildi. Hastalarýn cinsiyet, yaþ, yaralanma mekanizmasý, beher anatomik bölge baþýna yaralanma, baþlangýç vital bulgularý, Glasgow Koma Skalasý (GKS), yaralanma ciddiyet skoru (ISS) ve nihai sonuçlarý analiz edildi. Kesintisiz deðiþkenleri daha iyi tanýmlamak için iki kategori oluþturuldu: ≥60 ve <60 yaþ, ≥18 ve <18 ISS.
BULGULAR
Mortalite oraný %4,8 bulundu (n=35). Çok deðiþkenli saðkalým analizi sonuçlarý: yaþ ≥60 (p=0,0002), ≥18 ISS (p=0,003), yaya olma durumu (p=0,007), kraniyoserebral yaralanmalarda (p=0,01), torasik (p=0,01) ve abdominal yaralanmalarda (p=0,01), hastalarýn hastane mortalitelerine iliþkin baðýmsýz tahminlerdi.
SONUÇ
Motorlu taþýt kazalarýnda, yaþý ≥60, yaya olan, ISS ≥18, kranyoserebral, torasik veya karýn yaralanmasý olan travma hastalarý hastanede hayatýný kaybetme sonucu bakýmýndan yüksek risk altýndadýrlar.

OBJECTIVES
Identification and assessment of predictive factors of in-hospital mortality of trauma patients injured in vehicle accidents.
METHODS
We reviewed the Trauma Registry data of Herakleion University Hospital, a level I trauma center in Crete, Greece. All 730 consecutive, adult motor-vehicle trauma patients admitted to our hospital from 1997 to 2000 were included in the study. Variables included in the analysis were: sex, age, mechanism of injury, injuries per anatomic region, initial vital signs, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and the final outcome. In order to better describe continuous variables, two categories were created: age ≥60 and <60; ISS ≥18 and <18.
RESULTS
Mortality rate was 4.8% (n=35). Multivariate survival analysis showed that age greater than or equal to 60 years (p=0.0002), ISS greater than or equal to 18 (p=0.003), being a pedestrian (p=0.007), craniocerebral injuries (p=0.01), thoracic (p=0.01), and abdominal injuries (p=0.01) are independent predictors of the in-hospital mortality of the patients.
CONCLUSION
Trauma patients after vehicle accidents aged ≥60, pedestrians, those with an ISS ≥18 and craniocerebral, thoracic or abdominal injuries are at higher risk of an in-hospital fatal outcome.

AMAÇ
Diyafragma rüptürleri sýk görülmeyen fakat yüksek morbidite ve mortalite ile seyreden ciddi yaralanmalardýr.
GEREÇ VE YÖNTEM
Acil serviste son beþ yýl içinde travmatik diyafragma rüptürü saptanan 58 hastanýn dosyasý mortaliteyi etkileyen faktörleri belirlemek için incelendi.
BULGULAR
Hastalarýn ortalama yaþý 33, mortalite oraný %21 ve en sýk diyafragmatik rüptür nedeni penetran yaralanmalardý (%52). Sadece 12 hasta (%20) ameliyat öncesi dönemde diyafragma rüptürü tanýsý alýrken kalan 46 hasta ise cerrahi sýrasýnda taný aldý. Kýrk iki hastada sol diyafragma rüptürü saptandý. Ýntratorasik herniasyon 11 hastada saptandý. Herniasyon varlýðý mortaliteyi etkilemedi (p=0,155). Mortalite ile seyreden tüm hastalarda künt travma vardý ve en yaygýn ölüm nedeni hemorajik þok idi. Hastalarýn %88’inde eþlik eden yaralanmalar vardý ve mortal seyreden hastalarýn %92’sinde eþlik eden yaralanma mevcut idi.
SONUÇ
Travmalý hastada diyafragma yaralanmasýnýn tanýsý yüksek morbidite ve mortalite nedeni ile önemlidir. Travmatik diyafragma rüptürlerinde mortaliteyi etkileyen faktörler; künt travma, yüksek yaralanma þiddeti, þok varlýðý, üç üniteden fazla kan transfüzyonu ve dalak yaralanmasýdýr.

BACKGROUND
Diaphragmatic injuries are infrequent but severe injuries, associated with high morbidity and mortality.
METHODS
The hospital records of 58 patients with traumatic rupture of diaphragm which was diagnosed during surgery in emergency department during last five years were re-evaluated, in order to identify the factors on mortality.
RESULTS
The mean age of patients was 33 years. The most common cause of diaphragmatic rupture was penetrating injury (52%). The overall mortality rate was 21%. Preoperative diagnoses were accurately made in only twelve (20%) patients and remaining 46 patients were diagnosed during surgery. Rupture was located on the left side in 42 patients. Intrathoracic herniation was seen in eleven cases. Presence of herniation has no effect on mortality (p=0.155). All cases with mortal course were blunt trauma and the most common cause of death was haemorrhagic shock. Associated injuries were present in 88% of the patients; 92% of the mortal cases had an associated injury.
CONCLUSION
The diagnosis of diaphragmatic injury is important due to increased morbidity and mortality in traumatic victims. Blunt trauma, increased grade of injury, presence of shock, blood transfusions over three units and splenic injury are factors influencing mortality in traumatic ruptures of diaphragm.

AMAÇ
Kliniðimizce 1998 yýlýndan beri tedavi edilen, el rehabilitasyon polikliniðine el yaralanmasý nedeniyle baþvurmuþ olan pediyatrik yaþ grubundaki hastalarýn özelliklerinin belirlenmesidir.
GEREÇ VE YÖNTEM
Hastalar retrospektif olarak taranarak 0-16 yaþ arasýndakiler çalýþmaya alýndý (178 hasta; 126 erkek [%70,8], 52 kýz (%29,2); ort. yaþ 10,33±4,45; daðýlým 0-16). Demografik veriler, yaralanma nedeni-yeri, ameliyat-rehabilitasyon arasýndaki süre (hafta), takip süresi (hafta) kaydedildi.
BULGULAR
Rehabilitasyona baþvurma süresi ortalama 5,4±0,7 haftaydý. Sadece 99 hasta (%55,6) dört haftadan uzun (20,8±22,2) bir süre izlenebilmiþti. Yaralanma þekli hastalarýn 133’ünde (%74,7) kaza, 29’unda kasýtlý (%16,3), 15’inde doðumsal (%8,4) nedenliydi. Kaza sonucu olanlarýn 109’u (%61,2) ev, 53’ü (%29,8) ev dýþý kazalardandý. En fazla görülen ev kazasý cam kesiði, en fazla görülen çevre yaralanmasý düþme idi. Yaralanma yeri sýklýk sýrasýyla, bilek, metakarp, proksimal falanks, önkol, dirsek, pleksus, orta-falanks, üst-kol, tüm el, omuz, tüm kol ve bilateral el þeklindeydi. En sýk 4. parmak yaralanmýþtý. En çok görülen yaralanma tipi, fleksör tendon kesisi (%44,5), sinir kesisi, arter yaralanmasý, fraktür ve yanýk kontraktürü idi.
SONUÇ
Poliklinik verilere göre çocuklarda el yaralanmalarýnýn en çok erkeklerde meydana geldiði, evde cam kesmesi sonucu fleksör tendonlarý ilgilendirir þekilde olduðu, en sýk yaralanma düzeyinin bilek, en sýk yaralanan parmaðýn 4. parmak olduðu, þehir dýþýndan baþvurular nedeniyle hasta takibinin yetersiz kaldýðý söylenebilir.

BACKGROUND
To establish the characteristics of patients in pediatric age who have been referred to hand rehabilitation center since 1998.
METHODS
The patients were screened retrospectively and those within 0-16 age range were included into the study (178 patients; 126 males [70.8%], 52 females [29.2]; mean age 10.33±4.45; range 0 to 16 years). Demographic data, causes and locations of injury and follow-up period (week) were recorded.
RESULTS
Mean duration of application for rehabilitation was 5.4±0.7 weeks. Only 99 (55.6%) patients could be followed-up for a period more than 4 weeks (20.8±22.2 weeks). Types of injuries were categorized as accidental (n=133; 74.7%), intentional (n=29; 16.3%) and congenital (n=15; 8.4%). Accidents were related to domestic (n=109; 61.2%) and environmental causes (n=53; 29.8%). The most frequent domestic accident was glass injury and fall accident. The regions in order of decreasing frequency were wrists, metacarpal bones, proximal phalanges, forearms, elbows, plexus, mid-phalanges, total hands, shoulders, total arm and bilateral hands. Fourth digit was the most frequently injured digit. The most common types of injuries were as followings: flexor tendon cut (44.5%), nerve cut and arterial injuries, fractures and burn contractures.
CONCLUSION
Hand injuries occurred mostly in male children, the most frequent type injury was accidental domestic injury of the wrist flexor tendon caused by broken glass fragments and the most frequently injured digit was the 4th and adherence of the patients to the follow-up protocol was unsatisfactory since majority of referrals were out-of-towners.

AMAÇ
Ýþ kazasý sonucu oluþan yanýk travmalarýnda, ölüm meydana getirme riski olmasýndan dolayý adli rapor düzenlenmesi þarttýr. Adli olgularda travmanýn aðýrlýðýný belirten en önemli ölçüt olan, hayati tehlikenin saptanmasý maðdurun tedavisi kadar önemlidir. Bu çalýþma, bildirilen yanýk yüzde deðerlerinin, hayati tehlike kavramýný ne ölçüde karþýladýðýný araþtýrmak ve iþ kazalarýnda meydana gelen yanýk nedenlerini belirlemek amacýyla yapýldý.
GEREÇ VE YÖNTEM
Çalýþma Ekim 2004 ile Aralýk 2006 tarihleri arasýnda, tanýmlayýcý epidemiyolojik yöntemle, acil cerrahi servisi yanýk ünitesine gelen tüm olgular deðerlendirilerek gerçekleþtirildi. Olgularýn sosyo-demografik özelikleri sorgulandý. Veriler, frekans, aritmetik ortalama, standart sapma ve median kullanýlarak tanýmlandý. Kesikli deðiþkenler Ki-kare testi kullanýlarak, sürekli deðiþkenler Pearson korelasyon testi yardýmýyla incelendi.
BULGULAR
Toplam 128 olgunun %69,5’i erkek (n=89), %30,5’i (n=39) kadýn idi. Yanýk olgularýnýn %28,9’u (n=37) iþ kazasýydý. Ýþ kazasý nedenli yanýklarýn, %48,6’sý (n=18) sýcak su, %32,4’ü (n=12) alev, %10,8’i (n=4) elektrik ve %8,2’si (n=3) kimyasal yanýk idi. Olgularýn %19,50’inin (n=25) hayatýný kaybettiði, %80,50’sinin (n=103) iyileþerek taburcu edildiði saptandý. Yanýk yüzdesi %20’nin altýnda olan olgularda %1,3 (n=1) oranýnda, %20 ve üzerinde hesaplanan olgularda %49,0 (n=24) oranýnda ölüm görüldü (p=0,0001).
SONUÇ
Yanýðýn derecesi ölüm riski belirlenmesinde deðerli olmakla beraber yanýk alanýnýn geniþliði, ölüm riskinin belirlenmesi ve olayýn soruþturulmasýnda daha dikkatli davranýlmasý açýsýndan daha belirleyici bulunmuþtur.

BACKGROUND
Burn traumas resulting from industrial accidents may generate a death risk. In such cases a forensic report should be filled up. In forensic findings, the death risk which is associated with the degree of trauma, of the victim is as important as the treatment of the subject. The aim of our research was to investigate what degree of burns causes fatality and which type of industrial accidents cause them.
METHODS
This research was done between the dates October 2004 and December 2006 with the descriptive epidemiology method by the evaluation of all data entered emergency surgical room- burn unit. The results of the study were analyzed with respect to its socio-demographic characteristics clinical findings of the type of burn and the type of the event which caused the burn. Categorical variables were assessed using Chi-square test, continuous variables were tested by Pearson’s correlation.
RESULTS
For the total 128 incidents, 69.5% (n=89) were males and 30.5% (n=39) females. 28.9% (n=37) of the incidents were industrial accidents. 48.6% (n=18) of the burns were caused by boiling water, 32.4% (n=12) due to contact by flame, 10.8% (n=4) electrocution and %8.2 (n=3) due to burns by contact with chemicals. The 19.50% (n=25) of the incidents had ended up by loss of life, 80.5% (n=103) were cured and discharged. The incidents which had resulted under 20%, the mortality rate was 1.3% (n=1), the incidents which had above 20%, the mortality rate was 49.0% (n=24) (p=0.0001).
CONCLUSION
The degree of burn was found to be valuable in determining the death risk but the extent of the burned area was found to be more deterministic in assessing this particular risk.

AMAÇ
Hastanemizin genel cerrahi yoðun bakým ünitesinde çalýþan saðlýk personelinin el yýkama alýþkanlýklarýný belirlemek ve irdelemektir.
GEREÇ VE YÖNTEM
Kliniðimiz yoðun bakým ünitesinde, gün içerisinde yoðun bakým vizitlerinin olduðu zamanlarda, 30 dakikalýk süre ile saðlýk personelinin el yýkamayý gerektiren durumlarý belirlenip, el yýkama alýþkanlýklarý gözlendi.
BULGULAR
Gözlem süresi toplam 1710 dakika olan çalýþmada tüm saðlýk personelinin el yýkama alýþkanlýðý ortalama %23 olarak belirlendi. Hekim, hemþire ve yardýmcý saðlýk personeli gruplarýnda el yýkama alýþkanlýklarý sýrasýyla %12, %34 ve %19 olarak saptandý. Gruplar arasý fark istatistiksel olarak anlamlý idi (p<0,05).
SONUÇ
Bulgular irdelendiðinde yoðun bakým ünitesinde çalýþan saðlýk personelinin el yýkama alýþkanlýðýnýn kabul edilemez düzeyde düþük olduðu gözlendi. Bu nedenle, hasta bakýmýnýn bir parçasý olan el yýkama alýþkanlýðý bilincinin kazandýrýlmasýna yönelik zorlayýcý önlemler alýnmasý gerektiði düþüncesindeyiz.

BACKGROUND
The aim of this study was to determine the habit of handwashing among health care workers in the intensive care unit of hospitals’ general surgery department.
METHODS
Potential handwashing opportunities were detected and observations were recorded. Handwashing habit of health care workers was monitored for over 1710 min., during 30 min. observation periods.
RESULTS
In this study which had 1710 minutes of observation period, the overall habit of handwashing of the medical staff was 23%. Compliance among physicians, nurses and other health care workers were 12%, 34% and 19% respectively (p<0.05).
CONCLUSION
The handwashing habit of healthcare workers in our unit is unacceptably low. We believe that introduction of social pressure models will help to improve handwashing awareness of the health care worker.

Bu yazýda, künt toraks travmasý sonrasý torasik kavite duvarýnda oluþan bir defekt nedeniyle geliþen bir interkostal pulmoner herni olgusu sunuldu. Pulmoner herniasyon tanýsý, radyolojik olarak göðüs filmi ve bilgisayarlý tomografi taramasý ile doðrulandý. Ayný zamanda diyafragmatik bir rüptür varlýðýný da gösteren video destekli bir torakoskopi ile gerçekleþtirilen ilk incelemeden sonra, bir posterolateral torakotomi operasyonu yapýldý. Torasik duvar defekti, iki rekonstrüksiyon plaðý ile tamir edildi. Herni ise protez ‘mesh (yama)’ ile baþarýlý bir þekilde tamir edildi. Literatür araþtýrmasý, pulmoner herniasyonun tedavisi gerekli olduðunda bunun cerrahi onarým olmasý gerektiðini göstermektedir.

We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.

Çekal volvulus, Batý ülkelerindeki olgularýn %1’inden daha az bir kýsmýnda açýða çýkan ve sýk karþýlaþýlmayan baðýrsak týkanýklýðý nedenidir. Literatürde, sýk gerçekleþtirilen sayýsýz ameliyatla birlikte bazý minimal invaziv iþlemlerden sonra karþýlaþýlan bir komplikasyon olarak tanýmlanmýþtýr. Çekal volvulus, oluþmasýna izin vermeye yetecek, mobilite saðlayacak þekilde, belli ölçüde týbbi viseral rotasyon gerektirebilen herhangi bir cerrahi iþlem veya çekum ya da çýkan kolon ile lateral periton arasýndaki birleþtirme düzleminin kesintiye uðramasýndan sonra oluþmasý daha olasýdýr. Kadavra ve otopsi çalýþmalarý da, nüfusun %10-20 kadarýnýn volvulizasyon oluþmasýný saðlamaya yetecek ölçüde kolon hareketliliðine sahip olabileceði izlemini býrakmýþtýr. Çekal volvulus tanýsý ve tedavisine iliþkin bir gözden geçirmeyle birlikte renal hücreli karsinom nedeniyle uygulanan sað radikal nefrektomi ameliyatýndan altý gün sonra geliþen bir çekal volvulus olgusu olan 78 yaþýndaki J.R. isimli erkek hastayý sunuyoruz.

Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for less than 1% of cases in Western countries. In the literature, it has been described as a complication following numerous common surgeries as well as a number of minimally invasive procedures. Presumably, it is more likely to occur following any surgical procedure which might require some degree of medial visceral rotation or disruption of the fusion plane between the cecum or ascending colon with the lateral peritoneum, providing sufficient mobility to allow for cecal volvulization to occur. In addition, cadaver and autopsy studies have also suggested that 10-20% of the population may have sufficient mobility of the colon to allow for volvulization. We present a review of the literature pertaining to the diagnosis and management of cecal volvulus as well as the case of J.R., a 78-year-old male with cecal volvulus six days following a right radical nephrectomy for renal cell carcinoma.

Diyaframla mesane rüptürleri künt abdominal travmadan sonra nadirdir ve genellikle yüksek enerjili travmalardan sonra geliþirler. Tek baþlarýna oluþmalarý enderdir. Diyafram rüptürünün kesin tanýsý, þüpheye ve göðüs radyografi filminin dikkatle incelenmesine dayanýrken, mesane rüptürü olan hastalardaki temel bulgu makroskopik hematüridir. Suprapubik aðrý, hassasiyet ve idrar yapamama, mesane rüptürü ile ilgili ana belirti ve semptomlardýr. Bu yazýda, taný ve cerrahi tedavi konularýna özel vurgu yaparak, düþük enerjili bir travma sonucunda oluþan birlikte diyafram ve mesane rüptürlü bir olgudaki baþarýlý bir deneyimimizi sunuyoruz.

Diaphragmatic and urinary bladder ruptures are rare entities after blunt abdominal trauma and they are usually the results of high energy injuries. They seldom occur in isolation. For the diaphragmatic rupture, the accurate diagnosis depends on high index of suspicion and careful scrutiny of the chest X-ray, while gross hematuria is the hallmark finding in patients with bladder rupture. Suprapubic pain, tenderness, and inability to void are the main symptoms and signs of bladder rupture. In this report, we describe our successful experience with a case of combined diaphragmatic and urinary bladder rupture occurred in isolation as a result of low energy trauma, with special emphasis on diagnosis and surgical treatment.

Adenokarsinoid tümörler, karsinoid ve adenokarsinomalarýn histolojik özelliklerini taþýyan ve nadir görülen agresif tümörlerdir. Bu yazýda, apandiks duvarý ile mezoapandiksin bir adenokarsinoid tümör tarafýndan difüz þekilde infiltre edildiði, 32 yaþýndaki bir erkek hasta sunulmaktadýr. Tutulum nedeniyle, daha sonraki bir tarihte bir hemikolektomi ameliyatý gerçekleþtirildi. Biz, difüz apandiks tutulumu olan hastalarýn agresif bir cerrahi tedavi ve takip gerektirdiðini düþünüyoruz.

Adenocarcinoids are rare and aggressive tumors with histological features of both carcinoid tumor and adenocarcinoma. We report a case of a 32-year-old man with diffuse infiltration of the appendix wall and mesoappendix by an adenocarcinoid. Due to the involvement, a hemicolectomy was performed at a later date. We suggest that patients with diffuse appendiceal involvement require an aggressive surgical therapy and follow-up.