AMAÇ
Abdominal kompartman sendromu sonrasý geliþen akut böbrek yetersizliðinin renal venöz basýncýn artýþý ile iliþkili olduðu düþünülmektedir. Bu çalýþmada, deðiþik karýn içi basýnç deðerlerinde renal tübüler ve glomerüler hücrelerdeki histopatolojik deðiþiklikler ile plazma ve renal doku sitokin düzeylerindeki deðiþiklikler araþtýrýldý ve karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
On sekiz Spraque-Dawley cinsi sýçan rastgele üç gruba ayrýldý: Sham grubu, basýncýn 20 ve 30 mmHg düzeyinde 60 dakika tutulduðu grup 2 ve grup 3. Deneklerin, sol böbrekleri ve intrakardiyak kan örnekleri iþlem sonunda alýndý. Tümör nekroz faktör alfa (TNF-α) ve interlökin 6 (IL-6) düzeyleri hem renal dokuda hem de plazmada araþtýrýldý. Renal dokular, histopatolojik deðiþiklikler açýsýndan da deðerlendirildi.
BULGULAR
Sham grubu çalýþma gruplarý ile karþýlaþtýrýldýðýnda, renal doku ve plazma TNF-α, IL-6 düzeylerinin anlamlý olarak arttýðý saptandý (p<0,05). Renal doku deðiþiklikleri deðerlendirildiðinde, total histopatolojik skorlarýn arttýðý (p<0,05) tübüler deðiþikliklerin, glomerüler deðiþikliklerden daha belirgin olduðu saptandý.
SONUÇ
Sonuç olarak, karýn içi basýnç artýþý, doðrusal olarak renal tübüler histopatolojik deðiþiklikleri arttýrmaktadýr. Sitokinler abdominal kompartman sendromunda geliþen akut böbrek yetersizliðinde rol oynuyor olabilirler.

BACKGROUND
The reason for acute renal failure (ARF) in abdominal compartment syndrome (ACS) is thought to be due to the increase in renal venous pressure. In this study, the changes in plasma and renal tissue cytokine levels and histopathologic changes in renal tubular and glomerular cells were evaluated and compared in a model of acute elevation in abdominal tension with different pressures.
METHODS
Eighteen Sprague-Dawley rats were randomly assigned into three groups: Sham-operated rats and rats in Groups 1 and 2, in which 20 and 30 mmHg of intra-abdominal pressure (IAP) was applied for 60 minutes, respectively. Left kidneys of the animals and intracardiac blood samples were taken at the end of the procedures. Tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were investigated in plasma and renal tissue samples. Renal tissues were also evaluated for histopathologic changes.
RESULTS
Renal tissue and plasma TNF-α and IL-6 levels were found to be significantly increased when the sham-operated group was compared to the study groups (p<0.05). Renal tissue changes showed that the total histopathologic scores were significantly increased in study groups compared to the sham-operated group (p<0.05); tubular changes were more prominent than glomerular changes.
CONCLUSION
Abdominal tension linearly can cause renal tubular histopathologic changes. Cytokines may play a role in ARF due to ACS.

AMAÇ
Bu çalýþmanýn amacý, septik sýçanlarda karaciðer iþlev bozukluðu üzerine deksmedetomidin koruyucu etkisinin varlýðýný araþtýrmaktýr.
GEREÇ VE YÖNTEM
Sýçanlar randomize olarak dört gruba ayrýldý. Kontrol grubu (grup I, n=10), herhangi bir tedavi almadý. Deksmedetomidin grubuna (grup II, n=10) ve sepsis/deksmedetomidin grubuna (grup IV, n=10) 5 µg•kg-1•s-1 deksmedetomidin infüzyonu yapýldý. Sepsis, sepsis grubu (grup III, n=10) ve sepsis/deksmedetomidin grubuna kuyruk veninden E. Coli verilerek oluþturuldu. Tüm sýçanlara sepsisin 8. saatinde sakrifiye edildikten sonra orta hat laparotomisi uygulandý. Sýçanlarýn karaciðerleri histopatolojik inceleme için eksize edildi ve doku deðiþikliklerinin varlýðý açýsýndan incelendi.
BULGULAR
Sepsis grubundaki deðiþiklikler merkezi venöz konjesyon, hepatik sinüzoitlerde konjesyon ve dilatasyon ve portal alanda enflamasyondu. Bu parametreler sepsis/deksmedetomidin grubunda daha az olarak gözlendi. Sepsis ve sepsis/deksmedetomidin grubunda istatistiksel olarak anlamlý farklýlýk bulundu (p<0,001).
SONUÇ
Deksmedetomidin sýçanlarda deneysel olarak geliþtirilmiþ sepsiste karaciðer organ iþlev bozukluðunu engellemektedir. Biz deksmedetomidin sedasyonunun sepsise baðlý karaciðer iþlev bozukluðunda ve diðer hastalýklarýn lokal veya sistemik enflamasyonunda yararlý etkisi olabileceði görüþündeyiz.

BACKGROUND
In this pilot study, we aimed to investigate the effect of dexmedetomidine on liver tissues during experimental sepsis by histopathological examination.
METHODS
The animals were allocated randomly to four groups, two of which received endotoxin. In the Sepsis Group (n: 10) and Dexmedetomidine/Sepsis Group (n: 10), endotoxemia was induced by E. coli lipopolysaccharide derived from E. coli 0111: B4. Animals in the Control Group (n: 10) received an infusion of 0.9% saline (1.0 mL•kg-1•hr-1) intravenously. The Dexmedetomidine Group (n: 10) and Dexmedetomidine/Sepsis Group received a bolus injection of 0.9% saline (1.0 mL/kg), followed by dexmedetomidine administration (infusion at 5 μg•kg-1•hr-1). All rats were euthanized at the 8th hour of endotoxin infusion. Histopathological examinations were performed on liver tissues.
RESULTS
In the liver, central venous congestion, congestion and dilation of the hepatic sinusoids and inflammation of the portal tracts were noted in the Sepsis Group. These parameters were seen slightly in the Sepsis/Dexmedetomidine group. There was a statistically significant difference between the Sepsis and Sepsis/Dexmedetomidine Groups (p<0.001).
CONCLUSION
Dexmedetomidine has a protective effect on liver tissues during experimental sepsis in the rat. We propose that dexmedetomidine sedation may be useful in the therapy of the liver dysfunction associated with sepsis and in other diseases related to local or systemic inflammation.

AMAÇ
Saðlýklý bireylerde ve künt travma hastalarýnda akut kan kaybýnýn tahmininde inferior vena kava (ÝVC) çapýnýn deðeri saptandý, hemorajik þokun diðer parametreleri ile karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Elli gönüllü ve 28 ardýþýk hemorajik þok hastasý çalýþmaya alýndý. Hayati bulgular, kan laktatý ve serum bikarbonatý ölçüldü, þok indeksi ve baz fazlasý hesaplandý. ÝVC’nin Antero-posterior (AP) ve mediyolateral (ML) çaplarý sað subkostal bölgede inspirasyon ve ekspirasyon sýrasýnda ölçüldü. Hemerajik þok hastalarýndaki ÝVC çaplarý ve diðer hemorajik þok parametreleri kontrol grubununkilerle karþýlaþtýrýldý.
BULGULAR
Kabulde çalýþma grubu ile kontrol grubunun inspirasyon ve ekspirasyon sýrasýndaki ortalama AP, ML ve ÝVC çaplarý arasýnda anlamlý iliþki saptandý (p=0,000, p=0,000, p=0,000, p=0,000). Serum laktat seviyeleri bütün ÝVC çaplarý ile özellikle exspirasyon sýrasýndaki ÝVC ML çapý ile anlamlý korele idi (r=55).
SONUÇ
Hemorajik þok hastalarýnda transabdominal ultrasonografiyle ölçülen ÝVC çapý; þok indeksi ve akut kan kaybýnýn tahmininde yaygýn olarak kullanýlan kan basýncý, dakikadaki nabýz sayýsý, serum laktat seviyesi ve baz açýðý gibi diðer non-invaziv prediktörlerinden daha doðru bir prediktördür.

BACKGROUND
We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock.
METHODS
Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters.
RESULTS
A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration.
CONCLUSION
IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).

AMAÇ
Travmatik ciddi beyin yaralanmasý tedavisinde erken yapýlan dekompresif kranyektominin sonuçlarýný ve etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM
Travmatik ciddi beyin yaralanmasý olan 33 olguda, erken yapýlan tek taraflý dekompresif kranyektominin klinik ve radyolojik sonuçlarýný araþtýrmak için prospektif bir çalýþma yapýldý. Ortalama kranyektomi alaný, dekomprese edilmiþ beynin potansiyel geniþleme hacmi ve kranyektominin alt sýnýrý ile temporal kraniyal taban arasýndaki mesafe bilgisayarlý tomografilerden hesaplandý. Klinik sonuçlar modifiye Rankin skalasý (mRS) ile deðerlendirildi.
BULGULAR
Travma ile cerrahi giriþim arasýndaki zaman 3,1±1,9 saatti. Kranyektomi alaný ile hesaplanan hacim arasýnda doðrudan orantýlý korelasyon vardý (p<0,0001). Ayrýca, kranyektomi sonrasý mezensefalik sisternalarýn durumu ile kranyektominin kraniyal tabana olan uzaklýðý arasýnda da anlamlý korelasyon vardý (p<0,01). Bir yýllýk klinik sonuçlarýn deðerlendirmesi olgularýn %48,5’inde olumlu sonuç saðladý (mRS 0-3).
SONUÇ
Gerçek anlamda erken dekompresyon uygulanmasýna raðmen, olgularýmýzda yüksek oranda morbidite ve mortalite görülmesi altta yatan yaralanmanýn ciddiyetini yansýtmaktadýr.

BACKGROUND
The aim of our study was to evaluate the results and effectiveness of early decompressive craniectomy in the treatment of severe traumatic brain injury.
METHODS
We conducted a prospective study to investigate the clinical and radiological results of early unilateral decompressive craniectomy in 33 patients with severe traumatic brain injury. The mean area of the craniectomy, potential expansion volume of the decompressed brain, and distance between the lower border of the craniectomy and the temporal cranial base were calculated from computed tomography scans. Clinical results were analyzed with modified Rankin Scale (mRS).
RESULTS
Time to surgery after trauma was 3.1±1.9 hours. There was a direct proportionality correlation between the area of the craniectomy and the calculated volume (p<0.0001). There was also a significant correlation between the state of the mesencephalic cisterns after craniectomy and the distance of the craniectomy to the base of the cranium (p<0.01). Assessment of overall one-year clinical outcome demonstrated favorable outcome (mRS 0-3) in 48.5% of patients.

CONCLUSION
The high overall morbidity and mortality rates demonstrated in our group despite the performance of early decompressive procedures reflect the severity of the underlying injuries.

AMAÇ
Çalýþmanýn amacý, idrar tripsinojen-2 dipstik testinin acil serviste akut pankreatit ayýrýcý tanýsýndaki yeri ve önemini araþtýrmak ve sonuçlarý konvasiyonel yöntemlerle karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM
Çalýþma üst abdominal aðrýyla acil servise baþvuran hastalarda prospektif olarak yapýldý. Çalýþmaya alýnan toplam 87 hastanýn 32’si akut pankreatit tanýsý alan hastalardan oluþmaktaydý. Tüm hastalarda amilaz, lipaz, C-reaktif protein (CRP) ve Actim pancreatit dipstick kullanýlarak, idrar tripsinojen-2 bakýldý. Ýstatistiksel analiz SPSS 11.5 paket programý kullanýlarak yapýldý.
BULGULAR
Akut pankreatit tanýsý alan 32 hastanýn 21’inde (%65,6) idrar tripsinojen-2 pozitif bulundu. Testin pankreatit açýsýndan duyarlýlýðý yaklaþýk %64, özgüllüðü %85, pozitif prediktif deðeri %72, negatif prediktif deðeri %81 olarak belirlendi. Bu deðerler kontrol grubuna göre istatistiksel olarak anlamlýydý (p<0,01).
SONUÇ
Ýdrar tripsinojen-2 testinin duyarlýlýðý ve özgüllüðü amilaz ve lipaza kýyasla düþük olsa da, acil servislerde 5 dakika gibi kýsa bir sürede sonuç vermesi, ucuz olmasý, kullaným kolaylýðýna sahip olmasý ve negatif belirleyicilik deðerinin yüksek olmasý nedeniyle akut pankreatit tanýsýnýn dýþlanmasýnda önemli bir taný aracý olacaðýný düþünmekteyiz.

BACKGROUND
The aim of the study was to investigate the role and importance of the urine trypsinogen-2 dipstick test in the differential diagnosis of acute pancreatitis in the Emergency Department and to compare results with those of conventional tests.
METHODS
The study was performed prospectively in the patients admitting to the Emergency Department due to upper abdominal pain. Thirty-two of the 87 patients included in the study had acute pancreatitis diagnosis. Serum amylase, lipase, C-reactive protein (CRP) and urine trypsinogen-2 using Actim pancreatitis dipstick were studied in all patients. The statistical analysis was performed using SPSS 11.5 package program.

RESULTS
Urine trypsinogen-2 was found positive in 21 (65.6%) of 32 patients. The sensitivity of the test for pancreatitis was identified as 64%, specificity as 85%, positive predictive value as 72%, and negative predictive value as 81%. These values were statistically significant compared to the control group (p<0.01).

CONCLUSION
Although it has lower sensitivity and specificity compared to amylase and lipase, we suggest that urine trypsinogen-2 test may be an important diagnostic tool in excluding the diagnosis of acute pancreatitis, since it provides results within 5 minutes in the Emergency Department, is cheaper, has a higher negative predictive value, and is easy to use.

AMAÇ
Travma ve acil cerrahi yoðun bakým hastalarýnda venöz tromboembolide (VTE) düþük molekül aðýrlýklý heparin (DMAH) ile elastik çorap ve aralýklý pnömatik kompresyon (EÇ+APK) profilaksi yöntemlerinin VTE riski açýsýndan etkinliði ve güvenirliliði araþtýrýldý.
GEREÇ VE YÖNTEM
Haziran 2005 ile Haziran 2007 tarihleri arasýnda 7 günden uzun süre mekanik ventilatöre baðýmlý olarak yoðun bakýmda yatan 259 hasta prospektif olarak yatýþlarýnýn 3. ve 7. gününde alt ekstremite venöz Doppler ultrasonografi ile deðerlendirildi. Hastalarýn 152’sinde (%59) DMAH, 94 hastada (%36) EÇ ve APK kullanýldý.

BULGULAR
DMAH grubunda üç hastada (%2) derin ven trombozu (DVT) saptanýrken, EÇ ve APK grubunda bir hastada (%1) DVT saptandý. Kanama 15 hastada (%11) görüldü. VTE sýklýðý %1,5 (4/259) olarak saptandý. PE geliþen dört hastadan ikisinde ölümcül pulmoner emboli geliþti (%0,7).
SONUÇ
Ýstanbul Týp Fakültesi Acil Cerrahi biriminde, yüksek mortalite ve morbiditenin olduðu yoðun bakým hastalarýnda uygulanan VTE profilaksi protokolünü yeterli ve güvenli olduðuna inanýyoruz.

BACKGROUND
We aimed to evaluate the efficacy and safety of low molecular weight heparin (LMWH) compared to elastic stockings in combination with intermittent pneumatic compression (ES+IPC) in venous thromboembolism (VTE) prophylaxis in the intensive care unit (ICU) of trauma and emergency surgery.
METHODS
From June 2005 to June 2007, 259 patients who were on mechanic ventilation in the ICU were assigned to two groups as either LMWH (152 patients) or ES+IPC (94 patients). Color flow Doppler sonography was performed on the 3rd and 7th days.
RESULTS
Deep venous thrombosis was determined in 3 (2%) of the LMWH group and in 1 (1%) in the ES+IPC group. Minor bleeding was seen in 15 patients. The frequency of VTE was 1.5%. Two patients suffered from fatal pulmonary embolism (PE) among a total of 4 patients with PE.

CONCLUSION
We believe that the protocol applied for VTE prophylaxis in the Emergency Surgery Department of Istanbul Medical Faculty is effective and safe in this group with such high mortality and morbidity.

AMAÇ
Militanlýðýn patlak vermesinden itibaren mermi ile gerçekleþen vasküler yaralanmalar, Kaþmir vadisinde epidemik bir orana ulaþmýþtýr. Bu çalýþma, mermi ile gerçekleþen vasküler yaralanmalarýn tipi, mekanizmasý, baþvuru þekli ve tedavisini analiz etmek için yapýlmýþtýr.
GEREÇ VE YÖNTEM
Bu retrospektif çalýþmada, Ocak 1990 ile Ekim 2008 tarihleri arasýnda mermi ile gerçekleþen vasküler yaralanmasý olan hasta kayýtlarý incelendi. Mermi ile gerçekleþen vasküler yaralanmasý bulunan 580 hasta üzerinde çalýþýldý, bu tip yaralanmasý olmayanlar çalýþma dýþýnda tutuldu.
BULGULAR
Hastalarýn çoðu, safen ven interpozisyon grefti veya uç uca anastomoz yöntemi ile tedavi edilmiþtir. En yaygýn olarak karþýlaþýlan komplikasyonlar, enfeksiyon (%22,7) ile greft týkanýklýðý (%3,79) olmuþtur. Ampütasyon oraný %3,3 olmuþtur. Ampütasyon oraný, >6 saatlik bir gecikme ve eþlik eden kýrýklarla baþvuran hastalarda daha yüksek olmuþtur.
SONUÇ
Mermi ile gerçekleþen vasküler yaralanma, acil resüsitasyon ve revaskülarizasyon gerektirir. Ameliyat öncesi anjiyografi nadiren gerekir. Tanýya yardýmcý olmak üzere bazen Doppler incelemesi gerekli olabilir.

BACKGROUND
Missile vascular injuries have reached an epidemic proportion in Kashmir valley since the eruption of militancy. The present study was undertaken to analyze the mode, pattern, presentation, and management of missile vascular injuries.
METHODS
A retrospective study of patients with missile vascular injury from January 1990 to October 2008 was undertaken. Five hundred eighty patients with missile vascular injury were studied. All patients with vascular injury due to causes other than missiles were excluded from the study.
RESULTS
Most of the patients were treated by interpositional saphenous vein graft or end-to-end anastomosis. The most common complication was wound infection (22.7%) followed by graft occlusion (3.8%). The amputation rate was 3.3% and was higher in patients with a delay of >6 hours to revascularization and associated fractures.
CONCLUSION
Missile vascular injury requires prompt resuscitation and revascularization. Preoperative angiography is seldom necessary. Doppler study may sometimes be needed to aid in the diagnosis.

AMAÇ
Bu yazýda, düþük voltajlý elektrik akýmýnýn (elektrik çarpmasý) yol açtýðý ölümcül yaralanmalar, elektrik akýmý nedeniyle görülen en sýk yaralanmalarýn özellikleri deðerlendirildi.
GEREÇ VE YÖNTEM
Çalýþmada, 351 tanesi elektrik çarpmasý olan 945 olgu, 41 yýllýk bir periyod (1965-2006) boyunca belirlendi. Tanýmlayýcý istatistiksel analizler SPSS 11.0 programý kullanýlarak yapýldý.
BULGULAR
Elektrik çarpmasý, çalýþmaya alýnan elektrikle oluþan bütün hasarlarýn %37,14’ünün nedeniydi. Kurbanlarýn ortalama yaþý 35,25 idi (erkek ortalama yaþ 36,19; kadýn ortalama yaþ 32,55). Cinsiyete göre daðýlýmda erkek cinsiyeti (%74,07) belirgin þekilde daha sýktý. Elektrik çarpmasýna yol açmýþ bulunan koþullar arasýnda, ev kazalarý (%78,06) iþ kazalarýndan (%13,39) daha çok görülmekteydi. Ýntiharlar anlamlý þekilde nadirdir (%7,41). Tüm elektrik çarpmasý vakalarýnýn %66,10’u yaz döneminde, Haziran’dan Eylül’e kadar oluþmuþtur.
SONUÇ
Ev kazalarý, erkek/kadýn oranýnýn anlamlý bir farklýlýk göstermediði bir grupta daha hakim gözükmektedir. Olgularýn çoðunluðu yaz döneminde (Haziran - Eylül) ortaya çýkmaktadýr. Bu araþtýrmadan elde edilen bulgular, cinsiyeti, yaþý ve yýlýn sezonu göz önüne alarak elektrik çarpmasýný önlemeye yönelik farklý bir strateji oluþturulmasýna hizmet edebilir.

BACKGROUND
We describe herein the characteristics of lethal injuries caused by low-voltage electrical current (electrocution), the most frequent injury caused by electrical current.
METHODS
Nine hundred forty-five cases over a period of 41 years (1965-2006) were reviewed, of which, 351 electrocution cases were identified. The descriptive statistical analyses were carried out with the application of SPSS 11.0 software.
RESULTS
Electrocution accounted for 37.14% of all studied electricity-caused injuries. The average age of the victims was 35.25 years. The average age of male victims was 36.19 years and of female victims was 32.55 years. The distribution by gender showed a significant prevalence of the male sex (74.07%). Among the circumstances leading to electrocution, household accidents (78.06%) prevailed over occupational accidents (13.39%). Suicides were significantly rarer (7.41%). 66.10% of all electrocution cases occurred during the summer period from June through September.
CONCLUSION
Household accidents prevail among the circumstances under which electrocution occurs, with an insignificant difference in the male/female proportion in this group. The majority of electrocutions occurred during the summer period (June-September). The results obtained in this research can help in the development of a differentiated strategy for the prevention of electrocution, while taking into consideration gender, age and season of the year.

AMAÇ
Kompleks bölgesel aðrý sendromunun (KBAS), benzer tetikleyici etkenlere maruz kaldýðý halde bazý hastalarda geliþtiði, bazýlarýnda ise neden geliþmediði konusu açýk deðildir. Bu çalýþmada, üst ekstremitede travmatik yaralanma geçiren kiþilerde KBAS risk faktörleri araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmaya ünilateral el veya önkoldan mekanik yaralanma geçiren 165 hasta dahil edildi. Yaþ, boy, vücut kitle indeksi, yaralanan doku tipi, yaralanan el/önkol olasý risk faktörleri olarak incelendi.
BULGULAR
Seksen dört olguya KBAS tanýsý kondu. Kadýn/erkek oraný KBAS’li hastalarda daha yüksek idi. KBAS’li olgularýn yaþ ortalamasý daha yüksek idi. Yaralanan el/önkol KBAS’li olgularýn %64,2’sinde, KBAS olmayan olgularýn %62,9’unda dominant taraf idi. KBAS sýklýðý duyu sinir yaralanmasý geçirenlerde ve motor sinir yaralanmasý geçirenlerde geçirmeyenlere göre daha yüksek idi. Lojistik regresyon analizi KBAS riskinin motor sinir yaralanmasý geçirenlerde ve kadýnlarda yüksek olduðunu gösterdi.
SONUÇ
Bu çalýþma, motor sinir yaralanmasýnýn ve kadýn olmanýn KBAS için risk faktörü olduðunu göstermektedir. KBAS riskini azaltmak için koruyucu önlemlerin bu hastalarda odaklanmasý yararlý olabilir.

BACKGROUND
It is not clear why complex regional pain syndrome (CRPS) develops in some patients but not in others, despite similar initiating events. The aim of this study was to investigate risk factors for CRPS in cases who had suffered traumatic upper extremity injury.
METHODS
One hundred sixty-five patients who had suffered a mechanical traumatic injury isolated to their hand or forearm were included in this study. Age, gender, body mass index, tissue types injured, and side of affected forearm/hand were investigated as possible risk factors for CRPS.
RESULTS
CRPS was diagnosed in 84 patients. Female/male ratio was higher in patients with CRPS versus those without. The mean age was higher in patients with CRPS. The affected forearm/hand was the dominant side in 62.9% of patients without CRPS and in 64.2% of patients with CRPS. CRPS incidence was higher in patients with motor nerve injury and in patients with sensory nerve injury. A logistic regression showed that risk for CRPS was higher in patients with motor nerve injury and in females.

CONCLUSION
This study indicates that motor nerve injury and female gender are risk factors for CRPS. The prevention measures should be focused mainly on females and patients with motor nerve injury in order to reduce the risk of CRPS.

AMAÇ
Travmatik beyin hasarýnýn (TBH) yoðun bakýmý, yüksek maliyet, mortalite ve morbiditeye dayalýdýr, ancak bu konuda yayýnlanmýþ çalýþma sayýsý oldukça azdýr. Bu çalýþmanýn amacý, yoðun bakým ünitesine (YBÜ) kabul edilen TBH’li hastalarýn maliyetlerini ve saðkalým sonuçlarýný incelemektir.
GEREÇ VE YÖNTEM
2002-2006 yýllarý arasýnda Trakya Üniversitesi Hastanesi YBÜ kayýtlarý geriye dönük olarak incelendi. TBH’li hastalar saptanarak yoðun bakým maliyetleri ve saðkalým sonuçlarý deðerlendirildi.
BULGULAR
Çalýþma grubu 126 hastadan oluþmaktadýr ve bu hastalarýn %27,8’ine cerrahi giriþim uygulanmýþtýr. Erkek cinsiyet (%80,2) daha sýktýr, YBÜ’de kalýþ süresi ortalama 9,8±8,7 gündür ve motorlu taþýt yaralanmalarý (%59,5) YBÜ’ye kabuldeki en önemli nedendir. Mortalite oraný %50 ve Glaskow Koma Skoru (GKS) ortalamasý 6,1±1,9 olarak bulunmuþtur. Ortalama yoðun bakým kalýþ maliyeti 4846±5084 $’dýr. Kurtarýlan her bir yaþam maliyeti ve kazanýlan her bir yaþam yýlý maliyeti sýrasýyla 9533 $ ve 313,6 $ olarak hesaplandý. Yaralanma tipleri arasýnda saðkalým oranlarý istatistiksel anlamlý farklý bulundu (p=0,010). GKS’nin olgularýn saðkalým sonuçlarýný kestirmede prognostik bir faktör olduðu saptandý (Hazard Oraný: 0,643; %95 GA: 0,529-0.781; p<0,001).
SONUÇ
TBH’nin yoðun bakým maliyetleri oldukça yüksek bulunmuþtur, ayrýca yüksek düzeyde mortalite oranýna da sahiptir.

BACKGROUND
Intensive care of Traumatic Brain Injury (TBI) is associated with substantial morbidity, mortality and cost; however, there is very little published work on this topic. The purpose of this study was to examine direct costs and survival outcomes of patients with TBI admitted to an intensive care unit (ICU).
METHODS
A retrospective review of the records of Trakya University Hospital’s ICU from 2002-2006 was undertaken. Patients with TBI were determined and assessed regarding costs and survival.

RESULTS
The study group consisted of 126 patients, and 27.8% of them had been operated. Male gender (80.2%) was dominant, mean length of stay was 9.8±8.7 days, and motor vehicle injury (59.5%) was the major reason for ICU admission. Mortality rate was 50% and the Glasgow Coma Score (GCS) of the patients was 6.1±1.9. The average cost per ICU stay was US$ 4846±5084. Cost per life saved and per life-year saved were US$ 9533 and US$ 313.60, respectively. Survival rates were significantly different among injury types (p=0.010). GCS appeared to be a prognostic parameter in patient survival (Hazard Ratio: 0.643; 95%CI: 0.529-0.781; p<0.001).


CONCLUSION
Intensive care of TBI cases is characterized by high mortality and high cost.

AMAÇ
Bu çalýþmada, pediyatrik künt batýn travmalý hastalarda organ hasarýnýn bir göstergesi olarak ultrasonografiyle saptanan pelvik sývý varlýðýnýn önemi deðerlendirildi.
GEREÇ VE YÖNTEM
Ocak 2008 ve Aralýk 2008 tarihleri arasýnda Dicle Üniversitesi Týp Fakültesi Hastanesi Acil Servisine künt karýn travmasý ile baþvuran ardýþýk 85 pediyatrik hastanýn kayýtlarý geriye doðru deðerlendirildi. Hasta yaþý, cinsiyeti, yaralanma mekanizmasý, izole yaralanmalar, cerrahi giriþimler, hastaneye yatýþ ve mortalite mayi yerleþimine göre deðerlendirildi.
BULGULAR
Künt karýn travmasý olan toplam 85 pediyatrik hasta (63 erkek, 22 kýz; ortalama yaþ 7,88±3,403 yýl) bu çalýþmaya dahil edildi. Hastalarýn %40’ýnda intraperitoneal sývý, %60’ýnda pelvik sývý vardý. Hastalarýn çoðu (%35,3) yüksekten düþme nedeni ile baþvurmuþlardý. Yaralanma mekanizmasý ile sývý varlýðý ve sývý yerleþimi arasýndaki fark istatistiksel olarak anlamlý deðil idi (p>0,05). Yirmi dokuz hastada solid organ yaralanmasý vardý. Ýntraperitoneal sývýyi en çok arttýran dalak yaralanmasý idi (p<0,001). Hastalarýn %15,3’üne laparotomi yapýldý (bunlarýn tümünde intraperitoneal sývý vardý) %44,7 hasta kan transfüzyonuna ihtiyaç duydu. Ýntraperitonal sývý varlýðý laparotomi olasýlýðýný ve kan transfüzyon ihtiyacýný istatistiksel olarak artýrmýþtý (p<0,001). Mortalite oraný %4,8 idi.
SONUÇ
Ultrasonografi incelemesinde pelvik sývý varlýðýnda solid organ yaralanma olasýlýðý daha düþük iken, pelvis dýþý intraperitoneal sývý varlýðýnda solid organ yaralanma olasýlýðý daha yüksektir.

BACKGROUND
The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma.
METHODS
We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid.
RESULTS
A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88±3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%.

CONCLUSION
In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.

AMAÇ
Gebelikle iliþkili akut biliyer pankreatit (ABP) nadir bir hastalýktýr, taný ve tedavi anlamýnda da zorlu bir klinik tablodur. Bu yazýda, gebelikle iliþkili ABP nedeniyle takip ve tedavisi yapýlan hastalarýn verileri sunuldu.
GEREÇ VE YÖNTEM
Ocak 2005 ile Ocak 2010 tarihleri arasýnda genel cerrahi kliniðinde gebelikle iliþkili ABP tanýsý ile takip ve tedavisi yapýlan 27 hastanýn týbbi kayýtlarý gözden geçirildi.
BULGULAR
Toplam 27 hastadan 25’inin (%93) puerperal dönemde ve ikisinin (%7) gebelik döneminde olduðu saptandý. On yedi hasta (%63) konservatif tedavi yapýlarak ve sekiz hafta sonra kolesistektomi iþlemi uygulanmak üzere taburcu edilirken, 10 hastaya (%37) ilk baþvurularý sýrasýnda taburcu edilmeden önce kolesistektomi uygulanmýþtýr. Ölüm oraný %3 (n=1) olarak saptanmýþtýr.
SONUÇ
Gebelikle iliþkili ABP genellikle hafif ile orta derecede bir klinik seyir ve yüz güldürücü sonuçlara sahip, konservatif tedavinin baþarý ile uygulanabileceði bir hastalýktýr. Gebelikten baðýmsýz ABP’lerde genel olarak kabul edildiði gibi, gebelikle iliþkili ABP’lerde de, ilk trimestrda olan gebe hastalar hariç tutulmak üzere, ilk baþvuruda taburculuk iþlemi öncesi kolesistektomi uygulanmasý düþünülmelidir.

BACKGROUND
Pregnancy-associated acute biliary pancreatitis is a rare but challenging clinical entity in terms of diagnosis and management. We report our institutional medical data of pregnancy-associated acute biliary pancreatitis.
METHODS
Medical records of 27 patients admitted to our clinics for pregnancy-associated acute biliary pancreatitis between January 2005 and January 2010 were reviewed.
RESULTS
Of the 27 patients, 25 (93%) were in the post-partum period, and 2 (7%) were pregnant. Seventeen patients (63%) were managed with conservative treatment, and were scheduled for interval cholecystectomy, while 10 patients (37%) had early cholecystectomy prior to discharge. The mortality rate was 3% (n=1).

CONCLUSION
Pregnancy-associated acute biliary pancreatitis usually has a mild-to-moderate clinical course with a favorable outcome, and can be managed successfully with conservative treatment. Early cholecystectomy done prior to discharge in the initial admission should be considered in mild-to-moderate pregnancy-associated acute biliary pancreatitis, except in patients within the first trimester.

AMAÇ
Spontan ince baðýrsak hematomu nadir görülen ve ciddi komplikasyonlara neden olabilen bir klinik durumdur. Bu çalýþmanýn amacý, spontan intramural ince baðýrsak hematomu saptanan olgularda taný, tedavi ve takipteki tecrübelerimizi sunmaktýr.
GEREÇ VE YÖNTEM
Ýnce baðýrsak spontan intramural hematom tanýsý konulan hastalarýn verileri retrospektif olarak incelendi. Altý hasta çalýþmaya dahil edildi.
BULGULAR
Ýntramural kanamaya neden olarak dört hastada (%83) antikoagülasyon tedavisi ve bir hastada faktör VIII eksikliði belirlendi. Akut karýn aðrýsý, bulantý ve kusma en sýk baþvuru þikayetleri idi. Altý hastanýn beþinde taný karýn bilgisayarlý tomografisi ile kondu. Dört hasta konservatif olarak takip edildi ve iki hastada akut karýna baðlý cerrahi giriþime gerek duyuldu. Tüm hastalar sorunsuz taburcu edildi.
SONUÇ
Fiziksel inceleme ve radyolojik tetkikler hastalarýn özgeçmiþleri ile beraber deðerlendirildiðinde taný için yeterlidir. Konservatif tedavi hastalarýn çoðunda hematomun gerilemesini saðlar. Cerrahi tedavi komplike olgularda uygulanmalýdýr.

BACKGROUND
Spontaneous intramural hematoma of the small intestine is a rare clinical condition that may result in potentially serious complications. The purpose of this study was to present our experience with the diagnosis and management of spontaneous intramural hematoma of the small intestine.
METHODS
The medical records of the patients with spontaneous intramural hematoma of the small intestine were retrospectively reviewed. Six patients were included in this study.
RESULTS
Anticoagulation therapy and factor VIII deficiency were found to be responsible for the intramural hemorrhage in five patients (83%) and one patient, respectively. Acute abdominal pain followed by nausea and vomiting were the most common presenting symptoms. Abdominal computed tomography scan was diagnostic in five of the six patients. Four patients were followed up with conservative therapy. Surgical intervention was required in two patients due to acute abdomen. All patients were discharged from the hospital uneventfully.
CONCLUSION
The patient’s medical history, physical examination and radiological evaluation proved adequate for the diagnosis. Conservative therapy provides regression of the hematoma in most patients. Surgery should be reserved only for the complicated cases.

AMAÇ
Çalýþmanýn amacý, acil servis yanýk ünitesinde tedavi edilen çocuklarýn sosyo-demografik özelliklerini ortaya koyarak, bu olgularda gerekli hekim yaklaþýmýný tartýþmak ve yaþamsal tehlike kriterleri taþýyan ve taþýmayan hastalarýn prognozlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM
Çalýþma 14.10.2004 - 31.12.2006 tarihleri arasýnda, tanýmlayýcý epidemiyolojik yöntemle, acil cerrahi servisi yanýk ünitesine gelen 0-18 yaþ grubundaki olgularda (n=136) gerçekleþtirilmiþtir. Hazýrlanan yarý yapýlandýrýlmýþ bir görüþme formu ile yanýklý hastalara iliþkin bilgiler toplanmýþtýr. Veriler istatistiksel olarak deðerlendirilmiþtir.
BULGULAR
Olgularýn %66,2’si (n=90) erkek, %33,8’i (n=46) kadýndýr. Yaþ ortalamasý 3,9±4,1 yýl, ortalama yanýk yüzdesi 22,47±17,37 olarak hesaplanmýþtýr. Yanýk nedenleri arasýnda ilk sýrayý %77,2 oranla (n=105) suda haþlanmalar almaktadýr. Yanýk yüzdesi %20’nin altýnda olan olgularda %6,3 (n=6) oranýnda, %20’nin üzerinde olan olgularda %61 (n=25) oranýnda ölüm görülmüþtür (p=0,0001). I. derece yanýklý olgularýn %21’inde (n=25) ölüm gerçekleþirken, II.-III. derece yanýk olgularýnýn %35,3’ünde (n=6) ölüm meydana gelmiþtir (p=0,189). Yaþamsal tehlike taþýyan olgularda ölüm oranlarý, yaþamsal tehlike taþýmayan olgularda karþýlaþýlan ölüm oranlarýndan istatistiksel olarak anlamlýlýk gösterecek biçimde yüksek bulunmuþtur (p=0,033).
SONUÇ
Çocuklarda yanýk yüzdesinin geniþliði prognoz için çok belirleyicidir. Tüm yanýk olgularýnýn ihmal/istismar gibi deðerlendirilerek çocuklarýn güvence altýna alýnmasý önemli bir koruyucu hekimlik uygulamasý olacaktýr.

BACKGROUND
The aim of this study is to outline the sociodemographic and traumatic characteristics of children who were referred to the Burn Unit of Emergency Service with burn injuries, to discuss the doctors’ approach to these cases, and to compare the prognosis of patient groups with and without life-threat.
METHODS
This epidemiological study was carried out between 14 October 2004 and 31 December 2006 and included a total of 134 pediatric patients aged between 0-18 years. A semi-structured questionnaire form was designed to obtain the information from the study population. The obtained data were statistically evaluated.
RESULTS
66.2% (n=90) of the cases were male and 33.8% (n=46) were female. The mean age of the study population was 3.9±4.1 years and the mean percentage of burned body area was 22.47±17.37. The main cause of burn was scalding with hot water, with a frequency of 77.2% (n=105). When the percentage of burn area of the body was lower than 20%, the mortality was 6.3% (n=6), whereas it was 61% (n=25) when the burn area exceeded 20% of the body (p=0.0001). While the mortality was 21.0% (n=25) among the cases with first-degree burns, it was 35.3% (n=6) among those with second- and third-degree burns (p=0.189). Mortality ratio among the cases with life-threat was higher than those without life-threat, and this difference was statistically significant (p=0.033).

CONCLUSION
Extent of burn is a determinative factor for prognosis in children. Evaluation of all burn cases in children should be approached as cases of neglect/abuse; protection of these children in this manner will serve as an important practice of preventive medicine.

Nekrotizan fasiit ile tüberküloz birlikteliði son derece nadirdir. Tüberkülozun ilk klinik görüntüsünün histopatolojik yöntemle kanýtlanmýþ þekilde nekrotizan fasiit olduðu iki olgu sunuyoruz. Her iki olguda yinelenen cerrahi debridmanlar yapýldý. Bir olguda, ameliyattan bir yýl sonra bir sinüs akýntýsý kültüründe aside dirençli basil üredi. Diðer hastada, ameliyattan iki ay sonra pulmoner tüberküloz tanýsý kondu. Nükseden veya cerrahiye beklenmedik þekilde yavaþ yanýt gösteren nekrotizan fasiitli hastalarda tüberküloz tanýsýndan kuþkulanýlmalýdýr.

The association between necrotizing fasciitis and tuberculosis is extremely rare. We report two cases in which the initial clinical presentation of tuberculosis was that of necrotizing fasciitis proven by histopathology. Repeated adequate surgical debridement was performed in both. In one patient, acid-fast bacillus was cultured from a discharging sinus one year postoperatively. The other patient was diagnosed to have pulmonary tuberculosis two months postoperatively. The diagnosis of tuberculosis should be suspected in patients with necrotizing fasciitis with recurrence or unexpected slow response to surgery.

Yetmiþ yedi yaþýndaki erkek hasta hastaneye sol alt ekstremitede giderek kötüleþen akut iskemi bulgularýyla baþvurdu. Hastanýn hikayesinden, ortopedi kliniðinde koksartroz tanýsýyla total eklem protezi uygulandýðý ve altý ay sonra protezinin revize edildiði öðrenildi. Fiziksel incelemede sol alt ekstremite distal nabýzlarýnýn femoral arter düzeyinden itibaren alýnamadýðý saptandý. Sol kalça hareketleri aðrýlý ve dýþ rotasyon duruþu sýnýrlý idi. Doppler ultrasonografide sol ortak femoral arterde akut týkanýklýk olduðu saptandý ve hastaya saðdan sola femoro-femoral politetrafloroetilen greft ile baypas uygulandý. Baþarýlý cerrahi ve sorunsuz ameliyat sonrasý palpabl femoral ve popliteal atýmlý hastaya düþük molekül aðýrlýklý heparin verildi; hasta ortopedi kliniðine tedavisinin devamý için sevk edildi. Literatürde total kalça protezinin yer deðiþtirmesine baðlý vasküler oklüzyonlar ile ilgili bildirilmiþ olgu sunumlarýnýn nadir olmasý nedeniyle bu ilginç olguyu ve uyguladýðýmýz cerrahi giriþimimizin sonuçlarýný paylaþmak istedik.

A 77-year-old male patient was admitted to the hospital with a worsening acute ischemia of the left lower extremity. The patient, who had a coxarthrosis and was being followed by the orthopedic clinic, had undergone a total hip prosthesis, with a revision performed at the sixth month of its placement. The physical examination revealed the absence of the femoral, popliteal and distal pulses of the left lower extremity. The left hip movements were painful and limited in external rotation posture. Doppler ultrasonography showed an acute occlusion of the left common femoral artery due to the dislocated hip prosthesis, and right-to-left femorofemoral expanded polytetrafluoroethylene graft bypass was carried out. After successful surgery and an uneventful postoperative period with palpable femoral and popliteal pulses, the patient was put on low molecular weight heparin and referred to orthopedics once the ischemia had subsided with the intervention. Case reports regarding occlusions due to migration of total hip prosthesis are rare in the literature. The emphasis of this case report is to describe one such case.

Hava yastýklarý araç kazalarý nedeniyle oluþabilecek yaralanma ve ölüm risklerini azaltmakla birlikte açýlmasýna baðlý yaralanmalara neden olabilmektedir. Bu olgu sunumunda, bu þekilde oluþan bir göðüs kemiði kýrýðý, ultrasonografik tanýsý ve yaralanma mekanizmasý incelenerek sunuldu.

Although airbags reduce the overall risk of injury and death from motor vehicle accidents, the airbag may cause injuries during deployment. We present a case of apparently isolated sternal fracture caused by airbag deployment during a motor vehicle crash and we discuss the ultrasonographic diagnosis. We also examine the mechanism of injury caused by the airbag.

Bu olgu, interkostal göðüs tübünden çýkan askaris solucaný gibi çok seyrek bir duruma sahip olmasý nedeniyle sunulmaktadýr. Beþ yaþýndaki bir çocukta bulunan bir karaciðer apsesi sað plevral boþluðuna rüptüre olmuþtur. Sað plevral efüzyon için interkostal bir göðüs tüpü yerleþtirilmiþtir. Ameliyat sonrasý beþinci günde, göðüs tüpünden gelen 7 cm uzunluðunda bir solucan fark edilmiþtir. Ascaris lumbricoides, solucanlarýn hareketliliði nedeniyle ciddi komplikasyonlara yol açabilmektedir. Ýntestinal obstrüksiyon, volvulus, gangren, pankreatit, biliyer obstrüksiyon, kolanjiyohepatit ve karaciðer apsesi gibi komplikasyonlarýn oluþtuðu bildirilmekle birlikte intraplevral askariyazis son derece nadir bir durumdur. Bu sunum, yazý intraplevral askariyazisin bir klinik tablosu sunmakta ve bu komplikasyonun farkýnda olmanýn önemini vurgulamaktadýr.

A rare case of an Ascaris worm emerging through an intercostal chest tube is reported here because of its unusual presentation. A five-year-old male child had a liver abscess, which had ruptured into the right pleural cavity. An intercostal chest tube was inserted for right pleural effusion. On the 5th postoperative day, a 7 cm long worm was noticed emerging through the chest tube. Ascaris lumbricoides infestation can lead to serious complications because of the mobility of the worms. Though complications such as intestinal obstruction, volvulus, gangrene, pancreatitis, biliary obstruction, cholangiohepatitis, and liver abscess have been reported to occur, intrapleural ascariasis is an extremely rare situation. This report describes a clinical situation of intrapleural ascariasis and emphasizes the importance of remaining aware of this rare complication of ascariasis.

Muayene edilen hastalarda bulunan lezyonlarýn doðru tanýmlanmasý, adli týp uygulamalarý kadar hekimlik mesleðinde de son derece önemlidir. Ancak, pratisyen ve klinisyen hekimler çoðu zaman kendilerine baþvuran hastalardaki lezyon ve bulgularý tanýmlama ve bunlarý kayýt altýna alma konusunda gereken önemi göstermemekte, lezyonlarý eksik ya da hatalý olarak tanýmlamakta, bu da özellikle adli olgu niteliði taþýyan travmatik olaylarýn yorumlanmasýnda ve yargýlanma aþamasýnda doðru kararlarýn oluþmasýna engel teþkil etmektedir.
Bu yazýda, trafik kazasý sonucu müracaat ettiði hastanede yapýlan ilk muayene sýrasýnda göðüs üzerinde saptanan lezyon “ray þeklinde ekimoz” olarak tanýmlanmýþ, dolayýsýyla adli makamlar tarafýndan “þiddet veya istismara maruz kalmýþ olabileceði” düþüncesi ile þüpheli olarak deðerlendirilmiþ ve çözümlenmesi amacýyla anabilim dalýmýza gönderilmiþ dokuz yaþýnda bir erkek çocuk olgusu, adli týbbi çözümleme yönünden irdelenmiþtir.
Hasta ile ilk karþýlaþan hekimlerin adli olgularýn deðerlendirmesinde yeterince dikkat, özen veya önem göstermemeleri ya da gerekli bilgi donanýmýna sahip olmamalarý sonucunda neden olabilecekleri adli yorum ve yargý hatalarýna bir örnek teþkil eden olgu, konunun önemi nedeniyle ilginç bulunarak sunulmuþtur.

Correct identification of lesions in examined patients is as important in forensic medicine application as it is in the medical profession. However, general practitioners and clinicians often fail to give proper attention to the definition and recording of the lesions and clinical findings in patients. Additionally, the identification of the lesion is sometimes deficient or incorrect. This has hindered, particularly in traumatic events that are of a forensic nature, reaching accurate conclusions during the interpretative and legal phases. In this study, we describe the case of a nine-year-old boy admitted to the hospital following a traffic accident. During his evaluation, an ecchymosis “resembling a rail” on his chest was noted. Consequently, legal/judicial authorities suspected the child may have been exposed to violence or child abuse and he was referred to our department. Practitioners may contribute to inaccurate decisions/conclusions if they fail to give the necessary detailed attention during the forensic interpretation (detailed examination and recording of lesions) and judicial process or if they have insufficient knowledge on this subject. This case is submitted as an interesting example since it included the possibility of inaccurate conclusion and judgment.

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Massive intra-abdominal hemorrhage represents a challenging operative emergency. Temporary control of the aorta and inferior vena cava (IVC) using intra-luminal balloon occlusion, preemptive trans-thoracic clamping or infra-diaphragmatic clamping has been achieved with variable success. We report the use of wooden spoons with convex arches cut from their bases as a cheap and effective alternative. They can be used to compress the aorta or IVC against the vertebrae, giving vascular control while leaving good surgical access (Fig. 1). This equipment requires minimal financial investment and only basic woodworking skills.