AMAÇ
Þiddetli formundaki yüksek mortalite oraný ile akut pankreatit günümüzde halen týbbýn önemli bir sorunudur. Hastalýðýn þiddetinin erken belirlenmesi etkin tedavi için kritik öneme sahiptir. Çeþitli biyokimyasal belirteçler denenmiþtir ve halen denenmektedir. Ýdeal belirteç olguyu tanýyabilmeli ve pankreatitin hafif ve þiddetli formlarýný ayýrt edebilmelidir.
GEREÇ VE YÖNTEM
Bu prospektif çalýþmaya akut pankreatitli 34 olgu (14 erkek, 20 kadýn, ort. yaþ: 58 yaþ) ve kontrol grubundaki 33 olgu (17 erkek, 16 kadýn, ort. yaþ: 53 yaþ) dahil edildi. Hafif (n=29) ve aðýr (n=5) olgular baþvuru anýndaki, baþvurudan 24 ve 48 saat sonraki amilaz, C-reaktif protein (CRP), alfa-1 proteaz inhibitörü ve antikimotripsin düzeyleri açýsýndan karþýlaþtýrýldý.
BULGULAR
Akut pankreatit grubunda alfa-1 proteaz inhibitörü ve antikimotripsinin serum düzeyleri ilk 24 saatte yükseldi, buna karþýn CRP 48 saat sonra pik deðere ulaþtý. CRP þiddetli pankreatitli hastalarda anlamlý derecede yüksek konsantrasyonlar gösterirken, alfa-1 proteaz inhibitörü ve antikimotripsin düzeylerindeki hafif deðiþimler anlamlý deðildi.
SONUÇ
Baþvuru anýnda yüksek düzeyleri ile alfa-1 proteaz inhibitörü ve antikimotripsin akut pankreatitte erken sonuçlar verir. Bu deðiþkenlerin aktivasyonlarý 24 saat sonra düþer. Bu belirteçlerin akut pankreatitli hastalarda erken taný deðeri olabilir. Her ikisi de bu hastalýðýn hafif ve þiddetli olgularýný ayýrmada iyi olmadýðýndan, rutin klinik kullanýma dahil edilmemelidir.

BACKGROUND
Acute pancreatitis with high mortality of severe onset is still a major problem in medicine. Early identification of the severity of the disease is critical for effective treatment. Many markers have been tried and are still being tested. The ideal marker should be able to identify the cases and distinguish between mild and severe.
METHODS
This prospective study included 34 cases (14 males, 20 females, mean age: 58 years) of acute pancreatitis and 33 cases (17 males, 16 females, mean age: 53 years) as a control group. Mild (n=29) and severe (n=5) cases were compared with respect to serum levels of amylase, C-reactive protein (CRP), alpha-1-protease inhibitor, and antichymotrypsin on admission and 24 and 48 hours (h) after admission.
RESULTS
Alpha-1 protease inhibitor and antichymotrypsin levels were significantly elevated in the first 24 h; however, CRP peaked after 48 h in the acute pancreatitis group. While CRP showed significantly higher concentrations in patients with severe pancreatitis, alpha-1-protease inhibitor and antichymotrypsin levels changed slightly, but without significance, in severe cases.
CONCLUSION
Alpha-1 protease inhibitor and antichymotrypsin are early events in acute pancreatitis, with high levels on admission. Activation of these variables declines after 24 h. These markers may have early diagnostic value in patients with acute pancreatitis. Because neither of them is good at discrimination of mild and severe cases in the disease, they should not be incorporated into routine clinical investigations.

AMAÇ
Maksillofasiyal kýrýðý bulunan hastalar, bu travmaya eþlik eden kafa travmasý geçirme konusunda yüksek risk altýndadýrlar. Bu hastalarda kafa travmasýnýn erken anlaþýlmasý hastanýn saðkalýmý ve iyileþmesi için kritik öneme sahiptir.
GEREÇ VE YÖNTEM
Ocak 2006 ile Eylül 2009 tarihleri arasýnda hastanemizin acil servisine maksillofasiyal kýrýk nedeniyle gönderilen 246 hastanýn kayýtlarý geriye dönük olarak tarandý. Hastalarýn yaþ, cinsiyet, maksillofasiyal travmanýn nedeni, tipi, yerleþimi ve kafa travmasý analiz edildi.
BULGULAR
Hastalarýn yaþlarýnýn ortalamasý 23,61±16,75 idi (%83,3 erkek, %16,7 kadýn). Kraniyal yaralanma maksillofasiyal travmalý 38 hastada gözlendi. Hastalar arasýnda tek yüz kemiði kýrýðý bulunanlarda kafa travmasý riski çoklu kýrýklý hastalara göre 3,44 kat daha az gözlenirken (p<0,001), yüz kemiði çoklu kýrýlan hastalarda kafa travmasý geçirme riski anlamlý derecede artmýþtý (p<0,001). Ýçinde nazal kemik, maksiller kemik, mandibular kemik ve frontal bölge kýrýðý bulunan hastalarda kafa travmasý riski önemli derecede artmýþtý (p<0,05 her bir grupta).
SONUÇ
Çoklu yüz kemik kýrýðý bulunan hastalarda klinik bulgularý olmasa dahi kafa travmasý yönünden araþtýrýlmalarý gerekir.

BACKGROUND
Patients with maxillofacial fractures are at high risk of accompanying traumatic cranial injuries. Prompt determination of head injury in these patients is crucial for improving patient survival and recovery.
METHODS
The records of 246 patients with maxillofacial fractures referred to the emergency department of our hospital between January 2006 and September 2009 were reviewed in this retrospective study. The patients’ age and gender, cause, type and location of the maxillofacial fracture, and the cranial injuries were analyzed.
RESULTS
The mean age of the patients was 23.61±16.75 years (83.3% males and 16.7% females). Cranial injury was observed in 38 patients with maxillofacial trauma. While the risk of head injury was found to be 3.44-fold lower among patients with single facial bone fracture (p<0.001), the risk of experiencing head injury significantly increased in patients with multiple facial bone fractures (p<0.001). The risk of head trauma significantly increased in patients with fractures of the nasal bone, maxillary bone, mandibular bone, and with frontal region fractures (p<0.05 in each group).
CONCLUSION
The patients with multiple facial bone fractures should be investigated with regard to head injury even if they do not have clinical findings.
op

AMAÇ
Rekonstrüktif cerrahide asýl amaç, fonksiyonel ve yapýsal açýlardan en benzer doku ile yeniden yapýlanmanýn saðlanmasýdýr. Ancak rekonstrüktif cerrah ayný zamanda donör alan komplikasyonlarýný en aza indirmeye de odaklanmalýdýr.
GEREÇ VE YÖNTEM
Biz bu çalýþmamýzda beþ hastada distal ekstremite defektlerinde temporoparietal fasya flebi ve deri grefti ile rekonstrüksiyon deneyimlerimizi sunduk. Temporoparietal fasya flebi skalpte ayný bölgeden alýnan kýsmi kalýnlýkta deri grefti ile kaplandý.
BULGULAR
Greftin skalpten alýnmasý ile hem flep hem greft donör alanlarý saçlarýn arkasýnda gizlenmiþ oldu. Transfer edilen flep ve greftler tüm hastalarda herhangi bir donör alan komplikasyonu görülmeden olaysýz þekilde iyileþti.
SONUÇ
Distal ekstremite defektlerinde temporaparietal fasya kullanmanýn sayýsýz avantajýna ek olarak bunu ayný alandan alýnan kýsmi kalýnlýkta deri grefti ile kombine etmenin hem skarý saçlar tarafýndan gizleyerek donör alan morbiditesini azaltmasý hem de optimal rekonstrüktif sonuçlarý saðlamasý açýsýndan iyi bir seçenek olduðunu düþünüyoruz.

BACKGROUND
In reconstructive surgery, the ultimate goal in rebuilding a structure is to provide the most similar substitute from both the functional and structural points of view. At the same time, the reconstructive surgeon should focus on minimizing donor area complications.
METHODS
In this report, we present our experiences with the reconstruction of distal extremity defects using a free temporoparietal fascia flap in five patients. The flap was subsequently covered with a split-thickness skin graft harvested from the same region of the scalp as the flap donor site.
RESULTS
By procuring the skin graft from the scalp, the donor sites of both the flap and the skin graft were concealed by hair. The transferred flaps and skin grafts healed uneventfully in all patients without any complications at the donor or recipient site.
CONCLUSION
We conclude that this combination of harvesting a temporoparietal fascia flap, which has many advantages in reconstructing distal extremity defects, along with a skin graft from the same region as the flap, both hidden by hair, can limit donor site morbidity and achieve optimal reconstructive outcomes.

BACKGROUND
Head injury increases mortality in trauma patients. We aimed to study the epidemiological and clinical features of head injury in Al-Ain city, United Arab Emirates (UAE).

METHODS
Trauma patients with head injury who were admitted to Al-Ain Hospital for more than 24 hours and those who died in the hospital were included in the study. Data were prospectively collected from March 2003 - March 2006.
RESULTS
589 patients were studied, and 521 were males (88.3%). The median (range) age was 30 (1-89) years. The most common mechanism of injury was road traffic collision (67.1%) followed by fall from height (11.9%). Head injury was mild in 82.2% of patients, moderate in 5.7%, and severe in 12.1%. 20.9% of patients were admitted to the intensive care unit. 35 patients died (overall mortality 5.9%). Patients who died had significantly higher Injury Severity Score (p<0.0001), lower Glasgow Coma Scale (p<0.0001), and higher Abbreviated Injury Scale of the head (p<0.0001).
CONCLUSION
Motor vehicle collision was the main mechanism of head injury in the UAE followed by fall from height. Legislation for compulsory seatbelt usage and helmet usage by bicyclists and motorcyclists should be adopted. A safe work environment and preventive measures at work should be introduced.

AMAÇ
Travmatik beyin hasarý (TBH) bulunan hastalarda mortalite ile iliþkili faktörleri belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM
Ýran’da beþ yýllýk bir periyot boyunca 8 büyük kentte yürütülen ulusal travma projesinin veri kayýtlarý kullanýldý. TBH’li hastalar belirlendi, tek deðiþkenli ve çok deðiþkenli analizler yapýldý.
BULGULAR
Beyin yaralanmasý geçirmiþ 2274 hasta kaydýna ulaþýldý (1794 erkek, 480 kadýn). Hastalarýn ortalama yaþý 30,1±19,11 yýl idi, 345 hastanýn yaþý 12’den küçük, 137 hastanýn yaþý 65’den büyüktü. Hastalarýn 383’ü (%16,9) bir yaralanmaya baðlý ölmüþtü. Tek deðiþkenli analiz; mortalite ile þu faktörler arasýnda anlamlý bir birliktelik bulunduðunu gösterdi: Yaþ, cinsiyet, Glasgow koma skoru (GKS), yaralanma ciddiyeti skoru (YCS), sistolik, diyastolik ve ortalama arteriyel kan basýncý (KB) ve solunum oraný (SO) (p<0,05). Lojistik regresyon analizi, hastaneye varýþtan yarým saat sonrasýndan itibaren ölüm ile aþaðýdakiler arasýnda anlamlý bir iliþki bulunduðunu gösterdi: Yaþ (OR=1,04), GKS (OR=0,59), YCS (OR=1,03), ortalama arteriyel KB (OR=0,71) ve SO (OR=0,82).
SONUÇ
Bizim sonuçlarýmýz, acil servis bölümünün ilk tedavisi süresince özel bakým gerektiren TBH’li hastalarda prognostik faktörlerin yaþ, GKÖ, YCS, KB ve SO olduðunu göstermiþtir.

BACKGROUND
We aimed to determine factors associated with mortality rates in patients with traumatic brain injury (TBI).
METHODS
Registered data of a national trauma project conducted in eight major cities in Iran during a five-year period were used. Patients with a TBI were identified and both univariate and multivariate analyses were performed.
RESULTS
2274 brain-injured patients including 1794 males (78.9%) were identified. The mean age of the patients was 30.1 ± 19.11 years. The age of 345 patients was less than 12, while 137 patients were older than 65. 383 patients (16.9%) died as a result of their injury. Univariate analysis showed a significant association between mortality and the following factors: age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic, diastolic and mean arterial blood pressure (BP), and respiratory rate (RR) (p<0.05). The logistic regression analysis revealed a statistically significant association between death and age (odds ratio [OR]=1.04), GCS (OR=0.59), ISS (OR=1.03), mean arterial BP (OR=0.71), and RR (OR=0.82) one-half hour after hospital arrival.
CONCLUSION
Our results demonstrated that age, GCS, ISS, BP, and RR as prognostic factors in patients with TBI indicate those that need special care during the initial management in the emergency department.

AMAÇ
Gastrointestinal sistem (GÝS) kanamalarýnda kanama odaðýnýn saptanmasýnda, Tc-99m ile iþaretli eritrosit (RBC) sintigrafisinin rolü klinik deneyimlerimiz ýþýðýnda deðerlendirildi.
GEREÇ VE YÖNTEM
1995-2010 yýllarý arasýnda GÝS kanamasý odaðýnýn belirlenmesi amacýyla kliniðimize gönderilen 57 hasta (27 kadýn, 30 erkek; ortalama yaþ 43.9±24; daðýlým 1-91 yýl) geriye dönük olarak çalýþmaya alýndý. Sintigrafi öncesi hastalarýn 51’ine gastroskopi, 45’ine kolonoskopi, 9’una anjiyografi yapýlmýþtý.
BULGULAR
RBC sintigrafisi hastalarýn 31’inde pozitif ve 26’sýnda negatifti. Pozitif sintigrafik bulgular, 19 hastada ilk bir saatlik dinamik imajlarda, 7 hastada 1-4. saatler arasý statik imajlarda, 5 hastada ise 4-24. saatler arasýnda alýnan statik imajlarda kaydedildi. Toplam 14 hasta GÝS kanamasý nedeniyle ameliyat edildi. On üç hastada kanama yeri RBC sintigrafisi tanýsýyla doðrulandý (doðruluk: %92,8). Ameliyat edilmeyen 43 hastanýn 12’sinde nedeni bilinmeyen demir eksikliði anemisi vardý ki bu hastalarýn tümünde sintigrafi negatif olarak sonuçlandý. Yoðun kanama bulgularý olan 4 hasta medikal takip sürecinde kaybedildi, geri kalan 27 hastanýn kanamalarý kendiliðinden ya da konservatif tedavilerle durdu.
SONUÇ
Çalýþmamýz aktif GÝS kanamalarýnda kanama odaðýnýn belirlenmesinde sintigrafinin primer yöntem olmasý gerekliliðini göstermektedir. Özellikle ilk 1 saatlik dinamik görüntüleme esnasýnda saptanan pozitif imajlar, kanama odaðýnýn doðru yerinin saptanmasýnda ve cerrahi gerekliliðin belirlenmesinde yol göstericidir.

BACKGROUND
We aimed to evaluate the role of Tc-99m labeled red blood cell (RBC) scintigraphy for determination of localization of gastrointestinal system (GIS) bleeding.
METHODS
Fifty-seven cases (27 females, 30 males; mean age 43.9±24; range 1 to 91 years) who referred to our clinic between 1995-2010 were evaluated for determination of localization of GIS bleeding with RBC scintigraphy. Prior to scintigraphy, gastroscopy in 51, colonoscopy in 45, and angiography in 9 patients were performed.
RESULTS
RBC scintigraphies were positive and negative in 31 and 26 patients, respectively. Positive scintigraphic findings were obtained within the 1st hour of dynamic imaging in 19 patients, within the 1st-4th hour static images in 7, and within the 4th-24th hour images in 5 patients. Fourteen patients underwent surgical exploration. In 13 patients, the surgery confirmed the diagnosis by RBC scintigraphy (accuracy: 92.8%). Of 43 patients without surgical exploration, 12 had anemia due to iron deficiency and their scintigraphic evaluation were negative. Four patients died and in 27 patients, GIS bleeding ceased spontaneously or with conservative measures.
CONCLUSION
Scintigraphy should be the primary tool for accurate diagnosis of patients with active GIS bleeding. Positive dynamic images obtained within the first hour of imaging may be more accurate for demonstrating bleeding localization and a good predictor of requirement of surgical exploration.

AMAÇ
Aðýr travmatik beyin yaralanmalý (ATBY) ve bilateral reaktif olmayan pupil dilatasyonu (BRPD) olup, dekompresif cerrahi (DC) uygulanmýþ hastalarda Glasgow koma skalasý (GKS), kafa içi basýnç (KÝB), serebral perfüzyon basýncý (SPP) deðiþiklikleri ve uzun dönem klinik sonuçlarý deðerlendirildi.
GEREÇ VE YÖNTEM
Çalýþma gurubu, bölümümüzde ATBY nedeniyle DC uygulanan 147 hasta içerisinden BRPD’li 28 hastayý (11 kadýn, 17 erkek) içerdi.
BULGULAR
Ortalama GKS skoru, baþvuruda 4,96±1,20, ameliyat öncesi dönemde 4 idi. Ölen hastalarda, DC sonrasý ortalama KÝB deðerleri hayatta kalanlara göre anlamlý ölçüde yüksekti (p<0,05). Ayrýca, DC sonrasý KÝB azalmasý, yaþayan hastalarda yine anlamlý olarak yüksekti (p<0,05). Tümden mortalite oraný %61,02 bulundu. Baþvuruda ikinin üzeri GKS motor skoru anlamlý olarak düþük mortalite ile iliþkili idi (p<0,05). Yaþayan 4 hasta taburcu sonrasý birinci yýlda (%14,28) iþlevsel sonuç skoru (Glasgow sonuç skoru 4 ve 5) gösterdi.
SONUÇ
ATBY sonrasý BRPD’li hastalarda sonuçlar her zaman ölümcül ya da olumsuz olmayabilir. Hýzlý DC, özellikle baþvuru GKS skoru 6, 7 olan hastalarda iþlevsel saðkalým þansýný artýrabilir.

BACKGROUND
We investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS).
METHODS
The study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department.
RESULTS
The mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge.
CONCLUSION
Outcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

AMAÇ
Çocuk doðurma çaðýnda bulunan kadýnlardaki travma ile ilgili daðýlým ve nedenler araþtýrýldý.
GEREÇ VE YÖNTEM
Bu çalýþmadaki veriler, Al-Ain Hastanesi (Birleþik Arap Emirlikleri-BAE) Travma Kayýtlarýndan derlendi. 16 ile 45 arasý (çocuk doðurma çaðý) bir yaþa sahip olan ve 15 Mart 2003 ile Mart 2006 tarihleri arasýndaki periyotta travma nedeniyle hastaneye yatýrýlan kadýnlar çalýþmaya dahil edildi.
BULGULAR
Kadýnlar (n=171) ayný yaþ grubundaki bütün travma hastalarýnýn (n=1809) %9’unu kapsadý ve bunlarýn %29’u BAE ulusundandý. Kadýnlar için ortalama yaþ 30,5 yýl idi. Karayolu araç kazasý (KAK), baþlýca yaralanma nedeniydi (n=78, %46). Yanýklar, erkeklere göre kadýnlarda anlamlý olarak daha yüksek bulundu (p=0,001). Lomber kýrýklar anlamlý þekilde erkeklerde daha yüksekti (p=0,03), servikal kýrýklar anlamlý þekilde kadýnlarda daha yüksekti (p=0,04). Kadýnlarda pelvik kýrýklar %6,4, spinal kýrýklarý %7 ve her iki yaralanmanýn var olduðu %1,2 oranýnda ki hastaya taný konuldu, 3 kadýn öldü (%1,7); ölümlerin tümü KAK nedeniyle idi.
SONUÇ
Travmaya uðrayan kadýnlarýn çoðunluðu 20 ile 34 yaþ arasýndaydý. KAK, yaralanma ve ölümle ile ilgili baþlýca nedendi. Kadýnlarda travma, yüksek bir pelvik kýrýk insidansý ile birliktedir. Erkeklerdeki lomber yaralanmalarýn tersine, kadýnlarda daha yüksek servikal yaralanma oraný gözlendi.

BACKGROUND
We aimed to study the distribution and causes of trauma in women of child-bearing age.
METHODS
Data were collected from Al-Ain Hospital (United Arab Emirates-UAE) Trauma Registry. Females aged 16 to 45 years (child–bearing age) who were admitted with trauma between March 2003 and March 2006 were included in the study.
RESULTS
Females represented 9% (n=171) of all trauma patients (n=1809) of the same age group, of which 29% were UAE nationals. The mean age for females was 30.5 years. Road traffic collision (RTC) was the main mechanism of injury (n=78, 46%). Burns were significantly higher in females than males (p=0.001). Cervical fractures were significantly higher in females (p=0.04), while lumbar fractures were significantly higher in males (p=0.03). In females, pelvic fractures were diagnosed in 6.4%, spinal fractures in 7%, and both injuries in 1.2%. Three females died (1.7%), and all were due to RTC.
CONCLUSION
The majority of females involved in trauma were aged 20-34 years. RTC is the main mechanism of injury and fatality. Female trauma is associated with a high incidence of pelvic fractures. A higher rate of cervical injuries was observed in females in contrast to lumbar injuries in males.

AMAÇ
Tibia kýrýklarýnýn cerrahi tedavisinde oymalý ve oymasýz seçenekler vardýr. Oymalý çivilerin biyomekanik üstünlükleri vardýr ancak endosteal dolaþýma önemli ölçüde zarar verir. Oymasýz çiviler ise endosteal dolaþýmý korur fakat daha az stabil bir sabitleme saðlar. Her iki sistemde de distal kilit vidasý kaynaklý instabilite nedeniyle hemen tam aðýrlýk vermek mümkün deðildir. Ayrýca, distal kilit vidasý, skopi kullanma ihtiyacýnýn ve cerrahi sürenin uzamasýndan sorumludur. Bu çalýþmada, yeni intramedüller çivi ve oymasýz sistemle stabil bir sabitleme saðlayýp hemen tam aðýrlýk vermeye izin veren distal kilit vidasý sisteminin klinik sonuçlarý sunuldu.

GEREÇ VE YÖNTEM
2008 ile 2010 yýllarý arasýnda yeni intramedüller sistemle ameliyat edilmiþ 50 tibia kýrýðý (49 hasta) geriye dönük olarak deðerlendirildi. Ameliyattan hemen sonraki 1. gün tam aðýrlýða izin verildi. Hastalar ameliyat sonrasý en az 10 ay takip edildi.
BULGULAR
Distal kilitleme için ortalama skopi süresi 18 saniye (min: 10, maks: 30) idi. Ortalama kaynama süresi 9 hafta (min: 6, maks: 12). Nörovasküler yaralanma, derin enfeksiyon, yanlýþ veya gecikmiþ kaynama ve kaynamama yoktu.
SONUÇ
Biz bu çalýþmamýzla yeni geliþtirdiðimiz intramedüller çivinin ve distal kilit vidasý sisteminin distal kilit vidasýndan kaynaklanan stabilite problemlerinin çözülmesinde bir seçenek olabileceðini gösterdik. Ayrýca sistemimiz ameliyatta gereken skopi ihtiyacýný da önemli ölçüde azaltmaktadýr.

BACKGROUND
The surgical treatment of fractures of the tibia includes reamed and unreamed options. Reamed nails have mechanical advantages but they significantly harm the endosteal circulation. Unreamed nails spare the endosteal circulation, but provide a less stable fixation. In both systems, immediate full weight-bearing is not possible due to instability related to distal interlocking (DI). Further, DI is responsible for the majority of the fluoroscopy requirement and a significant loss of surgical time.
In our study, we present the clinical results of a new intramedullary (IM) nail and system, which allows stable fixation with an unreamed technique that permits immediate full weight-bearing, with a minimum fluoroscopy requirement for DI.
METHODS
Fifty tibia fractures (49 patients) operated using our new IM system between 2008 and 2010 were evaluated retrospectively. They were allowed full weight-bearing the day after surgery. The patients were followed at least 10 months postoperatively.
RESULTS
Mean fluoroscopy time was 18 seconds (min: 10, max: 30) for DI. Mean union time was 9 weeks (min: 6, max: 12). There was no neurovascular injury, deep infection, malunion, delayed union, or nonunion.
CONCLUSION
We demonstrated that our newly developed IM nail and new DI system may be an option to solve the stability problems sourced from the DI screw. It also significantly decreases the requirement of fluoroscopy.

AMAÇ
Radikal prostatektomi (RP) sýrasýnda iyatrojenik rektal yaralanma geliþen hastalarýn verileri deðerlendirildi.

GEREÇ VE YÖNTEM
2003 ile 2011 yýllarý arasýnda ameliyat edilen 451 RP (218 retropubik, 233 perineal RP) olgusu arasýnda, ameliyat sýrasýnda rektal yaralanma geliþen 7 hastanýn (6 perineal, 1 retropubik RP) pre-, intra- ve post-operatif döneme ait klinik verileri geriye dönük olarak incelendi.
BULGULAR
Yedi hastanýn ortalama yaþý 64,4 yýl idi. Rektal yaralanmanýn, 4 hastada prostatýn apikal diseksiyonu sýrasýnda, 1 hastada Denonvillier fasyasýnýn diseksiyonu sýrasýnda, 1 hastada rektoüretral kaslarýn kesilmesi sýrasýnda, 1 hastada ise anal sfinkterin hemen yakýnýndaki seviyede rektum diseksiyonu yapýlýrken geliþtiði tespit edildi. Rektal yaralanmanýn ortalama ebatý 2 (1-4) cm idi. Tüm olgularda yaralanan bölge anýnda fark edilerek çift-tabaka dikiþ ile primer olarak perioperatif onarýldý, hiçbir olguda kolostomi uygulanmadý. Altý olguda ameliyat sonrasý dönemde herhangi bir komplikasyonla karþýlaþýlmadý. Bir olguda ise yaralanan ve onarýlan rektum duvarýnda geliþen detaþman nedeniyle ameliyattan sonra 1. günde cerrahi gerekti ve hasta sorunsuz iyileþti. Ameliyat sonrasý takipte hiçbir hastada üretrorektal fistül, idrar inkontinansý veya üretral darlýk ile karþýlaþýlmadý.
SONUÇ
Radikal prostatektomi sýrasýnda fark edilmesi durumunda, rektum yaralanmalarýnýn tedavisinde çift-tabaka dikiþ ile primer onarým uygulanmasý yeterli olmaktadýr.

BACKGROUND
We evaluated the data of our patients who experienced rectal injury during radical prostatectomy (RP).

METHODS
We analyzed the data for the 7 patients (6 perineal, 1 retropubic) with iatrogenic rectal injury who were selected from 451 patients with RP (218 retropubic, 233 perineal) operated in our clinic between 2003 and 2011.
RESULTS
The mean age of the 7 patients was 64.4 years. Rectal injury occurred during prostatic apical dissection in 4 patients, during dissection of Denonvilliers fascia in 1 patient, during transection of the rectourethral muscles in 1 patient, and during dissection of the rectal region proximal to the anal sphincter in 1 patient. The mean size of the lesions was 2 (1-4) cm. All of the rectal injuries were recognized during the operation, and double-layered sutures were used for the primary repair. None of the cases required colostomy procedure. No postoperative complications were encountered in 6 of the patients; however, 1 patient underwent a second operation on the following day due to detachment at the injury site. None of the patients displayed urethrorectal fistula, urinary incontinence or urethral stricture.
CONCLUSION
Primary repair with double-layered suturing is sufficient for the treatment of rectal injuries that occur during RP if they are recognized intraoperatively.

AMAÇ
Ayaklanan gruplarýn kontrol edilirken uðradýklarý saçma ile silah yaralanmalarý incelendi.
GEREÇ VE YÖNTEM
Saçma tanesi ile gerçekleþen silah yaralanmalarý nedeniyle kaza ve acil servis bölümüne yatýrýlan toplam 198 hasta, anatomik bölge, ciddiyet ile yaralanma tipi, tedavi ve sonuçlar bakýmýndan deðerlendirildi.
BULGULAR
Hastalarýn %72,7’si, 16 ile 25 yaþ arasýnda idi. En sýk yaralanma bölgeleri ekstremiteler (%47,9), karýn (%36,3) ve göðüs (%31,3) idi. Hastalarýn %59,5’inde minör yaralanma vardý. Yaralanmalarý nedeniyle hastaneye yatýrýlan 80 hastanýn 43’ü (%53,7) ameliyat edildi. Altý adet ölüm (%3,03) gözlemlendi.
SONUÇ
Kendi baþýna saçma yaralarý önemsiz gibi görünebilir, ancak, kafaya, göðüse ve karýna yönelik potansiyel doku hasarýna neden olabilecek yaralanmalarýn deðerlendirilmemesi durumunda ölümcül sonuçlar ortaya çýkabilir. Hastalar, genel kurþun yaralanmalarý ile ayný þekilde deðerlendirilmeli ve tedavi edilmelidir.

BACKGROUND
Pellet gunfire injuries inflicted while controlling agitated mobs has been studied.
METHODS
A total of 198 patients admitted to the Accident and Emergency Department with pellet gun injuries were studied in terms of anatomic site, severity and type of injury, treatment, and outcomes.
RESULTS
72.7% of patients were aged 16-25 years. The most common sites of injury were the extremities (47.9%), abdomen (36.3%) and chest (31.3%). 59.5% of patients were found to have minor injuries. Of the 80 patients admitted to the hospital for their injuries, 43 (53.7%) required an operative procedure. Six deaths (3.03%) were observed.
CONCLUSION
While the pellet wound itself may seem trivial, if not appreciated for the potential for tissue disruption and injuries to the head, chest, and abdomen, there can be catastrophic results. Patients should be evaluated and managed in the same way as those sustaining bullet injuries.

AMAÇ
23 Ekim 2011 tarihinde Van ilinde deprem meydana geldi. Bu deprem çok büyük yýkýcý bir felaketti ve kitlesel yaralanmalara neden oldu. Burada sunulan tanýmlayýcý analizin, yanlýz bu çalýþma için deðil, ayný zamanda daha sonra yaþanabilecek afetler için de bir kaynak olarak kullanýlmasý amaçlanmýþtýr.

GEREÇ VE YÖNTEM
Deprem nedeniyle Van Bölge Eðitim ve Araþtýrma Hastanesine baþvuran hastalarýn ilk 7 günlük kayýtlarý geriye dönük olarak incelendi. Sonuçlar mevcut literatür ile karþýlaþtýrýldý.

BULGULAR
Depremzede 1582 hasta (806 erkek, 776 kadýn; ort. yaþ 36,9) acil servise baþvurdu. Hastalarýn 301’i yatarak tedavi gördü. Hastalarýn 84’ü (%28) ortopedi ve travmatoloji, 40’ý (%13) genel cerrahi ve çocuk cerrahisi, 26’sý (%9) göðüs cerrahisi, 34’ü (%11) beyin cerrahisi, 56’sý (%19) iç hastalýklarý, 39’u (%13) yoðun bakým, 22’si (%7) ise diðer servislere yatýrýldý. Ölenlerin sayýsý 60 idi.
SONUÇ
Deprem felaketi sonrasý mortalite ve morbidite oranýný azaltmak için erken ve etkili triyaja önem verilmelidir. Hastalar hastaneye nakledildikten sonra klinik özelliklerine göre tedavi uygulanmalý ve birçok kliniðin birbiriyle uyumlu ve iþbirliði içerisinde çalýþmalarý saðlanmalýdýr.

BACKGROUND
On 23 October 2011, an earthquake occurred in the city of Van, Turkey. This earthquake was an enormous devastating disaster and caused mass casualties. The descriptive analysis presented here serves as a reference not only for the present injury profile but also for future disaster response.

METHODS
This is a retrospective study based on the medical records of earthquake victims admitted to Van Training and Research Hospital. The results were compared with the current literature.
RESULTS
1582 earthquake victims (806 male, 776 female, mean age 36.9 years) were admitted to emergency service. 301 of the patients were treated with hospital care in different departments: 84 (27.9%) in orthopedics surgery, 40 (13.2%) in general and pediatric surgery, 26 (9%) in thorax surgery, 34 (11%) in neurosurgery, 56 (19%) in internal medicine, 39 (13%) in the intensive care unit, and 22 (7%) in other departments. The total number of deceased was 60.
CONCLUSION
To minimize mortality and morbidity after earthquake disaster, immediate and effective triage should be done, and after the patients are transported to the hospital, individualized treatment should be planned according to the patients’ respective clinical features. Coherent collaboration between many departments is vital.

Yedi yýl önce þizofreni tanýsý almýþ, 34 yaþýndaki erkek hastanýn kendi kafasýna 4 adet çivi çakmasýyla geliþen nadir bir penetran kafa travmasý olgusu sunuldu. Fiziksel incelemede kafasýnýn sað temporal ve paryetal bölgesinde saçlý deri içerisinde kraniyuma çakýlý 4 adet çivi vardý. Beyin omurilik sývýsý fistülü yoktu. Hastanýn nörolojik incelemesinde motor ve duyu defisiti yoktu. Glasgow koma skoru 15 idi. Direkt kafa grafisinde ve beyin bilgisayarlý tomografisinde (BT) çivilerin yaklaþýk 10 cm uzunluðunda olduðu ve deðiþik yönlere uzandýðý görüldü. BT anjiyografisinde büyük vasküler yapýlarda yaralanma yoktu. Genel anestezi altýnda sað temporal bölgede olan 2 çivi direkt çekilerek, sað paryetal bölgede olan 2 çivi ise mini kraniyotomiler ile çýkarýldý. Temporal bölge gibi kemiðin ince olduðu alanlarda çivi direkt çekilip çýkarýlabilir. Ancak paryetal kemik gibi kemiðin kalýn olduðu bölgelerde bu yöntemle çivilerin çýkarýlmasý her zaman mümkün olmayabilir.

We present a rare case of self-inflicted penetrating head trauma by a 34-year-old male who hammered four nails into his own head; he had been diagnosed with schizophrenia seven years before.
On the physical examination, four nails were observed in the hairy scalp that had been driven into the cranium in the right temporal and parietal areas of the head. No cerebrospinal fluid fistulas were present. On the neurological examination, no motor or sensory deficits were present. The Glasgow Coma Scale was 15. On direct skull X-ray and cranial computerized tomography (CT), the nails were seen to be approximately 10 cm long and extending in various directions. No injury was observed in the main vasculature on CT angiography. Under general anesthesia, two nails in the right temporal area were removed by extraction, and the other two nails in the right parietal area were removed through a mini craniotomy. In areas such as the temporal area where the bone is thin, nails can be removed by extraction. However, in areas like the parietal bone where the bone is thick, removal of the nails using this method may not always be possible.

Talus ve peritalar eklemin majör kýrýk ve çýkýklarý nadirdir. Bu yazýda, gecikmeli baþvuran, kapalý total talus çýkýðý, mediyal malleol kýrýðý ve posterior talar tüberkül kýrýðý yaralanmalý, nadir görülen olgu sunuldu. Bu yazýda, literatürdeki daha önceki sunum ve önerilen tedavi deðerlendirildi.

Major fractures and dislocation of the talus and peritalar joint are uncommon. We present here a very rare case of injury with delayed presentation of closed total talus dislocation with fractured medial malleolus and posterior talar tubercle fracture. This report analyzes previous reports in the literature and the proposed treatment.

Pilorik atrezi (PA) ve epidermolizis bülloza (EB) birlikteliði genetik etyolojisi iyi bilinen fakat ender rastlanýlan yenidoðanýn acil cerrahi hastalýðýdýr. PA/EB, pilor atrezisi ile cilt ve mukozalardaki bülloz lezyonlarýn beraberliði olarak tariflenir. Literatürde bugüne dek toplam 91 olgu bildirilmiþtir. Bu yazýda iki yeni olgu sunuldu, literatür taramasý yapýldý.
Olgu 1: Üç günlük hasta safrasýz kusma ve ekstremitelerde 2-3 cm çapýnda bülloz lezyonlarla baþvurdu. Karýn grafisinide sol üst kadranda hava-sývý seviyesi vardý. Laparotomide pilor atrezisi saptanarak piloropilorostomi uygulandý. Sorunsuz taburcu edilen hasta iki ay EB’ye baðlý aðýr sepsisten kaybedildi.
Olgu 2:
Ýki günlük hasta, boyunda, diz altýnda, ön yüzde, el sýrtýnda ve sol dirsek üstünde yaygýn cilt lezyonlarý mevcuttu. Karýn grafisinde, dilate mide ve distalinde gaz yokluðu dikkati çekti. Pilor atrezisi ön tanýsý ile ameliyat edilerek gastroduodenostomi uygulandý. Baþlangýçta oral beslenmeyi iyi tolere eden hasta ameliyat sonrasý 23’üncü cilt lezyonlarýna baðlý aðýr sepsis nedeniyle kaybedildi. PA/EB tanýsý alan hastalarýn hemen hemen hepsi ilk birkaç yýl içinde kaybedilmektedir. EB’den kaynaklanan komplikasyonlar ölümlerin en yaygýn nedenidir. Baþarýlý PA ameliyatlarýndan sonra bile, EB’ye baðlý cilt lezyonlarý, enfeksiyon ve metabolik problemlere yol açarak, ölümleri neredeyse kaçýnýlmaz hale getirmektedir.

The coexistence of pyloric atresia (PA) and epidermolysis bullosa (EB) is a rare but well-known surgical emergency in neonates. PA/EB is described by the association of atresia of the pylorus and bullous lesions on the skin. Ninety-one cases have been reported in the literature to date. We present two new cases and evaluate the association of PA/EB, its etiopathogenesis and the clinical properties.
Case 1:
A three-day-old female presented with nonbilious vomiting and bullous lesions 2-3 cm in diameter on the extremities. Abdominal X-ray showed a single air-fluid level in the left upper quadrant. At laparotomy, we found PA and performed a pyloro-pylorostomy. The patient died due to sepsis complication of EB two months after surgery.
Case 2:
A two-day-old male presented with severe dermal bullous lesions on the trunk, neck and extremities. His stomach was dilated and there was no gas distally. We found PA and performed gastroduodenostomy. Initially, he tolerated the feeding well, but he died due to severe sepsis on the postoperative 23rd day.
Almost all neonates born with the PA/EB result in a fatal outcome in the first few years. The complications related to EB are usually the cause of death. Even after successful repair of PA, skin lesions lead to death due to infection.

Ameliyat alaný yangýnlarý oldukça nadirdir. Yine de, bir felaket, hemen hemen her türlü cerrahiyi güçleþtirebilir. Ameliyat alaný yangýnlarýnýn çoðunluðu, oksijenden zengin bir ortamda alkol bazlý cerrahiye hazýrlama solüsyonlarýnýn, elektrikli cerrahi ekipmanýn veya kolay tutuþan kumaþlarýn kullanýlmasýndan kaynaklanmaktadýr. Biz, over kisti ve uterin miyomlarý nedeniyle jinekolojik cerrahi geçirirken alev yanýðýna maruz kalan hastayý sunuyoruz.

Operating room fires occur very rarely. Nevertheless, a disaster can complicate almost any kind of surgery. The majority of operating room fires result from the use of alcohol-based surgical preparation solutions, electro-surgical equipment, or flammable drapes in an oxygen-rich environment. We report a patient with an ovarian cyst and uterine myomas who suffered a flame burn while undergoing gynecological surgery.

Bu yazýda, kafa travmasý nedeniyle hastanemize baþvuran bir kadýn hastanýn bilgisayarlý tomografisinde (BT) hemorajik serebral kontüzyon benzeri radyolojik bulgular gösteren, insidental menenjiyoma eþlik eden nadir bir izole hemorajik kontüzyon olgusu sunuldu. Olgunun iki özelliði vardý. Birincisi, menenjiyom kafa travmasýna baðlý hemorajik kontüzyona neden olmakla birlikte beyin dokusunun bütünlüðü bozulmamýþtý. Ýkincisi, BT’de rastlantý sonucu fark edilen menenjiyomaya iliþkin hemorajik kontüzyonun serebral bir hemorajik kontüzyon olarak yanlýþ taný konulmuþ olmasý söz konusuydu. Bu olguda, bu nadir fenomeni açýklamaya yönelik olasý bir mekanizma önerdik.

The authors present an unusual case of isolated hemorrhagic contusion of an incidental meningioma showing radiological findings similar to those of a hemorrhagic cerebral contusion on computed tomography (CT) in a female patient who presented to our hospital for head trauma. This case has two characteristics. First, although the meningioma had a hemorrhagic contusion due to head trauma, most of the brain tissue was intact. Second, there was a possibility that the hemorrhagic contusion of the incidental meningioma on CT was misdiagnosed as a cerebral hemorrhagic contusion. In this case, we propose a possible mechanism to explain this rare phenomenon.

Ýntestinal malrotasyon, orta baðýrsak (midgut) bölümünün peritoneal kavitede arteria mesenterica superior etrafýnda normal fetal rotasyonunu yapamamasý ve fiksasyon bozukluðu ile seyreden bir geliþimsel anomalidir. Midgut rotasyon anomalilerine eriþkinlerde nadir rastlanýr. Bunlar, genellikle, klinik bulgulara sebep olduklarýnda cerrahi giriþimi gerektirirler. Tanýsýný koymak güç olsa da erken taný ve tedavi baþarýlý sonuç verir. Ýntestinal malrotasyon nadir olarak asemptomatik seyredip tanýsý genellikle insidental olarak konur. Bu yazýda, kliniðimize ince baðýrsak týkanýklýðý bulgularý ile baþvuran bir insidental intestinal malrotasyon olgusu literatür eþliðinde irdelendi.

Intestinal malrotation is a developmental anomaly of the midgut in which the normal fetal rotation of intestines around the superior mesenteric artery and their fixation in the peritoneal cavity fail. Rotational anomalies of the midgut are rare in adults. Operative intervention is required generally when they are symptomatic. While difficult to diagnose, prompt recognition and surgical treatment usually lead to a successful outcome. Intestinal malrotation is rarely asymptomatic and generally diagnosed incidentally in adults. In the present report, a case of incidental intestinal malrotation with clinical findings of small bowel obstruction is discussed with a literature review.