Purpose:
This study was planned to evaluate the hystopathological changes under light microscope when the ABS (mixture of five plant extracts) was applied in deep tissue hemorrhage and the systemic organ effects as animal study model.
Materials and Methods:
A total of 50 Wistar Albino rats were divided into 5 groups each consisting 10 rats. The rats underwent femoral vein puncture and treated with ABS tampon, ABS spray, Surgicel and one group left untreated. After 2 weeks, each group underwent partial tissue excision in the same femoral region and as well as from brain, heart, kidney and liver.
Results:
The specimens from all group was obtained from femoral region after two weeks and evaluated under light microscope. The light microscope revealed any histopathological changes on neurovascular structures or in deep connective tissues in all groups.
Conclusions:
Ankaferd Blood Stopper provided hemostasis and was observed to stop bleeding. There were any hystopathological changes in tissue level and no pathological effects in other organs tissues under light microscope, the remote organ tissue remain clear.

Amaç: Bu çalýþmanýn amacý kýkýrdak glukozaminin kýrýk iyileþmesi üzerinde etkisi olup olmadýðýnýn araþtýrýlmasýdýr.
Yöntemler: 61 diþi þýçan tibiasýnda tek taraflý kýrýk oluþturuldu. Sýçanlara ya 230mg/kg glukozamin sülfat verildi ya da ilaç verilmedi. Kýrýklar birinci, ikinci ve dördüncü haftalarda incelendi. Yeni kemik oluþum miktarý ve osteoblast sayýsý histolojik olarak ölçüldü. Histomorfometrik analiz için kýrýk iyileþmesi semikantitatif olarak skorlandý. Radyografik olarak kemik köprü oluþumu deðerlendirildi.
Sonuçlar: Glukozamin verilen grupta yeni kemik oluþumu ve osteoblast sayýsý 1. haftada anlamlý derecede yüksekti. 1. ve 4. haftalarda kontrol grubuna göre, glukozamin verilen grupta çevre bað dokusu hücre sayýsý bakýmýndan zengin, daha vasküler ve yeni oluþan kemik trabekülleri daha fazla sayýdaydý. Fakat radyolojik olarak 4. haftada kontrol grubu, glukozamin verilen gruptan daha iyi skorlar aldý.
Tartýþma: Bu veriler günlük glukozamin verilmesinin sýçan tibiasýnda kýrýk iyileþmesinin erken fazýný, artmýþ yeni kemik oluþumu ve osteoblast sayýsý ile histolojik olarak hýzlandýrdýðý, fakat radyolojik olarak ayný etkinin görülmediðini göstermektedir.

Background: The aim of this study is to determine whether glucosamine-sulfate has any effects on bone-healing.
Methods: An unilateral fracture was created in the tibia of sixty-one female rats. Rats were given no drug or 230mg/kg glucosamine-sulfate daily. Fractures were analyzed at first, second and fourth weeks after creation of fracture. Quantitative measurement for new bone formation and osteoblast lining were determined histologically. Semiquantitative score for fracture healing was used for histomorphometric analyses. Bridging bone formation was assessed radiographically.
Results: New bone formation and osteoblast lining were significantly higher in glucosamine-treated group at week 1. Surrounding connective tissue was more cellular, vascular, and the newly formed bone trabecules were in bigger amount in glucosamine-treated group, comparing to control group at week 1 and 4. But radiologically, the control group had better scores than that of the glucosamine-treated group at week 4.
Conclusion: These data demonstrate that daily glucosamine sulfate administration accelerate early phase of fracture repair in the rat tibia, with increased new bone formation and osteoblast lining histologically, but radiologic bone union is not favoured on radiographs

Amaç: Sað alt kadran (SAK) aðrýsý olan hastalarýn gereksiz hastane yatýþlarý ve bnegatif apendektomiler tedavi giderlerini artýrýr. Bu çalýþmada, apandisit skorlama sistemlerinin tedavi maliyetine etkisini deðerlendirmeyi amaçlandý.
Gereç ve Yöntem: Bir yýl içinde SAK ile hastanemiz genel cerrahi kliniðine kabul edilen hastalarýn kayýtlarý incelendi. Alvarado ve Lintula skorlarý hesaplandý. Ameliyat kararý vermede skorlama önerileri kullanýlmýþ olsaydý tedavi giderlerini saptamak için bir benzetim çalýþmasý düzenlendi.
Bulgular: 114 hastanýn 64’üne (%56) apendektomi yapýldý. Negatif apendektomi oraný %17.2 idi. Alvarado ve Lintula skorlarýnýn “yatýþ” ve “tedavi” kararý vermedeki genel doðruluk oranlarý sýrasýyla %82.7 ve %91.9 idi (p=0.102). Hastalarýn tümü için toplam tedavi maliyeti 39,655 $ idi. Alvarado ve Lintula skorlarý kullanýlmýþ olsaydý toplam tedavi giderleri sýrasýyla 34,087 $ ve 25,772 $ (p=0.015 ve p=0.000); negatif apendektomi oranlarý %18.5 ve %3.6 olacaktý.
Sonuç: Alvarado ve Lintula skorlarýnýn hastaneye kabul ve apendektomi kararý için kullanýlmasý akut SAK aðrýsý için tedavi giderlerini düþürecektir.

Background: Unnecessary hospital admissions and negative appendectomies increase healthcare costs of patients with right lower quadrant (RLQ) pain. This study aimed to evaluate the impact on the cost of treatment in appendicitis scoring systems.
Methods: Charts were reviewed of patients admitted to the general surgery ward of our hospital with RLQ pain within a year. Alvarado and Lintula scores were calculated and a simulation was performed to determine the treatment charges which would have been generated had the scoring recommendations been used for admission and surgical decision-making.
Results: Of the 114 admitted patients, 64 patients (56%) underwent appendectomy. The rate of negative appendectomy was 17.2 per cent. The overall accuracy rates of the Alvarado and Lintula scores for both ‘admit’ and ‘operate’ decision-making were 82.7 and 91.9%, respectively (p=0.102). Total charges for the 114 patients were $39,655. If the Alvarado or Lintula scores had been used, the total treatment charges would have been $34,087 and $25,772 (p=0.015 and p=0.000), with negative appendectomy rates of 18.5% and 3.6%, respectively.
Conclusion: The implementation of Alvarado and Lintula scores for the decision of hospital admission and appendectomy would have reduced overall treatment charges for acute RLQ pain.

Background: Acute appendicitis is the most common surgical nonobstetric pathology during pregnancy. In this report pregnant patients operated with diagnosis of acute appendicitis in the last 3 years are evaluated retrospectively.
Methods: Between January 2009 and January 2011, 20 pregnant patients were operated for acute appendicitis. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay, mean operative time and outcome.
Results: In 17 of 20 patients acute appendicitis was confirmed and appendectomy was performed. Ten of patients were operated with laparoscopic technique and remaining ten had open appendectomy. There was no fetal or maternal morbidity and mortality in any patient. All 20 patients delivered healthy babies on the postoperative course.
Conclusion: Acute appendicitis is a challenging diagnosis in pregnant patient, however early surgical intervention should be performed with any suspect. Type of surgery depends on the surgeon’s choice and experience.

AMAÇ: Bu çalýþmanýn amacý izole ekstremite travmalarýnda, acil servis doktorlarýnýn yorumlarýnýn resmi radyoloji raporlarýyla karþýlaþtýrýlmasýyla en zor yorumlama alanýný belirlemek ve acil doktorlarýnýn yorumlarýnýn doðruluðunu analiz etmektir.
GEREÇ VE YÖNTEM: Radyolog raporlarý ve acil servis doktorlarýnýn yorumlarý izole ekstremite travmalý hastalarda retrospektif olarak 01.05.2011’den 31.05.2011 tarihine kadar karþýlaþtýrýldý. Toplam 608 vakada 181 kýrýk saptandý.
BULGULAR: Yanlýþ yorumlanan kýrýklarýn yerleri sýrasýyla ayak bileði ve ayak (%51.4), bilek ve el (%32.4), dirsek ve önkol (%5.4), omuz ve üst kol (%5.4), kalça ve uyluk (%2.7), diz ve bacak (%2.7) olarak belirlenmiþtir. Acil servis doktorlarýnýn ve radyologlarýn tanýsal doðruluklarý arasýnda anlamlý bir fark saptanmadý (kapa=0.856, p=0.001).
SONUÇ: En sýk atlanan kýrýk tiplerinin bilinmesi, bu konuda eðitimin yoðunlaþtýrýlmasýyla acil servislerde kaçýrýlan vakalarýn minimuma indirilmesini saðlayabilir.

BACKGROUND: The purpose of the study was to analyse the accuracy of emergency physicians’ (EP) interpretation of extremity traumas to determine the most difficult area for interpretation compared with official radiology reports for direct X-ray.
METHODS: The radiologist reports and the EP reports of the direct X-rays from isolated extremity trauma patients were retrospectively compared from 01.05.2011 to 31.05.2011. A total of 181 fractures in 608 cases were confirmed.
RESULTS: The locations of the misinterpreted fractures were ankle and foot (51.4%), wrist and hand (32.4%), elbow and forearm (5.4%), shoulder and upper arm (5.4%), hip and thigh (2.7%), and knee and leg (2.7%). The diagnostic accuracy of the EPs and radiologists were not significantly different (kappa = 0.856, p=0.001).
CONCLUSION: Knowledge about the types of fractures that are most commonly missed facilitates a specifically directed educational benefit.

Objective: To assess the effect of prophylactic injection therapy during the index
gastroscopy on upper gastrointestinal bleeding due to Forrest type 2b duodenal ulcer.
Methods: The patients who were admitted with upper gastrointestinal bleeding and
who had emergency gastroscopy between January 2004 and January 2011 were
retrospectively recruited to the study. Among those, the patients with Forrest type 2b
duodenal ulcer were selected and divided into two groups. The patients in Group 1 had
only diagnostic gastroscopy, whereas those in Group 2 had prophylactic injection therapy
during the index gastroscopy.
Results: Eighty seven patients were included to the study. There were 41 patients in
Group 1 and 46 patients in Group 2. There was a significant difference in the incidence
of rebleeding (26.8% versus 6.5%, p=0.017). The mortality rate was similar in both
groups (9.7% versus 2.1%, p=0.184).
Conclusion: We recommend prophylactic injection therapy in patients with upper
gastrointestinal bleeding who have Forrest type 2b duodenal ulcer.

Amaç: Bu çalýþmada gastrointestinal kanal perforasyonlu hastalarda batýn bilgisayarlý tomografinin perforasyon bulgularýný ve perforasyon yerini belirlemedeki rolünü araþtýrdýk.
Gereç ve Yöntem: Temmuz 2007 ve temmuz 2010 tarihleri arasýnda, gastrointestinal kanal perforasyonu olduðu cerrahi olarak kanýtlanmýþ 47 hastanýn ameliyat öncesi batýn BT görüntüleri retrospektif olarak yeniden deðerlendirildi. Her bir hasta için BT de serbest hava, kontrast madde kaçaðý, duvar kalýnlaþmasý, duvar devamsýzlýðý, apse, flegmon ve serbest sývý varlýðý araþtýrýldý. Belirlenen bu bulgular ýþýðýnda perforasyon yeri tahmin edildi ve cerrahi sonuçlar ile karþýlaþtýrýldý.
Bulgular: Batýn BT bulgularýna göre; gastroduodenal perforasyonu olan hastalarýn %85,7’sinde, ince barsak perforasyonu olanlarýn %85,7’sinde, kalýn barsak perforasyonu olanlarýn %69,2’sinde, rektum perforasyonu olanlarýn %100’ünde, apendiks perforasyonu olanlarýn %90,9’unda, tüm hastalarýn ise %82,9’unda perforasyon yeri doðru olarak belirlendi. Gastrointestinal kanal perforasyonunda BT’ de en sýk rastlanan bulgu % 89.4 oraný ile batýnda serbest sývý idi. Diðer bulgularýn rastlanma oranlarý ise sýrasýyla þöyleydi; serbest hava: %76.6, segmental duvar kalýnlaþmasý: %48.9, duvar devamsýzlýðý: %25.5, apse: %12.8, flegmon: %10.6. Oral kontrast kullanýlan 30 hastanýn 7 sinde (%23.3) ekstraluminal kontrast kaçaðý saptandý.
Sonuç: BT gastrointestinal kanal perforasyon bulgularýný ve perforasyon yerini belirlemede oldukça etkilidir.

Background: In this study, we investigated the role of abdominal CT in determining perforation findings and site in patients with gastrointestinal tract perforation.
Methods: Preoperative abdominal CT scans of 47 patients who had surgically proven gastrointestinal tract perforation between July 2007 and July 2010 were reviewed, retrospectively. The presence of free air, leakage of contrast material, wall thickness, wall discontinuity, abscess, free fluid and phlegm on were investigated for each patient. The results were compared with the surgical outcomes.
Results: Perforation sites were determined correctly in 85.7% of the patients with gastro duodenal perforation, 85.7% of the patients with small bowel perforation, 69.2% of the patients with large bowel perforation, 100% of the patients with rectum perforation, 90.9% of the patients with appendix perforation, and 82.9% of all the patients according to the abdominal CT findings. The most common CT finding in gastrointestinal tract perforation was free fluid with a rate of 89.4%. The rate of other findings were as follows respectively: free air 76.6 %, segmental wall thickening 48.9%, wall discontinuity 25.5%, abcess 12.8%, phlegmon 10.6%. Of 30 patients who received oral contrast, 7(23.3%) had extraluminal contrast leakage.
Conclusion: CT is very effective in determining gastrointestinal tract perforation findings and site of perforation.

Amaç: Ýnferior omuz çýkýðý, ayrýca luxatio erecta olarak adlandýrýp omuz çýkýðýnýn nadir görülen bir tipidir. Görülme sýklýðý tüm omuz çýkýk arasýndaki yaklaþýk 200 (% 0.5) de 1 'dir. Bu çalýþmanýn amacý, inferior omuz çýkýðýnýn klinik ve radyolojik olarak sunumu, tedavisi ve nihai sonucun 6 olgu ile gözden geçirilmesidir.
Hastalar: Dört erkek ve iki kadýn, toplam 6 hasta aþaðý omuz çýkýðý tanýsý ile 2007 ve 2010 yýllarý arasýnda tedavi edilmiþtir. Tedavi ettiðimiz bu hastalar nedeniyle, bizim amacýmýz kaynaklar paralelinde deneyimimizi paylaþmaktýr.
Bulgular: Hastalarýn omuz fonksiyonlarýný deðerlendirmek için Constant omuz skorlamasý kullanýlarak aðrý, pozisyon, günlük yaþam aktiviteleri, eklem hareket açýklýklarý ve güçü kaydedildi. Hastalarýn tamamýnda kapalý redüksiyon ve rehabilitasyon ile tedavi sonrasý 2 yýl içinde tam fonksiyonel iyileþme saðlanarak mükemmel yada iyi sonuç alýndý.
Sonuçlar: Doktorlar bu nadir durumun oluþumuna aþina olmalý ve doðru redüksiyon teknikleri dýþýnda yapýlan erken redüksiyonlar neticesinde oluþabilecek muhtemel komplikasyonlarý önlemeleri gerekir.

Objectives: Inferior shoulder dislocation, also named as luxatio erecta, is a rare type of shoulder dislocation. Its incidence is about 1 in 200 (0.5%) among all shoulder dislocations. The objective of this study was to review six cases of inferior shoulder dislocation, their clinical and radiological presentation, management and final outcome.
Patients: Four male and two female, a total of 6 patients with the diagnosis of inferior shoulder dislocation have been treated between the years 2007 and 2010. Because of these patients that we have treated, our purpose is to present our experience with parallel research of the bibliography.
Results: Constant score was used to evaluate shoulder function. Pain, position, daily activities, range of motion and strength scores were noted. All patients had good to excellent results with full functional recovery within 2 years after closed reduction and shoulder rehabilitation.
Conclusions: Doctors should be familiar with the occurrence of this infrequent condition and should prevent possible complications that might result from early reductions with correct maneuvers except ordinary reduction techniques.

Amaç: Bu çalýþmada penetran abdominal hasar ile birlikte olan diafragma rüptürlerini inceledik.
Gereç ve yöntem: Bu çalýþmaya Ocak 1996- Aralýk 2010 tarihleri arasýnda Genel Cerrahi Kliniði’nde penetran abdominal travmalý 237 hastanýn kayýtlarý retrospektif olarak incelendi. Diafragmatik rüptüre sahip olmayan hastalar Grup 1 ve diafragmatik rüptüre sahip olan hastalar Grup 2 olarak ayrýldý.
Bulgular: 177 hastada diafragmatik hasar yoktu ve 60 hastada ise diafragmatik hasar vardý. Diafragmatik hasar hastalarýn 12’sinde saðda, 7’sinde bilateral ve 41’inde sol tarafta idi. 11 vakada toraksa herniasyon vardý ve en fazla kolon, mide, omentum, ince barsaklar ve dalak torakal kaviteye herniye idi. Postoperatif komplikasyon oranýmýz Grup 1’de %50 (n=89) ve Grup 2’de %47 (n=28) idi. Her iki grup arasýnda istatistiksel olarak anlamlý bir fark yoktu (p˃0.05). Hastanede kalýþ süresi Grup 2’de az miktar fazla olmasýna raðmen anlamlý bir fark yoktu (p˃0.05). Grup 1 ‘de 17 hasta (%9.6) ve Grup 2’de 4 hasta (%6.6) eksitus oldu. Mortalite hýzlarý iki grup arasýnda anlamlý deðil idi (p˃0.05).
Sonuç: Penetran abdominal travmalý hastalarda diafragmatik rüptür yaygýn deðildir. Penetran yaralanmalarda diafragma yaralanmasý olan hastalarla olmayan hastalar arasýnda fark bulunamamýþtýr.

Aim: In this study, we investigated the diaphragmatic ruptures that accompanied penetrating abdominal injury.
Material and Methods: Retrospectively 237 patients records with penetrating abdominal trauma in General Surgery Clinics between January 1996 and December 2010 were investigated. Patients with diaphragmatic rupture were designated to Group 1 and those without were designated to Group 2.
Results: There was no diaphragmatic injury in 177 patients, and there was diaphragmatic injury in 60 patients. Diaphragmatic injury was on the right side in 12, on the left side in 41, and bilateral in 7. Eleven had thoracic herniation and the most common hernia contents were colon, stomach, greater omentum, the small bowel and the spleen. The postoperative complication rate was 50% in Group 1 (n=89) and 47% in Group 2 (n=28). There was no significant difference between the two groups (p˃0.05). The length of hospital stay was slightly increased, but not significant in Group 2 (p˃0.05). Seventeen patients (9.6%) in Group 1 and four patients (6.6%) in Group 2 died. The mortality rates between the two groups were not significant (p˃0.05).
Conclusion: Diaphragmatic rupture is not common among patients with penetrating abdominal trauma. There was no difference between patients that had penetrating injuries with or without diaphragmatic injuries in terms of mortality and morbidity.

Giriþ: Spinal kord yaralanmasý ömür boyu süren etkiye sahiptir. Hastalar ve toplum için aðýr sosyal ve ekonomik etkileri vardýr. Bu çalýþmanýn amacý þehir yaþamýnýn TSCI üzerinde yarattýðý epidemiyolojik farklýlýklarý tanýmlamaktýr.
Materyal Metot: Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesi acil servisine Ocak 2007-Aralýk 2011 arasýnda baþvuran 409 TSCI hastasý deðerlendirildi. Kategorik deðiþkenler için Fischer Exact testi; parametrik veriler için Independent Samples T testi kullanýldý.
Sonuçlar: En sýk yaralanma þekli yüksekten düþmelerdi. 85(%20.8)hasta basit düþme sonucu yaralanmýþtý. En sýk ikinci yaralanma þekli basit düþmelerdi. 196(%48) hasta lomber spinal yaralanma geçirmiþti. En sýk lomber spinal yaralanmalar gözlenmiþti. Torakal bölge en sýk ikinci yaralanan bölgeydi. Lomber spinal yaralanmalar yüksekten düþmelerde daha sýktý (p=0.00011). Basit düþmelerde torakal bölge yaralanmalarý daha sýktý (p=0.003). Otomobil kazalarýnda belirgin þekilde servikal (p=0.00001) ve lomber (p=0.004) yaralanmalar daha sýktý.
Karar: Servikal yaralanmalar otomobil kazalarýnda daha sýk olmaktadýr. Þehir merkezinde otomobil kazasýna baðlý TSCI oraný diðer çalýþmalara göre daha azdý. Servikal yaralanma oranýda otomobil kazasý iliþkili TSCI oranýnýn azalmasý ile azalmýþtýr.

Objectives: Spinal cord injury has a lifetime serious impact. It has obvious social and economic effects for patients and society. The aim of this study was to collect recent information and analyze changes in the epidemiology of traumatic spinal injuries.
Patients and Methods: Data included TSCI patients admitted to ED of Haydarpasa Numune Training and Research Hospital between January 2007 and December 2011. 409 TSCI patients were included to the study. Categorical variables were analyzed with Fischer’s Exact Test and parametric variables were analyzed with Independent Samples T Test.
Results: Most common injury mechanism was fall from heights. 85(%20.8) patients were injured in low falls. Second most common injury mechanism was low falls. Most common injury was lumbar spine injury. 196(%48) patients suffered isolated lumbar spine injury. Thoracal spine injuries were the second most common injuries. Lumbar spinal injuries (p=0.00011) were higher in high falls. Low fall was a significant mechanism for thoracal spine injuries (p=0.003). Automobile accidents had a significant relation with cervical (p=0.00001) and lumbar spinal injuries(p=0.004).
Conclusion: Although cervical injuries were higher in automobile accidents, ratio of automobile accident related TSCI was less than other studies. Cervical injury ratio of population has decreased due to decrease in number of automobile accident related TSCI.

INTRODUCTION: Penetrating abdominal trauma (PAT) has been traditionally treated by exploratory laparotomy (EL). The aim of our study was to examine the use of diagnostic laparoscopy (DL) in the management of hemodynamically stable patients with PAT.
MATERIALS and METHODS: A prospective study was performed to compare the outcomes of hemodynamically stable patients with suspected intra-abdominal injuries due to abdominal stab wounds who underwent either EL or DL. Data extracted for analysis included demographic information, operative findings, length of hospital stay, mortality, and postoperative complications.
RESULTS: 52 hemodynamically stable patients were admitted to the trauma service. There were 45 male (86.5 %) and 7 female (13.5 %); average age was 34, 5 years-old (18 – 60). 26 (50 %) patients underwent EL, and 26 (50 %) patients underwent DL. Re-exploration by laparotomy was required in 9 of the 26 cases (34, 6 %). Patients who underwent DL had significantly shorter hospital stay (1,82±0,63 days versus 5,4 ±2,1 days; P<0.05) and shorter operation time (17,9±6,38 versus 68,4±33,2 minutes; P <0.05) than patients who underwent EL.
CONCLUSION: Selective use of DL in the hemodinamically stable patients with PAT effectively decreased the rate of negative laparotomies, minimized morbidity, and decreased hospital stay.
Key words: Diagnostic laparoscopy, penetrating abdominal trauma

Amaç: Konuyla ilgili ileri seviyedeki pratik bilgi birikimimize raðmen, el ve elbileðinin yabancý cisim penetrasyon yaralanmalarý, halen eksik tedaviler ve komplikasyonlarla gündeme gelebilmektedir. Konunun sosyal, etiolojik ve hukuki boyutu günlük yoðun pratik içinde atlanabilmektedir. Bu çalýþmada, konunun sosyal, klinik ve terapötik özelliklerini ele almak amaçlanmýþtýr.
Yöntem: Bir el cerrahisi kliniðince tedavisi yapýlmýþ 86 hastanýn retrospektif analizi yapýlmýþtýr.
Bulgular: Ortalama yaþý 32 olan popülasyonun %25,6’sý endüstriyel iþçilerden ( en kalabalýk mesleki grup) oluþmaktaydý. Baþvurularýn %26,7’si elektif idi. Yaralanma döneminde ek hastalýðý olanlar popülasyonun %15,1’ini, psikiyatrik tanýsý olanlar %5,8’ini oluþturuyordu. Ýþaret parmaðý en sýk yaralanan bölge (%33,7) idi. Operasyonlarýn %94,2’si lokal anestezi altýnda yapýlmýþtý. %30 hastada nöral, tendinöz ve/veya kemiksel hasar mevcuttu. Hastalarýn %30’u postoperatif el fizyoterapi programýna dahil edilmiþlerdi.
Sonuç: El ve elbileðinin yabancý cisim penetrasyon yaralanmalarý genel yönleri ve pratikte gözden kaçabilen özellikleri ile ele alýnmýþtýr.

Background: Despite significant practical knowledge and experience on foreign body penetration injuries of the hand and/or wrist; deficient managements and complications can still be encountered and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of this kind of injuries.
Methods: A retrospective analysis of 86 patients that needed evaluation and treatment in a Hand Surgery Division of a university hospital is made.
Results: The median age was 32 (min: 4, max: 63). Industrial workers constituted the most crowded occupational group (n: 22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities and five (5.8%) had psychiatric diagnoses at the time of the injury. Index finger was the most frequent site of injury (n: 29, %33.7). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. Conclusion: The practically well known general features of the issue and its aspects that could still be overlooked currently are reevaluated in the light of our observational data.

Background: Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation.
Case: A 52 year-old male is admitted on the 7th day of a living donor renal transplantation with serous drainage at incision site. He didn’t have any abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and US were found normally, but diffuse extraluminal air was detected at CT scan. There weren’t any pathological laboratory findings regarding to the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, no evidence about iatrogenic injury was seen. And there was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy was performed. He was discharged on the 9th day of the operation. His colostomy was closed on the first year of the operation.
Conclusion: Gastrointestinal complications can be fatal, but don’t seem to influence the long term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role on survival.

Background Post-traumatic superior sagittal sinus thrombosis is rare. The usual presentation is raised intracranial pressure symptoms.
Case report A case of post-traumatic superior sagittal sinus thrombosis is presented where CT scan revealed depressed fracture of vertex with parasagittal contusions. Despite surgical elevation of fracture and repair of superior sagittal sinus, patient developed thrombosis of anterior half of superior sagittal sinus with bilateral hemorrhagic infarcts in motor strip.
Discussion This case is reported for its rarity and to highlight the importance of post-operative vigil on such patients even after surgery. In such settings timely diagnosis and anticoagulant therapy is rewarding.

Diffuse idiopathic sceletal hyperosteosis is characterised with anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in patient with DISH after minor trauma. The patient was treated surgically. We also discussed symptamotology and common mechanisim of cord injury in DISH.

We present the case of a 34 years old Albanian male, who fell from the motorcycle during a high-speed accident, after performing a triple pivotal-round circle in air at the site of the impact, before falling on the ground. The clinical picture thereafter was one of a deep coma, treated in the intensive care unit for nine days, till the patient regained conscience and long-term rehabilitation procedures were put in place. The magnetic resonance and computed tomography images were very illustrative of a rotational head trauma mechanism, since apart from multiple callosal hemorrhages and the lack of cranial fractures, a linear complex fracture of the C6 was seen as well, justifying orthopedic treatment through immobilization of the cervical spine. Rotational angular acceleration seems to be an important causative factor toward provoking diffuse brain and/or axonal injury; the etiological importance on the direct skull impact is controversial, but anyhow not negligible.

Subhepatic-retrocaecal appendicitis is a rare entity in which the diagnosis is challenging. In patients presented with right abdominal pain with atypical clinical, laboratory and ultrasound (US) findings, acute appendicitis should be eliminated with computed tomography (CT). Multi detector CT (MDCT) can be used effectively for the diagnosis of retrocaecal appendicitis without additional preparation or focused examination. Here we present a patient of acute subhepatic-retrocaecal appendicitis in whom clinical and US findings mimicked acute cholecystitis. To the best of our knowledge, there is no previous report related to acute appendicitis presented with only pericholecystic fluid and could be diagnosed with MDCT. In conclusion; retrocaecal-subhepatic appendicitis is a rare condition which might be presented with atypical clinical, laboratory and radiological signs. US is usually insufficient for the definitive diagnosis. In this situation MDCT could be a rapid and efficient tool for localizing the appendix and for differential diagnosis.

Appendiks vemiformis duplikasyonu nadir bir konjenital anomalidir ve genellikle laparotomi esnasýnda tesadüfen saptanýr. Apendikslerin birinin diðerine ve çekuma göre lokalizasyonunu tanýmlamada ve ayný zamanda duplikasyonun boyutunu göstermede modifiye Cave ve Wallbridge sýnýflamasý kullanýlýr. Bizler, akut karýn aðrýsý nedeniyle laparotomi uygulanan 45 yaþýnda bir hastayý bildirdik. Operasyon bulgularý, apendiks duplikasyonu ile birlikte çift akut apandisit þeklinde idi. Tip B duplikasyon olmasý nedeniyle apendiksler ayrý ayrý alýndý. Apendektomi en sýk uygulanan abdominal cerrahi olmasý nedeniyle tüm cerrahlar bu nadir klinik antiteyi akýlda tutmalýdýrlar.

Duplication of the vermiform appendix is a rare congenital abnormality and usually found incidentally during laparotomy. Modified Cave and Wallbridge classification is used to describe the locations of both appendixes according to each other and the cecum and also indicates the extent of the duplication. We report a 45-year-old patient who underwent laparotomy for acute abdominal pain. The operative finding was double acute appendicitis in appendical duplication. The appendixes were separately removed as it was Type B duplication. Since appendectomy is the most common abdominal operation, all surgeons should keep this rare clinical entity in mind.

Baryum taþý, yoðunlaþmýþ baryum ile feçesten oluþur ve gastrointestinal sistem (GÝS) görüntüleme çalýþmalarýndan sonra nadiren görülür. Bu tür görüntüleme yöntemlerinde kullanýlan baryum apendiks lümenine girebilir ve lümeni daraltarak yada týkayarak nadiren akut apandisite sebep olabilir. Baryum yutularak ya da lavmanla yapýlan bu görüntüleme tetkiklerinde, baryum %80-90 apendiks lümenini doldurur ve apendiks görüntülenir, ve bu saðlýklý apendiks bulgusu olarak kabul edilir. Tetkik sonrasý %90-95 oranýnda baryum apendikste kalýr ve bu kalma süresi hastalarýn %10 unda 72 saatten uzundur. Baryumun apendikste kalýþý 2 aydan uzun sürerse komplike apendisitle sonuçlanabilir. Baryumlu çift kontrast kolon grafisinden 3 ay sonra, baryum taþýna baðlý akut apandisit tanýsý alan ve apendektomi yapýlan 46 yaþýnda erkek hasta sunulmaktadýr. Baryumlu görüntülemelerden sonra baryumun apendikste kalarak akut apandisite sebep olabileceði yönünden hastalar bilgilendirilmeli ki eðer karýn aðrýsý geliþirse, hýzlý bir þekilde uygun tedavi için bir saðlýk merkezine yönlendirilebilir ve erken müdahale ile akut apandisitin komplikasyonlarý önlenebilir.

A barolith consists of inspissated barium associated with feces and is seen, rarely, after barium studies for imaging the gastrointestinal system. The barium used in such studies can enter the appendiceal lumen and, rarely, can cause appendicitis by obliterating or narrowing the lumen of the appendix. The appendix fills with barium and the entire appendix is visualised in 80~90% of barium swallow or enema studies, and this is accepted as a reliable sign of a non-diseased appendix Post-examination retention of barium in the appendix is very common (90~95%) and 10% of the patients retain barium in the appendix beyond 72 h. If the barium is retained for more than two months, complicated appendicitis can result. We present a 46-year-old male who was diagnosed with acute appendicitis due to a barolith and required an appendectomy three months after a double contrast barium enema study. After barium studies, patients should be informed for retention of barium in the appendix and can cause acute appendicitis, so if abdominal pain develops, the patient can be referred to a medical centre for the appropriate treatment quickly and the complications of acute appendicitis can be prevented by early intervention.