AMAÇ: Piperin oksidatif hasara ve lipit peroksidasyonuna karþý koruyucu etkisi bildirilmiþ bir baharat türevidir. Çalýþmamýzda ince baðýrsak iskemi-reperfüzyon hasarýnýn önlenmesinde piperinin etkisini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Sýçanlar her biri 8 sýçan içeren 3 gruba ayrýldý. Sham grubundaki sýçanlara sadece laparotomi ve gözlem uygulandý. Kontrol ve çalýþma grubundaki hayvanlara 45 dakikalýk iskemiyi takiben 60 dakikalýk reperfüzyon uygulandý. Çalýþma grubuna piperin, reperfüzyon iþleminden hemen önce 10 mg/kg dozunda periton içi yolla verildi. Laktat seviyelerinin ölçümü için kan numuneleri alýndý. Histopatolojik inceleme, doku malondialdehid, süperoksit dismutaz ve glütatyon aktivitesi ölçümleri için de terminal ileum rezeksiyonu gerçekleþtirildi. Gruplar arasý istatistiki karþýlaþtýrma ANOVA testi ile yapýldý.
BULGULAR: Kontrol grubunda laktat ve malondialdehid seviyeleri çalýþma ve sham gruplarýna göre anlamlý olarak yüksekti (p<0.001). Çalýþma grubunda, süperoksit dismütaz ve glutatyon aktiviteleri kontrol grubundan anlamlý olarak yüksekti (p<0.001). Sham grubu her iki parametrede de en fazla aktiviteye sahipti. Histopatolojik incelemede kontrol grubunda villöz yapýnýn ve lamina propria bütünlüðünün bozulduðu görüldü.
TARTIÞMA: Reperfüzyondan hemen önce periton içi verilen 10 mg/kg piperin ince baðýrsaklarda iskemi-reperfüzyon hasarýný azaltabilir.

BACKGROUND: Piperine is a spice principle, and its protective role against oxidative damage and lipid peroxidation has been reported. In this study, we aimed to investigate the effects of piperine in the prevention of ischemia-reperfusion injury to the small intestine.
METHODS: Rats were allocated to three groups of 8 rats each. Rats in the sham group underwent laparotomy and observation only. Animals in the control and study groups underwent 45 minutes ischemia followed by 60 minutes reperfusion. In the study group, 10 mg/kg piperine was administered intraperitoneally just before the reperfusion procedure. Blood samples were obtained for measurement of lactate levels, and resection of the terminal ileum was performed to evaluate the histopathologic specimens and tissue malondialdehyde, superoxide dismutase, and glutathione activities. All results were expressed as mean±SD. Comparisons between groups were made by using the one way analysis of variance (ANOVA).
RESULTS: Lactate and malondialdehyde levels were significantly higher in the control group than the study and sham groups (p<0.001). In the study group, superoxide dismutase, and glutathione activities were significantly higher than in the control group (p<0.001). The sham group had the highest activities. Histopathologic examination showed disruption of villous pattern and lamina propria in the control group.
CONCLUSION: Intraperitoneal administration of 10 mg/kg piperine just before the reperfusion may reduce ischemia-reperfusion injury to the small intestine.

AMAÇ: Bu çalýþmada dik ve dike yakýn atýþ sonrasý serbest düþme hareketi gerçekleþtiren mermi çekirdeðinin hedef üzerinde hayati yaralanmalara neden olabilme potansiyelinin ortaya konulmasý hedeflendi.
GEREÇ VE YÖNTEM: Çalýþmada 9x19 mm ve 7,65x17 mm çapýndaki mermilerin namlu çýkýþ hýzlarý ölçüldü ve bu hýzlar EBV4® Dýþ Balistik Yazýlýmý kullanýlarak yatayla 65 derece ila 90 derece arasýnda beþer derecelik aralýklardaki atýþlarla simüle edildi. Mermilerin serbest düþme hareketleri ve düþüþ hýzlarý incelendi. Elde edilen sonuçlar, dokularýn eþik hýz deðerleriyle karþýlaþtýrýldý. Ayrýca adli ve basýn kayýtlarý incelenerek Türkiye’de oluþan bu tip yaralanmalarýn analizi yapýldý ve literatür eþliðinde deðerlendirildi.
BULGULAR: Havaya 65 ila 90 derece arasýnda beþer derecelik aralýklarla yapýlan atýþlar neticesinde serbest düþme hareketi yapan mermi çekirdeklerinin ortalama isabet hýzý ve kinetik enerji deðerlerinin 9x19 mm çapýnda mermi için 92,25 m/sn ve 34,05 J olduðu; 7,65x17 mm çapýnda mermi için 79,66 m/sn ve 14,91 J olduðu saptandý. Yapýlan arþiv taramasýnda 2000-2012 yýllarý arasýnda Türkiye’de 65 adet bu tip yaralanma tespit edildi ve bunlarýn 27 tanesinin ölümle sonuçlandýðý anlaþýldý.
SONUÇ: Elde edilen bulgular havaya yapýlan atýþtan sonra serbest düþen 9x19 mm ile 7,65x17 mm çapýndaki mermilerin isabet aný hýzlarýnýn cilt ve yassý kemik için eþik hýz ve kritik hýz sýnýrlarýný aþtýðý ve kinetik enerji deðerlerinin ciddi yaralanma oluþturabileceðini göstermektedir. Ýlk müdahale anýndaki muayene bulgularý ateþli silah yaralanmasýna benzer özellik göstermese de bunlarýn ASY olabileceði ihtimali unutulmadan deðerlendirilmeleri ve tedavileri yapýlýrken adli boyutu göz önüne alarak delilleri koruyacak þekilde davranýlmasýna dikkat edilmelidir.

BACKGROUND: It was aimed in this study to clarify the wounding potential of free-falling bullets fired at 90° or close to right angles.
MEHTOHDS: In this study, 9x19 mm and 7.65x17 mm bullets, which are commonly used among civilians, were used. The muzzle velocities of these ammunitions were measured. According to the muzzle velocity data, the free-falling motion and strike velocity of the 9x19 mm and 7.65x17 mm bullets were simulated using the EBV4® External Ballistics Software at angles of 65°-90° with firings at 5° intervals. The simulation results were compared with critical velocity of tissues. In addition, the judicial records and press reports on this type of wound were examined and evaluated in light of the literature.
RESULTS: The strike velocity and kinetic energy of free-falling bullets, which were fired into the air at 5° intervals between 65°-90°, were measured. The average strike velocity and kinetic energy of 9x19 mm bullets were 92.25 m/sec and 34.05 J and of 7.65x17 mm bullets were 79.66 m/sec and 14.91 J, respectively. As a result of the archives examination, 65 such wounds were detected between 2000 and 2012, and 27 of them resulted in death.
DISCUSSION: According to these results, the strike velocity of free-falling 9x19 mm and 7.65x17 mm bullets, which were fired into the air, exceeds the threshold and critical velocity limits of skin and flat bones, and the kinetic energy of the bullets is able to cause significant wounding. Even though the symptoms and features of these types of wounds may not be similar to those of ordinary gunshot wounds in the first medical examination, the first responders should be aware of the possibility of gunshot wounds, and they should take into account the criminal investigation phase during the treatment process; the necessary precautions should be taken in order to preserve the evidence.

AMAÇ: Akut ekstremite yaralanmasý olan hastalarda eriþkin acil serviste yapýlan iki ayrý morfin dozunun aðrý giderimi ve güvenliliðini karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Opiyoit analjesisine gerek duyan 200 acil servis hastasý randomize olarak iki gruba ayrýldý. Bu randomize çift-kör, plasebo kontrollü çalýþmada intravenöz yolla 0.10 mg/kg dozda morfin ve daha sonra hastalarýn bir bölümüne 0.05 mg/kg IV dozda morfin veya ayný miktarda plasebo verildi. Baþlangýçta (0.10 mg/kg morfin vermeden önce), 30 (çalýþma ilacý verilmeden hemen önce) ve 60 dakika sonra Görsel Analog Ölçekle aðrýnýn þiddet derecesi ve yan etkiler deðerlendirildi.
BULGULAR: Baþlangýca göre 30. dakikada önemli bir farklýlýk saptanmadý. Morfinin 0.15 mg/kg dozda yapýldýðý grupta diðer gruba (0.10 mg/kg doz grubu) göre bir saat sonra aðrý anlamlý derecede azalmýþtý (p<0.05). Bu grubun aðrý skorunda önemli bir iyileþme vardý (p<0.05). Giriþim ve kontrol grubunda aðrý sýrasýyla %52.70 ve %35.82 oranýnda azalmýþtý. Her iki grupta gözlemlenen yan etkiler açýsýndan istatistiksel açýdan anlamlý bir fark yoktu.
TARTIÞMA: Ýki morfin dozu yerine tek doz morfin uygulamasý ekstremite yaralanmalarýnda aðrý giderimi açýsýndan güvenli ve etkili bir yöntemdir. Bu hastalarda aðrýyý azaltmak için ilk standart 0.10 mg/kg dozdan 30 dakika sonra 0.05 mg/kg dozda morfin verilmesini önermekteyiz.

BACKGROUND: We aimed to compare pain relief and safety of two doses of morphine in adult emergency department (ED) patients with acute limb trauma pain.
METHODS: A total of 200 adult ED patients over 20 years of age requiring opioid analgesia were randomly allocated to two groups. Following a first dose of intravenous morphine sulfate at 0.10 mg/kg, a randomized double-blind placebo-controlled trial of intravenous morphine sulfate at 0.05 mg/kg versus the same amount of placebo was performed. Measurement of visual analogue scale pain intensity and assessment of adverse effects were performed at baseline (before morphine at 0.10 mg/kg), 30 minutes from baseline (just before study drug administration), and at 60 minutes from baseline (30 minutes after study drug).
RESULTS: No significant difference was found between groups at 30 minutes from baseline. There was significant reduction in final pain after 1 hour in the 0.15 mg/kg compared to 0.10 mg/kg group (p<0.05). In addition, there was a significant improvement in the mean score of pain in the same group (p<0.05). The percent of pain reduction in the intervention and control group relative to the basic measures was 52.70% and 35.82%, respectively. Adverse effects were present in both groups; however, there was no statistically significant difference between groups.
CONCLUSION: Using two doses of morphine instead of one is a safe and effective method for pain reduction in isolated limb trauma. We recommend performing a second injection of 0.05 mg/kg morphine 30 minutes after the initial standard dose of 0.10 mg/kg to decrease pain in these patients.

AMAÇ: Arter yaralanmasýný dýþlayan üst ekstremite penetran yaralanmasýnýn rutin cerrahi eksplorasyonu çok sayýda olumsuz sonuçlu açýnýmlara ve iyatrojenik yaralanmalara yol açmaktadýr. Bu hastalarda seçici cerrahi dýþý tedavi giderek daha fazla oranda benimsenmektedir. Bu çalýþma bu cerrahi dýþý tedavinin geçerliliðini deðerlendirme ve pratik bir algoritma sunma amacýyla gerçekleþtirilmiþtir.
GEREÇ VE YÖNTEM: Penetran üst ekstremite yaralanmalarý ardýndan üçüncü basamak sevk merkezine gelen tüm ardýþýk hastalar bu ileriye dönük gözlemsel kohort çalýþmasýna alýndý. Hastalar ATLS© kýlavuzlarý ve klinik belirtilerine göre yönetildi, ya acil cerrahiye alýndý veya ek tanýsal araþtýrmalar yapýlmadan veya gerekirse yapýlarak konservatif tedavi uygulandý. Fiziksel incelemeye göre daha önce hazýrlanan bir protokole uyarak bilgisayarlý tomografik anjiyografi (BTA) gerekli oldu.
BULGULAR: Dört aylýk çalýþma döneminde penetran üst ekstremite yaralanmasý olan 161 hasta çalýþmaya alýndý. On dördünde damar yaralanmalarý olan 16 (%9.9) hastaya acil cerrahi giriþim yapýldý. Ayrýca 8 (%5) hastaya BTA sonrasý vasküler eksplorasyon uygulandý. Geri kalan hastalarýn (n=137) vasküler sorunlarý cerrahi dýþý yöntemlerle tedavi edildi. Kýrýklarý veya sinir yaralanmalarý nedeniyle 18 (%11.2) yarý-seçici cerrahi giriþim gerekti. Ýzlem döneminde herhangi bir damar yaralanmasýnýn atlanmadýðý belirlendi.
TARTIÞMA: Üst ekstremitelerin penetran yaralanmalarýndan sonra rutin eksplorasyon veya BTA’ya gerek yoktur. Durumu stabil hastalar yalnýzca klinik bulgularýna göre ek araþtýrmalardan geçmelidir. Seçici cerahi dýþý tedavi bu yaralanmalardan sonra uygun ve güvenli bir tedavi stratejisidir.

BACKGROUND: Routine surgical exploration after penetrating upper extremity trauma (PUET) to exclude arterial injury leads to a large number of negative explorations and iatrogenic injuries. Selective non-operative management (SNOM) is gaining in favor for patients with PUET. The present study was undertaken to assess the validity of SNOM in PUET and to present a practical management algorithm.
METHODS: All consecutive patients presenting to a tertiary referral center following PUET were included in this prospective observational cohort study. Patients were managed along Advanced Trauma Life Support (ATLS©) guidelines, and based on clinical manifestations, either underwent emergency surgery or were treated conservatively with or without additional diagnostic investigations. Computed tomography angiography (CTA) was indicated by a preset protocol based on the physical examination.
RESULTS: During the four-month study period, 161 patients with PUET were admitted. Sixteen (9.9%) patients underwent emergency surgery, revealing 14 vascular injuries. Another 8 (5.0%) patients underwent vascular exploration following CTA. The remaining patients (n=137) were managed non-operatively for vascular matters. Eighteen (11.2%) patients required semi-elective surgical intervention for fractures or nerve injuries. During the follow- up, no missed vascular injuries were detected.
CONCLUSION: Neither routine exploration nor routine CTA is indicated after PUET. Stable patients should undergo additional investigation based on clinical findings only. SNOM is a feasible and safe strategy after PUET.

AMAÇ: Pediatrik popülasyonda serbest doku aktarýmý teknik yararlýlýðý ve güvenililirliði nedeni ile geniþ kabul görmektedir. Cerrahi iþlemin uygunluðu ve güvenililirliðini içeren baþlangýþ süpheleri artýk giderilmiþtir.
GEREÇ VE YÖNTEM: Otuz çocuk hasta (15 erkek, 15 kýz) Þiþli Etfal Eðitim ve Araþtýrma Hastanesi’nde serbest doku aktarýmý uygulanarak tedavi edildi. Hastalarýn defektleri alt ekstremitede (n=22), baþ ve boyunda (n=5) ve üst ekstremitede (n=3) yerleþimli idi. Defektlerin etiyolojileri araba kazalarýný, yanýk sekellerini, travmatik kontraktürlerini, ezilme yaralanmalarýný, maksillada epulisi ve ateþli silah yaralanmalarýný içerdi.
BULGULAR: Çalýþmamýzda aktarýlan serbest dokular latissimus dorsi kas flebi, kombine latissimus dorsi ve serratus kas flepleri, serratus anterior kas flebi, çapraz latissimus dorsi kas flebi, skapüler osteomyokutanöz flebi, paraskapüler fasyokutanöz flebini, fibuler osteokutanöz flebi, anterolateral uyluk flebini ve medial sirkumfleks femoral arter perforatör flebi ve crista iliaca osteocutanöz flebini içeriyordu.
TARTIÞMA: Serbest doku aktarýmýnýn çocuklardaki avantajlarý arasýnda yer alan çocuðun daha iyi flep büyümesine adaptasyonu ve çocuðun öðrenme kapasitesi sayesinde cerrahlar daha iyi ve fonksiyonel ve estetik sonuçlar saðlamaktadýrlar.

BACKGROUND: Free flap surgery in the pediatric population has gained widespread acceptance regarding its technical utility and reliability. Initial concerns as to the feasibility and reliability of the procedure in children were resolved over time.
METHODS: Thirty children (15 boys, 15 girls) were treated in Sisli Etfal Training and Research Hospital, Plastic and Reconstructive Surgery Clinic. Their mean age was 10.8 years. Defects were located on the lower extremity (n=22), head and neck (n=5) and upper extremity (n=3). The etiologies of the defects included vehicle accident, sequelae of burn, traumatic contractures, crush injury, epulis in the maxilla, and gunshot wound.
RESULTS: The free flaps performed in our series were latissimus dorsi muscle flap, combined latissimus dorsi and serratus muscle flaps, serratus anterior muscle flap, cross latissimus dorsi muscle flap, scapular osteomyocutaneous flap, parascapular fasciocutaneous flap, fibular osteocutaneous flap, anterolateral thigh flap, medial circumflex femoral artery perforator flap, and crista iliaca osteocutaneous flap.
CONCLUSION: The advantages of free flaps in children, which include better adaptation of the flap growth and better learning capacity of the children, provide the surgeon with more satisfactory functional and aesthetic results.

AMAÇ: Zehirlenmelere neden olan akrep sokmalarý yaþamý tehdit eden acil bir durumdur ve tropikal ve subtropikal bölgelerde ciddi saðlýk sorunlarýna neden olurlar. Bu çalýþmanýn amacý mortalite ve morbiditenin önlenebilir nedenlerinden olan akrep sokmasý nedeni ile baþvuran 123 hastanýn epidemiyolojik ve klinik özelliklerini belirlemektir.
GEREÇ VE YÖNTEM: Bu çalýþmada Ocak 2008 ile Eylül 2009 arasýnda Diyarbakýr Devlet Hastanesi Acil Servis’ine akrep sokmasý nedeni ile baþvuran 123 hastanýn demografik ve epidemiyolojik özellikleri geriye dönük olarak incelendi.
BULGULAR: Çalýþmaya alýnan 123 hastanýn %62.6’sý (n=77) kadýn ve %37.4’ü (n=46) erkekti. Olgularýn ortalama yaþý 33.5±17.3 (daðýlým, 2-80) yýl ve 27 (%22) hasta 18 yaþýndan daha gençti. Hastalarýn 98’i (%79.7) kýrsal alandan, 25’i (%20.3) þehir merkezindendi. Olgularýn çoðunluðu (%42.3) aktif çalýþma sýrasýnda ve uykuda (%19.5) akrep sokmasýna maruz kaldý. On bir (%8.95) hasta da evde çamaþýrlarýný yerleþtirirken akrep sokmasýna maruz kalmýþtý.
TARTIÞMA: Bu çalýþmanýn yöresel epidemiyolojik özellikleri göz önünde tutarak, saðlýk çalýþanlarýna akrep sokmalarýndan korunma için gerekli önlemlerin alýnmasýnda yardýmcý olabileceðini umarýz.

BACKGROUND: Scorpion sting resulting in envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to present the epidemiologic and clinical features of 123 cases presenting with symptoms of scorpion poisoning, a cause of preventable mortality and morbidity.
METHODS: This study retrospectively analyzed the epidemiologic and demographic features of a total of 123 patients who presented to Diyarbakýr State Hospital Emergency Service with scorpion sting between January 2008 and December 2009.
RESULTS: Among 123 patients who presented to Diyarbakýr State Hospital Emergency Service with scorpion sting between January 2008 and January 2009, 62.6% (n=77) were female and 37.4% (n=46) were male. The mean age of the patients was 33.5±17.3 years (2-80), and 27 (22%) patients were younger than 18 years. The place of residence was rural region in 98 (79.7%) patients and the city center in 25 (20.3%). The majority of victims were stung by scorpions while they were at active work (42.3%) or asleep (19.5%) in bed. Eleven (8.95%) patients were stung by a scorpion while putting on their own clothes.
CONCLUSION: This simple descriptive study will hopefully help healthcare providers take measures to prevent scorpion stings, which should take into consideration local epidemiological features.

AMAÇ: Türkiyede 2011 yýlýndaki tüm trafik kazalarýnýn %7.58’ini (n=21107) motorsiklet kazalarý oluþturmaktadýr. Çalýþmamýzda, motorsiklet kazalarý ve bu kazalara ait detaylarýn, saðlýk maliyetlerindeki rolleri araþtýrýldý.
GEREÇ VE YÖNTEM: 1 Temmuz 2010-30 Haziran 2011 tarihleri arasýnda çarpýþmalý ya da çarpýþmasýz motorsiklet kazalarý ile acil servise gelen hastalar ileriye dönük olarak incelendi. Kazazede ve kazaya ait detaylý bilgileri içeren formlar motorsiklet kazasý ile getirilen tüm yaralýlara doldurularak saðlýk maliyetleri araþtýrýldý. Veriler, SPSS v16 programýnda frekans, Kolmogorov-Smirnov, Mann-Whitney U ve ki-kare testleri kullanýlarak analiz edildi.
BULGULAR: Deðerlendirmeye alýnan 91 kazazedenin, yaþ ortalamasý 28.47. Deðerlendirmeye alýnan 91 kazazedenin baþvurusundan taburculuðuna kadar olan saðlýk maliyetleri ortalamasý 253.02$, ortancasý 55.90$ idi (daðýlým, 11.52- 7137.19$). Çalýþmaya göre, saðlýk maliyetleri ile kaza saati, motorsiklet tipi, yolun yüzeyi, koruyucu ekipman, hava ya da gün ýþýðý arasýnda kesin bir korelasyon yoktu.
TARTIÞMA: Çalýþmaya göre, kaza riski genç eriþkinlerle artmaktadýr. Buna baðlý olarak da, saðlýk maliyetleri artmaktadýr. Bu sebeple, yasal kurallarý yeniden belirlenmesi ve gerekiyorsa motorsiklet ehliyeti alma yaþý ve de eðitimleri düzenlenmelidir.

BACKGROUND: Of overall traffic accidents in 2011 in Turkey, 7.58% (n=21,107) were motorcycle accidents. Motorcycle accidents and their impact on healthcare costs are investigated in our study.
METHODS: Motorcycle accidents that occurred with/without a collision between 1 July 2010 and 30 June 2011 were studied prospectively through the inspection of patients visiting the Emergency Service. The healthcare costs relevant to each person injured in a motorcycle accident were investigated via forms. Data were analyzed using frequencies, Kolmogorov-Smirnov, Mann-Whitney U, and chi-square tests on the SPSS v16.0 program.
RESULTS: Ninety-one people involved in accidents, with a mean age of 28.47 years, were studied. The average healthcare expenditure for the 91 patients studied between reception and discharge was US$253.02 (median, US$55.90; range, US$11.52 - 7137.19). According to our study, there was no definitive correlation between the healthcare costs and the time of the accident, motorcycle type, nature of the road surface, protective equipment, weather, or daylight.
CONCLUSION: According to the current study, the risk of an accident increases with young adults. Concordantly, healthcare costs increase. Thus, it is important that the legal rules with respect to the age and education necessary for receiving a license to operate a motorcycle should be redefined, and if necessary, regulated.

AMAÇ: Bu çalýþmada, Suriye’de yaþanan çatýþmalar sonrasý hastanemize getirilen olgularýn demografisi, klinik özellikleri ve yapýlan harcamalarýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Bu amaçla Haziran 2011-Temmuz 2012 yýllarý arasýndaki 14 aylýk dönemde hastanemize getirilen 1355 Suriyeli olgunun acil servis giriþi olan 482’si çalýþmaya alýndý. Hastalarýn bilgisayar verileri geriye dönük olarak incelendi.
BULGULAR: Olgularýn 428’i (%88.8) erkek, 54’ü (%11.2) kadýn, yaþ ortalamalarý 30.4±14.9 yýl (min: 1, maks: 79), erkeklerin yaþ ortalamasý 30.8±17.2 yýl (min: 1, maks: 79), kadýnlarýn yaþ ortalamasý ise 27.3±16.9 yýl (min: 1.5, maks: 66) olarak belirlendi, cinsiyet bakýmýndan aralarýnda istatistiksel olarak anlamlý bir fark saptandý (p=0.007). Olgularýn en çok 21-30 yaþ grubunda (%41.1) olduðu belirlendi. En fazla baþvurunun 159 (%33) kiþiyle Haziran 2011, en az ise beþ kiþi (%1) ile Eylül 2011’de olduðu tespit edildi. Hastalar 112 Acil Servis ambulanslarý ile çevre ilçe hastaneleri ve kamplardan getirildi. Acil servise baþvuru sebebi en sýk 338 olgu (%70.1) ile ateþli silah yaralanmasý idi. En sýk konulan taný ise ekstremite yaralanmasýydý (153 olgu, %31.7). Adli olgu sayýsý 364 (%75.5) tespit edildi. Yüz otuz altý (%28.2) hastanýn acil servisde takip ve tedavisi yapýldý. Hastalar en sýk ortopedi ve travmatoloji bölümüne yatýrýlarak tedavi edildi (146 olgu, %30.3). Ortalama yatýþ süresi 9.9 gün (1-141 gün) idi. 456 olgu (%94.6) taburcu edilirken, 22 olgu (%4.6) öldü, dört olgu (%0.8) ise sevk edildi. Olgularýn maliyeti ortalama 3723 TL (min: 5 TL, maks: 69556 TL) olarak bulundu. Sürekli deðiþkenler arasý korelasyon testi yapýldýðýnda maliyeti ve yatýþ süresi arasýnda pozitif korelasyon saptandý (p=0.000).
TARTIÞMA: Getirilen olgular içinde genç erkek ve ateþli silah yaralanmasý olgularýnýn çokluðu dikkat çekti. Olgularýn çoðunluðu uygun takip ve tedavi sonrasýnda taburcu edildi. Alýnacak tedbirler sonrasýnda bu kötü sonuçlar engellenebilecek, önlenebilir maliyetler ortaya çýkmayacak ve ülke bütçelerinin zarar görmesi önlenebilecektir.

BACKGROUND: In the present study, it was aimed to assess the demographics, clinical features, and treatment costs of cases referred to our hospital after the Syrian civil war.
METHODS: Of 1355 Syrian civil war victims referred to our hospital during the 14-month period between June 2011 and July 2012, 482 cases presenting to the emergency department were included in the study. The electronic data of these patients were retrospectively analyzed.
RESULTS: Of 482 cases, 428 were male (88.8%) and 54 (11.2%) were female, with a mean age of 30.4±14.9 years (1-79 years). The mean age was 30.8±17.2 years (1-79 years) in males and 27.3±16.9 years (1.5-66 years) in females. There was a significant difference in terms of sex (p=0.007). It was found that the majority of the cases (41.1%) were aged 21-30 years. The highest number of admissions was recorded in June 2011 (159 patients, 33%), whereas the lowest number of admissions was in September 2011 (5 patients, 1%). All cases were transported to our hospital from nearby district hospitals and camps by emergency medical services. The most frequent presenting complaint was gunshot injury (338 cases, 70.1%). The most common diagnosis was extremity injury (153 cases, 31.7%). The number of forensic cases was found as 364 (75.5%). Of all the cases, 136 cases (28.2%) were managed in the emergency service, and the remaining cases were admitted to other services. They were most frequently admitted to the orthopedics ward (146 cases, 30.3%). The mean length of the hospital stay was 9.9 days (1-141).Overall, 456 cases (94.6%) were discharged, 22 cases died, and 4 cases were transferred to other facilities. The mean cost per case was estimated as 3723Turkish lira (TL) (15-69556). A positive correlation was found between cost and length of hospital stay.
CONCLUSION: Among all Syrian cases, the majorities of young males and gunshot injuries was striking. Most of the cases were discharged after appropriate management. Preventive measures can avoid these negative outcomes and so avoidable costs will not occur, and this can preclude the damage to the budgets of the countries.

AMAÇ: Maksillofasiyal travma tek baþýna veya diðer travmalara eþlik edecek þekilde görülebilir. Bu travmalarda mandibula kýrýðý görülme oraný yüksektir. Mandibulanýn tüm kýrýklarý arasýnda subkondil bölgesine ait kýrýklar özel bir yaklaþým gerektirir. Açýk redüksiyonla yapýlan internal sabitlemelerde; yüzde istenmeyen skar oluþumu, geçici/kalýcý fasiyel sinir felci gibi ek morbiditeler oluþabilir. Subkondil kýrýklarýnda endoskopik yaklaþýmla bu sorunlarý azaltmak mümkündür.
GEREÇ VE YÖNTEM: Çalýþmamýzda birbirini takip eden 13 hastadaki subkondil kýrýklarýna aðýz dýþýndan endoskopik yaklaþýmla gerçekleþtirdiðimiz onarýmlara iliþkin tecrübelerimizi aktarmayý amaçladýk. Ocak 2010 ve Haziran 2011 tarihleri arasýnda Ondokuz Mayýs Üniversitesi Týp Fakültesi Hastanesi Plastik Rekonstrüktif ve Estetik Cerrahi Kliniði’ne acilden baþvuran 13 hastadaki 15 subkondiler kýrýk bu çalýþmaya dahil edildi.
BULGULAR: Hastalara endoskopik veya açýk yaklaþým kullanýlarak giriþimde bulunuldu. Kýrýklardan dokuz tanesine aðýz dýþýndan yapýlan endoskopik yaklaþýmla baþarýlý biçimde plak-vida sabitlemesi yapýldý. Endoskopik onarým yapýlan kýrýklarýn yedi tanesinde proksimal parçalar laterale deplaseydi. Kýrýklarýn geri kalan altý tanesine ise endoskopik olarak baþlandýktan sonra tam açýk yaklaþýma dönülerek giriþim yapýldý. Bu altý kýrýðýn hepsinde de proksimal parçalar mediyale deplase haldeydi.
TARTIÞMA: Subkondil kýrýklarýnda aðýz dýþýndan endoskopik yaklaþýmla onarým yapmak mümkündür. Bu yaklaþýmda amaç iþleme baðlý ek morbiditeyi etkili biçimde azaltmaktýr. Endoskopik cerrahi ile tecrübesi az olan meslektaþlarýmýza tavsiyemiz baþlangýç olgusu olarak laterale deplase olmuþ düþük seviyedeki subkondil kýrýklarýný seçmeleridir.

BACKGROUND: We aimed to present the primary experience of one surgeon with a new surgical technique performed on the first 13 cases and to evaluate outcomes following an extraoral endoscopic approach to subcondylar fractures.
METHODS: Fifteen subcondylar fractures in 13 patients, who were treated at Ondokuz Mayis University Hospital between January 2010 and June 2011, were included in this study. Patients were operated on using either endoscopic or open approach.
RESULTS: Rigid plate fixation was completed endoscopically using extraoral approach in nine fractures, while six fractures were plated by conversion to a full-open approach. In all six fractures that could not be fixed endoscopically, the proximal fragments were medially displaced, whereas seven of nine fractures that were successfully fixed endoscopically were laterally displaced.
CONCLUSION: An extraoral endoscopic approach for subcondylar fractures is feasible and can be carried out with decreased morbidity. This approach is recommended for those with limited experience in endoscopy to treat low laterally displaced subcondylar fractures as their initial cases.

AMAÇ: Spinal kord yaralanmalarý geliþen nörolojik problemler nedeni ile oldukça ciddi maddi ve/veya manevi kayýplara neden olmaktadýr. Bu çalýþmanýn amacý yüksek morbidite ve mortalite oranlarý nedeni ile ciddi klinik sonuçlara yol açan, ancak ülkemize ait saðlýklý verilerin az olduðu spinal yaralanmalarýn klinik þiddet ve prognoz açýsýndan deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, fakültemiz etik kurulundan izin alýndýktan sonra Acil servisimize üç yýl içinde baþvuran 18 yaþ ve üzerindeki spinal travmalý 91 hasta (59 erkek, 32 kadýn) üzerinde gerçekleþtirildi. Hastalar demografik özellikler, klinik þiddet, geliþen komplikasyonlar ve mortalite açýsýndan deðerlendirildi.
BULGULAR: Hastalarýn 43’ü komplet, 48’i ise inkomplet yaralanmalý idi. Hastalarýn 46’sý yüksekten düþme, 35’i trafik kazasý ve 10’u diðer nedenlerden dolayý spinal yaralanmaya maruz kalmýþtý. Hastalarýn 52’sinde çeþitli komplikasyonlar görülürken 39’unda herhangi bir komplikasyon geliþmediði saptandý. Çalýþma grubumuzda yer alan 91 hastanýn 19’unun öldüðü 72’sinin ise hastaneden taburcu olduðu saptandý.
TARTIÞMA: Spinal kord yaralanmalarý genellikle kötü klinik sonuçlara yol açmaktadýr. Bu nedenle acil servisteki uygun yaklaþýmýn (erken taný ve doðru tedavi) önemi oldukça yüksektir. Bu hasta grubunda hem primer bakým hem de komplikasyonlarýn önlenmesi bakýmýndan gerekli önlemlerin alýnmasý klinik sonuçlarý olumlu yönde etkileyecektir.

BACKGROUND: Spinal cord injuries result in critical pecuniary and/or non-pecuniary losses due to the developing neurological problems. The objective of this study was to evaluate spinal injuries in terms of clinical severity and prognosis. Spinal injuries lead to serious clinical results due to the high rates of morbidity and mortality; however, there is a lack of reliable information on spinal injuries in our country.
METHODS: Following the approval of the Faculty Ethics Committee, this retrospective study was conducted on 91 patients aged ≥18 (59 male, 32 female) with spinal trauma who were admitted to the Emergency Department of Ondokuz Mayis University over three years. The patients were assessed in terms of demographics, clinical severity, developing complications, and mortality.
RESULTS: Forty-three patients had complete injuries, while 48 had incomplete injuries. Forty-six patients suffered spinal injuries due to fall from height, 35 patients due to traffic accidents, and 10 patients due to other reasons. Several complications were observed in 52 patients, while no complication occurred in 39 patients. We determined that 19 of 92 patients involved in this study died, while 72 were discharged from the hospital.
CONCLUSION: Spinal cord injuries generally result in unfavorable clinical results. Therefore, an appropriate approach (early diagnosis and true treatment) in emergency services has great significance.

AMAÇ: Bu çalýþmada; 2005-2012 yýllarý arasýnda orbita kýrýðý tanýsýyla Ýstanbul Þiþli Etfal Eðitim ve Araþtýrma Hastanesi’nde tedavi edilen 132 hastanýn klinik ve epidemiyolojik özellikleri deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Orbita kýrýðý nedeniyle tedavi edilen hastalara ait kayýtlar geriye dönük olarak incelendi. Hastalarýn yaþ ve cinsiyete göre daðýlýmlarý, travma etiyolojileri, semptomlarý, muayene bulgularý, kýrýk lokalizasyonlarý, eþlik eden sistemik yaralanmalar, uygulanan tedavi prosedürü ve tedavi sonrasý saptanan komplikasyonlar deðerlendirildi.
BULGULAR: Ortalama takip süresi 9(6-16) ay olan hastalarýn erkek-kadýn oraný 5.3-1 idi. Ortalama yaþ 32 (6-82) yýl idi. En sýk etiyolojik neden trafik kazalarý (%36) ve darp (%32) olarak saptandý. En sýk etkilenen duvar medial orbital duvardý (%33). Hastalarda en sýk görülen semptom travma bölgesinde zonklayýcý aðrý (%100) ve saptanan bulgu ise periorbital ödem ve ekimozdu (%100). En sýk eþlik eden sistemik yaralanma ise serebral travmaydý (%13.6). Hastalarýn %50.1’i týbbi tedavi ile konservatif olarak takip edilirken, %49.9’una cerrahi tedavi uygulandý. Tedavi sonrasý en sýk gözlenen komplikasyonun dermatomal duyu kaybý (%11) olduðu görüldü.
TARTIÞMA: Bu çalýþma orbital kýrýklarýnýn görülme sýklýðýnýn azaltýlabilmesi için trafik kazalarýný ve olasý kaza durumunda yaralanmayý önleyiciyi tedbirlerin alýnmasýnýn, eðitim programlarýnýn geliþtirilmesinin önemini vurgulamaktadýr.

BACKGROUND: The aim of this study was to evaluate the clinical and epidemiological features of 132 patients with orbital wall fracture who were treated at Þiþli Etfal Teaching and Research Hospital, Istanbul, between 2005-2012.
METHODS: The medical records of the patients with a diagnosis of orbital fracture were reviewed and analyzed. The patients were evaluated by age, gender, etiology, symptoms, examination findings, fracture location, associated injuries, treatment, and complications.
RESULTS: The mean follow-up time was 9 (6-16) months. The male-to-female ratio was 5.3-1. The average age was 32 (6-82) years. The leading causes of orbital fractures were traffic accidents (36%) followed by assaults (32%). The most frequently affected orbital wall was the medial wall (33%). The main symptom was throbbing pain in the traumatized area (100%), and the main examination finding was periorbital edema and ecchymosis (100%). The most frequent associated injury was cerebral trauma (14%). Sixty-seven patients (50.1%) were managed with medical treatment, and 65 patients (49.9%) underwent surgical treatment. The most common complication in the late period was dermatomal sensory loss (11%).
CONCLUSION: This study makes clear that the frequency of orbital injuries may be decreased by preventing traffic accidents, by taking precautions in the event they occur, and by promulgating social and educational work against violence.

AMAÇ: Çalýþmamýzda anterior veya posterior cerrahi yaklaþýmla bipolar protez uygulanan femur boyun kýrýklý hastalarýn fonksiyonel durumlarý ve ortaya çýkan komplikasyonlar geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM: Kasým 2007-Þubat 2011 tarihleri arasýnda femur boyun kýrýðý nedeni ile bipolar parsiyel protez uygulanan, takip süresi en az bir yýl olan 224 hasta (96 erkek, 128 kadýn) deðerlendirildi. Cerrahi yaklaþýma göre iki grup oluþturuldu. Kalça eklem kapsülü anteriordan açýlan (grup 1) grupta 92 (46 erkek, 46 kadýn; ortalama yaþ 78.4 yýl daðýlým 70-97) hasta, kapsülün posteriordan açýldýðý (grup 2) grupta ise 132 (50 erkek, 82 kadýn ortalama yaþ 77.9 daðýlým 70-96) hasta vardý. Grup 1’deki hastalarýn ortalama takip süresi 16.4 ay (12-34), grup 2’deki hastalarýn ortalama takip süresi 18.9 ay (12-39) idi.
BULGULAR: Ortalama Harris puaný grup 1’de 81.7±7.6 grup 2’de ise 79.2±6.9 olarak bulundu. Grup 1’de 19 hastada çok iyi, 52 hastada iyi, 15 hastada orta ve 6 hastada yetersiz sonuç, grup 2’de ise 29 hastada çok iyi, 74 hastada iyi, 21 hastada orta ve 8 hastada yetersiz sonuç elde edildi. Grup 2’de daha fazla çýkýk (%3.78) ve enfeksiyon (%3.03) görülsede; iki grup arasýnda fonksiyonel puanlama ve komplikasyonlar açýsýndan anlamlý fark bulunmadý (p>0.05).
SONUÇ: Kalça eklemine parsiyel protez uygulamasýnda cerrahi yaklaþým fonksiyonel sonuçlarý etkilememektedir. Kalça eklemine parsiyel protez uygulamasýnda kapsülün anterior açýlýmý çýkýk ve enfeksiyon açýsýndan daha güvenli olabilir.

BACKGROUND: We evaluated the functional status and postoperative complications of bipolar hemiarthroplasty patients with femoral neck fractures, which we operated using anterior and posterior approaches.
MEHTOHDS: Between November 2007 and February 2011, 224 patients were evaluated according to their surgical exposure type in two groups. The first group, which was approached anteriorly to the joint capsule, included 92 patients, and the second group, approached posteriorly, included 132 patients. The mean follow-up period for group 1 was 16.4 months and for group 2 was 18.9 months.
RESULTS: Harris hip score of group 1 was 81.7 and of group 2 was 79.2. In group 1, 19 patients had very good, 52 patients good, 15 patients moderate, and 6 patients insufficient results. In group 2, 29 patients had very good, 74 patients good, 21 patients moderate, and 8 patients insufficient results. Although we had higher hip dislocation and infection rates in group 2, there were no statistical differences between the two groups.
DISCUSSION: Surgical exposure type does not affect functional outcome in bipolar hip arthroplasty patients. Although statistically insignificant, we had higher hip dislocation and infection rates using the posterior approach in the selected femoral neck fracture patients. An anterior approach to the joint capsule appears to be more reliable.

AMAÇ: Penetran karýn travmalý (PKT) hastalarda selektif non-operatif yönetim (SNOY) genel kabul gören yaklaþým haline gelmiþtir. Bu çalýþma ülkemizdeki genel cerrahlarýn SNOY ile ilgili görüþlerini ve klinik uygulamadaki eðilimlerini belirlemek amacýyla yapýldý.
GEREÇ VE YÖNTEM: Anket sorularý cerrahlara online olarak sunuldu. Ankette katýlýmcýlarýn demografik özellikleri, PKT’li hastalarýn yönetimi ve SNOY ile ilgili görüþleri ve klinik uygulamalardaki eðilimleri araþtýrýldý. Veriler Microsoft® Excel®’de kayýt edilerek analiz edildi.
BULGULAR: Çalýþmaya toplam 180 genel cerrahi uzmaný katýldý. Delici-kesici alete baðlý karýn yaralanmasý (DKAY) olan hastalarda SNOY yaklaþýmýný klinik pratikte uygulayanlarýn oraný %64 iken, bu oran ateþli silaha baðlý karýn yaralanmasý (ASY) olan hastalarda %52 idi. Ancak cerrahlarýn %90’dan fazlasý hem DKAY’de, hem de ASY’de SNOY yaklaþýmýný uygulamadan önce ek görüntüleme ve ilave incelemelere gerek olduðunu savundu. SNOY yaklaþýmýný klinik pratiklerinde uygulamayan cerrahlarýn büyük çoðunluðu ise hem hastanýn yaþamýný hem de kendilerini adli olarak riske etmek istemediklerini belirtti.
SONUÇ: Ülkemizdeki genel cerrahlarýn penetran karýn travmasý olan hastalarýn yönetimindeki güncel yaklaþýmlar hakkýnda olumlu görüþ ve eðilimleri olmasýna raðmen yaklaþýk yarýsýnýn çeþitli sebeplerden dolayý pratikte yeteri kadar uygulamadýklarý saptandý. Travma ve acil cerrahinin yan dal olarak kabul edilmesi ve travma merkezlerinin yapýlandýrýlmasýnýn bu eksiklikleri ortadan kaldýracaðýný düþünmekteyiz.

BACKGROUND: In patients with penetrating abdominal traumas (PATs), selective non-operative management (SNOM) has been widely accepted. This study was designed to investigate the practice trends among Turkish surgeons regarding SNOM.
MEHTOHDS: The study was conducted as an online survey. Participants’ demographic characteristics and their management trends and opinions regarding patients with PATs and SNOM were studied. Data were recorded using MS Excel® and analyzed.
RESULTS: A total of 180 surgeons participated in the survey. SNOM approach rate in patients with stab injuries (SI) was 64%, whereas in patients with gunshot injuries (GSI), this rate was 52%. However, more than 90% of the surgeons declared that additional diagnostic studies were required before selecting SNOM approach in both SI and GSI. In addition, most of the surgeons who did not use SNOM in practice reported that they did not want to risk the patients’ lives or their careers.
DISCUSSION: Although our surgeons have constructive opinions and tendencies regarding contemporary approaches in the management of PATs, it is seen that nearly half of them prefer not to perform SNOM in practice for various reasons. We believe that approval of trauma and emergency surgery disciplines as subspecialties and funding- centralized trauma centers might correct this deficiency.

Dabigatran, kronik atriyum fibrilasyonunda antikoagülasyon için kullanýlan yeni bir pýhtý önleyici ilaçtýr. Dabitagran alan bir hastada acil laparotomi deneyimi sunulmaktadýr. Bu ilaç tedavisinin zorluklarý ve bu direkt trombin inhibitörü nedeniyle oluþan koagülopati ile baþa çýkma stratejileri tanýmlanmýþtýr.

Dabigatran is a newer oral anticoagulant, indicated for chronic atrial fibrillation anticoagulation. Experience with an emergent laparotomy in a patient on dabigatran is presented. Difficulties of this medication and strategies to deal with the coagulopathy from this direct thrombin inhibitor are described.

Altmýþ altý yaþýnda erkek hasta araç içi trafik kazasý sonrasý hastanemize getirildi. Travmaya baðlý subaraknoid kanama, çoklu kosta kýrýðý ve sol hemopnömotoraks mevcuttu. Troponin deðerlerinin yükselmesi (42 ng/ml, referans 0-1 ng/ml) nedeniyle kardiyoloji bölümüne konsülte edilen hastanýn elektrokardiyografisinde iskemi bulgusu yoktu ancak yapýlan transtorasik ekokardiyografide sað boþluklar ile triküspit kapak anulusu geniþlemiþ, triküspit kapak koaptasyonu bozulmuþ olarak izlendi. Triküspit kapak anterior leaflete ait subvalvuler yapýlarda rüptür ve prolapsus mevcuttu; buna baðlý önemli triküspit yetersizliði prolapsusa eþlik ediyordu. Sað ventriküler yetersizlik bulgularý bulunmayan hasta travmaya ait diðer tedavilerin tamamlanmasýnýn ardýndan cerrahi kliniðine gönderildi.

A 66-year-old male was brought to our hospital following a car accident. He had subarachnoid hemorrhage, multiple rib fractures, and left hemopneumothorax. He was referred to the Cardiology Department for elevated troponin levels (42 ng/ml, reference 0-1 ng/ml). The electrocardiogram was free of ischemia, whereas the transthoracic echocardiography revealed dilated right heart chambers, enlarged tricuspid annulus and coaptation failure of the tricuspid valvular leaflets. There was rupture on the subvalvular apparatus of the anterior leaflet of the tricuspid valve with accompanying prolapse, causing severe tricuspid valvular regurgitation. The patient did not present right ventricular failure signs and symptoms; he was referred to surgery after the resolution of associated thoracic and cranial injuries.

Ergotamin kullanýmýna baðlý geliþen vazospazm nadir görülen ve iyi bilinen bir komplikasyondur. Bu yazýda çoklu kýrýðý olan ve travma sonrasý 10. günde görülen ve ayný taraf alt ekstremitede tüm arterlerin etkilendiði arteriyospazm olgusu sunuldu. Bu olguda travma sonrasý anjiyospazm ile karýþabilecek olan ergotamin baðýmlýlýðý ve aþýrý doz egotamin kullanýmý sonucu ortaya çýkan arteriyospazm; epidural kateter aracýlýðý ile marcain infüzyonu, intravenöz yolla heparin, iliomedin ve nitronal infüzyonu ile tedavi edildi. Tüm arteryel vazospazm saptanan travma olgularýnda bu klinik durum akýlda tutulmalý ve hastadan anamnez alýnýrken ergotamin kullanýmý mutlaka sorgulanmalýdýr.

Vasospasm that develops in association with ergotamine use is a rarely seen but well-understood complication. A case is presented here of multiple fractures in which arteriospasm affecting all the arteries of the lower limb on the same side occurred 10 days post-trauma. In this case, the arteriospasm resulting from ergotamine addiction and high doses of ergotamine, which may be confused with post-traumatic angiospasm, was treated with a marcaine infusion by epidural catheter and heparin, iliomedin and nitronal infusion intravenously. This clinical condition should be borne in mind for all trauma cases determined to have arterial vasospasm, and the use of ergotamine must be queried when taking the anamnesis from the patient.

Travmaya baðlý izole ve kompleks hepatik kanal yaralanmalarý seyrek görülmektedir. Merkezimizde baþarýlýyla taný ve tedavisi yapýlan iki izole safra kanalý yaralanmasý sunulmaktadýr.

Isolated hepatic duct confluence injury due to trauma is unusual. Two cases of isolated bile duct injury are presented, which were diagnosed and managed successfully at our institution.

Bu yazýda nadir bir pediatrik brakial pleksus kesisi olgusu sunuldu. Sað aksiller bölgeyi etkileyen kesici cisim yaralanmasýna maruz kalan beþ yaþýndaki erkek çocuk acil olarak ameliyata alýndý. Aksiller arter, brakial pleksusun radial, ulnar ve muskulokutan sinir dallarý ile median sinirin lateral kökü tam olarak kesilmiþti. Median sinirin medial kökü ise parsiyel kesilmiþti. Brakiyal pleksusun kesilen tüm elemanlarý ve aksiller arter acil olarak onarýldý. Onarýmdan altý ay sonra bile belirgin bir fonksiyonel iyileþme saptandý. Ameliyat sonrasý 21. ayda, etkilenen ekstremitenin motor ve duyu fonksiyonlarý, ulnar sinir motor fonksiyonlarý dýþýnda, tama yakýn düzeldi. Yaralanan ekstremitede soðuk intoleransý veya atrofik deðiþiklikler gözlenmedi. Pediatrik yaþ grubunda brakiyal pleksus kesici yaralanmalarýnýn primer onarýmý, onarýmdan sonra görece kýsa sürede bile, baþarýlý fonksiyonel iyileþme sonuçlarý verebilir.

A rare case of pediatric brachial plexus laceration is presented. A five-year-old boy who sustained a sharp laceration on his right axillary region was immediately operated. The axillary artery, radial, ulnar and musculocutaneous nerve branches of the brachial plexus, and the lateral root of the median nerve were totally lacerated. The medial root of the median nerve was partially transected. All of the lacerated brachial plexus elements and axillary artery were immediately repaired. Significant functional recovery was determined even six months after the repair. Motor and sensory functions of the affected extremity were almost totally restored at the postoperative 21st month, except for the ulnar nerve motor functions. There was no cold intolerance or trophic change at the injured extremity. Primary repair of a brachial plexus laceration injury in the pediatric population can be expected to produce successful functional recovery results, even in a relatively short period after the repair.

Fýtýk kesesi içerisinde apendiks vermiformis bulunmasý Amyand hernisi olarak adlandýrýlýr. Hastalýk ismini Ýlk kez 1735 yýlýnda tanýmlayan Claudius Amyand’dan almýþtýr. Yetiþkinlerde görülme sýklýðý %0.51-%1 olarak bildirilmiþ olmasýna raðmen çocuk hasta grubunda olgu azlýðý nedeniyle, bildirilmiþ bir oran bulunmamaktadýr. Bu yazýda ameliyat edilen iki Amyand hernili olgu sunuldu. Birinci olgu yenidoðan döneminde ultrasonografi ile strangüle Amyand hernisi tanýsý konularak ameliyat edildi. Ýkinci olgu, kasýk fýtýðý tanýsý ile elektif þartlarda ameliyat edilirken ameliyat sýrasýnda taný alan hastaydý. Birinci olguda apendiksin dolaþýmýnýn bozulmuþ olduðu görülerek fýtýk onarýmýna ek olarak apendektomi yapýldý. Ýkinci olguda salim bulunan apendiks alýnmadý. Amyand hernisinde apendikse yapýlacak iþlem ile ilgili standart bir yaklaþým yoktur. Apendikste dolaþým bozukluðu gibi komplikasyonlarýn görüldüðü olgular dýþýnda apendektomi yapýlmasý zorunlu deðildir.

The presence of appendix vermiformis in an inguinal hernia sac is called Amyand’s hernia. The disease is named after Claudius Amyand, who performed the first documented and successful appendectomy during a hernioplasty in 1975. Finding an appendix within an inguinal hernia is reported at a rate of 0.51%-1% in the adult population, whereas there is no reported frequency of Amyand’s hernia in children due to its rare occurrence. Here, we report two cases of Amyand’s hernia. The first is a newborn, diagnosed with strangulated Amyand’s hernia by preoperative ultrasound examination of the groin. In this case, the appendix had compromised blood supply, so we performed appendectomy during the hernioplasty. The second patient was diagnosed with Amyand’s hernia during elective hernioplasty. In this case, the appendix had no evidence of circulatory or inflammatory disorders, so we performed simple hernioplasty and left the appendix in the abdominal cavity. In Amyand’s hernia, there are no standards in approaching the appendix. Appendectomy is not a necessity unless there are circulatory or inflammatory injuries.