AMAÇ: Karýniçi yapýþýklýklar morbiditenin önemli bir sebebi olmaya ve tedavi maliyetinin artmasýna neden olmaktadýr. Bu çalýþmada, abdominal cerrahi sonrasýnda yapýþýklýklarý önlemede bir parenteral beslenme ürünü olan ClinOleic’in intraperitoneal kullanýmýnýn yapýþýklýk oluþumuna etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Rastgele seçilen 40 yetiþkin Sprague-Dawley cinsi sýçana anestezi altýnda laparatomi yapýldý ve karýn yan duvarý ve çekumda abrazyon oluþturuldu. Peritoneal boþluða grup 1’de (kontrol grubu) %0.9 NaCl çözeltisi, grup 2’de soya yaðý, grup 3’de zeytin yaðý, grup 4’de ClinOleic uygulandý. Daha sonra karýn primer kapatýldý. Deneyin 30. gününde sýçanlar öldürüldü. Gruplarda yapýþýklýk miktarý kör olarak makroskopik deðerlendirme Majuzi skalasýna göre, histopatolojik deðerlendirme ise semikantitatif skorlama sistemlerine (enflamasyon grade skalasý, fibrozis grade skalasý ve vasküler proliferasyon grade skalasý) göre ölçüldü.
BULGULAR: Makroskopik olarak yapýþýklýk derecesi grup 1 ile karþýlaþtýrýldýðýnda grup 4’de anlamlý olarak düþüktü (p<0.005). Grup 4’de cerrahi sonrasý yapýþýklýk görülmedi. Grup 2, 3 ile grup 4 arasýnda yapýþýklýk derecesi açýsýndan istatistiksel fark saptanmadý. Histopatolojik skorlar ise grup1 ile karþýlaþtýrýldýðýnda grup 4’de belirgin olarak düþüktü (p<0.005). Grup 2, 3 ile grup 4 arasýnda histopatolojik anlamlý fark saptanmadý.
TARTIÞMA: Parenteral beslenme ürünü olan ClinOleic’in intraperitoneal kullanýmý deneysel þartlarda karýniçi yapýþýklýklarý önlemede baþarýlý bulunmuþtur. Klinikte de rahatlýkla uygulanabilecek bu yöntemin daha fazla klinik çalýsmaya ihtiyacý vardýr.

BACKGROUND: Although the English-language literature is full of studies about post-surgical adhesions, no definitive method has yet been identified to prevent them. The goal of this study was to investigate the effect of ClinOleic on reducing post-surgical adhesion formation.
METHODS: Surgery was performed on 40 adult female Sprague-Dawley rats that were randomly assigned to receive either intraperitoneal ClinOleic, which was used to mimic chyle (ClinOleic group), soybean oil (soybean oil group), olive oil (olive oil group), or 0.9% NaCl suspension (control group). All rats underwent laparotomy, side-wall and cecal abrasion, and primary closure. On the 30th day following surgery, rats were sacrificed and examined using the Majuzi adhesion classification and histopathological grading scales.
RESULTS: The adhesion and histopathological scores of the ClinOleic group were significantly lower compared to the control group (0.9% NaCl) (p<0.05). A statistically significant decrease in fibrosis was observed in the soybean and olive oil groups when compared to the control group (p<0.05). However, the adhesion grades of the ClinOleic, soybean and olive oil groups were comparable. We did not observe any post-surgical adhesions in the ClinOleic group.
CONCLUSION: The parenteral nutrition solution ClinOleic may be an effective and readily available agent for the prevention of post-surgical adhesions.

AMAÇ: Peritonit, cerrahi giriþimler sonrasýnda sýk görülen iltihabi bir reaksiyondur. Tedavide antibiyotikler ve cerrahi yer alýr. Hayatý tehdit eden enfeksiyonlarýn baþýnda gelmesi nedeniyle alternatif tedavi yöntemleri araþtýrýlmaktadýr. Bu çalýþmada, sýçanlarda oluþturulan deneysel peritonit modelinde, doku plazminojen aktivatörlerinin (tPA) mikrobiyolojik ve immünolojik etkilerinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Yirmi dört erkek Wistar albino sýçan sekizerli üç gruba ayrýldý. Fekal örnekler steril edildikten sonra, Bacteroides fragilis (104 CFU/ml) ve Escherichia coli (105 CFU/ml) bakteri süspansiyonu eklenerek intraperitoneal olarak sýçanlara uygulandý. Bir saat sonra tüm sýçanlara laparotomi yapýldý, peritoneal kavite debride edildi ve parsiyel omentektomi uygulandý. Kontrol grubuna (K) tedavi uygulanmadý, antibiyotik grubuna (A), günde iki defa intravenöz metronidazol+seftriakson tedavisi uygulandý. Antibiyotik ile birlikte doku plazminojen aktivatörü (A+T) alan üçüncü gruba, cerrahiden sonraki 1., 6. ve 24. saatlerde antibiyotiðin yaný sýra periton içine tPA enjekte edildi. Mikrobiyolojik ve immünolojik analizler için 24. saatte kan ve periton sývýsý, 72. saatte sadece periton sývýsý örneði alýndý. Cerrahinin beþinci günü tüm sýçanlar öldürüldü ve peritoneal kavitedeki makroskopik bulgular (apse oluþumu, boyutu ve yerleþimi) kaydedildi.
BULGULAR: Ortalama periton içi apse sayýsý kontrol grubunda en yüksek, üçüncü grupta (A+T) en düþük sayýda bulundu. Gruplar arasýndaki sitokin seviyelerinde anlamlý farklýlýk bulunmadý.
TARTIÞMA: Bu deneysel peritonit modelinde, doku plazminojen aktivatörü uygulanmasýnýn enflamatuvar cevabý fazla etkilemeden apse oluþumunu bir miktar azalttýðý bulunmuþtur.

BACKGROUND: We aimed to evaluate the microbiological and immunological effects of tissue plasminogen activator (tPA) in a rat model of peritonitis.
METHODS: Twenty-four male Wistar albino rats were divided equally into three groups. Peritonitis and thereafter laparotomy and partial omentectomy were performed in all rats. The control group (C) had no further treatment. The antibiotics group (A) received metronidazole and ceftriaxone. The antibiotic and tPA group (A+T) received the same antibiotics as well as tPA. For microbiological and immunological analysis, blood samples were obtained at the 24th hour, and peritoneal fluid samples were obtained at the 24th and 72nd hours. On the fifth day after surgery, all rats were sacrificed, and the macroscopic findings of the peritoneal cavity were recorded.
RESULTS: The mean number of intraperitoneal abscesses was significantly higher in the control group and the lowest in the twotreatment group (A+T). The levels of cytokines were not significantly different between groups. Giving tPA reduced the number and sizes of the abscesses with no significant difference in inflammatory response.
CONCLUSION: In this experimental peritonitis model, it can be postulated that tPA decreased abscess formation without exaggerating
the inflammatory response.

AMAÇ: Bu çalýþmada, Alvarado skorunun (AS) akut apandisiti (AA) saptamadaki güvenilirliði ve farklý parametrelerden ne oranda etkilendiði araþtýrýldý.
GEREÇ VE YÖNTEM: Akut apandisit þüphesi olan 18-70 yaþ arasý 313 hasta çalýþmaya alýndý. Acil serviste AS’leri hesaplanan hastalarýn taburcu, izlem ve ameliyat bilgileri kayýt edildi. Hastalar AS ≤4, AS 5-7 ve AS 8-10 olmak üzere üç gruba ayrýldý. Farklý parametrelerde hastalarýn AA ve apendiks perforasyon oranlarýna bakýldý.
BULGULAR: Hastalarýn (%55 kadýn, %45 erkek) yaþ ortalamasý 30.8±10.8 idi. Ameliyat edilen 211 hastanýn sýrasýyla akut apendisit (apendiks perforasyon) oranlarý: AS ≤4; %56.5 (%7.7), AS 5-7; %75.9 (%10), AS 8-10; %89 (%27.8) olarak bulundu. Negatif apendektomi %19.4 saptandý. AS 5-7 arasý erkeklerde skorlama daha güvenilir olmakla birlikte tüm gruplarda beden kütle indeksi (BKÝ) arttýkça güvenilirlik azaldý.
TARTIÞMA: Alvarado skoru ≤4 olan hastalar izlenmeli, taburcu edilen hastalar akut apandisit olabilecekleri hakkýnda bilgilendirilmelidir. AS’nin apandisiti saptamadaki etkisi, yaþ ve semptomlarýn baþlama süresinden etkilenmemektedir.

BACKGROUND: We aimed to investigate the reliability of the Alvarado score (AS) in determining acute appendicitis and the different parameters that affect the AS.
METHODS: Three hundred and thirteen patients suspected of acute appendicitis (AA) aged 18-70 years were included in this study. Patient data including AS calculated from emergency services and at discharge, follow-up, and operations were recorded. Patients were divided into three groups according to the AS, as AS <4, AS 5-7 and AS 8-10. AA and appendicitis perforation rates were compared according to the different parameters.
RESULTS: The mean age of patients (55% females, 45% males) was 30.8±10.8 years. The AA (appendix perforation) rates of 211 patients who underwent operation were found as: AS ≤4: 56.5% (7.7%), AS 5-7: 75.9% (10%), and AS 8-10: 89% (27.8%). The percentage of negative appendectomy was 19.4%. The scoring was more reliable in males with AS 5-7, and the reliability weakened as body mass index (BMI) increased in all groups.
CONCLUSION: Patients with AS ≤4 must be followed up and should be informed at the time of their discharge about the slight possibility of appendicitis. The effect of AS in determining the diagnosis of appendicitis is not influenced by age or symptom duration.

AMAÇ: Akut apandisitin tanýsý zor olabilmektedir. Bu retrospektif çalýþmada, nötrofil/lenfosit oranýnýn (NLR) akut apandisit tanýsýndaki ve komplike apandisit ile basit apandisit ayrýmýndaki belirleyiciliði araþtýrýldý.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý ile ameliyat edilmiþ 1067 hastanýn kayýtlarý retrospektif olarak incelendi. Histopatolojik deðerlendirmeye göre hastalar akut apandisit (G1) ve normal appendiks (G2) olarak iki ana gruba ayrýldý. Akut apandisit grubundaki hastalar ise yeniden basit apandisit ve komplike (perfore ve gangrene) olarak alt iki gruba ayrýldý.
BULGULAR: G1 grubunda 897, G2 grubunda 170 hasta vardý. G1a’da 753, G1b’de ise 144 hasta vardý. Akut apandisit tanýsý konulmasýnda NLR için cut-off deðeri 4.68 (p<0.001) olarak hesaplandý. Sensitivite %65.3, spesifite ise %54.7 idi. Komplike apandisit ayýrýmý için NLR cut-off deðeri 5.74 olarak hesaplandý. Sensitivitesi %70.8, spesifitesi ise %48.5 idi.
TARTIÞMA: Akut apandisit tanýsýnýn konulmasýnda ve komplike apandisit ayrýmýnda NLR klinik deðerlendirmeye ek olarak faydalý bir parametredir.

BACKGROUND: Accurately diagnosing appendicitis can be difficult. This retrospective study aimed to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict acute appendicitis pre-operatively and to differentiate between simple and complicated appendicitis.
METHODS: A database of 1067 patients who underwent surgery was evaluated. Based on postoperative histopathological examination, the patients were divided into two groups: acute appendicitis (G1) and normal appendix (G2). Patients in the acute appendicitis group were further divided into two subgroups: simple appendicitis (G1a) and complicated (gangrenous and perforated) appendicitis (G1b).
RESULTS: G1 included 897 patients and G2 included 170 patients. Among the 897 G1 patients, there were 753 G1a patients and 144 G1b patients. A NLR of 4.68 was associated with acute appendicitis (G1 vs G2, p<0.001). The sensitivity and specificity were 65.3% and 54.7%, respectively. A NLR of 5.74 was associated with complicated appendicitis (G1a vs G1b, p<0.001). The sensitivity and specificity of the two clinical features were 70.8% and 48.5%, respectively.
CONCLUSION: We suggest that preoperative NLR is a useful parameter to aid in the diagnosis of acute appendicitis and differentiate between simple and complicated appendicitis, and can be used as an adjunct to the clinical examination.

AMAÇ: Son yýllarda akut malign kalýn baðýrsak týkanmalarýnda gerek palyasyon gerek cerrahi öncesi dekompresyon amaçlý kolorektal stentlerin kullanýmý artýþ göstermektedir. Bu çalýþmada, kansere baðlý akut kolorektal týkanmalarda endoskopik stent uygulamasýnýn teknik ve klinik açýdan etkinliði, güvenilirliði ve klinik sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Mart 2006-Aralýk 2012 tarihleri arasýnda acil cerrahi kliniðimizde akut malign kalýn baðýrsak týkanmasý tanýsýyla tedavi edilen 100 hastanýn 42’sine stentleme uygulandý. Tüm hastalara kaplý olmayan geniþleyen metal stentler endoskopik yöntemle fluoroskopi eþliðinde yerleþtirildi. Hasta veritabaný kullanýlarak yöntemin etkinliði ve komplikasyonlar geriye dönük olarak deðerlendirildi.
BULGULAR: Stentleme iþlemi teknik açýdan 39/42 (%92.8), klinik açýdan 38/42 (%90.4) hastada baþarýyla uygulandý. Bunlardan 16 hastaya elektif cerrahi rezeksiyon uygulandý, diðer 26 hastada metastatik tümör veya yandaþ hastalýklar nedeniyle iþlem palyatif olarak kabul edildi. On (%23.8) hastada komplikasyon geliþti, en sýk tenesmus (n=3) izlendi. Stent migrasyonu, kanama ve rekto-sigmoid kolon perforasyonu ikiþer hastada izlendi. Bir olguda gaita sýkýþmasýna baðlý stent týkanmasý meydana geldi.
TARTIÞMA: Malignite kaynaklý akut kolorektal týkanmalarda stentleme efektif ve göreceli olarak güvenli bir iþlem olup, hafif dereceli komplikasyolara neden olur. Obstrüktif kolorektal kanser hastalarýnda elektif rezeksiyona olanak saðlamakta, ayrýca cerrahi tedaviye uygun olmayan olgularda palyasyon amaçlý kullanýlabilmektedir.

BACKGROUND: In recent decades, the use of colorectal stents for palliation or as a bridge to surgery in acute malignant colorectal obstruction has increased. We aimed to evaluate the technical and clinical efficacy, safety and clinical outcomes of endoscopic stenting for the relief of acute colorectal obstruction secondary to cancer.
METHODS: From March 2006 to December 2012, among 100 patients with acute malignant colorectal obstruction, stenting procedures were performed on 42 patients for relief of obstruction. Uncovered self-expanding metal stents (SEMS) were placed endoscopically under fluoroscopic guidance in all patients. Using the patient database, a review was conducted to determine the effectiveness of the procedure and the short- and long-term complications.
RESULTS: Stent placement was technically successful in 39/42 (92.8%) and clinically successful in 38/42 (90.4%) patients. Sixteen patients later underwent an elective surgical resection, and in 26 patients with metastatic disease or comorbidity, stent placement was palliative. Complications occurred in 10 (23.8%) patients, and the most common was tenesmus (n=3). Migration, bleeding, and recto-sigmoid perforation occurred in two patients each. Stent obstruction due to fecal impaction was seen in one case.
CONCLUSION: Stent placement for colorectal obstruction is an effective and relatively safe procedure, with minor complications. It not only allows subsequent elective resection, but is also definitive for palliative treatment in patients with obstructive colorectal cancer.

AMAÇ: Bu çalýþmada, laparoskopik apandektomi operasyonunun karýniçi enfeksiyon oluþumundaki rolü deðerlendirildi.
GEREÇ VE YÖNTEM: Aðustos 2010-Eylül 2011 arasýnda laparoskopik apandektomi yapýlan 48 çocuk hasta çalýþmaya alýndý. Çalýþmamýz tek merkezli ve prospektif olarak yapýldý. Her hastadan ameliyat sýrasýnda apandektomi öncesi ve sonrasý, aerob ve anaerob olmak üzere dörder adet kültür örneði alýndý. Hastalarýn demografik bilgileri toplandý. Sonuçlar istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý 10.9±3.3 idi, 29’u erkek, 19’u kýzdý. Apendektomi öncesi alýnan 48 aerob kültürün 18’inde üreme oldu (%38), E.coli en sýk üreyen mikroorganizma idi. Apendektomi sonrasý aerob kültürlerin 7’sinde (%15.9) üreme oldu, bakteri sayýsý anlamlý olarak azalmýþtý (p<0.05). Anaerobik kültürlerde ise 48 hastanýn 12’sinde (25%) apandektomi öncesi, 4’ünde (8.3%) ise apendektomi sonrasý üreme oldu. B. fragilis ensýk izole edilen organizma idi. Azalma istatistiksel olarak anlamlý idi (p<0.05).
TARTIÞMA: Bizim sonuçlarýmýz laparoskopik apendektominin karýniçi enfeksiyon riskini, özelikle de aneorop enfeksiyonlarýn riskini artýrmadýðý yönünde idi.

BACKGROUND: The aim of this study was to investigate the potential contributory role of laparoscopic appendectomy in the occurrence of postoperative intra-abdominal infections.
METHODS: A prospective single-center study including 48 patients who underwent laparoscopic appendectomy was conducted between August 2010 and September 2011. Two peritoneal samples were obtained from each patient in the pre- and post-appendectomy period. Aerobic and anaerobic microbiological cultures were obtained from the samples. The data were analyzed with statistical methods.
RESULTS: The mean age of the 48 patients (29 male, 19 female) was 10.9 years. Among the pre-appendectomy aerobic cultures, microorganisms were isolated in 18 of the patients (38%), with Escherichia coli being the most common. In post-appendectomy aerobic cultures, various bacteria were isolated in 7 patients (14.6%), with the numbers of bacteria statistically significantly reduced (p<0.05). Anaerobic microorganisms were isolated in 12 patients (25%) and 4 patients (8.3%) in pre- and post-appendectomy cultures, respectively, with Bacteroides fragilis the most common organism; there was a significant reduction in the bacterial count (p<0.05). Each patient was regarded as their own control.
CONCLUSION: Our results suggest that laparoscopic appendectomy does not cause an increase in intra-abdominal infections, and particularly not infections associated with anaerobic bacteria.

AMAÇ: Vücut yüzey alanýnýn %50’sinden fazlasýnýn yandýðý majör yanýklý hastalarda geniþ yanýk alanlarýnýn tedavisinde deri grefti donör alanlarý yetersiz kalýr ve bu hastalar genellikle geniþçe meþlenmiþ otogreftleme ve allogreftlemeye ihtiyaç duyarlar. 3: 1’in üzerindeki meþleme oranlarý kuvvetle az greft tutmasý, kötü veya gecikmiþ epitelizasyon ve hipertrofik skar ile beraberlik gösterir.
GEREÇ VE YÖNTEM: Bu çalýþmada otogreftler ve allogreftler 4: 1 oranýnda meþlendi. Deri greftlerini daha efektif kullanmayý ve greft alýnmasýna baðlý morbiditeyi azaltmayý amaçladýk. Majör yanýklý 9 hasta bu yöntemle tedavi edildi. Greft kazanç oranlarý ve gerçek greft geniþleme oranýnýn beklenen geniþleme oranýna olan yüzdesi hesaplandý.
BULGULAR: Ortalama 16. günde ve toplam 10 oto-allogreftleme ameliyatý gerçekleþtirildi. Greft tutma oraný %95 idi. Beþ hasta yaþamaya devam ederken 4 hasta çalýþma esnasýnda hayatýný kaybetti. Yaþayan hastalarda ortalama toplam vücut yanýk alan yüzdesi %58.8 iken ölen hastalarda bu oran %77.5 idi. Greft kazanç oraný %74.8 oldu. Gerçek greft geniþleme oraný beklenenin %43.7’si olarak bulundu.
TARTIÞMA: Bu çalýþmada, otogreftler ve allogreftler 4: 1 oranýnda meþlendiðinde, donör alan morbiditesinin azaltýldýðý ve 8. günde baþarýlý epitelizasyonun saðlandýðý gösterilmiþtir.

BACKGROUND: Patients suffering major burns of more than 50% total burn surface area lack an adequate skin graft donor site to resurface extensive burn wounds and usually need widely meshed autografting and allografting. Anything over the 3: 1 expansion ratio is strongly associated with low graft take, poor or delayed epithelialization, and hypertrophic scarring.
METHODS: In this study, both autografts and allografts were expanded at a 4: 1 ratio. We aimed to use skin grafts effectively and to decrease the morbidity due to graft harvesting. Nine patients with major burns were treated with this method. Graft gain ratio and percentage of actual expansion to predicted expansion were calculated.
RESULTS: Ten auto-allografting procedures were performed on a mean of day 16. Graft take was over 95% successful. Five patients survived, and four patients died. The mean total burn surface area was 58.8% in patients who recovered, and 77.5% in the patients who died. The graft gain ratio was 74.8%. The actual expansion rate was 43.7% of the predicted expansion rate.
CONCLUSION: In this study, we demonstrated that the donor site morbidities were reduced and successful epithelialization was completed on the eighth day after using both autograft and allograft meshed with a 4: 1 ratio.

AMAÇ: Çalýþmamýzda yüksek kinetik enerjili silahla yaralanmýþ olgulara ait ISS deðerlerinin týbbi müdahaleleri süresince gereksinim duyulan transfüzyon stratejileri ile iliþkisini ve son mod mortalite analizlerini gerçekleþtirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Olgulara ait týbbi veriler çalýþmaya dahil edildi. Olgularýn demografik özellikleri, yüksek kinetik enerjili silah türü, yaralanma þiddet skorlarý (Injury Severity Score, ISS), transfüzyon strateji seçenekleri, transfüzyon gereksinimi olan ve olmayan olgularýn ISS deðerleri açýsýndan anlamlý bir korelasyon olup olmadýðý analiz edildi. Hospitalizasyon sürecinde mortalite ile sonuçlanan olgulara ait nedenler ait deðerlendirildi.
BULGULAR: Yüz sekiz ardýþýk olgu çalýþmaya dahil edildi. Yaþ ortalamasý 25 olan olgularýn biri dýþýnda tamamý erkek idi. Olgularýn %64.8’inin uzun namlulu ateþli silahlar, %35.2’sinin patlayýcýlar ile yaralandýðý tespit edildi. Ortalama ISS deðeri 13.9 saptandý. Transfüzyon uygulanan gruptaki olgularýn ISS deðeri: 16 (median 5-48), uygulanmayan gruptaki olgularýn ISS deðeri ise 9 (median 3-36) olarak saptandý. Hospitalizasyon sürecinde mortalite ile sonuçlanan üç olguya ait nedenler; SIRS, MODS ve sepsis açýsýndan irdelendi.
SONUÇ: Yüksek kinetik enerjili silah yaralýlarýnda ISS deðeri yükseldikçe olgularýn transfüzyon gereksinimleri arasýnda korelasyon bulunduðu, patlayýcýlarla yaralananlarda ise bu gereksinimin ISS deðerinden baðýmsýz olduðu tespit edildi.

BACKGROUND: We aimed in this study to investigate the relationship between Injury Severity Score (ISS) and transfusion strategies required during medical intervention in patients wounded by high kinetic energy (HKE) gunshot, and to analyze end-mode mortality.
METHODS: The medical data of patients were included in the study. We evaluated whether there was any significant correlation in terms of demographic characteristics, HKE weapon type, ISSs, and transfusion strategy options and transfusion requirements.
RESULTS: Causes of mortality in cases resulting in mortality during hospitalization were evaluated. One hundred and eight consecutive patients were included in the study. All patients except one were male, with an average age of 25 years. 64.8% of them were injured by long-barreled firearms, whereas 35.2% were injured by explosives. Average ISS was 13.9. ISS values for the patients with and without transfusion were 16 (5-48) and 9 (3-36), respectively. Causes of mortality were evaluated in terms of systemic inflammatory response syndrome (SIRS), sepsis, and multiorgan dysfunction syndrome (MODS).
DISCUSSION: It was determined that there was a significant correlation between increase in ISS values in cases with HKE weapon wounds and their transfusion requirements, whereas this requirement was independent of the ISS value in cases with explosive wounds.

AMAÇ: Karaciðer travmasý nedeniyle son 7 yýlda kliniðimize baþvuran çocuklarda travma tiplerini, eþlik eden solid organ yaralanmalarýný, tedavilerini ve tedavi sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2005-Ocak 2012 arasýnda künt karýn travmalarýna baðlý karaciðer yaralanmasý nedeniyle tedavi edilen 52 hasta retrospektif olarak deðerlendirildi.
BULGULAR: Hastalarýn yaþlarý 1-17 (ortalama 8.3±5.4) yaþ arasýnda olup 32’si (%61.6) erkek, 20’si (%38.4) kýzdý. Hastalar en sýk araç dýþý trafik kazasý (19, %37), yüksekten düþme (15, %29), araç içi trafik kazasý (8, %15), bisiklet kazalarý (8, %15) ve üzerine cisim düþme (2, %4) nedeniyle baþvurdu. Hastalarýn 32’sinde (%61.5) izole karaciðer, 20’sinde (%38.5) eþlik eden diðer organ yaralanmalarý vardý. Hastalarýn 6’sýnda kafa (%11.5), 4’ünde (%7.6) toraks, 4’ünde (% 7.6) ekstremite, 3’ünde (%5.7) çoklu yaralanma vardý. Karýniçi organlardan 8’inde böbrek (%15), 8’inde (%15) dalak, 2’sinde (%4) GÝS, 2’sinde (%4) pankreas yaralanmasý vardý. Altý hasta (%11.5) Evre I, 14 hasta (%27) Evre II, 22 hasta (%42.5) Evre III, 9 hasta (%17) Evre IV, 1 hasta (%2) Evre V idi. Evre I ve II olan tüm hastalar konservatif tedavi yapýlýrken, cerrahi tedavi yapýlan 1 hasta (%4.5) evre III, 5 hasta (%50) evre IV, 1 hasta (%100) ise Evre V idi. Bu çalýþmada 52 hastanýn 45’i (% 86.5) konservatif takip edilirken, vital bulgularý stabil olmayan 6 hasta ameliyat edildi. Bir hasta ameliyat sýrasýnda hayatýný kaybetti (%1.9).
TARTIÞMA: Sonuç olarak, karaciðer travmalarýnda hemodinamik olarak stabil seyreden hastalarda konservatif tedavi tercih edilmelidir. Çocuklarda karaciðer travmalarýnýn çoðu konservatif tedavi edilebilmektedir. Konservatif tedavi daha kýsa hastanede kalýþ süresi, daha az transfüzyon ihtiyacý, morbiditenin ve mortalitenin daha düþük olmasý gibi avantajlara sahiptir.

BACKGROUND: We aimed to assess the causes of trauma that result in liver injury and additional solid organ injuries, management types and results of management in children referred to our clinic for liver injuries.
METHODS: The records of 52 patients who were managed for liver injuries due to blunt abdominal trauma between January 2005-2010 were reviewed retrospectively.
RESULTS: The patients were 1-17 (8.3±5.4) years old; 32 (62%) were male and 20 (38%) were female. Causes of injuries included pedestrian traffic accidents (19, 37%), falls from height (15, 29%), passenger traffic accidents (8, 15%), bicycle accidents (8, 15%), and objects falling on the body (2, 4%). Isolated liver injury was present in 32 patients (62%), while 20 patients (38%) had other organ injuries. Liver injuries were grade I in 6 patients (12%), grade II in 14 (28%), grade III in 22 (43%), grade IV in 9 (17%), and grade V in 1 (2%). Forty-five patients (87%) were managed conservatively in this series of liver injury, whereas seven patients (13%) who had unstable vital signs underwent surgery. The mortality rate, duration of stay in intensive care and hospital, and number of blood transfusions were higher in surgically managed patients, while hemoglobin level and blood pressure were significantly lower in surgically managed patients.
CONCLUSION: As a result, conservative management should be preferred in patients with liver injuries who are hemodynamically stable. Conservative management has some advantages, including shorter duration of stay in hospital, less need for blood transfusion and lower morbidity and mortality rates.

AMAÇ: Bu yazýda, intraorbital tahta cisim yaralanmalarýnýn klinik özellikleri, taný ve tedavi rejimlerini tanýmlamak amaçlandý.
GEREÇ VE YÖNTEM: 2002 ile 2012 yýllarý arasýnda Trakya Üniversitesi Týp Fakültesine baþvuran orbital yaralanmalar geriye dönük olarak incelendi. Tespit edilen 32 intraorbital tahta cisim yaralanmasý deðerlendirildi.
BULGULAR: Otuz iki yaralanmanýn, 16’sý aðaç kabuðu, 10 tanesi kalem, 5 tanesi çubuk, 1 tanesi ise çalýdan kaynaklanmaktaydý. Ameliyat öncesi görme keskinliði ameliyat sonrasý genelikle arttý (%69). Yaralanma zamaný ile baþvuru zamanlamasý arasýndaki süre, yabancý cisimin boyut ile kolere bulundu. Yaralanma lokalizasyonu, yaralanmanýn etiyolojisi ile iliþkili olup, %28’i superior, %25’i medial, %22’si lateral, %16’sý inferior, %9’u ise posterior orbita yerleþimliydi. Bilgisayarlý tomografi olgularýn %72’sinde tanýda tek baþýna yeterli iken, kalan %28’inde muhtemel yabancý cisim kanýsý verdi.
TARTIÞMA: Ýntraorbital tahta cisim yaralanmalarýnýn tanýsý, klinik ve radyolojik olarak fark edilmesi güç olduðundan zordur. Alýnan anamnezde eðer bir þüphe varsa, optimal hasta yönetimi gerçekleþtirilmelidir. Cerrahi öncesi, görüntüleme yöntemlerinden maksimum faydalanmalýdýr. Dikkatli bir ameliyat öncesi deðerlendirme ve görüntüleme, yüksek klinik þüphe, titiz cerrahi ve ameliyat sonrasý bakým intraorbital tahta cisim yaralanmalarýnýn anahtar noktalarýdýr.

BACKGROUND: We aimed to describe herein the clinical features, diagnosis and treatment of intraorbital wooden foreign body injuries.
METHODS: A case series review of orbital injuries managed at Trakya University Faculty of Medicine between 2002 and 2012 was performed retrospectively. The clinical analysis of 32 intraorbital wooden foreign body injuries was reviewed.
RESULTS: Among the 32 cases, injuries in 16 were caused by a tree branch, in 10 by a pencil, in 5 by a stick, and in 1 by a bush. With respect to preoperative vision, postoperative vision was improved in 69% of patients. Time lapse from injury to presentation was correlated with the size of the foreign body. The subjects were comparable in etiological factor, and distribution of injury according to orbit was as follows: superior 28%, medial 25%, lateral 22%, inferior 16%, and posterior 9%. Computerized tomography (CT) for foreign body was definitive in 72% (n=23) and suggestive in 28% (n=9).
CONCLUSION: The diagnosis of orbital wooden foreign body is difficult because it may be missed clinically and from the imaging perspective. If a foreign body is suspected, optimal patient management should be done. Prior to the surgery, imaging modalities should be maximally utilized. A careful preoperative evaluation, imaging studies, which are event-specific, a high index of suspicion, and rigorous surgery and postoperative care are the keys in the management of orbital wooden foreign body injuries.

Akut üst ekstremite iskemisi alt ekstremitenin vasküler hastalýklarýna göre daha nadir olup tüm olgularýn %15-32’sini oluþturur. Embolektomi olgularýn büyük kýsmýnda hýzlý ve etkili tedavi saðlar. Tekrarlayan ve embolektomi ile reperfüzyon saðlanamayan olgularda prognoz kötü olup amputasyonla sonuçlanan olgular bildirilmiþtir. Bu hasta grubunda embolektomi ile birlikte ya da sonrasýnda destekleyici tedaviler önem kazanmaktadýr. Bu yazýda küçük hücreli akciðer kanseri hastasýnda embolektomi sonrasý altý kez tekrarlayan brakiyal arter embolisine baðlý kritik üst ekstremite iskemisinde kurtarýcý teknik olarak yavaþ perkütan intraarterial doku plazminojen aktivatörü uygulamamýzý sunuyoruz.

Acute ischemia of an upper extremity occurs less frequently than vascular events of the leg and accounts for 15%-32% of all cases. Embolectomy provides prompt and effective treatment in the majority of cases. Recurrence of embolism and failed reperfusion can result in poor outcomes, even extremity loss. Adjunctive managements become important in this patient group. In this report, we present percutaneous intraarterial drip tissue plasminogen activator infusion to rescue the extremity in a patient with small cell lung cancer who experienced thromboembolism an additional six times following embolectomy.

Yirmi beþ yaþýnda bir erkek saldýrgan bir deve tarafýndan boynundan ýsýrýlmýþ ve boynunda üç küçük delici yara oluþmuþtur. Sol karotis nabzý zayýf hissediliyordu. Anjiyografi sol ana karotis arterin distal segmentinde düzensiz kesiler olduðunu gösterdi. Boynun eksplorasyonu bu bulgularý doðruladý. Otojen safen ven greft interpozisyonu baþarýyla uygulandý. Hasta evine iyi durumda gönderildi. Bu konuya iliþkin literatürü sistematik biçimde gözden geçirdik ve yalnýzca dört adet benzer olgu raporuna rastladýk. Deve ýsýrýðý yaralarý küçük boyutlarda olmalarýna raðmen derine penetre olabilerek ana damarlar dahil boyun oluþumlarýnda ciddi yaralanmalara neden olabilirler. Azgýnlýk dönemlerinde erkek develere yaklaþýrken dikkatli olunmalýdýr.

A 25-year-old man was bitten in the neck by an aggressive camel, causing three small puncture wounds. The left carotid pulse of the patient was weakly palpated. Angiography showed irregular dissection of the distal part of the left common carotid artery. Neck exploration confirmed the findings. An interposition autogenous saphenous vein graft was performed successfully. The patient was discharged home in good condition. We have systematically reviewed the literature on this topic, and only four other similar cases were reported previously. Although camel bite wounds are small, they may penetrate deeply, causing serious injuries to the neck structures including the major vessels. Care should be taken when approaching male camels during the rutting season.

Morel-Lavallee sendromu (MLS) deri altý dokunun alttaki fasyadan yýrtýlarak eldiven parmaðý gibi (kapalý tip) soyulduðu, ardýnda hematom ve sývýlaþmýþ yaðla dolu bir kavitenin kaldýðý önemli bir posttravmatik yumuþak doku yaralanmasýdýr. Genellikle büyük trokanter üzerinde meydana gelmesine raðmen, böðürde, kaba etlerde ve lumbodorsal bölgede de oluþabilmektedir. MLS, nadiren rapor edilen bir olgudur. Erken taný konservatif tedaviye yol açabildiði ve gecikince cerrahi eksplorasyon gerektiði için travma cerrahlarý ve radyologlar bu olgunun farkýnda olmalýdýr. Bu yazýda, genç bir eriþkinde sol hipokondriyum ve uyluðu ilgilendiren yaygýn bir Morel-Lavelle lezyonunu sunuldu, MRG bulgularý tartýþýldý ve yine MLS’nin ayýrýcý tanýlarý ve tedavi seçeneklerini tanýmlandý.

Morel-Lavallee syndrome (MLS) is a significant post-traumatic soft tissue injury in which the subcutaneous tissue is torn away from the underlying fascia (closed degloving), creating a cavity filled with hematoma and liquefied fat. It commonly occurs over the greater trochanter, but may also occur in the flank, buttocks and lumbodorsal regions. MLS is a rarely reported entity. The trauma surgeon and radiologist must be aware of this condition, as early diagnosis can lead to conservative management, while a delay can lead to surgical exploration. We report a case of extensive Morel-Lavallee lesion involving the left flank and thigh in a young adult. We discuss the magnetic resonance imaging findings and also describe the differential diagnoses and management options for MLS.

Total kafa derisi avulsiyonu seyrek görülen, sýklýkla saçlý deride defektlere yol açan, hatta yaþamý tehdit edici olabilen ciddi bir yaralanmadýr. Kafa derisi avulsiyonunda mikrocerrahiyle saçlý derinin replantasyonu ilk tedavi seçeneðidir. Bu yazýda, total kafa derisi avulsiyonu olan iki olguda mikrocerrahi replantasyon tekniðini anlattýk. Avulsiyona uðramýþ kafa derisi saçlý kafa derisi, alýn, göz kapaðý, kulak ve yüzün bir bölümünü içermekteydi. Acil serviste ilk tedavi hýzlý bir fiziksel inceleme sonrasý erkenden hemorajik þoku düzeltmek için kan transfüzyonu, intravenöz rehidrasyon ile yaranýn tamponla bastýrýlmasýndan ibarettir. Replantasyondan önce ameliyat öncesi dönemde, eþlik eden yaþamý tehdit edici yaralanmalarý ekarte etmek için tam bir travma araþtýrmasý yapýlmalýdýr. Ýki olguda tam olarak avülsiyona uðramýþ dokular ve organlar morfoloji ve fonksiyonlarýna kavuþmuþtur. Baþarýlý replantasyonlar diðer prosedürlere göre en iyi estetik ve fonksiyonel sonuçlarý saðlayabilmektedir. Avulsiyone kafa derisinin baþarýlý onarýmýnda mikrocerrahi tekniðe ilaveten acil serviste ameliyat öncesi deðerlendirme ve hazýrlýðýn önemli olduðu düþünülür.

Total scalp avulsion is a rare but serious injury often resulting in defects of the hair-bearing skin, and it may even be life-threatening. Microsurgical hair-bearing scalp replantation is the first choice for the treatment of scalp avulsion. In this article, we describe the microsurgical replantation of two cases with total scalp avulsion. The avulsed scalp involved the hairy scalp, forehead, eyelids, ears, and part of the face. Initial management in the emergency department (ED) included correction of hemorrhagic shock with early blood transfusion, intravenous rehydration, and wound compression after rapid physical examination. A full trauma and preoperative workup prior to attempts at replantation needs to be performed to exclude any associated life-threatening injuries. Good form and function of the completely avulsed tissues and organs were achieved in both cases. Successful replantations can achieve the best esthetic and functional results when compared with other procedures. In addition to the microsurgical technique, preoperative evaluation and preparation in the ED are considered to be an important part of the successful salvage of the avulsed scalp.

Yüksek transvers sakrum kýrýklarý genç hastalarda yüksek enerjili travma sonrasý meydana gelmektedir. Sakrumun radyografik deðerlendirmesinde ve sakral düzeydeki nörolojik defisitlerin politravmalý hastalarda deðerlendirmesindeki zorluklar nedeniyle bu yaralanmalar gözden kaçabilmektedir. Bu yazýda, üç olgudan oluþan, kauda ekina sendromu tanýsý çeþitli nedenlerle geç konulan (en az 48 saat), yüksek enerjili ve kanala basý yapan transvers sakrum kýrýklarýnda cerrahi tedavi sonuçlarý deðerlendirildi. Hastalara sakral laminektomi ve dekompresyon uygulanarak iki taraflý lumbopelvik fiksasyon uygulandý. Her ne kadar kauda ekina sendromu tanýsý geç konulsa da, cerrahi dekompresyon ve lumbopelvik fiksasyonun nörolojik fonksiyonlar ve aðrýda düzelme, erken desteksiz mobilizasyon üzerindeki olumlu etkilerini gözlemledik.

Transverse sacral fractures in young patients occur with high-energy mechanisms. Because of the drawbacks in radiographic and neurologic evaluations of the sacral area in polytrauma patients, misdiagnosis is quite common. In this study, we aimed to report our clinical results in three patients with displaced transverse sacral fractures compromising the sacral canal and concomitant late-diagnosed (at least 48 hours) cauda equina syndrome. Bilateral lumbopelvic fixation, followed by sacral laminectomy and decompression, was performed in all patients. Despite the late- diagnosed cauda equina syndrome, we observed that surgical decompression and lumbopelvic fixation had positive effects on neurologic recovery, pain relief and early unsupported mobilization.

Ýzole tubal torsiyonlu (ÝTT) pediatrik ve adölesan popülasyondaki hikaye, klinik yansýma, fiziksel inceleme, laboratuvar bulgularýnýn deðerlendirilmesi ve belirlenmesi ile bu olgularýn cerrahi yönetiminin gözden geçirilmesi için çalýþma gerçekleþtirildi. Hastanemizde Ocak 2000 ile Aralýk 2012 tarihleri arasýnda ÝTT tanýsý ile tedavi edilen tüm olgular geriye dönük olarak incelendi. ÝTT tanýsý fiziksel inceleme, ultrasonografi (USG), renkli Doppler USG ve bilgisayarlý tomografiyi (BT) de içeren radyolojik çalýþmalara dayanýlarak konuldu ve cerrahi giriþim ile doðrulandý. Çalýþma döneminde ÝTT’li üç olgu bulunmaktadýr. Olgularýn ikisi adölesan biri ise yenidoðan dönemindeydi. Ýki olguda sol taraflý ÝTT vardý. Yenidoðan olguda prenatal abdominopelvik kitle tanýsý vardý. ÝTT’li diðer iki olgu semptomlarýn baþlamasýndan üç gün sonra baþvurdu. Bu çalýþmadaki tüm olgular salpenjektomi ile tedavi edildi. Ýzole tubal torsiyon ameliyat öncesi olarak nadiren tanýnýr ve en sýklýkla salpenjektomi ile tedavi edilir. Bu nadir durumun daha iyi tanýnmasý tedavide ilerlemelere yardýmcý olabilir. Adneksiyal torsiyonlardaki over koruyucu yaklaþým gibi, daha erken taný ve mümkünse tubanýn korunmasýný da içeren çabuk cerrah giriþim ile bu olgularýn ileriki dönem üreme potansiyelleri artýrabilir.

This study was carried out to evaluate and determine the history, clinical presentation, and physical examination and laboratory findings in a pediatric (n=1) and adolescent (n=2) population with isolated tubal torsion (ITT) and to examine its surgical management. A retrospective review of all the cases of ITT treated in our hospital between January 2000 and December 2012 was performed. The diagnosis of ITT was performed by physical examination and radiological studies including ultrasonography (US), color Doppler US, and computed tomography (CT) and confirmed by surgical intervention. There were 3 children with ITT in the study period. Two of the patients were adolescents and one was diagnosed in the neonatal period. Two patients had left-sided ITT. The neonatal patient was diagnosed with abdominopelvic mass antenatally. ITT in the other two children occurred three days after the onset of symptoms. All the patients in this study were treated with salpingectomy. ITT is rarely diagnosed preoperatively, and is treated mostly by salpingectomy. A better recognition of this entity may help to improve the treatment of this rare condition. As advocated for ovarian salvage in adnexal torsions, earlier diagnosis and preservation of the tube, if possible, with prompt surgical intervention may increase the future reproductive potential of these patients.