AMAÇ: Deneysel kafa travmasý oluþturulan sýçanlarda geliþen beyin hasarý ve ödemine karþý eritropoetin, dekstran ve salin kombinasyonunun koruyucu etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Çalýþmada aðýrlýklarý 250–340 g arasýnda deðiþen 40 adet Wistar Albino cinsi erkek sýçan kullanýldý. Her biri 10 adet sýçan içeren dört deney grubu oluþturuldu. Bütün sýçanlara kafa travmasý oluþturuldu ve ilaçlar intraperitoneal (ip) yolla travmadan 10 dk sonra verildi. Kontrol grubuna (K) diðer gruplarla eþit hacimde serum fizyolojik enjekte edildi. Birinci gruba eritropoetin (EPO) 5000 Ü/kg verildi. Ýkinci gruba dekstran ve salin (DS) 8 ml/kg verildi. Son gruba da ayný doz ve miktarlarda eritropoetin, dekstran ve salin (EPO+DS) beraberce verildi. Yirmi dört saat sonra sýçanlar sakrifiye edilerek beyin dokularý çýkarýldý. Sað hemisferde yaþ ve kuru aðýrlýk çalýþýldý. Sol hemisferde glutatyon peroksidaz (GPx) aktivitesi ve malondialdehit (MDA) miktarý ölçüldü.
BULGULAR: Kontrol grubuna göre diðer gruplarda beyin ödeminin ve lipit peroksidasyonu son ürünü olan MDA’nýn deðiþik oranlarda azaldýðý, antioksidan enzim olan GPx aktivitesinin arttýðý tespit edildi.
TARTIÞMA: Bu çalýþmada, kafa travmasý oluþturulan sýçanlarda geliþen beyin ödemi ve oksidatif stresin oluþturduðu sekonder beyin hasarýnýn eritropoetin, dekstran ve salin kombinasyonu kullanýlarak azaltýlabileceði sonucuna varýldý.

BACKGROUND: The aim of this study was to investigate the protective effects of erythropoietin, dextran/saline and erythropoietin in combination with dextran/saline on brain edema and lipid peroxidation following traumatic brain injury in rats.
METHODS: In the study, 40 male 3-month-old albino Wistar rats, weighing 250–340 g, were divided into four groups, each consisting of ten rats. Traumatic brain injury was induced in all rats by the weight–drop method, and erythropoietin (5,000 U/kg) and/or dextran and saline (8 ml/kg) solutions were injected intraperitoneally ten minutes after trauma. Control animals received an equal volume of serum physiologic. All rats were sacrificed 24 hours later. Glutathione peroxidase activity and malondialdehyde levels were measured in the left hemisphere, and edema was quantitated by the wet–dry method.
RESULTS: Brain edema and the levels of malondialdehyde, the last product of lipid peroxidation in tissues, were decreased variably, and the activity of glutathione peroxidase, an antioxidant enzyme, was increased in others compared with the control group.
CONCLUSION: In this study, it was concluded that the brain edema that developed in rats on which head trauma was induced and the secondary brain damage caused by oxidative stress could be deceased using a combination of erythropoietin, dextran, and saline.

AMAÇ: Ciddi yanýk travmalarý kalýcý hipermetabolik yanýtla iliþkili olup kas kütlesinin uzun süreli kaybýna nitrojen ile kas kaybý arasýnda klinik negatif dengenin bozulmasýna yol açmaktradýr. MikroRNA’lar (miRNA’lar) hedef mRNA’larýn degradasyonunu teþvik ederek veya çevrimlerini engelleyerek gen ekspresyonunu negatif yönde post-transkripisyonel regülasyonunda kritik bir rol oynamaktadýr. Ciddi yanýk travmasýndan sonra miRNA’larýn katýldýðý iskelet kasý kaybýnýn mekanizmalarý hâlâ anlaþýlmýþ deðildir.
GEREÇ VE YÖNTEM: Bu çalýþmada mikrodizilim yöntemi kullanýlarak erken evrede sýcaða maruz býrakýlmýþ sýçanlarýn iskelet kaslarýndaki miRNA’larýn ekspresyonlarýndaki deðiþiklikler saptandý. Tüm veriler ortalama±standart sapma olarak sunuldu. Ýstatistiksel analizlerde baðýmsýz Student t-testi ve tek-yönlü ANOVA testi kullanýldý. Anlamlýlýk düzeyi olarak p<0.05 ve mikrodizilim yönteminde deðiþiklik katlarýnýn kestirim deðeri olarak 2.0 belirlendi. Eksprese edilen ve önemli farklýlýklar gösteren miRNA’lar Volcano Grafik filreleme yöntemiyle belirlendi. MEV yazýlým sistemi (v4.6, TIGR) kullanýlarak hiyerarþik küme analizi gerçekleþtirildi.
BULGULAR: Normal ve yaralanmýþ dokularda binlerce miRNA incelenebilmesine karþýn bunlarýn yalnýzca 69’unda önemli derecede up-regülasyon veya down-regülasyona uðramýþtý. Bu yöntem ýsýya maruz býrakýlmýþ sýçanlarýn eþleþtirilmiþ iskelet kasý dokularýnýn ayrýmýnda kullanýlabilir.
TARTIÞMA: Yanýk travmasýndan sonra iskelet kasý kaybýnýn patogenezinde miRNA’larýn disregülasyonu potansiyel bir rol oynamaktadýr.

BACKGROUND: Severe burn injuries are associated with a persistent hypermetabolic response, which causes long-term loss of muscle mass that results in a clinical negative balance of nitrogen and muscle wasting. MicroRNAs (miRNAs) play a critical role in post-transcriptional regulation of gene expression, which negatively regulates gene expression by promoting degradation of target mRNAs or inhibiting their translation. However, the mechanisms of skeletal muscle wasting after severe burn involved in miRNAs still remain unclear.
METHODS: In this study, the alterations of miRNAs expression profile in skeletal muscles of thermal rats were detected at an early stage by microarray. All data were presented as mean±SD. Statistical analysis was determined by independent Student’s t-test and one-way ANOVA. The significance was all set at p<0.05, and fold change cut-off was 2.0 for microarray. Significant differentially expressed miRNAs were identified through Volcano Plot filtering. Hierarchical clustering was performed using MEV software (v4.6, TIGR).
RESULTS: Thousands of miRNAs could be examined in normal and injured tissues, but only 69 of these were significantly upregulated or down-regulated, which could be used to discriminate skeletal muscles of thermal rats from matched tissues.
CONCLUSION: The deregulated miRNAs probably play a potential role in the pathogenesis of skeletal muscle wasting in burn trauma.

AMAÇ: Bu çalýþmada, acil servise ateþli silah yaralanmasý nedeniyle baþvuran hastalarýn yaralanma özellikleri, görüntüleme yöntemlerinin sonuçlarý, tedavi türleri, sonlaným, ölüm ve komplikasyon oranlarý araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük tanýmlayýcý çalýþmaya 1 Ocak 1999 ile 31 Aralýk 2013 tarihleri arasýnda Hacettepe Üniversitesi Eriþkin Acil Servisi’ne ateþli silah yaranmasý nedeniyle getirilen 142 hasta alýndý. Tüm hastalar için Glaskow Koma Skalasý (GKS), Revize Travma Skoru (RTS), Yaralanma Ciddiyet Skoru (ISS) ve penetran yaralanmalarda Travma ve Yaralanma Ciddiyet Skoru ve Saðkalým Olasýlýðý (TRISS) oranlarý hesaplandý.
BULGULAR: Çalýþmaya alýnan 142 hastanýn 128’i (%90.1) erkekti. Ortalama yaþ 36 olarak hesaplandý. Baþvuru anýnda ortalama GKS skoru 13, ortalama RTS 6.64, ortanca ISS 5 ve ortanca TRISS penetran travma için sað kalým olasýlýðý %99.4 hesaplandý. FAST ile hastalarýn üçünde (%13) karýn içi serbest sývý saptanýrken abdomen bilgisayarlý tomografi (BT) ile hastalarýn 11’inde (%58) solid organ ve baðýrsak yaralanmasý saptandý. Direkt akciðer grafisi ile bir hastada hemotoraks saptanýrken, toraks BT ile 10 (%40) hastada pnömotoraks, hemotoraks ve akciðer yaralanmasý tespit edildi. Çalýþmada 24 hasta hayatýný kaybetti; 18 (%75) hastada izole intrakraniyal yaralanma, iki (%8.3) hastada baþ boyun yaralanmanýn eþlik ettiði toraks yaralanmasý, dört (%16.7) hastada karýn içi organ yaralanmasý (bir hastada kraniyal yaralanma eþlik ediyordu) bulunuyordu. Acil servise 10 hasta kardiyopulmoner arrest olarak getirildi. Hayatýný kaybeden hastalarda GKS, RTS ve TRISS yaþayan hastalara göre anlamlý derecede düþük, ISS ise anlamlý derecede yüksek saptandý. Hayatýný kaybeden hastalarýn 23’ü (%95.8) ISS’ye göre kritik yaralanma düzeyine (ISS 25–75, aralýðýnda ve ISS >50) sahipti.
TARTIÞMA: Ateþli silahlara baðlý kraniyal yaralanmalarda mortalite düzeyleri çok yüksektir. Acil servise arrest olarak getirilen hastalarda spontan geri dönüþ görülmemektedir. Kurþuna baðlý iç organ hasarý tahmin edilenden daha fazla olmaktadýr. Toraks ve abdomendeki ateþli silah yaralanmalarýnda direkt grafiler ve FAST tanýda yetersiz olabilmektedir. Bu nedenle bu hastalarda ölümcül olan yaralanmalarýn erken dönemde tespit edilmesi için toraks ve abdomen BT istemi erken dönemde planlanmalýdýr. Yaralanma Ciddiyet Skoru, RTS ve GKS prognoz ve mortaliteyi öngörmede yaralýdýr. Özellikle ISS >50 olgularda mortalite oraný %96’ya kadar yükselmektedir.

BACKGROUND: This study aimed to evaluate injury patterns of patients admitted to the emergency department with gunshot wounds, results of imaging studies, treatment modalities, outcomes, mortality ratios, and complications.
METHODS: A retrospective descriptive study was carried out including a total number of one hundred and forty-two patients admitted to Hacettepe University Emergency Department with gunshot injuries between January 1, 1999 and December 31, 2013. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and theTrauma and Injury Severity Score (TRISS) probability of survival for penetrating trauma were calculated for all patients.
RESULTS: Among the one hundred and forty-two patients in the study, one hundred and twenty-eight (90.1%) were male. Mean age was 36 years. On admission, the average GCS score was 13, mean RTS was 6.64, median ISS was 5 and median TRISS probability for survival was 99.4% for penetrating trauma. Fluid was detected in three (13%) patients in FAST, whereas intra-abdominal solid organ injury and bowel injury were detected in 11 (58%) patients in abdominal CT. The pneumothorax, hemothorax and lung injuries were detected in 10 (40%) patients, whereas hemothorax was detected only in one patient with thoracic injury by chest X-ray. Twenty four (16.9%) patients died; eighteen patients (75%) had isolated severe intracranial injuries, two (8.3%) had thoracic injuries with head and neck injuries, and four (16.7%) patients had intra-abdominal organ injuries (one with concomitant head injury). Ten patients were brought to the ED in cardiopulmonary arrest. In dead patients, GCS, RTS and TRISS were significantly lower, and ISS were significantly higher than in surviving patients. Twenty three (95.8%) patients were in critical injury level (ISS 25–75, actually ISS >50) in the exitus group.
CONCLUSION: Mortality rates in gunshot wound patients with cranial injuries are very high. Spontaneous return is not seen in patients brought to the ED in arrest state. Bullets can cause internal organ injuries which can be greater than expected. In thoracoabdominal gunshot wound injuries, conventional X-ray and bedside FAST can be ineffective in detecting the whole extent of intrathoracic and intra-abdominal injuries. Thus, thoracic and abdominal CT should be planned early for hemodynamically stable patients in order to eliminate causes of fatality and make a timely and correct diagnosis. ISS, RTS and GCS are useful in predicting prognosis and mortality. Especially in patients with ISS scores >50, the mortality rate can be as high as 96%.

AMAÇ: Acil servise trafik kazasýna baðlý künt karýn travmasý ile baþvuran hastalarda klinik deðerlendirme, laboratuvar parametreleri ve radyolojik sonuçlarýn tedavi kararýna ve cerrahi sonuçlarýna etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya künt karýn travmasý geçirmiþ 222 hasta alýndý. Pearson ki kare, Mann-Whitney U ve lojistik regresyon testleri istatistiksel analiz için kullanýldý.
BULGULAR: Tüm hastalar tam kan, biyokimya analizi, karýn ultrasonografisi ile deðerlendirildi. Seksen iki hasta ayrýca karýn bilgisayarlý tomografisi ile incelendi. Yirmi üç hasta ameliyat edildi. Fiziksel inceleme, ultrasonografi ve bilgisayarlý tomografide pozitif bulgular, beyaz küre sayýsýnda ve karaciðer fonksiyon testlerinde artýþ, hemoglobinde düþüþ cerrahi giriþim ihtiyacýnda artýþ ile iliþkiliydi (p<0.05). Cerrahi giriþime ihtiyaç riskini pozitif fiziksel inceleme bulgularý 3.5 kat, karaciðer fonksiyon testlerinde artýþ 3.8 kat ve pozitif ultrasonografik bulgular 3.5 kat artýrmaktaydý.
SONUÇ: Künt karýn travmalý hastalarýn cerrahi giriþim açýsýndan deðerlendirilmesinde rahatsýz edici aðrýya yol açan ek yaralanmalarý olan ya da þuuru kapalý hastalarda güvenilir bir fizik muayene saðlanmasý mümkün olmamaktadýr. Laboratuvar testlerinin fiziksel inceleme ve radyolojik incelemeler ile birlikte deðerlendirilmesi gerekmektedir. Radyolojik yöntemler ise künt karýn travmalý hastalara yaklaþýmda özellikle entübe ve yeterli fiziksel inceleme yapýlamayan hastalarda karar vermede önemli bir role sahiptir.

BACKGROUND: The purpose of this study was to evaluate the effect of clinical, laboratory and radiological results on treatment decision and surgical results in patients with blunt abdominal trauma, who were admitted to the emergency department due to traffic accident.
METHODS: Two hundred and twenty-two patients with blunt abdominal trauma were included into this retrospective study. Pearson chi square, Mann-Whitney U test and logistic regression methods were used for statistical analysis.
RESULTS: All patients were analyzed by complete blood count and biochemistry and abdominal sonography. Eighty-two patients were also evaluated by CT. Twenty-three patients underwent surgery. Positive findings on physical examination, sonography and CT, increased white blood cell count and liver function tests, decreased hemoglobin were associated with the need for surgery.
DISCUSSION: For the surgical evaluation of patients with blunt abdominal trauma, a reliable physical examination is not possible when the patients have concomitant injuries causing disturbing pain, or when the patients are unconscious. Laboratory tests should be interpreted with the clinical and radiologic analysis. Radiologic procedures play an important role in the management of patients with blunt abdominal trauma, especially for intubated patients.

AMAÇ: Akut bakteriyel menenjit kafa travmalarýnýn bir komplikasyonu olarak geliþebilir. Bu çalýþmanýn amacý kafa travmalarý sonrasý geliþen eriþkin tekrarlayan bakteriyel menenjit (TBM) olgularýnýn demografik, klinik, mikrobiyolojik ve radyolojik özelliklerini sunmaktýr.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük olarak yapýldý. TBM geliþen olgularýn medikal kayýtlarý deðerlendirildi. Bunlardan kafa travmasý öyküsü olanlar çalýþmaya alýndý. TBM tanýsý klinik, bakteriyolojik ve laboratuvar testleri kullanýlarak konuldu. Hastalarýn demografik özellikleri, klinik gidiþi, beyin omurilik sývýsý (BOS) test sonuçlarý, radyolojik görüntüleme ve hastalarýn tedavileri deðerlendirildi.
BULGULAR: Toplam 212 akut bakteriyel menenjitli hasta çalýþmaya dahil edildi. TBM hastalarýn sayýsý 25 idi (%11.8). Bunlarýn da 18’i travmayý takiben geliþen ataklardý. Dört hastanýn BOS kültüründe S. pneumonia üremesi gözlendi. Beyin tomografisi (BT) sisternografisi 11 hastada kaçaðý gösterdi. Ayrýca on hastanýn BT incelemesinde kemik kýrýðý gözlendi. Hastalarýn %83’üne seftriakson tedavi olarak verildi. Akut bakteriyel menenjit öncesi sekiz hastada çocukluk çaðýnda düþme ve beþ hastada trafik kazasý öyküsü vardý. Dört hastada epilepsi ve bir hastada saðýrlýk geliþti.
TARTIÞMA: Tekrarlayan bakteriyel menenjit sýklýkla travmayý takiben geliþtiðinden dolayý, travma hikayesi olan menenjitli hastalarýn tekrar geliþme riski açýsýndan göz önünde bulundurulmasý gerekir.

BACKGROUND: Acute bacterial meningitis may develop as a complication after head trauma. The aim of this study was to present the demographic, clinical, microbiological and radiological characteristics of adult patients who presented with recurrent bacterial meningitis attacks after trauma.
METHODS: Using a retrospective approach, the medical records of patients with acute recurrent bacterial meningitis (RBM) were reviewed, and those who had a history of trauma were included into the study. RBM was diagnosed based on clinical, bacteriologic and laboratory results. Demographic characteristics, clinical course, laboratory test results including cerebrospinal fluid analysis (CSF), radiological images, and the applied treatments were evaluated.
RESULTS: A total of two hundred and twelve patients with acute bacterial meningitis were included into the study. RBM was diagnosed in twenty-five patients (11.8%), and in 18 of these patients (8.5%), the attacks had occurred subsequent to a trauma. In the CSF cultures of four patients, S. pneumoniae growth was observed. CT cisternography indicated CSF leaks in eleven patients. Moreover, bone fractures were observed in the CT images of ten patients. Ceftriaxone therapy was prescribed to 83% of the patients. Eight patients had a history of a fall in childhood, and five were involved in traffic accidents before acute bacterial meningitis. Four of the patients developed epilepsy and one developed deafness as sequelae.
CONCLUSION: Since RBM attacks are frequently observed following trauma, in patients with a history of trauma who present with meningitis, the risk of recurrence should be considered.

AMAÇ: Penetran kalp yaralanmalarý klinik sonuçlarý sebebiyle yüksek mortaliteye sahip ciddi yaralanmalardýr. Bu yaralanmalardaki en önemli problemlerden biri ekplorasyon için uygun yöntemi seçmektir. Genel olarak yaralanma bölgesine göre torakotomi ya da mediyan sternotomi yöntemlerinden birisi kullanýlarak eksplorasyon gerçekleþtirilir. Bu çalýþmada penetran kalp yaralanmasý olan hastalarda yapýlan mediyan sternotomi ve torakotomi sonuçlarý karþýlaþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2003 ile Aralýk 2013 arasýnda kliniðimizde penetran kalp yaralanmasý sebebiyle ameliyat edilmiþ toplam 40 hasta geriye dönük olarak incelendi. Bu hastalarýn 26 tanesine torakotomi (Grup 1) 14 tanesine de mediyan sternotomi (Grup 2) uygulandý. Her iki grup ameliyat öncesi ve ameliyat sýrasýnda veriler açýsýndan karþýlaþtýrýldý.
BULGULAR: Ýki grup arasýnda cinsiyet açýsýndan fark yoktu. Ancak yaþ ortalamasý Grup 2’de diðerine göre istatistiksel olarak daha yüksek idi (p<0.05). Etiyolojik faktörlere bakýldýðýnda ise Grup 1’de delici kesici alet ile yaralanma oraný Grup 2’den yüksek, Grup 2’de de giriþimsel iþlem komplikasyonuna baðlý yaralanma oraný Grup 1’den yüksek bulundu (p<0.05). Ameliyat sýrasýnda verilerden ise ek olarak akciðer yaralanmasý ve diðer baþka bölgede cerrahi müdahale oraný Grup 1’de Grup 2’ye göre istatistiksel olarak daha yüksek bulundu (p<0.05). Kullanýlan kan miktarý, operasyon süresi ve hastaneden taburcu olma süresi de Grup 1’de istatistiksel olarak daha yüksek bulundu (p<0.05).
TARTIÞMA: Penetran kalp yaralanmalarýnda eksplorasyon için kullanýlacak yönteme karar verilirken dikkate alýnan esas parametreler yaralanma bölgesi ve akciðer yaralanmasý olup olmadýðýdýr. Bununla birlikte etkinliði çok iyi bilinen torakotomi ve mediyan sternotomi arasýnda sað kalým açýsýndan herhangi bir fark yoktur. Ancak torakotominin mediyan sternotomiye göre bazý ameliyat sýrasýnda parametreler açýsýndan dezavantajlarý olduðu da akýlda bulunmalýdýr.

BACKGROUND: Penetrating cardiac injuries are high-risk, high-mortality injuries considering the outcomes. Therefore, it is important to choose the appropriate incision. In general clinical settings, thoracotomy and median sternotomy are choices of incisions to explore the injury. In this study, the results of median sternotomy and thoracotomy in penetrating cardiac injuries were compared.
METHODS: Between January 2003 and December 2013, forty patients, who underwent either thoracotomy or median sternotomy for penetrating cardiac injury, were retrospectively analyzed, and the collected data were compared. Twenty-six patients underwent thoracotomy (Group 1), and fourteen patients underwent median sternotomy (Group 2).
RESULTS: There was no statistically significant gender difference between the groups. However, the mean age in Group 2 was found to be significantly higher than the one in Group 1 (p<0.05).
CONCLUSION: There were no significant survival differences between the groups in the long term. Incision choice should be determined considering the site of injury and whether there is an accompanying pulmonary injury or not. On the other hand, thoracotomy has some draw backs compared to median sternotomy.

AMAÇ: Transorbital intrakraniyal penetran travmayý takiben geliþen serebrovasküler travma (TIPVT) nadirdir. Bu olgularda ilk muayene tablosunun göreceli olarak hafif olmasý altta yatan ve yaþamsal tehlikesi olan vasküler travmayý maskeleyebilir. Bu çalýþmada amacýmýz, TIPVT olgularýný ve endovasküler tedavi sonuçlarýmýzý incelemektir.
GEREÇ VE YÖNTEM: Subakut veya kronik fazda anjiyografik olarak dokümente edilmiþ altý TIPVT olgusu geriye dönük olarak incelendi. Altý hastanýn beþinde endovasküler tedavi uygulandý, bir olguda endovasküler tedavi denendi ancak konservatif tedavi kararý verildi.
BULGULAR: Tam görme kaybý ve hafif inme sonrasý tedaviye alýnan bir hasta haricinde hiçbir hastada nörolojik kayýp izlenmedi. Ýki olguda karotikokavernöz fistül, üç olguda anterior serebral, orta serebral ve kavernöz karotis arter anevrizmalarý, bir olguda tromboze kavernöz sinüs içinde koalisyon gösteren kavernöz anevrizmalar izlendi. Fistüller kaplý stentlerle, anevrizmalar parent arter oklüzyonu veya akým yönlendiricilerle tedavi edildi. Tüm hastalarda komplikasyonsuz bir iyileþme süreci izlendi.
TARTIÞMA: TIPVT olgularý hafif görünen yanýltýcý baþvuru tablosundan sonra geç dönemde kendisini gösterebilir. Bu olgularýn atlanmamasý için en küçük þüphede vasküler görüntüleme yapýlmalýdýr. Transkateter anjiyografik teknikler, TIPVT olgularýnýn teþhisine olduðu gibi iyi sonuçlarla tedavisine de olanak saðlamaktadýr.

BACKGROUND: Cerebrovascular trauma secondary to transorbital intracranial penetrating injury (TIPVI) is rare. Relatively benign initial presentation may mask the underlying life-threatening vascular injury in transorbital intracranial penetrations. The aim of this study was to evaluate clinical features and endovascular treatment of TIPVI.
METHODS: Six patients with angiographic documentation of TIPVI in subacute/chronic phase were reviewed retrospectively. Five were treated endovascularly; however endovascular treatment was aborted in one and conservative management was pursued.
RESULTS: Except for one case presenting with vision loss and mild stroke, no significant neurologic deficit was present. Vascular lesions included two cases of carotid-cavernous fistulas, three traumatic aneurysms of cavernous carotid, anterior and middle cerebral arteries and a unique case of coalescing cavernous aneurysms following a through-and-through injury in which the aneurysms united within the thrombosed cavernous sinus on follow up. Fistulas were treated with covered stents, aneurysms with parent artery occlusion or flow diverters. All patients had uneventful recoveries.
CONCLUSION: TIPVI may present in a delayed fashion after a seemingly benign presentation. A high index of suspicion is critical to rule out TIPVI with vascular imaging. Transcatheter angiographic techniques allow for both diagnosis and treatment of TIPVI with favorable results.

AMAÇ: Metakarpal kýrýklar elde en sýk rastlanan kýrýklardandýr. Uygun tedavi edilmedikleri takdirde fonksiyon kaybýna neden olabilirler. Bu yaralanmalarýn çoðu konservatif olarak tedavi edilebilir. Ancak belirgin kýsalma, rotasyonel deformite ve açýlanma oluþtuðunda cerrahi tedavi gereklidir. Bu yazýda metakarp kýrýklarýnýn açýk redüksiyon ve mini plaklar ile tespitinin sonuçlarýnýn sunulmasý amaçlandý.
GEREÇ VE YÖNTEM: Kliniðimizde 2006 ve 2013 yýllarý arasýnda düþük profilli mini plak osteosentezi yapýlmýþ, klinik ve radyolojik takibi olan 29 hastanýn 37 metakarp kýrýðý geriye dönük olarak incelendi. Kabul edilemeyen kýsalýk, rotasyonal deformite ve açýlanma olan olgulara dorsal giriþimle cerrahi giriþim planlandý. Tüm hastalara ameliyat sonrasý erken hareket baþlandý. Hastalara ameliyattan dört hafta sonra günlük aktivitelerde ellerini kullanmalarýna izin verildi. Objektif deðerlendirmede toplam eklem hareket açýklýðý ölçüldü. Parmaklarýn rotasyonel deformitesi deðerlendirildi. Kavrama gücü ve QuickDASH skorlarý yaralanmamýþ taraf ile karþýlaþtýrýldý. Metakarpal kýsalýk radyolojik olarak ölçüldü ve açýlanma hesaplandý.
BULGULAR: Ortalama yaþ 35.1 (19–61) yýl, ortalama takip süresi 32 (6–39) aydý. Travma sonrasý ameliyata kadar geçen süre ortalama 8.48 (2–23) gündü. Ortalama kýsalýk 7.58 (2–30) mm olarak ölçüldü. Radyolojik kaynamanýn görüldüðü olgularda posteroanterior planda ortalama açýlanma ameliyat öncesi 8.13 (0–42) derece, ameliyat sonrasý 3.55 (0–28) derece olarak ölçüldü. Lateral grafilerde ortalama açýlanma ameliyat öncesi 8.22 (0–39) derece, ameliyat sonrasý 3.66 (0–28) derece olarak not edildi. Ortalama QuickDASH skoru 3.6 (0–11.4) tü. Ortalama kavrama gücü kýrýk elde Jamar el dinamometrisi ile 41.05 (±8.3) kg, etkilenmemiþ tarafta 44.7 (±9) kg olarak ölçüldü. Saðlam el ile kýrýk el arasýnda kavrama gücü açýsýndan Mann-Whitney U testine göre istatistiksel olarak anlamlý bir fark elde edilmedi (p<0.05). Ortalama eklem hareket açýklýðý 271.1 (245–275) dereceydi. Dört olguda (%13.7) hareket kýsýtlýlýðý vardý, rehabilitasyon programý uzatýlarak çözüldü. Yine dört hastada (%13.7) irritasyona baðlý plak çýkarýlmasýna neden olan hareket kýsýtlýlýðý ve tenosinovit geliþmiþti. Bir hastada (%3.44) rotasyon ve kýsalýk ile kaynama gözlendi. Revizyon cerrahisi planlandý.
TARTIÞMA: Genel kýrýk prensiplerinde olduðu gibi metakarp kýrýklarýnda da hedef kýrýðýn uygun anatomik ve stabil redüksiyonunun saðlanarak tedavi edilmesi, kýrýðýn kaynamasýnýn saðlanmasý ve fonksiyon kaybýndan kaçýnabilmek için erken hareket baþlanmasýdýr. Yukarýda sayýlan tedavi prensiplerini karþýlayabildiðinden uygun olgularda açýk redüksiyon ve düþük profilli mini titanyum plak uygulamasý metakarp kýrýklarýnýn tedavisinde tedavi seçeneklerinden biridir.

BACKGROUND: Metacarpal fractures are among the most common fractures of the hand. They may lead to loss of function if treated improperly. These injuries can be treated conservatively. However, if significant shortening, rotational deformity and angulation occur, surgical treatment is required. In this article, results of metacarpal fractures treated with open reduction and internal fixation with mini plates were presented.
METHODS: We retrospectively reviewed the clinical and radiologic records of twenty-nine consecutive patients with 37 metacarpal fractures treated by open reduction and internal fixation with low profile mini plate fixation between 2006 and 2013. Surgical treatment with dorsal approach was planned for cases with unacceptable shortening, rotational deformity, and angulation. Early active motion was begun in all cases postoperatively. Patients were permitted to use their hands in daily activities four weeks after surgery. For objective assessment, total range of joint motion was measured. Rotational deformity of the fingers was assessed. Grip strength and quick DASH scores were compared with the uninjured side. Metacarpal shortening was evaluated radiologically, and angulation was measured.
RESULTS: Mean age was 35.1 years (19–61 years) and mean follow-up period was 32 months (6–39 months). While mean operation time was 8.48 days (2–23 days), mean shortening was 7.58 (2–30) mm. In cases with radiologically documented union, mean angulation in the posteroanterior plane was 8.13 (0–42) degrees preoperatively and 3.55 (0–28) degrees postoperatively. In lateral X-rays, mean angulation was 8.22 (0–39) degrees preoperatively and 3.66 (0–28) degrees postoperatively. Mean quick DASH score was 3.6 (0–11.4). Mean grip strength measurements by Jamar hand dynamometer were 41.05 (±8.3) kg for fractured hands, 44.7 (±9) kg for normal hands. No significant relationship was found between normal hand and fracture hand by Mann-Whitney U test.
CONCLUSION: As in general fracture treatment principles, goals in metacarpal fracture treatment are obtaining an anatomical and stable reduction, fracture union and beginning early movement to avoid loss of function. Open reduction and low profile titanium plate application in metacarpal fractures is the choice of treatment in suitable cases as it meets the above mentioned treatment principles.

AMAÇ: Biz bu çalýþmada endovasküler stent-greft ile tedavi ettiðimiz akut travmatik torasik aort transeksiyonu hastalarýndaki deneyimimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Eylül 2011 ile Eylül 2014 tarihleri arasýnda trafik kazasý veya yüksekten düþme sonrasý hastanelerimize getirilen on bir hasta çalýþmaya dahil edildi. Bilgisayarlý tomografi ile dokuz hastada aortik istmusta, iki hastada orta-distal torasik aortada, bir hastada ise hem aortik istmusta hem de orta torasik aortada akut aortik transeksiyon görüldü. Tedavi yöntemi olarak endovasküler yöntem tercih edildi. Bir hasta haricindeki tüm hastalar taný sonrasý 12 saat içerisinde tedavi edildi.
BULGULAR: Stent-greftler tüm olgularda baþarýyla yerine yerleþtirildi. Stent-greftler hedef damar çapýna oranla %10 ila %20 oranýnda daha geniþ çapta kullanýldý. Altý hastada stentin tutunmasý için yeterli proksimal alan saðlanmasý için sol subklavyen arterin orijini stent-greft ile kapatýldý. Bu hastalarýn ikisinde sol subklavyen arterdeki akýmýn devam etmesi için cerrahi karotiko-subklavyen by-pass ve endovasküler periskop stent-greft yöntemleri kullanýldý. Ýþleme baðlý ölüm, parapleji veya iskemik bulgu hiçbir hastada izlenmedi. Anjiyografi odasýnda kardiyopulmoner resüsitasyon ve aortada geçici balon oklüzyonu uygulanan kardiyak arrestli bir hasta iþlem sonrasý 12. saatte hayatýný kaybetti. Hastalarýn operasyon sonrasý ortalama hastanede kalýþ süresi 14.8 gün (4 ila 60 gün) olarak hesaplandý. On hastanýn ortalama takip süresi 16.6 ay idi (1 ila 36 ay).
TARTIÞMA: Bizim çalýþmamýzda elde ettiðimiz sonuçlar literatürdeki diðer çalýþmalara benzer þekilde akut aort transeksiyonunda endovasküler stent-greft tedavisinin kýsa ve orta vadede baþarýlý ve umut verici olduðunu desteklemektedir.

BACKGROUND: This study aimed to present our experience in patients with acute traumatic thoracic aortic transection treated by endovascular stent-graft.
METHODS: From October 2011 to October 2014, eleven patients were brought to our hospitals after suffering motor vehicle accident or fall from height. Computed tomography revealed acute traumatic transection of the thoracic aorta at the aortic isthmus just distal to the left subclavian artery in nine patients, at the middle or distal thoracic aorta in two, and both aortic isthmus and middle thoracic aorta in one. Endovascular technique was preferred as the treatment modality. All patients, except one, were treated within twelve hours of diagnosis.
RESULTS: Deployment of stent-grafts was successful in all cases. The stent-grafts were oversized between 10% and 20%. The origin of left subclavian artery was covered with stent-graft in six patients to achieve adequate proximal landing zone. In two of them, carotico-subclavian bypass and periscope graft placement were applied to maintain subclavian artery blood flow. There were no procedure related deaths, paraplegia or ischemic complications. A patient with cardiac arrest, on whom cardiopulmonary resuscitation and transient aortic balloon occlusion within the aorta were applied in the angiography suit died at the postoperative twelve hours. Mean hospital stay after procedures was 14.8 days (range, 4–60 days). Mean follow-up time of ten patients was 16.6 months (range, 1–36 months).
CONCLUSION: Our study supports that thoracic endovascular aortic stenting for acute transection is promising in terms of short- and mid-term results similar to other studies in the literature.

AMAÇ: Kraniyal ateþli silah yaralanmalarý (KASY) sonucu hastanemizde tedavi edilen olgular, bilgisayarlý tomografi (BT) sonucu ve klinik verilerine göre incelendi, mortalite üzerine etkili faktörleri belirlemek için veriler geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM: Çok merkezli çalýþmamýzda beyin cerrahisi kliniklerine KASY sebebi ile Ocak 2012–Kasým 2014 tarihleri arasýnda baþvuran 219 hasta geriye dönük olarak deðerlendirildi. Hastalarýn yaþ, cinsiyet, Glascow Coma Skala (GKS) skoru, BT bulgularý, morbidite ve mortalite durumlarý incelendi. Mortaliye etki eden faktörler analiz edildi.
BULGULAR: Hastalarýn yaþ ortalamasý 24.19±12.25 yýl olup, %85.8’i erkekti. Bilgisayarlý tomografide belirlenen en sýk bulgular kýrýk (%100), intrakraniyal kanama (%61.2) ve intrakraniyal yabancý cisimdi (%44.3). Hastalarýn %64.8’ine intrakraniyal operasyon uygulandý. Hastane baþvurusu esnasýnda ortalama GKS puaný 8±3.9, yaþayan hastalarýn ortalama GKS puanýnýn arttýðý saptandý (p<0.005). Hastalarýn mortalite oraný %29.2 ve morbidite oraný %36.1 idi. Mortaliteye etki eden faktörlerin GKS, kýrýk tipi, kanama, ödem ve tedavi þekliydi (p<0.05).
TARTIÞMA: Ateþli silah yaralanmalarý morbiditesi ve mortalitesi yüksek yaralanmalardýr. Morbidite ve mortalite üzerine birçok faktörün etki ettiði ve özellikle mortalite üzerine hastanýn yaþý, kanamanýn varlýðý, GKS ve tedavi protokollerinin etki ettiðini saptadýk.

BACKGROUND: Cranial firearm injuries (CFAI) are associated with significant morbidity and mortality.This study was aimed to determine the factors affecting mortality of CFAI cases managed in our institution by a retrospective analysis of CT scans and clinical data.
METHODS: This multicenter retrospective study examined two hundred and nineteen patients presenting to neurosurgery clinics after CFAI between January 2012 and November 2014. Age, sex, Glasgow Coma Score (GCS), CT findings, and mortality and morbidity rates of the patients were analyzed to determine the factors affecting mortality.
RESULTS: Mean age of the study population was 24.19±12.25 years, 85.8% of them were male. The most common CT findings were fracture (100%), intracranial hemorrhage (61.2%), and an intracranially located foreign body (44.3%). A cranial operation was performed in 64.8% of the victims. Mean GCS on admission was 8±3.9, which increased in survivors (p<0.05).
CONCLUSION: CFAIs are associated with increased mortality and morbidity. We determined that many factors affected morbidity and mortality rates, and patient age, presence of intracranial hemorrhage, GCS, and treatment protocols were significantly associated with mortality.

Glob avülsiyonu, aðýr maksillofasiyal travmalar sonucu oluþabilen nadir bir durumdur. Birkaç tane iki taraflý olarak rapor edilmiþ olgular mevcuttur. Bu yazýda, motorlu taþýt kazasý sonrasý acil servise getirilen bu zorlu duruma sahip 15 yaþýnda erkek hasta sunuldu.

Avulsion of the globe is a rare condition that can occur with severe maxillofacial trauma. A few bilateral cases have been reported. The objective of this study was to present a case of this challenging condition in a 15-year-old male patient who was admitted to the emergency service after a motor vehicle accident.

Behçet hastalýðý, kronik, nükslerle seyreden, pek çok sistemi tutan, idiyopatik enflamatuvar bir hastalýktýr. Gastrointestinal sistemde aðýzdan sonra en sýk tutulum yeri ileoçekal bölgedir. Behçet hastalýðýnýn neden olduðu intestinal ülserlerler, perforasyonlara neden olabilmektedir. On dokuz yaþýnda erkek hasta Behçet hastalýðý tanýsý ile hastanemize kabul edildi. Hastada akut karýn geliþmesi üzerine kliniðimizde ameliyat edildi ve laparotomi sýrasýnda terminal ileumda multipl perforasyonlar olduðu saptandý. Hastaya parsiyel ileum rezeksiyonu yapýldý. Ameliyat sonrasý dönemi sorunsuz seyreden hasta taburcu edildi. Hastanýn ileostomisi ilk ameliyattan sonraki ikinci ayda kapatýldý. On altý aylýk izlem periyodunda hastada klinik olarak önemli bir sorun görülmedi. Bu yazýda Behçet hastalýðýnýn tanýsý sýrasýnda nadiren görülen bir komplikasyon olan multipl ileum perforasyonu sunuldu ve yayýnlanmýþ olgularýn bilgisi altýnda tartýþýldý.

Behcet’s disease is a chronic, relapsing, multisystemic, idiopathic, and inflammatory disease. A common gastrointestinal site other than the mouth is the ileocecal region. Intestinal ulcers, due to Behcet’s disease, can cause perforation. A 19-year-old male patient was admitted to our hospital for Behcet’s disease. The patient developed acute abdomen, and laparotomy revealed multiple perforations throughout the terminal ileum. He underwent partial ileum resection. Postoperative period was uneventful, and the patient was discharged. The patient’s ileostomy was closed two months after the first operation. He was clinically well during the 16-month follow-up period. This study aimed to report multiple ileum perforations as an unusual complication of Behcet’s disease at the time of presentation and review of the current literature of reported cases.

Künt travmatik kardiyak yaralanma nadir olmakla birlikte yüksek mortalite ile iliþkilidir. Künt toraks travmasý sonrasý kalp yýrtýðýnýn oluþmasýndaki en geçerli teori; hýzlý deselerasyona baðlý atriumlarýn vena kava ve pulmoner venler ile birleþme yerlerinden oluþacak yýrtýlmadýr. Hemotoraks ve hemoperikardiyumun birlikte olduðu olgularda yaralanma genellikle kalp ve/veya büyük damarlardan kaynaklanabileceðinden median sternotomi ile olan yaklaþým yaralanmanýn tamiri için kolaylýk saðlar. Bu yazýda, 33 yaþýnda bir erkek olguda künt toraks travmasý sonrasý oluþan sol atriyal yýrtýðýn mediyan sternotomi ile baþarýlý bir þekilde tedavisi sunuldu.

Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

Bir diyafragmatik defektten toraksa herniye olarak masif distansiyona uðrayan mide dokusunun neden olduðu tansiyon gastrotoraks oldukça nadir, ancak ölümcül olabilen bir klinik durumdur. Akciðer ve mediasten basýsýna baðlý ciddi semptomlara neden olur. Nefes darlýðý þikayeti ile acil servise baþvuran ve travma öyküsü olmayan 27 yaþýnda kadýn hasta, ilk deðerlendirme sonrasý göðüs cerrahisi kliniðine konsülte edildi. Toraks bilgisayarlý tomografide sol hemitoraksda gastrotoraks tespit edildi. Hastanýn arrest olmasý nedeniyle resüsitasyona baþlandý ve acil sol torakotomi yapýlarak abdominal organlar redükte edildi ve diyafragmatik defekt primer onarýldý. Hasta operasyon sonrasý beþinci gün sorunsuz þekilde taburcu edildi.

Tension gastrothorax is a very rare but potentially fatal clinical condition in which the stomach that herniates through a diaphragmatic defect into the thorax is massively distended by trapped air. It leads to severe symptoms due to the compression of the lung and mediastinum. A 27-year-old female, who had no prior trauma history, applied to the emergency service with the complaint of respiratory disorder, and was consulted by the department of thoracic surgery. Thorax CT revealed presence of gastrothorax in the left hemithorax. Thus, the patient went into cardiopulmonary arrest and was resuscitated. Emergency thoracotomy was performed, abdominal organs were reduced and diaphragmatic defect was repaired. She was discharged on the fifth postoperative day without any complications.

Akut retrobulber hemoraji (ARBH) künt göz travmasý sonrasý görülen nadir bir oftalmik acildir. Hastanýn çoklu travmatik hasarý ve bilinç kaybý varsa semptomlar gizlenebilir. Hastada kalýcý görme kaybýný önlemek için hýzlý taný konup zaman kaybetmeden lateral kantotomi, kantoliz yapýlmalýdýr. Medikal tedavi cerrahi tedaviye ek olarak baþlanabilir. Lateral kantotomi ve kantoliz acil hekimleri tarafýndan uygulanabilecek kolay bir prosedürdür. Bu makalede travma sonrasý retrobulber hemoraji geliþen bir olgumuzu sunarken, retrobulber hemorajinin tanýsý, tedavisi ve takibi hakkýnda genel bilgi verilmiþtir.

Acute retrobulbar haemorrhage (ARBH) is a rare ophthalmic emergency observed following blunt eye trauma. Multiple trauma and loss of consciousness can hide symptoms of ARBH. Rapid diagnosis and immediate lateral canthotomy and cantholysis must be performed to prevent permanent visual loss in patients. Medical treatment can be added to surgical therapy. Lateral canthotomy and cantholysis are simple procedures that can be performed by emergency physicians. In this report, it was aimed to present a case with post-traumatic ARBH and provide general knowledge about the diagnosis, follow-up and treatment of ARBH.