BACKGROUND: Hemorrhagic shock is characterized by tissue hypoperfusion caused by a sharp reduction in the effective circulating volume of blood. The key to successful resuscitation lies in eliminating the shock as soon as possible while simultaneously restoring blood perfusion to vital organs. We present the applicability of pulsed arterial blood reinfusion for resuscitation of hemorrhagic shock.
METHODS: Sixty rabbits were randomly assigned to resuscitation and control groups. A rabbit hemorrhagic shock model was developed by bloodletting from the carotid artery. The dynamic changes in blood pressure, urine output, blood lactate, and other indicators were measured.
RESULTS: Compared with the control group, the mean arterial pressure (MAP), pulse pressure, and urine output were significantly higher in the resuscitation group at 60 min (MAP: 83.67±3.90 vs. 38.19±3.50 mmHg, p<0.001; pulse difference: 16.46±2.21 vs. 10.27±2.99 mmHg, p<0.001; urine output: 3.68±0.74 vs. 0.10±0.05 mL·kg−1·min−1, p<0.001), whereas the serum lactate level was significantly lower (3.82±0.50 vs. 6.49±0.61 mmol/L, p<0.001). In addition, the resuscitation group had a significantly higher lactate clearance rate (30 min: 0.26%±0.11% vs. 0.25%±0.14%, p<0.001; 60 min: 0.30%±0.09% vs. 0.67%±0.26%, p<0.001) than the control group.
CONCLUSION: Pulsed arterial resuscitation might be useful for emergency treatment of hemorrhagic shock.

AMAÇ: Travma sonrasý omurilik yaralanmalarýnda “ikincil hasar” olarak tanýmlanan süreçte N-metil-D-aspartik asit reseptör antagonisti riluzole ve apoptozisin temel efektörü olan kaspazlarýn genel inhibitörü Q-VD-OPh’nýn ayrý ayrý ve birlikte kullanýmlarýnýn ikincil hasar geliþimi üzerine olan etkilerinin incelemesi amaçlandý.
GEREÇ VE YÖNTEM: Bu çalýþmada Sprague-Dawley türünden saðlýklý 45 adet erkek sýçan kullanýldý. Omurilik travmasý dorsal 7, 8, 9 laminektomi sonrasý klip kompresyon yöntemi kullanýlarak gerçekleþtirildi. Ýlaçlar travmadan hemen sonra baþlamak üzere beþ gün boyunca intraperitoneal olarak uygulandý. Travma sonrasý denekler Tarlov skalasý ve eðik düzlem testi ile deðerlendirildi. Beþ gün sonra alýnan omurilik örnekler hemotoksilen - eozin ve TUNEL boyama yöntemi kullanýlarak histolojik incelemesi yapýldý.
BULGULAR: Histolojik inceleme sonrasý enflamatuvar yanýt, nekroz ve apoptoz riluzole ve kombine ilaç kullanýlan grupta diðer gruplara göre istatiksel olarak anlamlý iyi sonuçlar elde edildi. Deneklerin klinik motor fonksiyon deðerlendirilmesinde Q-VD-OPh kullanýlan grupta diðer gruplara göre istatistiksel olarak anlamlý iyi sonuçlar elde edildi.
TARTIÞMA: Q-VD-OPh ve riluzole-Q-VD-OPh kombinasyonun travmada ikincil hasarýn sýnýrlandýrýlmasýnda istatistiksel olarak iyi klinik ve histolojik sonuçlar elde edildi. Spinal travma sonrasý ikincil hasarýn etkisinin ortadan kaldýrýlmasý veya sýnýrlanmasý için laboratuvar çalýþmalarý daha kapsamlý yapýlmalýdýr.

BACKGROUND: We investigated the effects of an N-methyl-D-aspartate receptor antagonist, riluzole, and a pancaspase inhibitor and basic apoptosis mediator, Q-VD-OPh, in combination or alone in posttraumatic spinal cord injury.
METHODS: In our study, 45 healthy male Sprague Dawley rats were used. Spinal trauma was induced by the clip compression technique via thoracal 7, 8, 9 laminectomies. After inducing the trauma, the drug was continuously administered intraperitoneally for 5 days. After inducing the trauma, the subjects were assessed using Tarlov’s motor grading scale and inclined plane test. Five days after the trauma, the spinal cord specimens were harvested, and a histopathological examination was performed.
RESULTS: Compared with the other groups, a statistically significant difference with regard to better results for necrosis, inflammation, and apoptosis was observed in the riluzole only and combination groups. Statistically better motor function scores were observed in the Q-VD-OPh only group than in the other groups.
CONCLUSION: With regard to limiting secondary damage after trauma, statistically significant results were observed in the Q-VD-OPh only and Q-VD-OPh–riluzole combination groups. More extensive laboratory studies are required to limit and control the effects of secondary damage after spinal cord trauma.

AMAÇ: Aðýr ve çoklu travma hastalarýnda, hayat kurtarýcý prosedürlerin erken uygulanmasý artmýþ sað kalým ile iliþkilidir. Gece yapýlan savaþ senaryosunda bu hayat kurtarýcý giriþimlerin gece görüþ gözlüðü (GGG) yardýmýyla uygulanabilirliðini deneysel olarak saptamaya çalýþtýk.
GEREÇ VE YÖNTEM: Göðüs tüp torakostomi (GTT), acil krikotroidotomi (AK) ve iðne torakostomi (IT) giriþimleri 10 adet askeri saðlýk personeli tarafýndan gerçekleþtirildi. Çalýþmada giriþimlerin baþarý ve süreleri incelendi. Prosedürler, hazýrlanan maket/model üzerinde gündüz aydýnlýk odada ve GGG yardýmý ile karanlýk odada yaptýrýldý. Operatörler giriþimlerin kolaylýðýný derecelendirdi.
BULGULAR: Tüm giriþimler baþarýlý bulundu. Operatörler, gece yapýlan GTT ve AK giriþimlerini gündüz saatlerinde yapýlan giriþimlere göre zor buldu (p<0.05). Ýðne torakostomi gruplarý arasýnda zorluk açýsýndan anlamlý fark yoktu. Giriþimlerin tamamlanma süreleri açýsýndan karþýlaþtýrýldýðýnda, gündüz ve gece senaryolarý arasýnda fark yoktu.
TARTIÞMA: Gece görüþ gözlüðü kullanan operatörler, taktik ve medikal aktivitelerini yaparken gece görüþ gözlüklerini çýkarmalarýna ve ekstra ýþýk kaynaðý kullanmalarýna gerek olmadýðý konusunda uyanýk olmalýdýrlar.

BACKGROUND: In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario.
METHODS: Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions.
RESULTS: All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario.
CONCLUSION: The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

AMAÇ: Yanýk yaralanmalarý, koruyucu cilt bariyerinin sürekliliðini bozmakla kalmayýp ayný zamanda sistemik etkiler yoluyla invaziv enfeksiyonlarý ve sepsisi de kolaylaþtýrýr. Yanýk sahasý, kan ve idrar örnekleri, patojen ajaný belirlemek için sýklýkla kullanýlanýlýr. Bu çalýþmanýn amacý, hastane Enfeksiyon Kontrol Komitesi tarafýndan ‘enfeksiyon açýsýndan pozitif’ olarak onaylanan hastalarýn kültüründeki üremeleri analiz etmek ve bu üremelerin klinik etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya %10’dan fazla yanýk yüzey alaný olan ve Enfeksiyon Kontrol Komitesi tarafýndan “enfeksiyon varlýðý” olan yatan hastalar dahil edilidi. Hastalar yaþ, cinsiyet, yanýk etiyolojisi, toplam yanýk vücut alaný (TYVA), inhalasyon hasarý varlýðý, sepsis, pozitif kültürler, yara-kan-idrar numunelerinden alýnan mikroorganizmalar ve septik odak açýsýndan deðerlendirildi.
BULGULAR: Toplam 36 (%10.3) “enfeksiyon pozitif” hastanýn 26’sý (%72.2) erkek, yaþ ortalamasý 44±21 idi. Tüm grupta ortalama TYVA %45.58±23.1 idi. Acinetobacter baumannii, yara kültürlerinde en fazla izole edilen organizma idi. Enfeksiyon varlýðý doðrulanan hastalarda, idrar kültürlerinde izolasyon ile mortalite oranlarý arasýnda bir korelasyon vardý (p=0.023). Yirmi üçünde (%63.9) sepsis tespit edildi; bunlardan 21’inde inhalasyon yaralanmasý vardý. Ýnhalasyon hasarý ile sepsis arasýnda anlamlý bir iliþki vardý (p=0.015) ve hem sepsis hem de inhalasyon yaralanmasýnýn mortaliteyi artýrdýðý görüldü (sýrasýyla, p=0.027 ve p=0.009).
TARTIÞMA: Çalýþmanýn verilerine göre, yanýklý hastalarda toplam yanýklý vücut yüzey alaný mortalitede daha büyük öneme sahipken, sepsis ve/veya idrar yolu enfeksiyonu varlýðý da mortalite nedeni olarak iþaret edilmelidir.

BACKGROUND: Burn injuries facilitate invasive infections and sepsis not only by destroying the continuity of the protective skin barrier but also through systemic effects. The burn wound, blood, and urine samples are frequently cultured to determine the pathogen agent. The aim of this study was to analyze pathogen growth in patients’ cultures confirmed as “infection positive” by the hospital Infection Control Committee and to assess the clinical implications of these growths.
METHODS: Hospitalized patients included in the study were those with a total burned body surface area of >10% and “presence of infection” confirmed by the Infection Control Committee. The patients were evaluated with respect to age, gender, burn etiology, the total body surface area burned (TBSA), the presence of inhalation injury, sepsis, positive cultures, the microorganisms cultured in wound-blood-urine samples, and septic focus.
RESULTS: Of the total 36 (10.3%) “infection-positive” patients, 26 (72.2%) were male; the mean age of patients was 44±21 years. The mean burned TBSA of the whole group was 45.58%±23.1%. Acinetobacter baumannii was the most isolated organism in the wound cultures. In patients with confirmed infection, there was a correlation between the pathogen isolated in urine cultures and mortality rates (p=0.023). Sepsis was diagnosed in 23 (63.9%) patients, of whom 21 had inhalation injuries. There was a significant correlation between inhalation injury and sepsis (p=0.015), and both the presence of sepsis or inhalation injury increased mortality (p=0.027 and p=0.009, respectively).
CONCLUSION: According to the study data, the TBSA burned demonstrated a greater significance for mortality, although the presence of sepsis and/or urinary tract infection should also be noted as a cause of mortality in burned patients.

AMAÇ: Ranson skoru akut pankreatitin (AP) þiddetinde en yaygýn kullanýlan prognostik model olmasýna karþýn, iskemi modifiye albümin (ÝMA) son yýllarda çeþitli iskemi temelli hastalýklar için yeni bir belirteç olarak bildirilmiþtir. Amaç AP hastalarýnda Ranson skoru ve ÝMA arasýndaki korelasyonu araþtýrmaktýr.
GEREÇ VE YÖNTEM: Kýrk üç AP hastasý çalýþmaya dahil edildi. Tüm hastalar hafif ve þiddetli AP olarak sýnýflandýrýldý. Plazma ÝMA seviyesi tanýdan sonra ve tedaviden öncesi ölçüldü. Ýskemi modifiye albümin düzeyi ile amilaz düzeyi, Ranson skoru ve hastalýðýn þiddeti arasýndaki iliþki deðerlendirildi.
BULGULAR: Yirmi dokuz (%67.4) hastaya hafif AP tanýsý konarken, 14 (%32.6) hasta orta þiddetli veya þiddetli hastalýk formuna sahipti ve þiddetli AP olarak sýnýflandýrýldý. Hasta gruplarý arasýnda ÝMA düzeylerinde anlamlý bir fark yoktu (p=0.737). Ýskemi modifiye albümin düzeyleri ile amilaz düzeyleri (p=0.470), Ranson skoru (p=0.664) ve hastalýk þiddeti (p=0.741) arasýnda korelasyon saptanmadý.
TARTIÞMA: Çalýþmadan elde edilen sonuçlara göre, ÝMA AP’de hastalýk þiddetinin erken tahmininde yararlý bir belirteç olarak görünmemektedir. Önemli dezavantajlarýna raðmen, Ranson skoru hastalýðýn þiddetini daha doðru göstermektedir.

BACKGROUND: Although Ranson score is the most commonly used prognostic model in the severity of acute pancreatitis (AP), ischemia-modified albumin (IMA) has been reported as a novel biomarker of various ischemia-based diseases in recent years. The aim of the present study is to investigate the correlation between Ranson score and IMA in patients with AP.
METHODS: Forty-three patients with AP were included in the study. All patients were classified as mild and severe AP. Plasma IMA level was measured after diagnosis and before treatment. The correlation between IMA level and amylase level, Ranson score, and disease severity was evaluated.
RESULTS: Twenty-nine (67.4%) patients were diagnosed as mild AP; the remaining 14 (32.6%) patients had moderately severe or severe form of disease, and were classified as severe AP. There was no significant difference in the IMA levels between the patient groups (p=0.737). No correlation between IMA levels and amylase levels (p=0.470), Ranson score (p=0.664), and disease severity (p=0.741) was found.
CONCLUSION: According to the results from the study, IMA does not seem as a useful marker in earlier prediction of disease severity in AP. Despite important disadvantages, Ranson score still indicates the disease severity more accurately.

AMAÇ: Bu çalýþmada enflamatvuar belirteçlerin negatif apendektomi oranýný düþürmedeki rolünün, akut apandisitin (AA) bilgisayarlý tomografi (BT) bulgularýna dayanarak araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Akut apandisit ön tanýsýyla BT incelemesi yapýlan 92 hastanýn bilgileri geriye dönük olarak tarandý. Enflamatvuar belirteçler ile BT bulgularý arasýndaki iliþki araþtýrýlarak, ROC analizi ile enflamatvuar belirteçler ve BT bulgularýna ait kesim deðerleri belirlendi. Apendektomi yapýlan olgular, bu kesim deðerlerine göre yeniden deðerlendirilerek negatif apendektomi oraný yeniden hesaplandý. Gerçek negatif apendektomi oraný ile yeniden hesaplanan negatif apendektomi oraný arasýndaki fark ki-kare testi kullanýlarak analiz edildi.
BULGULAR: Apendiks çapý, apendiks duvar kalýnlýðý ve çekum duvar kalýnlýðý için kesim deðerleri sýrasýyla, 7.9 mm, 2 mm ve 2.3 mm olarak bulundu. Beyaz küre sayýmý, nötrofil/lenfosit oraný ve C-reaktif protein için kesim deðerleri sýrasýyla, 7.47, 4.06 ve 13 olarak bulundu. Gerçek negatif apendektomi oraný ile kesim deðerlerine göre yeniden hesaplanan negatif apendektomi oraný arasýndaki istatistiksel fark neredeyse anlamlý idi (p=0.058).
TARTIÞMA: Enflamatvuar belirteçler AA kesin tanýsý için tek baþlarýna yetersizdir. Ancak, çalýþmamýzda bulunan kesim deðerleri, özellikle arada kalýnan olgularda, kesin taný için faydalý olarak negatif apendektomi oranýnýn düþürülmesine katký saðlayabilir.

BACKGROUND: This study aimed to investigate the role of inflammatory markers in decreasing negative appendectomy rate (NAR) based on their relation with findings of acute appendicitis (AA) on computed tomography (CT).
METHODS: Ninety-two patients who underwent CT examination with suspected AA were included. We investigated the relation between CT findings of AA and laboratory inflammatory markers and also performed receiver operating characteristic (ROC) analysis to calculate cut-off values of inflammatory markers and CT findings of AA. Appendectomy cases were re-evaluated considering cut-off values to make the operation decision and NAR was recalculated. Chi-squared test was used to compare the actual and recalculated NAR.
RESULTS: Cut-off values of appendiceal diameter, appendiceal wall thickness, and caecal wall thickness were 7.9, 2, and 2.3 mm, respectively, for the diagnosis of AA. Cut-off values of WBC, NLR, and CRP on ROC analysis were 7.47, 4.06 and 13, respectively, for the diagnosis of AA. When the actual and recalculated NAR (21.9% versus 9.1%) were compared, the difference was found to be almost significant (p=0.058).
CONCLUSION: Inflammatory markers are not sufficiently powerful on their own to accurately diagnose AA. However, particularly in equivocal cases, proposed cut-off values may be helpful for accurate diagnosis and a lower NAR can be achieved.

AMAÇ: Bu yazýda kardiyak patoloji nedeniyle kardiyoloji ve kalp damar cerrahisi kliniklerinde antikoagülan ve antiagregan tedavisi altýnda spontan geliþen rektus kýlýf hematomunun mortalite ile iliþkisi sunuldu.
GEREÇ VE YÖNTEM: Ocak 2010 ve Aralýk 2015 tarihleri arasýnda Kartal Koþuyolu Yüksek Ýhtisas Eðitim ve Araþtýrma Hastanesi’nde spontan rektus kýlýf hematom tanýlý 27 hasta geriye dönük olarak deðerlendirildi.
BULGULAR: Hastalarýn 19’u (%70.4) kadýn, sekizi (%29.6) erkek olup yaþ ortalamalarý 63±12 (daðýlým, 32- 84) yýldý. Hastalarýn tamamýnda en az bir olmak üzere takip gerektiren ek hastalýk mevcuttu. Hastalarýn 14’ü sadece antikoagülan tedavi, sekizi sadece antiagregan tedavi ve geri kalan beþ hasta ise hem antikoagülan hem de antiagregan tedavi almaktaydý. Fizik muayenede olgularýn tümünde karýn alt kadranlarýnda aðrýlý palpabl kitle vardý. Bilgisayarlý tomografideki boyut ve lokalizasyona göre tiplendirildiðinde olgularýn yedisi Tip 1, altýsý Tip 2, 14’ünün ise Tip 3 olduðu saptandý. Olgularýn 23’üne týbbi tedavi uygulanýrken geriye kalan dört hastayada cerrahi tedavi uygulandý. Sekiz (%29.6) hastada mortalite izlendi.
TARTIÞMA: Sonuç olarak, rektus kýlýf hematomu nadir olup kardiyak nedenlerle antikoagülan ve antiagregan alan hastalarda sýklýðý artmaktadýr. Kardiyak nedenlerle hastane yatýþý esnasýnda rektus kýlýf hematomu geliþen, ek hastalýklarý olan ve hastanede kalýþ süresinin uzamasý nedeniyle ek komplikasyonlar geliþen hastalarda mortalite önemli ölçüde artmaktadýr.

BACKGROUND: This study presents the relationship between mortality and spontaneous rectus sheath hematoma (RSH) in inpatients receiving anticoagulant and antiaggregant treatment for cardiac pathology at cardiology and cardiovascular surgery clinics.
METHODS: Within the scope of our study, the cases of 27 patients who were diagnosed with spontaneous RSH between January 2010 and December 2015 at Kartal Kosuyolu High Speciality Training and Research Hospital were retrospectively evaluated.
RESULTS: Of the 27 patients, 19 (70.4%) were female and 8 (29.6%) were male. The mean age was 63±12 (32–84) years. All the patients had at least one comorbidity that necessitated follow-up. Fourteen patients received only anticoagulant treatment, 8 received only antiaggregant treatment, and the remaining 5 received both types of treatment. Physical examination of all patients revealed painful palpable masses in the lower quadrants of the abdomen. According to the results of computed tomography (CT) scans, which showed the size and localization of the masses, 7 of the cases were classified as Type I, 6 as Type II, and 14 as Type III. Although 23 of the cases received medical treatment, the remaining 4 patients received surgical treatment. Eight (29.6%) patients suffered mortality.
CONCLUSION: RSH is rare, but its prevalence is increased among patients receiving anticoagulant and antiaggregant treatment for cardiac reasons. The mortality rate markedly increased among patients who contracted RSH during hospitalization for cardiac reasons, had comorbidities, and experienced additional complications due to extended hospitalization.

AMAÇ: Primer epiploik apandisit (PEA) nadir görülen bir hastalýktýr.
GEREÇ VE YÖNTEM: Bu yazýda PEA tanýsý alan 45 hastanýn klinik verileri ve bilgisayarlý tomografi (BT) bulgularý geriye dönük olarak deðerlendirildi.
BULGULAR: Fizik muayene bulgularý ve aðrýnýn lokalizasyonuna göre hastalar akut apandisit (n=13), akut kolesistit (n=2), akut diverkülit (n=19), renal kolik (n=7) ve over patolojisi (n=4) öntanýlarýný aldýlar. Bu hastalara BT incelemesi sonucunda PEA tanýsý konuldu.
TARTIÞMA: Primer epiploik apandisit patogonomik olmayan klinik ve laboratuvar bulgularýna sahiptir ve akut karýn hastalýklarýnýn deðerlendirilmesinde akýlda tutulmasý gereken bir klinik antitedir.

BACKGROUND: Primer epiploic appendagitis (PEA) is an uncommon condition.
METHODS: We retrospectively reviewed the clinical records and computed tomography (CT) findings of 45 patients with PEA.
RESULTS: On the basis of physical examination and pain localization, presumptive clinical diagnosis was acute appendicitis (n=13), acute cholecystitis (n=2), acute diverticulitis (n=19), renal colic (n=7) and ovarian pathology (n=4).
CONCLUSION: Although it has no characteristic clinical and laboratory features, CT is the best modality for accurate diagnosis of PEA.

AMAÇ: Bu geriye dönük çalýþmamýzda akut biliyer pankreatitli hastalarda erken ve geç laparoskopik kolesistektomi sonuçlarýmýzý karþýlaþtýrarak, erken kolesistektominin güvenilirliðini, tekrarlayan biliyer pankreatit riskini, yatýþ günü ve morbidite üzerindeki etkilerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Okmeydaný Eðitim ve Araþtýrma Hastanesinde Ocak 2009 – Aralýk 2012 arasýnda akut biliyer pankreatitli 131 hasta çalýþmaya alýndý. Hastalarýn demografik özellikleri, þikayetlerinin süresi, ilk geliþteki biyokimya ve hemogram deðerleri, Ranson skoru, atak sayýsý, görüntülemeler, ameliyat türü ve süresi, ilk ataktan ameliyata kadar geçen gün sayýsý, yatýþ günü ve komplikasyonlar kaydedildi. Ameliyatlarýný ilk iki haftada olanlar erken (Grup 1), iki haftadan sonrakiler geç (Grup 2) olarak deðerlendirildi.
BULGULAR: Grup 1’deki 47, Grup 2’deki 84 hastaya laparoskopik kolesistektomi yapýldý. Hiçbir olguda açýk ameliyata geçilmedi, koledok yaralanmasý olmadý ve mortalite geliþmedi. Yatýþ günü ortalamasý, Grup 1’de 7.6±3.0 gün, Grup 2’de 10.7±8.3 gün idi ve gruplar arasýnda istatistiksel anlamlý fark bulundu (p=0.006). Ýki ve üzerinde atak sayýsý Grup 2’deki hastalarýn 15’inde (%18) saptandý ve istatistiksel anlamlý fark bulundu (p=0.000).
TARTIÞMA: Ranson ≤3 biliyer pankreatitlerde erken laparoskopik kolesistektomi, operasyon süresi ve morbiditeyi artýrmadýðýndan ve diseksiyon güçlüðü yaratmadýðýndan güvenle uygulanabilir. Geç kolesistektomiler tekrarlayan ataklar, yatýþ günü ve tedavi maliyetlerinde artýþa neden olmaktadýr. Randomize kontrollü çalýþmalarla hafif ve orta biliyer pankreatitlerde erken kolesistektominin etkinliði ve güvenilirliði doðrulanmalýdýr.

BACKGROUND: In this retrospective study, we aimed to assess the reliability of early cholecystectomy, risk of recurrent biliary pancreatitis, and their effects on hospital length of stay and morbidity by comparing the results of early and late laparoscopic cholecystectomy in patients with acute biliary pancreatitis.
METHODS: A total of 131 patients, who were diagnosed with acute biliary pancreatitis at Okmeydaný Education and Research Hospital in January 2009–December 2012, were included in the study. Demographic specifications of patients, duration of their complaints, biochemistry and hemogram values at first arrival, Ranson criteria, number of attacks, screenings, operation type and period, number of days between the first attack and operation, hospital length of stay, and complications were recorded. Patients who underwent cholecystectomy within the first 2 weeks were considered early (group 1) and those who under the operation after 2 weeks were considered late (group 2).
RESULTS: There were 47 patients in group 1 and 84 patients in group 2. Open surgery was not performed on any patient, and there was no choledoch injury and mortality. The average hospital length of stay was 7.6±3.0 days in group 1 and 10.7±8.3 days in group 2, with a statistically significant difference between the groups (p=0.006). Two or more number of attacks occurred in 15 patients in group 2 (18%), with a statistically significant difference between the groups (p=0.000).
CONCLUSION: Laparoscopic cholecystectomy is safe as it does not increase operation time and morbidity in biliary pancreatitis with a Ranson score of ≤3 or cause difficulty in dissection. Late cholecystectomy causes recurrent attacks and increases the hospital length of stay and treatment costs. Using randomized controlled studies, the effectiveness and reliability of early cholecystectomy in mild and moderate biliary pancreatitis can be verified.

AMAÇ: Akut kolesistitin (AC) baþlýca sebebi safra taþlarýdýr. Yaþlý hastalarda safra taþý insidansý artmaktadýr. Bu çalýþmada, akut kolesistitli yaþlý hastalarda erken kolesistektomi öncesi perkütan kolesistostominin (PK) etkinliðinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma konvansiyonel veya laparoskopik kolesistektomiye (LC) giden 85 erken evre akut taþlý kolesistitli hasta içermektedir. Tüm hastalar 65 yaþ üzerindedir.
BULGULAR: Hastalar iki gruba ayrýldý. Grup I; PK+erken kolesistektomi ve Grup II; yalnýzca kolesistektomi. Çalýþmamýzda yaþ, cinsiyet, cerrahi öncesi PK durumu, ameliyat sonrasý komplikasyon, ameliyat sonrasý mortalite, cerrahi yöntem ve ameliyat sonrasý hastanede kalýþ süresi kaydedildi. Ortalama yaþ 75.7±7.5 ve 73.7±7.2 idi. Ýki grup arasýnda anlamlý fark yoktu (p=0.041). Ameliyat sonrasý komplikasyon oraný PK uygulanmayan grupta iki kat iken, PK ile kolesistektomi yapýlan grupta az komplikasyon mevcuttu (p=0.032). Ameliyat sonrasý mortalite bariz þekilde PK sonrasý kolesistektomi uygulanan hastalarda düþüktü (p=0.017). Ortalama hastane yatýþ süresi grup I’de 5.6±2.4 gün ve Grup 2’de 11.2±7.7 gündü (p<0.001).
TARTIÞMA: Akut taþlý kolesistitte acil laparoskopik kolesistektomi hala en iyi cerrahi yöntemdir. Ayrýca çalýþmamýza göre, geriatrik hastalarda perkütan kolesistostomi geçiþ tedavisi ameliyat sonrasý komplikasyon oranlarýný azaltmada faydalý olabilir.

BACKGROUND: The main cause of acute cholecystitis (AC) is gallstones, and the incidence of gallstones in elderly patients is high.
METHODS: In this study, we aimed to investigate the efficacy of percutaneous cholecystostomy (PC) before early cholecystectomy in geriatric patients with AC. This retrospective study included 85 patients undergoing laparoscopic or conventional cholecystectomy during early stage of calculous AC.
RESULTS: All patients were over 65 years old and were divided into two groups: Group I, PC plus early cholecystectomy and Group II, only cholecystectomy without PC. Data on age, sex, status of PC before surgery, postoperative complications, postoperative mortality, surgical method, and postoperative hospitalization duration were recorded in our study. The average age in the groups I and II was 75.7±7.5 and 73.7±7.2 years, respectively, indicating insignificant difference (p=0.223). Although postoperative complication rate was two fold in the non-PC group, the PC plus cholecystectomy group has a few complications (p=0.032). Postoperative mortality was evidently lower in patients who first underwent PC and followed by cholecystectomy (p=0.017). The average hospitalization duration in groups I and II were 5.6±2.4 days and 11.2±7.7 days, respectively (p<0.001).
CONCLUSION: Urgent laparoscopic cholecystectomy is still the best surgical treatment modality for calculous AC. Further, our study results showed that in geriatric patients, bridge treatment, such as PC, can be useful for reducing postoperative complication rates.

AMAÇ: Kapitellar kýrýklar seyrek görülen dirsek yaralanmalarý olup uygun biçimde tedavi edilmediðinde aðýr fonksiyonel kýsýtlamaya neden olabilirler. Erkenden mobilizasyona olanak saðlayan stabil bir eklem durumunu gerçekleþtirmek için kapalý redüksiyon ve alçýyla tespitten açýk redüksiyon ve internal fiksasyona (ARÝF) kadar sayýsýz tedavi geliþtirilmiþtir. Geniþ bir lateral yaklaþým yoluyla Herbert vidalarý ve ARÝF yöntemi kullanarak bu kýrýklarý tedavi etmenin fonksiyonel sonuçlarýný belirledik.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmaya kapitellar kýrýklarý olan 15 hasta dahil edildi. Ýyi çekilmiþ bir radyografi önemli olduðundan her hastada bu husus vurgulandý. Beþ yýllýk çalýþma dönemi boyunca tüm kýrýklar geniþ bir lateral ekspozürle açýk redüksiyon ve Herbert vidalarý kullanýlarak internal fiksasyonla tedavi edildi. Ortalama 3.6 yýllýk (daðýlým, 1.5–6 yýl) takipte klinik, radyografik bulgular ve Mayo Dirsek Performans Ýndeksine göre deðerlendirmeler yapýldý.
BULGULAR: Bryan ve Morrey sýnýflandýrma sistemi kullanýlarak 9, tip I ve 6 tip IV kapitellar kýrýk tespit edildi. Kemiðin kaynamasýna kadar ortalama 12 hafta (daðýlým, 8–16 hafta) geçmiþ, tüm kýrýklar kaynadý. Ortalama fleksiyon geniþliði 130° (daðýlým, 125°–135°) idi. Hastalarýn tümünde fonksiyonel hareket aralýðý saðlandý; ortalama ekstansör hareket açýklýðý 10° (daðýlým, 0°-30°) idi. Son takipte bir olguda osteoartrit görüldü, herhangi bir avasküler nekroz veya heterotrofik osifikasyon gözlenmedi. Ýki hastada vidalarýn çýkartýlmasý gerekti. On hastada mükemmel ve beþ hastada iyi sonuçlar elde edildi.
TARTIÞMA: Herbert vidasýyla fiksasyon kapitellar kýrýklarda stabil bir tespit saðladýðý gibi geniþletilmiþ lateral açýnýmla bu kompleks kýrýklarýn internal fiksasyonu ardýndan dirsek hareketliliðinde iyi-mükemmel sonuçlar elde edilebilir.

BACKGROUND: Capitellar fractures are rare elbow injuries and can cause severe limitation of function if not properly managed. Numerous treatments have evolved, from closed reduction and cast immobilization to open reduction and internal fixation (ORIF), so as to achieve a stable joint that allows early mobilization. We determined the functional outcomes of treating these fractures with ORIF using Herbert screws via an extensile lateral approach.
METHODS: Fifteen patients with capitellar fractures were included in this retrospective study. A well taken lateral radiograph was important and stressed upon in all patients. All fractures were open reduced and internally fixed using Herbert screws via an extensile lateral approach over a period of 5 years. Clinical, radiographic, and Mayo Elbow Performance Index were evaluated at a mean follow-up of 3.6 years (range, 1.5–6 years).
RESULTS: Nine type I and six type IV capitellar fractures were identified using Bryan and Morrey classification system. The average time to bone union was 12 weeks (range 8–16 weeks) with no case of nonunion. The mean range of flexion was 130° (range 125°–135°). The average extensor lag was 10° (range 0°–30°), with a functional range of motion of elbow achieved in all patients. On the final follow-up, one case of osteoarthritis was seen, but no evidence of avascular necrosis or heterotrophic ossification was seen. Two patients needed screw removal. The outcome was excellent in 10 patients and good in five patients.
CONCLUSION: Herbert screw fixation provides stable fixation in capitellar fractures and good to excellent outcomes with excellent elbow motion, can be achieved following internal fixation of these complex fractures using the extended lateral exposure.

Ateþli silah yaralanmalarý, bacak distal bölgesinde kýrýk eþlik eden kemik, tendon gibi önemli yapýlarýn ekspoze olduðu yumuþak doku defektlerine yol açan travmalardan biridir. Bu bölgenin yeterli yumuþak doku desteðine sahip olmamasý nedeniyle lokal flep seçenekleri oldukça sýnýrlýdýr. Günümüzde bu bölgenin rekonstrüksiyonu için en uygun seçenekler serbest flepler ve perforator flepler olmasýna raðmen bu tür yüksek enerjili travmalar nedeniyle mevcut lokal flepler daha uygun hale gelmektedir. Bipediküllü flepler, çok çeþitli avantajlarý olmasý sebebiyle küçük ve orta boyutlu alt ekstremite defeklerinin rekonstrüksiyonunda sýkça kullanýlmaktadýr. Bu çalýþmanýn amacý, bacak distalindeki geniþ yumuþak doku defektlerinin rekonstrüksiyonu için daha önce literatürde tanýmlanmayan gecikmeli bipediküllü flebin kullanýmý ve hasta sonuçlarý üzerinden mevcut literatür gözden geçirilerek flebin kullanýmý tartýþýldý.

Shotgun injury is a trauma that leads to soft tissue defects, in which important structures such as the tendon and bone are exposed with fractures in the distal lower extremity. Because this region has insufficient soft tissue support, local flap options are highly limited. Although the most suitable options are free or perforator flaps for contemporarily reconstructing that region; owing to such high-energy traumas, the available local flaps are becoming more suitable. Besides having various advantages, bipedicled flaps are commonly used for reconstructing small- and medium-sized lower extremity defects. This study aimed to discuss the use of a delayed bipedicled flap, which has not been previously described in the literature.

Pankreas psödokisti tanýsý alan 11 yaþýndaki erkek çocuðun ince iðne aspirasyon biyopsisi sonrasýnda takipte birinci ayda tekrarladýðý izlendi. Endosonografi yardýmlý endoskopik drenaj ve üç yýllýk takipte herhangi bir problem olmayan hastanýn kontrol bilgisayarlý tomografsinde kist izlenmedi. Çocuklarda pankreatik psödokist yönetiminde endoskopik drenaj ve kistoduodenostomi minimal invaziv, güvenli ve etkin bir yöntemdir.

An 11-year-old morbidly obese boy was diagnosed with pancreatic pseudocyst. Following fine needle aspiration, the cyst recurred in 1-month follow-up. Therefore, endoscopic drainage and cystoduodenostomy was performed following endosonography. Control ultrasonography (USG) revealed a completely shrunken cyst. During the 3 years of follow-up, the patient was asymptomatic with no evidence of cyst on computerized tomography scans. Endoscopic drainage and cystoduodenostomy is a minimally invasive, effective, and safe approach in the management of pancreatic pseudocysts in children.

Eldiven tarzý avulsiyon yaralanmalarý el cerrahlarý çözülmesi zor problem oluþturur. Çünkü özellikle çoklu parmak yaralanmasýnda, rekonstrüktif mikrocerrahi, zaman sýnýrlamasý gibi nedenlerle zorluklar taþýr. Biz çoklu parmak “degloivng” yaralanmasý olan olgular için yeni bir metod öneriyoruz. Bu teknik iki aþamalý olarak distal bazlý radiyal ön kol flebi ile, yaralanmýþ tüm parmaklarýn sarýlmasý ve üçüncü hafta flep pedikülünün kesilmesini içeriyor. Erken yoðun fizik tedavi ile, el bileði ve parmak eklemlerinde oluþacak sertlikler önlenecektir.

Degloving hand injuries present challenging situations to hand surgeons as they present with difficulties in reconstructive microsurgery, particularly in multiple digital injuries. Time is a limiting factor when multiple degloving finger amputations are present. Thus, we proposed a repair method for multiple degloving finger injuries that involves coverage with a distal-based reverse forearm flap of all injured fingers in a two-stage procedure. Early vigorous physical therapy after pedicle division of the flap at postoperative third week eliminates joint stiffness problems at wrist and metacarpophalangeal joints.