AMAÇ: Montelukast, sisteinil lökotrien-1 reseptörünü spesifik ve geri dönüþümlü olarak inhibe eden, selektif bir lökotrien D-4 reseptör antagonistidir. Bu deneysel çalýþmada, akut iskemi/reperfüzyon (Ý/R) yaralanmasý oluþturulan Wistar albino türü sýçanlarda montelukastýn iskelet kasý reperfüzyon yaralanmasýna karþý olasý koruyucu etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Bu çalýþmaya 16 erkek Wistar albino türü sýçan alýndý. Sýçanlar, rastgele sýrasýyla kontrol (Ý/R) ve çalýþma (Ý/R + Montelukast) olmak üzere iki gruba ayrýldý. Ekstremite iskemisi, femoral artere klemp konarak saðlandý. Ýki saatlik iskemi süresini takiben iki saat süren reperfüzyon sonrasýnda, biyokimyasal analiz ve histopatolojik inceleme için kas örnekleri alýndý.
BULGULAR: Kontrol grubunun melondialdehit düzeyleri, montelukast grubundan istatistiksel olarak anlamlý düzeyde yüksekti (p=0.002; p<0.01). Montelukast grubunun süperoksit dismutaz düzeyleri ise kontrol grubundan istatistiksel olarak anlamlý düzeyde yüksek bulundu (p=0.001; p<0.01). Ýskemik kaslarýn histopatolojik incelemesinde iskemi reperfüzyon grubunun ödem, polimorfonükleer lökosit (PMNL) infiltrasyonu ve eritrosit ekstravazasyonu düzeyleri, tedavi grubundan istatistiksel olarak anlamlý düzeyde yüksekti. Tedavi edilen grupta ödem, PMNL infiltrasyonu ve eritrosit ekstravazyonu ise iskemi grubuna göre oldukça azalmýþ olarak izlendi.
TARTIÞMA: Bu iskelet kasý akut Ý/R yaralanmasý modelinde; montelukastýn iskelet kasý reperfüzyon yaralanmasýna karþý koruyucu etkisi vurgulandý. Montelukast, akut vasküler yaralanmalý ekstremite travmalarý olgularda ve turnike süresi uzamýþ ekstremite cerrahisinde, reperfüzyonun neden olduðu lokal ve sistemik komplikasyonlarý sýnýrlandýrarak ekstremitede fonksiyonel iyileþmeyi hýzlandýrabileceði sonucuna varýlmýþtýr. Ancak yine de bu etkinin yapýlacak deneysel ve klinik çalýþmalar ile de desteklenmesinin gerekli olduðu kanaatindeyiz.

BACKGROUND: Montelukast is a selective leukotriene D-4 receptor antagonist, which specifically and reversibly inhibits cysteinyl leukotriene-1 receptor. The aim of this study was to investigate the protective effect of Montelukast on skeletal muscle reperfusion injury created as acute ischemia-reperfusion (IR) injury in Wistar-albino rats.
METHODS: The study comprised 16 male Wistar-albino rats. The rats were randomly separated into two groups as control (IR) and treatment (IR+Montelukast). Ischemia was obtained using a femoral artery clamp. After reperfusion following a 2-hour ischemia, muscle samples were taken for biochemical and histopathological analyses.
RESULTS: Malondialdehyde levels were determined to be at statistically higher levels in the control compared with that in the Montelukast group (p=0.002, p<0.01). The superoxide dismutase levels were determined to be at statistically higher level in the Montelukast group compared with that in the control group (p=0.001, p<0.01). In the histopathological examination of the ischemic muscles, edema, polymorinfiltration and erythrocyte extravasation levels were found to be statistically significant higher in the control group than in the Montelukast group. Edema, polymorphonuclear infiltration, and erythrocyte extravasation levels were observed to be significantly reduced in the treatment group compared with that in the control.
CONCLUSION: In this model of skeletal muscle acute IR injury, the protective effect of Montelukast against skeletal muscle reperfusion injury was emphasized. We concluded that Montelukast could accelerate functional recovery in the extremity by limiting the local and systemic complications caused by reperfusion in cases such as extremity trauma with vascular injuries and extremity surgery with prolonged tourniquet application. However, further experimental and clinical studies are required to confirm this effect.

AMAÇ: Aðýr yanýk birçok yaralýda akut akciðer hasarýna neden olmakla birlikte iliþkin mekanizmalar pek araþtýrýlmamýþtýr. Mikro RNA’lar (miRNA’lar) sayýsýz fizyolojik ve fizyopatolojik sürecin önemli düzenleyicidirler. Ancak yanýða baðlý akciðer hasarýnda miRNA’larýn rolü test edilmemiþtir.
GEREÇ VE YÖNTEM: Altý saðlýklý erkek Sprague–Dawley sýçaný yanýk ve plasebo gruplarýna rastgele daðýtýldý. Yanýk olayýndan 24 saat sonra hematoksilen-eozin (HE) boyasýyla akciðer hasarý deðerlendirildi. Farklý oranlarda eksprese edilen miRA’lar dizilim hibridizasyonu ile belirlenmiþ, gerçek zamanlý nicel polimeraz zincir reaksiyonuyla (RT-qPCR) doðrulanmýþtýr. Biyoinformatik analizi ile hedef genler öngörüldü. Potansiyel olarak iliþkili biyolojik süreçler ve yolaklarý tanýmlamak için sýrasýyla Gen Ontolojisi (Gene Ontology) ve Kyoto Gen ve Geom Ansiklopedisi (Kyoto Encyclopedia of Genes and Genomes) veri tabanlarý kullanýldý. Akciðeri nötrofil infiltrasyou ve akciðer apoptozu miyeloperoksidaz immünohistokimyasal boyamasý (MPO) ve TUNEL (terminal dezoksinükleotidil transferaz-aracýlý dUTP nick- end labeling) yöntemiyle doðrulandý.
BULGULAR: HE boyalý kesitler açýkça akciðer hasarýný gösterdi. Toplam 21 ‘up’regüle ve 3 ‘down’regüle miRNA saptandý. Bu miRNA’larýn hedef genleri en yüksek oranda enflamasyon ve apoptozla iliþkili GO biyolojik süreç ve yolaklarý içerdi. MPO ve TUNEL boyamasýyla enflamasyon ve apoptoz doðrulandý.
TARTIÞMA: Farklý oranlarda eksprese edilen miRNA’lar enflamasyon ve apoptoza katýlarak yanýða baðlý akciðer hasarýnda en büyük olasýlýkla rol oynarlar.

BACKGROUND: Severe burn causes acute lung injury in many victims, but the related mechanisms have been barely investigated. microRNAs (miRNAs) important regulators in numerous physiological and pathophysiological process. However, the roles of miRNAs in burn lung injury are untested.
METHODS: Six healthy male Sprague–Dawley rats were randomly assigned into burn and sham groups. Lung injury was evaluated by hematoxylin and eosin (HE) staining at 24 h after injury. Differentially expressed miRNAs were determined by array hybridization and verified by real-time quantitative polymerase chain reaction (RT-qPCR). Bioinformatics analysis was undertaken to predict the target genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes databases were employed to identify potentially related biological processes and pathways, respectively. Neutrophil infiltration and apoptosis of the lung were confirmed by immunohistochemical staining of myeloperoxidase (MPO) and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL).
RESULTS: HE sections showed obvious lung injury, and 21 upregulated and three downregulated miRNAs were detected. Target genes of these miRNAs were most highly enriched in inflammation and apoptosis related GO biological processes and pathways. Inflammation and apoptosis were confirmed by MPO and TUNEL staining.
CONCLUSION: The differentially expressed miRNAs most likely participate in burn-induced lung injury by being involved in inflammation and apoptosis.

AMAÇ: Çalýþmanýn amacý, travmatik beyin hasarý nedeniyle yoðun bakým yatýþý yapýlan çocuklarda morbidite ve mortaliteye etki eden faktörleri belirlemektir.
GEREÇ VE YÖNTEM: Eylül 2014–Aralýk 2016 arasýnda 88 hasta deðerlendirildi. Glaskow koma skoruna göre üç grupta incelenen hastalarýn acil servis ve yoðun bakým süreçleri, verilen anti-ödem tedavileri, hedef serum ozmolariteye ulaþma süreleri, aksonal hasar varlýðý, entübasyon, trakeostomi oranlarý, yoðun bakým ve hastane yatýþ süreleri, Rotterdam-CT skorlamasý, travma þiddet ve PRISM–III skorlarý kayýt edildi.
BULGULAR: Yaþ arttýkça kafa travmasý þiddetinin arttýðý görüldü (p=0.010). Beyin ödemi tedavisi alan hastalarda, hedef serum ozmolariteye (ölçülen) ulaþma zamaný 8.5 (3.5–40) saat idi. ICP monitorizasyon oraný %8 olup, monitorizasyon yapýlamadýðý durumda takiplerin tekrarlayan tomografiler ile yapýldýðý ancak tedavi sürecini deðiþtirmediði saptandý. Aksonal hasarýn entübasyon, yoðun bakým ve hastane yatýþ sürelerini uzattýðý saptandý (p<0.001, p<0.001, p=0.030). Altý hastaya 14.33±1.03 günde trakeostomi açýldý; beþinin trakeostomileri ilk altý ay içinde kapatýldý.
TARTIÞMA: Mortalitenin %12.5 olduðu görüldü; hipotansiyon, akciðer kontüzyonu, travma þiddet ve Rotterdam-CT skorlarýnýn mortalite ile iliþkili idi. Rotterdam-CT skorunun sað kalýmda etkili baðýmsýz risk faktörü olduðu (p=0.001), skordaki bir birimlik artýþýn sað kalým oranýný 13.235 kat artýrdýðý (%95 GA 2.792–62.735); travma þiddet skorunun ise sýnýrda anlamlý olduðu saptandý (p=0.052; OO: 1.195 %95 GA 0.999–1.430). Beyin ölümü tanýsý alan altý hastanýn beþi hasta organ donorü oldu.

BACKGROUND: To explore the mortality risk factors of traumatic brain injury in pediatric intensive care unit admissions.
METHODS: Eighty-eight children (categorized using the Glasgow Coma Scale) between September 2014 and December 2016 were analyzed. Emergency department and intensive care course, treatment strategies, axonal injury, intubation and tracheostomy rates, length of intensive care and hospitalization, Rotterdam-CT scores, injury severity scores, and PRISM-III scores were recorded.
RESULTS: Older age was associated with trauma severity (p=0.010). Target serum osmolality was reached at 8.5 (3.5–40) hours in patients undergoing anti-edema therapy. ICP-monitoring rates was 8%; in absence of ICP-monitorization clinical follow-up was performed through repeated brain tomographies. Axonal injury was associated with prolonged intubation, intensive care and hospital stay (p<0.001, p<0.001, p=0.030). Six children required tracheostomy at 14.33±1.03 days; decannulations were performed within 6 months in five children.
CONCLUSION: Mortality rate was 12.5%; six patients progressed to brain death with organ donor approvals in five. Initial hypotension, lung contusion, injury severity scores and Rotterdam-CT scores were related with mortality. Rotterdam-CT score was determined as the independent risk factor for mortality; one increment in the score increased the odd of recovery by 20.334 times (%95 CI 1.999–206.879). ISS score was also borderline significant (p=0.052; OR: 1.195 %95 CI 0.999–1.430).

AMAÇ: Çalýþmanýn amacý inkarsere herni nedeniyle acil ameliyat planlanan hastalarda ameliyat öncesi dönemdeki nötrofil/lenfosit oraný (NLR) ile olasý baðýrsak rezeksiyonu gerekliliði arasýnda iliþki olup olmadýðýnýn araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Ýnkarsere herni nedeniyle ameliyat edilen 102 hastanýn verileri geriye dönük olarak incelendi. Ameliyat öncesi tam kan sayýmlarý ile yapýlan ameliyat ve varsa patoloji sonuçlarý kaydedildi. Baðýrsak rezeksiyonu yapýlan hastalarla yapýlmayan hastalar lökosit sayýsý, nötrofil oraný, eritrosit daðýlým geniþliði (RDW), trombosit daðýlým geniþliði (PDW), NLR, trombosit/lenfosit oraný (PLR) ve ortalama trombosit hacmi (MPV) açýsýndan karþýlaþtýrýldý.
BULGULAR: Hastalarýn 81’i inkarsere inguinal herni, 17’si inkarsere umblikal herni ve dördü de inkarsere insizyonel herni nedeniyle ameliyat edilmiþti. Hastalardan 26’sýna (%25) ameliyat sýrasýnda baðýrsak rezeksiyonu yapýlmýþ ve dördünde baðýrsak perforasyonu saptanmýþtý. Baðýrsak rezeksiyonu yapýlan grupta nötrofil oraný, PDW, NLR ve PLR deðerleri baðýrsak rezeksiyonu yapýlmayan gruba göre anlamlý oranda yüksekti.
TARTIÞMA: Yüksek NLR deðerleri klinikle birlikte deðerlendirildiðinde; özellikle görüntüleme yöntemlerinin kullanýlamadýðý durumlarda inkarsere herni nedeniyle ameliyat edilecek hastalarda baðýrsak nekrozu ve rezeksiyon gerekliliðini ameliyat öncesi dönemde öngörmede yardýmcý bir belirteç olarak kullanýlabilir.

BACKGROUND: The aim of this study was to evaluate the relationship between preoperative hematological inflammatory markers of the patients who underwent a surgery for incarcerated hernia and intestinal resection requirement.
METHODS: The data of 102 patients who underwent a surgery for incarcerated hernia were retrospectively evaluated. Whole blood cell counts were preoperatively measured, and operation types and pathology results were recorded. The patients with intestinal resections were compared with those without any resection in terms of leukocyte number, neutrophil rate, red cell distribution width (RDW), platelet distribution width, neutrophil-to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and mean platelet volume (MPV).
RESULTS: Eighty-one patients were operated for incarcerated groin hernia, 17 for incarcerated umbilical hernia, and 4 for incarcerated incisional hernia. Twenty-six patients (25%) had intestinal resections; in 4 of them, intestinal perforation was detected. In patients with intestinal resections,the neutrophil rate, PDW, NLR, and PLR values were significantly higher than those in the patients without any resections.
CONCLUSION: High NLR rates, certainly with clinical correlation, can be used as a biomarker to predict intestinal necrosis and the need for intestinal resection in patients who will undergo surgery for incarcerated hernia, particularlyin situations with lacking radiological imaging methods.

AMAÇ: Akut apandisit (AA) gerek taný anýnda yaþanan güçlükler nedeniyle gerekse de etiyopatogenetik bilinmeyenler açýsýndan halen araþtýrýlmaya devam eden önemli bir acil cerrahi patolojidir. Hücrede temel biyolojik iþlevleri olan, biyolojik bir belirteç olabilen ve çeþitli patolojiler ile iliþkilendirilmiþ mikroRNA’larýn (miRNA) AA’lý hastalardaki rolü hakkýnda bugün için yeterli bir veri bulunmamaktadýr. Bu çalýþma ile bazý miRNA’larýn AA’daki ekspresyonlarýný araþtýrmak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Erciyes Üniversitesi Genome and Stem Cell Center (GENKOK) Merkezi’nde 24 AA’lý ve 24 saðlýklý toplam 48 bireye ait numunelerde 41 miRNA’nýn real time PCR ile taramasý yapýldý. Elde edilen veriler uygun istatistiksel testlerle deðerlendirildi.
BULGULAR: Akut apandisitli hastalarýn ilk dört–altý saatlik döneminde miR-29c-3p iki kat arttý, bu yükselme saðlýklý bireylere göre istatistiksel açýdan anlamlý bulundu. Benzer þekilde let-7b-5p, let-7i-5p, miR-30a-5p, miR-29b-3p ve miR-23a-3p ekspresyonlarý da AA’da yaklaþýk iki kat artýþ gösterdi, ancak istatistiksel açýdan anlamlýlýk saptanmadý. Geri kalan 35 miRNA taramasýnda, AA’lý hastalar için özellik tespit edilmedi.
TARTIÞMA: Akut apandisit ve miRNA arasýndaki iliþki hakkýnda þimdiye kadar elde edilmiþ yeterli veri olmamasýna raðmen, mevcut araþtýrmaya göre AA’lý hastalarda akut dönemde miR-29c-3p’nin yükseldiði tespit edilmiþtir. Elde edilen bu veri ile miR-29c-3p’nin AA’lý hastalarda bir belirteç olabilme potansiyeli taþýdýðý ileri sürülebilecektir. Bu çalýþmanýn, alanýnda ihtiyaç duyulan daha geniþ miRNA taramalarýna temel bir araþtýrma olabileceði de düþünülmüþtür.

BACKGROUND: Acute appendicitis (AA) is a momentous, emergency, surgical pathology that has still been investigated for both etiopathogenetic unknowns and challenges in diagnosis. Presently, there is little information about the role of microRNAs (miRNAs), which have basic biological functions in the cell, can be a marker, and are associated with various pathologies, in patients with AA. The aim of this study was to investigate the expressions of some miRNAs in AA.
METHODS: Overall, 41 miRNAs were screened in 48 individuals comprising 24 patients with AA and 24 healthy controls at Erciyes University Genome and Stem Cell Center (GENKOK). The obtained data were analyzed using appropriate statistical methods.
RESULTS: miR-29c-3p was found to be increased 2-fold during the first 4–6 h in AA, and this increase was revealed to be statistically significant compared with healthy individuals. Similarly, expressions of let-7b-5p, let-7i-5p, miR-30a-5p, miR-29b-3p, and miR-23a-3p also increased approximately 2-fold in AA, although not statistically significant. No significant differences were found in the screening of the remaining 35 miRNAs in patients with AA.
CONCLUSION: Although there is little information about the relationship between AA and miRNAs currently, miR-29c-3p was reported to increase in the acute period of AA in this study. With the current results, it can be argued that miR-29c-3p bears the potential to be a marker in patients with AA. The present study may also be a basic research for more extensive and necessary miRNAs screening in this field.

AMAÇ: Trafik kazalarý halen ülkemizde önemli bir halk saðlýðý sorunu olup, araç içi trafik kazalarý da önemli bir morbidite ve mortalite nedenidir. Bu çalýþmada, trafik kazalarýnda kazazedenin araç içi pozisyonunun morbidite ve mortalite üzerine olan etkisinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Ege Üniversitesi Týp Fakültesi Hastanesi Acil Servisi’ne 01.05.2014–30.11.2014 tarihleri arasýnda araç içi trafik kazasý sonucu yaralanma nedeniyle baþvuran olgulardan onam verenler çalýþmaya dâhil edildi.
BULGULAR: Çalýþmaya dâhil edilen 519 olgunun 329’u (%63.4) erkek, 190’ý (%36.6) kadýndý. Yaþlarý 0–85 arasýnda deðiþmekte olup ortalamasý 33.11±16.86 olarak bulundu. Kazalarýn en sýk 18.00–23.59 saat aralýðýnda (%36.3), otomobil içinde (%79) ve bir baþka araçla çarpýþma (%61.7) sonucu gerçekleþtiði tespit edildi. Kazazedelerin %39.5’inin sürücü, %26.4’ünün sürücü yaný yolcu olduðu saptanmýþ olup, 110 km/sa hýzýn üzerinde oluþan kazalarda, 110 km/sa hýzýn altýnda olan kazalara göre, adli týbbi açýdan, yaralanmanýn yaþamsal tehlike oluþturmasýnýn yaklaþýk üç katýna (%37.5–%13.6), basit bir týbbi müdahale ile giderilemeyecek olmasýnýn ise yaklaþýk iki katýna (%56.3–%26.3) çýktýðý belirlendi.
TARTIÞMA: Trafik kazalarýnda yaralanan veya ölen kiþilerin çoðunun aktif iþ yaþamýnda olmasý, taný ve tedavi giderlerinin yanýnda ciddi bir rehabilitasyon ve iþ gücü kaybý oluþturmaktadýr. Bu çalýþma ve benzer çalýþmalar, alýnan önlemlerin etkinliklerini gösterdiði gibi deðiþen yaralanma profillerinin de anlaþýlmasý ve bunlarý önlemek için alýnacak önlemlere ýþýk tutmasý açýsýndan önemlidir.

BACKGROUND: Traffic accidents are still an important public health issue in our country and intra-vehicle accidents cause substantial morbidity and mortality. In this study, we aimed to investigate the effect of seating position on morbidity and mortality in traffic accidents.
METHODS: Patients who were admitted to the Emergency Department, Faculty of Medicine, Ege University between May 1, 2014 and November 30, 2014 due to injuries in motor vehicles and who signed informed consent were included.
RESULTS: In total, 519 cases were included, and 329 (63.4%) were male and 190 (36.6%) were female. The average age was 33.11±16.86 (range, 0–85) years. It was noted that the accidents most frequently occurred between 18.00 and 23.59 (36.3%) hours, in the car (79%), and due to collision with another car (61.7%). Although 39.5% of the injured individuals were drivers, 26.4% were front seat passengers. From a forensic medicine perspective, life-threatening injuries were approximately twice more common (37.5%–13.6%) in accidents with >110 km/h speed compared with accidents with <110 km/h speed. Accidents with >110 km/h speed caused approximately twice the amount (56.3%–26.3%) of injuries that cannot be resolved with simple medical intervention compared with accidents with <110 km/h speed.
CONCLUSION: Since most people who are injured or die in traffic accidents have an active professional life, significant rehabilitation expenditure and labor loss occur along with diagnosis and treatment costs. Our study and similar studies not only show the effectiveness of the measures taken but also provide an insight into changing injury profiles and precautions to prevent them.

AMAÇ: Hedef popülasyona (ani kalp durmasý yönünden potansiyel riskleri taþýyan hastalarýn aile üyeleri) yönelik hastane merkezli bir kardiyopulmoner resüsitasyon eðitim modeli geliþtirilmiþ olup, geçerli kýlmak amacýyla hedef popülasyon ile hedef dýþýnda kalan popülasyon arasýnda CPR eðitim sonuçlarýný karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Hastalarýn eðitim sürecindeki aile üyeleri hastanýn rahatsýzlýðýna baðlý olarak üç gruba ayrýlmýþtýr: 1) ani kalp durmasý riski taþýyan kalp hastalarýnýn aile üyelerinin dahil edildiði kardiyak (CS) risk grubu; 2) kardiyovasküler hastalýk yönünden risk faktörlerini taþýyan hastalarýn aile üyelerinin dahil edildiði kardiyovasküler (CV) risk grubu; ve 3) risk taþýmayan grup. Eðitim öncesi ve eðitim sonrasý anketler ve beceri testleri ile eðitim sonrasýnda 3 ay süreyle telefon üzerinden gerçekleþtirilen bir anket uygulanmýþtýr. Eðitime iliþkin sonuçlar deðerlendirilmiþtir.
BULGULAR: Toplam 203 aile üyesinin, 21 ayrý CPR eðitim sýnýfýna kaydý gerçekleþtirilmiþtir. CV grubuyla (n=79) ve risk taþýmayan grupla (n=36) kýyaslandýðýnda CS grubunda (n=88) eðitim düzeyi daha düþük olan ev hanýmlarý ve yaþlý bireyler yer almýþtýr. CS grubu, saðlýk uzmanlarý tarafýndan motive edilerek eðitime katýlmýþtýr. CS, CV ve risk taþýmayan gruplarda bilgi, CPR gerçekleþtirme konusundaki isteklilik ve beceriler yönünden ilerleme olduðu kaydedilmiþtir. CS grubunda yaþlý bireylere ve eðitim düzeyinin düþük olmasýna raðmen, eðitimin katkýsý diðer gruplardaki kiþilerle benzerlik göstermiþtir. CS grubunda, CPR eðitiminin getirdiði ilave yararlar ve yüksek yanýt oraný gözlenmiþtir.
TARTIÞMA: Kalp rahatsýzlýðý olan hastalarýn aile üyeleri, özellikle iyileþme ve ilave yararlar açýsýndan CPR eðitimi için uygun bir hedef popülasyon teþkil edebilmektedir. Hedefe yönelik uygulamalar, CPR iþlemini gerçekleþtirecek olan üçüncü kiþilerin sayýsýný artýrmak amacýyla etkili bir eðitim stratejisi olabilmektedir.

BACKGROUND: We developed a hospital-based cardiopulmonary resuscitation (CPR) training model focused on the target population (family members of patients with potential risks for cardiac arrest) and compared the outcome of CPR training between target and non-target populations for validity.
METHODS: Family members of patients in training were divided into three groups on the basis of patients’ diseases, as follows: 1) the cardio-specific (CS) risk group, including family members of patients with cardiac disease at risk of cardiac arrest; 2) the cardiovascular (CV) risk group, including family members of patients with risk factors for cardiovascular disease; and 3) the no-risk group. Pre- and post-training surveys and skill tests as well as a post-training 3-month telephone survey were conducted. Educational outcomes were analyzed.
RESULTS: A total of 203 family members were enrolled into 21 CPR training classes. The CS group (n=88) included elderly persons and housewives with a lower level of education compared with the CV (n=79) and no-risk groups (n=36). The CS group was motivated by healthcare professionals and participated in the training course. The CS, CV, and no-risk groups showed improvements in knowledge, willingness to perform CPR, and skills. Despite the older age and lower level of education in the CS group, the effects of education were similar to those in the other groups. A high rate of response and secondary propagation of CPR training were observed in the CS group.
CONCLUSION: Family members of patients with heart disease could be an appropriate target population for CPR training, particularly in terms of recruitment and secondary propagation. Targeted intervention may be an effective training strategy to improve bystander CPR rates.

AMAÇ: Bu çalýþmada, kardiyoloji ünitemizde gerçekleþtirilen endovasküler tedavide baþarýsýz olan, travmatik arteriovenöz fistüllü (AVF) hastalarda cerrahi deneyimimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Eylül 2014–Mayýs 2016 tarihleri arasýnda travmatik AVF’si olan toplam 27 hasta ameliyat edildi. Yaralanma yeri, cerrahi zamanlamasý ve kullanýlan cerrahi yöntemler geriye dönük olarak incelendi.
BULGULAR: Arteriyovenöz fistüller alt ekstremitede 26 hastada (%96.29), üst ekstremitede tek bir olguda (%3.7) bulundu. Etiyolojik faktörler 23 hastada (%85.18) ateþli silah yaralanmasý ve dört hastada (%14.81) penetran yaralanma idi. Alt ekstremitedeki AVF’ler, 21 hastada popliteal arter ve ven arasýnda, beþ hastada femoral arter ile ven arasýnda idi. Üst ekstremite AVF’li tek olguda brakiyal arter ve sefalik ven arasýnda iletiþim vardý. Cerrahi onarým için ligasyondan sonra arter ve venin primer onarýmý, arteriyel greft interpozisyon artý primer ven tamiri ve arteryal ve venöz greft interpozisyonu iki, beþ ve 20 hastada gerçekleþtirildi. Tüm olgularda safen ven greft olarak kullanýldý.
TARTIÞMA: Majör vasküler yapýlarýn yakýnýnda penetran travmalara maruz kalan hastalarda oskültasyon ile birlikte ayrýntýlý öykü alma ve fizik muayene yapýlmalýdýr. Arteriyovenöz fistüller cerrahi olarak veya endovasküler giriþimle (kaplý stent greft veya embolizasyon) tedavi edilebilir. Son yaklaþým, daha düþük komplikasyon oranlarý, prosedürün invaziv olmayan doðasý ve hastane içi maliyetlerin azalmasý ve iþ verimliliðinde azalma temel alýnarak ilk tercih yönetimini temsil edebilir. Bununla birlikte hemodinamik olarak kararsýz, endovasküler tedavi için uygulanabilir olmayan veya endovasküler tedavinin baþarýsýz olduðu hastalarýn önemli bir bölümünde ameliyat kaçýnýlmazdýr.

BACKGROUND: To present the surgical experience at a tertiary academic center of treating patients with traumatic arteriovenous fistulas (AVFs) who in whom endovascular treatment was contraindicated or in whom unsuccessful endovascular treatment had been performed.
METHODS: A total of 27 patients with traumatic AVFs who underwent surgery between September 2014 and May 2016 were included. The site of injury, timing of surgery, and the surgical methods utilized were analyzed retrospectively.
RESULTS: Arteriovenous fistulas were located in the lower extremity in 26 patients (96.29%) and in the upper extremity in one patient (3.7%). Etiological factors included gunshot injuries in 23 patients (85.18%) and penetrating injury in four patients (14.81%). AVFs in the lower extremity were between the popliteal artery and vein in 21 patients and between the femoral artery and vein in five patients. The one patient with upper-extremity AVF had a communication between the brachial artery and cephalic vein. Primary repair of the artery and vein after ligation, arterial graft interposition plus primary vein repair, and arterial and venous graft interposition were performed for surgical repair in two, five, and 20 patients, respectively. The saphenous vein was used for grafting in all cases needing grafts.
CONCLUSION: In patients enduring penetrating trauma in the close vicinity of major vascular structures, a detailed history-taking and physical examination should be performed along with auscultation. The endovascular approach may represent the initial choice of management because of its lower rate of complications, noninvasive nature, decreased in-hospital costs, and decreased loss of work productivity. However, surgery is still unavoidable option in a significant proportion of patients who are either hemodynamically unstable, contraindicated for endovascular treatment, or in whom endovascular treatment was unsuccessful.

AMAÇ: Bu çalýþmada geriye dönük olarak bilgisayarlý tomografide (BT) saptanan pterygoid plate (PP) kýrýklarý incelenerek, Le Fort kýrýklarý ile iliþkisiz olan PP kýrýk paternlerinin tanýmlanmasý ve sýnýflandýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Hastanemizde Nisan 2014 ile Nisan 2017 tarihleri arasýnda BT’de PP kýrýðý saptanmýþ hastalarýn týbbi bilgileri etik kurul onayý (37–05) alýndýktan sonra incelendi. Klinik bilgilerine ulaþýlamayan, BT görüntüleri tanýsal kalitede olmayan hastalar çalýþma dýþýnda býrakýldý.
BULGULAR: Çalýþmaya 178 hasta dahil edildi. Hastalarýn 135’inde Le Fort tipi kýrýklar (Erkek/Kadýn = 86/49; ortalama yaþ 37.2), 43’ünde (Erkek/Kadýn = 35/8; ortalama yaþ 38.6) Le Fort kýrýklarý ile iliþkisiz PP kýrýklarý saptandý. Le Fort dýþý PP kýrýklarý; zigomatikomaksiller kompleks (%30.2), temporal (%11.6), sphenotemporal buttress (%25.5), deplase mandibula (%23.3) ve nazal (%4.7) kýrýklara eþlik ediyordu. Ayrýca PP kýrýklarý, hastalarýn %4.7’sinde izoleydi. PP kýrýklarý, Le Fort ile birlikte olan ve olmayan hasta gruplarý arasýnda cinsiyet, yaþ, travmanýn tipi bakýmýndan istatistiksel olarak anlamlý iliþki bulunmadý (p>0.05).
TARTIÞMA: Klinik ve radyolojik olarak PP kýrýklarý sýklýkla Le Fort tipi kýrýklarý iþaret etse de izole veya Le Fort dýþý diðer kraniofasial kýrýklarla da az olmayan oranda birlikte görülebilir. Bilgisayarlý tomografi, farklý PP kýrýk paternlerinin tanýsýnda, tedavi þekillerinin belirlenmesinde ve takiplerinde deðerlidir.

BACKGROUND: This study aims to describe the major pterygoid plate fractures (PPFs) patterns unrelated to Le Fort fractures (LFFs) using maxillofacial computed tomography (CT).
METHODS: After obtaining our hospital ethics committee approval (37-05), data for PPF were acquired from the medical records of all the trauma patients who were diagnosed using CT at our hospital from April 2014 to April 2017.
RESULTS: Of the 178 patients, 135 (male/female = 86/49; mean age = 37.2 years) had LFF and 43 (male/female = 35/8; mean age = 38.6 years) had PPF without associated LFF. PPF patterns unrelated to LFF included temporal bone (11.6%), sphenotemporal buttress (25.5%), zygomaticomaxillary complex (30.2%), displaced mandible (23.3%), nasal (4.7%), and isolated fractures (4.7%). The etiologies of facial fractures were not significantly different between both sexes (p=0.576). No significant difference between Le Fort and non-Le Fort groups was found for age (p=0.603) and the causes of trauma (p=0.183).
CONCLUSION: PPF is most commonly seen with LFF, but it may also be seen alone or with other non-LFF indicating that all PPF are not related to LFF. Axial reformatted CT images can easily display PPF and the degree of displacement of the fragments, and they can be used to guide surgical reduction of the fractures.

AMAÇ: Bu çalýþmada Van ilinde burst kýrýðý olan hastalarda, bazý eser element seviyelerini (Zn, Fe, Mn, Mg, Cu, Cd, Co ve Pb) araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma, 15 Haziran 2015 ile 20 Ocak 2016 tarihleri arasýndaki dönemde iki hastaneye baþvuran burst kýrýðý olan hastalardan alýnan serum örnekleri üzerinde yürütüldü. Çalýþma, ek patolojileri olmayan toplam 44 katýlýmcýyý kapsadý. Bunlara, 18 yaþ üzeri patlama kýrýklarý olan ve nöroþirürji bölümüne kabul edilen 22 hasta ve 22 saðlýklý gönüllü dahildi. Mn, Cd, Cu, Pb, Fe, Co ve Zn dahil olmak üzere eser element ve aðýr metallerin serum seviyeleri Atomik Emilim Spektrofotometrisi (AAS) ile analiz edildi.
BULGULAR: Sonuçlar, Zn, Mn, Cu, Co ve Mg iz düzeylerinin anlamlý olarak düþük (p<0.001) olduðunu ve Fe, Cd ve Pb düzeylerinin hasta grubunda kontrol grubuna göre anlamlý olarak daha yüksek olduðunu ortaya koymuþtur. Zn, Mn, Cu, Co ve Mg seviyelerinin daha düþük olduðu ve Fe, Cd ve Pb düzeylerinin kontrol grubuna göre hasta grubunda daha yüksek olduðu bulundu.
TARTIÞMA: Patlamanýn olasýlýðý ve herhangi bir yaralanmaya neden olan sebepleri, hasta grubu ile saðlýklý grup arasýndaki eser element konsantrasyonu için bir gösterge dengesi olarak düþünülebilir ve patlama kýrýðýna maruz kalan kemik ile iliþkili bir risk faktörü olabilir. Burst kýrýðý etiyolojisinde Zn, Cd, Mn, Mg, Pb, Fe, Cu ve Zn düzeyleri önemli rol oynayabilir.

BACKGROUND: This study aimed to determine trace element levels (Zn, Fe, Mn, Mg, Cu, Cd, Co, and Pb) in patients with burst fractures in Van Province, Turkey.
METHODS: The study included a total of 44 participants with no additional pathologies, including 22 patients with burst fractures aged over 18 years who were admitted to the neurosurgery departments at two hospitals between June 15, 2015 and January 20, 2016 and 22 healthy volunteers. Serum samples were obtained from all participants to measure the serum levels of trace and heavy elements, including Mn, Cd, Cu, Pb, Fe, Co and Zn, using atomic absorbance spectrophotometry.
RESULTS: The trace element levels of Zn, Mn, Cu, Co, and Mg were significantly lower (p<0.001), whereas those of Fe, Cd, and Pb were significantly higher in the patient group than in the control group. In addition, the levels of Zn, Mn, Cu, Co, and Mg were lower and the levels of Fe, Cd, and Pb were higher in the patient group than in the control group.
CONCLUSION: The probability of burst fracture and its causes leading to any injury may be considered as an indicator balance for the concentration of trace elements between the patient group and control group and may also be a risk factor associated with the bone exposed to burst fracture Significant changes in serum levels of Zn, Cd, Mn, Mg, Pb, Fe, Cu and Zn elements can be observed in patients with burst fractures.

AMAÇ: Bu çalýþmanýn temel amacý; torasik travmalý hastalarda sternal kýrýk sýklýðýný, farklý sternal zonlarda kýrýðý olan ve deplase ve non-deplase sternal kýrýklý hastalardaki, cerrahi gereksinim, kardiyak bulgular ve tedavi sürecindeki farklýlýklarý belirlemektir.
GEREÇ VE YÖNTEM: Ocak 2011–Aralýk 2015 tarihleri arasýnda bir devlet hastanesine baþvuran torasik travmaya baðlý sternal kýrýklý olgularýn verileri analiz edildi. Hastalarýn verileri, demografik özellikler, travma özellikleri, klinik bulgularý ve tedavi yöntemlerini içermektedir.
BULGULAR: Çalýþma süresince baþvuran 2764 torasik travmalý hastanýn 72’sinde (%2.6) sternal kýrýk saptandý. Hastalarýn medyan yaþlarý 52 (ÇAA: 61–38) iken, aðýrlýðý erkekler oluþturdu (kadýn/erkek: 18/54). Sternal kýrýk olgularýnýn en sýk üç nedeni motorlu taþýt kazasý, düþme ve iþ kazasýydý. Olgularýn 15’inde deplase kýrýk olduðu bulundu. Anormal ekokardiyografi bulgularý, manubrium kýrýklý olgularda, korpus kýrýklý olgulara göre istatistiksel olarak anlamlý þekilde daha fazla idi. Korpus kýrýklý hastalarda, manubrium kýrýklýlara oranla istatistiksel olarak daha az sýklýkta cerrahi ihtiyacý geliþti. Ayrýca, deplase kýrýðý olan ve olmayan hastalar arasýnda cerrahi giriþim gereksinimlerine göre istatistiksel olarak anlamlý farklýlýk vardý (p<0.005).
TARTIÞMA: Manubriumda görülen ve deplase sternal kýrýklarda anormal ekokardiyografi bulgularý daha fazla sýklýkta görülmektedir.

BACKGROUND: This study mainly aimed to determine the frequency of sternal fractures in thoracic trauma patients and to assess the differences in surgical need, cardiac findings, and treatment processes between patients with fracture on different sternal zones and displaced and non-displaced sternal fractures.
METHODS: We analyzed the data of patients with sternal fracture due to thoracic trauma admitted to a state hospital between January 2011 and December 2015. Patient data comprised demographics, trauma characteristics, clinical findings, and treatment process.
RESULTS: Of the 2764 thoracic trauma patients admitted during the study period, 72 (2.6%) had sternal fracture. The median age was 52 (inter quartile range: 61–38) years; the patients were predominantly male (F/M: 18/54). The most common causes of sternal fractures were motor vehicle accident, fall, and work accident. Of all the patients, 15 had displaced fracture. Abnormal echocardiogram findings were significantly more frequent in patients having fractures on the manubrium than in those having fractures on the corpus of the sternum. Patients who had fracture on the corpus had significantly lesser surgery need than those who had fracture on the manubrium of the sternum. Also, there was statistically significant difference between displaced and non-displaced sternal fracture cases in terms of surgery need (p<0.005).
CONCLUSION: Abnormal echocardiography findings were more frequent in patients with sternal fracture on the manubrium and displaced fracture.

AMAÇ: Eklem içi ve parçalý distal radius kýrýklarýnýn tedavisinde volar kilitli plak uygulamasý ile K teli destekli eksternal fiksatör uygulamasýnýn fonksiyonel ve radyolojik sonuçlarýnýn karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Þubat 2010–Nisan 2013 tarihleri arasýnda kompleks intraartiküler distal radius kýrýðý için tedavi edilmiþ hastalar geriye dönük olarak tarandý. Dâhil edilme kriterlerini karþýlayan 18 ile 86 yaþ arasýnda (ortalama yaþ, 44.9±15.4) 114 hasta deðerlendirildi. Hastalarýn fonksiyonel deðerlendirmelerinde gonyometre ile eklem hareket açýklýklarý ve el dinamometresi ile kavrama güçleri ölçüldü. Sonuçlar Gartland–Werley ölçeði ile deðerlendirildi. Subjektif fonksiyonel deðerlendirmede Quick DASH ölçeði kullanýldý. Radyolojik deðerlendirme hastalarýn ameliyat sonrasý üçüncü ay ve ikinci yýlda el bileði grafileri ile yapýldý.
BULGULAR: Son kontroldeki fonksiyonel deðerlendirmede volar kilitli plakta (VLP) fleksiyon, ekstansiyon, pronasyon ve supinasyon eksternal fiksatörden (EF) anlamlý düzeyde yüksekti (p=0.001). Volar kilitli plaðýn Gartland-Werley skoru, QuickDASH skoru ve vizüel analog skoru (VAS), EF’den iyiydi (p=0.003, p=0.003 ve p=0.001, sýrasýyla). VLP’de ameliyat sonrasý son kontrolde saðlam tarafa göre kavrama gücü kaybý ortalama %4, EF’de ise %7 oranýndaydý.
TARTIÞMA: Volar kilitli plaðýn güvenli ve komplikasyondan uzak bir yöntem olduðu görülmüþtür. Volar kilitli plak günlük yaþam aktivitelerine erken dönüþ, fonksiyonel ve radyolojik sonuçlar açýsýndan tedavinin ikinci yýlýnda eksternal fiksatörden daha üstün bir yöntemdir.

BACKGROUND: The aim of this study was to compare the functional and radiological outcomes of K-wire-supported bridging external fixation (KW-EF) and volar locking plate (VLP) in the treatment of comminuted intra-articular distal radius fractures.
METHODS: Patients treated for complex intra-articular distal radius fractures between February 2010 and April 2013 were retrospectively investigated. A total of 114 patients (42 females and 72 males) with a mean age of 44.9±15.4 (range: 18–86) years were evaluated. Wrist ranges of motion were measured using a universal goniometer, and hand grip strength was determined using hand dynamometers. The results were evaluated with Gartland–Werley score. QuickDASH questionnaire was administered in subjective functional assessment. Radiological evaluations were performed, with wrist radiographs obtained on the 3rd month and 2nd year.
RESULTS: Wrist flexion, extension, pronation, and supination were all significantly better in the VLP group than in the KW-EF group at last control (p=0.001). Gartland–Werley, QuickDASH, and Visual Analog Scale were significantly better in the VLP than group than in the KW-EF group (p=0.003, p=0.003, and p=0.001, respectively). At the last follow-up, loss of grip strength compared with that on the uninjured side was 4% in the VLP group and 7% in the KW-EF group.
CONCLUSION: VLP is a safe method with low complication rates. It is superior to KW-EF as it facilitates early return to daily activities and shows better functional and radiological outcomes in the 2nd year of treatment.

AMAÇ: Tibia plato kýrýklarýnda, hibrid eksternal fiksatör uyguladýðýmýz hastalarýmýzýn klinik sonuçlarýný sunmayý ve uyguladýðýmýz joystik tekniðinin detaylarýný sunmayý amaçladýk. Tekniðimizde Shanz çivileri eþzamanlý joystik olarak kullanýlmakta ve redüksiyon saðlanmaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýz AO sýnýflama sistemine göre tip 41-C2 olan 72 bikondiler tibia plato kýrýklý hastayý içermektedir. Eklem redüksiyonu, kondillerden geçen shanz çivilerinin floroskopi eþliðinde eþ zamanlý yapýlmasý ilksine dayanmaktadýr. Daha sonra hybrid eksternal fiksatör sistemine adapte edilmektedir.
BULGULAR: Ortalama hasta yaþý 39 (21–67) ve ortalama takip süresi 21 (12–35) ay idi. ortalama diz fleksiyon ve ekstansiyon deðerleri sýrasý ile 105 (80–125) ve 0 (-5–7) dereceydi, ortalama varus ve valgus laksitesi 4.3 (2–7) ve 3.1 (2–5) dereceydi. Dört hastada 0.4–11 cm arasýnda deðiþen ekstremite kýsalýðý mevcuttu. Knee Society Clinical Rating System (KSS) skoru birinci yýl sonunda 48 hasta için mükemmel ve 19 hasta için iyiydi. Beþ hasta için yetersizdi.
TARTIÞMA: 6.5 mm kalýnlýðýnda Shanz çivileri ile eþ zamanlý yapýlan tekniðimizle kýsa cerrahi sürede hastanýn kýrýðý floroskopi eþliðinde redükte edilmekte ve fiksasyonu saðlanmaktadýr. Hiçbir hastada majör komplikasyon geliþmedi, erken yük verme ve hareket ile günlük yaþama çabuk döndüler.

BACKGROUND: This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction.
METHODS: The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system.
RESULTS: The median age of the patients was 39 (21–67) years, and the median follow-up time was 21 (12–35) months. The mean knee flexion and extension were 105° (80°–125°) and 0° (−5°–7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°–7°) and 3.10° (2°–5°), respectively. Four patients had leg shortness of 0.4–1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were “excellent” for 48 patients, “good” for 19 patients, and “inadequate” for 5 patients.
CONCLUSION: With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.

AMAÇ: Yaþlý popülasyondaki intertrokanterik femur (ÝTF) kýrýklarýnýn tedavisinde, redüksiyon kaybýný önlemek, erken mobilite saðlamak ve baðýmsýz yaþamýn restorasyonu için stabil kýrýk fiksasyonu çok önemlidir. Bu çalýþmanýn amacý, entegre iki sefaloservikal vida mekanizmasý içeren trokanterik antegrad intramedüller çivi (Intertan®; Smith & Nephew, Memphis, TN) kullanýlarak cerrahi tedavi edilen stabil ve instabil ÝTF kýrýklarýnýn sonuçlarýný ortaya koymak ve redüksiyon kaybý ile femur boynuna giden iki vidanýn pozisyonu arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmada 2010 ve 2011 yýllarý arasýnda ÝTF kýrýðý olan ve Intertan® ile cerrahi tedavi edilen 57 hasta (22 erkek, 35 kadýn) tüm plan deformiteleri ve redüksiyon kaybý açýsýndan incelendi. Redüksiyon kaybýný tarif etmek amacýyla iki indeks (frontal planda vida hiza indeksi [VHÝkoronal] ve lateral planda vida hiza indeksi [VHÝlateral]) belirlendi. Hastalar ayrýca Harris kalça skoru ve Barthel indeksine göre de deðerlendirildi.
BULGULAR: Ortalama hasta yaþý 77.1, ortalama takip süresi 21.7 aydý. Tüm hastalarda tam kaynama elde edildi. Hiçbir hastada varus kollapsý ya da redüksiyon kaybý gözlenmedi. Takip süresi sonunda, ortalama Barthel indeksi 90.7 olarak bulunurken, ortalama Harris kalça skoru 83.7 olarak belirlendi.
TARTIÞMA: Femur baþ/boyun fragmanýnýn rotasyonel stabilitesini saðlamaya ve lineer intraoperatif kompresyona olanak tanýyan, entegre iki sefaloservikal vida mekanizmasý içeren trokanterik antegrad intramedüller çivi, redüksiyon kaybýný önler ve femur baþýnda geniþ uygulama sahasý mevcuttur. Mekanizmanýn doðasý, stabilitenin devamlýlýðýný saðlayarak erken yük verdirilmesine ve erken mobilizasyona olanak tanýr. Ýntertrokanterik femur kýrýklarýnýn tedavisinde güvenli ve etkili bir tedavi seçeneðidir.

BACKGROUND: Stable fracture fixation is important in the treatment of intertrochanteric femur (ITF) fractures in the elderly population to prevent the loss of reduction, achieve early mobility, and restore independence. The aim of this study was to present the results of surgical treatment of stable and unstable ITF fractures using a trochanteric antegrade intramedullary nail with two cephalocervical screws in an integrated mechanism (Intertan®; Smith & Nephew, Memphis, TN) and evaluate the relationship between the loss of reduction and screw position in the femoral neck in two planes.
METHODS: The authors investigated all varus misalignments and losses of reduction in 57 patients (22 males, 35 females) treated for ITF fractures with the Intertan® between 2010 and 2011. Two indices (screw alignment index in the frontal projection [SAIcoronal] and screw alignment index in the lateral projection [SAIsagittal]) were defined to evaluate the loss of reduction. Patients were also evaluated according to the Harris hip score and Barthel independence index.
RESULTS: The mean patient age was 77.1 years. The mean follow-up period was 21.7 months. All patients achieved complete union. We did not detect any varus collapse or loss of reduction. At the end of the follow-up period, the mean Barthel independence index was 90.7, and the mean Harris hip score was 83.7.
CONCLUSION: The use of a trochanteric antegrade intramedullary nail with two cephalocervical screws allows for linear intraoperative compression and rotational stability of the head/neck fragment, prevents reduction loss, and has a wide application area in the femoral head. Its inherent continuous stability permits early weight-bearing and mobilization. It is a safe and an efficient option for the treatment of ITF fractures.

AMAÇ: Eþplanlama medial akromiyal spurlarýn ve distal klavikulanýn alt kýsmýnýn çýkarýlmasý demektir. Bu çalýþmanýn amacý, akromiyoklaviküler artrit olmayan hastalarda, eþplanlama uygulanan ve uygulanmayan artroskopik akromiyoplasti tedavisi yapýlan hastalarýn deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Sýkýþma sendromu nedeniyle, Grup 1’deki hastalara (9 erkek/31 kadýn) artroskopik subakromiyal dekompresyon ve akromiyoplasti uygulandý. Ayný endikasyon ile Grup 2’deki hastalara (8 erkek/21 kadýn) Grup 1’deki tedaviye ilave olarak eþplanlama uygulandý. Ortalama yaþ, Grup 1’de 48, Grup 2’de 46 idi. Ortalama takip süresi sýrasýyla 50 ay ve 44 ay idi.
BULGULAR: Takipte Constant skoru, çapraz addüksiyon testi ve akromiyoklaviküler hassasiyet kullanýldý. Ortalama ameliyat öncesi Constant skoru Grup 1’de 45 (aralýk: 34–76), Grup 2’de 39 (aralýk: 32–69) olarak bulundu. En son takipte ortalama Constant skorlarý Grup 1 için 78 (aralýk: 68–100 puan), Grup 2 için 84 (aralýk: 72–100 puan) olarak bulundu. En son takipte iki grup arasýnda istatistiksel olarak anlamlý fark yoktu (p<0.05). Grup 2’deki iki hastada, çapraz addüksiyon testi pozitif fakat semptomsuzdu.
TARTIÞMA: Klavikula lateralinin alt tarafýnýn eklem kapsül bütünlüðünde minimal bozulma oluþturarak akromiyon ile ayný seviyeye gelecek þekilde eksizyonu uzun dönemde akromiyoklaviküler eklem semptomlarý oluþturmamaktadýr.

BACKGROUND: Coplaning means the removal of medial acromial spurs and inferior aspect of the distal clavicle. The aim of the study was to evaluate the outcomes of arthroscopic acromioplasty with and without coplaning in patients without acromioclavicular (AC) joint arthritis.
METHODS: Because of impingement syndrome, arthroscopic subacromial decompression and acromioplasty was performed in Group 1 (9 males/31 female). In addition, coplaning was performed in Group 2 (8 males/21 females) by two different surgeons. The mean age was 48 in Group 1, 46 in Group 2. The mean follow-up was 50 months and 44 months, respectively.
RESULTS: Constant score, cross-body adduction test and AC joint tenderness was used for follow-up. The mean preoperative Constant scores were 45 points (range: 34–76 points) in Group 1, 39 points (range: 32–69 points) in Group 2. The mean Constant scores at the latest follow-up was 78 points (range: 68–100 points) for Group 1, 84 points (range: 72–100 points) for Group 2. There was no statistically difference between two groups at the latest follow-up (p<0.05). In two patients in Group 2, cross-body adduction test was positive but asymptomatic.
CONCLUSION: Excision of the inferior side of the lateral clavicle to the level of the acromion with minimal disruption of the joint capsule does not develop AC joint symptoms in long-term follow-up.

Acil cerrahi kliniðimize akut mekanik intestinal obstrüksiyon semptomlarý ile baþvuran 84 yaþýnda kadýn hasta sunuldu. Bilgisayarlý tomografi görüntülemesinde iki taraflý inkarsere obturator herni saptandý. Defektler poliprolen yama kullanýlarak Trans Abdominal Pre Peritoneal (TAPP) tekniði uygulanarak tamir edildi. Hasta ameliyat sonrasý dört gün boyunca yoðun bakým ünitesinde takip edildi, dokuzuncu gün sorunsuz taburcu edildi. Altýncý ay kontrollerinde herhangi bir sorunla karþýlaþýlmadý. Obturator herni, intestinal obstrüksiyonun ayýrýcý tanýsýnda düþünülmesi gereken, erken taný ve uygun cerrahi tedavi gerektiren bir kliniktir. Laparoskopik yaklaþým, açýk yaklaþýma göre daha az invaziv olup, iskemi ve peritonit bulgusu olmayan olgularda denenebilir. Bu hastalarda TAPP tekniði, tüm intraabdominal patololerin deðerlendirilmesi ve baðýrsaklarýn görüntülenebilmesi nedeniyle tercih edilmelidir.

Here, we report the case of an 84-year-old woman with acute mechanical intestinal obstruction (AMIO) who was admitted to our Emergency Department. Computed tomography (CT) scan revealed an incarcerated bilateral obturator hernia, and the defect was resolved using transabdominal preperitoneal (TAPP) technique with polypropylene mesh. The patient was administered an oral regimen two days after the operation. The patient stayed in the intensive care unit for 4 days and was uneventfully discharged on the 9th postoperative day. Follow-up was scheduled at the 6th month, during which no adverse events were detected and the patient did not report any complaints. Obturator hernia is among the differential diagnoses of intestinal obstruction requiring early diagnosis and prompt surgical intervention. Laparoscopic approach is less invasive compared with open surgery, and it can be attempted in cases presenting with no sign of ischemia or peritonitis. TAPP technique should be preferred since it allows the control of all intraabdominal pathologies and the viability of the intestines.