AMAÇ: Akut pankreatit, teknolojideki tüm geliþmelere raðmen morbiditesi ve mortalitesi yüksek bir hastalýktýr. Akut pankreatitte mortalite oraný tüm hastalar için %10 iken, bu oran enfekte olmuþ nekrotizan pankreatitli hastalarda yaklaþýk olarak %35’tir. Biz, bu çalýþmada öncelikle sýçanlarda akut pankreatit oluþturmayý, alfa tokoferol tedavi protokolünü denemeyi ve sonuçlarý biyokimyasal ve histopatolojik olarak ortaya koymayý amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada 24 adet erkek sýçan kullanýldý. Grup 1: Kontrol grubu olarak sekiz sýçana birer saatlik arayla altý kez toplam 80 mikrogram/kg (cerulein ile eþ hacimli) serum fizyolojik subkutan enjekte edildi. Grup 2: Sekiz sýçana birer saat ara ile altý kez toplam 80 ug/kg cerulein subkutan enjekte edildi. Grup 3: Sekiz sýçana birer saat ara ile toplam 80 mikrogram/kg cerulein ve birer saat arayla iki kez 30 mg/kg alfa-tokoferol intraperitoneal enjekte edildi.
BULGULAR: Ortalama Schoenberg skoru, serum amilaz, lipaz ve NGAL seviyeleri Grup 2’de Grup 1’e göre istatistiksel olarak anlamlý derecede yüsekti. Ortalama Schoenberg skoru, serum amilaz ve lipaz seviyeleri Grup 3’de Grup 2’ye göre istatistiksel olarak anlamlý derecede düþüktü.
TARTIÞMA: Cerulein ile oluþturulan pankreatit modelinde pankreatitin üzerine olan etkisini incelemek amacýyla 30 mg/kg alfa-tokoferol intraperitoneal olarak uygulandý. Alfa-tokoferolün pankres dokusu üzerine tedavi edici etkisi olabileceðini düþünmekteyiz.

BACKGROUND: Acute pancreatitis is a disease with high morbidity and mortality, despite all the advances in technology. The overall mortality rate of acute pancreatitis is 10%, whereas the mortality rate in infected necrotizing pancreatitis is approximately 35%. In this study, we aimed to establish acute pancreatitis in rats in order to try out the alpha-tocopherol treatment protocol and to reveal the results biochemically and histopathologically.
METHODS: Twenty-four male male Sprague–Dawley rats weighing between 300 and 350 g were used in the study. In Group 1, 80 µg/kg of normal saline was subcutaneously injected into eight rats; in Group 2, 80 µg/kg of cerulein was subcutaneously injected into eight rats; and in Group 3, 80 µg/kg of cerulein was subcutaneously injected into eight rats. In addition, 30 mg/kg of alpha-tocopherol was intraperitoneally injected into eight rats.
RESULTS: The mean Schoenberg score, serum amylase, and lipase and Neutrophil Gelatinase-Associated Lipocalin (NGAL) levels were statistically significantly higher in Group 2 than in Group 1. The mean Schoenberg score and serum amylase and lipase levels were statistically significantly lower in Group 3 than in Group 2.
CONCLUSION: In this experimental study rat model of cerulein-induced acute pancreatitis, 30 mg/kg of alpha-tocopherol was injected intraperitoneally to examine its effect on pancreatitis. The improvement was observed in the histopathological examination of pancreatic tissues. We think that alpha-tocopherol may have a therapeutic effect on pancreatic tissue.

BACKGROUND: The aim of the present study was to investigate the effects of curcumin on lung damage following ischemia/reperfusion (I/R) injury after hind limb ligation.
METHODS: Forty Wistar rats were divided into four groups: sham (G1), I/R (G2), curcumin plus sham (G3), and curcumin plus I/R (G4). Curcumin was administered (200 mg/kg) daily for 2 weeks before the study. I/R was induced by placement of rubber tourniquets at the greater trochanters for 2 h, followed by reperfusion for 4 h.
RESULTS: Curcumin pretreatment had significantly lower level of malondialdehydes and higher level of superoxide dismutase in the lung tissues (p<0.05) than the I/R group. Glutathione peroxidase activity was not significantly different among the groups (p>0.05). I/R caused severe histopathological injury (p<0.05), including inflammatory cell infiltration and intra-alveolar hemorrhage.
CONCLUSION: These results suggest that curcumin pretreatment has protective effects against lung injury induced by muscle I/R.

AMAÇ: Klinik skorlama sistemleri, son yýllarda negatif apandektomiyi azaltmak için kullanýlmaktadýr. Bununla birlikte, bu sistemlerin kullanýmý, teþhis doðruluðundaki farklýlýklardan dolayý sorgulanmaktadýr. Bu ileriye yönelik çalýþmada akut apandisit tanýsýnda daha önce tanýmlanan tüm deðiþkenlerin bir kombinasyonu kullanýlarak yeni bir klinik skorlama sistemi geliþtirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Aralýk 2016 ile Nisan 2017 arasýnda akut apandisit için acil apandisit ameliyatý yapýlan ardýþýk hastalar ileriye dönük olarak çalýþmaya dahil edildi. Hastalarýn ilk baþvurusu esnasýnda, daha önce kullanýlan klinik skorlama sistemlerinden alýnan deðiþkenleri içeren hazýr bir anket uygulandý. Histopatolojik analiz ana sonuç deðiþkeni olarak kabul edildi. Histopatolojik olarak akut apandisit bulgusu olmayan hastalar negatif appendektomi olarak tanýmlandý. Tüm deðiþkenlerin akut apandisit ile olan iliþkilerini belirlemek için istatistiksel deðerlendirme yapýldý. Nümerik deðiþkenlerin kestirim (cut-off) deðerlerini belirlemek için ROC ve AUC analizleri yapýldý.
BULGULAR: Ortalama yaþlarý 30.8±12.8 yýl ve negatif apendektomi oraný %5.5 olan 200 hasta çalýþmaya dahil edildi. 11.05/mm3’den daha yüksek lökosit sayýsý ve %71.2’den daha yüksek nötrofil oraný dýþýnda diðer deðiþkenler ile histopatolojik olarak kanýtlanmýþ akut apandisit arasýnda anlamlý bir iliþki gösterilemedi (sýrasýyla, p=0.003 ve p=0.015).
TARTIÞMA: Bu çalýþmada elde edilen bulgular, skorlama sistemlerinin geliþtirilmesinin ve/veya kullanýlmasýnýn akut apandisitin tanýsal doðruluðunu anlamlý bir þekilde iyileþtirmediðini göstermektedir.

BACKGROUND: Clinical scoring systems have been used to reduce negative appendectomy rate for several decades. However, the use of these systems has been questioned due to differences in their diagnostic accuracies. The aim of this prospective study was to develop a new clinical scoring system using a combination of all previously described variables for the diagnosis of acute appendicitis (AA).
METHODS: Consecutive patients who underwent emergency appendectomy for AA between December 2016 and April 2017 were prospectively included in the study. During admission, a prepared questionnaire including variables obtained from the previously used clinical scoring systems was administered. Histopathological analysis was regarded as the main outcome. Patients with no histopathological evidence of AA were defined as negative appendectomy. All variables were analyzed separately to assess their association with AA. A receiver operating characteristic curve with area under curve analysis was performed to obtain the cut-off values for numerical variables.
RESULTS: There were 200 patients with a mean age of 30.8±12.8 years with a negative appendectomy rate of 5.5%. There was no significant association between the variables and the detection of histologically proven AA except increased white blood cell count >11.05/mm3 and proportion of the polymorphonuclear leukocytes >71.2% (p=0.003 and p=0.015, respectively).
CONCLUSION: The present study shows that the development and/or use of scoring systems does not significantly improve the diagnostic accuracy of AA.

BACKGROUND: Trauma is an important health problem in children, and improvement in trauma care on the national level is possible only through the knowledge gathered from trauma registry systems. This information is not available in our country, because there is no current trauma registry system in the hospitals. Our aim in this paper is to explain the trauma registry system we have developed and to present the first year’s data.
METHODS: The planned trauma registry system was integrated into the emergency department registry system of 14 hospitals in the Izmir province. The data of pediatric patients with multiple trauma have been recorded automatically through the registry system. Demographics, vital signs, mechanism, the type of trauma, anatomical region, Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, the length of hospital stay, and the need for blood transfusion/endotracheal intubation/surgery/hospitalization were evaluated by the patient transfer status and outcome.
RESULTS: At the end of one year, a total of 356 pediatric major trauma patients were included in the study. The most common type of trauma was blunt trauma (91.9%), and the most common mechanism was vehicle-related traffic accident (28.1%). In the group with the Glasgow Outcome Scale ≤3; the age was greater, ISS was higher, and PTS was lower. Motorcycle accidents, sports injuries, and penetrating injuries were more frequent in this group. All scores were significantly different between direct and transferred patients. The referral time to the hospital of the transferred patients was longer than directly admitted patients, but the results were not different.
CONCLUSION: Pediatric major trauma is an important cause of mortality and morbidity, and our trauma registry system, which is a successful example abroad, is insufficient in our country. We hope that the trauma registry system we planned and the pilot application we started will be expanded to include other hospitals throughout the country with the aim of developing a national registry system.

Background: Trauma is an important health problem in children, and improvement in national trauma care is only possible through the knowledge gathered from trauma registry systems. This information is not available in our country, because there is no current trauma registry system at the hospitals. Our aim is to explain the trauma registry system we have developed and present the first year's data.
Methods: The planned trauma registry system was integrated into the emergency department registry system of 14 hospitals in Izmir province. The data of pediatric multiple trauma patients have been recorded automatically through the registry system. Demographics, vital signs, mechanism, type of trauma, anatomical region, ISS, PTS, GCS, length of hospital stay and need for blood transfusion/endotracheal intubation/surgery/hospitalization were evaluated by patient transfer status and outcome.
Results: At the end of one year, a total of 356 pediatric major trauma patients were included in the study. The most common type of trauma was blunt trauma (91.9%) and the mechanism was vehicle-related traffic accidents (28.1%). In the group with the worse outcome than the Glasgow outcome score, age was greater, ISS was higher and PTS was lower. Motorcycle accidents, sports injuries, and penetrating injuries were more frequent in this group. All the scales were significantly different between direct and transferred patients. The referral time to the hospital of the transferred patients were longer than directly admitted patients, but the results were not different.
Conclusion: Pediatric major trauma is an important cause of mortality and morbidity, and our trauma registry system, which is a successful example abroad, is not enough in the country. We hope that the trauma registry system we planned and started the pilot application will be expanded to include other hospitals throughout the country with the aim of developing a national registry system.
Key words: Pediatric trauma, major trauma, trauma registry, trauma system

AMAÇ: Bu çalýþmada Suriye’deki sivil savaþ sýrasýnda hastanemize getirilen maksillofasial travmalý olgularýn demografik, klinik özellikleri, tedavileri ve maliyetlerinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Maksillofasial travmalý 80 olgu çalýþmaya dahil edildi. Ek patolojisi olan olgular çalýþma dýþý býrakýldý. Olgular demografik ve klinik özellikleri, Injury Severity Score (ISS), Glaskow Koma Skoru (GKS), uygulanan tedaviler, maliyetleri ve sonuçlarý açýsýndan incelendi.
BULGULAR: Olgularýn 76’sý (%95) erkek, dördü (%5) kadýn, yaþ ortalamalarý 29.05±9.97 (13–56) idi. Suriye savaþ yaralýlarý %90.0 (n=72) oranýnda idi. En sýk travma oluþ mekanizmasý ateþli silah yaralanmasý 72 (%90.0) idi. En sýk lezyonun mandibula kýrýðý (n=48, %60.0) olduðu saptandý. ISS deðeri tüm hastalarda þiddetli travma deðeri olan 16’nýn altýnda bulundu. GKS deðeri dört (%5) hastada 8–12, 76 (%95) hastada 15 olarak tespit edildi. Kýrýk sonrasý tespit, redüksiyon ve greft-flep uygulamalarý (n=12, %15) en sýk yapýlan tedavi uygulamalarý idi. Ortalama yatýþ süresi 15.27±13.0 (2–60 gün) idi. Tüm olgular taburcu edildi. Olgularýn maliyeti ortalama 5581.55±56.3 (772–18697 TL) veya 1.251.24±14.2 (173–4.192 dolar) olarak bulundu. Travma skoru (p=0.004, r=-0.616), hastanede kalýþ süresi (p<0.001, r=+0.729) ve maliyet arasýnda önemli derecede uyumluluk vardý.
TARTIÞMA: Suriye savaþý sýrasýnda görülen maksillofasial travmalý olgularda ateþli silah yaralanmalý mandibula kýrýklý genç erkekler en sýk görülen gruptu. Komþu ülke Suriye’deki savaþ nedeniyle hastane yoðunluk ve maliyetinin arttýðý belirlendi.

BACKGROUND: This study aimed to assess the demographics, clinical features, and treatment costs of maxillofacial trauma cases referred to our hospital during the Syrian civil war.
METHODS: The study included 80 cases of maxillofacial trauma. Patients with additional pathologies were excluded from the study. The patients were examined with respect to their demographics and clinical characteristics, Injury Severity Score (ISS), Glasgow Coma Score (GCS), treatments applied, costs, and outcomes.
RESULTS: A total of 80 patients included 76 (95%) males and 4 (5%) females, with the mean age of 29.05±9.97 years (range, 13–56 years), and 72 (90%) of them were Syrians injured in the war. The most common mechanism of trauma was the firearms injury in 72 (90%) cases, and the most frequently seen lesion was the mandible fracture (n=48, 60%). The ISS of all the patients was <16, as a severe trauma score. The GCS value was 8–12 in 4 (5%) patients, and 15 in 76 (95%). The most common treatment applied were the reduction and fixation, and graft-flap following fracture (n=12, 15%). The mean duration of hospitalization was 15.27±13.0 days (range, 2–60 days). All patients were discharged from hospital. The mean cost per case was calculated as 5,581.55±56.3 Turkish Lira (range, 772–18,697 TL) or 1,251.24±14.2 US Dollars (US$173–4,192). There was a significant correlation between the costs and the length of hospitalization (p<0.001, r=+0.729) and trauma scores (p=0.004, r=−0.616).
CONCLUSION: Firearms-injured young males with mandible fractures were the most common group of maxillofacial trauma cases seen during the Syrian war. The intensity of patients and the cost of the hospital stay have significantly increased because of the ongoing conflict in the neighboring country of Syria.

AMAÇ: Güdük kapatýlmasý laparoskopik apendektominin (LA) en önemli aþamasý olarak görülmektedir. Güdüðün dikiþ ile kapatýlmasý maliyet açýsýndan en etkin yöntemdir. LA sonrasý yara yeri enfeksiyonu geliþmesi için tanýmlanmýþ risk faktörü, trocar giriþ alanýnýn inflame apendiks ile kontamine olmasýdýr. Bu çalýþmanýn amacý apendiks güdüðü kapatýlmasýnda tek-çift baðlama teknikleri ve spesimen çýkarma yöntemlerinin karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Ocak 2015 ve Ocak 2017 tarihleri arasýnda ameliyat edilen hastalara ait bilgiler ileriye dönük olarak doldurulan veritabanýnýn geriye dönük olarak incelenmesi ile elde edildi. Tek-çift baðlama teknikleri, spesimen çýkarma yöntemleri, ameliyat süresi, hastane kalýþ süresi, perioperative ameliyat sonrasý komplikasyonlar karþýlaþtýrýldý.
BULGULAR: Yüz otuz dört hastada (%63) ekstracorporeal çift baðlama, 79 hastada (%37) ekstracorporeal tek baðlama ile güdük kapatýldý. Ýki grupta ameliyat süreleri arasýnda fark saptanmadý (p=0.97). Hiçbir hastada güdük kaçaðý geliþmedi. Üç hastada (%1.4) intraabdominal apse geliþti. Yüz bir hastada (%47) apendiks direkt yöntemle çýkarýldý, 112 hastada (%53) ise spesimen torbasý kullanýldý. Beþ hastada yara enfeksiyonu geliþti (%2.3), bu beþ hastanýn tümünde spesimen torbasý kullanýlmamýþtý (p=0.02).
TARTIÞMA: Tek veya çift baðlama, güvenli ve uygun maliyetli güdük kapatma yöntemi olarak tanýmlanabilir. Spesimen torbasý kullanýmý ile yara yeri enfeksiyonu geliþme riski azaltýlabilir.

BACKGROUND: Stump closure is the most important part of a laparoscopic appendectomy (LA). Closing the appendix base with knot tying is the most cost-effective method. The defined risk factor for surgical site infection (SSI) after LA is the contamination of trocar entry area by inflamed appendicitis. This study aims to compare the single and double knot technique for stump control and specimen removal methods in LA.
METHODS: The data of patients who underwent LA between January 2015 and January 2017 were obtained from prospectively collected database. Single and double knot technique, specimen removal method, operation duration, hospital stay, and perioperative–postoperative complications were compared.
RESULTS: Extracorporeal double knot was used in 134 patients (63%), and single knot was used in 79 patients (37%). There was no difference between operation duration in the two groups (p=0.97). No stump leakage was observed in any patient. Intraabdominal abscess developed in three patients (1.4%). Appendix was removed from the abdomen directly in 101 patients (47%) and using specimen retrieval bag in 112 (53%). SSI developed in five patients (2.3%), and appendices of all of these five patients were removed from abdomen without using specimen retrieval bag. No SSI was detected in the group that used the specimen retrieval bag (p=0.02).
CONCLUSION: Single or double knot(s) tying can be defined as safe and cost-effective stump closure method. The risk of developing SSI can be reduced using specimen retrieval bag.

AMAÇ: Özofagus perforasyonu (ÖP), hýzlý taný ve tedavi gerektiren, yaþamý tehdit eden acil cerrahi bir durumdur. Nadir görülmesi taný ve tedavi seçeneklerini sýnýrlamaktadýr. Bu amaçla bazý skorlama sistemleri önerilse de tüm hastalarda uygulanamamaktadýr. Son yýllarda ÖP tedavisinde non-operatif seçenekler operatif yöntemlere göre daha ön plana çýkmaktadýr. Bu çalýþmanýn amacý ÖP olan hastalarýna uygulanan tedavi yöntemlerini ve bunlarýn sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kliniðimizde 2013 ve 2017 yýllarý arasýnda ÖP nedeniyle tedavi gören 13 hasta geriye dönük olarak deðerlendirildi. Pitsburg þiddet skorlamasý (PÞS), Sistemik kondisyon sýnýflamasý (SKS), Clavien-Dindo sýnýflamasý (KDS) tanýmlandý ve tedavi yöntemleri incelendi. Bu parametrelerin morbidite ve mortaliteyle olan iliþkileri Fisher tam olasýlýk testi ve çift serili korelasyon testi ile deðerlendirildi.
BULGULAR: Çalýþmaya toplamda 13 hasta (6 erkek, 7 kadýn; ortanca yaþ 64 yýl) dahil edildi. On hastada non-operatif tedavi seçenekleri uygulanýrken, üç hastaya cerrahi prosedürler uygulandý. Non-operatif tedavi seçenekleri uygulanan 10 hastadan ikisine sonrasýnda ek cerrahi prosedür uygulandý. Pitsburg þiddet skorlamasý, SKS, KDS skoru, hastanede kalýþ süresi, tanýya kadar geçen süre, hipotansiyon varlýðý ve þok mortalite ile koreleydi (p<0.05). Pitsburg þiddet skorlamasý, KDS skoru ve yoðun bakým ünitesinde kalým morbidite ile güçlü korelasyon göstermekteydi (p<0.05). Non-operatif ve operatif grup arasýnda mortalite ve morbidite açýsýndan anlamlý fark izlenmedi.
TARTIÞMA: Skorlama sistemleri hastalýðýn þiddetini belirlemede yardýmcý olsa da tedavi seçeneklerini belirlemede yetersiz kalmaktadýr. Erken taný ve tedavi hastalýðýn yönetiminde en önemli unsurdur. Operatif ve non-operatif prosedürlerin birbirine üstünlüðü yoktur. Fakat bu yöntemleri birbirlerinin tamamlayýcýsý olarak kullanmak hastalar açýsýndan daha faydalý olacaktýr.

BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP.
METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien–Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher’s exact test and biserial correlation test.
RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity.
CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.

AMAÇ: Çoklu travmalar ülkemizde ve dünyada özellikle genç eriþkinlerin ölüm nedenlerinin baþýnda gelmektedir. Bu çalýþmanýn amacý yoðun bakýmlarda takip edilmekte olan izole ya da diðer organ yaralanmalarý ile birlikte olan toraks travmalý olgularda mortalite için baðýmsýz prognostik faktörlerinin predikte edilmesidir.
GEREÇ VE YÖNTEM: Bu çalýþmada, 2007–2016 yýllarý arasýnda yoðun bakým ünitemizde takip edilmiþ olan toraks travmalý hastalarýn verileri geriye dönük olarak incelendi. Bu yýllar içerisinde yoðun bakým hasta kayýt sisteminde yer alan 8063 hasta arasýndan verilerine saðlýklý bir þekilde ulaþýlan 616 toraks travma hastasý saptandý. On sekiz yaþ altý olgular dýþlanarak kalan 564 hasta çalýþma grubu hastasý olarak belirlendi.
BULGULAR: Çalýþmaya alýnan 8063 hastanýn 616’sýnda (%7.6) toraks travmasý saptandý. Çalýþma kriterlerini saðlayan 564 çalýþma grubu hastasýnýn yaþ ortalamasý medyan (min-maks) 43 (18–87) idi. Hastalarýn 159’u (%28.1) mortalite ile sonlanýrken 405’i (%71.8) yoðun bakým ünitesinden taburcu edildi. Travma ve Yaralanma Þiddeti Skoru’nun (TRISS) mortalite takibi için, AUC deðeri: 0.922 (%95 CI: 0.899–0.946) idi. ROC analizine göre mortalite geliþme olasýlýðý için TRISS skoru 59.93 sýnýr kabul edildiðinde (Sensitivite; 0.88, Spesifisite: 0.87) olarak tespit edildi. Multivaryant lojistik regresyon analizinde mortaliteyi ön görmede her bir yaþ artýþ mortalitede 1.025 kat, santral sinir sistemi travmasý varlýðý mortalitede 2.147 kat, pulmoner kontüzyo varlýðý mortalitede 1.752 kat artýþla iliþkiliydi.
TARTIÞMA: Bu çalýþmanýn sonuçlarý ile toraks travma hastalarýnda ileri yaþ, pulmoner kontüzyon ve eþlik eden santral sinir sistemi travmasý yoðun bakým mortalitesini göstermede baðýmsýz birer risk faktörü olarak tanýmlanmýþtýr. Travma hastalarýnda en güncel skorlama sistemlerinden olan TRISS skoru da bu non-invaziv yaklaþýmýmýzý desteklemektedir.

BACKGROUND: Multiple traumas are a leading cause of mortality among young adults worldwide. Thoracic trauma causes approximately 25% of all trauma-associated deaths. This study aims to determine the independent prognostic factors of mortality in cases with thoracic trauma (isolated or with accompanying organ injuries) who were admitted to the intensive care unit (ICU).
METHODS: We retrospectively reviewed data from patients with thoracic trauma who were admitted to our ICU between 2007 and 2016. After excluding pediatric patients (aged <18 years), the study sample included 564 cases. From the records, we collected the patients’ demographical data, comorbid diseases, primary trauma as an indication for ICU admission, other traumas accompanying thoracic trauma, type of thoracic injury, and therapeutic interventions. The study sample was divided into two subsets: survival and non-survival groups. These two groups were compared with regards to first ICU day laboratory results and intensive care scores, mechanical ventilation times, and ICU stay lengths.
RESULTS: Of the 8063 patients admitted to the ICU between 2007 and 2016, 616 (7.6%) had thoracic trauma. The median age (min–max) of the 564 patients eligible for this study was 43 (18–87) years. Mortality occurred in 159 (28.1%) cases, while 405 (71.8%) were discharged from the ICU. Multivariate regression analyses were also performed, in which every increment in age was associated with a 1.025-fold increase in the odds of mortality due to thoracic trauma. Additionally, the presence of central nervous system (CNS) trauma was associated with a 2.147-fold increase, and the presence of pulmonary contusion was associated with a 1.752-fold increase.
CONCLUSION: Results of this study indicate that advanced age, the presence of pulmonary contusion, and accompanying CNS trauma are independent predictors of mortality in patients with thoracic trauma in the ICU. Our non-invasive approach is further supported by the trauma and injury severity score (TRISS) scoring system, which is one of the latest scoring systems used in trauma cases.

AMAÇ: Yanýk þokunda, kapiller permabilitedeki masif artýþ sebebiyle albümin ve intravasküler sývý hýzlýca ekstravasküler alana yer deðiþtirir. Bu nedenle hipoalbüminemi majör yanýklarda erken ve uzamýþ bir bulgu olarak karþýmýza çýkar. Hipoalbüminemi çeþitli sorunlara yol açmaktadýr. Bu çalýþmada, majör yanýklý hastalarýn ameliyat öncesi dönem albümin düzeylerinin ameliyattaki morbidite ve mortaliteye etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Hastanemizde 2011–2013 yýllarý arasýnda majör yanýk nedeniyle ameliyat olmuþ 61 hastanýn demografik verileri, ameliyat öncesi albümin düzeyleri, ameliyat kayýtlarý ve servis takipleri incelendi. Ameliyat sýrasýnda komplikasyonlar; hipotansiyon, bradikardi, satürasyon düþüklüðü, metabolik asidoz, idrar çýkýmýnda azalma, hiperglisemi olarak kaydedildi. Ameliyat sonrasý komplikasyonlar; entübasyon ve mekanik ventilatöre baðlanma, sepsis, ARDS, akut böbrek yetersizliði, trakeotomi, kanama, arrest, pnömoni, idrar yolu enfeksiyonu, doku enfeksiyon, konjektif kalp yetersizliði, plevral efüzyon olarak kaydedildi.
BULGULAR: Albümin düzeyi 2 gr/dL deðerinin altýnda ve üstünde olan hastalar arasýnda ameliyat esnasýnda komplikasyonlar sýrasýyla 31.4 ve 20.8; ameliyat sonrasý komplikasyonlar %60.0 ve %51.5; mortalite oranlarý %40 ve %25.8 olarak bulunmuþtur (p=0.148; p=0.251; p=0.85). Ameliyat sonrasý morbiditeyi etkileyen ameliyat öncesi albümin düzeyi için, albümin (g/dL) deðerinde ≥2.3’ün kesim noktasý olduðu bulunmuþtur (AUC=0.587, p<0.001, %95 GA: 0.476–0.699, cut-off albumin ≥2.3).
TARTIÞMA: Majör yanýklý hastalarda, albümin uygulamasý, zamaný ve dozu konusunda görüþ birliði oluþturulamamýþtýr. Yoðun bakým literatüründe albümin verilenlerde mortalite ve morbiditenin arttýðýný gösteren yayýnlar olmakla beraber, olumlu katkýsý olduðunu destekleyen yayýnlar vardýr. Majör yanýklý hastalarda hipoalbüminemi konusunda yardýmcý bir rehber elde edilememiþtir. Bu çalýþmada, albümin düzeyinin 2 gr/dL seviyesinin altýnda veya üstünde olmasý perioperatif morbidite ve mortalitede bir deðiþikliðe sebep olmamýþtýr.

BACKGROUND: Due to a massive increase in capillary permeability during the state of shock caused by burns, albumin and intravascular fluid rapidly move to the extravascular areas. Therefore, hypoalbuminemia is seen as an early and prolonged finding in major burns. Hypoalbuminemia leads to various problems. The aim of this study was to investigate the effect of the preoperative albumin level on perioperative morbidity and mortality in patients with major burns.
METHODS: Demographic data, preoperative albumin levels, surgical records, and clinical follow-up records of a total of 61 patients who underwent surgery for major burns in our hospital for the last 2 years were examined. Intraoperative complications were recorded, such as hypotension, bradycardia, low saturation, metabolic acidosis, reduced urine output, and hyperglycemia. Postoperative complications were recorded as intubation and the use of mechanical ventilator, sepsis, ARDS, acute renal failure, tracheotomy, hemorrhage, arrest, pneumonia, urinary tract infection, tissue infection, congestive heart failure, and pleural effusion.
RESULTS: In patients with albumin levels measured as <2 gr/dL and >2 gr/dL, intraoperative complications were determined at the rates of 31.4% and 20.8%, respectively, postoperative complications at 60.0% and 51.5%, respectively, and mortality rates at 40% and 25.8%, respectively (p=0.148, p=0.251, p=0.85, respectively). The cut-off point for the preoperative albumin level affecting postoperative morbidity was determined as ≥2.3 gr/dL (Area Under Curve=0.587; p<0.001; 95% Confidence Interval, 0.476–0.699; Cut-Off Albumin, ≥2.3).
CONCLUSION: There is as yet no consensus on the time and dosage of the delivery of albumin in patients with major burns. Although there are studies in the literature that have shown increased morbidity and mortality rates in individuals given albumin in the intensive care, there are also reports supporting the finding that it makes a positive contribution. No useful guidelines have been obtained on the subject of hypoalbuminemia in patients with major burns. The results of this study showed that the albumin level above or below 2 gr/dL did not create any change in perioperative morbidity and mortality; however, the preoperative level above 2.3 gr/dL was the cut-off value for morbidity.

AMAÇ: Stoma bölgesinin ameliyat öncesi iþaretlenmesi stomada problem olma olasýlýðýný azaltýr ve ameliyat sonrasý dönemde hastalarýn yaþam kalitesini arttýrýr. Bu prosedür için en iyi uygulayýcýlar ostomi hemþireleri ve kolorektal cerrahlardýr, çünkü eðitim programlarý sýrasýnda stoma tedavisi alýrlar. Bu çalýþmada, stoma oluþturulan hastalarda (elektif veya acil) ameliyat öncesi stoma yeri iþaretlemesi yapýlan ve yapýlmayan hastalar arasýndaki stoma problemi oranýný ve ameliyat sonrasý yaþam kalitesini karþýlaþtýrmayý amaçladýk. Ayrýca cerrahi asistanlarýnýn nöbet þartlarýnda stoma oluþturma konusundaki yaklaþým ve davranýþlarýný deðerlendirdik.

GEREÇ VE YÖNTEM: Ocak 2012–Aralýk 2013 tarihleri arasýnda gastrointestinal cerrahi geçiren hastalar deðerlendirildi. Ameliyat sonrasý stoma oluþturulan toplam 116 hasta ameliyat sonrasý dönemde stoma tedavisi hemþiresi tarafýndan takip edildi ve bu çalýþmaya alýndý. Ayrýca asistanlara stoma oluþturma ve stoma bakýmý hakkýndaki bilgilerini deðerlendirmek üzere bir anket yapýldý.

BULGULAR: Yüz on altý hastanýn 67’si (%58) erkekti. Ortanca yaþ 57±16 yýldý (daðýlým 17–87). On altý hastada (%14) beden kitle indeksi 30 kg/ m2’nin üzerinde tespit edildi. Ameliyat nedeni 93 hastada (%80) malign hastalýk idi. Doksan yedi hasta (%84) elektif olarak ameliyat edildi. Ameliyat öncesi stoma iþareti 72 hastaya (%62) yapýldý. Stoma 87 hastada (%75) ileostomi idi. Stoma ile ilgili komplikasyonlar 40 hastada (%35) gözlendi. Acil cerrahi (p=0.02), ameliyat öncesi stoma iþaretlenmesi (p<0.0005), adjuvan tedavi (p=0.004) ve stoma bakýmýný yapan kiþi ya da kiþiler (hastanýn kendisi veya akrabalarý) (p=0.05) stomaya baðlý komplikasyonlarla iliþkiliydi. Lojistik regresyon analizinde sadece cerrahi tip (acil veya elektif ), ameliyat öncesi stoma iþaretlemesi ve stoma bakýmýný yapan kiþinin stomaya baðlý komplikasyonlarý arttýrdýðýný ortaya koydu.

TARTIÞMA: Stoma yerinin ameliyattan önce iþaretlenmesi, stomaya baðlý komplikasyon riskini azaltýr ve hastalarýn yaþam kalitesini olumlu yönde etkiler. Çok deðiþkenli analiz, stoma bölgesini ameliyattan önce iþaretlemenin, acil bir durumda veya elektif bir ameliyatta yapýlmasýna raðmen stomaya baðlý komplikasyonlarý deðiþtirebilecek tek faktör olduðunu göstermektedir. Cerrahlarýn profesyonel kariyerleri sýrasýnda her zaman stoma prosedürü ile karþýlaþacaklarý ve stoma terapi hemþiresi ile çalýþma fýrsatlarýna her zaman sahip olamayacaklarý göz önüne alýndýðýnda, asistanlýk eðitimi sýrasýnda stoma bakým eðitimi verilmeli ve teþvik edilmelidir. Nöbetlerde tüm potansiyel stoma vakalarýnýn ameliyat öncesi stoma lokalizasyonunun belirlenmesi için asistanlar teþvik edilmelidirler.

BACKGROUND: Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting. The approach and behavior of surgical residents regarding stoma creation was also assessed.

METHODS: Patients who had undergone gastrointestinal surgery between January 2012 and December 2013 were assessed. A total of 116 of those patients who had a stoma created during the initial operation were followed by a stoma therapy nurse in the postoperative period and were enrolled in the current study. In addition, a survey of the residents was conducted to evaluate their knowledge about stoma creation and stoma care.

RESULTS: A total of 67 (58%) of the 116 patients included were male. The median age was 57±16 years (range: 17–87 years). A body mass index above 30 kg/m2 was detected in 16 patients (14%). The reason for surgery was malignant disease in 93 (80%) patients, and 97 cases (84%) were elective operations. Preoperative stoma marking was performed in 72 patients (62%). The stoma type was an ileostomy in 87 patients (75%). Stoma-related complications were observed in 40 patients (35%). Emergency surgery (p=0.02), preoperative stoma marking (p<0.0005), adjuvant therapy (p=0.004), and the stoma caretaker (patient or relatives) (p=0.05) were associated with stoma-related complications. Logistic regression analysis revealed that only the type of surgery (emergency or elective), preoperative stoma marking, and the stoma caretaker increased the rate of stoma-related complications.

CONCLUSION: Marking the stoma location before surgery reduces the risk of stoma-related complications and has a positive effect on the patient’s quality of life. Multivariable analysis indicated that marking the stoma site before the operation was the only factor that affected the rate of stoma-related complications, regardless of emergency or elective surgical conditions. Since surgeons will encounter the need for a stoma procedure during their professional career and they will not always have the opportunity to work with stoma therapy nurse, stoma care education should be provided during their residency (internship) education, and ascertaining a stoma localization before surgery for all potential stoma cases should be encouraged in emergency shifts.

AMAÇ: Çalýþmamýzýn amacý torakal ve lomber vertebra kýrýklarý nedeniyle posterior enstrümantasyon ve füzyon yapýlan ve ameliyatta ototransfüzyon yapýlan hastalarda hücre koruyucu sistemin etkinliðini ve maliyet etkinliðini belirlemektir.
GEREÇ VE YÖNTEM: Torakal ve lomber vertebra kýrýklarý nedeniyle posteriyor enstrümentasyon ve füzyon uygulanmýþ 121 hasta iki guruba ayrýldý: 59 hasta (23 erkek ve 36 kadýn) hücre koruyucu gurup, 62 hasta (22 erkek ve 40 kadýn) kontrol gurubuna dahil edildi. Hastalarýn hemoglobin, hemotokrit ve kýrmýzý hücre sayýsý (KHS) ameliyat öncesi ve sonrasý birinci, ikinci, üçüncü gün ve taburculuk esnasýndaki deðerleri deðerlendirildi. Transfüzyon oranlarý ve allojenik eritrosit transfüzyonlarýnýn (AET’ler) yaný sýra, transfüzyona tabi tutulan toplam oto ve allojenik transfüzyonlarýn maliyetleri karþýlaþtýrýldý.
BULGULAR: Perioperatif kan transfüzyonu hücre koruyucu grupta 0.2±0.6 ünite, kontrol grubunda 0.7±1.4 ünite olarak tespit edildi (p=0.01). Ameliyat sonrasý birinci, ikinci ve üçüncü günde hemoglobin, hemotokrit ve KHS arasýnda istatistiksel olarak anlamlý fark tespit edildi. Taburculuk hemoglobin, hemotokrit ve KHS arasýnda anlamlý farklýlýk saptanmadý. Perioperatif kan transfüzyonu ortalama maliyeti hücre koruyucu grupta $431±27.4, kontrol grubunda $34.5±66.25 olarak belirlendi (p<0.001).
TARTIÞMA: Hücre koruma sisteminin kullanýmý maliyet açýsýndan uygun deðildi, ancak özellikle ameliyat sonrasý allojenik kan transfüzyonlarýnýn oranýný ve sayýsýný azaltmada baþarýlýydý.

BACKGROUND: The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures.
METHODS: We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared.
RESULTS: The numbers of erythrocyte suspensions transfused perioperatively were 0.2±0.6 units in the cell saver group and 0.7±1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431±27.4 in the cell saver group and $34.5±66.25 in the control group (p<0.001).
CONCLUSION: The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

AMAÇ: Kalça kýrýklý yaþlý hastalarda ameliyat sonrasý mortalitenin yüksek olduðu bildirilmiþtir. Bunun nedeni genellikle ameliyat sonrasý geliþen komplikasyonlardýr. Güncel çalýþmalarda nötrofil-lenfosit oranýnýn (NLR), yüksek mortalite oraný ile iliþkili olduðu belirtilmektedir. Çalýþmamýzda amaç, kalça kýrýklý yaþlý hastalarda, hastaneye yatýþ esnasýndaki NLR’nin, ameliyat sonrasý mortalite ile iliþkisi olup olmadýðýný araþtýrmak idi.
GEREÇ VE YÖNTEM: Balýkesir Edremit Devlet Hastanesi Ortopedi ve Travmatoloji Kliniði’nde 65–80 yaþ arasý, ASA puaný 3 olan, stabil olmayan trokanterik kýrýk nedeniyle çimentolu bipolar kalça protezi uygulanan kadýn hastalar çalýþmaya dahil edildi. Tüm hastalar kýrýk sonrasý ilk 72 saat içinde ameliyat edilmiþ idi (amaca yönelik örnekleme tekniði). Grup 1 hastalar ameliyat sonrasý birinci yýl içinde ölenler (n=22, %44), grup 2 hastalar (n=28, %56) ise yaþayanlar idi. Her iki grup ameliyat öncesi NLR deðerleri açýsýndan istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda ameliyat öncesi NLR deðeri açýsýndan anlamlý fark tespit edildi (p<0.001). ROC analizinde kesim deðeri 4.7 bulundu.
TARTIÞMA: Buna göre ameliyat öncesi NLR deðerinin kalça kýrýklý yaþlý hastalarda mortalite ile iliþkili olduðu kanaatindeyiz.

BACKGROUND: Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that the neutrophil-to-lymphocyte ratio (NLR), which is a laboratory marker used to evaluate systemic inflammation, may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission NLR in elderly patients with hip fracture.
METHODS: We evaluated patients admitted to the Orthopaedic Surgery Department of Balikesir-Edremit State Hospital. Inclusion criteria were female gender, age between 65 and 80 years, ASA score of 3, unstable intertrochanteric fracture treated with hemiarthroplasty, and time between fracture and surgery less than 72 h. Patients with multiple fracture, previous same side or other side hip surgery, pathological fracture, such as fracture caused by tumor or metabolic bone disease (e.g., Paget’s disease), and malignancies were excluded from this study (purposive sampling technique). Finally, “case” (group 1) was defined as patients who died within 1 year after surgery, whereas “control” (group 2) was defined as patients who survived. Patients in group 1 and 2 were statistically compared in terms of NLR value on hospital admission. A total of 22 patients (44%) were included in group 1, and 28 (56%) were included in group 2.
RESULTS: We found that the admission NLR values of patients in the mortality group were significantly higher than those of patients in the control group (p<0.001). The cutoff value of NLR was calculated as 4.7 on ROC analysis.
CONCLUSION: We believe that the NLR value at admission could be used for risk stratification of mortality in elderly patients with hip fracture.

AMAÇ: Syndesmoz yaralanmasýnýn eþlik ettiði lateral malleol kýrýklarý oldukça sýktýr. Syndesmoz yaralanmalarý için birçok çeþit implant kullanýlmaktadýr. Bunlardan birisi de ANK çivisidir. Çalýþmamýzýn amacý syndesmoz yaralanmasýnýn eþli ettiði ayak bileði kýrýklarýnda ANK çivisi ile tedavinin uzun dönem klinik ve radyolojik sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: En az 10 yýllýk takibi yapýlabilen 48 hastanýn son kontrollerinde AOFAS (American Orthopaedic and Foot Society) klinik deðerlendirme formu kullanýlarak klinik sonuçlarý ve radyolojik deðerlendirme kriterleri ile artroz varlýðý araþtýrýldý.
BULGULAR: Hastalarýn ortalama yaþý 37.3 idi (17–69). Hastalar ortalama 129.9 ay (123–150) takip edildi. Weber B kýrýða sahip 22 hastada ortalama AOFAS skoru 93.36 idi. Weber C kýrýða sahip 22 hastada ortalama AOFAS skoru 97.66 idi. Kýrýk tipi ile AOFAS skoru arasýnda istatiksel olarak anlamlý fark saptanmadý. Travma sonrasý artroz geliþimi ile fibula kýsalýðý arasýnda anlamlý fark saptandý.
TARTIÞMA: ANK çivisi özellikle seçilmiþ olgularda; syndesmoz yaralanmasýnýn eþlik ettiði ayak bileði kýrýklarýnda baþarýlý þekilde uygulanabilir. Özellikle maliyet açýsýndan oldukça avantaja sahiptir.

BACKGROUND: Lateral malleolar fractures associated with syndesmotic injuries are common. Various surgical implants may be used for the management of syndesmosis injury. One of these is ANK nail. The aim of the present study was to assess the clinical and radiological outcomes of patients treated with ANK nail.
METHODS: Forty-eight patients who were followed up for a minimum of 10 years were reviewed retrospectively using American Orthopedic Foot and Ankle Society (AOFAS) score, radiological evaluation, and development of posttraumatic arthritis. Final data were collected at the last follow-up.
RESULTS: The mean age of the patients was 37.3 (17–69) years. The mean follow-up was 129.9 (123–150) months. Twenty-two patients had Weber type B fracture, and their mean AOFAS score was 93.36 points. The remaining 26 patients had Weber type C fracture, and their mean AOFAS score was 97.66 points. There was no relationship between the type of fracture and the clinical outcome. There was a significant correlation between shortening of the fibula and posttraumatic arthritis.
CONCLUSION: The ANK nail used for the management of ankle fractures may provide both fracture and syndesmosis stabilities in selected cases and is also a cost effective method as cheap as a cortical screw and a Kirschner wire.

Açýk karýnda enteroatmosferik fistül (EAF) yönetiminde týkaçla yeni izolasyon tekniði olarak adlandýrýlan yöntemimizi sunmayý amaçladýk. Hasta, Hartmann kolostomi ve insizyonel herni olan 71 yaþýnda bir erkek hastaydý. Kolorektal anastomoz sonrasý insizyonel fýtýk onarýmý için dual meç kullanýldý. Hasta, acil olarak EAF nedeniyle ameliyat sonrasý otuzuncu günde hastaneye tekrar baþvurdu. Yeni izolasyon tekniði uygulamasý iki kez farklý zamanlarda yapýldý. Genel anestezi gerekli deðildi, ancak ameliyat odasýnda steril koþullar saðlandý. Bir penroz dren, 5/0 polidioksanon ile EAF mukozasýna dikildi. Enterik içeriði sýzdýrmayan küçük bir havuz oluþturuldu. Sýzýntý testi, bu havuza serum fizyolojik dökülerek yapýldý. Havuzun etrafýndaki açýk karýn alaný organ koruyuculu süngerle ve steril dreple örtüldü. Örtü üzerinde bir açýklýk yapýldý ve sürekli formda -75 mmHg ile negatif basýnç tedavisi baþlatýldý. EAF, açýk karýn yarasýndan ve süngerden, el ile þekil verilebilen ve sýzdýrmaz halka macunu ile yapýlan týkaç yardýmýyla izole edildi. Bu iki uygulamadan sonra, EAF stomaya dönüþtürüldü. Ýnce baðýrsaðýn anastomozu 45 gün sonra yapýldý. Týkaçla yeni izolasyon tekniði sistemimizde, enterik sývý ve elektrolit kaybýný önlemenin yaný sýra EAF’nin kontrolü de saðlanabilir. Týkaçla yeni izolasyon tekniðinin üstünlükleri: 1. Her türlü EAF’de baþarýlý kontrol mümkün olabilir. 2. Sistemimiz için gerekli materyal kolayca bulunabilir. 3. Tüm EAF tipleri kýsa sürede stomaya dönüþtürülebilir. Sonuç olarak, Björck 4 açýk karýn hastalarýnda EAF tedavisi týkaçla yeni izolasyon tekniðiyle baþarýlý þekilde gerçekleþtirilebilir.

We aimed to present our method called as new isolation technique with stopper (NITS) to manage enteroatmospheric fistula (EAF) in an open abdomen (OA). The patient was a 71-year-old male with Hartmann colostomy and incisional hernia. A dual mesh was used for incisional hernia repair after colorectal anastomosis. The patient was urgently re-admitted to hospital due to EAF on the postoperative 30th day. The NITS application was performed twice at different times. General anesthesia was not required for the applications, but sterile conditions in operation room were provided. A Penrose drain was sutured with 5/0 polydioxanone onto the mucosa of EAF orifice. A small pool was created to protect enteric content from leakage. The leak test was performed by spilling saline into this pool. The sponge with visceral organ protector around the pool was adhered by adhesive sterile drape, and one opening was performed on drape. Negative pressure therapy was launched with -75 mmHg in continuous form. EAF was isolated from the OA wound and sponge with the help of stopper performed with adaptable and obstacle ring paste. After these two applications, EAF was converted to stoma. The anastomosis of small intestine was performed 45 days later. In our NITS system, control of EAF may be successfully provided besides prevention of loss of enteric fluid and electrolyte. Advantages of NITS: 1) Successful control in all types of EAF is possible with NITS. 2) The required material for NITS system can be found easily. 3) All types of EAF can be converted into stoma in a short time. Consequently, the therapy of EAF in Björck 4 OA patients may be carried out successfully with NITS method.

Gastrointestinal stromal tümör (GÝST), gastrointestinal sistemin nadir görülen tümörlerinden biridir. Gastrointestinal sistemin her yerinde olabilir ama en sýk sýrasýyla görüldüðü yerler mide, ince baðýrsaklar, kolorektal, omentum/mezenter, özefagus ve nadiren gastrointestinal sistem ile baðlantýsýz olarak retroperiton veya abdomendir. Genelde semptomsuz seyreder. Semptomlu olursa karýn aðrýsý, gastrointestinal sistem kanamasý, elle muayenede ele gelen kitle gibi bulgular verebilir. Hastalar genellikle obstrüksiyon bulgularý ve baþka tanýlarla ameliyata alýnmaktadýr. Sunacaðýmýz olgu acil kliniðe düþme sonrasý akut karýn ve hipovolemik þok bulgularýyla getirilen, acil þartlarda operasyona alýnan ve operasyonda mideden kaynaklý eksofitik büyümüþ tümör kanamasý olduðu saptanan olgudur. Olgu 32 yaþýnda, erkek hasta ve yapýlan kan incelemelerinde lökosit sayýmý 23.500/mm3, hemoglobin deðeri 7.9 gr/dL, nabýz 110/dk idi. Akciðer grafisinde diafragma altý serbest hava saptanmayan, ultrasonografisinde karaciðerden ayýrt edilemeyen kitlesel görünüm arzeden ve kapalý perforasyon – hemanjiom ayrýmý yapýlamayan hasta ameliyata alýndý. Ameliyatta yaklaþýk 1200 cc kan aspire edildi ve mideden ekzofitik uzaným gösteren kitle total olarak çýkarýldý. Patoloji sonucu GÝST olarak gelen hasta onkoloji bölümü tarafýndan rüptüre kabul edildi. Ameliyat sonrasý üç yýl imatinib tedavisi verildi ve bu süre içinde nüks saptanmadý. Travma sonucu acile baþvuran hastalarda akut karýn nedeninin her zaman travmayla ilgili olmayabileceði, hipovolemik þok veya baþka nedenlerden dolayý tansiyon düþmesi sonucu travmanýn gerçekleþebileceðini vurgulamak ve GÝST’nin kanayýp hipovolemik þoka ve torsiyona uðrayýp akut batýn bulgularýna yol açabileceðini sunmak istedik.

Gastrointestinal stromal tumors (GISTs) are among the rare tumors of gastrointestinal (GI) tract. GISTs occur respectively in the stomach, small intestines, colon and rectum, omentum and mesentery, esophagus, retroperitoneal space, and abdominal cavity. However, they may occur anywhere along the GI tract. Typically, these tumors generally do not cause symptoms; however symptomatic patients may show stomach pain, GI bleeding, and palpable abdominal masses. These patients usually undergo surgery for obstruction symptoms or some other diagnosis. Our patient was admitted to the emergency department with acute abdomen and hypovolemic shock due to fall. The patient underwent emergency surgery, which revealed active bleeding from a stomach tumor showing an exophytic pattern of growth. This patient was a 32-year-old male, and blood tests revealed a white blood cell count of 23.500/mm³ and a hemoglobin level of 7.9 gr/dL. The heart rate was 110 beats/minute. The chest radiograph showed no subdiaphragmatic free air, and abdominal ultrasound showed impression of a mass that could not be distinguished from the liver, along with closed perforation or hemangioma. During the surgical procedure, 1200 cc of blood was suctioned, and the exophytic tumor was removed completely. Histological analysis of the tumor showed GIST, and it was considered to be a ruptured tumor by the oncology consultant. The patient was applied imatinib for 3 years after the surgery, and the disease did not re-occur during this period. Our goal in this case study is to emphasize that trauma may not be necessarily the cause of acute abdomen for emergency patients but that it also may be caused by hypotension-associated hypovolemic shock or other causes, bleeding from a GIST along with tumor torsion.

Motorlu taþýt kazalarýndan sonra aðýr yaralanmalar için hava yastýklarý ve emniyet kemerleri ana koruma yöntemidir. Hava yastýðýnýn açýlmasý sonucu meydana gelen yaralanmalar hakkýnda birçok çalýþma bildirilmiþtir. Bu olgu sunumu, hava yastýðý kapaðýnýn çarpmasýndan kaynaklanan çoklu mandibula kýrýðý ile sonuçlanan ilk olgu sunumudur. Canlý olmayan kemik parçalarý debride edildi ve ortaya çýkan hemi-mandibula defekti serbest iliak krest flebi ile rekonstrükte edildi. Mukozal defekti yeniden oluþturmak için radyal ön kol serbest flebi yapýldý. Hava yastýklarý, önlemlere göre kullanýldýðýnda ölümcül yaralanmalarý önler. Bununla birlikte, açýlma sýrasýnda maksillofasiyal kemiklere ciddi þekilde zarar verebilirler.

Airbags and seatbelts are among the primary means of preventing severe injuries after motor vehicle accidents. Nonetheless, many studies have examined injuries that were related to airbag deployment. To our knowledge, this is the first case report of multiple mandible fractures caused by impact with the airbag cover. Removal of non-viable bone fragments was performed and the resulting hemi-mandible defect was reconstructed with a free iliac crest flap. A radial forearm free flap was used to reconstruct the mucosal defect. Airbags can prevent deadly injuries; however, they can also cause serious harm to the maxillofacial bones at the time of deployment.

Elli beþ yaþýnda erkek hastada, perfore duodenal ülserin tedavisi için yapýlan ameliyattan sonraki ikinci günde ciddi peritonite neden olan duodenal kaçak geliþti. Omentoplasti sonrasý tekrar sýzýntý nedeniyle ameliyattan iki gün sonra relaparotomi yapýldý. Nekrotik omentum, bulbus duodeniden ayrýlmýþtý. Omental yamanýn yeniden yerleþtirilmesi için canlý omentum bulunamadý. Dýþa dönmüþ duodenum mukozasý kesildi ve duodenum perforasyonu dikildi. Ýki yönlü vakum yardýmlý kapama (VYK), karýn sývý kültürü alýnarak ve karýn yýkanarak yapýldý. Ýki yönlü VYK deðiþim iþlemleri, sýzýntý sonlandýrýlana kadar her üç günde bir sürdürüldü. Tüm tedavi süreci yoðun bakýmda gerçekleþti. Duodenal sýzýntý ameliyattan 41 gün sonra tamamen durdu. Cilt altý tabakasý karýn ön duvarýnýn fasiyal tabakasýndan ayrýþtýrýldý; böylece, karýn cildi gergin olmadan kapatýldý ve hasta daha sonra taburcu edildi. Sonuç olarak, primer kaynak kontrolü duodenal sýzýntýlarý tedavi ederken sýklýkla zor olduðu için, iki yönlü VYK sistemi, peritonit kaynaðýný lokalize etmek ve toksik peritoneal materyali uzaklaþtýrmak için uygun bir çözümdür.

A 55-year-old male patient developed a duodenal re-leak, which caused severe peritonitis, on the second postoperative day after surgery to treat an acutely perforated duodenal ulcer. Relaparotomy was performed 2 days after surgery for the re-leak after omentoplasty. The necrotic omentum was dissociated from the bulbus duodeni. Viable omentum for reinsertion of the omental patch was not found. The turned-outward duodenal mucosa was excised and the duodenal perforation was sutured. Two-way vacuum-assisted closure (VAC) was carried out by taking a liquid culture of the abdomen and washing the abdomen. The two-way VAC exchange procedures were continued every 3 days until the re-leak was terminated. The whole treatment process occurred in the intensive care unit. The duodenal leak was completely stopped by 41 days after surgery. The subcutaneous layer was dissected from the fascial layer of the anterior wall of the abdomen; thus, the abdominal skin was closed without tension and the patient was subsequently discharged. In conclusion, since primary source control is often difficult when treating duodenal leaks, the two-way VAC system is a convenient solution for localizing the source of the peritonitis and removing toxic peritoneal material.