AMAÇ: Hemorajik þokun (HS) taný ve evrelemesinde iskemi modifiye albümin (IMA) ve IMA/albümin oranýnýn (IMAR) deðerini belirlemek.

GEREÇ VE YÖNTEM: Basýnç hedefli bir HS modeli oluþturuldu. Kontrol ve þok gruplarý, HS’ye çeþitli maruz kalma sürelerini simüle etmek için 30 dakika ve 60 dakika boyunca izlendi. Deneyler sýrasýnda tüm deneklere invaziv arter muayenesi yapýldý ve ayrýca ortalama arter basýncý (MAP) azalýþlarýna dayanarak hafif ve þiddetli þok gruplarýna ayrýldý. Gruplar arasýnda biyokimyasal ve histolojik karþýlaþtýrmalar yapýldý.

BULGULAR: Sonuçlarýmýz kontrol grubuna göre hem 30 hem de 60 dakikalýk þok gruplarýnda IMA, IMAR, laktat, total oksidan durumu (TOS), total antioksidan durumu (TAS) ve oksidatif stres indeksi (OSI) düzeylerini ortaya koydu. MAP bazlý þok evrelemesi açýsýndan, 30 dakikalýk ve 60 dakikalýk hafif ve þiddetli þok gruplarýndaki IMA, IMAR, laktat, TOS ve OSI düzeyleri kontrol grubundan daha yüksekti. Ancak, hafif ve þiddetli þok gruplarý arasýnda anlamlý fark yoktu. Deðerlendirilen tüm biyobelirteçler ile çeþitli organlarda HS kaynaklý hasar arasýnda anlamlý korelasyon tespit edildi. Bu korelasyon laktat ve IMAR düzeylerinde en yüksekti.

TARTIÞMA: Ýskemi modifiye albumin ve IMAR düzeyleri HS’nin erken tanýsýnda kullanýlabilir ve ayrýca HS’nin þiddetini belirlemede kullaným potansiyeline sahiptir. IMA ve IMAR ölçümü alternatif olarak veya HS tanýsýnda laktat ölçümüne ek olarak düþünülebilir

BACKGROUND: To determine the value of ischemia-modified albumin (IMA) and IMA/albumin ratio (IMAR) in the diagnosis and staging of hemorrhagic shock (HS).
METHODS: A pressure-targeted HS model was established in this study. The control and shock groups were monitored for 30 min and 60 min to simulate varying durations of exposure to HS. All subjects underwent invasive arterial monitoring during the experiment and were further divided into mild and severe shock groups based on decreases in mean arterial pressure (MAP). Biochemical and histologic comparisons were performed between the groups.
RESULTS: Our results revealed higher IMA, IMAR, lactate, total oxidant status (TOS) and oxidative stress index (OSI) levels in both the 30- and 60-min shock groups compared to the control group. Concerning MAP-based shock staging, IMA, IMAR, lactate, TOS and OSI levels in the 30-min and 60-min mild and severe shock groups were higher than those of the controls. However, there was no significant difference between the mild and severe shock groups. A significant correlation was determined between all the biomarkers evaluated and HS-induced damage in various organs. This correlation was highest in lactate and IMAR levels.
CONCLUSION: IMA and IMAR levels may be used in the early diagnosis of HS and also have the potential for use in determining the severity of HS. IMA and IMAR measurement may also be considered as an alternative or in addition to lactate measurement in the diagnosis of HS.

AMAÇ: Kanamayý kontrol etmek için farklý farmakolojik ajanlar geliþtirilmekle birlikte; geliþtirilen ajanlarýn yara yerinde pýhtý oluþumunu tetiklemesi ve devam ettirmesi için vasokonstrüksiyon, koagülasyon ve scaffold (çatý) etkisi oluþturmasý önemlidir. Amacýmýz, cilt yarýklarý, vücut dýþý yaralanmalar, travmatik kesikler, kendiliðinden ya da cerrahi giriþimler sonrasý oluþan minör ve majör açýk kanamalarýn durdurulmasý için kullanýlacak ajanlarýn kanama durdurucu özelliði yanýnda scaffold özelliðinin gösterilmesi amaçlanmýþtýr.

GEREÇ VE YÖNTEM: Çalýþmamýz deneysel olarak sýçanlar üstünde yapýldý. Sýçanlarda oluþturulmuþ femoral kanama modelimize kanama durdurucularýn etkileri incelendi. Araþtýrmamýzda kanama zamaný, scaffold oluþumu, histopatojik etki, SEM analizleri yapýldý.

BULGULAR: Deney modelinde aðýrlýk kaybý kontrol grubunda ortalama 5.0±1.3 gr, kitosan grubunda ortalama 2.9±1.1 gr, PD grubunda ortalama 2.7±1.0 olarak tespit edildi. Deney öncesi ve sonrasý aðýrlýk farký için kontrol grubu ile kitosan ve PD grubu karþýlaþtýrýldýðýnda deðiþim istatistiksel anlamlý bulundu. Scaffold oluþumu incelenirken gruplar arasý karþýlaþtýrma yapýldý ve istatistiksel olarak anlamlý idi. Scaffold oluþumu kitosan grubunda 6 (%75) tam, 2 (%25) zayýf olarak tespit edildi. PD grubunda ise 7 (%87.5) tam scaffold oluþumu, 1 (%12.5) zayýf scaffold oluþumu tespit edildi. Scaffold oluþumu kontrol grubu ile kitosan ve PD grubu ile karþýlaþtýrýldýðýnda sonuç anlamlý idi (p=0.002).

TARTIÞMA: Çalýþmamýzda PD ile oluþturulan scaffold; uygun bir gözeneklilik ve fibrin çatýya destek saðladýðý ve kanamanýn yeniden oluþmasýný önlediðini ortaya koymuþtur. PD’nin scaffold etkisi güçlüdür ve istatistiksel olarak anlamlý bulunmuþtur. PD bileþiði kitosan kadar kanama durdurmada etkili bulunmuþtur. PD’nin hisopatolojik olarak femoral bölgede hücrelerin ve damarlarýn doðal yapýsýna zarar vermediði gösterilmiþtir.

BACKGROUND: Different pharmacological agents are developed to control bleeding. However, it is critical for these agents to induce thrombin formation and have an effect on vasoconstriction, coagulation, and scaffold. In this study, we aimed to demonstrate the agents’ ability to stop bleeding properties on minor and major open bleedings after skin clefts, extracorporal injuries, traumatic cuts, spontaneous or surgical intervention besides scaffold properties. For this purpose, a new and authentic hemostatic agent, processed diatomite (PD) and the most preferred chitosan in the medical area were used to test blood stopping and scaffold effects in a rat femoral bleeding model. The samples were examined by scanning electron microscopy (SEM), and the results on blood stopping were shared.
METHODS: The current experimental study was conducted on rats. The effects of hemostatic agents on our femoral bleeding model were determined. In this study, 22 male Wistar albino rats weighing 158–215 g, were used. The rats were assigned randomly to three groups: control group (n=6), chitosan group (n=8), and PD group (n=8). Bleeding time, scaffold formation, weight differences, histopathological effect and scanning electron microscope (SEM) analyses were performed.
RESULTS: In our experimental model, weight loss was 5.0±1.3 g for the control group, 2.9±1.1 g for the chitosan group, and 2.7±1.0 g for the PD group, respectively. When weighed before and after the experiment, there was a significant change in weights of rats in chitosan, and PD groups regarding scaffold formation: it was complete for six rats (75%) and weak for two (25%) rats in chitosan group; however, it was complete for seven rats (87.5%) and weak for one (12.5%) rat in the PD group. Scaffold formation was significant for the chitosan and PD groups versus the control group (p=0.002).
CONCLUSION: In our study, the scaffold formed by PD exerts appropriate porousness and contributes to fibrin formation and prevent re-bleeding. PD had a strong and significant scaffold effect. The effectiveness of PD to stop bleeding was equal to chitosan. Besides being natural, hemostatic agents should not induce cellular damage. We histopathologically demonstrated that PD was harmless for the natural structure of cells and vessels in the femoral site.

AMAÇ: Yanýkta direkt termal etkiyle doku ölümü dýþýnda dermal vasküler oklüzyon ve akut tromboz görülür. Jackson tarafýndan termal yanýðýn baþlangýcýnda ortaya çýkan koagülasyon, staz ve hiperemi zonlarýnda oluþan yanýk modeli tariflenmiþtir. Bu çalýþmada antiiskemik ve vazodilatör etkinliði
olan %2 nitrogliserin staz bölgesine uygulanarak rutin tedavide kullanýlan gümüþ sulfadiyazin %1 krem ve basitrasin-neomisin pomad ile karþýlaþtýrýlarak yanýk tedavisinde etkinliði ve kullanýlabilirliðinin histomorfolojik ve immünhistokimyasal olarak deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmamýzda beþ gruptan oluþan 30 adet sýçan kullanýldý. Grup 1; kontrol, 2; sham, 3; basitrasin-neomisin sülfat, 4; %2
nitrogliserin ve 5; gümüþ sülfadiazin %1 olarak oluþturuldu. ‘Comb’ yöntemiyle yanýk oluþturulup 0, 24 ve 48. saatlerde bu bölgelere lokal olarak
vazelin-lanolin, basitrasin-neomisin sülfat, %2 nitrogliserin ve gümüþ sülfadiazin %1 uygulanýp 72. saate patolojik deðerlendirme için biyopsi alýndý.
Alýnan materyaller uygun þekilde saklanýp histomorfolojik ve CD 34 ve D 2-40 immün boyalarý ile boyanarak vasküler ve lenfatik yapýlar immünohistokimyasal olarak deðerlendirildi.
BULGULAR: Histopatolojik incelemelerde %2 nitrogliserin uygulanan grupta diðer gruplarla karþýlaþtýrýldýðýnda ödem, enflamasyon ve vasküler
proliferasyonda istatistiksel olarak anlamlý artýþ saptandý.
TARTIÞMA: Ýskemik olan staz zonunda topikal %2 nitrogliserinin vasküler proliferasyonu artýrdýðý gözlenmiþ olup yanýk tedavisinde etkinliðinin olabileceði gösterilmiþtir

BACKGROUND: Studies evaluating the recovery of the zone of stasis is an important issue in burn research. In this study, we aimed to evaluate and compare the efficiency of an anti-ischemic and vasodilatory agent, a topical agent containing 2% nitroglycerin with 1% silver sulfadiazine, and bacitracin-neomycin sulfate in the zone of stasis histomorphologically and immunohistochemically.
METHODS: We conducted an experimental study using 30 Wistar-Albino rats, each weighing 250–300 grams. The rats were divided randomly into five groups (six rats in each group). In this study, the “comb model,” which was deemed to be the most appropriate experimental model to produce an injury with predictable zones and was first described by Regas and Erhlich, was used. The following were applied to the zone of stasis after creating a burn model in 0, 24, and 48 hours: topical 2% nitroglycerin, 1% silver sulfadiazine, bacitracin-neomycin sulfate, and Vaseline-lanolin (sham). After 72 hours, biopsies were performed from the zone of stasis and evaluated by histomorphological and immunohistochemical CD 34 (expressed in human endothelial and hematopoietic cells) and D 2–40 (expressed in the endothelium of lymphatic capillaries) methods. The results were evaluated using the chi-square test.
RESULTS: Compared with the other groups, a statistically significant difference was found in edema, inflammation, and vascular proliferation in the nitroglycerin group. Significantly more intense staining for CD 34 was found in the nitroglycerin group compared with the other groups. Immunohistochemical staining for D 2-40 was also found statistically significant in the nitroglycerin group (p<0.05).
CONCLUSION: A topical containing 2% nitroglycerin increases vascular proliferation in the zone of stasis affects the recovery and may be used as a new agent in burn injury treatment.

AMAÇ: Bu çalýþmamýzýn amacý, redükte edilemeyen inguinal hernilerde baðýrsak oksijenizasyonunu deðerlendirmek için yeni bir yöntem olan near infrared spektrofotometri (NIR) spektroskopi tekniðini kullanmaktýr. Böylece erken dönemde baðýrsak oksijenizasyonu hakkýnda bilgi edinmeyi ve NIRS’nin kullanýlabilirliðini deðerlendirmeyi amaçladýk.

GEREÇ VE YÖNTEM: Çalýþmamýza inguinal hernileri olup elle redükte edilemeyen ve klinik bulgu ve görüntüleme yöntemleri ile ileus tespit edilen 40 hasta alýndý. Hastalarýn inguninal herni olan bölgeleri ile tam lateralinde herni olmayan bölgelerine NIRS proplarý yapýþtýrýlarak baðýrsak oksijenizasyonlarý ölçüldü. Normal ve herni olan bölgeler arasýndaki oksijenizasyon farklarý deðerlendirildi.

BULGULAR: Yaþ ortalamasý 65±14 olan, 14’ü kadýn (%35.0) ve 26’sý erkek (%65.0) toplam 40 hasta bu çalýþmaya alýndý. Hastalarýn redükte edilemeyen herni bölgesinde baðýrsak oksijenizasyonlarý normal bölgelerine göre düþüktü (p<0.001). Baðýrsak oksijenizasyonlarý düþük olan inguinal herni keseleri ameliyat edildiðinde inkarserasyon ve/veya strangülasyon tespit edildi. NIRS ölçümlerinin düþük ölçülmesi baðýrsaktaki inkarserasyon ve/ veya strangülasyonu tespit edebiliyordu fakat ikisi birbirinden ayýrt edilemiyordu.

TARTIÞMA: Bu çalýþmanýn bulgularý ýþýðýnda, strangülasyondan hapsedilmeyi ayýrt edememesine raðmen, NIRS bozulmuþ baðýrsak oksijenasyonu için iyi bir yöntem olarak görünmektedir. NIRS, indirgenemez fýtýklarda ultrasonografi bulgularýný desteklemek için kullanýlabilir. Bu nedenle, gelecekte acil serviste baðýrsak oksijenasyonunu deðerlendirmek ve izlemek için bu teknik kullanýlabilir.

BACKGROUND: The present study aims to investigate the usefulness of NIRS in identifying decreased blood flow in intestinal tissue inside the hernial sac in incarcerated hernias.
METHODS: Forty patients with manually irreducible inguinal hernias and with ileus determined by clinical findings and imaging were included in this study. Patients’ intestinal oxygenatýons were measured by placing NIRS probes over the areas of inguinal hernia and over non-herniated areas immediately lateral to these. Differences in oxygenation between normal and herniated areas were evaluated.
RESULTS: Forty patients, 14 women (35.0%) and 26 (65.0%) men, with a mean age of 65±14, were enrolled in this study. Intestinal oxygenation was lower in areas of irreducible hernia compared to normal regions (p<0.001). Incarceration and/or strangulation were detected when hernial sacs with low intestinal oxygenation were operated on. Low NIRS measurements were able to identify incarceration and/or strangulation in the intestine but were unable to distinguish between them.
CONCLUSION: In conclusion, in the light of the findings of this study, although not capable of differentiating incarceration from strangulation, NIRS appears to be a good method for showing impaired intestinal oxygenation. NIRS can be used to support ultrasonography findings in irreducible hernias. Therefore, this technique could be used in the future to evaluate and monitor intestinal oxygenation in the Emergency Department.

AMAÇ: Kolesistektomi, cerrahiye uygun olan kolesistit hastalarýnda kabul görmüþ bir tedavi yöntemidir. Perkütan kolesistostomi ise cerrahi açýdan yüksek riskli akut semptomlu kolesistit hastalarýnda geçici bir tedavi yöntemi olmakla beraber elektif kolesistektomi için hastaya zaman kazandýrabilir.
GEREÇ VE YÖNTEM: Bu çalýþmada ultrason eþliðinde perkütan transhepatik kolesistostomi yapýlmýþ ve dört–altý hafta sonra interval kolesistektomi uygulanmýþ olan 50 olgu sunuldu. Tüm hastalarda bilgisayarlý tomografide safra kesesi duvar bütünlüðünde bozulma veya Tokyo Guidelines 13 tanýsal kriterlerine göre grade II akut kolesistit bulgusu saptanmýþ olup beþ günlük týbbi tedaviye yanýt alýnamayan hastalara kolesistostomi iþlemi yapýlmasýna karar verildi.
BULGULAR: Kolesistostomi her ne kadar akut kolesistit tablosunun yatýþmasýnda etkili bir yöntem olsa da kolesistostomili olgularda dens fibrozis geliþimi nedeni ile yapýlacak olan interval kolesistektominin daha komplike bir hal aldýðý ve olgunun laparoskopik bitirilmesini zorlaþtýrdýðý görülmüþtür.
TARTIÞMA: Kolesistostomi iyileþme süreci içerisinde dens fibrozis geliþimine neden olarak laparoskopik kolesistektomiyi daha komplike hale getirmektedir. Dolayýsýyla kolesistostomi yapýlacak olgular bu bilgi de göz önünde bulundurularak daha dikkatle seçilmelidir.

BACKGROUND: Cholecystectomy is the well-accepted management method for acute cholecystitis in patients suitable for surgery. Percutaneous cholecystostomy is planned and used in patients at high surgical risk due to acute symptomatic cholecystitis and/or acute or chronic comorbidity. Percutaneous cholecystostomy can provide permanent treatment, or it may act as a bridge for elective cholecystectomy.
METHODS: We presented the outcomes of 50 patients who initially underwent ultrasound-guided transhepatic percutaneous cholecystostomy and 4–6 weeks later, an interval cholecystectomy. All patients had either impaired gallbladder wall integrity on contrast-enhanced abdominal computed tomography performed during admission or had grade II acute cholecystitis according to the Tokyo Guidelines 13 diagnostic criteria and severity grading of acute cholecystitis or exhibited clinical signs of acute cholecystitis on the fifth day of non-operative treatment.
RESULTS: Our results suggest that although percutaneous cholecystostomy is a useful method for alleviation of the emergency clinical condition in acute cholecystitis, it makes the interval cholecystectomy more difficult to perform due to the dense fibrosis developing during the healing process, eventually complicating laparoscopic cholecystectomy.
CONCLUSION: Cholecystostomy may cause fibrosis during the healing process, eventually complicating laparoscopic cholecystectomy. Thus, there is a need for better evaluation during the identification of indications for cholecystostomy.

AMAÇ: Akut apandisit (AA), akut karýn aðrýsýnýn en önemli nedenlerinden biridir. AA tanýsý için çeþitli laboratuvar belirteçleri çalýþýlmýþtýr, ancak hiçbiri fizik muayene veya görüntülemeye üstünlük göstermemiþtir. GCP-2/CXCL6, enflamasyon sýrasýnda makrofajlar ve epitelyal ve mezenkimal hücreler tarafýndan eksprese edilen bir kemokindir. Bu çalýþmanýn amacý AA hastalarýnda GCP-2/CXCL6’nýn tanýsal rolünü araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu kesitsel çalýþmada, serum GCP-2/CXCL6 düzeyi 56 AA hastasý ve 32 saðlýklý kontrolde ölçülmüþtür. Ayrýca, hasta ve kontrol gruplarýnýn hs-CRP ve lökosit (WBC) düzeyleri deðerlendirilmiþtir.
BULGULAR: Akut apandisit grubunun GCP-2/CXCL-6, hs-CRP ve WBC düzeyleri kontrol grubundan anlamlý derecede yüksekti (tüm karþýlaþtýrmalar için p<0.05). AA grubu arasýnda ise, GCP-2/CXCL6 seviyeleri kompleks AA’da (gangrenöz, apse ve perforasyon), kompleks olmayan AA’lara göre daha yüksekti (p<0.05). GCP-2/CXCL6 seviyeleri ile hsCRP seviyeleri arasýnda güçlü bir pozitif korelasyon bulunmuþtur (r=0.756, p=0.003) ve GCP-2/CXCL6 seviyeleri ile WBC sayýsý arasýnda orta derecede pozitif korelasyon bulunmuþtur (r=0.468, p=0.003). TARTIÞMA: GCP-2/CXCL6, AA teþhisinde ve karmaþýk olgularýn ayýrt edilmesinde, özellikle diðer laboratuvar belirteçleri ve görüntüleme teknikleriyle birleþtirildiðinde yararlý bir belirteç olabilir.

BACKGROUND: Acute appendicitis (AA) is one of the major causes of acute abdomen pain. Various laboratory markers have been studied for diagnosis of AA, but none of them have shown superiority to physical examination or imaging. GCP-2/CXCL6 is a chemokine expressed by macrophages and epithelial and mesenchymal cells during inflammation. The present study aims to investigate the diagnostic role of GCP-2/CXCL6 in AA patients.
METHODS: In this cross-sectional study, the serum level of GCP-2/CXCL6 was measured in 56 AA patients and 32 healthy control subjects. Also, hs-CRP and white blood cell count (WBC) levels of the patient and control groups were evaluated.
RESULTS: GCP-2/CXCL-6, hs-CRP and WBC levels of the AA group were significantly higher than the control group (p<0.05 for all comparisons). Among AA group, GCP-2/CXCL6 levels were higher in complex AA (gangrenous, abscess and perforation) ones when compared to non-complex AA (p<0.05). A strong positive correlation was found between GCP-2/CXCL6 levels and hs-CRP levels (r=0.756, p=0.003) and a moderate positive correlation between GCP-2/CXCL6 levels and WBC count (r=0.468, p=0.003).
CONCLUSION: GCP-2/CXCL6 can be a useful marker in AA diagnosis and discrimination of complex cases, especially if combined with other laboratory markers and imaging techniques.

AMAÇ: Bu çalýþmanýn amacý, 789 canlý donörden böbrek transplantasyon (CDBT) olgusunda cerrahi ve ürolojik komplikasyonlarýn geriye dönük olarak deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Anabilim dalýmýzda 1983 ve 2017 yýllarý arasýnda yapýlan 789 CDBT olgusunun klinik bilgileri cerrahi ve ürolojik komplikasyonlar bakýmýndan geriye dönük olarak deðerlendirildi.
BULGULAR: Ürolojik ve cerrahi komplikasyonlar 87 (%11.02) olguda tespit edildi. Olgularýn 44’ünde (%5.6) görülen ürolojik komplikasyonlar sekiz olguda üriner fistül (1’i distal üreter nekrozu ile birlikte), 10 olguda üreter stenozu, 1 olguda renal kalkül, 9 olguda semptomatik vezikoüreteral reflü ve 16 hastada giriþim gerektiren lenfosel idi. Cerrahi komplikasyonlar ise (n=43), 5’i renal arter stenozu ve 3’ü renal ven trombozu olmak üzere toplam 8 olguda vasküler komplikasyon, 14 yara yeri enfeksiyonu, 18 erken ameliyat sonrasý cerrahi eksplorasyon gerektiren perinefrik hematom, 2 akselere rejeksiyon nedeniyle renal allograft rüptürü ve bir ameliyat sýrasýnda alt segmental arter hasarý idi.
TARTIÞMA: Çalýþmamýzda ürolojik ve cerrahi komplikasyonlar alýcýlarýn %11.2’sinde saptanmýþtýr. Bu komplikasyonlarýn erken tanýnmasý ve uygun stratejilerle yönetilmesi greft kaybý riskini anlamlý ölçüde azaltmaktadýr.

BACKGROUND: This study aims to review retrospectively the surgical and urological complications encountered in 789 cases of living-related donor kidney transplantations (LRDKTs).
METHODS: In this study, the clinical records of 789 LRDKTs, which were performed between 1983 and 2017, were reviewed retrospectively concerning surgical and urological complications.
RESULTS: Overall, urological and surgical complications were encountered in 87 (11.02%) of the cases. Of the 789 patients, urological complications were detected in 44 of them (5.6%), including 8 urinary fistula (with 1 distal ureteral necrosis), 10 ureteric stenosis, 1 renal calculus, 9 symptomatic vesicoureteral reflux and 16 lymphoceles requiring intervention. As surgical complications (n=43), vascular complications were encountered in 8 cases; there were 5 cases with renal artery stenosis and 3 with renal vein thrombus. Wound infection was detected in 14 patients. Eighteen patients underwent surgical explorations due to perinephric hematoma during the early postoperative period. Renal allograft rupture due to accelerated rejection was developed in 2 cases. A lower segmental arterial injury occurred in 1 patient during the operation.
CONCLUSION: In our series, urological and surgical complications were detected in 11.02% of the recipients. Although complications still encountered, early identification of these complications with proper management strategies significantly decreases the risk of graft loss.

AMAÇ: Ýyatrojenik safra yolu yaralanmalarýný, nadir görülen bir komplikasyon olup erken tanýnmadýðýnda yüksek morbidite ve mortaliteye neden olur. Tedavisi, yaralanma boyutu ve yaralanmanýn fark edilmesine dek geçen süreye göre deðiþmekle birlikte, çoðunlukla endoskopik ve perkütan giriþimler yeterli olmaktadýr. Fakat bu tedaviler sonrasýnda ilerleyen yýllarda biliyer striktür, tekrarlayan kolanjit ataklarý ve hatta siroz gibi majör komplikasyonlara neden olabileceði unutulmamalýdýr. Bu yazýmýzda postkolesistektomi biliyer kaçaklara yaklaþýmýmýzý ve literatür eþliðinde tedavi yönetimini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2015–Temmuz 2019 tarihleri arasýnda biliyer kaçak nedeniyle tedavi ettiðimiz 105 hastanýn dosyasý geriye dönük olarak deðerlendirildi. Hastalarýn çoðunluðunu, dýþ merkezde kolesistektomi geçirip, biliyer kaçak saptanmasý üzerine kliniðimize sevk edilenler oluþturmakta idi. Hastalar kaçak yeri ve miktarýna göre belirlenen Strasberg sýnýflandýrmasýna göre gruplandýrýldý.
BULGULAR: Çalýþmaya alýnan 105 hastanýn 55’i erkek, 50’si kadýn olup ortalama yaþ 55.2±16.26 yýl (21–93 yýl) idi. Strasberg sýnýflamasýna göre; 57 hastada tip A, 1 hastada tip B, 3 hastada tip C, 29 hastada tip D ve 15 hastada tip E yaralanma mevcut idi. Seksen beþ hasta endoskopik ve giriþimsel radyolojik yöntemlerle baþarý ile tedavi edilirken, 20 hastaya cerrahi giriþim yapýldý.
TARTIÞMA: Biliyer kaçaktan þüphelenilen her hastada, ayrýntýlý tarama ve uygun tedavi morbidite ve mortalitede önemli bir düþüþ saðlar. Bu sebeple, erken taný hem erken hem de geç dönem sonuçlar açýsýndan çok önemlidir.

BACKGROUND: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature.
METHODS: The medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage.
RESULTS: Among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2 ±16.26 years (range, 21–93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery.
CONCLUSION: In all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes.

AMAÇ: Kafa travmasý pediatrik hastalarda acil servise en sýk baþvuru sebebidir. Kafa travmasýnda kafa içi basýncýn (KÝB) artmasý ikincil beyin hasarýna neden olmakla birlikte, hastanýn tedavisinde önemlidir. Optik sinir kýlýf çapýnýn (OSKÇ) ölçümü artmýþ KÝB’nin belirlenmesinde kullanýlabilir bir yöntemdir. Biz bu çalýþmada ciddi kafa travmalý pediatrik olgularda OSKÇ ile prognoz açýsýndan önemli Rotterdam bilgisayarlý tomografi skorlama (RBTS) sistemi arasýndaki iliþkiyi araþtýrmayý hedefledik.
GEREÇ VE YÖNTEM: Ocak 2017–Nisan 2018 tarihleri arasýnda 0–18 yaþ aralýðýnda hastanemiz acil servisine kafa travmasý (n=401) ve kafa travmasý dýþý (konvülziyon, solunum sýkýntýsý, baþ aðrýsý) (n=255) þikayetlerle baþvuran, bilgisayatlý tomografi (BT) çekilen toplam 656 hastalarýn görüntüleri ve týbbi kayýtlarý geriye dönük olarak deðerlendirildi. Hastalarýn yaþý, cinsiyeti, geliþ þikayeti, travmanýn þekli (yüksek enerjili-düþük enerjili) kaydedildi. Kafa travmasý ile baþvuran hastalar, hasta grubu; travma dýþý sebeplerle baþvuran ve çekilen beyin BT’si normal olarak yorumlanan hastalar kontrol grubu olarak belirlendi. BT bulgularýna göre travmatik beyin hasarlarý Rotterdam kriterlerince skorlandý. Hastalar 0–3 yaþ, 3–6 yaþ, 6–12 yaþ ve 12–18 yaþ olarak yaþlarýna göre sýnýflandýrýldý.
BULGULAR: Çalýþmamýzda pediatrik olgular için OSKÇ’nin yaþ aralýklarýna göre tomografik referans deðerleri belirlendi. Ciddi kafa travmalý hastalarýn OSKÇ ile kontrol grubu arasýnda anlamlý farklýlýk mevcuttu (p<0.05). RBTS ve OSKÇ arasýnda korelasyon izlenmiþ olup ciddi kafa travmasýnda (scor 4–5–6) kullanýlabilecek, yaþ aralýklarýna göre kestirim deðerleri belirlendi.
TARTIÞMA: Çalýþmamýz pediatrik ciddi kafa travmasýnýnda prognozu belirlemede RBTS sistemine ek olarak artmýþ KÝB’nin gösterilmesinde OSKÇ deðerlerinin de kullanýlabileceðini göstermiþtir. Ayrýca çalýþmamýzda pediatrik hastalar için OSKÇ’nin tomografik referans deðerleri belirlenmiþtir.

BACKGROUND: Pediatric head trauma is the most common presentation to emergency departments. Increased intracranial pressure (ICP) may lead to secondary brain damage in head trauma and early diagnosis of increased ICP is very important. Measurement of optic nerve sheath diameter (ONSD) is a method that can be used for determining increased ICP. In this study, we aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and Rotterdam computer tomography scores (RCTS) in pediatric patients for severe head trauma.
METHODS: During January 2017–April 2018, medical records and imaging findings of children aged 0–18 years who underwent computed tomography (CT) imaging for head trauma (n=401) and non-traumatic (convulsions, respiratory disorders, headache) (n=255) complaints, totally 656 patient were evaluated retrospectively. Patients’ age, sex, presentation and trauma type (high energy-low energy) were identified. Non-traumatic patients with normal cranial CT findings were considered as the control group. CT findings of traumatic brain injury were scored according to Rotterdam criteria. Patients were divided into groups according to their age as follows: 0–3 years, 3–6 years, 6–12 years and 12–18 years.
RESULTS: In our study, tomographic reference measurements of the ONSD in pediatric cases were presented according to age. There was a statistically significant difference between ONSD of severe traumatic patients and the control group. Correlation between RCTS and ONSD was determined and age-specific cut-off values of ONSD for severe traumatic scores (score 4–5–6) were presented.
CONCLUSION: In our study, reference ONSDs of the pediatric population for CT imaging was indicated. Our study also showed that ONSD measurement is a parameter that can be used in addition to the RCTS to determine the prognosis of the patient in severe head trauma, by reflecting increased intracranial pressure.

AMAÇ: Yanýk merkezi yoðun bakým ünitemizde tedavi edilen elektrik yanýklý hastalarýn verilerini gözden geçirerek tedavi sonuçlarýmýz ile birlikte komplikasyonlarý tartýþmak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Eylül 2017–Aðustos 2018 tarihleri arasýnda yanýk merkezi yoðun bakým ünitesinde yatan elektrik yanýklý hastalarýn demografik verileri, yanýk mekanizmasý, prezentasyonu, ortalama yanýk total vücut alaný yüzdesi (TBSA), kýsaltýlmýþ yanýk þiddeti indeksi (ABSI) skorlarý, komplikasyonlar ve tedavi yaklaþýmlarý geriye dönük olarak incelendi.
BULGULAR: Yanýk merkezi yoðun bakým ünitemize yatýrýlan hastalarýn (n=139) %17.9’u elektrik yanýðý hastasý idi. Hastalarýn tümü erkekti ve ortanca yaþlarý 27.0 yýl idi. Hastalarýn 23’ü yüksek voltaj (%92), ikisi düþük voltaj (%8) elektrik ile yanmýþtý. Ortanca yanýk TBSA skoru 20.0 idi. Sekiz hastada eþlik eden baþ, vertebra veya ekstremite yaralanmalarý mevcuttu. Hastalarýn 16’sý (%64) iþte yaralanmýþtý. On altý hasta (%64) komplikasyonla iyileþti. Komplikasyonla iyileþen grupta yoðun bakým ve toplam hastane kalýþ süreleri istatistiksel olarak anlamlý derecede yüksekti (sýrasýyla, p=0.005 ve p=0.001), ancak TBSA ve ABSI skorlarýnda anlamlý farklýlýk görülmedi. TBSA ve ABSI skorlarý yoðun bakým ve toplam hastane yatýþ süreleri ile korele bulundu.
TARTIÞMA: Elektrik yanýklý hastalarýmýzýn yüzdesi literatürde belirtilenden yüksektir. Yanýk TBSA ve ABSI skorlarýnýn prognozla iliþkili olmadýðý görülmüþtür. Elektrik yanýklý hastalarýn çoðunluðu iþ kazasýnda yüksek voltajla yaralandýðýndan, iþ güvenliði ilkelerine uyulmasý bu yaralanmalarý azaltabilir. Elektrik yanýklarýnda komplikasyon oraný yüksek olduðundan hastalarýn deneyimli saðlýk ekibi eþliðinde, tam donanýmlý merkezlerde, güncel rehberlere göre tedavisi yapýlmalýdýr.

BACKGROUND: To review the records of electrical burn patients hospitalized in our burn intensive care unit (ICU) and to report the complications together with our treatment results.
METHODS: Demographic data, burn mechanism, presentation, percentage of burn total body surface area (TBSA), abbreviated burn severity index (ABSI) scores, complications and treatment approaches of electrical burn patients admitted to our burn ICU between September 2017 and August 2018 were evaluated retrospectively in this study.
RESULTS: Electrical burn injury patients consisted of 17.9% of the patients who were hospitalized in burn ICU (n=139). All patients were male, and the median age was 27.0 years. Twenty-three patients (92%) were burned with high voltage electricity. The median percentage of burn TBSA score was 20.0. Eight patients had an accompanying head, a vertebra or extremity injuries. Sixteen patients (64%) were injured at work. Sixteen patients (64%) recovered with complications. ICU stay and total hospital stay were significantly higher in the group that healed with complications (p=0.005 and p=0.001, respectively). However, no significant differences were detected in burn TBSA and ABSI scores. TBSA and ABSI scores were correlated with ICU and total hospital stay.
CONCLUSION: The proportion of our electrical burn patients is higher than reported in the literature. Burn TBSA and ABSI scores seem unrelated to prognosis. As the majority of patients are burned with high-voltage electricity at work, these injuries can be reduced by following occupational safety principles. Because of the high rate of complications in electrical burns, an experienced health team in well-equipped centers should treat patients in accordance with updated guidelines.

AMAÇ: Bu çalýþmada sivil nedenli abdominal ateþli silah yaralanmalý (ASY) hastalarda selektif non-operatif tedavi (SNOT) sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2009 ile Ocak 2018 tarihleri arasýnda sivil nedenli abdominal ASY nedeniyle yatýrarak takip ve tedavi ettiðimiz hastalar ileriye yönelik veri tabanýnda geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, yaralanma þekli, anatomik yaralanma bölgesi, Yaralanma Þiddet Skoru (ISS), Revize Edilmiþ Travma Skoru (RTS), Penetran Abdominal Travma Ýndeksi (PATI), uygulanan tedavi yöntemi, ameliyata alýnma süresi, hastanede yatýþ gün sayýsý ve mortalite yönünden irdelendi.
BULGULAR: Hastalarýn 84’ü (%89.4) erkek, 10’u (%10.6) kadýn, ortalama yaþ 32.7 (4–60 yaþ) idi. Seksen iki hasta (%87.2) tabanca mermisi, 12 (%12.8) hasta tüfek saçmasý ile yaralanmýþtý. Tüm hastalarýn ortalama ISS, RTS ve PATI deðerleri sýrasýyla 17.05, 7.27 ve 9.21 bulundu. Hastalarýn 21’ine (%22.3) hemodinamik instabilite, 27’sine (%28.7) ise peritonit bulgularý nedeniyle hemen acil laparatomi ve/veya torakotomi uygulandý. Diðer 46 (%48.9) hasta kliniðe yatýrýlarak takip edildi. Bu hastalardan peritonit bulgularý geliþen 5’ine (%5.3) erken laparatomi, 8’ine (%8.5) geç laparatomi uygulandý. Geriye kalan 33 (%35.1) hasta non-operatif olarak tedavi edildi. Flank yaralanmalarýnýn %61.1’i, sað torakoabdominal yaralanmalarýn %50’si, posteriyor abdominal yaralanmalarýn %44.4’ü, pelvik yaralanmalarýn %42.1’i ve sol torakoabdominal yaralanmalarýn %27.8’i baþarýlý þekilde SNOT uygulamasý ile taburcu edildi. Sadece 6 (%6.4) hastaya gereksiz laparatomi uygulandý, toplam 10 (%10.6) hastada mortalite geliþti.
TARTIÞMA: Hemodinamisi stabil olan ve peritonit bulgusu mevcut olmayan, belirli anatomik lokalizasyondaki sivil nedenli abdominal ASY’li hastalarýn bir kýsmý, delici-kesici alet yaralanmalý hastalar gibi non-operatif tedavi edilebilir. Böylece gereksiz laparatomi ve buna baðlý komplikasyonlar azaltýlabilir. Özellikle flank, posterior abdominal, torakoabdominal ve pelvik bölgenin ASY’de non-operatif takip ve tedavinin baþarý oranlarýnýn yüksek olduðu hatýrda tutulmalýdýr.

BACKGROUND: In this study, we aimed to evaluate the results of selective non-operative management in patients with civilian abdominal gunshot wounds.
METHODS: Patients hospitalized and monitored in our clinic due to civilian abdominal gunshot wounds between January 2009 and January 2018 were retrospectively examined. Patients were studied concerning age, gender, mechanism of injury, anatomic injury site, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), Revised Trauma Score (RTS), treatment method, time to operation, days of hospitalization and mortality.
RESULTS: Of the patients, 84 (89.4%) were male, and 10 (10.6%) were female with a mean age of 32.7 (range 4–60). The mean ISS, RTS and PATI values of all patients were 17.05, 7.27 and 9.21, respectively. Immediate laparotomy and/or thoracotomy were performed in 21 (22.3%) of the patients due to hemodynamic instability and in 27 (28.7%) of the patients because of peritonitis findings. The remaining 46 (48.9%) patients were managed non-operatively. Among these patients, early laparotomy was performed in five (5.3%) and late laparotomy in eight (8.5%) patients who developed peritonitis symptoms. The other 33 (35.1%) patients were treated non-operatively. Of these patients, 61.1% of the patients with flank injuries, 50% of the patients with right thoracoabdominal injuries, 44.4% of the patients with posterior abdominal injuries, 42.1% of the patients with pelvic injuries and 27.8% of the patients with left thoracoabdominal injuries were successfully treated non-operatively. Non-therapeutic or negative laparotomy was performed on six (6.4%) patients. Mortality was 10.6% (n=10) in all patients.
CONCLUSION: Some patients with a civilian abdominal gunshot wound in certain anatomical localization who are hemodynamically stable and have no peritonitis symptoms can be non-operatively managed just as in patients with abdominal stab wounds. Success rates of selective non-operative management are high, especially in gunshot wounds of flank, posterior abdominal, thoracoabdominal and pelvic regions.

AMAÇ: Bu çalýþmanýn amacý, Ýstanbul’daki üçüncü basamak bir hastaneye baþvuran Fournier gangreni hastalarýnýn demografik, klinik ve cerrahi verilerini analiz etmektir.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2010–Ocak 2015 tarihleri arasýnda Ýstanbul Üniversitesi-Cerrahpaþa Cerrahpaþa Týp Fakültesi Genel Cerrahi, Plastik Cerrahi ve Üroloji Anabilim Dallarý tarafýndan takip edilen Fournier gangrenli 35 hasta dahil edildi. Cinsiyet, yaþ, yatýþ süresi, altta yatan neden(ler), debridman sayýsý, predispozan faktörler ve 10 yýllýk bir süre içinde cerrahi ile ilgili veriler geriye dönük olarak deðerlendirildi ve analiz edildi.
BULGULAR: Otuz beþ hastanýn yaþ ortalamasý 58.14±12.71 idi. Otuz beþ hastanýn 20’sinde (%57.1) diabetes mellitus (DM) mevcuttu. Hastalarýn 12’si (%34.2) yoðun bakým ünitesinde (YBÜ) yatýrýldý. YBÜ’de kalma süresinin yaþ, hematokrit seviyesi, FGSI ve UFGSI’den anlamlý derecede etkilendiði bulundu (sýrasýyla, p=0.013, p=0.030 p=0.025 ve p=0.002).
TARTIÞMA: Fournier gangreni, mortalite oraný yüksek fulminan bir enfeksiyondur. FG tanýsý için fizik muayene ve öykü oldukça önemlidir. En sýk görülen komorbidite DM’dir. Yaþ, hematokrit seviyesi, FGSI ve UFGSI skorlarý hastalarýn YBÜ’de kalýþ sürelerini etkilediði bulunmuþtur.

BACKGROUND: Is the present study aims to analyze demographic, clinical and surgical data of all patients with FG (Fournier’s gangrene) admitted to a tertiary healthcare hospital in the largest city of Turkey.
METHODS: This study included 35 patients with Fournier’s gangrene, who were followed by the General Surgery, Plastic Surgery, and Urology Departments of Istanbul University Cerrahpaþa Faculty of Medicine from January 2010 to January 2015. Demographic and clinical data, including gender, age, length of stay at the hospital, the underlying cause(s), number of debridement, predisposing factors, and surgical reconstructive data over 10 years were assessed and analyzed retrospectively.
RESULTS: The mean age of the 35 patients was 58.14±12.71 years. Diabetes mellitus was present in 20 of the 35 (57.1%) patients. Twelve of the patients (34.2%) were hospitalized in the intensive care unit (ICU). Length of stay in the ICU was found to be significantly influenced by age, hematocrit level, FGSI and UFGSI (p=0.013, p=0.030 p=0.025 and p=0.002, respectively).
CONCLUSION: Fournier’s gangrene is a fulminant infection with a high mortality rate. Physical examination and anamnesis are quite important for the diagnosis of FG. DM is the most common comorbidity. Age, hematocrit level, FGSI and UFGSI scores affect the patients’ length of stay in the ICU.

AMAÇ: Hasarýn derecesi, travmanýn ciddiyetinin belirlenmesinde halen güncel ve önemli bir konudur. Bu amaçla dünyada çeþitli travma skorlama sistemleri kullanýlmaktadýr. Yaralanma þiddeti skoru ve revize travma skorlarý bunlardan biridir. Bu yazýda, þu anda sýklýkla kullanýlan ve bilim tarafýndan büyük ölçüde olgunlaþan bu iki travma puanlama sisteminin iþlevlerini devlet hastanesi düzeyinde deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Geriye dönük arþiv taramasý ile klinik çalýþmalar yürütmek üzere etik kurul onayýný takiben; 1 Ocak 2012 ve 31 Aralýk 2017 tarihleri arasýndaki veriler, 29 Mayýs Devlet Hastanesi’nde travmatik yaralanma tanýsý alan tüm hastalarda mortaliteyi etkileyen faktörleri belirlemek amacýyla geriye dönük olarak incelendi. Eksik veya net olmayan veriler çalýþmaya alýnmadý. Sürekli deðiþkenler için basit ve standart sapma, ikili deðiþkenler için yüzde ve frekans deðerleri kullanýldý. Sürekli deðiþkenlerin deðerlendirilmesinde, baðýmsýz gruplarda daðýlým durumuna göre Student t-testi veya Mann-Whitney U-testi kullanýldý. Ýkili deðiþkenler ki-kare testi ile deðerlendirildi. Tek deðiþkenli analizlerde anlamlý olduðu tespit edilen deðiþkenler lineer ve ikili lojistik regresyon (LR) modeli ile tekrar deðerlendirildi.
BULGULAR: Tüm hastalarýn yaþ ortalamasý 37.53±14.47 yýldý [erkek (35.68±13.9) – kadýn (40.61±15.1) – (p=0.116)]. Genel popülasyon için ortalama yaralanma travma skoru 3.18±8.46 idi. Yaralanma þiddeti skoru (ISS) cinsiyeti ile ilgili farklýlýk görülmemiþtir [(3.93±10.49 ve 1.91±2.34) (p=0.727)]. Yaþ ile ilgili olarak, gözden geçirilmiþ travma skoru (RTS) için istatistiksel anlamlýlýk kaydedilmedi [(7.60±0.91’e karþýlýk 7.81±0.16) (p=0.207)]. Yaralanma mekanizmasý ile ilgili olarak, iki travma skoru arasýnda bir fark saptandý; hem ISS hem de RTS’nin istatistiksel önemi vardý. Sonuçlar ISS [penetrant (6.56±6.47) ile künt (2.45±8.68) (p=0.002)] ve RTS [penetrant (7.41±0.54) ile künt (7.74±0.79) (p=0.001)] için bulundu. Lojistik lineer regresyon ile son istatistiklerden sonra, penetran yaralanma için solunum hýzý istatistiksel olarak anlamlý idi [AOR 0.22 (0.001, 0.47) (p<0.05)]. RTS skoru bileþenleri için ayrýntýlý subanalizde orta dereceli travmalarda solunum hýzý da anlamlýydý [AOR 0.22 (0.001, 0.47) (p=0.004)].
TARTIÞMA: Her iki ISS ve RTS de orta dereceli yaralanma tiplerinin hepsinde önemsizdir. Diðer yandan solunum hýzý özellikle penetran ve orta dereceli yaralanmalarda önemli bir belirteçtir.

BACKGROUND: The degree of damage presents a pressing issue in determining trauma severity. Various trauma-scoring systems, such as the injury severity and revised trauma scores, are used worldwide. In this study, we aimed to evaluate the functionalities of these two trauma scoring systems, which are presently used frequently and have scientifically evolved at the state hospital level.
METHODS: Following approval from the ethics committee to conduct clinical studies with retrospective archive screening, data between January 1, 2012, and December 31, 2017, were retrospectively analysed for determining the factors affecting mortality in all patients diagnosed with traumatic injury in 29 Mayýs State Hospital. Incomplete or unclear data were excluded from this study. Mean and standard deviation were used for continuous variables; percentage and frequency values were used for binary variables. For evaluating continuous variables, Student’s t-test or Mann–Whitney U-test was used in independent groups based on their distribution status. Dichotomous variables were evaluated using the chi-square test. The results and significant in univariate analyses were evaluated again by the linear and binary logistic regression model.
RESULTS: Mean age of all patients was 37.53±14.47 years [male (35.68±13.9) versus female (40.61±15.1) (p=0.116)]. Mean injury trauma score for the general population was 3.18±8.46. No dissimilarity was noted regarding gender for the injury severity score (ISS) [(3.93±10.49 versus 1.91±2.34) (p=0.727)]. Regarding age, for revised trauma score (RTS), no statistical significance was noted [(7.60±0.91 versus 7.81±0.16) (p=0.207)]. Regarding the injury mechanism, we detected a difference between the two trauma scores; both ISS and RTS also had statistical significance. The results were found for ISS [penetrant (6.56±6.47) versus blunt (2.45±8.68) (p=0.002)] and for RTS [penetrant (7.41±0.54) versus blunt (7.74±0.79) (p=0.001)]. After the final statistics with logistic linear regression, the respiratory rate was statistically significant for penetrant injury [AOR 0.22 (0.001, 0.47) (p≤0.05)]. In the detailed subanalysis for RTS score components, respiratory rate was also significant in moderate traumas [AOR 0.22 (0.001, 0.47) (p=0.004)].
CONCLUSION: Both ISS and RTS are nonsignificant in all moderate injury types. On the other hand, respiratory rate is an important marker, especially in penetrant moderate injuries.

AMAÇ: Yabancý cisim (YC) yutulmasý, çocuklarý tedavi eden tüm kliniklerde sýkça karþýlaþýlan bir durumdur. Ebeveynler ve doktorlar için önemli kaygýlara neden olmaktadýr. Amacýmýz YC yutan çocuklarda en uygun yaklaþýmý belirlemekti.
GEREÇ VE YÖNTEM: 2005–2017 yýllarý arasýnda YC yutulmasý ile baþvuran 1000 çocuðun kayýtlarý geriye dönük olarak incelendi.
BULGULAR: Bin çocuðun %53.8’i erkekti. En sýk görülen YC tipi madeni paraydý (%35). Hastalarýn %49’unda direkt grafide YC görülmedi ve bu hastalarýn %86’sýna herhangi bir müdahale yapýlmadý. Beþ yüz dört (%51) X-ray pozitif olan hastada, özofagus (%68) en yaygýn yerleþim yeriydi. Hayatý tehdit eden komplikasyonlar trakeoözofageal fistül (1), Meckel divertikül perforasyonu (1) ve rijit endoskopiye baðlý perforasyon (1) idi.
TARTIÞMA: En fazla yutulan YC’lerden olan madeni paranýn þekil ve büyüklüklerinin ülkelere göre deðiþtiðini ortaya koyduk ve bunun da kendiliðinden geçiþ sonuçlarýmýzý etkilediðini gördük. Madeni paranýn kendiliðinden gastrointestinal sistemi terk etme oranýný literatüre göre oldukça düþük, %48 olarak bulduk. Düðme (saat) pili yutup midesine geçmiþ, semptomsuz hastalarda ise, “acil endoskopik çýkarým” deðil, “dikkatli/yakýn takip” yaklaþýmý öneriyoruz. Hastalar evde izlenmeli ve yönetilmelidir. Çalýþmamýzda, pilin mideye ulaþmasý durumunda, %85’inin gastrointestinal sistemden kendiliðinden ve sorunsuzca geçtiðini belirledik.

BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children.
METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study.
RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel’s diverticulum perforation (1), and perforation due to rigid endoscopy (1).
CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a “watchful waiting” approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.

AMAÇ: Bu çalýþma Hartmann prosedürü kapatýlmasýnýn ameliyat öncesi ve ameliyat sýrasýnda risk faktörlerine dayanarak sonuçlarýný deðerlendirmektedir.
GEREÇ VE YÖNTEM: Kliniðimizde Ocak 2010–Ocak 2016 yýllarý arasýnda Hartmann prosedürü uygulanan 78 olgu geriye dönük olarak incelendi.
BULGULAR: Olgularýn 45’i erkek, 33’ü kadýndý. Olgularýn 32’si malignite, 15’i divertikül perforasyonu, 11’i sigmoid volvulus nedeniyle ameliyat edilmiþtir. Otuz iki olguda Hartmann kapatýlmasý yapýlabilmiþtir. Hartmann kapatýlmasý için morbidite ve mortalite oranlarý sýrasýyla %37.5–%0.0 idi.
TARTIÞMA: Hartmann prosedürü kapatýlmasý kabul edilebilir morbidite oranlarý ile güvenilir bir cerrahi olarak görünmektedir. Doðru hasta seçimi, doðru operasyon zamanlamasý ve titiz bir cerrahi hazýrlýk yapýldýðý takdirde Hartmann prosedürü kapatýlmasýnýn morbidite ve mortalite riski minimalize edilebilir.

BACKGROUND: This study evaluated the outcome of the reversal of Hartmann’s procedure based on preoperative and intraoperative risk factors.
METHODS: We retrospectively reviewed 78 cases, whom we applied the Hartmann’s procedure either electively or under emergency conditions in our clinic between the years 2010 and 2016.
RESULTS: Of the cases reviewed in this study, 45 patients were males, and 33 patients were females. Of all cases included in this study, 32 cases were operated due to malignancies, 15 cases were operated due to a perforated diverticulum, and 11 cases were operated due to sigmoid volvulus. Reversal of Hartmann’s was performed in 32 cases. The morbidity and mortality rates for the reversal of Hartmann’s procedure were 37.5% and 0.0%, respectively.
CONCLUSION: The reversal of Hartmann’s procedure appears to be a safe operation with acceptable morbidity rates. If the correct patient selection, correct operation timing and meticulous surgical preparation are performed, the risk of morbidity and mortality of the reversal of Hartmann’s procedure can be minimized.

AMAÇ: Akromiyoklaviküler (AC) eklem hasarý, 100.000’inde 3 ile 4 sýklýðýnda görülen bir yaralanmadýr. AC eklem yaralanmalarýnýn tedavisi için optimal tedavi konusunda net bir fikir birliði olmadýðýndan çok sayýda cerrahi teknik tanýmlanmýþtýr. Çalýþmamýzda literatürde bildirilen diðer tekniklerle karþýlaþtýrýldýðýnda, minimal-invaziv polimer serklaj tel sistemi ile olumlu klinik sonuçlar elde edeceðimizi hipotez edilmiþtir.
GEREÇ VE YÖNTEM: Bölümümüzde 2014–2017 tarihleri ​​arasýnda subakut AC yaralanmasý olan tüm yetiþkin hastalar geriye dönük olarak taranarak klinik ve radyografik olarak incelendi. Ameliyat öncesi ve sonrasý klinik sonuçlar ASES skoru, Constant skoru ve UCLA omuz skoru ölçeði ile deðerlendirildi.
BULGULAR: Çalýþmaya ayný minimal-invaziv tekniði kullanarak ayný cerrah tarafýndan cerrahi tedavi uygulanmýþ tip 5 AC yaralanmasý olan beþ hasta dahil edildi. Ortalama takip süresi 22.4 aydý (18–29). Ameliyat öncesi ortalama korakoklavikular (CC) uzaklýðý cerrahi tarafta 19.7 mm (16.4–24.5 mm), kontralateral tarafta 9.48 mm idi. Ameliyat sonrasý erken dönemde ortalama CC mesafesi 7.1 mm (4.5–11.2 mm) idi. Son takipte, ortalama CC mesafesi 13.8 mm (7.3–21.2 mm) idi. Ameliyat öncesi ortalama Constant skoru 48, UCLA omuz skoru 14.8, ASES omuz skoru 49.26 idi. Hastalarýn son takiplerinde ortalama Constant skoru 91.6, UCLA omuz skoru 33.8, ASES omuz skoru 93.75 idi. Cerrahi sonrasý nörovasküler komplikasyon görülmedi. Klinik veya radyografik implant yetersizliði veya fiksasyon kaybý görülmedi. Son takipte hiçbir hastada AC eklem artriti görülmedi.
TARTIÞMA: Tip 5 AC eklem yaralanmalarý için bildirilen diðer artroskopik ve açýk teknikler ile karþýlaþtýrýlabilir sonuçlar saðlayan yeni bir minimal-invaziv polimer serklaj tel tekniði tanýmlanmýþtýr.

BACKGROUND: AC joint injury is a common disorder with a reported incidence of three to four cases per 100.000. A multitude of surgical techniques has been described for the treatment of the AC joint injuries with no clear consensus regarding the optimal treatment. We hypothesized that we would obtain favorable clinical outcomes using a novel minimally-invasive polymer cerclage wire system compared to other reported techniques in the literature.
METHODS: All adult patients treated with subacute AC separations in our department between the dates of 2014–2017 were retrospectively reviewed clinically and radiographically. Clinical outcomes scores that were obtained preoperatively and postoperatively included ASES score, constant score and the UCLA shoulder rating scale.
RESULTS: Five patients with Type 5 AC separations were included in this study who underwent surgical treatment by the same orthopedic surgeon (G.H.) using the same minimally-invasive technique. The mean follow-up period was 22.4 months (range 18 to 29). Mean preoperative coracoclavicular (CC) distance was 19.7 mm (range 16.4 to 24.5 mm) on the surgical side and 9.48 mm on the contralateral side. Mean early postoperative CC distance was 7.1 mm (range 4.5 to 11.2 mm). At the latest follow-up, the mean CC distance was 13.8 mm (range 7.3 to 21.2 mm). Mean preoperative Constant score was 48, the UCLA shoulder rating score was 14.8, and the ASES shoulder score was 49.26. Mean follow up Constant score was 91.6, UCLA shoulder rating score was 33.8 and ASES shoulder score was 93.75. No neurovascular complication was observed after procedure. There were no cases of clinical or radiographic failure or loss of fixation. No AC joint arthritis was observed at the latest follow-up.
CONCLUSION: We present a novel minimally-invasive polymer cerclage wire technique which provides comparable results as other reported arthroscopic and open techniques for Type 5 AC joint separations.

AMAÇ: Çalýþmada, cerrahi yöntemlerle tedavi edilen asetabulum kýrýklarýnda uyguladýðýmýz cerrahi yaklaþýmlarý, oluþan komplikasyonlarý ve elde edilen klinik ve radyolojik sonuçlarý deðerlendirerek prognoz üstünde etkin olan parametreleri saptamak amaçlandý.
GEREÇ VE YÖNTEM: Ocak 1994–Ocak 2014 tarihleri arasýnda deplase asetabulum kýrýðý tanýsýyla cerrahi tedavi uygulanan 144 olgudan, en az iki yýl süreyle klinik ve radyolojik takipleri yapýlan (ortalama takip süresi 34 ay, daðýlýmý 2–8 yýl) ve yaþ ortalamasý 36.3 yýl (19–67 yýl) olan 75’i erkek, 28’i kadýn toplam 103 hasta çalýþmaya alýndý.
BULGULAR: Hastalarýn klinik olarak %64’ünde mükemmel ve iyi, %36’sýnda orta ve kötü sonuç, radyolojik olarak ise %57.3’ünde mükemmel ve iyi, %42.7’sinde orta ve kötü sonuç elde edildi. Kýrýðýn kompleks olmasý (ki-kare p=0.023), travma ile operasyon arasý sürenin artmasý (p=0.039), cerrahi sürenin altý saatten uzun sürmesi (ki-kare p<0.001), eklem içi basamaklaþmanýn 3 mm’den fazla olmasý (Fisher’s p=0.033), mekanik blok oluþturan komplikasyonlarýn geliþmesi (ki-kare p<0.001) klinik sonuçlarý kötüleþtirmekteydi. Hastalarýn yaþýnýn klinik sonuç üzerine anlamlý etkisi yoktu (p=0.461).
TARTIÞMA: Cerrahi olarak tedavi edilen asetabulum kýrýklarýnýn prognozuna etki eden üç temel parametrenin; kýrýk tipi, cerrahi giriþim süresi ve redüksiyon kalitesi olduðu, travma ile operasyon arasýnda geçen sürenin sonuçlarý dolaylý olarak etkilediði, avasküler nekroz, heterotropik ossifikasyon ve artirtin ise sadece uzun dönem sonuçlarý üzerinde olumsuz etkiler yarattýðý tespit edildi.

BACKGROUND: This study aims to evaluate the surgical approaches, complications, clinical and radiological findings in acetabular fractures treated with surgical methods and to determine the parameters affecting prognosis.
METHODS: Out of 144 patients undergone surgical treatment with the diagnosis of displaced acetabular fractures between 1994 and 2014, a total of 103 patients with 75 male and 28 female with a mean age of 36.3 years (range 19–67 years) whom clinical and radiologic follow-ups (mean: 34 months, range 2–8 years) were performed at least for two years were included in this study.
RESULTS: Clinically excellent to good outcomes were obtained in 64% of the patients and moderate to poor outcomes were recorded in 36% of the patients, while radiologically excellent to good outcomes were achieved in 57.3% of the patients and moderate to poor outcomes were recorded in 42.7% of the patients. Presence of one of the complications, creating mechanical block (chi-square p<0.001), complex fractures (chi-square p=0.023), increased duration between trauma and operation (p=0.039), operational time taking longer than six hours (chi-square p<0.001), more than 3 mm intra-articular step (Fisher’s p=0.033), avascular necrosis (p<0.001), arthritis (p=0.006) and heterotopic ossification (p=0.007) worsened the clinical outcomes (chi-square p<0.001). The age of the patient was not effective on the clinical outcome (p=0.461).
CONCLUSION: It was found that three major parameters affecting the prognosis of acetabular fractures are as follows: type of fracture, operational time and reduction quality. The duration between trauma and operation indirectly affects the outcomes. Avascular necrosis, heterotopic ossification and arthritis may cause negative effects only on long term outcomes.

AMAÇ: Bu çalýþmanýn amacý kýrýk sonrasý apoptozisin indüklenip indüklenmediðinin belirlenmesi ve eðer öyleyse ekstrensek ya da intrensek hangi apoptotik yolaðýn aktif olduðunun gösterilmesidir.
GEREÇ VE YÖNTEM: Kliniðimize baþvuran ve travma nedeniyle kýrýk tanýsý konulmuþ olan 30 kiþi, hasta grubu ve hasta grubu ile benzerlik gösteren gönüllülerden oluþan saðlýklý 37 bireyden kontrol grubu oluþturuldu. Kýrýk sonrasý birinci gün hastalardan alýnan kanlardan ELISA yöntemi ile sitokrom C, granzim B ve kaspas-8 testleri çalýþýldý.
BULGULAR: Çalýþmaya toplam 67 kiþi dahil edildi (kýrýk grubunda 30, kontrol grubunda 37 kiþi). Hasta grubunda ortalalama yaþ 62.03 (min: 18, maks: 91), kontrol grubu ortalama yaþý 61.62 (min 25, maks: 90). Kaspas-8 hasta grubunda anlamlý yüksek bulundu 0.37 ng/mL (Std: 0.06), (p=0.002); gruplar arasýna sitokrom C ölçüm deðerleri arasýnda fark izlenmedi (p=0.173). Granzim B hasta grubunda anlamlý olarak daha yüksek ölçüldü 52.56 pg/mL (Std: 8.51), (p=0.007).
TARTIÞMA: Uzun kemik kýrýklarý olan hastalarda ekstrensek apoptotik yolak aktivasyonunu gösteren serum kaspas-8 ve granzim B düzeyleri yüksektir. Ancak, serum sitokrom C düzeyleri açýsýndan gruplar arasýnda anlamlý bir fark bulunamadý. Bu çalýþma, kýrýk sonrasý olaylarý yöneten moleküler yolaklarýn daha iyi anlaþýlmasý için tasarlanacak gelecek çalýþmalara rehber olabilir ve kýrýk tedavisinin gelecekteki ilerlemesi için önemlidir.

BACKGROUND: The primary objective of this study was to investigate whether or not apoptosis is induced following bone fracture, and if so, to investigate whether the extrinsic or intrinsic pathway of cell death is stimulated.
METHODS: A total of 30 patients who presented at our clinic and were diagnosed with bone fracture following trauma were included in the study group. A control group was formed of 37 age and gender-matched volunteers. On the day after the fracture, blood samples taken from the patients were examined for cytochrome C, granzyme B and caspase-8 with the ELISA method.
RESULTS: A total of 67 individuals were evaluated (fracture group: 30, control group: 37) in this study. Caspase-8 was found to be statistically significantly high in the patient group (0.37±0.06 ng/mL, p=0.002). No significant difference was determined between the groups in respect to cytochrome C values (p=0.173). The granzyme B values were determined to be significantly high in the patient group (52.56±8.51 pg/mL, p=0.007).
CONCLUSION: These results obtained from patients with a long bone fracture demonstrated that serum caspase-8 and granzyme B levels were higher in patients than in the control group, thereby showing activation of the extrinsic pathway. However, no significant difference was determined between the groups concerning serum cytochrome C levels. This study may guide future studies designed for better understanding of the molecular pathways that govern the events during a fracture, which will be important for the future advancement of fracture treatment.

AMAÇ: Ýntramedüller çivileme (ÝMÇ) tekniði, alt ekstremite uzun kemiklerinin kapalý kýrýklarýnýn tedavisinde altýn standarttýr. Ortopedik cerrahlar için ÝMÇ prosedürlerindeki en önemli sorunlardan biri distal kilitleme vidalarýnýn (DKV) yerleþtirilmesidir. DKV’larýn en az radyasyona maruz kalma ile doðru ve hýzlý bir þekilde yerleþtirilmesi çok önemlidir. Bu çalýþmada, tibia kýrýklarýnda ÝMÇ ile osteosentez uygulanan hastalarda ameliyat süresi ve radyasyon maruziyeti açýsýndan iki farklý distal kilitleme yönteminin sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Ýleriye yönelik yapýlan bu çalýþmada toplamda 72 hastadan dahil etme ve dýþlama kriterlerini karþýlayan 56 olgunun sonuçlarý deðerlendirildi. Hastalar distal vidalama yöntemine göre iki gruba ayrýldý. Grup-1 (n=29) distal kilitleme için serbest el tekniði (SET) kullanýlan hastalarý, Grup-2 (n=27) distal kilitleme için elektromanyetik yönlendirme sistemi (EMYS) kullanýlan hastalarý içeriyordu. Hastalarýn demografik ve týbbi bilgileri, ameliyat süreleri, kanama miktarlarý, toplam floroskopi süreleri, distal kilitleme için geçen süreler, maruz kalýnan radyasyon dozu ölçümleri, distal vida kilitleme için teþebbüs sayýlarý, hatalý vida yerleþimleri, komplikasyonlar ve takip süreleri kaydedildi. Gruplar demografik veriler ve klinik sonuçlar açýsýndan karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda cinsiyet ve taraf açýsýndan istatistiksel olarak anlamlý fark yoktu (sýrasýyla, p=0.928 ve p=0.432). Grup 1’deki yaþ ortalamasý Grup-2’den daha yüksekti ve fark istatistiksel olarak anlamlý idi (p=0.012). Ancak, Grup-1’de hastanede kalýþ süresi açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p=0.140). Diðer taraftan Grup-2’de distal atým sayýsý, floroskopi süresi, etkili radyasyon dozu ve operasyon süresi Grup-1’e göre daha düþüktü, ancak bu fark istatistiksel olarak anlamlý deðildi (sýrasýyla, p=0.057, 0.073, 0.058 ve 0.056). Grup-1’deki üç olguda ve Grup-2’deki iki olguda ilk denemede distal kilitlemede baþarýsýzlýkla karþýlaþýldý. Her iki grupta bir hastada aseptik kaynamama gözlendi.
TARTIÞMA: Hem SET hem de EMYS distal vidalama tekniði, distal kilitleme için oldukça etkili yöntemlerdir. Ameliyat süresi, floroskopi süresi ve radyasyona maruz kalma benzerdir. Geleneksel ÝMÇ uygulamalarýndaki distal kilitlemelerde, etkili, kolay ve ucuz olduðu için SET tercih edilebilir.

BACKGROUND: Intramedullary nailing (IMN) technique is the gold standard for the treatment of closed fractures of the lower extremity long bones. For orthopedic surgeons, one of the most important problems in IMN procedures is the fixation of distal locking screws (DLS). Accurate and rapid placement of DLSs with minimal radiation exposure is crucial. In this study, we aimed to compare the results of two different distal locking methods concerning surgery duration and radiation exposure in patients who underwent osteosynthesis of tibia fractures with IMN.
METHODS: In this prospective study, the results of 56 patients who met the inclusion and exclusion criteria from 72 patients were evaluated. Patients were divided into two groups according to the distal screwing method. Group 1 (n=29) comprised patients who used free-hand technique (FHT) for distal locking, while Group 2 (n=27) consisted of patients who used electromagnetic guidance system (EMGS) for distal locking. Demographic and medical data of the patients, duration of surgery time, amount of bleeding, total fluoroscopy counts, the time elapsed for distal locking, the measure of radiation exposure, number of attempts for distal screw locking, incorrect screw placements, complications and follow-up time were recorded. The groups were compared concerning demographic data and clinical results.
RESULTS: There was no statistically significant difference between the groups about gender and side (p=0.928 and p=0.432, respectively). The mean age in Group-1 was higher than that of Group-2, and the difference was statistically significant (p=0.012). However, there was no statistically significant difference in length of hospital stay in Group-1 (p=0.140). On the other hand, in Group-2, the number of distal shots, fluoroscopy duration, effective radiation dose and operation duration were lower compared to Group-1, although this difference was not statistically significant (p=0.057, 0.073, 0.058 and 0.056, respectively). Failure was encountered in distal locking during the first attempt in three cases in Group-1 and in two cases in Group-2. Aseptic nonunion was observed in one patient in both groups.
CONCLUSION: Both the FHT distal screwing technique and the EMGS distal screwing technique are highly effective methods for distal locking. The duration of operation, the duration of the fluoroscopy and radiation exposure were similar. FHT can be preferred for distal locking in conventional intramedullary nail applications, as it is effective, easy and inexpensive.

AMAÇ: Yoðun bakým alanýnda travma konusunun önemli bir yeri olmasýna raðmen halen bu konuda literatürdeki yayýnlarýn bütünsel olarak deðerlendirildiði bir bibliyometrik araþtýrma bulunmamaktadýr. Bu çalýþmada 1980 ve 2018 yýllarý arasýnda yoðun bakým araþtýrma alanýnda yayýnlanmýþ travma konusundaki makalelerin bibliyometrik analiz yöntemleri kullanýlarak analiz edilmesi sonucunda; en fazla alýntý yapýlan önemli makalelerin ve bu konudaki en fazla atýf alan ve yayýn üreten dergilerin belirlenmesi, ülkelerarasý iþbirliklerinin ortaya konulmasý ve bu konudaki trend konularýn ortaya çýkarýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Araþtýrmamýzda yayýn taramasý Web of Science (WoS) veri tabaný kullanýlarak gerçekleþtirildi. Literatür taramasý sadece Yoðun Bakým araþtýrma alanýnda indekslenen yayýnlarda yapýldý. Ýlgili yayýnlara ulaþmak için arama anahtar kelimesi olarak “trauma” kullanýldý. Travma konusunda gelecek yýllarda yayýnlanmasý öngörülen makale sayýsýný tahmin etmek amacýyla doðrusal regresyon analizi gerçekleþtirildi.
BULGULAR: Literatür taramasý sonucunda toplam 10.851 yayýn bulundu. Bu yayýnlarýn 6.489’u (59.8%) makale kategorisinde idi. En fazla yayýn yapan ilk üç ülke Amerika Birleþik Devletleri 4.096 (%63.1) Kanada (401) ve Almanya (380) idi. Türkiye 41 yayýnla 21. sýrada idi. En fazla atýfý 1987 yýlýnda yayýnlanan “Evaluating trauma care - the triss method” baþlýklý makale almýþtý. En fazla yayýn üreten ve en çok atýf alan dergi “Journal of Trauma Injury Infection and Critical Care” idi.
TARTIÞMA: Bu çalýþma yoðun bakýmda travma konusunda araþtýrma yapan klinisyenler ve bilim adamlarý için faydalý bir rehber olacaktýr.

BACKGROUND: There is not a holistic bibliometric study evaluating the publications in the literature even though trauma is a paramount subject in the field of critical care. This study aimed to investigate the important articles and journals receiving the most citations and publishing the most articles, revealing international cooperation and uncovering trend topics in this subject as a consequence of analyzing articles on trauma in the field of critical care published between 1980 and 2018 using bibliometric analysis methods.
METHODS: Publication scan in this study was performed using Web of Science (WoS) database. Literature review was limited to only publications indexed in the field of Critical Care. “Trauma” was used as the keyword to reach relevant publications. Linear regression analysis was performed to predict the number of articles foreseen to be published in the upcoming years in the subject of trauma.
RESULTS: As a result of the literature review, a total of 10851 publications were found. Six thousand four hundred and eighty-nine (59.8%) of these publications were under the category of article. First three countries with the most publications were respectively as the United States of America (4096) (63.1%), Canada (401) and Germany (380). Turkey ranked 21 with 41 publications. The article titled “Evaluating trauma care - the triss method” published in 1987 had received the most citations. The journal with the most publications and citations was “Journal of Trauma Injury Infection and Critical Care”.
CONCLUSION: This study will be a useful guide to all scientists and clinicians conducting research on trauma in critical care.

AMAÇ: Bu çalýþmada, S.B. Ýzmir Tepecik Eðitim ve Araþtýrma Hastanesi Çocuk Acil Servisi’ne son üç ayda baþvuran hastalarýn kesitsel analiz çalýþmasý ile travma olgularýnýn deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ýzmir S.B.Ü. Tepecik Eðitim ve Araþtýrma Hastanesi Çocuk Acil Eðitim Kliniði’ne baþvuran 0–18 yaþ arasý 46038 hastanýn dosya kayýtlarý geriye dönük olarak incelendi.
BULGULAR: Toplam 46,038 hasta (%53.6 erkek) acil servise baþvurmuþtur. Ortalama yaþ her iki cinsiyet içinde 7.07 olarak saptandý. Baþvurusunda travma öyküsü olgularýn yaþ ortalamasý 9.3 iken travma öyküsü olmayanlar olgularýn yaþ ortalamasý 6.7 olduðu görüldü. Hastalarýn %82.7’sini travma öyküsü olmayan erkek olgu oluþtururken %86.9’unu travma öyküsü olmayan kýz olgular oluþturmaktadýr. Baþvuru tanýlarý incelendiði zaman en sýk görülen taný üst solunum yolu enfeksiyonudur (%58.5). Baþvurularýn yarýsýndan fazlasý acil gözlem ünitesinde izlenmiþtir (%62.5). Hastalar yaþ gruplarýna göre deðerlendirildiðinde, %49.2’sini 1–6 yaþ grubu çocuklarýn oluþturduðu saptandý. Baþvuran olgularýn %10.5’i infant ve %38.7’si oyun çocuðu iken, 1–6 yaþ grubunda %54.7 ile erkek hasta baþvuru sayýsý fazla olduðu dikkat çekmektedir. Bu olgularýn %49.5’inde travma yoktu. Olgularýn %78.3’ünün direkt çocuk acile, ikinci sýklýkla %16.6 ile yeþil alan 1 ve yeþil alan 2’ye baþvurduðu görülmektedir. Olgularýn %98.2’si ayaktan acil servise baþvurmaktadýr. Baþvurularýn %48.8’inin mesai saati dýþýnda olduðu görülmektedir. Baþvuran olgularýn %97.6’sýnýn tedavisinin devamý amacýyla yatýþý düþünülmemiþ eve gönderilmiþtir. Yatýþý planlanan olgularýn ise ortalama serviste kalýþ zamaný 4.53 gündür. Baþvuran yedi olgu hayatýný kaybetmiþtir.
TARTIÞMA: Hastalarýn çoðunluðu birinci basamak saðlýk hizmetlerinde yönetilebilen acil olmayan nedenlerle çocuk acil servise baþvurmuþtur.

BACKGROUND: This study aims to carry out a cross-sectional analysis of the applications during three months to the Pediatric Emergency Service of Ýzmir University of Health Sciences, Tepecik Training and Research Hospital and determination of demographical features and distribution of cases in line with provided data and planning the positive changes and innovations in the current service and functioning of the Pediatric Emergency Service.
METHODS: The file records of 46038 patients between the ages of 0–18 who applied to the University of Health Science, Tepecik Training and Research Hospital Pediatric Emergency Training Clinic were examined retrospectively in this study.
RESULTS: A total of 46038 patients (53.6% male) applied to the emergency service. The average age was 7.07 for both genders. In the application, the average age of the patients with a history of trauma was 9.3, whereas the average age of the patients without a history of trauma is 6.7. While 82.7% of the patients was male with no trauma history, 86.9% was female without a history of trauma. When the application diagnoses were examined, the most common diagnosis was Upper Respiratory Infection (58.5%). More than half of the applications were monitored in the emergency observation unit (62.5%). When the patients were evaluated according to age groups, 49.2% of them were the children aged between 1–6. While 10.5% of the applicants were infants, and 38.7% were game children, it was noteworthy that the number of male patients was higher in the 1–6 age group, with 54.7%. There was no trauma in 49.5% of the cases. 78,3% of the cases were applied directly to the Paediatric Emergency. Secondly, 16.6% were to the Green Area-1 and Green Area-2. 98.2% of the cases were applied to the Emergency Service for ambulatory care. The 48.8% of the applications were made out of working hours. 97.6% of the cases were not hospitalized for the treatment and were addressed to home. The average staying period of the hospitalized cases in the Service was 4.53 days. Among applications, seven cases died.
CONCLUSION: Most of the patients admitted to pediatric emergency service for non-urgent reasons which can be managed in primary care services.

AMAÇ: Havayolu sorunlarý, ateþli silah yaralanmalarýnda mortaliteyi etkileyen en önemli faktörlerden biridir. Bu çalýþmanýn amacý, bir Rol II hastanesinde patlama ve mermi yaralanmalarý nedeniyle ileri hava yolu desteði uygulanan hastalarýn verilerini incelemektir.
GEREÇ VE YÖNTEM: Çalýþmaya, Ocak 2015 ile Eylül 2016 tarihleri arasýnda bir Role II hastanesinde ileri hava yolu desteði uygulanan 93 hasta dahil edildi. Hastalar patlayýcý (Grup A) (el yapýmý patlayýcýlar, roket ve mayýn) ve mermi (Grup B) yaralanmalarý olarak iki gruba ayrýldý (tüfek ve tabanca mermi) travma yaralanmalarý. Gruplar hastane öncesi entübasyon, NISS (Yeni Yaralanma Þiddeti Skoru), kardiyopulmoner resüsitasyon (CPR), acil cerrahi müdahale ve mortalite oranlarý açýsýndan karþýlaþtýrýldý.
BULGULAR: Hasta gruplarý arasýnda demografik ve klinik özellikler açýsýndan fark yoktu. Otuz altý hasta A grubuna, 57 hasta B grubuna alýndý. Acil cerrahi müdahale oranlarý açýsýndan gruplar arasýnda istatistiksel olarak anlamlý fark yoktu (p=0.42). Ancak gruplar arasýnda hastane öncesi entübasyon (p=0.001), CPR uygulamasý (p=0.001), mortalite (p=0.001) oranlarý ve NISS (p=0.002) skorlarý arasýnda istatistiksel olarak anlamlý bir fark gözlendi.
TARTIÞMA: Ýleri hava yolu gerektiren mermi yaralanmalarý, patlama yaralanmalarýndan daha yýkýcý ve daha ölümcüldür. Bunun nedeni, mermi ile ateþli silah yaralarýnda doðrudan hava yolu veya organ hasarý oluþmasý olabilir.

BACKGROUND: Airway problems are one of the most important factors affecting mortality in firearm injuries. The present study aims to examine the data of patients who underwent advanced airway support due to explosion and bullet injuries in a Role II hospital.
METHODS: Ninety three patients who underwent advanced airway support due to gunshot wounds in a Role II hospital between January 2015 and September 2016 were included in this study. The patients were divided into two groups as blast (Group A) (handmade explosives, rocket, and mine) and bullet (Group B) (rifle and pistol bullet) trauma injuries. The groups were compared regarding pre-hospital intubation, NISS (New Injury Severity Score), cardio-pulmonary resuscitation (CPR), emergency surgical intervention and mortality rates.
RESULTS: There was no difference between the patient groups concerning demographic and clinical features. Thirty-six patients were included in group A, and 57 patients were included in group B. There was no statistically significant difference between the groups about emergency surgical intervention rates (p=0.42). However, a statistically significant difference was observed between the groups in terms of pre-hospital intubation (p=0.001), CPR application (p=0.001), mortality (p=0.001) rates and NISS (p=0.002) scores.
CONCLUSION: Bullet injuries that require advanced airway are more destructive and more deadly than explosion injuries. This may be due to direct airway or organ damage in bullet gunshot wounds.

AMAÇ: Klinik, laboratuvar ve görüntüleme yöntemlerinin geliþmesine raðmen akut apandisit tanýsý her zaman kolay olmamakta ve negatif apendektomi oranlarý hala yüksek seyretmektedir. Bu çalýþmada amaç skorlama sistemlerinin kendi baþýna ve ultrasonografi (USG) ile beraber deðerlendiðinde, doðru taný oranlarýna (DOR: Diagnostic Odds Ratio) ve negatif apendektomi oranlarýna etkilerinin ortaya konulmasý amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmamýza akut apandisit tanýsýyla ameliyat edilen ardýþýk 202 hasta ileriye yönelik olarak dahil edildi. Tüm hastalarýn Ohmann, Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA), Lintula, Eskelinen ve Alvarado skorlama sistemleri kullanýlarak ameliyat öncesi skorlarý hesaplandý. Olgularýn tümüne abdominal ultrasonografi randomize olarak uygulandý. Skorlama sistemlerinin sensitivitesi ve spesifitesi eþik deðerlerine göre hesaplanmýþtýr. Eðri altýndaki alan (AUC), ROC analizi ile hesaplanmýþtýr. Regresyon modelinde baðýmlý deðiþken olarak apandisit histolojik tanýsý kullanýlýrken, baðýmsýz deðiþkenler olarak skorlama sistemleri ve USG tercih edildi.
BULGULAR: Negatif apendektomi oraný %15.8’di. Akut apandisit tanýsýnda her iki cinsiyet için de en belirleyici yöntemin Ohmann olduðu görüldü (Diagnostic Odds Ratio (DOR)=24.2, %95 GA 6.98–84.44). Benzer þekilde en düþük negatif apandektomi oranlarý kadýnlarda %6.9, erkeklerde %3.4 ile Ohmann ölçeðiyle elde edildi. Ölçekler, USG ile kombine edildiðinde, akut apandisit belirleyiciliðinde artýþ olmadýðý görüldü. Bununla birlikte kadýnlarda Ohmann ile USG kombine edildiðinde negatif apandektomi oranlarýnýn daha da düþtüðü görüldü (%6.9 ve %4).
TARTIÞMA: Ohmann skorlamasý kadýn ve erkek hastalarda akut apandisit için iyi bir belirleyici olmasýnýn yaný sýra, en iyi negatif apendektomi oranlarýný saðlamaktadýr. USG ile skorlama sistemlerinin kombinasyonu akut apandisit taný deðerini arttýrmamaktadýr, ancak kadýnlarda USG ile Ohmann ölçeði birlikte kullanýldýðýnda negatif apandektomi oranlarý oldukça düþmekteyken, erkeklerde bu fayda minimumdur.

BACKGROUND: Despite the development of clinical, laboratory, and imaging methods, the diagnosis of acute appendicitis is not always easy, and negative appendectomy rates are still high. This study aims to reveal the effects of different scoring systems on the diagnostic accuracy of acute appendicitis and negative appendectomy rates, alone or when evaluated together with ultrasonography.
METHODS: In this study, 202 consecutive patients who underwent emergency appendectomy for acute appendicitis were included. Clinical scores of all patients were preoperatively calculated using Ohmann, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), Lintula, Eskelinen, and Alvarado scoring systems. Abdominal ultrasonography (USG) was performed randomly in all cases. The sensitivity and specificity of scoring systems were calculated according to the threshold values. The area under the curve (AUC) was calculated using ROC analysis. In the regression model, histological diagnosis of appendicitis was used as the dependent variable, while scoring systems and USG were preferred as independent variables.
RESULTS: The negative appendectomy rate was 15.8%. In the diagnosis of acute appendicitis, Ohmann was the most predictive for both genders (DOR=24.2, 95% CI 6.98–84.44). Similarly, the lowest negative appendectomy rates were obtained with the Ohmann score as 6.9% in females and 3.4% in males. When the scores were combined with USG, the rate of diagnostic accuracy for acute appendicitis was not increased. However, when Ohmann and USG were combined, negative appendectomy rates were further reduced for women from 6.9% to 4%.
CONCLUSION: In addition to being a good diagnostic predictor of acute appendicitis in male and female patients, Ohmann score provides the best negative appendectomy rates. The combination of USG and scoring systems does not increase the diagnostic accuracy of acute appendicitis. However, negative appendectomy rates are significantly reduced when the USG and Ohmann scale are used together in females, while this reduction is minimal in men.

AMAÇ: Bir tür alev yanýðý olan tandýr yanýðý, tandýrýn çok yüksek sýcaklýða çýkabilmesi nedeniyle daha fazla mortalite ve morbiditeye neden olmaktadýr. Bu nedenle, bu çalýþmada tandýr yanýklarý ve diðer alev yanýklarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmada tandýr yanýklarý ile diðer alev yanýklarýný yaþ, cinsiyet, toplam yanýk yüzey alaný, yanýk derinliði, yatýþ zamanlarý, yatýþ süreleri, yapýlan cerrahi iþlemler, yara kültür sonuçlarý, yanýk lokalizasyonu ve mortalite açýsýndan karþýlaþtýrdýk.
BULGULAR: Tandýr yanýklý hastalarýn ortalama hastanede kalma süresi 27.6±9.5 gün idi. Buna karþýn tandýr dýþý yanýklý hastalarýn ortalama hastanede kalma süresi ise 16.5±12.5 gün idi. Bu iki grup arasýnda hastanede kalma süreleri arasýnda anlamlý derecede farklýlýk saptandý (p<0.001). Bir alev yanýðý türü olan tandýr yanýklarý, diðer alev yanýklarýna göre kadýn ve çocuklarý çok daha sýk etkilemekte (p=0.0001), daha derin yanýklara sebep olmakta (p=0.0001), daha fazla cerrahi müdahale gerektirmekte (p=0.0001) ve daha sýk yara yeri enfeksiyonuna neden olmaktadýr.
TARTIÞMA: Tandýr gibi yüksek dereceli yanýklarýn, diðer alev yanýklarýndan ayrý bir grup olarak ele alýnmasýnýn faydalý olacaðýný düþünüyoruz. Bu konuda yapýlacak baþka çalýþmalarýn tandýr yanýklarýnýn tedavisi konusunda yeni yaklaþýmlar getireceðine inanýyoruz.

BACKGROUND: Because internal temperature of tandir may reach up very high levels, tandir burns, which is one of flame burns, may cause more morbidity and mortality than those of other flame burns. Therefore, we aimed to compare tandir burns with other flame burns in the present study.
METHODS: In this study, we compared tandir burns with other flame burns concerning age, gender, total burn surface area, burn depth, hospitalization times, hospitalization duration, surgical procedures performed, wound culture results, burn localization and mortality.
RESULTS: Tandir burn patients were treated in the hospital for an average of 27.6±9.5 days, while non-tandir burn patients were treated for a period of 16.5±12.5 days. A significant difference was found between the hospitalization periods of the two groups (p<0.001). Tandir burn, which is a type of flame burn, affects the women and children much more frequently than other flame burns (p=0.0001), causes deeper burns (p=0.0001), which requires more surgical intervention (p=0.0001) and causes more frequent wound site infection.
CONCLUSION: We think that it would be beneficial to treat high-temperature burns, such as tandir burns, as a separate group from other flame burns. We believe that further studies to be conducted in this field will bring new approaches to the treatment of tandir burns.

AMAÇ: Bu çalýþmada, nadir bir akut karýn nedeni olan spontan rektus hematomu (SRH) ile gelen hastalarda endovasküler tedavinin sonuçlarýný incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Aralýk 2016–Aralýk 2018 tarihleri arasýnda, hastanemiz acil servisine akut karýn nedeni olan SRH nedeniyle baþvurup endovasküler embolizasyon tedavi iþlemi uygulanan hastalarý geriye dönük olarak inceledik.
BULGULAR: Çalýþmamýzda, uzun süreli antikoagülan kullanýmý olan SRH tanýsý ile hastanemiz acil servisine baþvuran 53–95 yaþ arasý (ort. 75.5) beþ kadýn, bir erkek olmak üzere toplam altý hastaya endovasküler embolizasyon tedavi iþlemi yapýldý. Çalýþmamýzda, hastalarýn fizik muayene bulgularý, laboratuvar deðerleri, bilgisayarlý tomografi (BT), BT anjiyografi ve dijital subtraksiyon anjiyografi (DSA) bulgularý sunulmuþtur. Üç hastada inferiyor epigastrik arterden iki hastada superfisiyal sirkumfleks iliak arterden aktif ekstravazasyon izlenmiþ sadece bir hastada kanama odaðý saptanmamýþtýr. Ýþlem tekniðinde hematomun olduðu taraftan ultrason eþliðinde 5 Fr arteryel kýlýf yerleþtirildi. Daha sonra vertebral diagnostik kateteri (5 Fr veya 4 Fr) kullanýlarak inferiyor epigastrik arter ve derin sirkumfleks arterler selektif olarak kataterize edildi. Mevcut diagnostik kataterin içerisinden mikrokateter yardýmýyla süperselektif kataterizasyon ile aktif ekstravazyonun olduðu arter ve dallarý ayrýlabilir koil kullanýlarak embolize edildi. Embolizasyon sonrasý yapýlan kontrol anjiyografilerde patolojik boyanmalar ortadan kalktý ve tam embolizsayon saðlandý. Hastalarda endovasküler iþlemle iliþkili herhengi bir komplikasyon geliþmedi. Sadece bir hastada anjiyografi incelemesinde aktif ekstravazasyon saptanmamýþ olup yatarak takip, kan transfüzyonu, antibiyotik, analjezik desteði uygulandý. Ancak ileri kalp yetersizliðine baðlý nedenlerden dolayý hayatýný kaybetti.
TARTIÞMA: Spontan rektus hematomu akut karýn aðrýsýna neden olabilen hayatý tehdit edici bir durum olup endovasküler embolizasyon bu hasta grubunda hýzlý uygulanabilen, güvenli ve etkili bir tedavi seçeneðidir.

BACKGROUND: In this study, we aimed to review spontaneous rectus sheath hematoma (RSH) and the results of endovascular therapy in patients presenting with a rare acute abdomen.
METHODS: We evaluated the patients with RSH because of acute abdominal pain and applied endovascular embolization treatment who were admitted to our hospital emergency department retrospectively between December 2016 and December 2018.
RESULTS: Rectus muscle sheath bleeding is an extremely rare and urgent emergency intervention. In the etiology, chronic severe cough crises and trauma may be the cause of haemorrhage in the elderly patient group; spontaneous bleedings may be seen with the increase in the use of anticoagulants. In this study, a total of six patients, 53–95 years old (mean 75.5) endovascular embolization treatment was administered on who were admitted to our hospital with the diagnosis of RSH and long-term anticoagulant use. In our series, physical examination findings, laboratory values, computed tomography (CT), CT angiography and digital subtraction angiography (DSA) findings were presented. The findings showed an active extravasation from the superficial circumflex iliac artery in two patients and the inferior epigastric artery in three patients. We had no bleeding focus in only one patient. An ultrasound-guided 5 Fr arterial sheath was placed on the side of the hematoma in the procedure. Then, the inferior epigastric artery and deep circumflex arteries were selectively catheterized using the Vertebral Diagnostic Catheter (5 Fr or 4 Fr). Superselective catheterization, with the help of microcatheter from the existing diagnostic catheter, was used to embolize the arteries and branches with active extravasation using a detachable coil. In the control angiographies performed after embolization, pathological staining disappeared, and complete embolization was achieved. There were no complications associated with the endovascular procedures. No active extravasation was detected in angiography examination, and inpatient follow-up, blood transfusion, antibiotics and analgesic support were performed in only one patient. However, it was ex as a result of reasons related to advance heart failure.
CONCLUSION: RSH is a life-threatening condition that may cause acute abdominal pain, and endovascular embolization is a safe and effective treatment option that can be applied quickly in this patient group.

Posteriyor reversible ensefalopati sendromu (PRES), nörolojik bulgular ve serebral hemisferlerin posteriyor bölgelerinde vazojenik ödem ile karakterize klinik ve radyolojik bir sendromdur. Sepsis ve septik þok yakýn zamanda PRES’te etiyolojik bir faktör olarak kabul edilmiþtir. Yoðun bakým ünitesinde intraabdominal sepsis ve PRES’i takiben olumsuz nörolojik sonlanýmý olan bir hastayý sunuyoruz. Sepsis hastalarýnda ensefalopatinin bir nedeni olarak PRES’in daha geniþ tanýnmasý gerekmektedir.

Posterior reversible encephalopathy (PRES) is a clinical and radiological syndrome characterized by neurological findings and vasogenic edema in the posterior regions of the cerebral hemispheres. Sepsis and septic shock have recently been recognized as an etiological factor in PRES. In this case report, we are presenting a patient with intraabdominal sepsis and PRES followed in the intensive care unit with an unfavorable neurological outcome. Wider recognition of PRES as a cause of encephalopathy in sepsis patients is necessary.

Subkutan amfizem, cilt altý yumuþak dokuya hava girmesiyle oluþur. Genellikle göðüs duvarý veya boyun yumuþak dokularýnda ortaya çýkar. Travma sonrasý pnömotoraks veya cilt laserasyonlarýna baðlý geliþebildiði gibi baþka nedenlerle de oluþabilmektedir. Mediastinal amfizem tek baþýna veya subkutan amfizemle birlikte görülebilir. Çok nadir sebeplerinden bir tanesi de mastoid kemik kýrýðýdýr. Mastoid hücrelerinde bulunan hava retrofaringeal bölgeden veya çeþitli boyun kompartmanlarý arasýndan mediastene doðru yayýlabilir. Genellikle bu hastalarda palpasyonla krepitasyon alýnmasý dýþýnda ciddi nörolojik veya klinik bulgu izlenmemektedir. Bu yazýda servikal subkutan ve mediastinal amfizemin nadir nedenlerinden biri olan mastoid kýrýðý sunulmaktadýr.

Subcutaneous emphysema occurs when air enters the soft tissue, which usually appears in the soft tissues of the chest wall or neck. It may also arise from pneumothorax or skin lacerations after trauma or other reasons. Mediastinal emphysema may be either associated with subcutaneous emphysema or seen alone. The air in the mastoid cells may spread from the retropharyngeal region or various neck compartments into the mediastinum. Usually, no severe neurological or clinical findings are observed except crepitation on palpation. We present a case report of a mastoid fracture as a rare cause of cervical subcutaneous and mediastinal emphysema.

rakeobronþiyal yaralanmalar künt göðüs travmalarýnýn nadir ancak ciddi komplikasyonudur. Yazýmýzda kamyonet tarafýndan ezilme sonucu karinaya doðru vertikal rüptürle beraber sol ana bronþu tamamen kopan ve inen aortasýnda kendini sýnýrlamýþ rüptür geliþen hastayý sunmaktayýz. Hastaya sol üst lobektomi ve alt lobun sol ana bronþa tekrar takýlmasý ameliyatýný uyguladýk. Bunu takiben aortadaki psödoanevrizmayý kapsayacak þekilde damar içi stent yerleþtirildi. Hasta ameliyat sonrasý sorun yaþanmadan dokuzuncu günde taburcu edildi. Yandaþ büyük yaralanmalarla komplike olmuþ trakeobronþiyal travmalarýn baþarýlý tedavisi geliþmiþ ve tecrübeli travma merkezlerinde hýzlý ve mücadeleci multidisipliner yaklaþým gerektirmektedir.

Tracheobronchial injury is an uncommon but severe complication of blunt thoracic trauma. In this study, we present a patient who developed complete avulsion of the left main bronchus with a vertical rupture toward the carina accompanying a contained rupture of the descending aorta after being run over by a van. We performed a left upper lobectomy and reimplantation of the lower lobe to the left main bronchus. Subsequently, an endovascular stent was placed to cover the pseudoaneurysm. The patient was discharged on day nine after an uneventful postoperative course. Tracheobronchial trauma complicated with concomitant major injuries apparently requires a rapid and challenging multidisciplinary approach in a well-developed and experienced trauma centre for a successful treatment.