AMAÇ: Baðýrsak mikrobiyotasý sinir sistemi fonksiyonunu modüle etmektedir. Literatürde bu modülasyonda oksidatif stres ve apoptoz mekanizmalarý üzerinden birçok sinir sistemi hasarýnda kullanýldýðý gösterilmektedir. Bu çalýþmada sýçan travmatik beyin hasarý (TBH) modelinde probiyotik (PB) tedavisine baðlý nöroprotektif etkilerinin histolojik ve elektroensefalografik (EEG) veriler ile araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: 40 erkek Wistar albino sýçan 4 gruba ayrýldý. Grup 1, Kontrol grubu (KONTROL, n=10) olup travma uygulanmadý. Grup 2, aðýrlýk düþürme tekniði ile yapýlan Travma grubuydu (TBH, n=10). Grup 3, taklit grubu (SHAM) olup (TBH+SS, n=10) sýçanlara günde 500 μl steril salin (SS) oral gavaj ile verildi. Grup 4, PB tedavi grubu olup (TBH+PB, n=10) sýçanlar günlük olarak 500 μl PB oral gavaj ile 7 gün tedavi edildi. Beyin örnekleri travmadan 7 gün sonra toplandý. Beyin örneklerinde histopatolojik deðerlendirme HE ile yapýldý. eNOS ile oksidatif stres, VEGF ile damarlanma, S100 ile gliosis ve kaspaz 3 ile apoptoz ile immünohistokimyasal olarak deðerlendirildi. TUNEL ile apoptotik indeks saptandý. Ek olarak, EEG ve Somatosensoriyal uyarýlmýþ potansiyel (SUP) kayýt bulgularý karþýlaþtýrýldý.
BULGULAR: TBH ve sham gruplarýnda kontrol göre oldukça anlamlý (p<0.001) hasar oluþturulduðu HE boyamalarý ile saptandý. Oluþturulan hasar-da, PB tedavisinin anlamlý (p<0.01) bir iyileþmeyi saðladýðý bulundu. PB tedavisi ile oksidatif stres (p<0.01), gliosis (p<0.01) ve apoptoz (p<0.05) azalýrken, anjiyogenez (p<0.01) arttý. Bu bulgularý destekler biçimde yazýlým aracýlý yapýlan EEG ve SUP incelemesinde; Delta dalga gücü ve teta /alfa oraný TBH ile artarken PB tedavisi ile azaldý.
SONUÇ: Sonuçlar PB tedavisinin sýçanlarda oksidatif stres, apoptoz ve gliosizi azaltýp damarlanmayý artýrarak anlamlý bir iyileþme saðladýðýný gösterdi. Literatürde bildiðimiz kadarý ile ilk defa yazýlým aracýlý EEG ive SUP analizi ile PB tedavisi için histolojik sonuçlarýn desteklendiði gösterildi.

BACKGROUND: The gut microbiota modulates nervous system function. In the literature, it has been shown that this modula-tion is used in many nervous system injuries through oxidative stress (OS) and apoptosis mechanisms. In this study, it was aimed to investigate the neuroprotective effects of probiotic (PB) treatment in a rat traumatic brain injury (TBI) model with histological and electroencephalographic (EEG) data.
METHODS: Forty male Wistar albino rats were divided into four groups. Group 1 was the control group (CONTROL, n=10) and no trauma was applied. Group 2 was the trauma group with the weight-drop technique (TBH, n=10). Group 3 was the sham group (SHAM), (TBH+sterile saline [SS], n=10) rats were given 500 µL of SS per day by oral gavage. Group 4 was the PB treatment group, (TBH+PB, n=10) rats were treated daily for 7 days with 500 µL of PB oral gavage. Brain samples were collected 7 days after trauma. Histopathological evaluation of brain samples was done with HE. OS with Endothelial nitric oxide synthase, vascularization with Vas-cular Endothelial Growth Factor, gliosis with S100, and apoptosis with caspase 3 were evaluated immunohistochemically. Apoptotic index was determined with TUNEL. In addition, EEG and somatosensory evoked potential (SEP) recording findings were compared.
RESULTS: It was determined by HE staining that there was a significant (P<0.001) damage in the TBI and sham groups compared to the control group. It was found that PB treatment provided a significant (P<0.01) improvement in the damage created. While OS (P<0.01), gliosis (P<0.01), and apoptosis (P<0.05) decreased with PB treatment, angiogenesis (P<0.01) increased. In support of these findings, in the software-mediated EEG and SUP examination; Delta wave power and theta/alpha ratio increased with TBI and de-creased with PB treatment.
CONCLUSION: The results showed that PB treatment provided a significant improvement in rats by reducing OS, apoptosis, and gliosis and increasing vascularity. To the best of our knowledge in the literature, it was shown for the 1st time that histological results for the treatment of PB were supported by software-mediated EEG and SEP analysis.

AMAÇ: Çalýþmada, Dermalix® (Dx)'in yara iyileþmesi ve anastomoz kaçaðý üzerine olan etkisinin sýçan uç uca kolon anastomozu modelinde deðer-lendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþma; negatif kontrol grubu (n=10, sadece laparotomi), kontrol grubu (n=15, kolon anastomozu) ve deney grubu (n=15, kolon anastomozu ve anastomoz bölgesine uygulanan Dx) olmak üzere 3 gruba bölünmüþ halde 40 sýçan üzerinde gerçekleþtirilmiþtir. Sýçanlar postoperatif 3. günde sakrifiye edilmiþ ve rezeke edilen kolon segmentlerinde infüzyon pompasý yardýmý ile patlama basýncý (mmHg) ve nötrofil infiltrasyonu, epitel rejenerasyonu, granülasyon dokusu oluþumu, lokal inflamatuar yanýt, neovaskülarizasyon ve yabancý cisim reaksiyonu dahil olmak üzere yara iyileþmesinin patolojik parametreleri deðerlendirilmiþtir.
BULGULAR: Anastomoz kaçaðý oraný anlamlý derecede düþük (1 sýçan vs 6 sýçan, p=0.040) ve ortalama patlama basýncý Dx deney grubunda kont-rol grubuna göre önemli ölçüde yüksek (2.95 kat, ortalama 121mmHg vs 41 mmHg, p<0.05) bulunmuþtur. Dx'in neovaskülarizasyonu artýrarak yara iyileþmesini önemli ölçüde hýzlandýrdýðý deðerlendirilmiþtir (p<0.001). Kontrol ve deney grubu diðer patolojik parametreler açýsýndan benzer sonuçlar saptanmýþtýr.
SONUÇ: Anastomoz kaçaðý oranýnýn önemli ölçüde düþük olmasý, özellikle patlama basýncý ve neovaskülarizasyon üzerindeki olumlu etkileri göz önünde bulundurulduðunda Dx, anastomoz kaçaðýný önlemede umut vadeden bir teknoloji olarak görülmektedir.

BACKGROUND: This study aimed to evaluate the effect of Dermalix® (Dx) on wound healing and anastomotic leakage in a rat model of end-to-end colon anastomosis.
METHODS: The study was carried out on 40 rats, as divided into three groups, including a negative control group (n=10, laparotomy only) control group (n=15, colon anastomosis), and the experimental group (n=15, colon anastomosis plus Dx applied to anastomo-sis site). The rats were sacrificed on the 3rd post-operative day, and resected colon segments were evaluated for bursting pressure (mmHg) using an infusion pump set-up and for pathological parameters of wound healing including neutrophil infiltration, epithelial regeneration, granulation tissue formation, local inflammatory response, neovascularization, and foreign body reaction.
RESULTS: Anastomotic leakage rate was significantly lower (1 rat vs. 6 rats, P=0.040). Moreover, mean bursting pressure was signifi-cantly (2.95 times) higher (mean 121 vs. 41 mmHg, respectively, P<0.05) in the Dx experimental group than in the control group. Dx was considered to significantly accelerate wound healing by increasing neovascularization (P<0.001). Control and experimental groups were similar in terms of other pathological parameters.
CONCLUSION: Based on significantly lower rate of anastomotic leakage and its positive effects especially on the bursting pressure and neovascularization, Dx seems to be considered as a promising technology in preventing anastomotic leakage.

AMAÇ: Kurkumin ve umbilikal kord-kaynaklý mezenkimal kök hücrelerin (UK-MKH) deneysel tendon hasar iyileþmesini olumlu yönde etkilediði bilinmektedir. Bu çalýþma, kurkumin ve UK-MKH’lerin tek baþýna ve birlikte kullanýlmasýnýn bireysel etkilerini ve potansiyel sinerjistik etkilerini ince-lemeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM: 80 diþi Wistar albino sýçan rastgele beþ gruba ayrýldý: Kontrol, Kurkumin, Susam Yaðý, MKH ve Kurkumin+MKH gruplarý. Tüm sýçanlarda, hem sað hem de sol Aþil tendonlarýnda punch yardýmýyla tendon hasarý oluþturuldu. Kontrol grubuna herhangi bir tedavi uygulanmadý. Diðer deney gruplarýnda yara bölgesine lokal olarak Kurkumin, kurkumin için bir çözücü olarak kullanýlan susam yaðý, MKH ve MKH ve kurkumin kombinasyonu uygulandý. Her bir grupta, hayvanlarýn yarýsý postoperatif 2. haftada diðer yarýsý da 4. haftada sakrifiye edildi. Sað Aþil, biyomekanik test için kullanýlýrken, sol Aþil histolojik deðerlendirme ve tip I, tip III kollajen ve tenomodulinin immünohistokimyasal analizi için kullanýldý.
BULGULAR: 2. haftada, Kurkumin, MKH ve Kurkumin+ MKH gruplarýnda Kontrol grubuna kýyasla histolojik olarak iyileþmede istatistiksel anlamlý ilerleme gözlendi. 2. ve 4. haftalarda Kurkumin grubunda tip III kollajen, Kontrol grubuna kýyasla önemli ölçüde arttý. 4. haftada tenomodulin, Kurku-min ve MKH gruplarýnda Kontrol grubuna kýyasla önemli ölçüde arttý. Tendon gerim gücü 4. haftada, MKH ve Kurkumin+MKH gruplarýnda Kontrol grubuna kýyasla önemli düzeyde arttý. Tedavi gruplarý arasýnda iyileþme üzerindeki olumlu etkiler açýsýndan birbirlerine üstünlük gözlenmedi.
SONUÇ: Lokal olarak kullanýlan Kurkumin ve UK-MKH, sýçanlarýn Aþil tendonlarýnda punch ile oluþturulan hasarýn iyileþmesinde birbirine üstünlükleri olmayacak þekilde olumlu etkiler göstermiþtir. Bununla yanýsýra, birlikte uygulandýklarýnda iyileþme üzerine sinerjistik etkileri gözlenmemiþtir.

BACKGROUND: It is known that curcumin and umbilical cord-derived mesenchymal stem cells (UC-MSCs) positively affect experi-mental tendon injury healing. This study investigated individual effects and potential synergistic effects of using curcumin and UC-MSCs alone and together.
METHODS: Eighty female Wistar albino rats were randomly divided into five groups: Control, curcumin, sesame oil, MSCs, and Curcumin+MSCs groups. In all rats, punch tendon defect was created in both right and left Achilles tendons. While no additional treatment was applied to the control group, curcumin, sesame oil used as a solvent for curcumin, MSCs, and MSCs and curcumin com-bination were applied locally to the injury site, respectively, in the other groups. Curcumin was solved in sesame oil before application. In each group, half of the animals were euthanized in the post-operative 2nd week while the other half were euthanized in the post-operative 4th week. The right Achilles was used for biomechanical testing, while the left Achilles was used for histological evaluation and immunohistochemical analysis of type I, Type III collagen, and tenomodulin.
RESULTS: Histologically, significant improvement was observed in the curcumin, MSCs, and Curcumin+ MSCs groups compared to the control Group in the 2nd week. In the 2nd and 4th weeks, Type III collagen was significantly increased in the curcumin group com-pared to the control group. In week 4, tenomodulin increased significantly in the curcumin and MSCs groups compared to the control group. Tendon tensile strength increased significantly in MSCs and Curcumin+MSCs groups compared to the control group in the 4th week. No superiority was observed between the treatment groups regarding their positive effects on recovery.
CONCLUSION: Locally used curcumin and UC-MSCs showed positive effects that were not superior to each other in the healing of injury caused by a punch in the Achilles tendons of rats. However, synergistic effects on healing were not observed when they were applied together.

AMAÇ: Bu çalýþmanýn amacý erken ve geç dönem travmatik beyin hasarý (TBH) hastalarýnda mikroRNA (miRNA) biyogenezinde yer alan proteinlerin ekspresyon düzeylerinin farklýlýk gösterip göstermediðini araþtýrmak ve bunun prognoza etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Þiddetli TBH hastalarýndan, travmadan 4 ila 6 saat ve 72 saat sonra alýnan kan örneklerinde Dicer, Drosha, DiGeorge Sendromu Kritik Bölge 8 (DGCR8), Exportin5 (XPO5) ve Argonaute2 (AGO2) seviyeleri ölçüldü ve kontrol grubuyla karþýlaþtýrýldý. Hastalarýn prognostik takibi Glasgow Koma Skalasý skoru kullanýlarak yapýldý.
BULGULAR: Þiddetli TBH'li hastalarda miRNA biyogenez proteinleri Dicer, Drosha, DGCR8, XPO5 ve AGO2'nin ekspresyonunda istatistiksel olarak anlamlý bir deðiþiklik yoktu. Ancak þiddetli TBH derecesinden hafif TBH derecesine düzelen hastalarda Dicer ekspresyonu artmýþ ve bu hastalarýn çoðunda AGO2 ekspresyonu azalmýþtýr. Yoðun bakýmdan kýsa sürede taburcu olan hastalarda Dicer ekspresyon profilinin arttýðý görüldü.
SONUÇ: MikroRNA'lar ve biyogenez proteinleri, gelecekte TBH'li hastalar için prognostik ve terapötik kararlara rehberlik edebilir.

BACKGROUND: This study aims to investigate whether the expression levels of proteins involved in microRNA (miRNA) biogenesis vary in early- and late-stage traumatic brain injury (TBI) patients and to evaluate its effect on prognosis.
METHODS: Dicer, Drosha, DiGeorge Syndrome Critical Region eight (DGCR8), Exportin5 (XPO5), and Argonaute2 (AGO2) levels were measured in the blood samples of severe TBI patients collected 4–6 h and 72 h after the trauma and compared with the control group. Prognostic follow-up of the patients was performed using the Glasgow Coma Scale score.
RESULTS: There were no statistically significant changes in the expression of the miRNA biogenesis proteins Dicer, Drosha, DGCR8, XPO5, and AGO2 in patients with severe TBI. However, the expression of Dicer increased in the patients who improved from the severe TBI grade to the mild TBI grade, and the expression of AGO2 decreased in most of these patients. The Dicer expression profile was found to increase in patients discharged from the intensive care unit in a short time.
CONCLUSION: MicroRNAs and their biogenesis proteins may guide prognostic and therapeutic decisions for patients with TBI in the future.

AMAÇ: Modifiye Graham omentopeksi, peptik ülser perforasyonu onarýmýnda en sýk kullanýlan ameliyat tekniðidir; ancak literatürde falsiformopeksi ile ilgili çok az veri bulunmaktadýr. Amaç, falsiformopeksinin peptik ülser perforasyonu onarýmýndaki uygulanabilirliðini modifiye Graham omento-peksi ile karþýlaþtýrarak araþtýrmaktý.
GEREÇ VE YÖNTEM: Peptik ülser perforasyonu nedeniyle opere edilen 471 hastanýn verileri retrospektif olarak incelendi. Hastalar modifiye Graham omentopeksi ve falsiformopeksi olarak sýnýflandýrýlarak klinik özellikleri, ameliyat bulgularý ve ameliyat sonrasý komplikasyonlar açýsýndan birbirleriyle karþýlaþtýrýldý.
BULGULAR: Modifiye Graham omentopeksi ve falsiformopeksi sýrasýyla 425 (%90.2) ve 46 (%9.8) hastaya uygulandý. Ýki grup temel hasta özellikleri ve ameliyat öncesi laboratuvar bulgularý açýsýndan benzerdi (p>0.05). ASA fiziksel durumu gruplar arasýnda anlamlý olarak farklýydý (p=0.001). Anastomoz kaçaðý dýþýndaki komplikasyonlar açýsýndan gruplar arasýnda istatistiksel olarak anlamlý fark bulunmadý. Anastomoz kaçaðý falsiformopeksi yapýlan hastalarda modifiye Graham omentopeksi yapýlan hastalara göre daha sýk gözlendi (P=0.017).
SONUÇ: Falsiformopeksi tekniði, modifiye Graham omentopeksi yöntemine göre daha yüksek anastomoz kaçaðý oranýna sahip olmasýna raðmen, peptik ülser perforasyonlarýnýn onarýmýnda, özellikle omentumun yokluðu veya uygun olmayan omentum varlýðý gibi çeþitli nedenlerle modifiye Gra-ham omentopeksi uygulanamayan durumlarda alternatif bir yöntem olarak akýlda tutulmalýdýr.

BACKGROUND: Modified Graham omentopexy is the most commonly used operative technique in the repair of peptic ulcer perfo-ration (PUP); however, there is little data on falciformopexy in the literature. The aim is to investigate the feasibility of falciformopexy in the repair of PUP, comparing with modified Graham omentopexy.
METHODS: Data of 471 patients who were operated for PUP were retrospectively analyzed. Patients’ demographics, pre-operative basic laboratory findings, American Society of Anesthesiologists (ASA) status, operative findings, and post-operative complications were recorded. The patients were classified into two groups modified Graham omentopexy and falciformopexy, and then compared with each other in terms of clinical characteristics, operative findings, and post-operative complications.
RESULTS: Modified Graham omentopexy and falciformopexy were performed in 425 (90.2%) and 46 (9.8%) patients, respectively. The two groups were similar in terms of basic patient characteristics and pre-operative laboratory findings (P>0.05). ASA physical status was significantly different between the groups (P=0.001). No statistically significant difference was found between the groups in terms of complications, except for an anastomotic leak. Anastomotic leak was observed more frequently in patients who underwent falciformopexy than in patients with modified Graham omentopexy (P=0.017).
CONCLUSION: Although falciformopexy technique has a higher rate of leak compared to the modified Graham omentopexy method, it should be kept in mind as an alternative method for repair of PUP, especially in cases where omentopexy cannot be applied for various reasons such as the presence of unavailable or unsuitable omentum.

AMAÇ: Fournier kangreni genital ve perineal bölgelerin hýzla ilerleyen ve hayatý tehdit eden nekrotizan fasiitidir. Fournier kangreni ile iliþkili ölüm oranýný tahmin etmek için Laor ve ark. Kanýtlanmýþ prognostik önemi olan bir indeks olan Fournier's Gangrene Severity Index'i (FGSI) geliþtirdi.C-reaktif protein/albümin (CAR) inflamatuar bir belirteç olup, birçok çalýþmada prognoz ve taný üzerinde belirleyici etkiye sahip olduðu bildirilmiþti. Çalýþmamýz Fournier Gangrenli hastalarda mortaliteyi öngörmede CAR oranýnýn prognostik deðerini belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþma, 2019-2022 yýllarý arasýnda Fournier gangreni nedeniyle opere edilen 58 hastayý içermektedir. Araþtýr-ma verileri, hastane otomasyon sisteminden alýnan elektronik ve kaðýt hasta dosyalarý, ameliyat notlarý, klinik takip formlarý, anamnez, yoðun bakým formlarý ve laboratuvar test sonuçlarýndan elde edildi. Hastalarýn CAR oranlarý ile yaþ, cinsiyet, komorbiditeler, ostomi yapýlýp yapýlmadýðý, hastanede kalýþ süresi, yara kültüründe üreme, izole edilen bakteri türleri, FGSI skorlarý ve laboratuvar test sonuçlarý CAR oranýnýn Fournier kangreni ile iliþkili mortaliteyi öngörmedeki prognostik rolü araþtýrýldý.
BULGULAR: Çalýþmada 45 erkek ve 13 kadýn olan çalýþma grubunun yaþ ortalamasý 57 (min.17, maks. 85) idi. En sýk predispozan faktör 32 (%55.1) diabetes mellitus idi. Baþvuru sýrasýnda en sýk görülen semptomlar eritem (%89.6), þiþlik/sertleþme (%82.7), aðrý (%41.3), ateþ (%31) ve cerahat içeren akýntý (%37.9) idi. Çalýþmaya dahil edilen 58 hastada mortalite görüldü. Diabetes mellitustan (%55.1) sonra en sýk görülen komorbidite kardi-yovasküler hastalýktý (%39.6). Ex olan ve olmayan hastalarýn medyan yaþlarý sýrasýyla 60 (min. 56, maks. 85) ve 56 (min. 18, maks. 80) idi. CAR oraný, mortal olmayan grupta Fournier kangren hastalarýný ölenlerden etkili bir þekilde ayýrt etti. 2.8'lik CAR oraný kesme deðeri, hayatta kalan Fournier kangren hastalarýný ölenlerden etkili bir þekilde ayýrdý.
SONUÇ: Çalýþma bulgularý, CAR oranýnýn Fournier kangreni ile iliþkili mortaliteyi tahmin etmede etkili bir biyobelirteç olarak hizmet edebileceðini göstermiþtir.

BACKGROUND: Fournier’s gangrene (FG) is a rapidly progressing and life-threatening necrotizing fasciitis of the genital and perineal regions. To estimate the mortality rate associated with FG, Laor et al. developed the FG severity index (FGSI), an index with proven prognostic significance. On the other hand, the C-reactive protein (CRP)/albumin (CAR) ratio is a proven objective marker of inflam-matory response. In light of the foregoing, the objective of this study is to assess the prognostic value of the CAR ratio in predicting mortality in patients with FG in comparison with FGSI.
METHODS: This retrospective study consisted of 58 patients who were operated on for FG between 2019 and 2022. Research data were obtained from electronic and paper patient files, surgery notes, clinical follow-up forms, anamnesis, intensive care forms, and laboratory test results obtained from the hospital automation system. The clinical course of each patient was reviewed based on these records. The relationships between patients’ CAR ratios and their demographic and clinical characteristics, including age, gender, and comorbidities, whether ostomy was performed, length of hospital stay, growth in wound culture, isolated bacterial species, FGSI scores, and laboratory test results (hemoglobin, sodium, potassium, bicarbonate, glucose, blood urea nitrogen (BUN), creatinine, albumin, and CRP levels, white blood cell counts, hematocrit values, glucose-to-potassium, neutrophil-to-lymphocyte, platelet-to-lymphocyte, and lymphocyte-to-CRP ratios) and the prognostic power of CAR ratio in predicting the mortality associated with FG were investigated.
RESULTS: The mean age of the study group, 45 male and 13 female, was 57 (min. 17, max. 85) years. The most common predisposing factor was diabetes mellitus (DM), which was present in 32 (55.1%) patients. The most common symptoms at admission were erythema (89.6%), swelling/hardening (82.7%), pain (41.3%), fever (31%), and purulent discharge (37.9%). Of the 58 patients included in the study, six had died. The most common comorbidity, second to DM (55.1%), was cardiovascular disease (39.6%). The median ages of patients who had died and survived were 60 (min. 56, max. 85) and 56 (min. 18, max. 80) years, respectively. CAR ratio effectively differentiated FG patients who had survived from those who had died (area under the curve [AUC]: 0.907 [0.824–0.984]). The CAR ratio cutoff value of 2.8 effectively differentiated FG patients and FSGI scores who had survived from those who had died (AUC: 0.904 [0.823–0.992]).
CONCLUSION: The study findings demonstrated that the CAR ratio might serve as an effective biomarker in predicting the mortal-ity associated with FG.

AMAÇ: Akut kolesistitli hastalarda erken kolesistektomi önerilmesine raðmen, konservatif tedaviyi takiben gecikmiþ kolesistektomi (DC) özellikle yaþlý eriþkin hastalarda oldukça tercih edilen bir yöntemdir. Bununla birlikte, bazý ciddi vakalar gecikmiþ acil kolesistektomi (OC) gerektirir. Bu çalýþ-ma, laboratuvar bulgularýnýn ve Tokyo þiddet sýnýflandýrmasýnýn (TokyoSC) yaþlý hastalarda OK ihtiyacý olanlarý ayýrt etme yeteneðini deðerlendirmeyi amaçladý.
GEREÇ VE YÖNTEM: Akut kolesistitli geriatrik hastalarýn baþvuru sýrasýndaki laboratuvar/radyolojik/klinik bulgularý ve TokyoSC geriye dönük olarak incelendi. DC ve OC gruplarý karþýlaþtýrýldý.
BULGULAR: 164 hastanýn yaþ ortalamasý 72.3±6.4 idi. Beyaz kan hücresi, nötrofil (NEU), olgunlaþmamýþ granülosit (IG), C-reaktif protein, nötrofil-lenfosit oraný (NLR) ve TokyoSC parametrelerinin tümü farklýlaþmada p < 0,001'de anlamlýydý. NLR'nin özgüllüðü %98 ve TokyoSC'nin duyarlýlýðý %98'dir.
SONUÇ: NLR, NEU, IG ve TokyoSC, akut kolesistit nedeniyle takip edilen yaþlý eriþkin hastalarda konservatif tedavi + DC planlanýrken OC ihtiyacý olan hastalarý ayýrt etmede etkiliydi. NLO >9.9 ve TokyoSC orta/yüksek ise yaþlý hastalarda konservatif tedavi + DC yerine erken kolesistektomi tercih edilmelidir.

BACKGROUND: Although early cholecystectomy is recommended for patients with acute cholecystitis, conservative treatment followed by delayed cholecystectomy (DC) is a highly preferred modality, especially in older adult patients. However, some severe cases require overdue urgent cholecystectomy (OC). This study aimed to evaluate the ability of laboratory findings and Tokyo severity classification (TokyoSC) to differentiate those with the need for OC among elderly patients.
METHODS: Laboratory/radiological/clinical findings of geriatric patients with acute cholecystitis on admission and TokyoSC were retrospectively analyzed. The DC and OC groups were compared.
RESULTS: The mean age of the 164 patients was 72.3±6.4 years. White blood cell, neutrophil (NEU), immature granulocyte (IG), C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), and TokyoSC parameters were all significant at P<0.001 in differentiation. NLR had a specificity of 98%, and TokyoSC had a sensitivity of 98%.
CONCLUSION: NLR, NEU, IG, and TokyoSC were effective in differentiating patients who needed OC while planning conservative treatment + DC for older adult patients who were followed up due to acute cholecystitis. If the NLR is >9.9 and TokyoSC is moderate/high, early cholecystectomy should be preferred instead of conservative treatment + DC in aged patients.

AMAÇ: Bu çalýþmanýn amacý, bariatrik cerrahide major vasküler yaralanmalarýn insidansýný, risk faktörlerini, klinik sunumunu ve yönetimini araþtýr-mak; özellikle karýn boþluðuna farklý eriþim yöntemlerinin rolüne odaklanmaktýr.
GEREÇ VE YÖNTEM: Bariatrik cerrahi uzmanlarýnýn katýlýmýyla ülke genelinde bir anket çalýþmasý gerçekleþtirildi ve major vasküler yaralanmalarýn yaygýnlýðý deðerlendirildi. Ýki ulusal bariatrik cerrahi derneðinin WhatsApp gruplarý aracýlýðýyla 365 cerraha anket gönderildi ve 76 cerrah anketi ta-mamladý. Çalýþma popülasyonu, bariatrik cerrahi uygulayan genel cerrahlarý içeriyor ve anket 12 sorudan oluþuyordu.
BULGULAR: Katýlýmcýlarýn %16.9'u bariatrik cerrahi sýrasýnda major vasküler yaralanma yaþadýklarýný bildirdi. Yaralanmalarýn çoðunluðu (%75) trokar giriþinde meydana geldi ve geri kalan vakalar diseksiyon aþamasýnda ortaya çýktý. Önemli bir þekilde, cerrahlarýn %66.7'si eriþim için optik trokarlar kullandý, %27.8'i Veress iðne tekniðini uyguladý. Erken tespit oranlarý farklýlýk gösterdi; %45'i yaralanmayý hemen fark etti, %30'u ise üç dakika içinde tespit etti. Yaralanmalarýn çoðu (%52.4) laparoskopik olarak onarýldý ve yalnýzca üç cerrah kardiyovasküler cerrahlardan yardým talep etti. SONUÇ: Major vasküler yaralanmalar, laparoskopik bariatrik cerrahide nadir ancak potansiyel olarak ciddi komplikasyonlardýr. Ýnsidanslarýný anla-mak, zamanýnda taným ve uygun yönetim, olumsuz etkileri en aza indirmek için hayati öneme sahiptir. Bu çalýþmanýn bulgularý, vasküler yaralanmalarýn desenlerini ve özel eriþim yöntemlerinin olasý rolünü aydýnlatarak bariatrik cerrahide hasta güvenliðini artýrmak için deðerli görüþler sunmaktadýr.

BACKGROUND: The aim of this study was to investigate the incidence, risk factors, clinical presentation, and management of major vascular injuries during bariatric surgery, with a specific focus on the role of different access methods in abdominal cavity entry.
METHODS: A nationwide survey was conducted among bariatric surgeons to assess the prevalence of major vascular injuries. A questionnaire was distributed to 365 surgeons through WhatsApp groups of two national bariatric surgery societies, with 76 surgeons completing the survey. The study population included general surgeons practicing bariatric surgery, and the questionnaire consisted of 12 questions.
RESULTS: Among the participants, 16.9% reported experiencing a major vascular injury during bariatric surgery. The majority of injuries (75%) occurred at the trocar entrance, with the remaining cases during the dissection phase. Notably, 66.7% of surgeons used optical trocars for access, while 27.8% employed the Veress needle technique. Early detection varied, with 45% identifying the injury immediately and 30% recognizing it within three minutes. Most injuries (52.4%) were repaired laparoscopically, and only three surgeons sought assistance from cardiovascular surgeons.
CONCLUSION: Vascular injuries are infrequent but potentially serious complications in laparoscopic bariatric surgery. Understand-ing their incidence, timely recognition, and proper management are crucial to minimize adverse effects. The findings of this study shed light on the patterns of vascular injuries and the potential role of specific access methods, providing valuable insights for enhancing patient safety in bariatric surgery.

AMAÇ: Rüptüre abdominal aort anevrizmasýnýn (rAAA) açýk onarýmýndan sonra postoperatif hastane içi mortaliteyi öngörmede Harborview Týp Merkezi (HMC) mortalite risk skorlama sisteminin güvenilirliðini deðerlendirmeyi ve diðer olasý mortalite risk faktörlerinin varlýðýný araþtýrmayý amaçladýk
GEREÇ VE YÖNTEM: 01 Ocak 2004 ile 31 Aralýk 2021 tarihleri arasýnda rAAA nedeniyle açýk onarým yapýlan hastalar bu tek merkezli kohort çalýþmasýna retrospektif olarak dahil edildi. 30 günlük hastane mortalite riski, HMC risk skorlama sistemi kullanýlarak hesaplandý. Mortalite ve diðer perioperatif deðiþkenler arasýndaki iliþki incelendi. Mortaliteyi etkileyen faktörleri belirlemek için lojistik regresyon analizi yapýldý. HMC mortalite risk skorunun prediktif deðerini elde etmek için Ýþlem Karakteristik (Receiver Operating Characteristic) Eðrisi analizi kullanýldý.
BULGULAR: Bu çalýþmaya toplam 91 hasta dahil edildi. Hayatta kalan hastalar ile ölenler arasýnda istatistiksel olarak anlamlý bir fark vardý. Preope-ratif hasta verilerinin tek deðiþkenli lojistik regresyon analizi, hematokrit, laktat ve þok indeksi deðerlerinin, baþvuru þeklinin, bilinç kaybýnýn ve HMC risk skorunun postoperatif mortaliteyi anlamlý olarak etkilediðini ortaya koydu. Ancak çok deðiþkenli lojistik regresyon analizinde sadece HMC risk skoru postoperatif mortalite ile iliþkiliydi (p<0.001). HMC risk skoru, tüm hastalar için 0,912 AUC deðeri ile 30 günlük mortaliteyi tahmin edebilir. SONUÇ: Çalýþmamýz, HMC risk skorunun hastane içi mortaliteyi güvenilir bir þekilde tahmin edebileceðini gösterdi, ancak bu skorlama sisteminin kolay ve pratik hesaplanmasýndan ödün vermeden güvenilirliðini daha da artýran baþka parametreler ortaya koymadý.

BACKGROUND: We aimed to evaluate the reliability of the Harborview Medical Center (HMC) mortality risk scoring system in predicting post-operative in-hospital mortality after open repair (OR) of a ruptured abdominal aortic aneurysm (rAAA) and to inves-tigate the presence of other possible mortality risk factors.
METHODS: Patients who underwent OR for rAAA between January 01, 2004, and December 31, 2021, were retrospectively included in this single-center cohort study. The 30-day hospital mortality risk was calculated using the HMC risk scoring system. We as-sessed the relationship between mortality and other perioperative variables. Logistic regression analysis was performed to determine the factors affecting mortality. Receiver operating characteristic curve analysis was utilized to obtain the predictive value of the HMC mortality risk score.
RESULTS: A total of 91 patients were included in this study. A statistically significant difference existed between the patients who survived and those who died. Univariate logistic regression analysis of the pre-operative patient data revealed that the hematocrit, lactate, shock index values, admission type, loss of consciousness, and HMC risk score significantly affected post-operative mortal-ity. However, in the multivariate logistic regression analysis, only the HMC risk score was associated with post-operative mortality (P<0.001). The HMC risk score could predict 30-day mortality, with an AUC of 0.912 for all patients.
CONCLUSION: Our study showed that the HMC risk score could reliably predict in-hospital mortality, but it did not reveal any other parameters that further increased the reliability of this scoring system without compromising on its straightforward and practical calculation.

AMAÇ: Akut Kolesistit (AK), cerrahi pratikte en sýk görülen acil hastalýklardan biridir. Altýn standart tedavi laparoskopik kolesistektomi olmasýna raðmen, bazý hastalarda yaþ, komorbidite ve baþvurudaki gecikmeler nedeniyle perkütan kolesistostomi (PK) uygulanmaktadýr. PK uygulanan hasta-larda zamanlamanýn klinik sürece etkisini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Þubat 2017 ile Aralýk 2021 tarihleri arasýnda PK uygulanan hastalar çalýþmaya dahil edildi. Ýlk 72 saatte PK uygulananlar erken PK grubu, 72 saat sonra uygulananlar ise geç PK grubu olarak belirlendi. Hastalarýn demografik bilgileri, drenaj öncesi klinik bilgileri, ilk üç gün biyo-kimyasal deðerleri, hastanede kalýþ süreleri, drenaj sonrasý erken ve geç dönemde morbidite ve mortalite, elektif kolesistektomi bilgileri kaydedildi. Bu veriler iki grup arasýnda karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 122 hasta dahil edildi. 98 hastaya (%80.3) erken PK, 24 hastaya (%19.7) geç PK uygulandý. Medyan takip süresi erken PK grubunda 26.6 ay (min: 0.25-maks: 67), geç PK grubunda 26.4 ay (min: 0,6-maks: 66) idi (p=0.408). Tokyo sýnýflamasýna göre ortalama yaþ, erkek ve kadýn daðýlýmý, eþlik eden hastalýk, Charlson komorbidite indeksi (CCI), hepatopankreatolilier patoloji (HPBP), endoskopik retrograd kolanjiyo-pankreatografi (ERCP) ve derece (TG18) açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p>0.05). Biyokimyasal parametreler arasýnda fark yoktu (p>0.05). Çalýþmamýzda erken PK grubunda ortalama hastanede kalýþ süresi 6 (min: 2-maks: 36) gün, geç PK grubunda ortalama 9 gün (min: 5-maks: 20) idi (p< 0.001). PK'den sonra 16'sý akut kolesistit olan toplam 25 hastada HPBP geliþti. Erken ve geç PK gruplarý arasýnda PK sonrasý HPBP ge-liþimi açýsýndan istatistiksel olarak anlamlý fark yoktu (p=0.576). Ameliyat oraný ve ameliyat tipi (acil/elektif, açýk/laparoskopik/konversiyon, total/subtotal, süre) açýsýndan erken ve geç PK grubu arasýnda istatistiksel olarak anlamlý fark yoktu (p>0.05).
SONUÇ: Doðru zamanlamayla ilgili tartýþmalar devam etmektedir. Çalýþmamýzda erken PK uygulanan hastalarýn hastanede kalýþ sürelerinin daha kýsa olduðunu bulduk. Hasta özellikleri ve akut kolesistit þiddeti açýsýndan erken ve geç gruplar arasýnda fark yoktu. Akut kolesistit tedavisinde PK iþlemi, hasta bazlý endikasyonlar yerine, randomize kontrollü çalýþmalarla objektif verilerle belirlenen algoritmalara dayanmalýdýr.

BACKGROUND: Acute cholecystitis (AC) is one of the most common emergency diseases in surgical practice. Although the gold standard treatment is laparoscopic cholecystectomy, percutaneous cholecystostomy (PC) is performed in some patients due to age, comorbidity, and delays in admission. We aimed to investigate the effect of timing on the clinical process of patients undergoing PC.
METHODS: Patients who underwent PC between February 2017 and December 2021 were included in the study. Those who un-derwent PC in the first 72 h were determined as the early PC group, and those who underwent PC after 72 h were determined as the late PC group. Demographic information of the patients, clinical information before drainage, biochemical values of the first 3 days, length of hospital stay, morbidity and mortality in the early and late period after drainage, and elective cholecystectomy information were recorded. These data were compared between the two groups.
RESULTS: One hundred and twenty-two patients were included in the study. Early PC was performed in 98 patients (80.3%) and late PC was performed in 24 patients (19.7%). The median follow-up period was 26.6 months (min: 0.25-max: 67) in the early PC group and 26.4 months (min: 0.6-max: 66) in the late PC group (P=0.408). There was no statistically significant difference in mean age, distribu-tion of males and women, concomitant disease, Charlson Comorbidity Index, hepatopancreatobiliary pathology (HPBP), endoscopic retrograde cholangiopancreatography in history and grade (TG18) compared to Tokyo classification (P>0.05). There was no difference between the biochemical parameters (P>0.05). In our study, the median length of hospital stay was 6 (min: 2-max: 36) days in the early PC group, and the median was 9 days (min: 5-max: 20) in the late PC group (P<0.001). A total of 25 patients developed HPBP after PC, 16 of which were AC. There was no statistically significant difference between the early and late PC groups in terms of HPBP develop-ment after PC (P=0.576). There was no statistically significant difference between the early and late PC group in terms of the rate of surgery and type of operation (emergency/elective, open/laparoscopic/conversion, total/subtotal, duration) (P>0.05).
CONCLUSION: Discussions about the right timing are ongoing. In our study, we found that patients who underwent early PC had shorter hospital stays. There was no difference between the early and late groups in terms of patient characteristics and severity of AC. PC procedure in AC should be based on algorithms determined by objective data instead of patient-based indications with ran-domized controlled trials.

AMAÇ: Bu çalýþmanýn amacý, pediatrik hastalarda açýk glob yaralanmalarýnda bilgisayarlý tomografi (BT) bulgularý ile pediatrik oküler travma skoru (POTS) ve oküler travma skoru (OTS) arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Açýk glob yaralanmasý (AGY) olan 34 pediatrik hastada BT bulgularý 9 ana kategoriye ayrýldý: Skleral irregularite, lens dislokasyonu, anormal vitreus dansitesi, koryoretinal tabaka kalýnlaþmasý, preseptal kalýnlýk artýþý, intraoküler yabancý cisim ve hava, vitreus hemorajisi, retina dekolmaný ve perforasyon. Farklý tip ve sayýdaki BT bulgularý ile POTS ve OTS arasýndaki iliþki deðerlendirildi.
BULGULAR: Ortalama travma yaþý 6.6±3.1 idi. Hastalarýn 9’u kadýn (%26.5) 25’i (%73.5) erkekti. En yaygýn BT bulgularý skleral irregülarite ve pre-septal kalýnlýk artýþýdýr (%47.1). Çok deðiþkenli analizde 1 veya daha az BT bulgusu olan 16 hasta (median POTS deðeri 80 (71.25-90.0)) ile 2 ya da 3 BT bulgusu olan 11 hasta (median POTS deðeri 60 (15-70)) arasýnda p deðeri <0.05 bulundu. 1 veya daha az BT bulgusu olan 16 hasta (median POTS deðeri 80 (71.25-90.0)) ile 4 veya daha fazla BT bulgusu olan 7 hasta (median POTS deðeri 45 (25-80)) arasýnda p deðeri <0.05 bulundu. 2 ya da 3 BT bulgusu olan 11 hasta (median POTS deðeri 60 (15-70)) ile 4 veya daha fazla BT bulgusu olan 7 hasta (median POTS deðeri 45 (25-80)) arasýnda p deðeri>0.05 bulundu. BT bulgu sayýsý ile OTS evreleri arasýnda anlamlý farklýlýk bulunamadý. Anormal vitreus dansitesi var olan hastalarda (median 45 (30-69.6)) POTS anlamlý iken (p<0.05) OTS deðeri anlamlý bulunmadý (p>0.05). Diðer BT bulgularýnda ise POTS ve OTS arasýnda anlamlý fark bulunmadý.
SONUÇ: BT bulgularýnýn sayýsý, AGY olan pediatrik hastalarda POTS skorunu öngörmede ve dolayýsýyla görsel prognozu tahmin etmeye yardýmcý olabilir. Yeterli klinik verilerin bulunmadýðý acil durumlarda, BT'nin objektif bulgularý oküler travmanýn ciddiyetini ve muhtemelen uzun vadeli görsel sonucunu tahmin etmeye yardýmcý olacaktýr.

BACKGROUND: The aim of this study is to assess the relationship between computed tomography (CT) findings in open globe injuries (OGIs) in pediatric patients and the pediatric ocular trauma score (POTS) and OTS in pediatric ocular trauma.
METHODS: In 34 pediatric patients with OGI, CT findings were categorized into nine main categories: Scleral irregularity, lens dislocation, abnormal vitreous density, choroid-retinal layer thickening, preseptal thickness increase, intraocular foreign body and air, vitreous hemorrhage, retinal detachment, and perforation. The relationship between different types and numbers of CT findings and the POTS and OTS was evaluated.
RESULTS: The mean age of trauma was 6.6±3.1. Of the patients, 9 (26.5%) were female and 25 (73.5%) were male. The most com-mon CT findings are scleral irregularity and increased preseptal thickness (47.1%). In univariate analysis, a P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]). A P<0.05 was found between 16 patients with 1 or less CT findings (median POTS value 80 [71.25–90.0]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). A P > 0.05 was found between 11 patients with 2 or 3 CT findings (median POTS value 60 [15–70]) and 7 patients with 4 or more CT findings (median POTS value 45 [25–80]). No significant difference was found between the number of CT findings and OTS stages. While POTS was significant (P<0.05) in patients with ab-normal vitreous density (median 45 [30–69.6]), OTS value was not significant (P>0.05). There was no significant difference between POTS and OTS in other CT findings.
CONCLUSION: The number of CT findings may assist in predicting POTS and, consequently, estimating visual prognosis in pediatric patients with OGI. In emergency situations where, sufficient clinical data are unavailable, the objective findings from CT may help in assessing the severity of ocular trauma and potentially predicting long-term visual outcomes.

AMAÇ: Trikobezoar, yutulan kýl kütlesinin sindirim sisteminde birikmesiyle oluþan, çocuklarda nadir görülen bir klinik durumdur. Bu durum, saçlarýný yolmak için karþý konulamaz bir dürtüye sahip olan Trichotillomania'dan (TTM) muzdarip, psikiyatrik geçmiþleri olan genç kadýnlarda görülür. Ol-dukça nadir görülen ve deðiþken klinik tablolarý olan bu patolojinin taný ve tedavisi zordur. Bu çalýþmanýn amacý, çocuklarda intestinal obstrüksiyon bulgularýnýn ayýrýcý tanýsýnda trikobezoar farkýndalýðýný artýrmak ve bu nadir patolojinin taný ve tedavisini deðerlendirmektir.
GEREÇ VE YÖNTEM: 2009-2022 yýllarý arasýnda hastanemiz çocuk cerrahisi kliniðinde trikobezoar nedeniyle tedavi edilen hastalarýn verileri ret-rospektif olarak incelendi.
BULGULAR: Kliniðimizde bu süreçte 6 kýz hasta Trikobezoar tanýsý ile tedavi edildi. Hastalar,anamnez, fizik muayene, batýn ultrasonografisi (USG) ve son olarak endoskopi yardýmý ile taný aldý. USG, mide duvarý infiltrasyonu olmadýðýný ve heterojen lezyonun pilor yolu ile duodenuma devamlýlýðýný gösterebildi. Tüm hastalar kontrastlý batýn grafisi ile deðerlendirildi. Olgularýn dördüne beþ cerrahi giriþim uygulandý. Ýki kez ameliyat edilen bir olguda ilk ameliyatta distal intestinal satellit bezoar fark edilemedi. Ýki hastada trikobezoar saptandý ancak cerrahi gerekmedi. Bu hastalar daha gençti ve erken baþlangýçlý TTM'ye sahipti (10 yaþýndan önce). Hastalar ortalama 10,8 yýl takip edildi ve nüks saptanmadý.
SONUÇ: Trikobezoar çocuklarda intestinal týkanýklýðýn nadir fakat geç taný aldýðýnda ölümcül komplikasyonlar yaratabilen bir sebebidir. Hastalýðýn yönetimi için bir algoritma izlenmemesi taný ve tedavi aþamasýnda zorluklara neden olmaktadýr. Özellikle psikiyatrik hikayesi bilinen hastalarda farkýn-dalýkla yapýlmýþ tüm batýn USG ve laparaskopi gereksiz tetkiklerin önüne geçebilir.

BACKGROUND: Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology.
METHODS: The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed.
RESULTS: Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected.
CONCLUSION: Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.

AMAÇ: Radyal önkol flebi, uzun pedikülü ve ince yapýsý ile rekonstrüktif mikrocerrahinin en sýk kullanýlan fleplerinden birisidir. Ön koldaki donör bölge, fonksiyonel önemi olan ve görünür bir anatomik bölgedir. Bu çalýþmada konvansiyonel radial ön kol flep pedikülünün diseksiyonunda endos-kop kullanýlarak ön kolda uzunlamasýna ve büyük bir izin kalmasýnýn önüne geçildi. Ayrýca flep baþarýsýzlýðýný ve donör saha morbiditesini azaltmak için kübital fossada 2-3 santimetrelik ayrý bir insizyon yapýlarak arteriyel, venöz ve sinir yaralanmalarý önlendi.
GEREÇ VE YÖNTEM: Bu çalýþmaya 2014-2021 yýllarý arasýnda baþ-boyun bölgesi rekonstrüksiyonunda radial ön kol flebinin pedikül diseksiyonu için endoskop kullanýlan hastalar dahil edildi. Flep subfasyal plandan kaldýrýldý. Sefalik ven bütün hastalarda kullanýldý. Pedikül ve sefalik ven endoskop yar-dýmýyla diseke edildi. Pedikül diseksiyonu antekubital bölgeye ulaþtýðýnda deriden 2-3 cm'lik bir kesi yapýldý. Her hasta için iki ven anastomozu yapýldý. BULGULAR: Bu retrospektif çalýþma 51 hastadan oluþmaktadýr. 45 hastada baþ boyun bölgesi kanser cerrahisine, 6 hastada ise travmaya baðlý defekt vardý. Cilt adasýnýn boyutu ortalama 40.3 cm2 iken deri greftinin alaný ortalama 24.2 cm2 idi. Antekübital bölgede iz ortalama 2.6 cm idi. Ameliyat sonrasý dönemde venöz veya arteriyel dolaþým bozukluðu gözlenmedi. Hiçbir hastada kýsmi veya tam flep kaybý olmadý. Altý (%11.7) hastada radial sinirin yüzeyel duyu dalýnýn olduðu cilt bölgesinde lokalize uyuþma devam etti.
SONUÇ: Endoskopik radyal önkol flebi ile ön koldaki uzunlamasýna kesinin ve bu bölgedeki yara iyileþme problemlerinin önüne geçilmektedir. Kýsmi veya tam flep kaybýnýn olmamasý, radyal önkol flebinin endoskopik olarak çýkarýlmasýnýn güvenli ve güvenilir bir yöntem olduðunu göstermiþtir.

BACKGROUND: The radial forearm flap is one of the most commonly used flaps of reconstructive microsurgery with its long pedicle and thin structure. The donor site at the forearm is a visible anatomic region that has high mobility and functional importance. In this study, a longitudinal and large scar was avoided on the forearm during pedicle dissection of the conventional radial forearm flap with the utilization of an endoscope. Furthermore, arterial, venous, and nervous injuries were avoided by performing a separate inci-sion of 2–3 cm at the cubital fossa to reduce flap failure and donor site morbidity.
METHODS: The patients who underwent pedicle dissection of the radial forearm flap with the aid of an endoscope for head-neck reconstruction between 2014 and 2021 were included in this study. The flap was harvested from the subfascial plane. The cephalic vein was used in all of the patients. When the pedicle dissection reached the antecubital region, an incision of 2–3 cm was performed from the skin. Two vein anastomoses were performed for each patient.
RESULTS: This retrospective study consists of 51 patients. While 45 of the patients were the result of head and neck cancer, six of them had a defect caused by trauma. The average area of skin islands was 40.3 cm2, while the full-thickness skin graft size was 24.2 cm2. An average of 2.6 cm of scar tissue was formed at the antecubital region. No venous or arterial compromise was observed in the post-operative period. There was no partial or total flap loss in any patient. Localized numbness persisted in the skin area where the superficial sensory branch of the radial nerve is located in 6 (11.7%) patients.
CONCLUSION: With endoscopic radial forearm flap harvesting, the longitudinal incision in the forearm and wound healing prob-lems are avoided. The absence of partial or total flap loss has shown that endoscopic harvesting of the radial forearm flap is a safe and reliable method.

AMAÇ: Depremler, insan vücuduna ciddi zararlar verebilen yýkýcý olaylardýr. Omurga, deprem travmasýndan sýklýkla etkilenen, insan vücudunun önemli bir parçasýdýr. Bu çalýþmanýn amacý, 2023 Türkiye Depremi'ne sekonder olarak geliþen torakolomber kýrýklarý incelemek ve klinik sonuçlarý-mýzý ortaya koymaktýr.
GEREÇ VE YÖNTEM: Depremden etkilenen, enkaz altýndan kurtarýlan ve daha sonra omurga kýrýklarý nedeniyle kliniðimizde tedavi edilen 15 hasta verisi, geriye dönük olarak incelendi. Hastalarýn klinik, radyolojik ve cerrahi özellikleri kaydedildi ve sonuçlarý deðerlendirildi.
BULGULAR: Onbeþ hastanýn 12'si kadýn ve 3'ü erkekti. Yaþlarý 22 ila 79 arasýndaydý. Enkaz altýnda kalma süresinin ortalamasý 4,7 saatti. Frankel sýnýflandýrmasýna göre, hastalarýn 12'si (%80) Frankel E, 2'si (%13.3) Frankel A ve 1'i (%6.6) Frankel C olarak kategorilendirildi. Bu 12 hastadan 6'sýna cerrahi tedavi uygulandý, toplamda 9 hastaya ise konservatif tedavi verildi. Dört hastada birden fazla omur kýrýðý tespit edildi. Birden fazla kýrýðý olan 3 hastaya konservatif tedavi uygulanýrken, 1 hasta L1 kýrýðý nedeniyle ameliyat edildi. Tüm ameliyatlar omurilik kanalýnýn dekompresyonunu ve omur-ga enstrümantasyonunu içeriyordu. Torakolomber bileþke kýrýklarý olmayan hastalardan birinde T8 kýrýðý, birinde L4 kýrýðý ve birinde de eþlik eden lomber pleksus yaralanmasý bulunan bir sakral kýrýk vardý.
SONUÇ: Torakolomber kýrýklar deprem nedeniyle sýklýkla oluþan omurga yaralanmalarýndan biridir. Ancak bu kýrýklarýn oluþum mekanizmasý tam olarak bilinmemektedir. Cerrahi tedavi, ilerleyen nörolojik bozukluklarý olan hastalarda öncelikli tedavi seçeneði iken, stabil kýrýklar için ise konser-vatif tedavi tercih edilen bir tedavi yöntemidir.

BACKGROUND: Earthquakes are devastating events that may severely injure the human body. The spine is one of the important parts of the human body that may be affected by earthquake trauma. The aim of this study is to focus on thoracolumbar fractures secondary to the 2023 Turkey Earthquake.
METHODS: The data of 15 patients who were affected by the earthquake, rescued from the rubble, and subsequently treated for spinal fractures in our department were reviewed retrospectively. The clinical, radiological, and surgical features of the patients were recorded, and the outcomes were investigated.
RESULTS: Among the 15 patients, 12 were female, and 3 were male. Their ages ranged from 22 to 79 years. The average duration of being trapped under debris was 4.7 hours. According to the Frankel classification, 12 patients (80%) were categorized as Frankel E, 2 patients (13.3%) as Frankel A, and 1 patient (6.6%) as Frankel C. Of these patients, 6 underwent surgical treatment, while a total of 9 patients received conservative treatment. Multiple vertebral fractures were identified in 4 patients. While 3 patients with multiple fractures were treated conservatively, 1 patient underwent surgery due to an L1 fracture. All surgeries consisted of spinal canal de-compression and spinal instrumentation. Among patients without thoracolumbar junction fractures, 1 had a T8 fracture, 1 had an L4 fracture, and 1 had a sacral fracture along with an accompanying lumbar plexus injury.
CONCLUSION: Thoracolumbar fractures are frequently observed after earthquakes. However, the exact mechanism of these fractures is not well known. Surgical management should be reserved for patients with progressive neurological deficits, while conservative treatment is the option for stable fractures.

AMAÇ: Karotis arteri yýrtýlmasýyla ortaya çýkan nöroonkolojik acil bir durum olan karotis patlamasý (KP), esas olarak ýþýnlanmýþ baþ ve boyun kanseri hastalarýnda rapor edilmiþtir. Bu çalýþmada bu olgularda dekonstrüktif ve rekonstrüktif endovasküler tedavi deneyimimizi sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 2003 ile 2022 yýllarý arasýnda kulak, aðýz veya burun kanamasý ile baþvuran ve konservatif tedavilere yanýt vermeyen akut KP'lý 17 hasta çalýþmaya dahil edildi. Dekonstrüktif embolizasyon vasküler týkaçlar, geniþleyen hidrojel sarmallar, yapýþtýrýcý ve balon kullanýlarak yapýldý. Eðer damar anatomisi ve patolojisi uygunsa kapalý stent ile rekonstrüktif tedaviyi tercih ettik. Ýþlemlerin klinik baþarýsýný deðerlendirmek için tüm hastalar klinik ziyaretler ve modifiye Rankin skalasý ile takip edildi. Dekonstrüktif ve rekonstrüktif tedavi yöntemlerinde komplikasyon sonuçlarý ki-kare testi ile karþýlaþtýrýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 20-64 (ortalama 50.9) olup, üçü kadýn (%18), 14'ü (%82) erkekti. 19 anjiyografi sýrasýnda 14 hastaya 15 en-dovasküler iþlem uyguladýk. 15 tedavinin tümünde anýnda hemostaz ve tam teknik baþarý sapþandý (p=1.0). Hastalarýn altýsýna (%35) internal karotis arterde kaplý stent kullanýlarak rekonstrüktif tedavi uygulanýrken, dokuzuna eksternal karotis arter veya internal karotis arterde (%65) dekonstrüktif embolizasyon uygulandý. Tedavi paradigmalarý (dekonstrüktif vs. rekonstrüktif) ile komplikasyon geliþimi arasýnda ki-kare baðýmsýzlýk testi kullanýlarak anlamlý bir iliþki saptanmadý X² (2, N=15) = 0.07, p=0.79.
SONUÇ: Son yýllarda ortaya çýkan endovasküler tedaviler, hayatý tehdit eden akut KP vakalarýnda umut verici sonuçlar ortaya koymaktadýr. Çalýþ-mamýz bu hastalarda uygulanan dekonstrüktif ve rekonstrüktif endovasküler paradigmalar arasýnda anlamlý bir fark bulmadý. Ancak çalýþmamýzda ve literatürdeki veriler heterojen ve yetersiz olup, kanýt düzeyinin daha yüksek olmasý gerekmektedir.

BACKGROUND: Carotid Blowout (CBO), a neuro-oncological emergency characterized by the rupture of the carotid artery, has been predominantly reported in patients with head and neck cancer who have undergone radiation therapy. In this study, our objective is to share our experience with deconstructive and reconstructive endovascular treatments for CBO.
METHODS: This study includes 17 patients who experienced intractable acute CBO, presenting with ear, oral, or nasal bleeding, between 2003 and 2022. We employed deconstructive embolization using vascular plugs, expanding hydrogel coils, glue, and balloons. If vascular anatomy and pathology permitted, we opted for reconstructive treatment using a covered stent. All patients underwent clini-cal follow-up visits, and we used the modified Rankin Scale to evaluate the clinical success of the procedures. We compared outcomes in terms of complications between the deconstructive and reconstructive treatment methods using the Chi-square test.
RESULTS: The patient cohort had an age range of 20–64 years (mean 50.9), including three females (18%) and 14 males (82%). We conducted 15 endovascular procedures on 14 patients during 19 angiography sessions. All 15 treatments achieved immediate hemo-stasis, resulting in complete technical success (p=1.0). Six patients (35%) underwent reconstructive treatments with covered stents in the internal carotid artery, while nine patients (65%) underwent deconstructive embolization in either the external or internal carotid artery. We found no significant association between the treatment paradigms (deconstructive vs. reconstructive) and the development of complications using a Chi-square test of independence X² (2, n=15)=0.07, p=0.79.
CONCLUSION: Recent advancements in endovascular treatments have shown promising results in managing life-threatening acute CBO cases. Our study found no significant difference in outcomes between deconstructive and reconstructive endovascular paradigms in such patients. However, it is important to note that the available data, including ours, is heterogeneous and scarce, necessitating higher levels of evidence to draw more definitive conclusions.

AMAÇ: Bu çalýþmada Vancouver tip B1 periprostetik femur kýrýðý nedeniyle kablo plak fiksasyonu yapýlan hastalarý ve klinik sonuçlarýný deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: 2014-2019 yýllarý arasýnda periprostetik kýrýk nedeniyle opere edilen vancouver tip B1 hastalarý araþtýrýldý. Hastalarýn; yaþý, cinsiyeti, vücut kitle indeksi, takip süresi, ameliyat süresi, kanama miktarý, non-union oranlarý, periprostetik kýrýk öncesi son ameliyatlarý, son ameliyat ile periprostetik kýrk arasý geçen süre, implant sað kalýmý, hasta sað kalýmý ve komplikasyonlarý kaydedildi. Ayrýca bu hastalarýn postoperatif klinik fonksiyonlarýný da karþýlaþtýrýldý.
BULGULAR: Çalýþma kriterlerini (Vancouver tip B1 kýrýðý) karþýlayan 23 hasta belirlendi. Hastalarýn yaþ ortalamasý 60 (49-76), ortalama vücut kitle indeksi 26.3 (17.5-40.7) ve ameliyat sonrasý ortalama takip süresi 14 (6-36) aydý. Cinsiyet daðýlýmýna bakýldýðýnda 5 (%22) erkek ve 18 (%78) kadýndý. Kýrýk öncesi son ameliyat ile kýrýk arasýndaki ortalama süre 6 ay (0-30) idi. Ameliyat süresi ortalama 95 dakika (60-180) iken kanama miktarý ortalama 310 ml (150-600) idi. Hastalarýn fonksiyonel deðerlendirmeleri; Toplamda beþ hastada ameliyattan sonra ambulatuar yetenekleri azalmýþtý. Takiplerde 2 hastada non-union gözlendi ve bu hastalara tedavi için açýk cerrahi uygulandý.
SONUÇ: Periprostetik kýrýklarýn en sýk görülen formlarýndan biri olan Vancouver B1 tipi kýrýklarda kablo ve kilitli plak uygulamalarý baþarýlýdýr. Ame-liyat süresinin kýsa olmasý ve kan kaybýnýn az olmasý gibi nedenlerle öne çýkan bu tedavi yönteminde komplikasyon durumunda revizyon artroplasti seçeneði devam etmektedir.

BACKGROUND: In this study, it was aimed to evaluate the patients who underwent cable plate fixation due to a Vancouver-type B1 periprosthetic femur fracture and their clinical results.
METHODS: Vancouver-type B1 patients who were operated on for periprosthetic fractures between 2014 and 2019 were investi-gated. Age, gender, body mass index (BMI), follow-up time, operation time, bleeding amount, non-union fracture, last surgery before fracture, the time between previous surgery and fracture, implant survival, patient survival, and complications were recorded. In addi-tion, the postoperative clinical functions of these patients were compared.
RESULTS: 23 patients who met the study criteria (Vancouver type B1 fracture) were identified. The mean age of the patients was 60 (49–76) years, the mean BMI was 26.3 (17.5–40.7), and the postoperative mean follow-up period was 14 (6–36) months. Considering the gender distribution, there were 5 (22%) men and 18 (78%) women. The mean time between the last surgery before the fracture and the fracture was 6 months (0–30). While the mean operation time was 95 min (60–180), the average amount of bleeding was 310 mL (150–600). Functional evaluations of patients: In total, five patients had decreased ambulatory abilities after surgery. Nonunion was observed in 2 patients during the follow-ups, and these patients underwent open surgery for treatment.
CONCLUSION: Cable and locking plate applications are successful in Vancouver type B1 fractures, which are one of the most common forms of periprosthetic fractures. In this technique, the duration of the operation can be shortened under ideal conditions, and the need for blood and blood products is reduced as blood loss is reduced. If there is a complication, you still have the chance to treat it with the option of revision arthroplasty.