AMAÇ: Duodenal ülser perforasyonu ciddi bir durumdur. Cerrahi tedavide bir takým yöntemler tanýmlanmýþ ve kullanýlmýþtýr. Bu çalýþmada, duode-nal perforasyonlarda “primer tamir” ve “tamir yapmadan dren konulmasý” yöntemlerinin etkinliklerinin, hayvan modeli kullanýlarak karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Her biri on sýçandan oluþan üç eþdeðer grup oluþturuldu. Birinci (primer tamir / sütürlü grup) ve ikinci grupta (tamir yapmadan dren konulmasý / sütürsüz drenaj grubu) duodenumda perforasyon oluþturuldu. Birinci grupta perforasyon sütürle tamir edildi. Ýkinci grupta ise perforasyon sütürle tamir edilmeden, karýn içine sadece dren yerleþtirildi. Üçüncü gruba (kontrol grubu) sadece laparotomi uygulandý. Hayvan deneklere preoperatif dönemde, postoperatif 1. ve 7. günlerde nötrofil sayýsý, sedimantasyon, serum C-reaktif protein (CRP), serum total antioksidan kapasitesi (TAK), serum total tiyol, serum nativ tiyol ve serum miyeloperoksidaz analizleri yapýldý. Histolojik ve immünohistokimyasal (transforming growth factor beta-1 [TGF-β1])) analizleri yapýldý. Gruplardan elde edilen kan analizleri, histolojik ve immunohistokimyasal bulgular istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Postoperatif 7. gün TAK ve postoperatif 1. gün MPO deðerleri dýþýnda birinci ve ikinci grup arasýnda anlamlý fark yoktu (p>0.05). Ýkinci grupta doku iyileþmesi birinci gruba göre daha belirgin olmasýna raðmen gruplar arasýnda anlamlý fark yoktu (p>0,05). Ýkinci grupta izlenen TGF-β1 immünreaktivitesi birinci gruba göre anlamlý olarak yüksek bulundu (p<0.05).
TARTIÞMA: Sütürsüz drenaj yönteminin duodenal ülser perforasyonu tedavisinde primer tamir yöntemi kadar etkili olduðunu ve primer onarým yöntemine alternatif olarak güvenle uygulanabileceðini düþünüyoruz. Ancak sütürsüz drenaj yönteminin etkinliðinin tam olarak belirlenebilmesi için daha ileri çalýþmalara ihtiyaç vardýr.

BACKGROUND: Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of “primary repair” and “drain placement without repair” methods in duodenal perforations using an animal model.
METHODS: Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-β1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically.
RESULTS: There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-β1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05).
CONCLUSION: We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.

AMAÇ: Bu çalýþmanýn amacý, makine öðrenmesi (ML) algoritmalarýndan biri olan Random Forest’i (RF) akut apandisit (AAp) ön tanýsý olan hastalar-dan oluþan bir veri setine uygulamak ve AAp tanýsý ile iliþkili en önemli faktörleri deðiþken önemliliðine göre ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu vaka-kontrol çalýþmasýnda AAp için biyobelirteçleri tahmin etmek üzere AAp’si olan (n=40) ve olmayan (n=44) iki hasta grubunu karþýlaþtýran açýk eriþimli bir veri seti kullanýldý. Veri setinin modellenmesinde RF kullanýldý. Veriler eðitim ve test veri seti olmak üzere ikiye ayrýldý (80: 20). Model performansý için doðruluk, dengeli doðruluk, duyarlýlýk, özgüllük, pozitif tahmin deðeri (PPV) ve negatif tahmin deðeri (NPV) performans metrikleri deðerlendirildi.
BULGULAR: RF modeline ait doðruluk, dengeli doðruluk, duyarlýlýk, özgüllük, PPV, NPV ve F1 skorlarý sýrasýyla %93.8, %93.8, %87.5, %100, %100, %88.9 ve %93.3 olarak hesaplandý. Modele iliþkin deðiþken önem deðerlerinin ardýndan, AAp tanýsý ve öngürüsü ile en çok iliþkili olan deðiþkenler sýrasýyla fekal kalprotektin (%100), radyolojik görüntüleme (%89,9), beyaz kan testi (%51,8), C-reaktif protein (%47,1), semptomlarýn hastane ziya-retinde baþlamasý (%19.3), hasta yaþý (%18.4), ALT düzeyleri >40 (<%1), ateþ (< %1) ve mide bulantýsý/kusma (<%1) olarak belirlendi. TARTIÞMA: Bu çalýþmada ML yöntemi ile AAp için bir tahmin modeli geliþtirildi. Bu model sayesinde AAp’i yüksek doðruluk ile öngören biyobelir-teçler belirlendi. Böylece klinisyenlerin AAp tanýsýna karar verme süreci kolaylaþacak, yüksek doðruluk ile zamanýnda taný konulabilmesi sayesinde perforasyon ve gereksiz ameliyat riskleri en aza indirilecektir.

BACKGROUND: The aim of this study is to apply random forest (RF), one of the machine learning (ML) algorithms, to a dataset consisting of patients with a presumed diagnosis of acute appendicitis (AAp) and to reveal the most important factors associated with the diagnosis of AAp based on the variable importance.
METHODS: An open-access dataset comparing two patient groups with (n=40) and without (n=44) AAp to predict biomarkers for AAp was used for this case−control study. RF was used for modeling the data set. The data were divided into two training and test dataset (80: 20). Accuracy, balanced accuracy (BC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) performance metrics were appraised for model performance.
RESULTS: Accuracy, BC, sensitivity, specificity, PPV, NPV, and F1 scores pertaining to the RF model were 93.8%, 93.8%, 87.5%, 100%, 100%, 88.9%, and 93.3%, respectively. Following the variable importance values regarding the model, the variables most associated with the diagnosis and prediction of AAp were fecal calprotectin (100 %), radiological imaging (89.9%), white blood test (51.8%), C-reactive protein (47.1%), from symptoms onset to the hospital visit (19.3%), patients age (18.4%), alanine aminotransferase levels >40 (<1%), fever (<1%), and nausea/vomiting (<1%), respectively.
CONCLUSION: A prediction model was developed for AAp with the ML method in this study. Thanks to this model, biomarkers that predict AAp with high accuracy were determined. Thus, the decision-making process of clinicians for diagnosing AAp will be facilitated, and the risks of perforation and unnecessary operations will be minimized thanks to the timely diagnosis with high accuracy.

AMAÇ: COVID-19 pandemisi, kolorektal kanserin (KRK) taný ve tedavisi de dahil olmak üzere global olarak klinik hizmetlerin önemli bir kýsmýný etkiledi. Pandeminin zirve yaptýðý ilk dönemde, sokaða çýkma yasaðý uygulandý, elektif cerrahi ve poliklinik hizmetleri kýsýtlandý. Bunun sonucunda kolonoskopi iþlemlerinde ve hastaneye yatýþta önemli bir azalýþ görüldü. Bu çalýþmada, pandeminin týkayýcý kolorektal kanserli hastalarýn hastaneye geliþ özelliklerinde ve perioperatif sonuçlarý üzerine etkisini araþtýrmak hedeflendi.
GEREÇ VE YÖNTEM: Tek merkezli, retrospektif kohort olarak dizayn edilen bu çalýþmada, yüksek hacimli, üçüncü basamak bir üniversite hastane-sinde kolorektal adenokarsinom tanýsý ile ameliyat edilen hastalar dahil edildi. Hastalar Türkiye’de COVID-19 tanýsý alan ilk hastanýn taný tarihinden (18/03/2020) 15 ay önce ve sonra olmak üzere iki gruba ayrýldý. Hasta demografik bilgileri, ilk baþvuru özellikleri, klinik sonuçlar ve patolojik veriler üzerinden karþýlaþtýrýldý.
BULGULAR: Toplam 215 hasta kolorektal kanser ön tanýsýyla 30 ay içinde ameliyat edildi. (COVID dönemi: 107, COVID öncesi: 108). Hasta de-mografik özellikleri, tümör yerleþimi ve klinik evreleme iki grup arasýnda benzerdi. COVID döneminde týkayýcý KRK ile baþvuran (p<0.01) ve acil baþvuruda bulunan (p<0.01) hasta sayýsý anlamlý olarak arttý. Fakat 30 günlük morbidite, mortalite ve patolojik sonuçlar arasýnda anlamlý fark yoktu (p>0.05).
TARTIÞMA: Çalýþmada, pandemi dönemide acil baþvuruda anlamlý artýþ ve elektif baþvuruda azalma gözlense de COVID-19 döneminde ameliyat edilen hastalar postoperatif sonuçlar deðerlendirildiðinde dezavantajlý deðillerdi. Kolorektal kanserli hastalarýn acil baþvurularý ile ilgili risklerin azaltýl-masý ile ilgili yapýlacak çalýþmalar olumsuz sonuçlarýn azaltýlmasýnda etkili olacaktýr.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of clinical care including diagnosis and treatment of colorectal cancers (CRCs) globally, including in Türkiye. During the initial peak of the pandemic, elective surgeries and outpatient clinics were restricted in addition to the government-imposed lockdown, resulting in a decrease in the number of colonoscopies being performed and patients admitted to inpatient wards for treatment of CRCs. In this study, we aimed to investigate whether the pandemic has affected presentation characteristics and outcomes of obstructive colorectal cancer in this period.
METHODS: This is a single-center, retrospective cohort study based on all CRC adenocarcinoma patients that underwent surgical resection in a high-volume tertiary referral center in Istanbul, Türkiye. Patients were divided into two groups before and after 15 months of identification of “patient-zero” in Türkiye (March 18, 2020). Patient demographics, initial presentation characteristics, clin-ical outcomes, and pathological cancer stages were compared.
RESULTS: Overall, 215 patients underwent resection for CRC adenocarcinoma during 30 months (COVID era: 107, pre-COVID era: 108). Patient characteristics, tumor location, and clinical staging were comparable between two groups. During the COVID period, the number of obstructive CRCs (P<0.01) and emergency presentations (P<0.01) increased significantly compared to the respective pre-COVID period. However, there were no differences between 30-day morbidity, mortality, and pathological outcomes (P>0.05).
CONCLUSION: Although the results of our study indicate a significant increase in emergency presentation and a decrease in elective admissions of CRCs during the pandemic, patients treated during the COVID period were not at a significant disadvantage in terms of post-operative outcomes. Further efforts should be made to decrease risks related to an emergency presentation of CRCs for future adverse events.

AMAÇ: Splenik arteriyel embolizasyon (SAE), künt dalak yaralanmasý ile iliþkili arteriyel kanamanýn yönetimi için etkili bir müdahaledir. Bununla birlikte, çocuk ve ergen hastalardaki rolü ve klinik sonuçlarý belirsizdir. Bu çalýþmanýn amacý, çocuk ve ergen hastalarda künt dalak yaralanmalarýnda SAE’nun rolünü ve klinik sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: 1 Kasým 2015 ile 30 Eylül 2020 tarihleri arasýnda üçüncü basamak bir referans hastanesindeki bölgesel bir travma merkezine nakledilen künt dalak yaralanmasý olan ≤17 yaþýndaki hastalarda retrospektif bir kohort çalýþmasý gerçekleþtirildi. Nihai çalýþma popülasyonu, künt dalak yaralanmasý olan 40 çocuk ve ergen hastadan oluþmaktaydý. Hasta demografik bilgileri, yaralanma mekanizmalarý, yaralanmalarýn ayrýntýlarý, anjiyografik bulgular, embolizasyon teknikleri ve dalak kurtarýlma oranlarý ve prosedürle ilgili komplikasyonlar dahil olmak üzere teknik ve klinik sonuçlar incelendi.
BULGULAR: Künt dalak yaralanmasý olan 40 çocuk ve ergen hastanýn 17’sine SAE (%42,53) uygulandý. Klinik baþarý oraný %88,2 (15/17) idi. Embolizasyonla iliþkili komplikasyon veya klinik baþarýsýzlýk vakasý gözlenmedi. Tüm hastalarda SAE sonrasý dalak kurtarýmý saðlandý. Ek olarak, düþük dereceli (Dünya Acil Cerrahi Derneði [WSES] dalak travmasý sýnýflandýrmasý I veya II) ve yüksek dereceli (WSES sýnýflandýrmasý III veya IV) dalak yaralanma gruplarý arasýnda klinik sonuçlarda (klinik baþarý ve dalak kurtarma oranlarý) istatistiksel olarak anlamlý bir fark gözlenmedi.
TARTIÞMA: Splenik arteriyel embolizasyon (SAE) güvenli ve uygulanabilir bir prosedürdür ve çocuk ve ergen hastalarda künt dalak yaralanmalarýnýn baþarýlý dalak kurtarýlmasýnda etkilidir.

BACKGROUND: Splenic arterial embolization (SAE) is an effective intervention for the management of arterial hemorrhage asso-ciated with blunt splenic injury. However, its role and clinical outcomes in pediatric and adolescent patients are unclear. The aim of this study is to assess the role and the clinical outcomes of SAE for blunt splenic injuries in pediatric and adolescent trauma patients.
METHODS: A retrospective cohort study was performed in patients aged ≤17 years with blunt splenic injury transferred to a re-gional trauma center in a tertiary referral hospital between November 01, 2015, and September 30, 2020. The final study population consisted of 40 pediatric and adolescent patients with blunt splenic injuries. The patient demographics, mechanisms of injury, details of injuries, angiographic findings, embolization techniques, and technical and clinical outcomes, including spleen salvage rates and pro-cedure-related complications, were examined.
RESULTS: Of the 40 pediatric and adolescent patients with blunt splenic injury, 17 underwent SAE (42.53%). The clinical success rate was 88.2% (15/17). No cases of embolization-related complications or clinical failure were observed. Spleen salvage after SAE was achieved in all patients. In addition, no statistically significant differences were observed in clinical outcomes (clinical success and spleen salvage rates) between low-grade (World Society of Emergency Surgery [WSES] spleen trauma classification I or II) and high-grade (WSES classification III or IV) splenic injury groups.
CONCLUSION: SAE is a safe and feasible procedure, and is effective for successful spleen salvage of blunt splenic injuries in pediatric and adolescent patients.

AMAÇ: Akut sað ventrikül disfonksiyonu ve belirgin hemodinamik bozulma olmaksýzýn miyokardiyal hasarý olan orta-yüksek riskli pulmoner emboli (PE) hastalarý trombolitik tedavi (TT) için aday olabilir. Bu çalýþmada orta-yüksek riskli PE hastalarýnda düþük doz uzamýþ TT ve fraksiyone olmayan heparinin (FOH) klinik sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþmaya 83 [kadýn: 45 (%54.2), ortalama yaþ: 70.07±10.7 yýl] dahil edilen akut PE tanýlý, düþük doz ve yavaþ infüzyon TT veya FOH ile tedavi edilen hasta retrospektif olarak deðerlendirildi. Çalýþmanýn birincil sonuçlarý, herhangi bir nedenden ölüm ve hemodinamik dekompansasyon ve þiddetli veya yaþamý tehdit eden kanama kombinasyonu olarak tanýmlandý. Ýkincil son noktalar, tekrarlayan PE, pulmoner hiper-tansiyon ve orta derecede kanama idi.
BULGULAR: Orta-yüksek riskli PE’nin baþlangýç tedavi stratejisi 41 (%49.4) hastada TT ve 42 (%50.6) hastada FOH idi. Düþük doz uzamýþ TT tüm hastalarda baþarýlý oldu. Hipotansiyon sýklýðý TT sonrasý anlamlý olarak azalýrken (%22’ye karþý %0, p<0.001), FOH tedavi sonrasý azalmadý (%2.4’e karþý %7.1, p=0.625). Hemodinamik dekompansasyon oraný TT grubunda anlamlý olarak daha düþüktü (%0’a karþý %11.9, p=0.029). Ýkincil son nokta oraný FOH grubunda anlamlý olarak daha yüksekti (%2.4’e karþý %19, p=0.016). Ayrýca pulmoner hipertansiyon prevalansý FOH grubunda anlamlý olarak yüksekti (%0’a karþý %19, p=0.003).
TARTIÞMA: Düþük doz, yavaþ t-PA infüzyonu ile uzun süreli TT rejiminin, akut orta-yüksek riskli PE’li hastalarda FOH’ye kýyasla daha düþük hemo-dinamik dekompansasyon ve pulmoner hipertansiyon riski ile iliþkili olduðu bulundu.

BACKGROUND: Patients with intermediate-high risk pulmonary embolism (PE) who have acute right ventricular dysfunction and myocardial injury without overt hemodynamic compromise may be candidates for thrombolytic therapy (TT). In this study, we aimed to compare the clinical outcomes of low-dose prolonged TT and unfractionated heparin (UFH) in intermediate-high risk PE patients.
METHODS: This study enrolled 83 (female: 45 [54.2%], mean age: 70.07±10.7 years) retrospectively evaluated patients with the diagnosis of acute PE who were treated with low-dose and slow-infusion of TT or UFH. The primary outcomes of the study were de-fined as a combination of death from any cause and hemodynamic decompensation, and severe or life-threatening bleeding. Secondary endpoints were recurrent PE, pulmonary hypertension, and moderate bleeding.
RESULTS: The initial management strategy of intermediate-high risk PE was TT in 41 (49.4%) patients and UFH in 42 (50.6%) cases. Low-dose prolonged TT was successful in all patients. While the frequency of hypotension decreased significantly after TT (22 vs. 0%, P<0.001), it did not decrease after UFH (2.4 vs. 7.1%, p=0.625). The proportion of hemodynamic decompensation was significantly lower in the TT group (0 vs. 11.9%, p=0.029). The rate of secondary endpoints was significantly higher in the UFH group (2.4 vs. 19%, P=0.016). Moreover, the prevalence of pulmonary hypertension was significantly higher in UFH group (0 vs. 19%, p=0.003).
CONCLUSION: Prolonged TT regimen with low dose, slow infusion of tissue plasminogen activator was found to be associated with a lower risk of hemodynamic decompensation and pulmonary hypertension in patients with acute intermediate-high-risk PE compared to UFH.

AMAÇ: Tam kan viskozitesi (WBV), kardiyovasküler olaylarýn güçlü bir tahmincisidir. Akut mezenterik iskemi, abdominal organlarý ve baðýrsaklarý besleyen arterlerde ani týkanmaya baðlý olarak iç organ hasarý ve baðýrsak nekrozu ile sonuçlanan, mortalite oraný yüksek, ciddi bir durumdur. Bunun-la birlikte, kan viskozitesi ile akut mezenterik iskemi (AMI) arasýndaki iliþki þimdiye kadar yeterince çalýþýlmamýþtýr. Çalýþmamýzda, mezenter arterin primer aterosklerotik týkanýklýðýndan kaynaklanan akut mezenterik iskemi için WBV’nin prediktif deðerini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Bu çalýþma, Ocak 2015-Þubat 2021 tarihleri arasýnda (AMI) tanýsý almýþ toplam 55 hasta ve kontrol grubu olarak 50 saðlýklý eriþkin üzerinde yapýldý. Tam kan viskozitesi, karýn aðrýsý ile acile baþvuran ve tetkikler sonucunda akut mezenter iskemi teþhisi konulan hastalarýn kan testlerinden hematokrit ve plazma protein seviyeleri kullanýlarak De Simon formülü ile hesaplandý.
BULGULAR: Yaþ (72.1±12.4 ve 65.7±6.4; p<0,001) ve hipertansiyon (%40 ve %23 p=0.002) dýþýnda baþlangýç demografik özellikleri açýsýndan iki grup arasýnda anlamlý fark saptanmadý. Tam kan viskozitesinin hem düþük kesme hýzýnda (LSR) ( (46.3±21.7 vs. 33.4±13.1, p<0.001) hem de yüksek kesme hýzýnda (HSR) (16.5±1.1 vs. 15.8±0.7, p<0.001) AMI hastalarýnda anlamlý olarak daha yüksek olduðu hesaplandý.
Tek deðiþkenli lojistik regresyon analizinde, AMI’yi öngörmede yaþ (OR: 1.066 CI: 1.023-1.111, p=0.003), hipertansiyon (OR: 3.612CI: 1.564-8.343, p=0.003), HSR’de WBV (OR: 2.074 CI: 1.193-3.278, p=0.002) ve LSR’de WBV (OR: 2.156 CI: 1.331-3.492, p=0.002) deðerlerinin anlamlý deðiþkenler olduðnu tespit ettik. Ancak çok deðiþkenli analizden sonra sadece hipertansiyon (OR: 3.537 GA: 1.298-9.639, p=0.014) ve yaþ (OR: 1.085 GA: 1.026-1.147, p=0.004) anlamlýlýk gösterdi. ROC analizinde, LSR için 43.5 kesim deðeri, mezenterik iskemi hastalarýnda %72 duyarlýlýða ve %70 özgüllüðe (eðri altýndaki alan (EAA): 0.743, p<0.001) ve HSR için 16.29 kesim deðerinin %78 duyarlýlýða ve %76 özgüllüðe sahip olduðunu tespit ettik (EAA: 0.773, p<0.001).
TARTIÞMA: Çalýþmamýzda De Simon formülü ile elde edilen WBV deðerinin primer mezenter arter týkanýklýðýndan kaynaklanan akut mezenterik arter iskemisi geliþimini öngörmede deðerli bir parametre olduðunu belirledik.

BACKGROUND: Acute mesenteric ischemia is a serious condition with high mortality rate, resulting internal organ damage and intestinal necrosis due to sudden occlusion in the arteries feeding the abdominal solid organs and intestines. The most common causes of acute mesenteric artery ischemia are embolic processes and thrombosis that develops on the basis of primary mesenteric artery atherosclerosis. Whole blood viscosity (WBV) was defined by De Simon and could be calculated with a formula that consists of total plasma protein and hematocrit (HCT). In our study, we aimed to investigate the predictive value of WBV for acute mesenteric ischemia caused by primary mesenteric artery occlusion.
METHODS: Between January 2015 and February 2021, a total of 55 patients with a retrospective diagnosis of acute mesenteric ischemia (AMI) and 50 healthy volunteers as a control group were included in the study. WBV was calculated with the De Simon for-mula using the HCT and plasma protein levels from the blood tests of healthy volunteers and patients at the time of admission with acute abdomen.
RESULTS: No significant differences between the two groups in terms of baseline demographic characteristics except the preva-lence of age (72.1±12.4 vs. 65.7±6.4; p<0.001) and hypertension (40% vs. 23% p=0.002). AMI patients had significantly higher WBV values both at low shear rate (LSR) ([46.3±21.7 vs. 33.4±13.1, p<0.001] and high shear rate [HSR] [16.5±11 vs. 15.8±0.7, p<0.001]). The univariate analysis identified several variables for predicting AMI including age (odds ratio [OR]: 1.066 confidence interval [CI]: 1.023–1.111, p=0.003), hypertension (OR: 3.612 CI: 1.564–8.343, p=0.003), WBV at HSR (OR: 2.074 CI: 1.193–3.278, p=0.002), and WBV at LSR (OR: 2.156 CI: 1.331–3.492, p=0.002). However, after multivariate analysis, only hypertension (OR: 3.537 CI: 1.298–9.639, p=0.014) and age (OR: 1.085 CI: 1.026–1.147, p=0.004) showed significance. In receiver operating characteristic analysis, a cut-off value of 43.5 WBV for LSR had a 72% sensitivity and a 70% specificity for prediction of mesenteric ischemia patients (area under curve [AUC]: 0.743, p<0.001) and a cut-off value of 16.29 WBV for HSR had a 78% sensitivity and 76% specificity for prediction of mesen-teric ischemia patients (AUC: 0.773, p<0.001).
CONCLUSION: In our study, we determined that the WBV value obtained with the De Simon formula is a valuable parameter in predicting the development of acute mesenteric artery ischemia caused by primary mesenteric artery occlusion.

AMAÇ: El yanýklarý sýklýkla oluþan ve sonuclarý kiþinin günlük bakým fonksiyonlarýný, çalýþma hayatýný, istihdamý, serbest zaman etkinliklerini ve genel saðlýkla ilgili yaþam kalitesini önemli ölçüde etkileyen travmalardýr. El yanýðý travmalarýnda genel amaç, el fonksiyonunu optimize etmektir. El fonksi-yonlarýnýn rehabilitasyonu ve restorasyonu; hastanýn baðýmsýzlýðý, topluma ve iþine yeniden entegrasyonu için kritik öneme sahiptir.
GEREÇ VE YÖNTEM: Bu çalýþmanýn amacý, yanýk merkezimize baþvuran ve tedavi edilen 105 el yanýðý travmalý hastayla ilgili deneyimimizi sunmak ve erken rehabilitasyonun hastalarýn önceki sosyal yaþamlarýna ve iþlerine dönme yetenekleri üzerindeki etkinliðini göstermektir.
BULGULAR: Çalýþmamýza 2017-2021 yýllarý arasýnda Gülhane Eðitim Araþtýrma Hastanesi yanýk merkezinde yatarak tedavi gören 105 akut ciddi el yanýðý travmasý olan hastalar dahil edildi. Hastalara her gün seanslar halinde rehabilitasyon programý uygulandý. El yanýðý olan hastalar hareket açýklýðý (ROM), kavrama kuvveti, Cochin El Fonksiyon Ölçeði (CHFS) ve Michigan El Anketi (MHQ) ile taburculuktan 12 ay sonra deðerlendirildi. Parmaklarýn aktif hareket toplamý ortalamasý >180 derece idi. Dominant elin kavrama kuvveti ortalama deðerleri erkeklerde 27.2±9.3 kg, kadýnlarda 22.0±8.8 kg, erkeklerde dominant olmayan el kavrama kuvveti 24.05±13.8 kg, kadýnlarda ise 17.8±10.3 kg idi. CHFS’de 5 maddenin toplam puaný 19.0 idi. MHQ’daki ortalama toplam puan 62.3±27.4 idi. Elde edilen tüm veriler normal veya kabul edilen fonksiyonel aralýklar içindeydi. Spearman korelasyon katsayýsý, MHQ ile CHFS arasýnda negatif bir korelasyon olduðunu göstermektedir (p≤0.01).
TARTIÞMA: El yanýðý travmalarýndan sonra

BACKGROUND: Hand burn trauma occurs quite commonly and the outcome of hand burns can significantly impact self-care daily function, work and employment, leisure activities, and overall health-related quality of life. The overall goal of the management of hand burn trauma is to optimize hand function. Rehabilitation and restoration of hand function are critical for the patient’s independence and re-integration into society and work. The purpose of this study is to present our experience with 105 hand burn trauma patients admitted and treated in our burn center and to show the efficacy of early rehabilitation on their ability to return to their prior social life and work.
METHODS: In our study, we included that 105 patients with acute severe hand burn trauma were hospitalized in Gulhane burn center between 2017 and 2021. They underwent rehabilitation program daily sessions. Patients with hand burns are evaluated by ranges of motions (ROM), grip strength, Cochin Hand Function Scale (CHFS), and Michigan Hand Questionnaire (MHQ) 12 months after the injury.
RESULTS: Overall, mean digital total active motion were >180°. The mean values for grip strength of dominant hand for men were 27.2±9.3 kg, for women were 22.0±8.8 kg and non-dominant hand for men were 24.05±13.8 kg, for women were 17.8±10.3 kg. Total score of 5 items was 19.0 in CHFS. The mean overall score on the MHQ was 62.3±27.4. All obtained data were within normal or accepted functional ranges. Spearman correlation coefficient indicates a negative correlation between MHQ and CHFS (p≤0.01).
CONCLUSION: A comprehensive rehabilitation program is essential in helping patients to regain optimal function after hand burn trauma. Physiotherapy and occupational therapy is most beneficial when started at the time of admission.

AMAÇ: Derin boyun enfeksiyonu (DBE), enfeksiyonun hýzla yayýlarak ciddi komplikasyonlara neden olma ihtimalinden dolayý potansiyel olarak yaþamý tehdit eden bir durumdur. Bu nedenle, diðer boyun enfeksiyonlarýndan daha fazla dikkat gerektirir. Ancak COVID-19 pandemisi döneminde izolasyon yönergeleri nedeniyle birçok zorluk yaþanmýþtýr. Acil serviste ilk karþýlaþýldýðýnda var olan hasta semptomlarý aracýlýðýyla DBE’nun erken öngörülebilirliðini araþtýrdýk.
GEREÇ VE YÖNTEM: Bu çalýþma, Ocak 2016’dan Þubat 2021’e kadar yumuþak doku boyun enfeksiyonu þüphesi olan hastalarýn retrospektif bir incelemesidir. Semptomlar; ateþ, yabancý cisim hissi, göðüs rahatsýzlýðý/aðrý, submandibular aðrý, odinofaji, disfaji, ses deðiþikliði ve þiddetli aðrý olarak geriye dönük analiz edildi. Ayrýca temel karakteristik veriler, laboratuvar bulgularý ve prevertebral yumuþak doku (PVYD) kalýnlýðý deðerlendirildi. Bilgisayarlý tomografi (BT) ile DBE ve diðer boyun enfeksiyonlarý teþhis edildi. Derin boyun enfeksiyonunu öngörmek üzere baðýmsýz faktörleri belirlemek için lojistik regresyon analizi yapýldý.
BULGULAR: Çalýþmaya alýnan 793 hastanýn 267’sine (%33.7) DBE, 526’sýna (%66.3) diðer yumuþak doku boyun enfeksiyonlarý tanýlarý konuldu. Ýki grup arasýndaki karþýlaþtýrmada, C-reaktif protein (CRP), sodyum, PT (INR), yabancý cisim hissi, göðüs rahatsýzlýðý/aðrý, submandibular aðrý, odino-faji, disfaji, þiddetli aðrý ve PVYD kalýnlýðý, istatistiksel olarak anlamlý farklýlýk gösterdi. Derin boyun enfeksiyonunu öngörmek için baðýmsýz faktörler; semptomlar arasýndan þiddetli aðrý (odds ratio: 6.336 (3.635–11.045), p<0.001), yabancý cisim hissi (odds ratio: 7.384 (2.776–19.642), p<0.001), submandibular aðrý (odds ratio: 4.447 (2.852–6.932), p<0.001) ve disfaji (odds ratio: 52.118 (8.662 – 313.588), p<0.001) ve laboratuvar testleri arasýndan CRP (odds ratio: 1.034 (1.004–1.065), p=0.026) ve PT (INR) (odds ratio: 29.660 (3.363 – 261.598), p=0.002) idi. C2 seviyesindeki (odds ratio: 1.953 (1.609–2.370), p<0.001) ve C6 seviyesindeki (odds ratio: 1.179 (1.054–1.319), p=0.004) PVYD kalýnlýðý da öngörü için baðýmsýz birer deðiþken olarak gösterildi.
TARTIÞMA: Boðaz aðrýsý veya boyun aðrýsý olan hastalarda disfaji, yabancý cisim hissi, þiddetli aðrý ve submandibular aðrýsý olanlarýn DBE olma olasýlýðý daha yüksektir. Derin boyun enfeksiyonu ciddi komplikasyonlara neden olabilir; bu nedenle, yukarýdaki semptomlara sahip hastalar önemli kompli-kasyon potansiyeli nedeniyle yakýndan izlenmelidir.

BACKGROUND: Deep neck infection (DNI) is a potentially life-threatening disease because infections spread quickly, causing se-rious complications. Therefore, more attention is needed than other neck infections, but there are many difficulties due to isolation guidelines in the period of coronavirus disease 2019 pandemic. We investigated the early predictability of DNI through patient symptoms at the first emergency department encounter.
METHODS: This was a retrospective study of patients with suspected soft-tissue neck infections from January 2016 to February 2021. Symptoms were retrospectively analyzed in fever, foreign body sensation, chest discomfort/pain, submandibular pain, odynopha-gia, dysphagia, voice change, and severe pain. Furthermore, baseline characteristic data, laboratory findings, and pre-vertebral soft-tissue (PVST) thickness were evaluated. DNI and other neck infections were diagnosed through computed tomography. Logistic regression analysis was conducted to determine the independent factors for predicting DNI.
RESULTS: In the 793 patients included in the study, 267 (33.7%) were diagnosed with DNI, and 526 (66.3%) were diagnosed with other soft-tissue neck infections. In the comparison between the two groups, C-reactive protein (CRP), sodium, PT (INR), foreign body sensation, chest discomfort/pain, submandibular pain, odynophagia, dysphagia, severe pain, and PVST thickness showed statisti-cally significant differences. Independent factors for predicting DNI were severe pain (odds ratio: 6.336 [3.635–11.045], p<0.001), for-eign body sensation (odds ratio: 7.384 [2.776–19.642], p<0.001), submandibular pain (odds ratio: 4.447 [2.852–6.932], p<0.001), and dysphagia (odds ratio: 52.118 [8.662–313.588], p<0.001) among symptoms and CRP (odds ratio: 1.034 [1.004–1.065], p=0.026) and PT (INR) (odds ratio: 29.660 [3.363–261.598], p=0.002) in laboratory tests. PVST thickness at C2 (odds ratio: 1.953 [1.609–2.370], p<0.001) and C6 level (odds ratio: 1.179 [1.054–1.319], p=0.004) was also shown as an independent variable for prediction.
CONCLUSION: Among patients with sore throat or neck pain, patients with dysphagia, foreign body sensation, severe pain, and submandibular pain are more likely to have DN. DNI can cause serious complications; therefore, patients with the above symptoms should be closely observed due to the potential for significant complications.

AMAÇ: Komplike apandisit tanýsýyla basit apendektomi zor olabilir ve bu durumda bazen geniþletilmiþ rezeksiyona ihtiyaç duyulur. Bu nedenle geniþletilmiþ rezeksiyon olarak tercih edilen ileoçekal rezeksiyon ve sað hemikolektomi prosedürlerini; hastalarýn demografik verileri ve preoperatif laboratuvar tetkiklerinden (WBC (White Blood Cell), N/L (Neutrophil-to-lymphocyteratio), CRP (C-reactive protein)) deðerleri, ameliyat süresi, postoperatif komplikasyonlar, hastanede yatýþ süresi ve bir aylýk mortalite olarak karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Kliniðimizde Þubat 2015- Aralýk 2020 tarihleri arasýnda komplike apandisit tanýsýyla geniþletilmiþ rezeksiyon yapýlan hastalar geriye dönük olarak deðerlendirildi. Sað hemikolektomi veya ileoçekal rezeksiyon prosedürü uygulanan hastalar iki gruba ayýrýldý.
BULGULAR: Komplike apandisit tanýsýyla geniþletilmiþ rezeksiyon uygulanan 55 hastanýn 32’sine (%58.1) sað hemikolektomi ve 23’üne (%41.8) ileo-çekal rezeksiyon yapýldý. Gruplar arasýnda demografik özellikler, preoperatif laboratuvar (WBC, N/L oraný, CRP) deðerleri, Clavian-Dindo komp-likasyon sýnýflandýrmasý, ortalama hastanede yatýþ süresi ve bir aylýk mortalite açýsýndan istatistiksel olarak anlamlý fark yoktu (p>0.005). Operasyon süresi bakýmýndan ise gruplar arasýnda istatistiksel olarak anlamlý fark vardý (p<0.001).
TARTIÞMA: Geniþletilmiþ rezeksiyon planlanan komplike apandisit tanýlý hastalarda ileoçekal rezeksiyon prosedürü güvenle tercih edilebilir.

BACKGROUND: Simple appendectomy with a complicated appendicitis diagnosis could prove difficult, sometimes requiring ex-tended resection. Hence, we aimed to compare two procedures that are preferred for extended resection, ileocecal resection, and right hemicolectomy, in terms of patients’ demographic data, preoperative laboratory values (white blood cell [WBC], Neutrophil-to-lymphocyte ratio [N/L], C-reactive protein [CRP]), operation times, postoperative complications, length of hospital stay, and 1-month mortality rates.
METHODS: We retrospectively reviewed patients who underwent extended resection with the diagnosis of complicated appen-dicitis in our clinic from February 2015 to December 2020. We divided the patients into two groups those who underwent right hemicolectomy and those who underwent ileocecal resection.
RESULTS: Among the 55 patients who underwent extended resection with the diagnosis of complicated appendicitis, 32 (58.1%) underwent right hemicolectomy and 23 underwent ileocecal resection (41.8%). The groups did not differ statistically significantly in terms of demographic characteristics, preoperative laboratory values (WBC, N/L, CRP), Clavien–Dindo classification scores, mean hospital stay, or 1-month mortality rates (p>0.005). However, there was a statistically significant difference between the groups in terms of operation time (p<0.001).
CONCLUSION: Ileocecal resection is a safe procedure for patients diagnosed with complicated appendicitis who are scheduled for extended resection.

AMAÇ: Bu çalýþma, zemin seviyesinden düþmelerde yaralanma paternlerini belirlemeyi ve yaþýn yaralanma þiddeti üzerindeki etkisini araþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Zemin seviyesinden düþmeler nedeniyle seviye 1 travma merkezine baþvuran 4712 hastayý retrospektif olarak belirledik ve bilgisayarlý tomografi (BT) çekilen 1214 hastanýn verilerini analiz ettik. Demografi, gövde muayene bulgularý, BT'de tespit edilen yaralanmalar kaydedildi. Yaþýn yaralanma þiddeti üzerindeki etkisini araþtýrmak için hastalar <65 ve ≥65 yaþ olarak gruplandýrýldý.
BULGULAR: Ortalama yaþ 57 idi ve hastalarýn %55.20'si kadýndý. Mortalite oraný %0.50 idi. BT'de 489 (%40.30) hastada yaralanma tespit edildi. Kýrýklar en sýk görülen yaralanma tipiydi. 32 (%2.60) hastada travmatik kafa içi kanama tespit edildi. Kaburga kýrýðý olan 63 hastanýn sadece üçünde (%0.20) eþlik eden akciðer hasarý vardý. Fizik muayenenin negatif prediktif deðeri göðüs yaralanmasý için %95.80 idi. Abdominal BT çekilen 116 hastanýn hiçbirinde batýn içi yaralanma tespit edilmedi. ≥65 yaþ grubunda hastaneye yatýþ da daha yüksekti (p<0.001). Tüm ölümler (n=6) ≥65 yaþ hastalarda görüldü.
TARTIÞMA: Sonuçlarýmýz, zemin seviyesinden düþmelerin yaþlýlarda daha fazla yaralanmaya neden olarak daha fazla hastaneye yatýþ ve ölümle so-nuçlandýðýný göstermektedir. Normal fizik muayene bulgularý, zemin seviyesinden düþen, bilinci açýk, koopere ve oryante hastalarda tüm vücut BT'ye gerekliliði azaltabilir.

BACKGROUND: This study aimed to determine injury patterns in ground level falls (GLFs) and investigate the effect of age on the severity of injury.
METHODS: We retrospectively identified 4,712 patients who presented to a Level 1 trauma center due to GLFs and analyzed the data of 1,214 patients who underwent computed tomography (CT). Demographics, torso examination findings, and injuries detected on CT were recorded. To investigate the effect of age on injury severity, the patients were grouped as those aged <65 and ≥65 years.
RESULTS: The mean age was 57 years, and 55.20% of the patients were female. The mortality rate was 0.50%. Injury was detected in 489 (40.30%) patients on CT. Fractures were the most common injury type. Traumatic intracranial hemorrhage was detected in 32 (2.60%) patients. Only three (0.20%) of the 63 patients with rib fractures had concomitant lung injury. The negative predictive value of the physical examination (PE) was 95.80% for chest injury. Intra-abdominal injury was not detected in any of the 116 patients who underwent abdominal CT. Hospitalization was also higher in the ≥65-year group (p<0.001). All mortalities (n=6) were seen in patients aged ≥65 years.
CONCLUSION: Our results indicate that GLFs cause more injuries in the elderly, resulting in more hospitalizations and mortality. Normal PE findings may reduce the need for whole-body CT in GLF patients who are conscious, cooperative, and oriented.

AMAÇ: Aksiyel bilgisayarlý tomografi (BT) kesitlerinde 24 kaburganýn tamamýnýn incelenmesi fazla vakit alabilmesinin yaný sýra günlük pratikte kosta kýrýklarý kolaylýkla gözden kaçabilir. Kostalarýn deðerlendirmesini kolaylaþtýrmak amacýyla, kostalarý iki boyutlu bir planda hýzlý bir þekilde deðerlendirilmeyi saðlayan, “Rib Unfolding” (RU) isimli bilgisayar destekli taný koyma yazýlýmý geliþtirilmiþtir. RU yazýlýmýný kýrýk tespiti için kullanmanýn; güvenilirliðini, tekrarlanabilirliðini ve hýzlandýrýcý etkisini deðerlendirmenin yaný sýra ve uygulamanýn neden olabileceði sorunlarý belirlemeyi amaçladýk. GEREÇ VE YÖNTEM: Çalýþmada gözlemci olarak görev almayacak olan araþtýrmacýlar tarfýndan, göðüs travmasý olan 51 hastalýk örneklem oluþtu-ruldu ve örneklem içerisinde kýrýklarýn karakterizasyonu ve daðýlýmý kaydedildi. Bu hastalarýn BT görüntüleri örneklemi oluþturan radyologlar arasýnda yer almayan, 5 yýllýk (Gözlemci-A) ve 18 yýllýk (Gözlemci-B) toraks radyolojisi deneyimleri olan, iki radyolog tarafýndan kýrýklarýn varlýðý, varsa tipi (nondeplase/ deplase/ minimal deplase) ve deðerlendirme süreleri açýsýndan deðerlendirildi.
BULGULAR: 22 hastada toplam 113 kýrýk saptandý. Aksiyel BT görüntüleri için ortalama deðerlendirme süresi, gözlemci-A için 146,64 saniye ve gözlemci-B için 119,29 saniye idi. RU görüntüleri için ortalama deðerlendirme süresi, gözlemci-A için 66,44 saniye ve gözlemci-B için 32,66 saniye idi. RU yazýlýmý desteði ile gözlemci-A ve gözlemci-B’nin deðerlendirme periyotlarý arasýnda; aksiyal CT görüntü deðerlendirmesine göre istatistiksel olarak anlamlý azalma gözlendi (p<0.001). Gözlemciler arasý κ deðeri 0,638 iken, gözlemci içi sonuçlar RU ve aksiyel BT deðerlendirmelerini karþýlaþ-týrýrken orta (κ: 0,441) ve iyi (κ: 0,752) tekrarlanabilirlik gösterdi. Gözlemci-A, RU görüntülerinde %47.05 nondeplase kýrýk, %48.93 minimal deplase (≤2 mm) kýrýk ve %38.77 deplase kýrýk saptadý (p=0.009). Gözlemci-B, RU görüntülerinde %23.52 nondeplase kýrýk, %57.44 minimal deplase (≤2 mm) kýrýk ve %48.97 deplase kýrýk saptadý (p=0.045).
TARTIÞMA: RU yazýlýmý kýrýk tespitini oldukça hýzlandýrmakla beraber, düþük sensitivite, yalancý negatiflik ve kýrýðýn deplasman derecesinin düþük gösterilmesi gibi dezavantajlar göstermektedir.

BACKGROUND: Examination of all 24 ribs on axial computed tomography (CT) slices might become a leeway and rib fractures (RF) may easily overlook in daily practice. Rib unfolding (RU), a computer-assisted software, that promises rapid assessment of the ribs in a two-dimensional plan, was developed to facilitate rib evaluation. We aimed to evaluate the reliability and reproducibility of RU software for RF detection on CT and to determine the accelerating effect to determine any drawback of RU application.
METHODS: Fifty-one patients with thoracic trauma formed the sample to be assessed by the observers. The characterization and distribution of RFs on CT images in this sample were recorded independently by the non-observers. Regarding the presence or ab-sence of RF, CT images were assessed blindedly by two radiologists with 5 years (observer-A) and 18 years (observer-B) of experience in thoracic radiology. Each observer assessed the axial CT and RU images on different days under non-observer supervision.
RESULTS: A total of 113 RFs were detected in 22 patients. The mean evaluation time for the axial CT images was 146.64 s for ob-server-A and 119.29 s for observer-B. The mean evaluation time for RU images was 66.44 s for observer-A and 32.66 s for observer-B. A statistically significant decrease was observed between the evaluation periods of observer-A and observer-B with RU software compared to the axial CT image assessment (p<0.001). The inter-observer κ value was 0.638, while the intra-observer results showed moderate (κ: 0.441) and good (κ: 0.752) reproducibility comparing the RU and axial CT assessments. Observer-A detected 47.05% non-displaced fractures, 48.93% minimally displaced (≤2 mm) fractures, and 38.77% displaced fractures on RU images (p=0.009). Ob-server-B detected 23.52% non-displaced fractures, 57.44% minimally displaced (≤2 mm) fractures, and 48.97% displaced fractures on RU images (p=0.045).
CONCLUSION: RU software accelerates fracture evaluation, while it has drawbacks including low sensitivity in fracture detection, false negativity, and underestimation of displacement.

AMAÇ: Bu çalýþmanýn amacý, pediatrik popülasyonda gerçek ve ekivalan Monteggia kýrýklý çýkýklarýndaki fonksiyonel sonuçlarýmýzýn bildirilmesidir. Bunun yanýnda tedavi seçenekleri hakkýnda bir literatür incelemesi de yaptýk.
GEREÇ VE YÖNTEM: 2009-2021 tarihleri arasýnda beþi cerrahi, üçü konservatif tedavi edilen hasta saptandý. Bu hastalarýn altýsý kýz çocuðu, ikisi ise erkek çocuðuydu. Tedavi anýnda ortalama yaþ 7 idi. Ortalama takip süresi 55 hafta (aralýk, 12-128) olarak bulundu. Mayo Elbow Performance Score (MEPS) ve Oxford Elbow Score (OES) sonuçlarýn deðerlendirilmesinde kullanýldý. Eklem hareket açýklýðý ve kavrama güçleri de deðerlendirildi.
BULGULAR: Bu sekiz hastada, iki Bado tip 1 ve altý Monteggia ekivalan yaralanmasý saptandý. Bado tip 1 yaralanmalar için kapalý redüksiyon ve alçýlama birincil tedavi olarak kullanýldý. Fakat bu hastalarýn birinde redislokasyon geliþmesi üzerine cerrahi tedaviye geçildi. Ayný hastada cerrahi son-rasýnda ikinci kere dislokasyon geliþmesi üzerine konservatif tedaviyle takip edildi. Üç Monteggia ekivalan yaralanma kapalý redüksiyon ve alçýlama ile komplikasyonsuz tedavi edildi. Bir hastada ulnanýn plastik deformasyonuyla beraber radius baþýnýn anterior çýkýðý vardý ve bu hastada CORA’ya uygun düzeltici ulnar osteotomi uygulandý.
TARTIÞMA: Monteggia yaralanmalarý için ana tedavi yöntemi ulnar uzunluðun geri kazanýlmasýdýr. 3 boyutlu rekonstrüksiyonlu bilateral BT görüntüleme tedaviyi hastaya göre özelleþtirmek için preoperatif planlamada kullanýlabilir. Radius baþý subluksasyonunun erken tespiti ve gereken giriþimin yapýlmasý için geç kalýnmamasý amacýyla yakýn gözlem elzemdir.

BACKGROUND: This study aims to describe the functional outcome of true and equivalent Monteggia fracture-dislocations in the pediatric population. We also provided a review of the literature about the treatment options.
METHODS: Five surgically and three conservatively treated patients were identified who were treated in 2009-2021. The study pop-ulation consisted of six female and two male patients. The mean age at the time of treatment was 7. The mean follow-up time was 55 months (range, 12–128). The Mayo Elbow Performance Score and the Oxford Elbow Score were used for outcome evaluation. Range of motion and grip strengths were also evaluated.
RESULTS: There were two Bado type 1 and six Monteggia equivalent injuries. Closed reduction and casting were utilized for the two Bado type 1 injuries as the initial treatment. However, one had a radial head re-dislocation and had to be treated operatively. This patient had a radial head re-dislocation after the surgery and was followed up conservatively. Three Monteggia equivalent injuries were treated with closed reduction and casting, with no complications. One patient had a radial head anterior dislocation with plastic deformation of the ulna, and this patient was managed with CORA-based corrective ulnar osteotomy. For Monteggia injuries, the main treatment objective is to restore the ulnar length. Bilateral computed tomography imaging with 3D reconstruction can be utilized in preoperative planning of Monteggia fracture-dislocations to customize the treatment. Close observation is essential to detect radial head subluxation, which needs early intervention before irreversible changes occur.
CONCLUSION: The true/equivalent Monteggia fractures’ main treatment goal is to restore the ulnar length. Conservative treatment, with a close follow-up, is the first option if closed reduction can be achieved. If closed reduction is not possible, careful preop-erative planning and early rehabilitation are key to success for management of Monteggia fractures.

AMAÇ: Bilek güreþi sýrasýnda üst ekstremiteye büyük bir rotasyonel tork kuvveti uygulanýr. Bilek güreþi omuz, dirsek ve el bilek eklemlerinde kas ve tendon yaralanmalarý ve hatta kemik kýrýklarýna sebep olabilir. Bu çalýþmanýn amacý, bilek güreþi sonrasý tedavi þekillerini, fonksiyonel sonuçlarý ve spora dönüþ durumlarýný sunmaktýr.
GEREÇ VE YÖNTEM: 2008-2020 yýllarý arasýnda hastanemize baþvuran hastalarýn travma mekanizmalarý, tedavi þekilleri, klinik sonuçlarý ve spora dönüþ durumlarý retrospektif olarak deðerlendirildi. Son takipte hastalarýn fonsiyonel skorlarý (DASH skoru, Constant skoru) deðerlendirildi. BULGULAR: Yaþ ortalamasý 20±6.1 (12-33) olan 18(82%) erkek, 4(%18) kadýn toplam 22 hasta çalýþmaya dahil edildi. 10 hastada humerus þaft kýrýðý, 10 hastada izole yumuþak doku yaralanmasý, 1 hastada medial epikondil kýrýðý ve 1 hastada omuz çýkýðý vardý. Hastalarýn ikisi (%10) hasta profesyonel bilek güreþçisiydi. Humerus cisim kýrýðý olan hastalarýn son kontrol (ortalama 4 yýl) DASH skorlarý ortalamasý 0.57 (0-1.7 min max) idi. Ýzole yumuþak doku yaralanmasý olan hastalarýn tümü 1 ay içinde spora döndü. Humerus cisim kýrýðý olan hastalarda spora dönüþ süresi daha uzun ve fonksiyonel skor daha düþüktü (p<0.043). Uzun dönem takipte hiçbir hastada sakatlýk tespit edilmedi. Yumuþak doku yaralanmasý olan hastalarýn kemik yaralan-masý olan hastalara göre daha fazla bilek güreþine devam ettiði görüldü (p<0.001)
TARTIÞMA: Çalýþmamýz bir saðlýk kuruluþuna bilek güreþi sonrasý herhangi bir þikayetle baþvuran hastalarýn deðerlendirildiði en geniþ hasta serisini sunmaktadýr. Bilek güreþi sadece kemik patolojileriyle sonuçlanan bir spor deðildir. Bilek güreþi sporcularýna spor sýrasýnda sakatlanabilecekleri ancak tam bir iyileþme olacaðý bilgisinin verilmesinin sporcularý rahatlatacaðý ve cesaretlendireceði düþünülebilir.

BACKGROUND: In the sport of arm wrestling, the great rotational force is applied to the upper extremity, which can result in muscle and tendon injuries in the shoulder, elbow, and wrist joints, and even bone fractures. The aim of this study was to present the treatment modalities, functional outcomes, and return to sport after arm wrestling injuries.
METHODS: A retrospective evaluation was made of the trauma mechanisms, treatment modalities, clinical outcomes, and time of return to sports of patients admitted to our hospital with an arm wrestling injury between 2008 and 2020. At the final follow-up examination, the functional scores (DASH score and constant score) of the patients were evaluated.
RESULTS: Evaluation was made of 22 patients comprising 18 (82%) males and 4 (18%) females with a mean age of 20±6.1 years (range, 12–33 years). Two (10%) patients were professional arm wrestlers. The DASH scores at the final follow-up (mean 4 years) examination were 0.57 (min: 0 and max: 1.7) for the patients with humerus shaft fracture. All the patients with isolated soft-tissue injuries returned to sports within 1 month. Patients with humeral shaft fractures returned to sports later and had a lower functional score (P<0.05). There was no disability in any patient during long-term follow-up. Patients with soft-tissue injuries continued arm wrestling more than patients with bone injuries (P<0.001).
CONCLUSION: This study constitutes the largest patient series evaluating patients presenting at a health-care institution with any complaint after arm wrestling. Arm wrestling is not a sport that only results in bone pathologies. Therefore, providing the participants in this sport with information that they may be injured in arm wrestling but there will be a full recovery, may reassure and encourage them.

Yüksek enerjili balistik yaralanmalar çok parçalý fasiyal kýrýklara yol açabilmektedir. Bu kýrýklarýn tedavisi enfeksiyon ve sert ve yumuþak doku kaybý nedeniyle zorlayýcý olabilir. Böyle vakalar açýk redüksiyon ve internal tespit için uygun olmayabilir. Bu raporda eksternal fiksasyonun esas tedavi öncesinde cerrahi bir aþama olarak uygulandýðý 2 ateþli silah yaralanmasý vakasý sunuldu. Eksternal fiksasyon uygulamasý ile var olan enfeksiyon kontrol altýna alýnmýþ ve yumuþak dokular tamir edilmiþtir. Bu sayede rekonstrüksiyon plaklarý ve gerekli ise otojen kemik greftleme yardýmý ile oral rehabilitasyona uygun ortam saðlanmýþtýr.

High-energy ballistic injuries may cause comminuted facial fractures. Treatment of such fractures might be challenging because of in-fection and soft- and hard-tissue loss. These cases may not be amenable to open reduction and internal fixation. We present 2 cases of gunshot fractures, for which external fixation was used as a surgical step before definitive treatment. With the use of external fixation, existing infection had been controlled and soft tissues had been restored, which allowed oral rehabilitation with reconstruction plates and autogenous bone grafting, if needed.

Penis baþý ampütasyonu sünnetin nadir ve katastrofik bir komplikasyonudur. Ampütasyonu takiben penis baþýnýn rekonstrüksiyonu endikedir. Olgumuz, sünnetten altý ay sonra tarafýmýza baþvuran beþ yaþýndaki bir erkek çocuðun ampüte penis baþýnýn yeniden yapýlandýrýlmasý için yeni bir tekniði tarif etmektedir. Sünnetten hemen sonra bölge hastanelerinde kanama kontrolü nedeniyle opere olan hastada idrar çýkýþ deliðinin darlýðý, iþeme güçlüðü ve penis þekil bozukluðundan dolayý tarafýmýza baþvurdu. Muayenede penis 3 cm uzunluðundaydý. Ameliyata alýnan hastaya tam penil deglo-ving yapýldý. Kalan penisin distal kýsmý fibröz doku çýkarýlarak hazýrlandý. Kanama kontrolü için bölge hastanelerinde penis dorsal tarafa yerleþtirilen dartos flepleri ventral taraftan iki eþit benzer parçaya bölünerek penisin üst kýsmýnda iki yana perde þeklinde açýldý ve glanular yaka benzeri bir yapý oluþturuldu. Aðýzdan alýnan 5×3 cm bukkal mukoza getirilerek dartos flepleri üst yüzeyleri örtüldü. Bu yapý penis baþý olarak, glans þekli olarak penisin üzerine örtüldü ve spongiozumla birlikte serbestleþtirilen üretra buraya sütüre edildi. Hasta ameliyat sonrasý dönemde hiperbarik oksijen tedavisine alýndý. Hastanýn takiplerinde penis baþý benzeri kozmetik yapý gözlendi ve hastada normal idrar üroflovmetre sonuçlarý elde edildi. Bu yöntem, literatürde ilk defa kullanýlan cerrahi onarým tekniðidir. Bukkal mukozal greft ile kaplý dartos flep kullanýmý, penis boyutu uygun olduðunda amputasyon sonrasý penis baþýnýn geç rekonfigürasyonu için kabul edilebilir kozmetik ve fonksiyonel sonuçlarý olan baþarýlý ve basit bir prosedürdür.

Penile glans amputation is a rare and catastrophic complication of circumcision. Reconstruction of the penile glans was indicated following amputation. Our report discusses a novel technique for reconfiguration of the amputated penile glans of a 5-year-old male admitted 6 months following a complicated circumcision. The parents complained of severe meatal stenosis and penile disfigurement. The penis was 3 cm long. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. Dartos flaps, which had been placed on the dorsal side by the previous surgery center, were divided into two similar parts from the ventral side and opened to both sides at the top of the penis, such as a curtain, and a glanular collar-like structure was obtained by bringing 5 cm × 3 cm buccal mucosa. This structure was covered on the penis as glans, and the freed urethra with the spongiosum was sutured here. The patient was taken to hyperbaric oxygen therapy in the postoperative period. The patient’s glans-like cosmetic structure was observed during follow-up, and the patient was urinating normally. This is the first surgical repair technique to use this method in the literature. The use of a dartos flap covered with a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for the late reconfigurating a neoglans shape after a glans penis amputation when the penile size is suitable.