Giriþ ve Amaç: Akut mezenterik iskemi özellikle yaþlý popülasyonda görülmektedir. Ortalama yaþam ömrünün arttýðý günümüz dünyasýnda giderek artan bir insidansa sahiptir. Erken taný morbidite ve mortaliteyi azaltan en önemli etken olup, erken tanýyý saðlamada sensitivitesi ve spesifitesi yüksek bir belirteç halen bulunmamaktadýr. Biz bu çalýþmamýzda thiol ile mevcut aktif kullanýlan belirteçler olan C reaktif protein ve laktat ile karþýlaþtýrarak mezenterik iskemi erken tanýsýnda daha sensitif ve spesifik bir serum belirteci bulmayý amaçladýk.
Gereç ve Yöntem: Çalýþmamýzda 32 adet 10-12 haftalýk 250-300 gr aðýrlýðýnda Wistar Albino erkek rat kullanýldý. 32 rat bir tanesi kontrol olmak üzere 4 gruba ayrýldý. Diðer 3 grubun superior mezenter arteri baðlandý. Bir gruptan 2, ikinci gruptan 4, üçüncü gruptan 6 saat sonra kan örneði alýnarak ratlar sakrifiye edildi. Sakrifiye edilen deneklerde mezenter iskemi ve düzeyi gözlendi. Alýnan örnekler uygun koþullarda ayrýþtýrýlarak biyokimyasal olarak analiz edildi.
Bulgular: CRP iskemi süresi arttýkça yükselmekle beraber bu yükseliþ istatistiksel olarak anlamsýz bulunmuþtur (p>0, 05). Laktattaki deðiþimler ise istatistiksel olarak anlamlý bulunmuþtur (p<0, 05). Total ve native thiol deðerlerinin deðiþimleri arasýndaki fark istatistiksel olarak anlamlý bulunmuþtur (p<0, 05).
Sonuç: Akut mezenterik iskeminin erken tanýsýnda CRP non spesifik bir parametre olmakla beraber laktat çalýþmamýzda da görüldüðü gibi önemini korumaktadýr. Total thiol ve native thiol deðiþim farklarý istatistiksel olarak anlamlý bulunmuþtur. Bu anlamlý farkýn kendini 4. saat deðerlerinde göstermesi erken tanýda bu parametrelerin önemini gözler önüne sermektedir. Thiol parametrelerinin ucuz ve hýzlý sonuçlanmasý sayesinde literatüre eklenecek yeni çalýþmalar ile mezenter iskemi tanýsýnda yol alýnabileceði düþünülmektedir.

Introduction and Purpose: Acute mesenteric ischemia is especially seen in the elderly population. It has an increasing incidence in today's world where the average life expectancy is increasing. Early diagnosis is the most important factor reducing morbidity and mortality, and there is still no marker with high sensitivity and specificity for early diagnosis.In this study, we aimed to find a more sensitive and specific serum marker in the early diagnosis of mesenteric ischemia by comparing thiol with the currently used markers C-reactive protein and lactate.
Materials and Methods: In our study, 32 Wistar Albino male rats, 10-12 weeks old, weighing 250-300 g, were used. 32 rats were divided into 4 groups, one of which was the control group. The superior mesenteric artery of the other 3 groups was ligated. Blood samples were taken after 2 hours from the first group, 4 hours from the second group, and 6 hours from the third group. Then the rats were sacrificed. Mesenteric ischemia and its level were observed in sacrificed subjects. The samples were separated under appropriate conditions and analyzed biochemically.
Results: As the ischemia time increased, CRP increased and this increase was found to be statistically insignificant (p>0.05). The changes in lactate were found to be statistically significant (p<0.05). The difference between the changes of total and native thiol values was found to be statistically significant (p<0.05).
Conclusion: Although CRP is a non-specific parameter in the early diagnosis of acute mesenteric ischemia, lactate maintains its importance as seen in our study. Differences in total thiol and native thiol changes were statistically significant. The fact that this significant difference is observed at the 4th hour values, reveals the importance of these parameters in early diagnosis. Thanks to the economic and fast results of thiol parameters, it is thought that new studies to be added to the literature can lead to the diagnosis of mesenteric ischemia.
Keywords: Mesenteric ischemia, thiol, lactate, early diagnosis

AMAÇ: Deneysel ve karþýlaþtýrmalý çalýþmada, üç farklý dikiþ materyalinin intestinal anastomoz iyileþmesi üzerindeki lokal etkilerinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Üniversite Etik Kurulu'nun (E-60758568-020-176720) etik onayý alýndýktan sonra çalýþmaya baþlandý. 24 sýçan üzerinde prospektif, deneysel bir karþýlaþtýrmalý analiz yapýldý. Denekler üç eþit gruba ayrýldýlar; Grup 1'e vikril dikiþ materyali ile kolon anastomozu yapýldý, Grup 2; polipropilen dikiþle kolonik anastomoz yapýldý ve Grup 3’e; polidioksanon (PDS) dikiþle kolonik anastomoz uygulandý. Ýkinci operasyon postoperatif 7. günde yapýldý. Adezyon skoru, anastomoz kaçaðý, anastomoz patlama basýncý, hidroksiprolin düzeyleri ve histopatolojik incelemeler deðerlendirildi.
BULGULAR: Tüm hayvanlar hayatta kaldý ve deney sýrasýnda anastomoz kaçaðý, baðýrsak týkanýklýðý veya yara enfeksiyonu gözlenmedi. Adezyon skoru Diamond sýnýflamasýna göre deðerlendirildi ve tüm gruplarda aynýydý. Medyan anastomoz patlama basýncý vikril grubunda 125.75 mmHg (10-241), polipropilen grubunda 159.25 mmHg (113-190), PDS grubunda 154.50 mmHg (20-212) bulundu. Hidroksiprolin doku konsantrasyonlarý; vikril grubunda 1699.92±220.8 ng/mg (1509.81-2186.47), polipropilen grubunda 1126.24±607.12 ng/mg (53.22-1815.63) ve PDS grubunda 1547.86±335.2 ng/mg (973.66 -1973.2) bulundu. Histopatoloji ile deðerlendirilen enflamatuvar yanýt açýsýndan gruplar arasýnda fark yoktu. Deðerlendirilen tüm deðiþkenlerde istatistiksel anlamlýlýk görülmedi.
SONUÇ: Bu deneysel çalýþma, intestinal anastomoz ve doku iyileþmesinin dikiþ materyallerine baðlý farklý sonuçlarý olmadýðýný göstermektedir. Emilebilen, yavaþ emilebilen ve emilemeyen dikiþ materyalleri her durumda ve güvenle kullanýlabilir.

BACKGROUND: This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing.
METHODS: Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated.
RESULTS: All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10–241) in the Vicryl group, 159.25 mmHg (113–190) in the polypropylene group, and 154.50 mmHg (20–212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81–2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22–1815.63), and 1547.86±335.2 ng/mg (range: 973.66–1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated.
CONCLUSION: This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

AMAÇ: High mobility group box-1/receptor for advanced glycation end products (HMGB-1/RAGE) etkileþiminin, periton içine feces enjekte edilerek (FIP) indüklenen akut akciðer hasarýndaki (AAH) rolünün gösterilmesi, çözülebilir RAGE (sRAGE) ve HMGB-1 seviyelerinin tespit edilerek papaverinin RAGE iliþkili NF-κB yolaðý üzerindeki etkisinin araþtýrýlmasý ve bu etkilerin enflamatuvar ve oksidatif stres biyobelirteçlerin, toraks BT’de Hounsfield Unit (HU) deðerlerinin ve histopatolojik sonuçlarýn incelenerek desteklenmesi çalýþmamýzýn hedefleridir.
GEREÇ VE YÖNTEM: Sepsisle indüklenen AAH modeli oluþturmak üzere 37 Wistar sýçana FIP uygulandý. Hayvanlar aþaðýdaki gibi dört gruba ayrýldý: Kontrol grubu (tedavi almayan), plasebo grubu (FIP ve 1 saat sonra salin uygulanan), FIP ve 1 saat sonra 20 mg/kg/gün ve 40 mg/kg/gün papaverin uygulanan gruplar. FIP uygulanmasýndan 20 saat sonra tüm hayvanlara BT çekildi ve akciðer parankiminde HU deðerleri ölçüldü. Tümör nekrosis faktör (TNF)-, HMGB1, sRAGE, C- reaktif protein (CRP), malondialdehit (MDA) ve laktik asit (LA) plazma deðerleri belirlendi ve arteryel kan gazýndan PaO2 and PaCO2 ölçüldü. Akciðer hasarý histopatolojik olarak deðerlendirildi.
BULGULAR: TNF-, IL-6, CRP, HMGB1, MDA, LA seviyeleri, histopatoloji skorlarý ve BT’den elde edilen HU deðerleri normal gruba göre plasebo grubunda anlamlý derecede artmýþ ve sRAGE seviyeleri düþmüþtü (Tüm bulgularda p<0.05). Papaverine uygulanan dozdan baðýmsýz olarak tüm bulgularý anlamlý olarak tersine çevirmiþ ve sRAGE seviyelerini artýrarak ve proinflamatuvar sitokinleri baskýlayarak HMGB1/RAGE etkileþiminin inhibisyonunu göstermiþtir.
SONUÇ: AAH sýçan modelinde papaverinin iyileþtirici etkileri olduðu sonucuna vardýk.

BACKGROUND: Our target was to show the role of high mobility group box-1/receptor for (HMGB1/RAGE) interaction in feces intraperitoneal injection procedure (FIP)-induced acute lung injury (ALI) pathophysiology, to investigate the effect of papaverine on RAGE associated NF-κB pathway by determining the level of soluble RAGE (sRAGE) and HMGB1, and to support this hypothesis by evaluating inflammatory biochemical, oxidative stress markers, Hounsfield unit (HU) value in computed tomography (CT), and histo-pathological results.
METHODS: FIP was performed on 37 Wistar rats for creating a sepsis-induced ALI model. The animals were assigned into four groups as follows: Normal control (no treatment), placebo (FIP and saline), and receiving 20 mg/kg and 40 mg/kg per day papaverine. Twenty h after FIP, CT examination was performed for all animals, and HU value of the lung parenchyma was measured. The plasma levels of tumor necrosis factor (TNF)-α, HMGB1, sRAGE, C-reactive protein (CRP) and malondialdehyde (MDA), and lactic acid (LA) were determined and PaO2 and PaCO2 were measured from arterial blood sample. Lung damage was assessed by histopathological.
RESULTS: TNF-, IL-6, CRP, HMGB1, MDA, LA levels, histopathologic scores, and HU values of CT were significantly increased and sRAGE levels were decreased in the saline-treated group against normal group (all P<0.05). Papaverine significantly reversed all results regardless of the dose (all P<0.05) and demonstrated inhibition of HMGB1/RAGE interaction through increasing sRAGE levels and suppresses the pro-inflammatory cytokines.
CONCLUSION: We concluded that papaverine has ameliorating effects in rat model of ALI.

AMAÇ: Apendiks nöroendokrin tümörleri (NET), apendiksin en sýk görülen tümörleridir ve sýklýkla insidental olarak saptanýr. Bu çalýþmanýn amacý kliniðimizde insidental olarak taný konulmuþ apendiks NET’leri retrospektif olarak deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2009-Ocak 2022 tarihleri arasýnda Ankara Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde akut apandisit tanýsý ile apendektomi yapýlan 8304 hastanýn 33’ünün histopatolojik sonuçlarý apendiks NET olarak deðerlendirildi ve bu olgularýn retrospektif analizi yapýldý. Hastalar yaþ, cinsiyet, tümör infiltrasyonu, tümör yerleþimi, tümör boyutu, cerrahi sýnýr, Dünya Saðlýk Örgütü sýnýflamasýna göre grade, yapýlan cerrahi, lenf nodu metastazý, Ki67 indeksi, mitoz sayýsý, takip süresi ve saðkalým açýsýndan deðerlendirildi.
BULGULAR: Çalýþmada apendiks NET oraný %0.4 olarak bulundu.Taný alan 33 olgunun 15’i (%45.5) erkek ve 18’i (%54.5) kadýndý, hastalarýn yaþ ortalamasý 35.48 (16-84 arasý) idi. 1 olguda (%3.03) pozitif cerrahi sýnýr saptandý ve sað hemikolektomi gerçekleþtirildi. Diðer tüm olgular apendek-tomi sonrasý takibe alýndý. Medyan takip süresi 89 (7-145) aydý. Hiçbir olguda nüks gözlenmedi. Bir olguda takip sýrasýnda tümör dýþý nedenlere baðlý mortalite geliþti.
SONUÇ: Apendiks NET’ler genellikle asemptomatiktir ve akut apandisit nedeniyle yapýlan apendektomi sonrasý insidental olarak ortaya çýkar. Apendiks NET’ler genellikle 2 cm’nin altýndadýr ve iyi prognoza sahiptir.

BACKGROUND: Appendix neuroendocrine tumors (NETs) are the most common tumors of the appendix and are most often diagnosed incidentally. The aim of this study was to retrospectively evaluate appendix NETs diagnosed incidentally in our clinic.
METHODS: Of 8304 patients who underwent appendectomy with the diagnosis of acute appendicitis in Ankara Training and Re-search Hospital, General Surgery Clinic between January 2009 and January 2022, 33 had histopathology results evaluated as appendix NET, and a retrospective analysis was made of these cases. The patients were evaluated in terms of age, gender, tumor infiltration, tumor location, tumor size, surgical margin, tumor World Health Organization grade, surgery performed, lymph node metastasis, Ki67 index, number of mitosis, follow-up time, and survival.
RESULTS: The rate of appendix NET was found to be 0.4%. The 33 cases comprised 15 (45.5%) males and 18 (54.5%) females with a mean age of 35.48 years (range: 16–84 years). Positive surgical margin was determined in 1 (3.03%) case, in which right hemicolectomy was performed. All other cases were followed up after appendectomy. The median follow-up was 89 (7–145) months. No recurrence was observed in any case. Mortality developed during follow-up in one case due to non-tumoral causes.
CONCLUSION: Appendix NETs are generally asymptomatic and appear incidentally after appendectomy due to acute appendicitis. Appendix NETs diagnosed incidentally are generally below 2 cm and have a good prognosis.

AMAÇ: Perkütan Kolesistostomi (PK), cerrahi açýdan yüksek risk taþýyan akut kolesistit (AK) hastalarý için minimal invaziv bir tedavi yöntemidir. Bu çalýþmanýn amacý, COVID 19 pandemisi öncesi ve sýrasýnda PK ile tedavi edilen akut kolesistitli hastalarýn özelliklerini karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: 2019-2021 yýllarý arasýnda akut kolesistit (AK) tanýsý ile PK uygulanan hastalarýn verileri hastane kayýt sistemi taranarak analiz edildi. 11 Mart 2020 - 11 Mart 2021 arasýndaki COVID 19 pandemi döneminde akut kolesistitli toplam 110 hasta PK ile tedavi edildi. Mart 2019-Mart 2020 arasýndaki pandemi öncesi dönemde PK uygulanan 99 hasta kontrol grubu olarak çalýþmaya eklendi. Çalýþmaya dahil edilen 209 hastanýn verileri kaydedildi ve tanýmlayýcý istatistiksel analiz yapýldý. Ýki grubun hasta özellikleri karþýlaþtýrýldý.
BULGULAR: Mart 2019-Mart 2021 tarihleri arasýnda AK tanýsý konulan ve cerrahi açýdan yüksek risk taþýmasý nedeniyle ameliyat edilemeyen 209 hastanýn deðerlendirilmesi yapýldý. Hastalarýn yaþ ortalamasý pandemi döneminde 63.84 (21-97), pandemi öncesi dönemde 68.43 (31-100) olarak bulundu. Pandemi grubunda kadýn hasta oraný %45.5, pandemi öncesi grupta %44.5’ti. Ortalama iþlem-taburculuk süresi pandemi döneminde 3.85 gün, pandemi öncesi 3.34 gün saptandý. American Society of Anesthesiologists fiziksel durum sýnýflamasý (ASA-PS) pandemi grubu hastalarýn %56.4’ünde 1 veya 2, pandemi öncesi grubun %78.8’inde 3 veya 4 olarak belirlendi. Pandemi döneminde 45 (%40,9) hastada AK’ye eþlik eden komorbidite yoktu, pandemi öncesi dönemde 77 (%77.8) hastada AK’ye eþlik eden en az bir komorbid durum saptandý. Akut kolesistit için þiddet derecesi, pandemik gruptaki hastalarýn %97.3’ünde 2 (orta) ve pandemi öncesi gruptaki hastalarýn %26.3’ünde 3 (aðýr) olarak saptandý. Pandemi dönemindeki 110 hastadan 14’ü COVID 19 pozitif veya þüpheliydi. Her iki grupta da PC ile iliþkili mortalite gözlenmedi. Pandemi döneminde PK yapýlan 40 hastaya, pandemi öncesi dönemde ise 38 hastaya cerrahi uygulandý.
SONUÇ: Perkütan kolesistostomi, COVID 19 pandemisinin alevlendiði dönemde ameliyathane ve yoðun bakým yükünü azaltan etkili ve güvenli bir tedavi yöntemidir. Bu nedenle COVID 19 hasta sayýsýnýn arttýðý dönemlerde PC endikasyonlarýný geniþletmek mantýklý bir seçenek gibi görünüyor.

BACKGROUND: Percutaneous cholecystostomy (PC) is a minimally invasive temporary treatment for patients with acute cholecys-titis (AC) who are at high risk for surgery. The aim of this study was to compare the characteristics of patients with AC treated with PC before and during the coronavirus disease 2019 (COVID 19) pandemic.
METHODS: The data of patients who underwent PC with the diagnosis of AC between 2019 and 2021 were analyzed by scanning the hospital registry system. During the COVID 19 pandemic period of March 11, 2020, to March 11, 2021, 110 patients with AC were treated with PC. In the pre-pandemic period of March 2019 to March 2020, 99 patients who underwent PC were added to the study as a control group. The data of the 209 patients included in the study were recorded, and descriptive statistical analysis was performed. The patient characteristics of the two groups were compared.
RESULTS: Evaluation was made of 209 patients who were diagnosed with AC between March 2019 and March 2021 and could not be operated on due to the high risk of surgery. The average age of the patients was 63.84 years (21–97) in the pandemic period and 68.43 years (31–100) in the pre-pandemic period. The rate of female patients was 45.5% in the pandemic group and 44.5% in the pre-pandemic group. The mean procedure-discharge time was 3.85 days in the pandemic period and 3.34 days pre-pandemic. The American Society of Anesthesiologists physical status classification (PS) was determined to be 1 or 2 in 56.4% of the pandemic group patients and 3 or 4 in 78.8% of the pre-pandemic group. There was no comorbidity accompanying AC in 45 (40.9%) patients in the pandemic period, and at least one comorbid condition accompanying AC was detected in 77 (77.8%) patients in the pre-pandemic period. The severity grading for AC was 2 (moderate) in 97.3% of the patients in the pandemic group and 3 (severe) in 26.3% of the patients in the pre-pandemic group. Of the 110 patients in the pandemic period, 14 were Covid 19 positive or suspected. PC-related mortality was not observed in either group.
CONCLUSION: PC is an effective and safe treatment method that reduced the operating room and intensive care burden during the exacerbation of the COVID 19 pandemic. Therefore, it seems like a logical option to expand the PC indications at times when the number of COVID 19 patients increases.

AMAÇ: Ýnkarsere ve/veya strangüle inguinal herni tanýsý ile baþvuran hastalarýn tedavisi çoðu zaman cerrahidir. Strangülasyon ve nekroz mevcut ise laparotomi ihtiyacý doðar ve buna baðlý morbidite riskinde artýþ olabilir. Günümüzde ameliyat öncesinde baðýrsakta iskemi ve nekroz olup olmadýðýný net olarak saptamak mümkün deðildir. Bu çalýþmada, thiol/disülfid hemostazý, delta nötrofil indeks (DNÝ) ve iskemi modifiye albumin (ÝMA) para-metrelerinin inkarsere ve strangüle herni olgularýnda klinik etkinliðini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Nisan 2021- Kasým 2021 yýllarýnda genel cerrahi polikliniðine inguinal herni nedeniyle ve acil servise inkarsere ve/veya stran-güle herni ön tanýsý ile baþvuran hastalar çalýþmaya dahil edildi. Hastalar dört gruba ayrýldý; inguinal herni nedeniyle elektif onarým yapýlan hastalar (Grup 1), inkarsere herni nedeniyle operasyon yapýlmadan gözlemlenen hastalar (Grup 2), inkarserasyon nedeni ile baðýrsak rezeksiyonu yapýlmadan fýtýk onarýmý yapýlan hastalar (Grup 3) ve strangülasyon nedeni ile baðýrsak rezeksiyonu uygulanan hastalar (Grup 4) þeklinde gruplandýrýldý. Ek olarak Grup 1'de olan hastalar kontrol grubu, Grup 2, 3 ve Grup 4'de olan hastalar inkarsere/strangüle herni grubu olarak tanýmlandý. Hastalarýn demogra-fik verileri, yatýþ süresi, vücut kitle indeksi (VKÝ), ek hastalýklarý, öykü ve fizik muayene bulgularý, radyolojik tetkikleri, uygulanan tedavi, WBC (White blood cells), laktat, DNÝ, thiol-disülfid ve ÝMA parametreleri deðerlendirildi.
BULGULAR: Ýnkarsere/strangüle grubundaki WBC, disülfid/native thiol, disülfid/total thiol ve ÝMA deðerleri kontrol grubuna göre daha yüksek iken, kontrol grubundaki native thiol, total thiol deðerleri inkarsere/strangüle grubuna göre daha yüksek olarak izlendi (p<0,05). Laktat bakýmýndan gruplar arasýnda istatistiksel olarak anlamlý bir farklýlýk bulunmamakta iken (p>0.05), Grup 4 hastalarda WBC ortalamasý Grup 1’e göre, baðýrsak rezeksiyonu ve anastomoz yapýlanlarda DNÝ ortalamasý ise takiple taburcu edilen gruba göre daha yüksek olarak izlendi (p<0.05).
SONUÇ: Ýnkarsere/strangüle herni olgularýnda, thiol disülfid hemostazý, ÝMA ve DNÝ paremetrelerinin ameliyat öncesinde deðerlendirilmesinin; intraoperatif olarak karþýlaþýlabilecek zorluklarý ve hastaya uygulanacak olan cerrahi iþlemi önceden tahmin etmede etkin ve kolay uygulanabilir bir yöntem olabileceði düþüncesindeyiz.

BACKGROUND: The treatment of patients presenting with the diagnosis of incarcerated and/or strangulated inguinal hernia is mostly surgery. If strangulation and necrosis are present, the need for laparotomy arises, which may increase the risk of morbidity. Currently, it is not possible to clearly determine whether there is bowel ischemia and necrosis before surgery. In this study, we aimed to investigate the clinical efficacy of the thiol–disulfide homeostasis, delta neutrophil index (DNI), and ischemia-modified albumin (IMA) parameters in incarcerated and strangulated hernia cases.
METHODS: Patients that presented to the general surgery outpatient clinic due to inguinal hernia or to the emergency department of the hospital with a preliminary diagnosis of incarcerated and/or strangulated hernia in April 2021-November 2021 were included in the study. The patients were divided into the following four groups: patients that underwent elective repair for inguinal hernia (Group 1), those who were followed up without surgery due to incarcerated hernia (Group 2), those who underwent hernia repair without bowel resection due to incarceration (Group 3), and those who underwent bowel resection due to strangulation (Group 4). Group 1 was defined as the control group, while Groups 2, 3, and Group 4 were evaluated as the incarcerated/strangulated hernia group. The demographic data of the patients, length of hospital stay, body mass index, comorbidities, medical history and physical examina-tion findings, radiological examinations, treatments applied, white blood cell (WBC) count, lactate, and DNI, thiol–disulfide and IMA parameters were evaluated.
RESULTS: The WBC count, disulfide/native thiol, disulfide/total thiol, and IMA values were significantly higher in the incarcerated/strangulated hernia group than in the control group, while the native thiol and total thiol values were higher in the latter than in the former (P<0.05). There was no statistically significant difference between the groups in terms of lactate (P>0.05), but the mean WBC count was higher in Group 4 compared to Group 1, and the mean DNI was significantly higher among the patients who underwent bowel resection and anastomosis than in those that were followed up and discharged (P<0.05).
CONCLUSION: We consider that the preoperative evaluation of the thiol–disulfide homeostasis, IMA, and DNI parameters in incarcerated/strangulated hernia cases can be an effective and easily applicable method in predicting difficulties that may be encountered intraoperatively and the surgical procedure to be applied to the patient.

AMAÇ: Enfektif endokardit birkaç farklý klinik duruma neden olabilen ve acil cerrahi tedavi gerektirebilen ciddi bir kalp hastalýðýdýr. Çalýþmamýzda akut cerrahi tedavi uygulanan enfektif endokarditli hastalarýn hastane içi mortalite sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Retrospektif çalýþmamýza akut cerrahi tedavi uygulanan enfektif endokarditli ardýþýk toplam 107 hasta dahil edildi. Hastalar hastane içi mortalite varlýðýna göre hastane içi mortalite olmayan grup 1 (n=89) ve hastane içi mortalite olan grup 2 (n=18) olarak iki gruba ayrýldý. Her iki grupta demografik, laboratuvar ve klinik parametreler deðerlendirildi.
BULGULAR: Ortalama yaþ (50±14; 64±14, p<0.001) ve kronik böbrek yetmezliði insidansý [9 (%10.1); 8 (%44,4), p=0.001] grup 2'de daha yüksek, ejeksiyon fraksiyonu ise grup 2'de daha düþüktü [50.0±9.3; 44.6±12.9, p=0.039]. Pozitif kan kültürü insidansý da grup 2'de daha yüksekti [41 (46.1); 14 (77.8), p=0.014]. Aortik biyoprotez ameliyatý [2 (2.2); 6 (33.3), p<0.001] ve mitral biyoprotez ameliyatý [4 (4.5); 5 (27.8), p=0.008] grup 2'de daha yüksekti ve septik þok insidansý da grup 2'de daha yüksekti [1 (1.1); 3 (16.7), p=0.015]. Ayrýca çok deðiþkenli lojistik regresyon analizlerinde ileri yaþ [Odds oraný: 1.068, %95CI: 1.009-1.130, p=0.024] ve pozitif kan kültürünün [Odds oraný: 4.436, %95CI: 1.044-18.848, p=0.044] hastane içi mortalitenin baðýmsýz belirteçleri olduðu bulundu.
SONUÇ: Ýleri yaþ, düþük ejeksiyon fraksiyonu, yüksek kreatinin, pozitif kan kültürü, yüksek sistolik pulmoner arter basýncý, septik þok enfektif en-dokardit nedeniyle acil cerrahi uygulanan hastalarda hastane içi ölümü öngördürücüsü olarak belirlendi.

BACKGROUND: Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality.
METHODS: A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups.
RESULTS: The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009–1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044–18.848, P: 0.044) were found to be independent predictors of in-hospital mortality.
CONCLUSION: Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.

AMAÇ: Altmýþ beþ yaþ üstü cerrahi uygulanan hastalarýn, pre-intra ve postoperatif deðiþkenlerinin tümü postoperatif yoðun bakým ünitesi (YBÜ) takip gerekliliðini belirler. Ameliyat öncesi hem cerrahi hem anesteziyi ilgilendiren, kolay ve hýzlý þekilde gerçekleþtirilecek ideal skorlama sistemleri ile postoperatif YBÜ endikasyonu belirlenerek yüksek riskli hastalarda morbidite ve mortalite geliþimi engellenebilir. Çalýþmamýzda, YBÜ endikas-yonunu belirlemede Amerikan Anesteziyolojistler Derneði (ASA) skoru, Akciðer Ultrason skoru (LUSS), Charlson Yaþ Ekli Komorbidite Ýndeksi (CACI), Cerrahi Sonuç Risk Aracý (SORT) skorunun etkinliklerini karþýlaþtýrdýk. Çalýþmamýzýn hipotezi, real görsel olan LUSS’un, YBÜ endikasyonu belirlemede tarama testi olan SORT, CACI ve diðer skor olan ASA’ya göre üstün olduðunu göstermektir.
GEREÇ VE YÖNTEM: Çalýþmaya, 65 yaþ üstü, elektif þartlarda cerrahi uygulanacak, 101 hasta alýndý. Hastalarýn demografik özellikleri, klinik paramet-releri, YBÜ endikasyonlarý, ASA, LUSS, CACI ve SORT’larý prospektif olarak hesaplanýp kaydedildi. Hastalarýn ASA, LUSS, CACI ve SORT’larýnýn, postoperatif YBÜ’ne yatýþ ihtiyacýnýn belirlenmesine etkisi incelendi.
BULGULAR: Ameliyat sonrasý YBÜ'ne yatýrýlmasý gereken hastalarýn yaþý, ameliyat sonrasý YBÜ'ne yatýrýlmasý gerekmeyenlere göre anlamlý derecede yüksekti (p<0.001). Gruplar cinsiyet, vücut kitle indeksi (VKÝ), sigara kullanýmý ve anestezi tipi açýsýndan farklýlýk göstermedi (p>0.05). ASA, LUSS, CACI, SORT postop YBÜ'ne yatýrýlmasý gereken hastalarda anlamlý olarak daha yüksekti (p<0.001). Ameliyat sonrasý YBÜ endikasyonu olan hasta-lardan, ameliyat sonrasý YBÜ’ne ihtiyacý olan hastalarýn oraný daha yüksekti (p<0.001). Konsültasyon sayýsý, ameliyat sonrasý YBÜ’ne yatýþ gerektiren hastalarda anlamlý olarak daha yüksekti (p<0.001). SORT’un, ameliyat sonrasý YBÜ'ne yatýþ ihtiyacýný tahmin etmede en yüksek doðruluk olduðu bulundu.
SONUÇ: Altýmýþ beþ yaþ üstü elektif cerrahi uygulanan hastalarýn preoperatif deðerlendirme sürecinde YBÜ endikasyonunu belirlemede ASA, LUSS, CACI, SORT’un etkili olduðu tespit edilmiþtir. Buna karþýn SORT’un etkinliði diðerlerinden üstün bulunmuþtur.

BACKGROUND: All pre-operative, intra-operative, and post-operative variables of the patients at 65 years of age who had a surgi-cal procedure determine the necessity of post-operative intensive care unit (ICU) monitoring. The indication for post-operative ICU is detected through ideal scoring systems related to the surgery and anesthesia that will be performed easily and fast would prevent the development of morbidity and mortality in high-risk patients. In the present study, we compared the efficacy of the American Society of Anesthesiologists (ASA) score, lung ultrasound score (LUSS), Charlson age-added comorbidity index (CACI), and surgical outcome risk tool (SORT) score of the indication for ICU. The hypothesis of our study is to show that real visual LUSS is superior to the screening test SORT, CACI, and the other score, ASA, for ICU indication determination.
METHODS: The study enrolled 101 patients over 65 years of age who will have surgical procedures under elective conditions. De-mographic features, clinical parameters, ICU indications, ASA, LUSS, CACI, and SORTs of the patients were calculated prospectively and recorded. The effects of patients' ASA, LUSS, CACI, and SORT on determining the need for postoperative ICU admission were examined.
RESULTS: The age of patients who needed post-operative ICU admission was significantly higher than those who did not need post-operative ICU admission (P<0.001). The groups did not show differences in terms of gender, body mass index, smoking, and type of anesthesia (P>0.05). ASA, LUSS, CACI, and SORT were significantly higher for patients who needed post-operative ICU admission (P<0.001). The proportion of patients who needed post-operative ICU admission was higher for patients with post-operative ICU indication (P<0.001). The number of consultations was significantly higher for patients who needed post-operative ICU admission (P<0.001). SORT was found to be the highest accuracy for predicting the need for post-operative ICU admission.
CONCLUSION: It was detected that ASA, LUSS, CACI, and SORT are effective for the determination of the ICU indication in the pre-operative evaluation process of patients over the age of 65 who had elective surgery. However, the efficiency of SORT was found to be superior to the others.

AMAÇ: Diyabetik ayak hastalarýnda standart tedavi ve bakým yaklaþýmýnda özellikle hücresel baðýþýklýk, enfeksiyon ve diðer komplikasyonlarýn ortaya çýkmasýný sýnýrlandýrmak ve yara iyileþmesini saðlamak için glukoz ve HbA1c seviyesinin optimum düzeyde tutulmasý öncelikle önemsenmektedir. GEREÇ VE YÖNTEM: Bu araþtýrma, genel cerrahi diyabetik ayak kliniðinde, diyabetik ayak tanýsýyla servis yatýþý yapýlarak cerrahi uygulanan ardýþýk 301 hasta ile yürütülmüþtür. Hastalara ait HbA1c deðerleri ile WAGNER ve PEDÝS evreleri ile yapýlan cerrahi iþlemler arasýndaki iliþki analiz edildi ve tedavi sonuçlarý deðerlendirildi.
BULGULAR: HbA1c deðerleri %10.1 ve üzeri olanlar ile, Wagner evre 4 diyabetik ayak yara geliþimi arasýnda istatistiksel olarak %90’lýk anlamlý bir iliþ-ki olduðu saptandý (p=0.037). HbA1c %10 ve üzeri olanlar ile PEDIS evre 3 yara geliþmesi arasýnda %85 oranýnda istatistiksel olarak kuvvetli bir iliþki olduðu saptandý. HbA1c deðerleri arttýkça, PEDIS evre 3 yara oluþumu arasýnda istatistiksel olarak anlamlý bir iliþki olduðu analiz edilmiþtir (p=0.003). HbA1c deðerleri ile olgulara uygulanan cerrahi operasyonlar karþýlaþtýrýldýðýnda istatistiki olarak %26 oranýnda kuvvetli olmayan bir iliþki olduðu ve HbA1c deðerleri arttýkça cerrahi amputasyon seviyesinin artabileceði saptandý.
SONUÇ: Bu araþtýrmanýn sonuçlarý, diyabetik ayaklarda HbA1c deðerleri yükseldikçe, Wagner ve PEDIS evrelerinin artacaðý ve iliþkili olarak hastalýk þiddetinin artacaðý yönündedir. Yaný sýra cerrahi amputasyon sýnýrlarýnýn artmasýyla doku kaybýnýn artabileceði öngörülmektedir. Diyabetik ayak hastalýk þiddetinin düþürülmesi ve uzuv kaybýnýn önüne geçilebilmesi için diyabet tedavi ve glisemik kontrol uyumunun arttýrýlmasý gerekmektedir.

BACKGROUND: Diabetic foot is a complex syndrome that is associated with other diabetic complications, such as peripheral arte-rial disease and peripheral neuropathy. Optimization of plasma glucose and glycated hemoglobin (HbA1c) is one of the main principles of standard care and treatment approaches in individuals with diabetes mellitus (DM). In this study, the relationship of HbA1c level at the time of diagnosis was evaluated with diabetic foot disease severity score and surgical extension in patients with Type 2 DM.
METHODS: This study included 301 consecutive patients who were diagnosed with diabetic foot in the general surgery diabetic foot clinic and were hospitalized for surgery. The relationships between the HbA1c levels of the patients with the Wagner and PEDIS (Perfusion, Extent, Dept, Infection, Sensation) classification system grades, and the surgical procedures performed were analyzed and the treatment outcomes were evaluated.
RESULTS: It was determined that there was a 90% statistically significant relationship between HbA1c values of ≥10.1% and the de-velopment of Wagner Grade 4 diabetic foot ulcer (DFU) (P=0.037). A strong statistically significant relationship at the rate of 85% was determined between HbA1c values of ≥10.1% and the development of PEDIS Grade 3 ulcers. As the HbA1c values increased, so there was determined to be a statistically significant relationship with the development of PEDIS Grade 3 ulcer (P=0.003). In the comparison of the HbA1c values according to the type of surgery performed, a weak relationship was determined at the rate of 26%, and it was determined that as the HbA1c values increased, so there could be an increase in the amputation level.
CONCLUSION: The results of this study showed that as HbA1c values at diagnosis increased in patients with diabetic foot; Wagner/PEDIS grades, disease severity, surgical extension, amputation level, and tissue loss increased. To reduce the severity of diabetic foot disease and prevent amputation, compliance with diabetic treatment and glycemic control should be increased.

AMAÇ: Literatürde majör yanýklý hastalarda insülin rezistansýnýn görüldüðü ve bunun persistan olduðunu belirten yayýnlar olsa da yeterli düzeyde deðildir. Bu çalýþma, majör yanýklý hastalarda travma sonrasý erken dönemde insülin seviyeleri ile insülin rezistansýný araþtýrmak ve insülin rezistansýnýn görülme sýklýðýný belirlemek amacýyla planlandý.
GEREÇ VE YÖNTEM: Çalýþmaya toplam 68 hasta alýndý. Çalýþmaya dahil edilen tüm hastalarýn hastaneye yatýþlarýndan itibaren 4 hafta boyunca haftalýk olarak deðerlendirmeleri yapýldý. Deðerlendirmede demografik bilgiler, yanýk hasarýnýn özellikleri, HbA1c, açlýk serum glukoz düzeyleri, procalcitonin, insülin seviyeleri ile insülin direnci (IR) gibi parametrelere bakýldý.
BULGULAR: Hastalarýn yanýk yaralanmalarý deðerlendirildiðinde; 69 (%75) hastada alev yanýðý, 15 (%16.3) hastada elektrik yanýðý saptandý. Çalýþmaya alýnan 68 hastanýn sadece 25'inde bazý haftalarda IR görüldü. Sadece 11 (%16.17) hastada, hastaneye kabul edildikleri birinci günden taburcu olana kadar IR belirlendi. IR olan ve olmayan hastalar 2 grup olarak deðerlendirildi, biyokimyasal parametreleri karþýlaþtýrýldý ve glukoz ve prokalsitonin düzeyleri arasýnda anlamlý fark bulunamadý (p>0.05). Takip edilen tüm hastalarda ilk hafta glukoz düzeyi >100 mg/dl olarak belirlendi ancak sonraki haftalarda bu deðerler normal referans aralýðýndaydý.
SONUÇ: Majör yanýklý hastalarda serum insülin düzeylerinin ve insülin rezistansýnýn araþtýrýldýðý bu retrospektif kesitsel çalýþmada hastalarýn sadece bir kýsmýnda insülin direncine rastlandý. Ýnsülin direncinin görüldüðü hastalarda ise bu durum persistant olduðuna dair yeterli kanýtlara ulaþýlamadý. Sonuç olarak, Homa-IR'nin direkt yanýk travmasýyla ilgisi olmadýðý ve tedavinin seyri sýrasýnda baþka ek patolojilerin buna sebep olabileceði görüþündeyiz.

BACKGROUND: Many studies have reported that insulin resistance (IR) is present and persistent in patients with major burns; however, the evidence remains insufficient. This study was planned to investigate insulin levels and IR in the early post-traumatic period in patients with major burns and to determine the prevalence of IR after burn injury.
METHODS: This study included 68 patients. These patients were followed up once a week for 4 weeks after hospitalization. In the follow-up examinations, demographic and burn injury characteristics; HbA1c, procalcitonin serum glucose, and insulin levels; and IR were evaluated.
RESULTS: IR was seen in some weeks only in 25 of the 68 patients included in the study. Among all patients, IR was determined in only 11 (16.17%) patients from the 1st day of hospitalization until discharge. Patients with and without IR were evaluated as 2 groups, and their biochemical parameters were compared, and no significant difference was found between glucose and procalcitonin levels (P>0.05). Glucose levels were >100 mg/dL in the first few weeks in all patients who were followed up; however, they returned to the normal range in the following weeks.
CONCLUSION: In patients with IR, there was insufficient evidence to conclude that the condition persists. We believe that the HOMA-IR value is not directly related to burn injuries and that other additional pathologies may cause it during treatment.

AMAÇ: Diyafram rüptürünün tanýsý ve cerrahi tedavi gerektiren hastalarýn ayýrt edilebilmesi, mevcut teþhis algoritmalarýna ve ileri görüntüleme tek-niklerinin varlýðýna ragmen halen güçtür. Zamanýnda tedavi edilmediðinde, kesici/delici alet yaralanmalarýna baðlý akut travmatik diyafragma hasarý, organ herniasyonu mevcudiyetinde artan bir eðilimle birlikte, yüksek bir mortalite ve morbidite oranýna sahiptir. Bu çalýþmada, anterior torakoabdo-minal býçak yarasý olan hastalarda tanýsal laparoskopinin etkinliðini araþtýrmayý ve olgularýn takip sonuçlarýný karþýlaþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: Ekim 2012-2022 arasýnda kesici/delici alet yaralanmasý ile baþvuran hastalarýn yer aldýðý kurumsal veri tabanýmýzý retrospektif olarak inceledik. Tanýsal laparoskopi uygulanan hastalar diyafragma yaralanmasý varlýðýna göre iki gruba ayrýldý. Demografik veriler, bilgisayarlý tomog-rafi (BT) görüntülemenin tanýdaki baþarýsý, hemomediastinum, pnömomediasten varlýðý, tüp torakostomi uygulamasý, eþlik eden organ yaralanmasý, cerrahi tipi, cerrahi süresi, komplikasyonlarý ve hastanede kalýþ süreleri, gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Penetran sol torakoabdominal yaralanmasý olan 39 hastaya tanýsal laparoskopi yapýldý, BT'nin tanýsal duyarlýlýðý %63.16 (%95 GA %38.36 ila %83.71) ve özgüllüðü %100 (%95 GA %82.35 ila %100.00) idi. Analiz edilen deðiþkenler açýsýndan gruplar arasýnda istatistiksel olarak anlamlý bir fark bulunamazken, ameliyat süresi diyafragma hasarý bulunan grupta anlamlý olarak daha uzun saptandý (p<0.01). On dört hastada eþlik eden visseral organ yaralanmalarý mevcuttu.
SONUÇ: Tanýsal laparoskopi, acil serviste, özellikle tecrübeli bir radyoloðun 24 saat bulunamamasý durumunda ve hastanýn ayný ekip tarafýndan yakýn takibinin saðlanamadýðý durumlarda altýn standart bir taný yöntemi olma özelliðini halen korumaktadýr.

BACKGROUND: The diagnosis of a diaphragmatic rupture and the identification of patients for surgical repair is challenging despite current diagnostic algorithms and imaging technologies. Unless treated on time, acute traumatic diaphragmatic injury due to stab wounds has a high mortality and morbidity rate, with an increasing trend in the presence of organ herniation. In this study, we aimed to investigate the efficacy of diagnostic laparoscopy in patients with an anterior thoracoabdominal stab wound and to compare the follow-up outcomes of cases.
METHODS: We retrospectively reviewed our institutional database of patients who were admitted with stab wounds between Oc-tober 2012 and 2022. Patients who underwent diagnostic laparoscopy were divided into two groups depending on the presence of a diaphragmatic injury. We analyzed demographics, the success of computed tomography (CT) imaging in the diagnosis, the presence of hemomediastinum, pneumomediastinum, tube thoracostomy application, associated organ injury, type of surgery, duration of surgery, complications, and the length of stay between the groups.
RESULTS: Of the 39 patients with penetrating left thoracoabdominal injury underwent diagnostic laparoscopy, CT had a diagnostic sensitivity of 63.16% (95% Confidence interval [CI] 38.36–83.71%), and a specificity of 100% (95% CI 82.35–100.00%). We could not find a statistically significant difference between the groups in terms of studied variables, while operation time was significantly higher in the diaphragmatic injury group (P<0.01). Fourteen patients had accompanied visceral injuries.
CONCLUSION: Diagnostic laparoscopy is still the gold standard particularly in the ER setting, particularly in the absence of an experienced radiologist for 24 h and when the close monitoring of the patient by the same team cannot be provided.

AMAÇ: Bu çalýþmada, acil ve elektif transüretral giriþimler sýrasýnda profilaktik antibiyotik kullanýmý için en uygun antimikrobiyal ajanlarýn tespit edilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþma Mart 2021-Mart 2022 tarihleri arasýnda Türkiye'nin farklý coðrafi bölgelerinde yer alan beþ hastanede gerçekleþtirildi. Acil ve elektif transüretral iþlemler öncesinde alýnan idrar kültürlerinde üreme tespit edilen hastalara ait veriler retrospektif olarak hastanelerin veri kayýt sistemlerinden elde edildi. Hastalarýn demografik verileri (yaþ ve cinsiyet), eþlik eden hastalýklarý, geçirilmiþ ürolojik iþlemler, ürogenital sistem anomalileri, üretral kateter kullanýmý (kalýcý veya temiz aralýklý kateterizasyon), kültürde üreyen mikroorganizmalar ve antibiyotik duyarlýlýklarý not edildi. Son 1 ay içinde herhangi bir nedenle hastaneye yatýrýlan veya antibiyotik kullanan hastalar çalýþma dýþý býrakýldý.
BULGULAR: Çalýþmaya 742 erkek (51.2%) ve 708 kadýn (48.8%) olmak üzere toplam 1450 hasta alýndý. Hastalarýn oratalama yaþý 55.3±19.36 (1-98) yýl idi. En sýk görülen komorbidite diabetes mellitus olarak saptandý (18.7%). Ýdrar kültürlerinde en sýk izole edilen mikroorganizmalar, sýklýk sýrasýna göre: ESBL (-) E. coli 418 hasta (28.8%), ESBL (+) E. coli 309 hasta (21.3%), Klebsiella pneumonia 183 hasta (12.6%), Enterococcus faecalis 124 hasta (8.6%) ve Pseudomonas aeruginosa 89 hasta (6.1%) olarak tespit edildi. Amerikan Üroloji Derneði ve Avrupa Üroloji Derneði klavuzlarýnýn profilaksi için önerdiði antimikrobiyal ajanlara karþý duyarlýlýk oranlarý: Sefepim %87.1, Ampisilin+Sulbaktam %84, TMP-SMX %71.6, Amoksisilin + Klavulanate %63.5, Sefoksitin %59, Seftazidim %58.6, Sefuroksim %43.5, Seftriakson %43 ve Sefiksim %38.4 olarak bulundu.
SONUÇ: Çalýþmamýzýn sonuçlarýna göre güncel kýlavuzlar tarafýndan profilaksi için tavsiye edilen antimikrobiyal ajanlar idrar kültürlerinde en sýk izole edilen patojenlere karþý yeterli koruma saðlamamaktadýr. Ürologlar endoskopik üretral giriþimler sýrasýnda antibiyotik profilaksisini hasta bazýnda düþünmeli, uygun protokolleri takip etmeli ve yerel antibiyotik direncini göz önünde bulundurmalýdýr.

BACKGROUND: In this study, we aimed to determine the most appropriate antimicrobial agents for prophylactic antibiotic use during emergency and elective transurethral procedures.
METHODS: The study was conducted in five hospitals located in five different geographical regions of Türkiye. The microorganism cultured in urine before emergency and elective transurethral procedures in these centers between March 2021 and March 2022 were reviewed retrospectively from the hospital records. Demographic data (age and gender) of the patients, comorbid disorders, previous urological procedures, anomalies of the urogenital tract, use of urethral catheters (permanent or clean intermittent catheterization), cultured microorganisms, and antibiotic susceptibilities were noted. The patients hospitalized or had antibiotics for any reason in the previous 1 month were excluded from the study.
RESULTS: A total of 1450 patients, 742 men (51.2%) and 708 women (48.8%), were included in the study. The mean age of the patients was 55.3±19.36 (1–98) years. Diabetes mellitus was evident in 271 (18.7%) patients. The five most common microorgan-isms cultured in urine, in order of frequency, were: ESBL (-) Escherichia coli in 418 (28.8%), ESBL (+) E. coli in 309 (21.3%), Klebsiella pneumonia in 183 (12.6%), Enterococcus faecalis in 124 (8.6%), and Pseudomonas aeruginosa in 89 (6.1%). The susceptibility rates to antimicrobial agents recommended for prophylaxis by the American Urology Association and the European Association of Urology guidelines were found as follows: cefepime 87.1%, ampicillin+sulbactam 84%, TMP-SMX 71.6%, amoxicillin+clavulanate 63.5%, cefoxitin 59%, ceftazidime 58.6%, cefuroxime 43.5%, ceftriaxone 43%, and cefixime 38.4%.
CONCLUSION: We found that currently recommended antimicrobials provide poor coverage for the most common pathogens isolated. Urologists should consider patient-based antibiotic prophylaxis in endoscopic urethral procedures, follow appropriate proto-cols, and consider local antibiotic resistance.

AMAÇ: Gebelikte travma, obstetrik olmayan maternal ve fetal mortalite ve morbiditenin en önemli nedenlerinden biridir. Çalýþmamýzýn amacý travmanýn tipine ve þiddetine göre oluþabilecek olumsuz perinatal sonuçlarý deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu retrospektif kohort çalýþmada, 1 Ocak 2017 ile 31 Aralýk 2022 tarihleri arasýnda Prof. Dr. Cemil Taþçýoðlu Þehir Hastanesi Kadýn Hastalýklarý ve Doðum acil servislerine konsültasyon için baþvuran 18-50 yaþ arasý travma geçirmiþ gebeler deðerlendirildi. Demografik özel-likler, travma bulgularý, Yaralanma Þiddet Skorlamasý ve obstetrik sonuçlar kaydedildi.
BULGULAR: 900'ü gebe olmak üzere toplam 1825 travma hastasý konsültasyon için acil jinekoloji kliniðimize sevk edildi. Doðum bilgilerine ulaþtýðý-mýz 153 gebe hasta çalýþma grubu olarak seçildi. Hastalarýn yaþ ortalamasý 25.56±5.99 yaþ, travma geçirdiði gebelik haftasý ortalamasý 21.59±9.89 hafta idi. Hastalarda %67.97 düþme, %30.07 þiddet ve darp ve %1.96 trafik kazasý izlendi. Travma günü doðum oranlarý, hospitalizasyon durumlarý, ISS ≥9 ve kýrýk varlýðý 3. Trimestrde anlamlý olarak yüksek bulundu. Hospitalizasyon ve 3. Trimester travmalarý ISS ≥9 grubunda anlamlý olarak daha fazla görülmekteydi. (p=0.0001, p=0.028 ).
SONUÇ: Genel popülasyonla karþýlaþtýrýldýðýnda, travma geçirmiþ gebelerde PPROM-PROM, fetal ölüm, fetal distres, sezaryen doðum, plasenta dekolmaný ve erken doðum oranlarý artmýþtýr. ISS skoru düþük olan hastalar da, ciddi travma hastalarý gibi gebelik döneminde perinatal komplikas-yonlar açýsýndan yakýndan izlenmelidir.

BACKGROUND: Trauma during pregnancy is one of the most important causes of non-obstetric maternal and fetal mortality and morbidity. The aim of our study is to evaluate the adverse perinatal outcomes that may occur according to the type and severity of the trauma.
METHODS: In this retrospective cohort study, pregnant traumatized women aged 18–50 years and referred for consultation to the Prof. Dr. Cemil Tascýoglu City Hospital’s emergency services of the departments of gynecology and obstetrics, between January 1, 2017, and December 31, 2022, were evaluated. Demographic characteristics, trauma findings, Injury Severity Scoring (ISS), and obstet-ric outcomes were recorded.
RESULTS: A total of 1825 trauma patients, including 900 pregnants were referred to our emergency gynecology clinic for consulta-tion. One hundred and fifty three pregnant patients, whose birth information we reached, were selected as the study group. The mean age of the patients was 25.56±5.99 years and the mean gestational week at the time of trauma was 21.59±9.89 weeks, the patients had fallen (67.97%), had been exposed to violence (30.07%), and had a traffic accient (1.96%). The patient’s delivery and hospitalization status on the day of trauma, fracture and ISS ≥9 were statistically significantly at a higher rate in the 3rd trimester. Rates of hospitaliza-tion and 3rd trimester traumas were found to be significantly higher in the ISS ≥9 group. (P=0.0001, P=0.028, respectively).
CONCLUSION: Compared to the general population, the rates of preterm premature rupture of membranes-premature rupture of membranes, fetal death, fetal distress, cesarean delivery, placental abruption, and preterm delivery increased in traumatized pregnant women. Patients with low ISS scores should also be followed closely during pregnancy in terms of perinatal complications, as well as the severe trauma group.

AMAÇ: Çocuklarda ateþli silahlar nedeniyle meydana gelen batýn yaralanmalarý, geliþen teknoloji ve ameliyat tekniklerine raðmen yüksek komplikas-yon ve mortaliteye sahip travmalardýr. Bu çalýþmada, Suriye’deki sivil savaþ sonucu çocuklarda meydana gelen yüksek hýzlý mermi ve þarapnel kaynaklý meydana gelen penetran abdominal ateþli silah yaralanmalarýnda mortalite ve komplikasyona etki eden faktörler deðerlendirilmiþtir.
GEREÇ VE YÖNTEM: Bu çalýþma Kilis Devlet hastanesinde Ocak 2016-Þubat 2017 tarihleri arasýnda penetran abdominal ateþli silah yaralanmasý sonucu baþvuran 53 hasta ile vaka serisi olarak yapýlmýþtýr. Türkiye’nin Suriye ile sýnýr ili olan Kilis’deki devlet hastanesine Suriye’deki iç savaþ sonucu penetran abdominal ateþli silah yaralanmasýna uðrayan ve hastanemize transvers edilip ameliyat edilen 6 ay-17 yaþ arasý hastalar deðerlendirmeye alýndý. Hastalarýn sosyodemografik bilgileri, cerrahiye kadar geçen süre, yaralanan abdominal organ sayýsý, yaralanmaya neden olan ateþli silah tipi, büyük damar yaralanmasý ve ekstremite yaralanmasý eþlik etmesi, laparatomiye ek olarak torakotomi gerektiren toraks yaralanmasý varlýðý, kolostomi uygulanmasý, penetran abdominal travma indeksi, pediatrik travma skoru ve þok durumu deðerlendirildi.
BULGULAR: Çalýþmamýzda penetran abdominal travma indeksi’nin yüksek olmasýnýn istatistiksel olarak komplikasyon ve mortalite oranlarýný arttýr-dýðý bulunmuþtur (p<0.001, p=0.002). Ayrýca pediatrik travma skoru’nun düþük olmasýnýn komplikasyon geliþimini ve mortaliteyi istatistiksel olarak arttýrdýðý tespit edilmiþtir (p=0.001, p<0.00). PTS>8 olan hastalarýn hiçbirinde mortalite gözlenmemiþ olup, PTS≤8 olan hastalarda %27.3 oranýnda mortalite gözlenmiþ ve bu sonucun istatistiksel olarak anlamlý olduðu tespit edilmiþtir (p=0.003). Þok tablosunun mortaliteyi anlamlý olarak arttýrdýðý ve þok tablosunda olmayan hiçbir hastanýn hayatýný kaybetmediði tespit edilmiþtir (p<0.001). Çalýþmamýzda yaralanan intraabdominal organ sayýsýnýn artmasýnýn hem komplikasyon hem de mortalite üzerinde istatistiksel olarak anlamlý þekilde etkili olduðu belirlendi (p<0.001, p=0.002). SONUÇ: Penetran abdominal ateþli silah yaralanmasý olan çocuk hastalarda penetran abdominal travma indeksi ve pediatrik travma skorunun mortalite ve morbiditeyi öngörmede etkin olduðu tespit edilmiþtir. Çatýþma alanlarýnda hýzlý ve etkin þekilde ilk müdahalenin yapýldýktan sonra uygun transportun saðlanmasý bu hasta grubunda oldukça önemlidir.

BACKGROUND: Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated.
METHODS: This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients’ sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated.
RESULTS: In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively).
CONCLUSION: The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

AMAÇ: Deplase eklem içi kalkaneal kýrýklarýn (DEÝKK) optimal tedavisi için tartýþmalar devam etmektedir. Geleneksel olarak, ekstensil lateral yakla-þým (ELY) en çok tercih edilen yaklaþým olmuþtur. ELY, mükemmel kýrýk fragmana eriþim ve çökmüþ posterior fasetin doðrudan deðerlendirilmesini saðlasa da, bu yaklaþýmýn hematom, yüzeysel/derin enfeksiyon ve yara iyileþme sorunlarý gibi yüksek oranda ciddi komplikasyonlarý vardýr. Bu tür komplikasyonlarýn üstesinden gelmek için, eksternal fiksasyon, perkütan fiksasyon, artroskopik yardýmlý fiksasyon ve sinüs tarsi yaklaþýmý (STY) gibi daha minimal invaziv teknikler yakýn zamanlarda tanýmlanmýþtýr. Bu çalýþmanýn birincil amacý, deplase eklem içi kalkaneus kýrýklarýnýn tedavisinde STY ve ELY'yý karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Kliniðimizde deplase eklem içi kalkaneus kýrýðý nedeniyle ameliyat edilen hastalar çalýþmaya dahil edildi. Sanders tip II, III, IV, kapalý deplase eklem içi kalkaneus kýrýðý olan ve 18 yaþ üstü hastalar belirlendi. Hastalarýn fizik muayeneleri ve radyolojik deðerlendirmeleri yapýlarak klinik skorlarý dolduruldu. Hastalar Sanders sýnýflamasýna göre alt gruplara ayrýldý ve bu alt gruplara göre tekrar karþýlaþtýrmalar yapýldý. BULGULAR: STY grubunda 37 hasta (4 kadýn, 33 erkek), ELY grubunda 44 hasta (6 kadýn, 38 erkek) vardý. STY grubu için yaþ ortalamasý 44.42±13.57 (18-61 arasý), ELY grubu için 37.32±11.09 (18-56 arasý) idi. Klinik sonuçlarda, SF-12/MCS-12 (Mental Score) ve VAS skoru dýþýndaki tüm parametreler STY grubunda ELY grubuna göre anlamlý olarak daha iyiydi. Ýki grup arasýnda radyografik sonuçlarda Böhler açýsý dýþýnda anlamlý bir fark gözlenmedi. STY grubunda ELY grubuna göre anlamlý olarak daha az enfeksiyon meydana geldi (p=0.021). Sanders sýnýflamasýna göre, AOFAS, FADI ve SF-12/PCS-12 ve FFI skorlarýndaa Sanders tip 2 için STY ve ELY gruplarý arasýnda anlamlý fark saptanmazken, Sanders tip 3 ve 4 için STY grubundaki deðerler ELY grubuna göre oldukça yüksekti.
SONUÇ: Deplase eklem içi kalkaneus kýrýklarýnda STY, kalkaneusun geniþliðini, yüksekliðini ve uzunluðunu eski haline getirmek ve eklem dizilimini yeniden yapýlandýrmak için güvenli ve etkili bir yöntem olarak kabul edilir ve artýk operatif tedavi gerektiren tüm kalkaneal kýrýklar için standart tekniðimiz haline gelmiþtir.

BACKGROUND: Controversy still exists for optimal treatment for displaced intra-articular calcaneal fractures (DIACFs). Conven-tionally, the extensile lateral approach (ELA) has been the most preferred approach. Although ELA provides excellent fracture access and direct evaluation of the depressed posterior facet, this approach has a high rate of serious complications, such as hematoma, superficial/deep infection, and wound healing issues. To overcome such complications, more minimally invasive techniques including external fixation, percutaneous fixation, arthroscopic assisted fixation, and sinus tarsi approach (STA) have been recently described. The primary aim of this study was to compare STA and LEA in the treatment of DIACFs.
METHODS: Patients who were operated for DIACFs in our clinic were included in the study. Patients with closed DIACFs of Sanders Type II, III, IV, and over 18 years of age were identified. Physical examinations and radiological evaluations of the patients were per-formed, and clinical scores were filled. Patients were divided into subgroups according to the Sander’s classification and comparisons were made again according to these subgroups.
RESULTS: There were 37 patients (four female and 33 male) in STA group and 44 patients in LEA group (six female and 38 male). The mean age was 44.42±13.57 years (range, 18–61) for STA group and 37.32±11.09 years (range, 18–56) for the LEA group. In clinical outcomes, except for short-form survey (SF-12)/MCS-12 (Mental Score) and visual analog scale score, all the parameters were signifi-cantly better in STA group compared to LEA group. No significant difference was observed between the two groups in radiographic results, except for the Böhler angle. Significantly less infection occurred in the STA group compared to LEA group (P=0.021). According to Sander’s classification, American Orthopedic Foot and Ankle Society, foot and ankle disability index, and SF-12/PCS-12 and foot function index scores, no significant differences were determined between STA and LEA groups for Sanders Type 2, whereas the values were considerably higher in STA group than in LEA group for Sanders Type 3 and 4.
CONCLUSION: In DIACFs, STA is considered a safe and effective method for restoring the width, height, and length of the calca-neus and reconstruction of joint alignment and has now become our standard technique for all calcaneal fractures requiring operative treatment.