Ýnce barsaklarda mezenter arter iskemisine baðlý iskemi-reperfüzyon hasarýný ve PGE2'nin etkisini gözlemek için 40 sýçanda eksperimental çalýþma yapýldý. Sham, ligasyon, deney ve ligasyon + prostaglandin E2 guruplarý yapýldý. Superior mezenterik arter aortadan çýkýþ yerinden atravmatik mikrovasküler klemplerle tutularak bir saatlik iskemi ve iki saatlik reperfüzyon saðlandý. 1 ve 3. saatlerde CPK, LDH, AST ve ALT analizi için kan örnekleri, malondialdehit ve redükte glutatyon saptanmasý ve histopatolojik inceleme amacýyla intestinal doku örnekleri alýndý. CPK, LDH, AST ve ALT deðerleri SMA ligasyonunu takiben yükseldi ve PGE2 verilen gurupta anlamlý düþme saptandý. Glutatyon seviyesi ligasyon gurubunda oldukça düþük, PGE2 verilen gurupta lipit peroksidasyonun ürünü olan malondialdehit anlamlý olarak düþük saptandý. Sonuç olarak histopatolojik bulgularýn biyokimyasal bulgularla paralellik gösterdiði ve PGE2'nin barsaklardaki, iskemik hasarý anlamlý olarak azalttýðý, daha da önemlisi iskemik hasarýn irreversible safhaya gelmesini önlediði gözlendi.

To observed the ischemia reperfusion damage and the effect of PGE2 resulting from mezenter arterial ischemia on 40 rats an experimental study is carried out. One-hour ischemia and two hour reperfusion model is applied by clemping the superior mesenteric artery at bifurcation site from aorta abdominal with atravmatic microvasculer in sham, ligation, experiment and ligation + PGE2 (n=10) groups. The blood samples were taken for alanine transaminase (ALT), aspartate transaminase (AST), lactic dehydrogenase (LDH), creatinin phosphokinase (CPK) analysis at 1st and 3rd hours. Intestinal tissue samples were removed for malonyldialdehyde and reduced glutathione determinations and histopathologic examination. CPK, LDH, AST and ALT values increased after the SMA ligation and there was a meaningful decrease in the group that was given PGE2. Glutation levels were rather low in the ligation group and malonyldialdehyde, the product of lipid peroxidatiton decreased in the PGE2 group. Finally; it is observed that histopathologic findings were in concordance with biochemical results and it is also found out that PGE2 lessens the ischemic damage in small intestines, furthermore, PGE2 enhances the ischemic damage to reach irreversible phase.

Bu deneysel çalýþmada bir antihelmintik ve immünostimülatör olan levamizolün normal ve kan transfüzyonu yapýlmýþ kobaylarda anastomoz iyileþmesi üzerine etkilerini araþtýrmak amacýyla, her grupta 14 kobay (Guinea Pig) olmak üzere 4 grup halinde toplam 56 kobay ve kan transfüzyonu için de 10 adet kobay kullanýldý. Tüm kobaylarda intestinal anastomoz uygulandý. Grup A: Kontrol grubu, Grub B: Kan transfüzyonu yapýlan grup, Grup C: Batýniçi levamizol uygulanan grup, Grup D: Transfüzyon ve levamizol uygulanan grup. Deney gruplarýnda mortalite hýzý kaydedildikten sonra deneklerin yarýsýna postoperatif 3. günde ve diðer yarýsýna 7. günde olmak üzere relaparotomi uygulandý. Ýntraabdominal sepsis bulgularý, anastomoz dirençleri, patlama basýnçlarý deðerlendirildi. Gruplar arasýndaki istatistiksel karþýlaþtýrma "Varyans Analiz" testi ile yapýldý. Transfüzyon grubunda sepsis bulgularý arttý ve patlama basýncý kontrol grubuna göre anlamlý olarak düþük bulundu. Kan transfüzyonundan sonra intraabdominal verilen levamizolün intraabdominal sepsisi ve anastomoz absesini azaltarak mortaliteyi düþürdüðü, ayrýca anastomoz iyileþmesi ve anastomoz direncini anlamlý alarak (p<0.01) arttýrdýðý gözlendi. Levamizol uygulanan gruplarda histopatolojik iyileþme sadece transfüzyon uygulanan gruba göre daha iyi bulundu. Levamizolün transfüzyon olmadan verildiðinde ise kontrol grubu ile eþdeðerde mortalite ve morbiditiye sahip olduðu bulundu.

In this experimental study, the effects of an antihelmintic and immunostimulating agent (drug) levamizol on anastomosis recovery in blood transfused and normal Guinea pigs were investigated. A total of 56 animals were divided into 4 groups of each consisted of 14 subjects. An additional 10 Guinea pigs were employed for blood transfusion. Intestinal anastomosis were performed on all subjects. Following postoperative treatments were exercised: Group A: None (control group), Group B: Blood transfusion, Group C: Intraabdominal levamizol, Group D: Transfusion+ Levamizol after recording the mortality rate of each group, relaparotomy was applied on 50% the subjects on the 3rd postoperative day, and on the remaining 50% of the subjects on the 7th postoperative day. Findings on intraabdominal sepsis, resistance of anastomosis, explosion pressure were evaluated. Statistical comparision of groups were accomplished by the variance analysis. In the transfusion group an increase in the sepsis findings were determined and the blowing pressure was found to be meaningfully lower than the control group. Intraabdominal levamizol application f allowing the blood transfusion was observed to reduce the mortality by diminishing the intraabdominal sepsis and anastomosis abscess, and to increase the anastomosis pressure and recovery (p<0.01). The histopathological recovery in levamizol administered groups were found to be better than the group received only blood transfusion. Levamizol application without blood transfusion resulted in equal mortality and morbidity to that of control group.

Alt gastrointestinal sistemdeki lezyonlardan kaynaklanan ve hastayý hemorajik þoka sürükleyen abondan kanamalar, geliþmiþ taný ve tedavi yöntemlerine raðmen, Acil Cerrahi birimleri için klinik önemlerini korumaya devam etmektedir. Masif alt GÝS kanamalara cerrahi yaklaþým tarzýyla birlikte taný ve tedavi yöntemlerinin doðru seçimi mortalite ve morbiditeyi doðrudan etkilemektedir. Son dört yýl içinde kliniðimizde taný ve tedavisi yapýlan 34 hasta geriye dönük olarak incelenmiþtir. Hastalarýn 13'ünde (%38) acil cerrahi giriþim gerekli olmuþtur. Hastalarýn 19'unda (%56), ameliyat edilenlerin ise 11'inde (%84,6) ameliyat öncesi taný konmuþtur. Bunlarda en sýk kanama nedeni divertiküler hastalýktýr (%26,3). Otuzdört hastanýn 3'ü postoperatif dönemde kaybedilmiþtir. Toplam mortalite ve cerrahi mortalite sýrasýyla %8 (3/34 hastada) ve %23'tür (3/13 hasta). Kendiliðinden veya medikal tedaviyle durmayan masif alt GÝS kanamalarda acil ameliyat kararýnýn geciktirilmesi özellikle yaþlý hastalarda mortaliteyi arttýrmaktadýr. Ameliyat öncesi veya sýrasýyla kanama yerinin belirlenemediði olgularda körleme sýnýrlý rezeksiyonlar yerine total kolektomi tercih edilmelidir.

Massive bleedings originating from lesions of lower gastrointestinal system, still have their clinical importance for Surgical Emergency Units, despite contemporary diagnostic and therapeutic modalities. Mode of surgical approach, correct choices for diagnosis and treatment directly influence mortality and morbidity. In this study, 34 patient who were diagnosed and treated in our department are retrospectively investigated. Emergency surgical intervention has been necessary in 13 cases (38%). Preoperatif diagnosis was possible in 19 of 34 patient (56%) and in 11 of 13 surgically treated patients (84,6) in which most frequent cause of bleeding was diverticular disease (26,3%). Three of 34 patients died in postoperative period. Overall and operative mortality were 8% (3/34 patient) and 23% (3/13 patient) respectively. Delayed surgical treatment in massive lower gastrointestinal bleeding that doesn't stop spontaneously or with medical measures taken, increases the mortality, particularly in elderly patients. Instead of blind limited resections, total abdominal colectomy should be preferred if pre or per-operative diagnosis is not succeeded.

Bu retrospektif çalýþmada 1985-1994 yýllarý arasýnda Çukurova Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý'nda karýn travmasý nedeniyle laparotomi yapýlan 888 hastanýn kayýtlarý incelendi ve negatif laparotomi sýklýðý araþtýrýldý. Hastalarýn 399(%45) 'u künt karýn, 489(%55) 'u penetran karýn travmalý idi. Penetran yaralanmalarýn 171(%35)'i ateþli silah (AS), 318(%55)'i delici kesici alet (DKA) yaralanmasýna baðlý idi. Künt travmalarýnda negatif laparatomi oraný %16,5, nonterapötik laparotomi oraný ise 2,3 olarak bulundu. Negatif laparatomi ve nonterapötik laporotomi oranlarý AS yaralanmalarýnda %7, %1,2 DKA yaralanmalarýnda ise %22,7 ve %2,5 idi. Künt karýn travmalarýnda ve AS yaralanmalarýnda negatif laparotomi oranlarý literatürle uyumlu idi. DKA yaralanmalarýnda ise Negatif laparotomi ve nonterapötik laparotomi oranlarý seçici gözlem, lokal yara eksplorasyonu ve tanýsal peritoneal lavaj uygulayan gruplara göre yüksek bulundu. DKA yaralanmalarýnda dikkatli fizik muayene, yara eksplorasyonu ve tanýsal peritoneal lavajýn negatif laparotomi oranýný azaltacaðý ve morbiditeyi önleyeceði düþüncesindeyiz.

In this retrospective study, the records of 888 patients whom were treated because of abdominal trauma in Çukurova University, School of Medicine, Department of General Surgery between 1985 and 1994 were reviewed and the incidence of negative laporotomy was investigated. Three hundred-ninty-nine(%45) patients had blunt abdominal trauma 499(55%) had penetrating abdominal trauma. Penetrating abdominal trauma included 171 (35%) gunshot wounds, 318(65%) stab wounds. Of 399(35%) patients with blunt abdominal trauma, the incidence of negative laporotomy was 66 (16.5%) and 9 (2.3%) patients had nontherapeutic laparotomy. The incidence of negative laporotomy was 12(7%) and 2 (1.2%) patients had nontherapeutic laparotomy in 171(35%) patients with gunshot wounds. Of 388 (65%) patients with stab wounds, the incidence of negative laparotomy was 72(22.7%) and 8(2.5%) patients had non therapeutic laparotomy. The incidence of negative laparotommy was found similar with literature in the patients with blunt abdominal trauma and gunshod wounds. The patients with stab wounds, the incidence of negative laporotomy was higher than patients managed by selective conservative treatment. We believe that the incidence of negative laparotomy will reduce by careful physical examination, local wound exploration and diagnostic peritoneal lavage and also prevent to morbidity in patients with stab wounds.

Sivil rektal yaralanmalarýn tedavisinde, fatal septik komplikasyonlarýn geliþimini önlemek amacýyla saptýrýcý kolostomi ve perirektal dokularýn drenajý gereklidir. Rutin distal rektumun yýkanmasý ve rektumun primer tamiri halen tartýþma konusudur. Bu amaçla, rektum yaralanmasý nedeniyle son 10 yýllýk dönem içinde kliniðimizde tedavi edilen 19 olgu yaþ, cinsiyet, yaralanma þekli, yaralanma anýndan tedaviye dek geçen süre, travma skorlarý (Abdominal Travma indeksi, Düzeltilmiþ Travma Skoru, Yaralanma Þiddet Skoru, Rektal Yaralanma Skoru), ek organ yaralanmalarý varlýðý, uygulanan cerrahi prosedürlerin morbidite ve mortalite geliþimine etkisi açýsýndan chi-kare, Fischer kesin olasýlýk testi ve lineer regresyon analiz yöntemleri ile retrospektif olarak deðerlendirilmiþtir. Yaralanma nedeni 12 (%62.2) olguda künt travma, diðer olgularda ateþli silah yaralanmasý idi. ATY ortalamasý 24.3, YSS ortalamasý 32.6, DTS ortalamasý 5.5 olarak hesaplanmýþtýr. ATÝ>27 ve YSS>40 olan olgular ile yaralanma anýndan tedavi edildiði döneme kadar geçen sürenin 24 saati aþtýðý olgularda, geliþen morbiditenin oraný istatistiksel olarak anlamlý bulunmuþtur. Rektum yaralanmak olgularda, geliþen morbiditenin oraný istatistiksel olarak anlamlý bulunmuþtur. Rektum yaralanmak olgularýn 7 (%36.8)'sine rektal tamir, 6 (%31.5)'sýna distal rektal yýkama iþlemi uygulanmýþtýr. Presakral drenaj olgularýn 18 (%94.7)'üne, diverting kolostomi ise olgularýn tümüne uygulanmýþtýr. Toplam morbidite oraný %52.6, mortalite oraný %10.4 olarak saptanmýþtýr. Kýsýtlý sayýda hasta grubuna dayanmasýna raðmen, uygulanan cerrahi iþlemlerin, morbidite geliþimine etkisi anlamlý bulunmamýþtýr. Bu konuda çok merkezli prospektif randomize çalýþmalara gereksinim vardýr.

Current management of civilian rectal injuries mandates complete fecal diversion and presacral drainage of the presacral drainage of the presacral tissues to prevent fatal septic complications. Routine distal colon washout and primary repair of the rectum still remains challenging problems in the management. In an effort to elucidate these issues, we reviewed 19 patients with rectal trauma over the last 10 years. Rectal injury was due to gunshot wounds in 7 (36.8) patients, blunt trauma in 12 (62.2) patients. The mean Revised Trauma Score 5.5, Abdominal Trauma Index 24.3, and Injury Severity Score 32.6. Proximal colostomy was done in all patients and presacral drains were placed in 18 (94.7%). Broad spectrum antibiotics were administered for a minimum 5 days. Primary rectal repair was performed in 7 (36.8%) and distal rectal washout in 6 (31.5) patients. Patients were evaluated with respect to injury mechanism, shock on arrival, missing time from injury to therapy, rectal wound severity, associated injuries, perioperative blood transfussions, trauma scores and surgical procedures by using uni-and multi-variate analysis. Total morbidity rate was 52.6%, mortality rate 10.4%. Delayed surgery more than 24 hours and high trauma scores (ATI>27 and ISS>40) were the significant factors on morbidity. Although based on a small group of patients, surgical procedures such as distal rectal washout and primary repair of the rectum had no significant effect on prognosis. Ultimate resolution of these issues demands a multicenter prospective randomized trial.

Cumhuriyet Üniversitesi Týp Fakültesi Genel Cerrahi Kliniðinde Ocak 1991 ile Ocak 1996 yýllarý arasýnda ince barsak yaralanmasý olan 50 hasta retrospektif olarak incelendi. Duedonum yaralanmalarýnýn teþhis ve tedavisi farklý özellikler gösterdiðinden bu gruba dahil edilmediler. Hastalarýn 45'i erkek 3'ü kadýndý, yaþ ortalamasý 34.6 (11-65) idi. Yaralanmalarýn 27 (%54)'si künt travmaya baðlýydý, 20 (%40)'si penetran yaralanma, penetran yaralanmalarýnda 5'i delici kesici alet yaralanmasý, 15'i ateþli silah yaralanmasýydý. 3(%6) olgumuzda iatrojenik yaralanma mevcuttu. Teþhiste direk grafi, bilgisayarlý tomografi (BT) kullanýldý. Periton lavajý ve ponksiyon hipovolemi belirtilerinden hipotansiyon ve taþikardisi olan hastalara yapýldý. Özellikle peritoneal irritasyon bulgularýn saptanmasý için fizik muayene sýk olarak tekrarlandý. 24(%48) olgumuzda diðer karýn içi organ yaralanmasý eþlik etmekteydi. Perforasyonlar 29 (%58)' unda primer olarak onarýldý, 19(%38)'unda rezeksiyon + anastomoz, 2(%4)'sinde rezeksiyon anastomoz ile birlikte primer sütür yapýldý. Çalýþmamýzda morbidite 16 (%32), mortalite 4 (%8) olarak bulundu. Exitus olan 4 hastanýn 3'ü künt travmaya maruz kalmýþtý ve bu hastalarýn ikisinde jeneralize peritonit hali mevcuttu, eþlik eden organ yaralanmasý yoktu. Künt travmaya baðlý ince barsak perforasyonlarýnda mortalitenin yüksek olmasýnýn nedeni tanýdaki gecikme olarak deðerlendirildi.

50 patients with small intestinal injury were examined, between January 1991 and January 1996 in Cumhuriyet University Medidal Faculty General Surgery Department. Patients with duodenal traumas were excluded from this study, because of their different properties in diagnosis and treatment. 47 of the patients were men and 30 of them were women with a mean age of 34.6 (11-65) years. 27 (%54) of the injuries were due to blunt traumas and 20 (%40) were penetrating traumas. Five of the penetrating traumas were due to knife and 15 of them were due to gunshot. In 3 (%6) of them, traumas were because of the iatrogenic lacerations. In diagnosis direct X-Ray and computerized tomography were used. When there were hypotension and tachycardia diagnostic peritoneal lavage and parasenthesis were performed. Physical examination was often done to detect the peritoneal irritation. In 24 (%48) patients observed associated injuries observed. 29 (%58) of the perforations had simple closure while in 19 (%38) of them resection+anastomasis and in 2 (%4) of them resection + anostomasis + simple closure were performed. In this study morbidity was 16 (%32), and mortality 4 (%8). 3 of the 4 exitus patients had blunt traumas and two of them had generalized peritonitis and there was no associated injury. As a result we can say that high level of the mortality in small intestinal injuries was to delay in diagnosis.

Bu çalýþmaya Ankara Numune Hastanesi Beyin Cerrahi Kliniðinde Ocak 1990-Haziran 1996 yýllarý arasýnda yatýrýlarak tedavi edilen 1450 kafa travmalý hasta alýnmýþtýr. Hastalar çocuk (0-16 yaþ), eriþkin (17-60 yaþ) ve yaslý (61 ve üstü) olarak 3 yas grubuna ayrýlmýþtýr. Hastalarýn %75'i erkek, %25'i kadýn olup, %89.5'ini eriþkin ve çocuk yaþ grubu oluþturmuþtur. Yaþ aralýðý ise 1 gün-92 yaþ arasýndadýr. Çocuklarda düþme (%54), eriþkin (%61) ve yaþlýlarda (%50) trafik kazalarý, travmanýn en fazla nedenini oluþturmuþtur. Hastalarýn yaklaþýk 1/3'ü yaz aylarýnda travmaya uðramýþtýr. Glaskow koma skalasýna (GKS) göre hastalarýn %66'sý hafif (GKS: 13-15), %16.6'sý orta (GKS: 9-12), %17.5'i þiddetli (GKS: 3-8) travmaya maruz kalmýþtýr. Glasgow sonuç skalasýna (GSS) göre olgularýn %71'i tam iyileþme ile taburcu edilirken, %15.7'si ölümcül seyretmiþtir. Ölen hastalarýn %62'sini eriþkinler oluþturmuþ ve %56.1'ine trafik kazalarý neden olmuþtur. Bu çalýþmada ülkemizde kafa travmalarý konusunda epidemiyolojik açýdan yeterli olmayan istatistiksel veriler saptamak amaçlanmýþtýr.

The 1450 head injury patients, which were hospitalized in Ankara Numune Hospital Neurosurgery Department between January 1990-June 1996 have been included in this study. The cases have been grouped in to three according to their ages; pediatrics (0-16 ages), adults (17-60 ages), elders (61 age and above). The 75% of the cases were male, and 25% were woman. Adults and pediatric groups compromised the 89.5% of all cases. The age range was 1 days-92 age. The commonest etiology of trauma were falling (54%) in children, traffic accidents in adults (61%) and elders (50%). Approximately 1/3 of the traumas were come true in summer. According to Glasgow coma scale (GCS), 66% of the cases in mild (GCS: 13-15), 16.5% were moderated (GCS: 9-12), and 17.5% were in severe (GCS: 3-8) trauma groups. According to Glasgow outcome scale (GOS) 71% of the cases were good recovered. The mortality rate was 15.7% and 62% of them were adults. The commonest reason of trauma in died cases was traffic accident (56.1%). In this study; the aim is to obtain statistical datas which are not actually enough to constitute the epidemiology of head trauma in country.

Ocak 1985-Aralýk 1996 arasýnda Erciyes Üniversitesi Týp Fak. Genel Cerrahi Kliniðinde künt travmaya baðlý 38 izole ince barsak yaralanmalý hasta araþtýrýldý. Travma nedeni 23 hasta ile en sýk trafik kazalarýna baðlý idi (%60). Fizik muayenede 27 hastada (%71.1) akut karýn bulgularý vardý. Ultrasonografi (USG) tüm hastalara uygulandý ve sekiz hastada karýnda serbest sývý kolleksiyonu tespit edildi. Diagnostik Peritoneal Lavaj 19 hastaya (%50) uygulandý ve iki hastada yalancý negatif sonuç alýndý. Hastalarýn 21 'inde bir veya daha fazla ekstraabdominal organ yaralanmasý vardý (%55.3). 27 hasta (%71.1) travmadan sonraki ilk 12 saatte operasyona alýndý. Yaralanmanýn lokalizasyonu, 15 hastada jejunum (%39.5), 17 hastada ileum (%44.7) ve 6 hastada multipl (%15.8) idi. Tedaviye 23 hastaya (%60.5) devaskülarize dokularýn debridmaný ve primer onarým uygulanýrken, 14 hastaya (%36.9) rezeksiyon + primer anastomoz uygulandý. Bir hastaya (%2.6) rezeksiyondan sonra ileostomi açýldý. Postoperatif dönemde bir hastada intraabdominal abse, iki hastada yara enfeksiyonu geliþti. 5 hasta (%13.2) ekstraabdominal majör travmalara baðlý olarak kaybedildi. Künt travmaya baðlý izole ince barsak yaralanmalarýnda taný koyma güçlüðü vardýr. Diagnostik Peritoneal Lavaj taný deðeri yüksek bir metoddur. Tedavide amaç devaskülarize dokularýn debridmaný sonrasý primer tamir veya rezeksiyon + primer anastomozdur. Mortalite genellikle ekstraabdominal yaralanmalara baðlýdýr.

Between January 1985-February 1996 38 patients with isolated small bowel injuries due to blunt trauma were evaluated in Erciyes University Medical School General Surgery department The most frequent reason of the trauma was traffic accident with 23 patients (60.5%). 27 patients (71.1%) had acute abdomen in physical examination. Ultrasonography of the abdomen was performed in all patients, and was positive for intraabdominal fluid in eight patients. Diagnostic peritoneal lavage performed to 19 patients (50%) and showed two false negative results. One or more extraabdominal organ injuries occured in 21 patients (55.3%). 27 patients (71.1%) were accepted to the operation in the initial 12 hours of the trauma. The site of injury was jejunum 15 (39.5%), ileum 17 (%44.7%), multiple sites 6 (15.8). In operation debridement of devascularized tissue and primary sutur performed to 23 patients (60.5%) while 14 patients (36.9%) had resection + primary anastomosis. After resection, ileostomy was performed to one patient (2.6%). In the postoperative period, in one patient intraabdominal abscess and in two patients wound infection occurred. Five patients (13.2%) died because of extraabdominal major trauma. Diagnosis of the small bowel injuries due to blunt trauma is dificult. Peritoneal lavage is valuable a diagnostic method. Debridement of devascularized tissues and primary sutur or resection + primary anastomosis is the goal of the treatment. Mortality usually depends on the extraabdominal injuries.

Damar yaralanmalarýnýn acil giriþim gerektirmesi, mortalite ve morbidite açýsýndan önemli bir klinik antite olmasý önemini artýrmaktadýr. 1987-1996 yýllarý arasýnda G.A.T.A Haydarpaþa Eðitim Hastanesi Kalp ve Damar Cerrahi Kliniði'inde damar yaralanmasý nedeniyle tedavi yaþlarý 19-61 arasýnda deðiþen, 52'si erkek, 7'si kadýn toplam 59 olgu retrospektif olarak incelendi. Ýncelenen olgularýn %59.3'ünde sadece arter, %5.1'inde sadece ven ve %21'inde ise her iki damarýn birlikte yaralandýðý gözlendi, %52,5'inde primer onarým, %44.1'inde greft interpozisyonu ve %3.4'ünde ise ligasyon gerekti. Mortalite olmadý ve olgularýn %3.5'inde venöz yetmezlik (n=2), %3.5'inde enfeksiyon (n=2), %1.7'inde erken tromboz (n=1), %1.7'sinde arteriovenöz fistül (n=1) ve %1.7'sinde (n=1) ise metatarsal düzeyde amputasyon olmak üzere toplam %10.3'ünde komplikasyon geliþti. Damar yaralanmalarýnda, müdahale yapýlana kadar geçen sürenin kýsalýðý prognozu belirleyen en önemli unsur olurken, deneyimli bir ekiple en uygun cerrahi giriþimin uygulanmasý ve ciddi bir postoperatif bakým prognozu belirleyen en önemli faktör olmaktadýr.

Vascular injuries require urgent surgical interventions in order to prevent serious complications of (mortality and morbidity. This study retrospectively reviews ten years experience of the vascular traumas managed at the Department of Cardiovascular Surgery, GATA Training Hospital between 1987 and 1996. Amongst these cases, (59) 59.3% were arterial, 5.1% were venous and 21% combined arterial and venous traumas. 52.5% of cases were managed by primary surgical repair, 44% of cases by graft interpositioning and 3.4% of cases were managed by ligation. Overall complication rate was 10.3%. As we investigated the complications; 1.7% (n=1) early fistula, 3.5% (n=1) the most serious complication which was an amputation at metatarsal level. The most important prognostic factor of the outcome of surgical treatment was the time period between the traumatic injury and surgical intervention. Shorter the time elapsed after the injury, after better the results in terms of prognosis. Additionally, appropriate intervention by an experienced surgical team and intensive postoperative care were the important points to consider.

6 yýllýk period boyunca cerrahi olarak tedavi edilen 104 epidural hematom olgusu analiz edildi. Bilgisayarlý beyin tomografisinin (BBT) yaygýn olarak kullanýldýðý dönemi ve öncesi dönemi kapsayan bu serideki 88 olguya BBT ile taný konulurken, kalan 16 olgu anjiografi ve eksploratif burr hole tekniði ile taný aldý. Mortalite oranýmýz %14.4'dür. BBT çekilen grup kendi içinde deðerlendirildiðinde bu oran %10.2 iken, anjiografi-eksplorasyon grubu için %37.5'dur. Bu seride mortalitenin tamamý Glasgow koma skoru (GKS) 8 puanýn altýnda olan olgularda görüldü. Hematom kalýnlýðý, orta hat yapýlarýnýn þifti ve travma ile taný arasýndaki sürenin giriþ GKS'yi etkilediðini gördük. Ve bu çalýþmada giriþ GKS, intradural lezyon varlýðý ve mortalite arasýndaki iliþkiyi analiz ettik.

One hundred and four consecutive cases operated for epidural hematoma over 6 years period were analyzed. This series included patients from both before and after the advent of cumputed tomography (CT). CT scans were obtained in 88 cases. Angiography and exploratory burr holes were performed in 16 cases. The overall mortality was 14.4 %. The mortality rates were 10.2% in CT group and 37.5% in the angiography and exploration group. The glasgow coma scores (GCS) of all patients who died in this series less than 8. We concluded that the thickness of hematoma, the degree of shift of midline structures and the time interval between the trauma and diagnosis affected the GCS of the patients. And there were correlations between GCS and presence of associated intradural lesions with mortality.

Toraks Travmasý nedeniyle kliniðimizde tedavi gören 1749 olgu yaþ gruplarýna ve yaralanma tipine göre 3 gruba ayrýldý. Künt travma oraný çocuklarda %54 eriþkinlerde %47 iken yaþlýlarda bu oran %71 idi (p<0.001). Penetran travma oraný çocuk ve eriþkinlerde sýrasýyla %46 ve %53 iken yaþlýlarda bu oran %29 idi (p<0.001). Laparotomi penetran travmalý eriþkin olgularda (%23.1) daha sýk yapýlmýþtýr ve çocuk ve yaþlý gruplar ile karþýlaþtýrýldýðýnda istatistiki olarak anlamlý bulunmuþtur (p<0.001 ve p<0.05). Künt travmalý olgularda mortalite oraný yaþlýlarda eriþkinlere (p<0.001) ve çocuklara (p<0.05) göre karþýlaþtýrýldýðýnda istatistiki olarak anlamlý bulundu. Penetran travmalý olgulardaki mortalite oraný yaþlý ve çocuk grubu arasýnda (p<0.05) ve çocuk ve eriþkin grubu arasýnda (p<0.05) istatistiki olarak anlamlý bulundu. Penetran travmalý 77 olguda (%8.75), künt travmalý 69 (%7.9) olguda torakotomi yapýlmýþtýr. Künt travmalý olgulardaki genel mortalite oraný %7.2 penetran travmalý olgularda %5.2 idi.

1749 thoracic trauma patients were divided into 3 groups according to age and type of injury. Blunt thoracic trauma comprised 54% of children, 47% of adults and 71% of elderly (p<0.001). Penetrating trauma was the cause in 48% of children, 53% of adults and 29% of elderly. Laparotomy was performed more frequently in the adult patients with penetrating injury and was found significant compared to children and elderly (p<0.00l and p<0.05). For penetrating injury thoracotomy rate was not significant among the groups. For blunt injury mortality rate significant in the elderly compared to adults (p<0.00l) and to children (p<0.05). For penetrating injury mortality was significant between elderly and children (p<0.05) and between children and adults (p<0.05). Thoracotomy rate was 8.75% for penetrating and 7.9% for trauma. Overall mortality rate was 7.9% for blunt and 5.2% for penetrating injuries.

Karýn ameliyatlarýný takiben ilk 30 gün içinde yapýlan relaparotomiler erken dönem relaparotomisi olarak adlandýrýlmaktadýr. Yüksek mortalite ile seyreden bu duruma en sýk septik komplikasyonlar yol açmaktadýr. Son yýllarda görüntüleme yöntemlerindeki geliþmelere ve ameliyata ek olarak yapýlan tedavi modalitelerindeki yeniliklere raðmen mortalite oranlarý belirgin olarak düþmemiþtir. Çalýþmamýzda Pamukkale Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalýnda 18 aylýk sürede yapýlan 771 laparotomi sonrasý relaparotomi gerektiren 22 hasta retrospektif olarak deðerlendirilmiþtir. Çalýþmanýn sonucunda en sýk ve mortal seyreden relaparotomilerin septik komplikasyonlar nedeniyle yapýlan relaparotomiler olduðu kanaatine varýlmýþtýr.

Relaparotomies carried out within 30 days after abdominal operations have been named early relaparotomies. Early relaparotomies have resulted in high mortality rates. They have been mostly caused by septic complications. Mortality rates have not been decreased significantly, although imaging methods and treatment modalities other than operation have advanced in the recent years. In this study, 22 relaparotomies after 771 laparotomies done in 18 months in the department of general surgery, Medical Faculty of Pamukkale University have been evaluated. We have concluded that the most frequent and the most mortal relaparotomies were those done for septic complications.

Bu çalýþmada tedavi ettiðimiz 7 penil fraktürlü olgudaki tecrübelerimiz sunulmaktadýr. Bütün olgular acil olarak operasyona alýnmýþ ve hematom boþaltýmý ile tunika albugineadaki yýrtýðýn tamiri þeklinde tedavi edilmiþtir. Penil fraktüre eþlik eden üretral yaralanma bir olguda görülmüþtür. Ortalama takip süresi 9 aydýr. Erektil fonksiyonun erken kazanýlmasý ile sonuçlar yüz güldürücüdür. Bir olguda aðrýlý ereksiyonlar görülmüþtür. Bu baþarýlý sonuçlar ve konservatif tedavinin bildirilen yüksek komplikasyon oranlarý nedeniyle, penil fraktürde acil cerrahi tedavinin önemi vurgulanmýþtýr.

In this study, we present our experience in the management of 7 patients with penile fracture. All the patients were managed by immediate surgical repair, consisting complete evacuation of the hematoma and repair of the tear in the tunica albuginea. Urethral injury associated with penile fracture was seen in one patient. Mean follow-up time was 9 months. The results were excellent with early recovery of erectile function. Painful erections were observed in one patient. Because of these good results and the reported high complication rate of conservative treatment, the need f or immediate surgical repair is emphasized.

A 8-year-old boy was admitted after traffic accident with any neurologic symptoms. An epidural hematoma was observed at the high cervical region on CT. No fracture and dislocation was detected. Any volume differences of hematoma was detected on control CT. Epidural hematoma has been disappeared with conservative treatment after 6 months. This case was reported due to high cervical location and rarity of the hematoma, asymptomatic presentation because of the anatomical characteristics. Conservative treatment has to be choice with radiological control in the patients with minor neurologic findings, stable or improved status. However, emergency decompression has to be performed in neurologically deteriorated patient.