AMAÇ: Omurilik yaralanmasý, hayatta kalanlarý yaþamlarý boyunca çeþitli týbbi komplikasyon riski altýnda býrakan yýkýcý bir travmadýr. Lerkanidipin, anti-apoptotik, anti-enflamatuvar ve anti-oksidatif özelliklere sahip üçüncü nesil bir kalsiyum kanal blokeridir. Bu çalýþmanýn amacý, deneysel omurilik travmasý modelinde lerkanidipinin nöroprotektif etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: 21 adet Wistar sýçan rastgele 3 gruba ayrýldý. Grup 1'e (G1) laminektomi uygulandý. Grup 2 (G2) ise laminektomi sonrasý travmaya maruz kaldý. Laminektomi sonrasý travmaya maruz kalan Grup 3 (G3) ise lerkanidipin ile tedavi edildi. Lerkanidipin intraperitoneal olarak 7 gün süreyle uygulandý. Histopatolojik ve immünohistokimyasal deðerlendirmeler yapýldý.
BULGULAR: TUNEL boyama açýsýndan gruplarda anlamlý farklýlýk görülmedi. Öte yandan NF-κβ gruplar arasýnda anlamlý derecede farklýydý. G2, G1 ve G3'e kýyasla önemli ölçüde daha yüksek NF-κβ seviyelerine sahipti.
SONUÇ: Üçüncü kuþak bir kalsiyum kanal blokeri olan lerkanidipin, omurilik yaralanmasýnda oluþan enflamatuvar yanýtlara karþý etkilidir. Apoptozu önleyip önlemediði veya fonksiyonel iyileþmeyi iyileþtirip iyileþtirmediði daha ileri çalýþmalara ihtiyaç duyar. Bildiðimiz kadarýyla lerkanidipinin omurilik yaralanmasý üzerindeki nöroprotektif etkilerini inceleyen bu çalýþma literatürde ilk olma özelliðini taþýmaktadýr.

BACKGROUND: Spinal cord injury is a devastating trauma that leaves survivors at risk for several medical complications throughout their lives. Lercanidipine, a third-generation calcium channel blocker, possesses anti-apoptotic, anti-inflammatory, and antioxidative properties. This study aimed to evaluate the neuroprotective effects of lercanidipine in an experimental spinal cord trauma model.
METHODS: Twenty-one Wistar rats were randomly assigned to three groups. Group 1 (G1) underwent laminectomy. Group 2 (G2) were subjected to trauma following laminectomy. Group 3 (G3) were exposed to trauma following laminectomy and treated with lercanidipine. Lercanidipine was administered intraperitoneally for seven days. Histopathological and immunohistochemical evaluations were conducted.
RESULTS: Regarding Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, there was no significant difference among the groups. However, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) levels were significantly different across the groups. G2 had significantly higher NF-κB levels compared to G1 and G3.
CONCLUSION: Lercanidipine, a third-generation calcium channel blocker, is effective against inflammatory responses induced in spinal cord injury. Further studies are required to determine its capability in preventing apoptosis or improving functional recovery. To the best of our knowledge, this study is the first in the literature to examine the neuroprotective effects of lercanidipine on spinal cord injury.

biyokimyasal parametreler üzerindeki etkilerini ölçmektir.
GEREÇ VE YÖNTEM: Kýrk adet diþi Wistar albino sýçaný 5 gruba ayrýldý: Grup 1 kontrol grubuydu. Diðer 4 grupta 30 dakika süreyle karaciðer is-kemisi oluþturuldu. Grup 3, 4 ve 5'e sýrasýyla 1 saatlik, 2 saatlik ve 3 saatlik ek olarak reperfüzyon uygulandý. Deney sonunda biyokimyasal inceleme için intrakardiyak kan örnekleri, histopatolojik inceleme için ise karaciðerden doku örnekleri alýndý. Elafin, iskemi modifiye albümin (IMA), toplam antioksidan durumu (TAS) ve toplam oksidan durumu (TOS) düzeyleri de incelendi.
BULGULAR: Serum elafin düzeyi grup 2'den itibaren azalarak en düþük düzeye grup 5'te ulaþtý (p<0.01). ÝMA düzeyi kontrol grubunda en düþük, grup 5'te ise en yüksekti (p<0.01). TOS, aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) düzeyleri kontrol grubunda en düþük, grup 5'te ise en yüksekti (p<0.01). Grup 5 en yüksek IMA/albümin oranýna sahipti, ancak bu dört grup arasýnda anlamlý bir fark yoktu. En düþük TAS düzeyi kontrol grubunda bulundu ancak diðer gruplarda stabil ve anlamlý bir artýþ saptanmadý. Alkalen fosfataz (ALP) ve albümin düzeyleri açýsýndan gruplar arasýnda anlamlý bir artýþ saptanmadý. Serum elafin düzeyi ile AST, ALT ve TOS düzeyleri arasýnda negatif korelasyon mevcuttu (p<0.01). Reperfüzyon yapýlan gruplarda (grup 3, 4, 5) grade 1 histopatolojik sonuç sayýsý daha fazla bulundu. Histopatolojik alt grup analizinde; grade 1 grupta elafin düzeyi daha düþük iken, AST, ALT ve TOS düzeyleri yüksek bulundu (p<0.01). Ayrýca grade 1 grupta ÝMA/Albümin oranýnýn daha yüksek olduðu görüldü (p=0.02).
SONUÇ: Hepatik iskemi-reperfüzyon hasarýnda reperfüzyon süresi arttýkça elafin düzeyinin azaldýðý görüldü. Reperfüzyon süresi arttýkça hem hepatosit hasarý hem de oksidan kapasitenin arttýðý, bu bulgular ile elafin düzeyi arasýnda negatif korelasyon olduðu tespit edildi. Dolayýsýyla elafinin hepatik iskemi-reperfüzyon hasarýnda koruyucu bir rolü olabilir ve klinisyenlere karaciðer hasarýný göstermede yardýmcý olabilir.

BACKGROUND: The aim of this study was to quantify serum levels of elafin, a serine protease inhibitor, and to assess its effects on histopathological and biochemical parameters in hepatic ischemia-reperfusion injury.
METHODS: Forty female Wistar albino rats were divided into five groups: Group 1 served as the control group. Liver ischemia was induced for 30 minutes in the other four groups. An additional 1-hour, 2-hour, and 3-hour reperfusion was induced in Groups 3, 4, and 5, respectively. At the end of the experiment, intracardiac blood samples were obtained for biochemical examination, and tissue samples from the liver were taken for histopathological examination. Levels of elafin, ischemia-modified albumin (IMA), total antioxi-dant status (TAS), and total oxidant status (TOS) were also examined.
RESULTS: Serum elafin levels decreased beginning from Group 2, with the lowest level reached in Group 5 (p<0.01). The IMA level was the lowest in the control group and the highest in Group 5 (p<0.01). TOS, aspartate aminotransferase (AST), and alanine amino-transferase (ALT) levels were lowest in the control group and highest in Group 5 (p<0.01). Group 5 had the highest IMA/albumin ratio, although no significant differences were found between these four groups. The lowest TAS level was found in the control group, but a stable and significant increase was not detected in the other groups. No significant differences were found between the groups in terms of alkaline phosphatase (ALP) and albumin levels. A negative correlation was observed between serum elafin levels and AST, ALT, and TOS levels (p<0.01). The number of Grade 1 histopathological results was found to be higher in the groups with reperfusion (Groups 3, 4, 5). In histopathological subgroup analysis, while the elafin level was lower in Grade 1 group, AST, ALT, and TOS levels were higher (p<0.01). Additionally, the IMA/albumin ratio was found to be higher in the Grade 1 group (p=0.02).
CONCLUSION: In hepatic ischemia-reperfusion injury, elafin levels decreased as the reperfusion time increased. As the reperfusion time increased, both hepatocyte damage and oxidant capacity increased, with a negative correlation observed between these findings and elafin levels. Therefore, elafin may play a protective role in hepatic ischemia-reperfusion injury and could assist clinicians in assessing liver injury.

AMAÇ: Kritik hastalarda, özellikle septik þok hastalarýnda, sývý yönetimi klinisyenler için zorlayýcý olabilmektedir. Hemodinamik instabilitesi olan hastalarýn tedavisinde birincil adýmlardan biri intravasküler hacmin optimize edilmesidir. PLR manevrasý, çok sayýda çalýþma ve meta-analizle gösterildiði gibi sývý duyarlýlýðýný deðerlendirmek için güvenilir bir testtir. Bununla birlikte, kullanýmý kardiyak output ölçülmesini gerektirir, bu da genellikle kolay deðildir ve klinisyen deneyimi ve özel ekipman kullanýmý gerektirir. Endtidal karbondioksit (ETCO2 ) ölçümü nispeten kolaydýr ve vücudun CO2 üretimine, CO2'nin akciðerlerden kan dolaþýmýna difüzyonuna ve kardiyak debiye baðlý olduðu için sabit metabolik koþullar altýnda genellikle stabildir. Diðer iki parametre sabitse (metabolik koþullar ve dakika ventilasyonu), ETCO2 kalp debisi hakkýnda bilgi saðlayabilir. Bu çalýþmanýn amacý, ETCO2 ölçümünün sývý duyarlýlýðýný göstermede ne kadar hassas olduðunu araþtýrmaktýr.
GEREÇ VE YÖNTEM: Septik þok tanýsý alan ve dahil edilme kriterlerini karþýlayan tüm hastalara pasif bacak kaldýrma testi uygulandý ve ekokardiyografi ile kardiyak output ölçüldü. Kalp debisinde %15 veya daha fazla artýþ olan hastalar sývýya yanýt veren grup olarak kabul edilirken, %15'in altýnda artýþ olan veya hiç artýþ olmayan hastalar yanýt vermeyen grup olarak sýnýflandýrýldý. Hastalarýn yoðun bakým ünitesine kabul tanýlarý, baþlangýç laboratuvar parametreleri, PLR manevrasý öncesi ve sonrasý tidal volüm ve dakika volümü, ortalama ve sistolik kan basýncý, kalp hýzý, pulse pressure varyasyonu (PPV) deðerleri, ETCO2 deðerleri kaydedildi.
BULGULAR: ETCO2 PLR testinden önce ve sonra, iki grup arasýnda istatistiksel olarak anlamlý bir fark yoktu, ancak ETCO2 deðiþimi (ΔETCO2) yanýt veren grupta anlamlý olarak daha yüksekti. Yanýt vermeyen grupta ΔETCO2 %2.57 (0.81) iken yanýt veren grupta %5.71 (2.83) idi (p<0.001). Sývý yanýtýný öngörmek için ΔETCO2, baþlangýç SVV, ΔSVV, baþlangýç KAH, ΔKAH ve baþlangýç PPV ve ΔPPV için ROC analizi yapýlmýþtýr. ΔETCO2, %4 veya daha yüksek olduðunda sývý duyarlýlýðýný %85 duyarlýlýk ve %86 özgüllük ile öngörmüþtür. ΔETCO2 %5 veya daha yüksek olduðunda, eðri altýndaki alan (AUC) 0.89 (%95 güven aralýðý, 0.828-0.961) ile %99.3 özgüllük ve %75.5 duyarlýlýkla sývý yanýtýný öngörmüþtür.
SONUÇ: Bu çalýþma, septik hastalarda PLR testi sýrasýnda ETCO2'nin sývý duyarlýlýðýný yüksek duyarlýlýk ve özgüllükle gösterebileceðini ve kalp debisine alternatif olarak kullanýlabileceðini göstermektedir.

BACKGROUND: In critically ill patients, especially those with septic shock, fluid management can be a challenging aspect of clinical care. One of the primary steps in treating patients with hemodynamic instability is optimizing intravascular volume. The Passive Leg Raising (PLR) maneuver is a reliable test for assessing fluid responsiveness, as demonstrated by numerous studies and meta-analyses. However, its use requires the measurement of cardiac output, which is often complex and may necessitate clinician experience and specialized equipment. End-Tidal Carbon Dioxide (ETCO2) measurement is relatively easy and is generally stable under steady metabolic conditions. It depends on the body's CO2 production, diffusion of CO2 from the lungs into the bloodstream, and cardiac output. If the other two parameters (metabolic conditions and minute ventilation) are constant, ETCO2 can provide information about cardiac output. The aim of the present study is to investigate the sensitivity of ETCO2 measurement in demonstrating fluid responsiveness.
METHODS: All patients diagnosed with septic shock and meeting the inclusion criteria were subjected to a passive leg raising test, and cardiac outputs were measured by echocardiography. An increase in cardiac output of 15% or more was considered indicative of the fluid responder group, while patients with an increase below 15% or no increase were classified as the non-responder group. Patients' intensive care unit admission diagnoses, initial laboratory parameters, tidal volume, minute volume before and after the PLR maneuver, mean and systolic blood pressure, heart rate, Pulse Pressure Variation (PPV) values, and ETCO2 values were recorded.
RESULTS: Before and after the ETCO2 test, there was no statistically significant difference between the two groups. However, the change in ETCO2 (ΔETCO2) was significantly higher in the responder group. In the non-responder group, ΔETCO2 was 2.57% (0.81), whereas it was 5.71% (2.83) in the responder group (p<0.001). Receiver Operating Characteristic (ROC) analysis was performed for ΔETCO2, baseline Stroke Volume Variation (SVV), ΔSVV, baseline Heart Rate (HR), ΔHR, baseline PPV, and ΔPPV to predict fluid responsiveness. ΔETCO2 predicted fluid responsiveness with a sensitivity of 85% and a specificity of 86% when it was 4% or higher. When ΔETCO2 was 5% or higher, it predicted fluid responsiveness with a specificity of 99.3% and a sensitivity of 75.5%, with an Area Under the Curve (AUC) of 0.89 (95% confidence interval, 0.828-0.961).
CONCLUSION: This study demonstrates that in septic patients, ETCO2 during the PLR test can indicate fluid responsiveness with high sensitivity and specificity and can be used as an alternative to cardiac output measurement.

AMAÇ: Ýnkarsere herni acil cerrahi müdahale gereken bir tablodur. Baðýrsak iskemisinin deðerlendirilip rezeksiyon kararýnýn alýnabilmesi için inkar-sere segmentin tam olarak ortaya konmasý gerekir. Bu çalýþmada amacýmýz acile baþvurup inkarsere herni nedeniyle operasyon planlanan hastalarda yapýlan TAPP'ýn uygulanabilirliðini ortaya koymaktýr.
GEREÇ VE YÖNTEM: Çalýþma retrospektif olarak planlandý. Ocak 2015 ile Haziran 2023 tarihleri arasýnda hastanemiz acil servisine baþvurup TAPP yöntemi ile ameliyat edilen hastalar çalýþmaya dahil edildi.Tüm hastalarda laparoskopik eksplorasyon ile önce inkarsere olan segment ortaya kondu. Rezeksiyon gerekliliði deðerlendirildi. Sonrasýnda laparoskopik yöntemle herni onarýmý yapýldý. Hastalarýn demografik özellikleri, yapýlan ameliyat, baðýrsak rezeksiyon gerekliliði, postoperatif morbidite ve mortalite ve nüks yönünden sonuçlarý not edildi.
BULGULAR: Belirlenen süre içerisinde 109 hasta inkarsere herni nedeniyle baþvurdu. Baþvuran hastalardan 12’i laparoskopik cerrahiye uygun olma-dýðý veya laparoskopik ameliyat kabul etmediði için çalýþma dýþý býrakýldý. 97 hastaya TAPP uygulandý. 6 hastada anestezi indüksiyonu sonrasýnda ba-ðýrsaðýn redükte olduðu izlendi. Hastalarýn 9'unda ise baðýrsakta iskemi-nekroz izlendiði için rezeksiyon anastomoz uygulandý, 7'sinde laparoskopik, 2'sinde açýk teknik kullanýldý. Postoperatif 7 hastada seroma, 3'ünde hematoma 2'sinde ise yara enfeksiyonu görüldü. Mortalite izlenmedi. Yapýlan takiplerde 1 hastada nüks görüldü.
SONUÇ: TAPP hem inkarsere ansý deðerlendirme þansý vermesi hem de laparoskopinin avantajlarý nedeniyle seçili hastalarda acil cerrahi de uygulanabilecek bir prosedürdür.

BACKGROUND: Incarcerated inguinal hernia requires emergency intervention.The incarcerated segment should be thoroughly inspected in order to evaluate the degree of ischemia and decide whether resection is required.The aim of this study is to evaluate the applicability of TAPP for patients seen in the emergency department for incarcerated inguinal hernias.
METHODS: The study was done retrospectively.Patients who presented to the emergency department and were operated with the TAPP technique were included.Ýn all patients laparoscopic abdominal exploration was done to determine the extent of the incarcerated intestinal segment and evaluate the need for resection.TAPP technique was used to laparoscopically repair the hernia. The demographics of the patients,technique used for the hernia repair,necessity for resection,postoperative mortality and morbidity and recurrence rates were recorded.
RESULTS: 109 patients were seen for incarcerated hernia.12 patients were excluded either because they were not suitable for or did not consent to laparoscopic repair.97 patients had hernia repair with TAPP technique.Ýn 6 patients spontaneous reduction of the incarcerated segment was observed after anesthesia induction.Ýn 9 patients necrosis of the incarcerated segment was observed and re-section and anostomosis was performed.7 patients had laparoscopic 2 patients had open resections.Seroma was observed in 7, hema-toma in 3 and wound infection in 2 patients postoperatively.No mortality was seen.1 patient had a recurrence in the follow up period.
CONCLUSION: TAPP technique is a good alternative for selected patients undergoing emergency hernia repair because it provides the surgeon with the possibility to evaluate the incarcerated intestinal segment thoroughly while preserving the advantages of laparoscopic surgery.

AMAÇ: Komplike olmayan apandisit varlýðýnda tedavi standart appendektomi olmakla birlikte, uygunluk halinde medikal tedavi de uygulanabilir. Komplike apandisit varlýðýnda ise cerrahi karmaþýk bir hal alabilmekte, morbidite ve mortalite oranlarý artmaktadýr. Bu çalýþmanýn amacý komplike akut apandisiti ameliyat öncesinde tanýyabilmektir.
GEREÇ VE YÖNTEM: Retrospektif olarak dizayn edilen bu çalýþmada, Alvarado skoru temel alýnarak yeni bir skorlama sistemi geliþtirildi. Yeni skorlama sisteminde Alvarado skoru, kadýn cinsiyet olmasý, yüksek direkt bilirubin varlýðý, artmýþ apandisit kalýnlýðý ve görüntüleme ile komplikasyon veya apendekolit varlýðý puanlandý.
BULGULAR: Akut apandisit nedeniyle ameliyat edilen, yaþ ortalamasý 38.50±12.94 yýl olan toplam 404 hasta çalýþmaya dahil edildi. Hastalarýn %45.8'i kadýndý. Hastalarýn %25'inde komplike akut apandisit vardý. Komplike akut apandisit varlýðý, skoru 10.5 ve üzerinde olan hastalarda %86.1 duyarlýlýk ve %90.4 özgüllük ile gösterildi.
SONUÇ: Ameliyat öncesi dönemde, ameliyat sýrasýnda ve sonrasýnda geliþebilecek komplikasyonlarý öngörebilmek, hastaya doðru bilgilerle uygun tavsiyelerde bulunmak ve uygun olduðunda medikal tedaviyi deðerlendirmek için akut komplike apandisit tanýsýný koymak kritik öneme sahiptir. Yeni skorlama sistemi akut komplike apandisiti tanýmak için etkili bir yöntemdir.

BACKGROUND: In the presence of non-complicated appendicitis, treatment typically involves a simple appendectomy and can even be managed medically. However, in cases of complicated appendicitis, surgery becomes more difficult, and the morbidity and mortality rates increase. This study aims to develop a method for recognizing complicated acute appendicitis operatively.
METHODS: This retrospective study developed a scoring system based on the Alvarado score. Several variables were scored in this new scoring system, including the Alvarado score, female gender, elevated direct bilirubin, increased appendicitis thickness, and the presence of complications as evidenced by imaging or appendicoliths.
RESULTS: The study included a total of 404 patients with a mean age of 38.50±12.94 years, all operated on for acute appendicitis. Of these, 45.8% were female. Complicated acute appendicitis was present in 25% of the patients. The presence of complicated acute appendicitis was identified with a sensitivity of 86.1% and a specificity of 90.4% in patients who scored 10.5 or above.
CONCLUSION: It is critical to identify perioperative and postoperative complications, provide appropriate patient counseling, and consider medical treatment when appropriate to diagnose acute complex appendicitis effectively. The new scoring system is an effective method for recognizing acute complicated appendicitis.

AMAÇ: Pnömomediastinum, mediasten içinde hava birikimi durumunu ifade eder. Bu durum spontan veya ikincil (travma, iyatrojenik) nedenlere baðlý olarak geliþebilir. Nadir görülmekle birlikte en sýk baþvuru semptomlarý olan göðüs aðrýsý ve nefes darlýðý nedeniyle geniþ bir ayýrýcý taný skalasýnýn üyesidir.
GEREÇ VE YÖNTEM: Çalýþmamýz retrospektif, gözlemsel ve kohort bir araþtýrmadýr. Araþtýrmamýza acil servise baþvuran ve bilgisayarlý tomografi sonucu pnömomediastinum tanýsý alan hastalar dahil edildi. Hastalarýn sosyodemografik özellikleri, baþvuru þekilleri, göðüs tüpü ve diðer cerrahi iþlemler, sonuçlarý ve hasta sonlanýmlarý incelendi. Çalýþmanýn birincil sonuç noktasý, travmatik ve spontan pnömomediastinum sonuçlarý; hastane yatýþý, torakostomi tüp takma gerekliliði, cerrahi iþlem gerekliliði ve mortalite olarak belirlendi. Ýkincil sonuç, diðer klinik özelliklerin ve laboratuvar parametrelerinin sonuçlarla iliþkisini belirlemeyi amaçladý.
BULGULAR: Çalýþma, 67 olgu ile tamamlandý. Olgularýn yaþ ortalamasý 44.89±2.41 yýldýr. Olgularýn %67.2'si (n=45) erkektir. Geliþme þekli göz önüne alýndýðýnda, olgularýn %40.3'ü (n=27) spontan, %59.7'si (n=40) travma sonrasý pnömomediastinum tanýsý almýþtýr. Semptomlar arasýnda hastalarýn %50.7'sinde (n=34) dispne ve %49.3'ünde (n=33) göðüs aðrýsý bulunsa da öksürük, ateþ, bulantý-kusma, yutma zorluðu gibi semptomlar da farklý oranlarda rapor edilmiþtir. Hastalarýn %9'unda (n=6) akciðer hastalýðý, %29.9'unda (n=20) ek hastalýk, %3.0'unda (n=2) madde kullanýmý öyküsü bulunurken, %14.9'unda (n=10) torakostomi tüp takýlmýþ ve %20.9'unda (n=14) cerrahi iþlem uygulanmýþtýr. Hastalarýn %35.8'i (n=24) yo-ðun bakým ünitesine yatýrýlmýþ ve %13.4'ü (n=9) hayatýný kaybetmiþtir. Ortalama toplam hastanede yatýþ süresi 8.68±1.12 gün olarak hesaplanmýþtýr. Pnömomediastinum geliþim þekli ile hastane yatýþý arasýnda istatistiksel olarak anlamlý bir iliþki saptanmamýþtýr (p=0.507).
SONUÇ: Pnömomediastinum olgularýnýn nedenlerini incelediðimizde, travma öyküsü bulunan hastalarýn torakostomi tüp takma ve cerrahi müdaha-le gereksinimi daha sýk olduðunu gördük. Ancak spontan ve travmatik olgular olarak sýnýflandýrýldýðýnda, her iki grup da benzer klinik seyir ve sonuçlar sergilemiþtir. Her iki grup da olumlu klinik sonuçlar göstermiþtir.

BACKGROUND: Pneumomediastinum signifies the accumulation of air within the mediastinum. This condition can develop sponta-neously or as a secondary condition due to trauma or iatrogenic causes. Although rare, it is part of a wide differential diagnosis scale due to its most common presenting symptoms: chest pain and shortness of breath.
METHODS: Our study is a retrospective, observational, and cohort investigation. It included patients who presented to the emer-gency department and were diagnosed with pneumomediastinum through computed tomography. The study evaluated patients' so-ciodemographic features, methods of presentation, chest tube insertion, other surgical procedures, outcomes, and patient dispositions. The primary outcome of the study focused on the results of traumatic and spontaneous pneumomediastinum: hospital admission, the necessity for thoracostomy tube insertion, requirement for surgical procedures, and mortality. The secondary aim was to determine the relationship between other clinical features and laboratory parameters and their impact on the outcomes.
RESULTS: The study comprised 67 cases. The average age of the cases was 44.89±2.41 years. Of the cases, 67.2% (n=45) were male. In terms of development, 40.3% (n=27) of cases were classified as spontaneous, and 59.7% (n=40) were post-trauma pneumomediasti-num diagnoses. Among symptoms, 50.7% (n=34) of patients experienced dyspnea, and 49.3% (n=33) presented with chest pain, while symptoms like cough, fever, nausea, vomiting, and swallowing difficulty were reported in varying proportions. Among the patients, 9.0% (n=6) had lung disease, 29.9% (n=20) had comorbidities, 3.0% (n=2) had a history of substance use, 14.9% (n=10) underwent thoracostomy tube insertion, and 20.9% (n=14) required surgical procedures. While 35.8% (n=24) of the patients were admitted to the intensive care unit, 13.4% (n=9) died. The mean total hospital stay was calculated as 8.68±1.12 days. No statistically significant relationship was found between the development of pneumomediastinum and hospital admission (p=0.507).
CONCLUSION: Upon examining the causes of pneumomediastinum cases, it was observed that patients with a history of trauma required thoracostomy tube insertion and surgical intervention more frequently. However, when classified as spontaneous or trau-matic, both groups exhibited similar clinical courses and outcomes. Both groups demonstrated favorable clinical outcomes.

AMAÇ: COVID-19 pandemisi, dünya genelinde saðlýk sistemlerini zorlayan ve toplumlarýn yaþam biçimlerini etkileyen benzersiz bir durumu beraberinde getirdi. Sosyal izolasyon önlemleri, seyahat kýsýtlamalarý ve iþ yerlerinin kapanmasý gibi önlemler, motosiklet kullanýmýnýn artmasýna ve bu dönemde motosiklet kazalarýnýn önemli bir sorun haline gelmesine yol açtý. Bu klinik araþtýrmanýn amacý, COVID-19 Pandemisi dönemindeki motosiklet kazalarýný incelemek ve bu kazalarýn artýþýnýn nedenlerini ve sonuçlarýný detaylý olarak incelemektir.
GEREÇ VE YÖNTEM: Bu araþtýrmada tek saðlýk merkezine ait týbbi kayýtlar incelenmiþ ve belirlenmiþ bir zaman aralýðýndaki motosiklet kazalarýnýn analizi için çeþitli yöntemler kullandýk. Ayrýca, ülkemizde pandeminin baþlangýcýndan önce ve sonra motosiklet kullanýmý ile kazalar arasýndaki iliþkiyi incelemek için istatistiksel analizlerini yaptýk. Biruni Üniversitesi Týp Fakültesi Hastanesi'nde Kasým 2015-Nisan 2023 tarihleri arasýnda kayda geçirilmiþ, motosiklet kazasý öyküsü ile yaralanan ve ayný merkezde takip, tedavisi yapýlan 386 hastanýn kayýtlarý retrospektif olarak incelendi. Olgularýn yaþ, cinsiyet, yaralanma mekanizmasý, yaralanma bölgesi, yaralanma ciddiyeti, kask kullanýmý, kýrýk varlýðý ve bölgesi, kazanýn zaman daðýlýmý ve diðer önemli doku yaralanmalarýn ciddiyet durumlarýný ve yaralanma bölgesi, kýrýklar ve kaza detaylarý ile “Yaralanma Þiddeti Skoru” (Injury Severity Score –ISS) arasýndaki iliþkiyi araþtýrdýk.
BULGULAR: Motosiklet kazalarýnda yaralanan 386 kazazedenin (Erkek n=333, Kadýn n=53), motorsikletli kurye (n=137, %35.5), bireysel motosiklet kullanýcýsý (n=168, %43.5), motosiklet kazasý maðduru (n= 81, %21) ana baþlýklarý altýnda daðýlýmý incelendiðinde, 305 kazazedenin sürücü (%79), 33’ünün (%8.5) motorsiklet yolcusu, 47 kazazedenin yaya (%12.2) ve 1 kazazedenin (%0.3) ise paten sürücüsü olduðunu belirledik. Yaralanma mekanizmalarý incelendiðinde; otokontrolü kaybetme -çarpýþmasýz kazalar- nedeniyle oluþan kazalarýn baskýn olduðu (n=225, %58.3) görüldü. Kazazedelerin tamamý kýrýk varlýðý ve kýrýk bölgesi yönünden incelendiðinde; toplamda 175 kýrýk saptadýk. Sürücülerde kýrýklarýn daha çok sýklýkla üst ekstremite, pelvis ve alt ekstremite kýrýklarý þeklinde olduðunu bulduk. Tüm olgular kemik kýrýklarý ve yumuþak doku yaralanmalarý yönünden incelendiðinde; total kemik kýrýðý sayýsý ve total yumuþak doku travmasý sayýlarý arttýkça ISS deðerlerinin artýþ gösterdiðini belirledik.
SONUÇ: Klinik çalýþmamýzýn bulgularý, COVID-19 pandemisinin toplumun hareketliliðini sýnýrlamak için alýnan önlemlerin motosiklet kazalarýnda bir artýþa neden olduðunu göstermektedir. Özellikle bireysel motosiklet kullanýmý ve motorlu kurye hizmetleri sýrasýnda meydana gelen kazalarýn sayýsýnda belirgin bir artýþ saptanmýþtýr.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has led to a unique set of circumstances, straining health-care systems and affecting the way of life in societies around the world. Measures such as social isolation, travel restrictions, and workplace closures have led to an increase in motorcycle use. Consequently, motorcycle accidents have become a significant problem during this period. This study presents detailed research conducted to examine motorcycle accidents during the COVID-19 pandemic and to understand the causes and consequences of the increase in these accidents.
METHODS: This research evaluated records from a single health examination and used various models to analyze motorcycle acci-dents within a specified time period. Additionally, retrospective analyses were conducted to examine associations between motorcycle use and crashes in our country before and after the pandemic. The records of 386 patients who were injured in motorcycle accidents and followed up, received treatment, and were recorded at Biruni University Hospital between November 2015 and April 2023 were retrospectively examined. Noted details included the victims' age, gender, injury mechanism, injury site, injury severity, helmet use, presence and location of fractures, time distribution of the accident, and the severity of other important tissue injuries. The relationship between the injury site, fractures, and accident details, and the "Injury Severity Score" (ISS) was also investigated.
RESULTS: Among the 386 injured victims in motorcycle accidents, 333 were male and 53 were female. Of these, 168 (43.5%) were motorcycle drivers, 137 (35.5%) were motorcycle couriers, and 81 (21%) were pedestrians. A total of 186 (48%) injuries occurred before the pandemic (November 2015-March 2020), while 200 (52%) were sustained during the pandemic. The study indicates a noticeable increase in motorcycle injuries, particularly among motor couriers, especially during the pandemic quarantine periods. Post hoc analysis revealed that motor couriers had significantly lower ISS compared to other professions (p=0.009 and p=0.045, respectively). Motorcyclists who wore helmets were found to have significantly lower ISS than those who did not wear helmets (p<0.05). Furthermore, it was found that the ISS was positively correlated with the number of bone fractures, total soft tissue injury, and significant clinical characteristics (r=0.758, r=0.756, and p<0.001, respectively).
CONCLUSION: This clinical study’s findings demonstrate that the measures implemented during the pandemic to limit society's mobility have led to an increase in motorcycle accidents. Notably, there has been a significant rise in the number of accidents, particularly involving individual motorcycle use and motorcycle courier services.

AMAÇ: Künt travmalý hastalarda lümenli organ yaralanmalarý, solid organ yaralanmalarýna göre daha az sýklýkta görülen ve kolaylýkla teþhis edilemeyen bir klinik tablo olup, bu durum yüksek mortalite ve morbiditeyle sonuçlanabilir. Karýniçi solid organ yaralanmalarýnda son derece güvenilir olan geliþmiþ görüntüleme cihazlarý içi boþ organ yaralanmasýný göstermeyebilir. Bu çalýþmada, künt travmaya baðlý içi boþ organ yaralanmasý bulunan hastalarýn teþhis ve tedavisi ile ilgili klinik tecrübemizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Nisan 2011 ve Aralýk 2021 tarihleri arasýnda künt abdominal travmaya baðlý lümenli organ yaralanmasý bulunan hastalar bu çalýþmaya dahil edildi. Hastalarýn demografik verileri, yaralanma mekanizmalarý ve yerleri, yaralanan organlar, uygulanan cerrahi tedavi yöntemleri, ameliyat öncesi ve cerrahi sürecinde gözlenen bulgular, morbidite ve mortalite prospektif veri tabanýnda kayýt edilerek retrospektif olarak deðerlendirildi.
BULGULAR: Kliniðimizde yatýrarak tedavi edilen 607 künt travmalý hastanýn 35'inde (%5.8) içi boþ organ yaralanmasý bulundu. Bu hastalarýn %88.6’sý erkekti. Motorlu taþýt kazalarý en sýk yaralanma nedeni idi (%80). Yatýþtan ameliyata kadar geçen ortalama süre 26±21.2 saat idi. Ortalama Yaralanma Þiddet Derecesi 21.8±13.6 idi. En sýk rastlanan bulgu abdominal defanstý (%60). Jejunum ve ileum en sýk yaralanan organlardý (%51.4). Mortalite ve morbidite oranlarý sýrasýyla %11.4 ve %17.1 olarak bulundu.
SONUÇ: Yatýþtan sonra 24 saat içinde düþmeyen lökositoz deðerleri içi boþ organ yaralanmasý þüphesini düþündürebilir. Herhangi bir lümenli organ yaralanmasýna iþaret eden fizik muayene ve/veya görüntüleme bulgusu varlýðýnda cerrahi eksplorasyon gecikmeden gerçekleþtirilmelidir.

BACKGROUND: Hollow viscus injuries (HVIs) present less frequently than solid organ injuries in patients with blunt abdominal trauma, potentially leading to significantly increased morbidity and mortality rates. Modern imaging equipment, confidently used for diagnosing solid organ injuries, may fail to identify hollow viscus injuries. In this study, we aim to present our tertiary center’s experience with this entity.
METHODS: Patients treated in our clinic from April 2011 to December 2021 for hollow viscus injury following blunt abdominal trauma were included in this study. We recorded and retrospectively evaluated patients’ demographic data, injury site and mechanism, preoperative and perioperative findings, and mortality rates in a prospective database.
RESULTS: Of the 607 blunt trauma patients, 35 (5.8%) had hollow viscus injuries, with 88.6% being male. Motor vehicle accidents were the leading cause of injury (80%). The mean duration between admission and surgical exploration was 26±21.2 hours. The mean Injury Severity Score was 21.8±13.6. Rigidity was the most frequent clinical finding (60%). The jejunum and ileum were the most frequently injured organs (54.1%). Mortality and morbidity rates were 11.4% and 17.1%, respectively.
CONCLUSION: Nondeclining white blood cell (WBC) counts within 24 hours of admission, alongside any physical or radiological finding indicating an HVI, should prompt immediate surgical exploration.

AMAÇ: Bu çalýþma, açýk glob yaralanmalý (AGY) pediatrik hastalarý modifiye pediatrik oküler travma skoru (MPOTS) ile deðerlendirmeyi ve nötro-fil/lenfosit oraný (NLO), trombosit/lenfosit oraný (TLO) parametrelerinin prognoz ve MPOTS ile iliþkisini incelemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþma, AGY'li pediatrik hastalar üzerinde yapýlmýþtýr. Hastalarýn demografik verileri, yaralanma tipi, yaralanma-ameliyat süresi, tam oftalmolojik muayeneleri, baþlangýç ve son görme keskinlikleri, ön segment ve fundus bulgularý, NLO ve TLO kaydedildi. Hastalar MPOTS skorlarýna göre üç kategoriye ayrýldý: kategori 1 (≤30 puan), yüksek risk; kategori II (35–65 puan), orta risk; ve kategori III (≥70), düþük risk.Kategoriler arasýndaki farklýlýklar istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþmaya 22 hasta alýndý. Kategori 1'de yaralanma-ameliyat süresi daha uzundu (p=0.018). Kategori 1'de en sýk görülen yaralanma tipi 4 (%50) hastada glob rüptürü idi ve gruplar arasýndaki fark anlamlýydý (p=0.041). Kategori 1 diðer kategorilere göre daha düþük son görme keskinliðine ve daha yüksek NLO ve TLO deðerlerine sahipti (tüm deðerler için p<0.050). NLO ve TLO, MPOTS ile anlamlý negatif korelasyona sahipti (sýrasýyla, r= -0.869, p<0.001; r= -0.809, p<0.001).
SONUÇ: MPOTS, pediatrik AGY hastalarýnýn prognozunu deðerlendirmek için etkili ve pratik bir yöntemdir. Pediatrik hastalarda AGY sonrasý NLO ve TLO'nun MPOTS ile negatif korele olduðu gösterilmiþtir.

BACKGROUND: This study aims to assess pediatric patients with Open Globe Injury (OGI) using the Modified Pediatric Ocular Trauma Score (MPOTS) and to investigate the correlation between Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lympho-cyte ratio (PLR) parameters with the prognosis determined by MPOTS.
METHODS: In this retrospective study, we included pediatric patients with OGI. Recorded data encompassed demographic details, injury type, duration from injury to surgery, complete ophthalmological examinations, initial and final visual acuities, anterior segment and fundus findings, and NLR and PLR values. Patients were categorized into three groups based on their MPOTS scores: Grade I (≤30 points), indicating high risk; Grade II (35-65 points), moderate risk; and Grade III (≥70 points), low risk. Differences between categories were statistically evaluated.
RESULTS: The study comprised 22 patients. In Category I, the duration from injury to surgery was longer (p=0.018). The most common injury type in this category was globe rupture, occurring in four (50%) patients, with a significant difference noted between the groups (p=0.041). Category I exhibited lower final visual acuity and higher NLR and PLR values compared to the other categories (p<0.050 for all values). Both NLR and PLR demonstrated significant negative correlations with MPOTS (respectively, r=-0.869, p<0.001; r=-0.809, p<0.001).
CONCLUSION: The Modified Pediatric Ocular Trauma Score is an effective and practical method for assessing the prognosis of pediatric patients with Open Globe Injury (OGI). Furthermore, there is evidence indicating a negative correlation between MPOTS and the increase in NLR and PLR values that often follows OGI in this patient population.

AMAÇ: Ýzole distal radius ve radius baþý kýrýklarý çok sýk görülen yaralanmalar olmakla birlikte, eþ zamanlý ipsilateral kýrýklarý nadirdir. Her iki uçta basit yer deðiþtirmemiþ kýrýklardan, ayný tarafta ciddi parçalý proksimal ve distal radyal kýrýklara kadar farklý formlarda meydana gelebilir. Parçalý distal radius ve radius baþý kýrýklarýnýn eþlik ettiði az sayýda vaka rapor edilmiþtir; herhangi bir tedavi kýlavuzu mevcut deðildir ve kararlar kiþisel tavsiyelere dayanmaktadýr. Çalýþmamýzýn amacý, bu yaralanma þekline iliþkin farkýndalýðý artýrmak, yaralanmanýn mekanizmasýný, tedavi yaklaþýmýný ve fonksiyonel sonuçlarýný tartýþmaktýr.
GEREÇ VE YÖNTEM: 2016-2021 yýllarý arasýnda distal ve proksimal radius kýrýklarýnýn eþ zamanlý ipsilateral parçalý kýrýklarý olan iskelet matüritesini tamamlamýþ hastalar çalýþmaya alýndý ve retrospektif olarak incelendi. Demografik bilgiler, yaralanma mekanizmasý, tedavi yaklaþýmý ve komplikasyon oraný analiz edildi. Redüksiyonun yetersizliði veya kaybýna yönelik radyografik deðerlendirme ve radyal eðim, radyal uzunluk ve palmar eðim dahil olmak üzere distal radiusun radyografik parametreleri ameliyattan hemen sonra ve son takipte yapýldý. Klinik sonuçlar her iki eklem hareket açýklýðýný ölçen VAS skoru hesaplanarak ve son takipte Quick DASH skoru kullanýlarak belirlendi.
BULGULAR: Toplam 11 hasta dahil edilme kriterlerini karþýladý, hepsinde ayný tarafta Mason III radius baþý kýrýðý ve tip C (AO sýnýflamasýna göre) eklem içi distal radius kýrýðý vardý. Radius baþý kýrýðý için masa üstü radius baþý rekonstrüksiyonu ve proksimal radius plak ile fiksasyonu, distal radius kýrýðý için ise anatomik volar kilitli plak ile osteosentez yapýldý. Ortalama takip süresi 32 (12-65) ay idi. Son takipte tüm hastalarda hem radius baþý hem de distal radiusta osseöz kaynama gözlendi. Ortalama VAS istirahatte 1.5 (0-7), aktivitede 3.9 (0-9), Quick DASH skoru ortalamasý ise 32 (12-65) idi. Önemli bir komplikasyon görülmedi.
SONUÇ: Ayný taraftaki distal radius ve radius baþýnýn eþzamanlý parçalý kýrýklarý, çoðunlukla açýk el üzerine yüksekten düþme sonucu oluþan yüksek enerjili travmadan kaynaklanabilecek farklý bir yaralanma modelini temsil eder. El bileði yaralanmalarýnda dirseðin, dirsek travmalarýnda el bileðinin klinik muayenesine ve radyolojik görüntülemesine önem verilmelidir. Radius baþýnýn masa üzerinde rekonstrüksiyonu ve açýk redüksiyon ve volar plakla internal fiksasyonu ile yapýlan tedavi, uzun vadede iyi radyolojik ve fonksiyonel sonuçlara yol açabilir.

BACKGROUND: Although isolated distal radius and radial head fractures are common injuries, simultaneous ipsilateral fractures are uncommon. They can range from simple undisplaced fractures at either end to severely comminuted ipsilateral proximal and distal radial fractures. Few cases have been reported with concomitant comminuted distal radius and radial head fractures, and no treatment guidelines are available. Decisions are often based on personal recommendations. The purpose of our study is to increase awareness of this injury pattern and to discuss the mechanism of injury, treatment approach, and functional outcome.
METHODS: Skeletally mature patients with comminuted simultaneous ipsilateral fractures of the distal and proximal radius from 2016 to 2021 were identified and studied retrospectively. Demographic information, mechanism of injury, treatment approach, and complication rate were analyzed. Radiographic assessment for inadequacy or loss of reduction and radiographic parameters of the distal radius, including radial inclination, radial length, and palmar inclination, was performed immediately postoperatively and at the final follow-up. Clinical outcomes were determined by calculating the Visual Analog Scale (VAS) score, measuring the range of motion in both joints, and using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at the final follow-up.
RESULTS: A total of 11 patients met the inclusion criteria. All had ipsilateral Mason III radial head fractures and type C (according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification) intra-articular distal radius fracture. On-table radial head reconstruction and fixation with a proximal radius plate were used for radial head fractures, and osteosynthesis with an anatomic volar locking plate was used for distal radius fractures. The mean follow-up duration was 32 months (range 12-65 months). At the final follow-up, osseous union of both the radial head and distal radius was observed in all patients. The mean VAS score was 1.5 (range 0-7) at rest and 3.9 (range 0-9) with activities, while the mean QuickDASH score was 32 (range 12-65). No significant complications were recorded.
CONCLUSION: Simultaneous comminuted fractures of the ipsilateral distal radius and radial head represent a distinct injury pattern, most likely resulting from high-energy trauma, such as falling from a height onto an outstretched hand. Greater emphasis should be placed on clinical examination and radiological imaging of the elbow in cases of wrist injuries and vice versa. Treatment involving on-table reconstruction of the radial head and open reduction and internal fixation with a volar plate can lead to good radiological and functional outcomes.

Travma, küresel olarak ölümlerin altýncý sebebi olup, genç hastalarda morbidite ve mortalitenin en önemli nedenidir. Baðýrsak ve mezenterin künt yaralanmasý karýn travmalarýnýn sadece %1-5'ini oluþturmakla birlikte yüksek morbidite ve mortaliteye sahiptir. Bu olgu sunumunda, trafik kazasý sonrasý emniyet kemeri nedeniyle mezokolon yaralanmasý geliþen ve sigmoid kolon iskemisi sonucu perforasyon geliþen bir hasta sunuldu. Yirmi bir yaþýndaki erkek hasta 2 gün önce geçirdiði trafik kazasý sonrasý acil servise karýn aðrýsý ve kusma þikayetiyle baþvurdu. Yapýlan bilgisayarlý tomografide sigmoid kolon perforasyonundan kaynaklanan karýn boþluðunda serbest hava ve pelvik bölgedeki serbest sývý görüldü. Hasta tanýsal laparotomi yapýlmak üzere acil ameliyata alýndý. Yapýlan inceleme sonucu sigmoid kolon mezosunun yýrtýldýðý, iskemi ve perforasyona neden olduðunu görüldü. Ayrýca, iskemi olmadan ileoçekal valfe yakýn terminal ileum mezenterinde bir yýrtýk daha saptandý. Kýsmi sigmoid kolon ve ileal rezeksiyonlar, sýrasýyla kolokolik anastomoz ve çift namlulu ileostomi ile gerçekleþtirildi. Travma hastalarýnda detaylý klinik muayene ve radyolojik deðerlendirme, visseral organ yaralanmalarýnýn erken tanýsýnda önemli rol oynamaktadýr. Künt karýn travmalý hastalarda izole mezenter yaralanmasýný erken teþhis etmek peritonit bulgularý geç ortaya çýkabileceði için zor olabilmektedir. Özellikle emniyet kemeri takan hastalarda, karýn cildindeki kemer pozisyonuna uyan ekimoz bulgularý emniyet kemeri yaralanmasý açýsýndan uyarýcý olabilmektedir. Ýntestinal hasarýn erken tanýnmasý ve onarýmý ciddi komplikasyonlarý önleyebilir.

Trauma is the sixth leading cause of death globally and the leading cause of morbidity and mortality in young patients. Blunt bowel and mesenteric injuries are rare, occuring in only 1-5% of blunt abdominal traumas, and are associated with high morbidity and mortality. In this report, we present a case of a patient with sigmoid colon perforation due to ischemia caused by mesenteric injury, who was admitted to the hospital with abdominal pain two days after a car accident. A twenty-one-year-old man was admitted to the emergency department with abdominal pain and vomiting, having been involved in a car accident as a driver two days prior. Computed tomogra-phy revealed free air in the abdomen, originating from the perforation of the sigmoid colon wall, and free fluid in the pelvic area. The patient underwent immediate laparotomy. Exploration revealed a rupture in the sigmoid mesocolon, causing ischemia and perforation. Additionally, there was a rupture in the mesentery of the terminal ileum close to the ileocecal valve, but without ischemia. Partial sig-moid colon and ileal resections were performed, followed by colocolic anastomosis and double-barrel ileostomy. He was discharged in good health after a 20-day hospital stay. Thorough clinical examination and radiological evaluation can aid in detecting visceral injuries in trauma patients. Early recognition and repair of intestinal damage can prevent severe complications.