Acil poliklinik ve ambulans çalýþanlarý da dahil olmak üzere Acil Týp Sistemleri (ATS), medya için zengin haber kaynaklarýdýr. Bu durum özellikle Felâket bölgelerinde ve kurtarma hizmetleri sýrasýnda sýklýkla medya ile acil týp servislerinin birlikte çalýþmasýný ve birinin diðerine konu olmasýný gerektirebilir. Çoðu Felâket ayrýntýlarýyla incelendiðinde görülmüþtür ki; medya-acil týp sistemi birlikteliði, olumlu olabileceði gibi olumsuz sonuçlarda doðurabilmektedir. Bu iliþkilerin iyi düzenlenebildiði durumlarda ortaya çýkabilecek yeni yaralanmalar ve ölümler engellenebileceði gibi, kötü düzenlenen iliþkiler sunulan hizmetin etkinliðini zaten kýsýtlý olan haberleþme ve enerji kaynaklarýný azaltabilir, dahasý acil týp ve kurtarma hizmetinin tamamiyle devre dýþý kalmasýna da neden olabilir.

Comprising the emergency services and ambulance staff, The Emergency Medical Services (EMS) are productive news resources for the media. Especially during rescue work and in disaster areas this condition may oblige the media and EMS to become subject for each other. Detailed examination of most disasters have experienced that cooperation of the media and EMS may both result in positive and negative impacts. Existance of new injuiries and deaths may be prevented by well arranged relations, when poor organisation of relations may result in decreased effectiveness of provided services, communication and energy resources which are already restricted, moreover it may knock out the EMS totally.

Çalýþmamýzda, 1978-1996 yýllarý arasýnda, D.Ü. Diþhekimliði Fakültesi Aðýz-Diþ-Çene Hastalýklarý ve Cerrahisi kliniðinde tedavi edilen 2308 fasiyal fraktürlü hastada; Güneydoðu Anadolu bölgesindeki sosyo-ekonomik ve coðrafik yapý ile iklim koþullarýnýn; fasiyal fraktürlerin etyoloji, yaþ, cinsiyet, anatomik lokalizasyonlar ve mevsimsel daðýlýmlarý üzerindeki etkilerinin araþtýrýlmasý amaçlanmýþtýr. Etyolojik sebepler arasýnda, trafik kazalarý ve düþmelerin birbirlerine yakýn oranlarda ilk sýralarda yer aldýðý, fraktürlerin en sýk olarak görüldüðü yaþ grubunun 0-10 yaþ grubu olduðu tespit edilmiþ ve vakalarýn büyük çoðunluðunu erkeklerin oluþturduðu saptanmýþtýr. Tüm fasiyal fraktürler içerisinde izole fraktürlerin % 88.85 oranýnda görüldüðü ve en fazla sayýda fraktürün mandibulada meydana geldiði tespit edilmiþtir.

In our study, on 2308 patients with facial fractures between 1978-1996 who have had their treatment in department of Oral and Maxillofacial Surgery Faculty of Dentistry University of Dicle, the investigation of following subjects has been aimed; the relationship between socio-economic and geographic situation with seasonal conditions in Southeast Anatolia, the effects of facial fractures on etiology, age, sex, anatomic localization and seasonal distribution. It bas been revealed that traffic accident and falling rank, the first, very closed the each other, among the etiologic reasons and it has been pointed out that the age group most frequently subject to fractures is 0-10 age group the majority of the cases are composed of male patients. It has been determinated that isolated fractures are seen on a 88.5 % basis among all facial fractures and the majority of the fractures are seen in manibula.

Bu çalýþmada 1995-1997 yýllarý arasýnda 34 hematüri bulgulu genel vücut travmalý olgu, hematüriye yaklaþým açýsýndan, literatür de gözden geçirilerek, retrospektif olarak irdelendi. Olgularýn 5'inde makroskopik (2'si gros hematürili), 25'inde mikroskopik hematüri ve 4'ünde üretroraji saptandý. Hematüriye sebep; 17 olguda yüksekten düþme, 12 olguda trafik kazasý ve 4 olguda ateþli silah yaralanmasý olarak belirlendi. Bu olgularýn sadece 3'ünde (%8.83) ürolojik cerrahi giriþim yapýldý. Taný aracý olarak 20 olguda ultrasonografý (US), 6 olguda bilgisayarlý tomografi (BT), 4 olguda intravenöz pyelografi (1VP) ve 4 olguda üretrografi kullanýldý. Hematüriye yaklaþýmda temkinli ve o ölçüde de sabýrlý olmak gerektiði sayýndayýz.

We investigated our approach to hematuria in 34 cases with hematuria and multitraumas who admitted to Emergency Department of our hospital between 1995-1997 retrospectively, supplemented by the review of the current literature. It was determined that there were macroscopic hematuria in 5 cases (gross hematuria in two cases), microscopic hematuria in 25 and urethroragia in 4. Reasons of hematuria were, f ailing from height in 17 cases, automobile accidents in 12 cases and gunshot injury in 4 cases. Surgical procedures were performed to only 3 (8.83%) of these cases. Ultrasonography, computerized tomography, intravenous pyelography and urethrography in 20, 6, 4 and 4 cases respectively, were used as a diagnostic imaging techniques. We advocate that one should be careful and patient while the hematuria was being evaluated.

Peritonitis tüberkülozun nadir görülen bir þeklidir. Bu çalýþmada tüberküloz peritonitin ultrasonografýk bulgularýnýn deðerlendirilmesi amaçlandý. Karýn aðrýsý, karýnda þiþlik, ateþ ve kilo kaybý yakýnmalarýyla müracaat eden altý olgu prospektif olarak incelendi. Sonografýk incelemede olgularýn tamamýnda asit saptandý. Üç olguda homojen anekoik görünüm, iki olguda asit içinde ekojen yýkýntý ürünleri vardý. Yaygýn asitli olgularda fibröz septalar ve dört olguda ince inkomplet mobil bantlar saptandý. Üç hastada peritoneal yüzeyde nodülerite izlendi. Olgularýn üçünde omental kalýnlaþmayý teyit eden omental kek bulgusu saptandý. Lokalize veya yaygýn asitin, septasyon ve internal ekolarýn, peritoneal kalýnlaþma ve nodüleritenin tespitinin þiddetle tüberküloz peritoniti düþündürebileceði, ultrasonografinin tanýda önemli bir rol oynadýðý ve böylece hastalarýn laparoskopi ve laparotomi gibi daha invaziv yöntemlerden korunabileceði kanýsýna verildi.

Peritonitis is a rare form of tuberculosis. The evaluation of the ultrasonographic findings in tuberculous peritonitis was intended in this study. Six cases who referred to the hospital suffering from abdominal pain, abdominal swelling, fever and weight loss were evaluated by ultrasonography prospectively. Ascites was found in all cases by sonographic examination. Homogenous anechoic appearance in three and echogenic debris in the ascites in two cases were present. Fibrous septates were detected in cases with disseminated ascites and fine, incomplete mobile strands in four of cases. Nodularity was observed on the peritoneal surface in three patients. In three cases, omental cake sign which confirms the omental thickening was detected. It is concluded that localized or diffuse ascites, septations and internal echoes, peritoneal thickening and nodularity, may strongly suggest tuberculous peritonitis, and ultrasonography plays an important role in the diagnosis, and prevents further invasive interventions such as peritoneoscopy and laparotomi.

Haziran - Aralýk 1996 tarihleri arasýnda OGÜTF Acil Servisinde genel vücut travmasý nedeni ile tedavi edilmiþ olan 734 olgu yaralanma þiddetinin belirlenebilmesi amacý ile GKS, KYS ve TS ile deðerlendirilmiþtir. Eksitus olan vakalarda mortalitenin tahmin edilebilmesinde üç skorlama sisteminin de duyarlý olduðu görülmüþ, hospitalizasyon ve operasyon ihtiyacýnýn belirlenmesinde ise KYS nin daha duyarlý olduðu görülmüþtür.

734 patients that had been treated for general body trauma were examined with GCS, AIS, TS in order to detect the injury severity between June-December 1996. It is found that all tree scoring systems could be used in order to detect the mortality for exited patients. It is also found that AIS could be used in order to detect the hospitalisation and operation need.

Bu çalýþmada; kliniðimizde tedavi edilen künt ve penetran penis yaralanmalý hastalar retrospektif olarak deðerlendirilmiþtir. Ocak 1990 ile Ekim 1997 tarihleri arasýnda, Dicle Üniversitesi Hastanesi Üroloji kliniðinde penis yaralanmasý nedeniyle 40 hasta tedavi edilmiþtir. Bu hastalar; yaþ, yaralanma þekli, fizik muayene bulgularý, radyolojik bulgular, yandaþ organ yaralanmalarý, tedavi þekilleri, postoperatif erken ve geç komplikasyonlarý yönünden deðerlendirilmiþtir. Hastalar 20-55 (ortalama 28) yaþlarý arasýnda olup, yaralanma nedeni 29 hastada künt travma, 11 hastada ise penetran travmadýr. Künt penil travmalý 3 hastaya medikal tedavi uygulanýrken, diðer 37 hastada cerrahi tedavi uygulanmýþtýr. Yandaþ organ yaralanmalarý, penetran travmalý hastalarda daha fazla saptanmýþtýr. Postoperatif komplikasyon olarak 2 hastada yara enfeksiyonu, 1 hastada üretra darlýðý, 1 hastada penil ereksiyonda yetersizlik ve 5 hastada cinsel iliþkiyi engellemeyen penil kurvatür saptanmýþtýr. Sonuç olarak; penis yaralanmalý hastalarýn cerrahi giriþim ile ciddi komplikasyon olmaksýzýn baþarý ile tedavi edilebileceðine inanýyoruz.

In this study, we reviewed retrospectively the patients with blunt and penetrating penile injury who were treated in our clinic. Between January 1990 and October 1997, 40 patients with penile injury have been treated at Urology department of Dicle University Hospital. These patients have been evaluated for age, the type of injury, the finding of physical examination, the results of radiographic evaluations, the presence of associated organ injuries, management, postoperative immediate and delayed complications. Patients age ranged from 20 to 55 (average age 28). The causes of injuries were blunt trauma in 29 patients, and penetrating trauma in 11 patients. While three patients with blunt penile injury have been treated with medical management, remaining cases (37 patients) were managed by surgery. Associated organ injuries in penetrating trauma were higher than those of blunt trauma. Postoperative complications were wound infection in 2 patients, urethral stricture in 1 patient, insufficient penil erection in / patient and penil curvature that does not prevent satisfactory vaginal generation in 5 patients. As a result; we believe that penile injury can be treated successfully without severe complications, when they treated with early surgical intervention.

Uçak kazalarý, özellikle sað kurtulma þansýnýn son derece az olmasý nedeniyle en ciddi kazalardan kabul edilirler. Uçak kazalarý ile ilgili yayýn Türkçe literatürde olmadýðý gibi yabancý literatürde de fazla yoktur. Ayrýca Van uçak kazasýnda yolcularýn 1/4 ünün sað olarak kurtulmasý da bizi bu çalýþmaya iten sebepler arasýndadýr. 29.12.1994 tarihinde ikinci Ankara-Van uçaðý saat 15.45 sýralarýnda Van havaalanýna iniþ yaparken, kötü hava koþullarý nedeniyle daða çarparak düþmüþtür. 76 yolcudan 55'i olay yerinde, 2'si hastanede olmak üzere toplam 57 yolcu hayatýný kaybetmiþ ve 19 yolcu ise sað olarak kurtulmuþtur. Yaralý yolcular, primer patolojileri itibari ile beþi göðüs cerrahisi, dördü ortopedi ve travmatoloji, üçü beyin cerrahisi ve ikisi de genel cerrahi kliniklerine yatarak tedavi görürken, diðer yedi yaralý ise müþahade amaçlý olarak yatýrýlýp kýsa bir süre sonra taburcu edilmiþtir.

Airplane accidents are believed to be one of the most serious accidents resulting usually with death. No air crash is reported in Turkish literature and very few are in the foreign literature. Salvation of one forth of the passengers in Van airplane accident let us to this clinical study. Van-Ankara plane crushed to the mountain just before landing to Van airport at 15.45 on 29 December 1994. Fifty five of the 76 passengers died immediately at the accident area and 2 died in the hospital, where as 19 left alive. Five of the victimes were enterned to the thoracic surgery department, 4 to the orthopedics, 3 to the neurosurgery and 2 to the general surgery departments due to their primary pathologies. The other 7 patients were observed for a while and externed without any complications.

Bu çalýþma Duodenal ülser perforasyonlu vakalarda hastanede kalýþ süresi ve bu süreye etki eden faktörleri araþtýrmak, multivaryan bir istatistik çalýþmasý ile hangi faktörlerin daha önemli olduðunu saptamak amacýyla yapýlmýþtýr. Duodenal ülserlerin týbbi tedavisinde gerçekleþen büyük ilerlemeler ile birlikte perforasyonlar daha ileri yaþ gruplarýnda görülmeye baþlanmýþtýr. Bu yaþ gruplarýnda mortalite ve morbidite daha yüksek olmakta ve yandaþ hastalýklarda sýk görülmektedir.Bu durum cerrahlarý tedavi protokolleri üzerinde tekrar düþünmeye yöneltmektedir. Duodenal ülser perforasyonu nedeni ile opere edilen 214 olgu Apache II skorlama sistemi kullanýlarak retrospektif olarak incelenmiþtir. Olgularýn % 81.7sinde perforasyonun kronik zeminde geliþtiði,% 12.8'inin akut ülser perforasyonu olduðu görülmüþtür. Hastanede kalýþ süresi ortalama 7 gün olmuþtur. Perforasyon çapý 0.5 cm'in altýnda olan olgularda kalýþ süresi 7.5 gün, 0.6cm- 1cm olanlarda 8.8 gün, 1 cm ve üzerinde olanlarda 16.2 gün olmuþtur. Hastanede kalýþ süresini uzatan faktörler 11 puanýn üzerindeki Apache II skoru, 1cm'nin üzerindeki perforasyonlar ve komplikasyonlarýn mevcudiyeti olmuþtur.Operasyonun türü hastanede kalýþ süresini etkilememiþtir.

The aim of this research is to investigate the factors effecting duration of hospitalization in perforated duodenal ulcer cases and to determine important factors by use of a multivariant stastical methods. After great improvements in medical treatment of duodenal ulcers, perforations have begun to occur in older age groups. The mortality and morbidity rates have been higher and accompanying disorders are more common in those groups. This fact has lead the surgeons to discuss preexisting therapeutic protocols once more. 214 patients operated for duodenal ulcer perforation have been studied retrospectively by means of Apache II scoring system. Perforations have been found to occur in cronic ulcers in 81.7% of patients, and the remaining 18.3% in acute ulcer cases. The duration of hospitalization was 7 days on the average. The factors increasing the duration of hospitalization included Apache II scores above 11 points, perforations larger than 1 cm diameter, and the presence of complications.

Akut epidural hematom (AEH), akut subdural hematom (ASH), subakut subdural hematom (SSH), kronik subdural hematom (KSH), travmatik intraserebral hematom (TÝK) ve travmatik subaraknoid kanama (TSAK) olarak sýnýflayabileceðimiz travmatik intrakranyal kanamalar (TÝK) dördüncü dekat altý en önemli ölüm nedenlerinden birisidir. Son dört yýl içinde Þiþli Etfal Hastanesi Beyin Cerrahisi acil polikliniðimize baþ vuran 5410 kafa travmasý olgusundan TÝK tespit edilen 250 olgu retrospektif olarak deðerlendirildi. En sýk iki neden düþmeler ve trafik kazalarý idi. Olgularýn yaþý ilk dört dekatta ve yedinci dekatta pik yapmakta idi. Trafik kazalarýnýn yarýya yakýnýnda alkol kullanýmý, ilk dekatta görülen travmalarda bisiklet kazalarýnýn sýklýðý dikkati çekti. Yüzyirmiyedi olgu cerrahi, 123 olgu ise konservatif olarak tedavi edildi. En sýk görülen kanama tipi ASH idi. Mortalite oraný % 13.6 olup, en mortal kanama ASH olarak tespit edildi. Bu çalýþmada, TÝK'lerin tipleri, etyolojik ve fizyopatolojik özellikleri, tedavi prensipleri ve mortalite oranlarý göz önünde bulundurularak tartýþýldý.

Traumatic intracranial hemorrhages (TÝK) can be classified as acute epidural hematomas (AEH), acute subdural hematomas (ASH), subacute subdural hematomas (SSH), chronic subdural hematomas (KSH), traumatic intracerebral hematomas (TÝH) and traumatic subarachnoid hemorrhages (TSAK), and they are one of the common causes of death before fourth decade. During last four years, from 5410 cases, admitted to Þiþli Etfal Hospital Emergency Service due to a trauma history, 250 cases had TÝK and they are discussed retrospectively in this study. Falls and traffic accidents were the frequent causes of the trauma. Usually, the cases were in their first four or seventh decade. Near to half of the cases who had traffic accident had alcohol use, and bicycle accidents were one of the most common causes at the first decade. Hundred and twenty-seven cases were treated surgically, and 123 conservatively. Acute epidural hematomas were the most common type of the hemorrhages. The mortality rate was 13.6%, and the most mortal hemorrhages were ASH. In this study, the different types of TÝK are discussed with their etiology and physiopathology, treatment principles and mortality rates.

Dicle üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Kliniðinde 1991-l996 yýllarý arasýnda yaþlarý ortalama 9 (5-13) olan 9 kollum femoris kýrýklý hasta travmadan sonra ilk 24 saat içerisinde operasyona alýndý. Kýrýklar Delbet-Collona sýnýflamasýna göre gruplandýrýldýðýnda, 4'ü Tip I, 3'ü Tip II, 2'si ise Tip IV olarak deðerlendirildi. Ýntrakapsüler kýrýk hematomu boþaltýldýktan sonra açýk redaksiyon uygulandý. Hastalar ortalama 22 (13-36) ay takip edildiler. Ratlif kriterlerine göre 2 olgu kötü, 1 olgu orta, 6 olgu ise iyi olarak deðerlendirildi. Olgularýmýzdan 1 'inde avasküler nekroz, 1 'inde imlant yetmezliði ve koksa vara, 1 'inde ise erken epifiz kapanmasý geliþti. Çocuk deplase kollum femoris kýrýklarýnda erken dönemde intrakapsüler hematomun boþaltýlmasý, açýk redüksüyon ve internal fiksasyonun komplikasyon oranýný düþüreceði kanaatindeyiz.

Early stage open reduction results of collum femoris fractures of children. We reviewed 9 children's fractures of the femoral neck treated in the department of orthopaedic Surgery and Travmatology of the Dicle Universty Medical School during 1991-1996. The main age at the time of fracture 9 (5-13) and the mean length of follow-up after fracture was 22 month (13-36). The patients were operated in the first 24 hours following trauma. Delbet-Colonna's classification was used to classify the type of fracture; four type 2, three type 3, two type 4. According to Ratliffs classification, final results of six cases evaluated good, one fair, two poor. We observed one avasculer necrosis, one premature physeal closure and coxa vara related to previous complication. In child deplaced collum femoris fractures, we are of the opinion that intracapsulary hematome drainage, reduction and internal fixation will reduce the complication rate.

Akut apandisit, cerrahinin en sýk rastlanan acil olgularýndandýr. Sadece hikaye, fizik muayene ve yardýmcý laboratuvar bulgularýna dayanýlarak taný koymak bazen güç olabilir. Þüpheli olgularda ultrasonografinin faydalý bir taný aracý olduðu bildirilmiþtir. Çalýþmamýz, akut apandisitin tanýsýnda ultrasonografinin sensitivite ve spesifitesini araþtýrmak amacý ile planlandý. Haziran 1995-Kasým 1997 tarihleri arasýnda 52 olgu çalýþmaya alýndý. Klinik muayene ve yardýmcý laboratuvar bulgularý ile 32 olguda akut apandisit tanýsý konuldu. 20 olgunun kliniði þüpheli idi. Ultrasonografýk inceleme sonucunda, 34 olguya akut apandisit tanýsý konuldu. Bu olgulardan 3'ü klinik olarak kesin akut apandisit ön tanýsý konulan olgular arasýnda ve 3'ü þüpheli olgular arasýnda idi. Klinik takip sonucunda, ultrasonografik incelemede apandisit ile uyumlu bulgu saptanmayan bir olguda akut apandisit saptandý. Ultrasonografide yanlýþ pozitif sonuç gözlenmedi. Ultrasonografinin akut apandisit tanýsýnda sensitivitesi %97.1, spesifisitesi% 1 00, pozitif tahmin deðeri %100, negatif tahmin deðeri %94.5 ve taný doðruluðu %98.1 olarak tesbit edildi. Ayrýca 6 olguda baþka ve 4 olguda ise ilave patolojiler saptandý. Sonuç olarak, ultrasonografinin, akut apandisitten þüphelenilen olgularý deðerlendirmede sensitivite ve spesifitesinin yüksek olduðu ve ilave abdomen patolojilerini tesbit ederek tedavinin planlanmasýna katkýda bulunduðu gözlendi.

The diagnosis of acute appendicitis may be difficult to establish based on history, physical findings and supplementary laboratory values. It is reported that ultrasonography is a useful tool in the diagnosis of suspected appendicitis. This study was designed to evaluate the sensitivity and specificity of abdominal ultrasonography for acute appendicitis. From June 1995 to November 1997, 52 patients who had possible appendicitis was evaluated. The ultrasonographic study showed 34 acute appendicitis. There was no false positive but one, false negative. The sensitivity was %97.1, the specificity was % 100, the positive predictive value was %100, the negative predictive value was %94.5 and the diagnostic accuracy was %98.1. Clinically suspected appendicitis can be confirmed or excluded by ultrasonographic examination and if there is no evidence of acute appendicitis, ultrasonography can often established alternative diagnosis. Consequently, it may be decreased negative laparotomy and complication of delayed diagnosis.

Karýna yönelik ateþli silah yaralanmalarý yüksek mortalite ve morbidite oranýna sahip bir travma grubudur. Karýna yönelik ateþli silah yaralanmasý nedeniyle servisimizde opere edilen 55 hastanýn kayýtlarýný retrospektif olarak inceledik. Beþ olgu laparotomide organ yaralanmasý bulunmadýðýndan negatif eksplorasyon olarak deðerlendirildi (% 9.1). Geriye kalanlarýn 16'sýnda yalnýzca bir, 34'ünde ise birden fazla karýn içi organ yaralanmýþtý. En sýk yaralanan üç organ; kolon, ince barsak ve karaciðer idi. Üçü peroperatif dönemde olmak üzere toplam 7 hasta kaybedildi (% 12.7). Hastalarýn 10'unda deðiþik komplikasyonlar görüldü. Ortalama hastanede yatýþ süresi 14.3 gündü. Sonuç olarak; karýna yönelik ateþli silah yaralanmalarý, hastanede kalýþ süreleri uzun ve morbidite-mortalite oranlarý yüksek bir yaralanma þeklini oluþturmaya devam etmektedir.

Firearm injuries affecting abdominal regions are a subgroup of trauma surgeries with high mortality and morbidity rates. The records of 55 cases operated in our department were reviewed. Five cases with no intraabdominal organ injury were recognised as negative exploration (9.1 %). Sixteen cases had only one and 34 cases had more than one organ injury. The three most injured organs were the colon, the small intestine, and the liver. There were 7deaths including3peroperative (12.7%). The average length of hospital stay was 14.3 days. In conclusion, our results show that firearm injuries affecting abdominal organs still continue to represent one of the trauma subgroups with long hospital stay and with high morbidity mortality rates.

Patients who have diafragmatic herniation are admitted to hospitals with very different clinical findings. Diafragmatic herniation is one of the high risk surgical groups of thoracic trauma. This pathology can be diagnosed in immediate posttraumatic period as well as years later. Having high risk complications, they must be operated when diagnosed. Here we present a case of 14 year old boy, who had fallen from high 9 years ago. He had been hospitilised but no pathology had been found. 9 years later he was admitted to our hospital with the diagnose of pleural effusion. Thoracentesis revealed no effusion and the spleen was noticed in the thoracic ultrasonographic examination. After-the diagnosis was established the patient was operated. The patient was discharged without complication. Patients who have abnormal chest X-ray findings and have old thoracic trauma history should awake surgeons against traumatic diafragmatic herniation.

Spinal subaraknoid kanama, sýklýkla spinal arteriovenöz malformasyon, anevrizma patlamasý veya tümör gibi nontravmatik lezyonlar sonucunda görülür. Literatürde travmanýn neden olduðu spinal subaraknoid kanamaya çok az rastlanmýþtýr. Bu çalýþmada, pleksus brakiyalis yaralanmasýna baðlý monoparezinin araþtýrýlmasý sýrasýnda, manyetik rezonans görüntülemesinde rastlantýsal olarak saptanan travmatik servikal spinal subaraknoid kanama olgusu sunulmuþtur.

Spinal subarachnoid hemorrhage is frequently seen in non-traumatic lesions of spinal cord such as spinal arteriovenous malformation, aneurism rupture or tumour. Traumatic spinal subarachnoid hemorrhage is a very rare situation in literature. We report a case determined spinal subarachnoid hemorrhage by magnetic resonance imaging incidentally while the investigation of monoparesis caused by brachialplexus injury.

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction. It is related to volvulus of the sigmoid colon and is mainly seen in geographic localizations where volvulus is common. The ileum twists around the base of the sigmoid and both loops are often gangrenous. These patients are usually in poorer general condition. Unfamiliarity with the condition may have disastrous consequences at surgical management. The aim of this case report showing the full-blown clinical features of ISK is to discuss the diagnostic and therapeutic challenges in this special form of bowel volvulus. Vigorous critical care and prompt individualized surgical treatment may improve the survival rate.

Acute spontaneous massive rectal prolapse requiring urgent surgical management is an extremely rare entity. The prolapsed bowel segment may become incarcerated. Progressive edema may then lead to strangulation and gangrene. Ulceration of the exposed mucosa may cause bleeding. The operative management of an acute massive rectal prolapse is discussed in this case report.