Çalýþmamýzda sýçanlarda alkali ile oluþturulmuþ özofagus yanýðýnda deksametazon ve prednizolonun striktür geliþimi üzerine etkilerinin karþýlaþtýrýlmasý amaçlanmýþtýr. Çalýþmamýzda 40 adet Spraque-Dawley cinsi rat (225-250 gr) kullanýldý. Ratlar herbiri 10 denekten oluþan 4 gruba ayrýldý. Grup 1 ratlarda özofageal lümen içi normal serum fizyolojik ile yýkandý. Grup 2 sýçanlarda %50'lik NaOH ile özofagus yanýðý oluþturuldu ve parenteral antibiyotik verildi. Grup 3 ratlarda özofagus yanýðýný takiben deksametazon (1mg/kg/gün)+parenteral antibiyotik baþlandý. Grup 4 ratlarda özofagus yanýðýný takiben prednizolon (2mg/kg/gün) +parenteral antibiyotik baþlandý. Ratlarýn tümü 21. günde sakrifiye edilerek abdominal özefaguslarý histopatolojik inceleme için çýkarýldý. Grup 1 rotlarda submukozal kollojende artýþ, muskularis mukoza hasarý ve tunika muskularis hasarýna rastlanmadý. Grup 2,3 ve 4 ratlarýn, Grup 1 ratlarla karþýlaþtýrýlmasýnda submukozal kollajende artýþ, muskularis mukoza hasarý ve tunika muskularis hasarý saptandý (p<0,0001, p<0,000l, p<0,0001. Grup 3 rotlar ile grup 2 ratlarýn her üç parametre açýsýndan karþýlaþtýrýlmasýnda grup 3'de lezyonlarýn daha az geliþtiði ve istatistiksel olarak anlamlý olduðu saptandý (p < 0,001, p<0,001, p<0,001). Ayný paremetrelerin ýþýðýnda Grup 4 ile Grup 2 ratlarýn karþýlaþtýrýlmasýnda muskularis mukoza ve tunika muskularis hasarý açýsýndan anlamlý farklýlýk saptandý (p < 0,001, p < 0,001). Grup2 ile Grup 4 arasýnda submukozal kollojende artýþ yönünden fark bulunmadý (p > 0,05). Sonuç olarak, prednizolon muskularis mukozaya kadar ilerleyen yeni kollajen sentezini azaltabilir ancak darlýk oluþumunu azaltýcý etkisi deksametazona göre belirgin deðildir.

In this experimental study, we aimed to evaluate the effects of prednisolone and dexamethasone developing of strictures in alkali esophageal burns of rats. Fourty Spraque-Dawley rats weighting between 225 and 250 gram were used. Rats were randomly divided into 4 groups. In Group 1 rats (control), esophageal lumen was washed with normal saline. In Group 2 rats, distal esophagus was burned with 50% NaOH solution and parenteral antibiotics were given. In Group 3 rats, after esophageal burn developing, dexamethasone (1 mg/kg/day) and parenteral antibiotics were given. In Group 4 rats, after esophageal burn developing, prednisolone (2mg/kg/day) and parenteral antibiotics were given. All rats were sacrificed at 21 st days of procedure. All rats were evaluated for submucosal collagen increase damage of muscularis mucosa and tunica muscularis histopathologically. There were nosubmucosal collagen increase, muscularis mucosa and tunica muscularis damage in Group 1. There was significant difference for submucosal collagen increase, muscularis mucosa and tunica muscularis damage when groups 2,3 and 4 was compared to Group I (p<0.0001, p<0.0001, p<0.0001). There was also significant difference for 3 parameter when Group 3 was compared to Group 2(p<0.001,p<0.001,p<0.001).There was significant damages in muscularis mucosa and tunica muscularis when Group 4 was compared to Group 2 (p< 0.001, p < 0.001). No significant difference was found for submucosal collogene developing between when Group 4 was compared to Group 2 (p>0.05). As conclusion, prednisolone may reduce submucosal collagen synthesis, but the preventine effects ofesophageal stricture is less than dexamethasone.

1995-1999 yýllarý arasýnda kliniðimize akut karýn nedeni ile baþvuran ve spontan ince barsak perforasyonu saptanan olgular; yaþ, cins, hastaneye baþvuru süresi, etyoloji, mortalite ve morbidite yönünden deðerlendirildi. Akut karýn nedeni ile baþvuran 640 hastanýn 14'ü (%2.1) spontan ince barsak perforasyonu idi. Yaþ ortalamalarý 57 olan olgularýn 3'ü kadýn, 9'u erkekti. Hastaneye baþvuru süreleri ortalama 4.9 gün idi. Mortalite oraný %21.4, morbidite oraný %35.7 idi. Baþvuru anýnda hesaplanan APPACHE II skoru yaþayan hastalarda ortalama 6.5, ölen hastalarda ortalama 13.3 tür 8 olguda perforasyonun sebebi bilinmezken 6 olguda sebep karsinom metastazý (1), crohn hastalýðý (1), divertikülit (1), amiloidozis (1), bezoar (1) ve radyoterapi (1) olarak belirlendi. Beþ olguya ostomi, diðerlerine segmenter rezeksiyon-debridman + anastoýnoz tekniði uygulandý. SÝP kliniðimizde sýk görülmeyen bir tablodur. Bulgular nonspesifik olduðu için taný çoðunlukla ameliyatta konulmaktadýr. Etyoloji genellikle belirsiz olup, uygun olgularda rezeksiyon ve primer anastomoz güvenle uygulanabilmektedir.

Aim: To analyse the cases admitted to our clinic due to spontaneous small bowel perforation. Material and method: Between 1995-1999, the cases admitted to our clinic for acute abdominal pain and diagnosed as spontanous small bowel perforations were analysed retrospectively. The age, sex, admittance time, etiology mortality and morbidity of these patients were evaluated. Results: 640 patient were admitted in this period and 14 of them were spontanous small bowel perforations (2.1%). Nine of them were male and three were female. Mean age of the patients was 57. Mean admittance time to the hospital was 4.9 days. Mortality rate was 21.4% and morbidity rate was 35.7%. The mean APPACHE II score of the patients died on the admission was 13.3 and survived was 6.5. The causes of the perforation were metastatic carcinoma (1), bezoar (1), radiotherapy (1), crohn disease (1) and amiloidosis (1). The etiology was unknown in 8 patients. Temporary ileostomy was performed in five cases and resection + anastomosis was performed in rest of the remaining cases. Discussion and conclusion -Small bowel perforation is an uncommon condition in the clinical practice. The findings of this entity are nonspecific, and the diagnosis is usully made in the operating room. The etiology is mostly unclear. Resection and primary anastomoses can be useful in the suitable cases.

Bu çalýþýna petroz kemik kýrýklarýnýn klinik öneminin ortaya konulmasý amacý ile yapýldý. Çalýþmada kliniðimize kafa travmasý sonucu baþvuran olgulardan petroz kemik kýrýðý saptanan 47si retrospektif olarak incelendi. Olgularýn klinik ve radyolojik özellikleri kaydedildi. Kýrýða baðlý en sýk görülen komplikasyonlar otoraji, iþitme azalmasý, vertigo, fasyal sinir yaralanmasý ve otoreydi. Petroz kemik kýrýklarý kemiðin içerdiði yapýlar nedeni ile ciddi komplikasyonlara yol açabildiðinden olgulara belirli prensiplerle yaklaþýlmalý ve travma sonrasý yakýndan izlenmelidirler.

This study was designed to discuss the clinical importance of petrous bone fractures. 47 of the head injuries with petrous bone fracture were investigated retrospectively. Clinical and radiological characteristics of the cases were recorded. Most common complications due to fractures were otorrhagie, reduction in the sense of hearing, vertigo, facial nerve injury and otorrhea. Petrous bone fractures can cause serious complications because of certain structures lying in the bone. For that reason cases should be systematically approached and closely maintained in the early and late posttraumatic period.

Bu yazýda travma cerrahisinde önemli bir problem olan gereksiz laparatomiler (GL) konusundaki literatür bilgileri ýþýðýnda kendi tecrübelerimizi irdeledik. Son 9 yýllýk dönemde travma nedeniyle ameliyat ettiðimiz190 hastanýn 47si (%24.7) GL olarak deðerlendirildi. Bu hastalar içinde en büyük grubu 24 hasta (%51.1) ile kesici delici alet yaralanmasýna (KDAY) maruz kalanlar oluþturuyordu. Hastalardan 26'sý (%55.3) alkollüydü. Hastalardan 25'inde (%13.2) eksplorasyon dýþýnda bir þey yapýlmazken negatif laparatomi (NL), 22 olgu (%11.5) ise non terapötik laparatomi (NTL) olarak deðerlendirildi. Gereksiz laparatomi oraný ise (NL+NTL) %24.7 (%13.2 + %11.5) olarak bulundu. Ortalama hastanede kalýþ süresi 5.2 (3-43) gündür. Morbiditemiz kabul edilebilir düzeyde (%10.6) ve mortalitemiz yoktur. Batýn içi yaralanmanýn tanýsýnda non invaziv ve invaziv tüm testlerin güvenilirliði kýsýtlý olduðundan periton bütünlüðünü bozan penetran yaralanmalar ve ultrasonografi yada diagnostik peritoneal lavaj ile batýn içi yaralanma düþünülen tüm olgulara araþtýrýcý laparatomi uyguladýk. Ancak özellikle son iki yýldýr bizde de batýn içi yaralanma olup olmadýðý konusunda karar verilemeyen hastalarýn klinik muayene, vital bulgular, tam kan sayýmý, ultrasonografi ve bilgisayarlý tomografi gibi laboratuar tetkikleri ile takip edilmesi tercih edilmektedir.

In this study, we analysed our experience in unnecessary laparatomy, which is an important problem in trauma surgery with the help of the literature. During the last nine years period, 47 of the 190 patients (24.7%) whom we operated due to trauma were considered as unnecessary laparatomy. Stab wounds consists of the biggest group with 24 patients (51.1%). Majority of the patients (55%) were drunk. We applied laparatomy to all of the patients in which peritoneal entirety were deteriorated and/or USG or DPL give rise to thought intro abdominal haemorrhage or visceral impairment; because non-invasive and invasive tests are not reliable exactly yet. We carried out only an exploration of the abdomen for 25 of the patients (13.2%) which consists of the negative laparatomy group. There was an only small superficial, non-bleeding lesion of the liver or spleen, laceration of the amentum, which requires no further surgical treatment in the remaining 22 patients (%11.5) which consists of the non-therapeutic laparatomy group. Both of these groups forms the unnecessary laparatomy group. The morbidity rate is acceptable (10.6%) and we don't have mortality.

Trafik kazalarý, 40 yaþ altý eriþkinlerde kaza sonucunda meydana gelen ölümlerin baþlýca nedenlerindendir. Bu ölümlerin azaltýlabilmesi çok basit önlemlerle olasýdýr. Yöntem: A.Ü.T.F. Göðüs Cerrahisi A.B.D'nda Ocak 1988 ve Þubat 1998 arasýnda künt ve penetran göðüs travmalý 532 hasta deðerlendirildi. Hastalarýn 4087 erkek 124'ü kadýndý. Künt travmalý 448 hastanýn 128'inde kosta fraktürü, 93'ünde kosta fraktürü ve pnömotoraks, 32'inde kosta fraktürü ve hemotoraks, 94'ünde kosta fraktürü ve hemopnömotoraks, 44'ünde yelken göðüs, 48'inde sternum fraktürü, sekizinde diafragma rüptürü ve bir hastada da özofagus rüptürü vardý. Penetran travmalý 84 hastanýn 18'inde pnömotoraks, 12'sinde hemotoraks, 29'unda hemopnömotoraks, üçünde diafragma rüptürü, yedisinde büyük damar yaralanmasý, bir hastada sol atrium ve yine bir hastada özofagus-trakea ve larinks yaralanmasý söz konusuyken 13 hasta asemptomatikti. Sonuçlar: Tedavi sonuçlarý kosta fraktürü, kosta fraktürü ile pnömotoraks ve hemotoraks olan hastalarda baþarýlýydý. Bu grupta morbidite ve mortalite gözlenmedi. Hemopnömotoraksý olan 123 hastanýn, 18'i gözlemde tutuldu, 91'ine göðüs tüpü konuldu (Göðüs tüpü konulmasýnýn ardýndan 26 hasta ameliyata alýndý), sekiz hasta ise doðrudan operasyona alýndý. Bu grupta mortalite oraný %5.69 (7/123)'du. Yelken göðüslü hastalarýn 41'inde mekanik ventilasyon gerekti ve 11 hasta SIRS, karaciðer ve böbrek yetmezliðinden kaybedildi. Sternum fraktürlü olgularýn yalnýzca dokuzuna cerrahi fiksasyon gerekti. Tüm diafragma yaralanmalarý primer onarýldý. Toraks travmalarýnda, doðru taný ve uygun cerrahi yaklaþým bu tür yaralanmalarda morbidite ve mortalitenin azaltýlmasýnýn temelini oluþturur.

Traffic vehicle accidents are the main causes of accidental death under the age of40. Simple prevention can reduce these deaths. Method: We have reviewed 532 patients with blunt and penetrating chest trauma between January 1988 and February 1998. There were 408 males and 124 females. There were rib fractures in 128 patients, rib fractures with pneumothorax in 93 patients and rib fractures with hemothorax in 32 patient, rib fractures with hemopneumothorax in 94 patients, flail chest in 44 patients, sternal fractures in 48 patients, diaphragmatic ruptures in 8 patients and one esophageal rupture in 448 patients with blunt chest injuries. Penetrating injuries were present in 84 patients: 18 pneumothoraces, 12 hemothoraces, 29 hemopneumothoraces, 3 diaphragmatic ruptures, 7 major vessels injuries, one left atrium injury, one esophagus-trachea-larynx injury; 13 patients were asymptomatic. Result: The results of the treatment were generally good in rib fractures, rib fractures with pneumothorax and hemothorax. No morbidity and mortality were observed in these groups. In 123 patients with hemopneumothorax, 18 patients were hospitalized and tube thoracostomy was performed in 97patients (26patients underwent immediate thoracotomy after chest tube insertion), emergency thoracotomy was performed in 8 patients. In this group mortality rate was 5.69 % (7/123). In flail chest group, 41 patients needed mechanical ventilation support and 11 patients died were due to SIRS, hepatic and renal failure. Surgical fixation for sternal fractures was carried out in 9 patients. All diaphragmatic injuries were performed primary repair. In thoracic trauma, correct diagnostic and appropriate therapeutic approach, remain the cornerstone of treatment to minimize the morbidity and mortality of such injuries.

Uzun süreli tatillerde bir çok kamu hizmeti aksamakta ve kesintisiz hizmet veren kurumlar ihtiyaca cevap veremez duruma gelmektedir. Tatillerden en çok etkilenen kurumlardan birisi de hastanelerdir. Sosyal hareketliliðin olduðu her yerde ve her durumda mutlaka hasta sayýsý da artacaktýr. Ülkemizde en büyük sosyal hareketlilik bayram tatillerinde olmaktadýr. Bu çalýþmada amaç, uzun süreli resmi tatillerde olan saðlýk problemini gündeme getirmek, bu dönem içinde acil servislerde yaþanan problemleri tartýþmak ve çözüm yollarýný aramaktýr. 1999 yýlý içinde Ramazan ve Kurban bayramlarýnda hafta sonlarý da birleþtirilerek dokuzar gün tatil yapýldý. Bu çalýþmada beriki tatil dönemindeki 18 günlük sürede Týp Fakültesi Hastanesi acil servisine baþvuran hastalar incelendi. Sonuçlar ayný dönemin bir ay öncesi ile karþýlaþtýrýldý.Her iki tatil süresinde acil servise toplam 2036 hasta baþvurmuþtur. Ayný dönemin 1 ay öncesi ile karþýlaþtýrýldýðýnda toplam hasta sayýsýnda % 32 artýþ olmuþtur. Bu hastalardan 610'u(%29) travma hastasýdýr. 310 hasta (%15) herhangi bir servise yatýrýlmýþtýr. 28 hasta (%1.3) çeþitli nedenlerden dolayý kaybedilmiþtir. Hastalar tanýlarýna göre incelendiðinde tatil döneminde toplam hasta sayýsýnýn % 75'i travma dýþý hastalardýr. Travma hastalarý incelendiðinde tatil döneminde trafik kazasý hastalarýnda % 15 artma olmuþtur. Bu dönemde iþ kazalarý ise % 5 azalmýþtýr. Tatil döneminde servislere yatýrýlan hasta sayýlarýnda belirgin bir artýþ tespit edilmemiþtir. Sonuç olarak resmi tatil sürelerinin uzamasý hastalar ve acil servislerin iþleyiþi açýsýndan dezavantajdýr. Tatil dönemlerinde acil servise baþvuran hasta sayýsý artmaktadýr. Artan talebe cevap verebilmek için ek tedbirler alýnmalýdýr. Özellikle trafik kazalarýnýn azaltýlmasý için gerekli çalýþmalar yapýlmalýdýr.

Long-term holidays often hinder public services and non-stop continuous service institutions can not respond to the requirements. Hospitals are the most affected institutions during such holidays. Increase in the patient counts should also be expected where and when social activities frequently arise. The most augmented rise in social activities in our country are during the Bairam holidays. This study aims to deal with health problems during official long-term holidays, discuss those problems which take place in the emergency department and offer solutions. The Ramadan and Eiyd Bairam holidays in the year 1999, were officially combined with the weekends and both prolonged to nine days. In this study, those patients who were admitted to the Emergency Department Medical School, during the 18 days period through the previous month the both holidays were investigated. The result were compared with a similar period. 2036 patients were admitted to the emergency department during both holidays. When compared with one month ago, total patient count was increased by 32%. 610 (29%) of the patients were trauma patient. Trauma patients were increased by 59%. 310 patients (15%) were hospitalized. 28 patients (1.3%) were lost due to various reasons. 75% of the patients were non-trauma patients. Investigating the traumatized patients, road accidents are increased by 15% during the holidays, where industrial accidents were decreased by 5%. The number of hospitalized patients is not increased during the holidays. To conclude, prolonged the holidays are deleterious for both the patients and the emergency services. The number of patients applying to the emergency department is increased during the holidays. Additional measures must be undertaken to supply the increased demand. Necessary work-ups should also be held especially to avoid road traffic accidents.

Vertebra ve spinal kord yaralanmasý, nadir görülmeyen ve sonrasýnda ortaya çýkan nörolojik problemler nedeniyle oldukça ciddi kayýplara neden olan bir travma türüdür. Bu nedenle vertebra travmasýnýn epidemiyolojik ve prognostik yüzünü inceleyen retrospektif bir çalýþma yaptýk. U.Ü.T. F Ýlk ve Acil Yardým Servisine Aðustos 1996-Mayýs 1999 yýllarý arasýnda baþvuran 1632 travma olgusu içinde 46 (%2.8) olguda vertebra ve/veya spinal travmaya rastlandý. Hastalarýn 23 tanesinde nörolojik defisit saptanýrken, diðer 23 hastada nörolojik muayene normaldi. Nörolojik muayenesinde patoloji saptanan ve interne edilen 19 hastanýn, 4'üne (%21) konservatif tedavi uygulanýrken, 15 hasta (%79) cerrahi yöntemlerle tedavi edildi. Cerrahi tedavi sonrasýnda hiçbir hastada ek nörolojik defisit ve komplikasyon geliþmedi. Hastalarýn önemli bir kýsmýnda kýsmi düzelme saptanýrken az sayýdaki olguda tam düzelme görüldü.

Vertebral and spinal cord injuries are not uncommon and can result in neurological deficits that beger significant losses, Looking from this vantage point, conducting a retrospective study, we evaluated the epidemiological and prognostic features of vertebral traumas. Between August 1996-May 1999, of 1632 cases presented following a traumatic incident, in 46 (2.8%) a vertebral and/or spinal trauma was found. In 23 patients neurological deficits were detected, whereas in the ocher23 patients neurological examination was pormal. Of 19 patients found to have neurological, pathologies and referned for further management, 4 (%21) received conservative therapy, whereas 15 (79%) patients underwent surgical procedures. Non of the patients developed additional neurological complications following surgery. A significant proportion of the patients had partial recover/,where as a few recovered completely.

509 olgunun; 519 diz altý amputasyonu bu çalýþmada deðerlendirildi. 482 olgu kara mayýnlarý nedeniyle yaralanmýþtý. 6 saatten daha kýsa sürede olay yerinden bölge cerrahi hastanelerine getirilen 421 amputasyon güdüðü, radikal debridmaný takiben primer olarak kapatýldý (Grup 1). Yeterli debridman yapýldýðýna karar verilemeyen ya da 6 saatten sonra getirilen 98 amputasyon güdüðüne ise açýk aýnputasyon uygulandý(Grup II). Ortalama 3-6gün sonra bütün olgular GATA Ortopedi ve Travmatoloji A.D'na nakledildiler. Grup IIde 14 olgu(%2.9) güdük ucundaki enfeksiyon nedeniyle tekrar opere edildi. Grup II de hiçbir olguda güdük ucu enfeksiyonuna rastlanýlmadý. Grup II' de güdüklerin %86.7 si, Grup II'de güdüklerin %79.6'sý problemsiz iyileþti. Gazlý gangren ve tetanus hiçbir olguda görülmedi.

The results of 519 below knee amputations of 509 war wounded cases were reviewed. 482 cases were wounded by land mine. If the delay in evacuation between the injury and arrival to the battlefield hospital was less than 6 hours, 421 amputation stumps (Group I) contrary to classical fashion were closed primarily after meticulous debridement. Open amputation was performed after debridement in the remaining 98 amputation stump (Group II) After an average of 3.6 days, all the cases were evacuated back to our center where the primary delayed closure was done to Group II. 14 patients in Group I (2.9%) were reoperated because of wound sepsis of the stump. Wound sepsis was not encountered in Group 11.86.7% of stumps in Group I and 79.6% of stumps in Group 11 had healed without a problem. No gas gangrene or tetanus was encountered in any cases.

Saðlýk Bakanlýðý Taksim Hastanesi, Ortopedi ve Travmatoloji Kliniðine Ocak 1993- Mart 1998 tarihleri arasýnda baþvuran ve cerrahi tedavi uygulanan 25 hastanýn 27 patellasýnda yapýlan fonksiyonel ve radyolojik deðerlendirmede 5 hasta mükemmel (%18.5), 7 hasta iyi (%26), 10 hasta orta (%37) ve 5 hasta kötü (% 18.5) olarak deðerlendirilmiþtir. Gergi bandý uygulanan 15 hastadan 2 hasta mükemmel (% 13.33),4 hasta iyi (%26.6), 7 hasta orta (%47), 2 hasta kötü sonuç (13.3) olarak deðerlendirilmiþtir. Magnuson tekniði uygulanan 2 hastanýn sonuçlarý iyi, bir hastanýn sonucu orta,bir hastanýn sonucu kötü olarak deðerlendirilmiþtir. Modifiye gergi bandý uygulanan 7 hastadan üçü mükemmel (% 43), bir hasta (14.2) iyi, bir hasta orta (%14.2) ve 2 hasta da kötü (%28.4) olarak deðerlendirilmiþtir. Hiçbir hastada kaynama gecikmesi veya kaynamama meydana gelmedi.Sonuç olarak çok parçalý kýrýklarda uygulanabilirliði, rijit fiksasyon saðlamasý ve erken harekete izin vermesi, vida veya ilave tekniklerle kombine edilebilmesi gibi özellikleri nedeniyle modifiye AO germe bandý tekniði patella kýrýklarýnýn cerrahi tedavisinde öncelikli olarak düþünülebilir.

A total of 25 patients underwent 27 operations due to patellar fracture of the Department of Orthopaedic and Traumatology, Taksim State Hospital between January 1993andMarch 1998. The results were evaluated based on radiological and functional criteria. According to Böstman criteria, consequently.5 patients were classified as "excellent", 7 patients as "good", 10 patients as "moderate", 5 patients as poor. On the other hand, among the 15 patients who had "tension band" as the treatment alternative, 2 patients were graded as "excellent", 4 patients were "good", 7patients "moderate", 2 patients "poor". Four patients underwent surgery using Magnuson Tecnique.Among them 2 showed good, 1 showed moderate and the other one showed poor result. 7 patients had modified tension band. Three patients had "excellent", one patients had good, one patient had moderate and 2 patients had poor results, respectively. There was no delayed union or nonunion in any case. In conclusion, considering the applicability in multiple fractures and combinations with other technique such as screw application technique, modified tension band should be considered as a primary treatment approach. It also provide rigid fixation and early mobilization of the patient.

Klavikula üst ekstremite fonksiyonlarýnda önemli bir role sahiptir. Bu nedenle klavikula kýrýklarýnýn tedavisine gerekli önem verilmelidir. Bu kýrýklar çoðunlukla konservatif yöntemlerle tedavi edilmesine raðmen cerrahi gerektiren kýrýklar da az deðildir. 1990-1998 yýllarý arasýnda, Atatürk Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalýna baþvuran 500 klavikula kýrýklý olgunun, yaþlarý 15-60 (ortalama 28.9) yýl olan 52'si açýk redaksiyon ve intrameduller Kirschner teli tesbiti ile tedavi edilmiþtir. Kýrýk 37 olguda (%71.2) orta, 12 olguda (%23.1) lateral ve 3 olguda (%5.8) medial bölgede yerleþimliydi. Ameliyat sonrasý dönemde 5 olguda (%9.6) oral antibiyotik tedavisi ile iyileþen tel dibi enfeksiyonu görüldü. 5-12 (ortalama 7.4) ay takip edilen olgularýn hepsinde 2-5 (ortalama 2.5) ayda kaynama oluþtu. Bu çalýþmanýn sonucunda intrameduller Kirschner teli ile tesbitin cerrahi gerektiren klavikula kýrýklarýnda uygun ve yeterli bir tedavi yöntemi olduðuna karar verildi.

Because the clavicle has a important role on the functions of upper extremity, the treatment of its fractures should be given importance. The fractures required surgical treatment aren't rare although these fractures are treated usually with conservative methods. Between 1990-1998 years, in The Department Of Orthopaedics and Traumatology Of Atatürk University Medical School, fifty-two of 500 patients with a fracture of the clavicle, whose ages ranged from 15 to 60 years (average age, 28.9 years), were treated with open reduction and the fixation of intramedullary Kirschner wires. Of these fractures, 37 (71.2 %) were in the middle third, 12 (23.1%) the lateral and 3 (5.8 %) the medial. In 5 (9.6 %) cases, there were pin track infections which were recovered with the oral antibiotic treatment. In all of the cases who were f allow ed-up 5-12 (average 7.4) months, fracture healing became in 2-5 (average 2.5) months. It was concluded that the fixation of intramedullary Kirschner wires was the suitable and sufficient treatment on the clavicle fractures required the surgical treatment.

Günümüzde yüksek enerjili travmalarýn sýk olarak ortaya çýkmasý sonucu oluþan kýrýk tiplerinden biri olan asetabulum kýrýklarýnda tedavinin amacý femur baþý ve asetabulum arasýndaki eklem uyumunu saðlamaktýr. Bu amaç doðrultusunda S.B.Haseki Hastanesi Ortopedi ve Travmatoloji Kliniði'nde 1992-1998yýllarý arasýnda asetabulum kýrýðý tanýsý ile 56 olgunun tedavisi yapýldý. Bu olgulardan son kontrolleri yapýlabilen 20 olgunun klinik sonuçlarý Merle d'Aubigne, radyolojik sonuçlarý ise Thomson- Epstein'e göre deðerlendirildi. Ortalama 43.6 ay takibi yapýlan konservatif olarak tedavi edilmiþ 10 olguda çok iyi ve iyi sonuçlarýn oraný % 50, ortalama 34.5 ay takibi yapýlan cerrahi olarak tedavi edilmiþ 10 olguda ise çok iyi ve iyi sonuçlarýn oraný % 60 olarak bulundu. Deneyimli ellerde anatomik redaksiyon ve stabilizasyonun saðlanmasýyla, cerrahi tedavi sonuçlarýnýn daha iyiye doðru gideceði sonucuna varýldý.

One type of the fractures, due to the frequent occurrence of high energy traumas nowadays, is the fracture of acetabulum. The goal of the treatment in fractures of acetabulum is to provide the convenience of the articular surfaces between acetabulum and the femoral head. We treated 56 patients with acetabulum fractures in Haseki State Hospital between 1992-1998. 20 of this patients have been controlled clinically according to Merle d'Aubigne and radiologically according to Thomson Epstein. 10 of this cases, that treated conservativelly, after mean follow up 43,6 months, have good or excellent results 50%. 10 patients have been operated and after mean 34,5 months follow up 60 % have good or excellent results. As a result of increasing ratio of anatomical reduction and stabilization, we believe that, in experienced hands surgical conditions will be improved.

Torakotomi sýrasýnda oluþabilen kot fraktürleri, akciðer rezeksiyonu uygulanan hastalarda çoðu kez postoperative morbiditeyi artýrmaktadýr. Bu çalýþma, farklý iki torakotomi sýrasýnda geliþen iatrojenik kot fraktürü insidansýný araþtýrmak için planlandý. Yaþlarý 51-69 arasýnda deðiþen 67 hasta iki gruba ayrýldý. 46 Hastada (Grup 1) standart posterolateral torakotomi (PLT) uygulanýrken, 21 olgu (Grup II) kas-kesimsiz vertikal torakotomi (VT) insizyonu ile açýldý. Her iki grupta, lobektomi yada "wedge"rezeksiyon yapýldý. Grupta yer alan yedi (%15.2) ve II.Gruptaki beþ (%23.8) hastada kot fraktürü geliþti. VT grubunda fraktür insidansý anlamlý derecede yüksek bulundu (p<0.05). Literatürde son zamanlarda sýkça önerilen kas-kesimsiz torakotomi sýrasýnda, kot fraktürü oluþumunu önlemek için büyük özen gösterilmesi gerekir.

Inadvertent rib fracture, which may occur during thoracotomy, is often associated with an increased postoperative morbidity after pulmonary resections. This trial was planned to evaluate the occurrence of the iatrogenic rib fracture in two different types of thoracotomies. 67 patients, ranging in age 51-69, were divided into two groups. Standard posterolateral thoracotomy (PIT) was performed in 46 patients (Group I), whereas a muscle-sparing vertical thoracotomy (VT) incision was used in 21 patients (Group II). Lobectomy or a wedge resection was performed in both groups. Iatrogenic rib fracture was noted in seven patients (% 15.2) and in five patients (%28.3) in Group I and II, respectively. The incidence of fracture was significantly high (p < 0.05) in VT group. During muscle-sparing thoracotomy techniques, which are suggested more frequently in recent literature, great care should be taken to avoid this complication.

Hastanemiz "Enfeksiyon Kontrol Komitesi" tarafýndan, 1997-1998 yýllarýnda hastanemiz Yanýk Ünitesine yatýrýlan 263 hastada, nozokomiyal infeksiyon (NKÝ)' larýn sýklýðýný, türlerini, infeksiyon etkenlerini ortaya koymak için, prospektif aktif sürveyans çalýþmasý gerçekleþtirildi. Ýki yýllýk sürede 69 hastada 91 NKÝ görüldü ve NKÝ hýzý %34.6 olarak saptandý. NKÝ geliþen hastalarda en sýk (yanýklarýn %46.4) termal yanýk vardý. En sýk NKÝ türü, yanýk yarasý enfeksiyonu idi ve 1997 de NKÝ' larýn %65.5(n=38)' ni ve 1998'de %54.5(n = 18)' ni oluþturmaktaydý. Yanýk Tedavi Ünitesinde en sýk izole edilen etkenler Pseudomonas spp (%58) ve Eschericha spp (%22) idi. Yanýk merkezleri için etkili enfeksiyon kontrol programlarý; hastalarýn mikrobiyal kolonizasyon surveyansý, çevre hijyenini takip iþlemleri, gerektiði zaman yanýk yarasýnýn mikrobiyal durumunun biyopsi ile deðerlendirilmesi, enfeksiyon sebebi ve insidansýnýn izlenmesi, klinik veri ve kültürlerin belli zamanlarda enfeksiyon kontrol komitesi tarafýndan gözden geçirilmesini içermektedir.

In order to find out the incidence, types, agents of nosocomial infections, this research which a prospective active surveillance was performed in 263 patients hospitalised at the burn unit departments of our hospital between 1997 and 1998 by "Infection Control Committee". It was determined that 91 nosocomial infections was in 69 patients in the course of last two years, the incidence ofnosocomial infection was 34.6%. Thermal burn was determined at most in patients (46.4 %) exposed to nosocomial infections. The most common nosocomial infection site was burn wound infection (65.5% (n=38) in 1997 and 54.5% (n=18) in 1998). The most frequently isolated micro-organisms were Pseudomonas spp (58%) and Eschericha spp (22%) in the Burn Unit. Effective infection control programs for burn centers should include scheduled microbial surveillance of colonisation of patients, environmental hygiene monitoring procedures, biopsy assessment of the microbial status of the burn wound as necessary, monitoring of the incidence and causes of infection, and timely review of culture and clinical data by an infection control commitee.

Travmatik aort rüptürleri nadir tanýnan, taný ve tedavi aþamasýnda kardiyotorasik cerrahlara çeþitli güçlükler çýkaran lezyonlardýr. Bu klinik antitenin tartýþmalý yönlerini klinik deneyimlerimiz ve aort tamirinde kullandýðýmýz deðiþik bypass teknikleri açýsýndan irdeledik. Kliniðimizde 1996 ile 1999 yýllarý arasýnda 6 hasta travmatik aort rüptürü tanýsýyla tedavi edilmiþtir. Dört hastada kronik rüptür mevcut iken 2 hasta akut dönemde kliniðimize baþvurmuþtur. Hastalarýn tümünde hastaneye geldiklerinde çekilen göðüs grafilerinde patolojik bulgular saptanmýþtýr. Tüm hastalarda desendan aortaya greft interpozisyonu uygulanmýþtýr. Dört hastada tamir total derin hipotermik sirkulatuvar arrest altýnda uygulanmýþtýr. Bir hastada aort tamiri kross-klemp altýnda yapýlýrken, bir diðer hastada ise parsiyel sol atrio-femoral bypass altýnda tamir gerçekleþtirilmiþtir. Operatif veya postoperatif mortalite olmamýþtýr. Hiçbir hastada parapleji/paraparezi gözlenmemiþtir. Hastalar 5. ve 13. postoperatif günler arasýnda taburcu edilmiþtir (ortalama 10.7 3.6 gün). Postoperatif takip dönemi 2 ay ile 42 ay arasýnda olup hastalarýn tümü hayattadýr. Kontrol göðüs grafîlerinde veya bilgisayarlý tomografi tetkiklerinde bir patoloji yada rekürrent anevrizma tespit edilmemiþtir. Travmatik aort rüptürlerinin cerrahi tedavisinde atrio-femoral bypass veya total hipotermik sirkulatuvar arrest gibi tekniklerin uygulanmasýnýn baþlýca anevrizmanýn lokalizasyonuna ve büyüklüðüne baðlý olduðunu söyleyebiliriz. Bu nedenle hastanýn klinik durumuna göre operatif tedavi tekniðinin belirlenmesi gerekmektedir.

Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. To address controversial aspect of this disease, we reviewed our experience to evaluate outcome and to outline critical technical aspects of bypass management and aortic repair. Six patients with traumatic thoracic aortic rupture were managed between 1996-1999. Four patients had chronic, the other two had acute traumatic thoracic aortic rupture. In all patients chest X-ray findings were abnormal. In all patients graft interposition was performed. In four patients repair were performed under total hypothermic circulatory arrest. In one patient repair was performed with simple aortic cross-clamping and in the remaining patient repair was performed with partial left atrio-femoral bypass. There was no perioperative or postoperative mortality. Paraplegy orparaparesia was not seen. Patients were dischargedfrom hospital between postoperative day Sand 13 (mean 10.7 3.6days). All patients are still alive at follow-up periods between 2 months to 42 months. Serial chest X-rays and computed tomographies showed no evidence of any pathology or recurrent aneurysm in any patient. Management options for surgical technique and bypass including left atrio-femoral or venoarterial bypass with total hypothermic circulatory arrest are mainly dependent location and extension of aneurysm and patient physical condition. Therefore, the decision should be tailored to the specific clinical situation.

Mayýs 1992 ile Aðustos 1999 süresini kapsayan bu geriye dönük çalýþmada, 41 ortopedik ve damar yaralanmasýnýn birlikte olduðu olgularda, cerrahi yaklaþým irdelenmiþtir. Bu stratejide en önemli basamak ekstremitenin yaralanma sonucunda kaybedilme tehlikesinin, en kýsa zamanda algýlanmasýdýr. Yirmidört olgu da alt ekstremitede, 17 olguda üst ekstremitede yaralanma vardý Olgularýn 37si künt travma, 14 penetran travmaya maruz kalmýþlardý. Bir olgu kaybedildi. Tüm olgulara doppler tetkiki yapýlmýþtýr. Altý olguda geç dönemde ampütasyon uygulanmýþtýr, amputasyon oram %14.6' dir. Ampute olan olgularda ileri derecede yumuþak doku hasarý olan ve 4 saatin üzerinde hastaneye gelen olgulardý. Otojen greft kullanýlan olgularda dolaþým problemi gözlenmemiþtir. Suni greftlerin 3 ünde greft yetmezliði gözlenmiþtir. Damar giriþimi kemik stabilizasyonu öncesinde yapýlmýþtýr. Beþ olguya anjiografîk tetkik yapýlmýþtýr. Bu olgular ileri derecede parçalý kýrýk olan ve damar yaralanma veya ekstremitenin ezilmesine baðlý intima hasarýnýn ileri boyutlarda olacaðý düþünülerek uygulanmýþtýr. Bu tip yaralanmalar multidisipliner yaklaþým gerektirmekte, hýzlý damar giriþimi, kemik stabilizasyonu, gereken olgularda zaman geçirmeden fasiotomi, yapýlabilirse sinir tamiri ve canlý olan yumuþak dokunun korunarak, mümkün olduðu kadar yaranýn açýk býrakýlmamaya çalýþýlmasý gerekmektedir.

This is a study of 41 patients with combined orthopedic and vascular injuries that have been operated between May 1992 and August 1999. The most important step is recognization of limb threat. 24 patients had lower and 17 had upper extremity injuries. One case had died. Six delayed amputations were performed. The amputations ratio is 14.6% in this group. The amputation is due to extreme injuries and late intervention. No complication was observed in autogenous greft. We observed graft failure in three patients who were used synthetic graft. We performed vascular approach before stabilization of the bone. We used anjiography in five patients who had extreme crush injuries. We conclude that improved outcome requires a coordinated multidisciplinary approach, expeditious limp revascularization, rapid bone stabilization, if necessary fasciotomy should be done ontime. It is better to close the wound primarily or with a transposing flep.