Aralýk 1998 ve Kasým 2000 tarihleri arasýnda, ülke genelinde 2'si eðitmen kursu ve 6'sý standart kurs olmak üzere toplam 8 Travma ve Resüsitasyon Kursu (TRK) düzenlemiþtir. Yapýlan anket sonuçlarýna göre 63 eðitmen ve 121 kursiyerin görüþleri deðerlendirilmiþtir. Deðerlendirme sonuçlarýnýn ilerideki kurslara katkýda bulunacaðýna inandýðýmýzdan, bu çalýþmada tartýþmayý uygun bulduk. Ýki eðitmen kursuna katýlan 63 eðitmenden 55'i üniversite, geri kalan 8'i ise eðitim hastanelerinde görev yapmaktadýr. Altý standart kursa toplam 121 hekim katýlmýþ ve yaþ ortalamalarý 34 olarak belirlenmiþtir. Katýlýmcýlarýn hekimlik yaptýðý ortalama süre 10 yýl (3 ay- 43 yýl) olarak saptanmýþtýr. Kursa katýlan doktorlarýn % 94'ü kursu içeriði yönünden yeterli bulmuþtur. Kurs kitabýný, katýlýmcýlarýn % 15'i þekil ve resim açýsýndan yetersiz bulmuþtur. Kursun hedef kitlesinin en çok acil servis doktorlarý ve pratisyen hekimler olmasý gerektiðine inananlar çoðunluktadýr. Sonuç olarak en büyük eleþtirinin uygulamalý eðitimin eksikliði ve video oturumlarýnýn azlýðý ile TRK kitabýmda þekillerin eksikliði olduðunu belirlemiþ bulunmaktayýz. Hedefimiz bu tip eleþtirilerin ýþýðýnda, yeni kurslarýn daha verimli ve yararlý olmasý yönünde gerekli deðiþiklikleri yapmak, acil travma ve resüsitasyon konusunda, ülke genelinde bir standardizasyona getirmektir.

Eight Trauma and resuscitation Courses (TRC): two instructor and 6 student courses have been organized in Turkey between December 1998 and November 2000. Questionnaire results of 121 students and 63 instructors were reviewed. We strongly believe that these results will be supportive for the courses in the future. Fifty-five of the instructors were from university, and 8 were from teaching hospitals. 121 doctors attended six student courses, the average age of whom was 34. Average time period following university graduation was 10 years (3 months 43 years) for the participants. Among these, 94 % found the course content sufficient. The course book was determined as insufficient in terms of drawings and pictures by 15%. The main target population of the course was selected as emergency service doctors and practitioners. As a result we determined that the main criticisms were insufficient practical and video sessions and the lack of drawings in the course book our main goal is to accomplish the required changes, and make new courses more yielding and profitable, thus introduce standardization in terms of trauma care nationwide.

Hasta sevk ederken acil servislerin en önemli çalýþma ilkelerinden birisi de hasta þevkinde varolan kurallara uyumdur. Bu çalýþma bölgemizde bu kurallara uyumun ne kadar saðlandýðýný anlamak amacýyla yapýlmýþtýr, 01.05.1999-01.07.19999 tarihleri arasýnda acil servisimize baþka bir hastaneden ambulans ile gelen 180 hastada Amerikan Acil Týp Uzmanlarý Derneði (ACEP) nin hasta sevk kurallarýna uyumun saðlanýp saðlanmadýðý araþtýrýlmýþtýr. Bulgular kurallara uyumun yeterli olmadýðýný göstermiþtir. Çalýþmanýn sonuçlarý çevre hastanelerin acil servis ve travma bakýmýndan sorumlu hekimlerinin aylýk travma eðitim toplantýsýnda sunulacak, bu konuda Ýl Saðlýk Müdürlüðü, Ýl ve Ýlçe Devlet Hastaneleri, SSICya baðlý hastaneler ile görüþülerek belli protokollerin oluþturulmasý saðlanacak, hasta þevkinde daha iyi koþullar yaratýlmaya çalýþýlacaktýr.

Emergency departments must comply with the rules of patient transportation. The aim of this study was to find out the compliance of the emergency departments in our region with patient transport the rules and regulations. 180 patients transported to our emergency department by an ambulance from another hospital, between 01.05.1999-01.07.1999 were analyzed. ACEP's (American College of Emergency Physicians) patient transportation rules were taken as a reference for comparison. Our findings have shown that the compliance to these rules is insufficient. Results of the study, will be presented to our colleagues working in the emergency departments in our region, in one of our monthly trauma meetings. State Department of health in the city, two state hospitals and Social Security hospitals in the region will also be informed about the results so that certain guidelines for better patient transportation can be established in the region.

Künt veya penetran abdominal travmasý ve dalak yaralanmasý olan hastalarda halen en sýk kullanýlan cerrahi yöntem splenektomidir. Bu çalýþmada, travmalý ve dalak yaralanmasý olan hastalarda uyguladýðýmýz cerrahi yöntemleri ve sonuçlarýný incelemeyi amaçladýk. Toplam 225 hastanýn 55 (%24)'i kadýn, 170 (%76)'i erkek, yaþ ortalamasý 29 idi. Moore sýnýflamasýna göre; birinci derece 23 (%10), ikinci derece 96 (%43), üçüncü derece 75 (%33), dördüncü derece 24 (%11) ve beþinci derece dalak yaralanmasý 7 (%3) hastada tespit edildi. Splenektomi 203 (%90) hastaya uygulandý. Kalan 22 hastanýn 18'ine (%8) (I. ve II. derece dalak yaralanmasý olan hastalar) splenorafý, 4'üne (%2) (II. derece yaralanma) parsiyel splenektomi yapýldý. Toplam 27 (%12) hastada mortalite geliþti. Ýlave organ yaralanmasý ile mortalite arasýnda belirgin bir korelasyon olduðu tespit edildi (Fisher Ki-Kare Testi; X2=9,538, p<0.002). Sonuç olarak; dalak yaralanmalarýnda, özellikle I ve II derece yaralanmalarda nonoperatif tedavi yöntemlerine olan yönelim hastalarýn yarýsýna yakýnýnda gereksiz splenektomileri önleyebilir. Kombine yaralanmalar mortaliteyi artýran en önemli faktörlerden biridir.

Splenectomy is the frequently used surgical method for the treatment of traumatic splenic injuries. In this study, the patients who had traumatic splenic injuries were investigated and the results of surgical treatments were evaluated. There were 225 patients with traumatic splenic injuries, which contains 55 (24%) female and 170 (76%) male. The mean age was 29 (range 16-71) years. Severity of splenic injury was classified according to Moore organ injury scaling and there were 23 (10%) patients in grade 1,96 (43%) in grade II, 75 (33%) in grade HI, 24 (11%) in grade IV and 7 (3%) in grade V. Splenectomy was performed in 203 (90%) patients, splenoraphy in 18 (8%) and partial Splenectomy in 4 (2%) patients. The overall mortality was 12%. A positive correlation was estimated between the combined trauma and the mortality (Fisher's Chi-Square test; X2-9,538, p<0.002). In conclusion, non-operative treatment methods may prevent unnecessary splenectomies, especially in grade I and II blunt or penetrating splenic injuries. Combined injuries are the major factor increasing the mortality.

Özofagus yaralanmalarý son yýllardaki antibiyotik ve cerrahi tekniklerdeki geliþme, monitörizasyon, solunum ve beslenme desteðinde artýþa raðmen hala mortalitesi yüksek bir klinik tablodur. Prognoz ve tedavi þeklinin belirlenmesinde; perforasyon yeri, perforasyonun oluþumu ile teþhis arasýnda geçen süre, perforasyon bölgesinde organik veya fonksiyonel týkanmanýn olmasý, perforasyonun enflame veya tümörlü bölgede yer almasý, gastro-özofajial reflünün bulunmasý, yandaþ yaralanma ve hastalýklar ile yaþ önemli rol oynar. Bu çalýþmada Ocak 1995 ile Ocak 2001 tarihleri arasýnda Ýstanbul Týp Fakültesi, Genel Cerrahi ABD, Acil Cerrahi Servisine özofagus yaralanmasý nedeniyle baþvuran 7 olgu retrospektif olarak deðerlendirildi. Olgularýn 5'i erkek, 2'si kadýn olup, ortalama yaþ 36 idi (12-75). 4 olguda servikal, 3 olguda torakal özofagus yaralanmasý tespit edildi. Perforasyon nedenleri 3 olguda kurþunlanma, 1 olguda yabancý cisim (kemik)yutma, 1 olguda býçaklanma, 2 olguda iatrojenik yaralanma idi. 3 olgu eksitus olurken, 4 olgu þifa ile taburcu edildi. Mortalitesi oldukça yüksek olan özofagus perforasyonlarýnda erken teþhis ve uygun tedavi yönteminin seçimi hayat kurtarýcý olup, erken teþhisi saðlayan en önemli etken ise yaralanmanýn varlýðýndan þüphe etmektir.

Despite progress in the management of esophageal perforations by early diagnosis, antibiotics, monitoring, and respiratory and nutritional support, it still remains as a disasterous condition. The most common cause of esophageal perforation is iatrogenic disruption. The result in the management of esophageal perforation is influenced by several factors: localization and size of the rupture, length of delay in diagnosis, age, extent of mediastinal and pleural contamination, the presence of underlying esophageal diseases, and inflamation or tumor at the perforation localization. In this study, 7 cases of esophageal perforations in the last six years have been analysed retrospectively. In study group, there were 5 males and 2 females, and the mean age was 36 (12-75). The most common cause of perforation was gunshot injury (3 cases), and stab wound (1 case), foreign body (1 case), iatrogenic distruption (2 cases). Three patients died and four patients were discharged from hospital with recovery. Esophageal perforation is a life-threatening condition. Early diagnosis and repair reduces the morbidity and mortality.

Acil týp uzmanlýk programlarý ülkemizde henüz 6yýllýk bir geçmiþe sahiptir. 1995 yýlýnda kurulan ülkemizin ikinci üniversite acil týp departmaný olan S.Ü.T.F Acil Týp Anabilim Dalý ve kliniði 5 yýl içinde oldukça uzun bir yol almýþtýr. S.Ü.T.F Acil Týp Kliniðinde 6 aylýk süre içinde gözlem ve yoðun bakým ünitelerinde izlenen 974 hastanýn acil týp kliniðinde ortalama 45.53 saat kaldýðý, bu süre sonunda 55.75'inin taburcu edildiði, % 45.25'inin ilgili kliniklere devir edildiði, % 4.00'ünün öldüðü saptanmýþtýr. Kliniðin 6 aylýk faaliyet sonuçlarýnýn incelendiði bu makaleden elde edilen sonuçlar ektedir. Acil týp uzmanlýk programlarýnýn baþlamasýndan sonra sevk idaresinden acil týp uzmanlarýnýn sorumlu olduðu acil servis sýra spesifik kliniklerin acil ve ayrý kliniklere sahip olmasý gündem gelmiþtir. Acil týp klinikleri 2 üniteden oluþur; 1- Gözlem ünitesi, 2- Yoðun bakým ünitesi, Gözlem Ünitesi: Acil servislerde geçen ilk saatlerden sonra taburcu olma ya da hastaneye yatýrýlma iþlemlerine alternatif olarak ilk kez ABD' de yaklaþýk yirmi yýl önce kullanýlmaya baþlamýþtýr.

In our country emergency medicine expertise programmes have 6-year post yet. The second university emergency medicine department, S.U.T. F. Emergency Medicine Department and clinic, which was founded in 1995, has a long way in 5 years. 934 patient who has followed in observation and intensive care units had stayed in emergency medicine clinic for 45.53 hours on an average, after this time % 53 had dischanged from hospital, % 42.25 had send to other connecte clinics, % 4 died in S. U.T.F emergency medicine clinic in 6 months. The results of this article can be summarize as the emergency medicine clinic is successful as other clinics, reduced waiting on transport problems and prevented the complications because of unwilling behaviours to emergency patients. Becoming wides preaol of emergency medicine expertise programmes and emergency medicine clinics can be solution for reducing the delay in help, identification and treatment of patients.

Safra taþý ileusu, yüksek mortalite riski taþýyan nadir bir barsak týkanmasý þeklidir. Bu nadir hastalýðýn preoperatif tanýsý zordur. Bu çalýþmanýn amacý, ince barsak týkanmalý olgularda safra taþ ileusu þüphesini destekleyen bazý basit öðelerin ortaya konmasýdýr. Bu amaçla 25 yýllýk bir dönemde inkarsere dýþ fýtýklar haricindeki mekanik barsak týkanmalý 1230 ve safra taþý ileusu bulunan 8 olgunun hastane kayýtlarýný retrospektif olarak inceledik. Ýnce barsak týkanmalý olgularýn %0.9'unda (8/886) neden olarak safra taþý bulundu. Sekiz olgumuz da ortalama yaþý 74 olan kadýnlardý. Ýnce barsak týkanmalý yaþlý (+ 70 yýl) kadýnlarýn % 18'inde safra taþý ileusu tanýsý vardý. Adezyonlara neden olan önceki karýn ameliyatlarý dýþarýda tutulduðunda bu yaþlý kadýn grubunda safra taþý ileus oraný %36'ya yükseldi. Önceki ultrason incelemeleri 5 (%62) olguda safra kesesi taþý varlýðýný göstermiþti. Yalnýzca bir olguda (%12.5), safra yollarýnda gaz varlýðýný gösteren direkt grafi sayesinde preoperatif olarak taný konabildi. Týkanma enterolitotomi ile tedavi edildi. Ýki (%25) olguda kolesistektomi eklendi. Erken postoperartif dönemde iki olgu (%25) kaybedildi. Ýleri yaþ, kadýn cinsi, bilinen safra taþý varlýðý hikaye, tanýyý destekleyen öðeler olarak ortaya çýktý. Sonuç olarak safra taþý ileusu, inkarsere dýþ fýtýðý olmayan, karýn içi ameliyat geçirmemiþ ince barsak týkanmalý yaþlý kadýnlarda sýk görülen bir týkanma nedenidir. Pnömobili preoperatif tanýyý koydurabilen radyolojik bulgudur.

Gallstone ileus is an uncommon intestinal obstruction with unexpectedly high mortality. It is not easy to diagnose this uncommon disease preoperatively. The aim of our study is to establish some simple criteria supporting the suspicion of gallstone ileus patients with small intestine obstruction. We retrospectively analysed hospital records of 8 patients with gallstone ileus and 1230 cases of mechanical intestinal obstruction, excluding incarcerated external hernias. Gallstones were the cause of occlusion in 0.9% (8/886) of patients with small bowel obstruction. All our 8 patients were women with an average age of 74 years. Gallstone ileus was diagnosed 18% of elderly (+70 years) women with small intestine obstruction. This rate raised to 36% in this group of elderly women if previous abdominal operations that would produce adhesion were excluded. Previous ultrasonographic examinations had demonstrated gallstones in 5 (62%) patients. Only one patient (12.5%) was diagnosed preoperatively with plain X ray film demonstrating gas in the biliary tract. The obstruction was treated with enterolithotomy. Cholecystectomy was performed in two (25%) patients. The mortality was 25% in early postoperative period. Advanced age, female sex, and positive patient's history of known gallstone in the gallbladder have appeared as strong criteria. Gallstone ileus is a common cause of intestinal obstruction in elderly women with no previon abdominal operations and without incarcerated external hernia. Pneumobilia is more common radiological finding to establish the diagnosis of gallstone ileus in these patients.

Derin ven trombozu (DVT)'nun en ciddi ve ölümcül komplikasyonu halen pulmoner emboli (PE)'dir. Pulmoner emboli profilaksisinde kullanýlan yöntemlerden biri de vena kava inferior filtresi (VKF) uygulanmasýdýr. 1999-2000 yýllarýnda Ýstanbul Týp Fakültesi Genel Cerrahi Anabilimdalý Travma ve Acil Cerrahi Servisinde yatýrýlan 12 (8 erkek, 4 kadýn) hastaya VKF uygulandý. Filtrelerin 10'u kalýcý, 2'si geçici tipte idi. Spinal kord travmasý sonrasý geliþen kalýcý nörolojik defisitli (parapleji veya kuadripleji) 8 hastaya kalýcý filtre uygulandý. Kalýcý filtre uygulanan iki hastada ise malignite mevcuttu. Ýleri evre serviks kanseri olan ilk olguda alt ekstremitede DVT geliþti ve kanama riski yüksek olduðundan VKF uygulandý. Mesane kanseri olan diðer hastada ise düþük molekül aðýrlýklý heparin (DMAH) kullanýrken DVT geliþmiþti. Daha kýsa süreli PE profilaksisi gerektiren iki hastaya ise geçici VKF uygulandý. Bu olgulardan birincisinde, kapalý kafa travmasý (subaraknoidal kanama) tanýsýyla yatmakta iken 8. gününde alt ekstremitede DVT geliþti ve yüksek kanama riski olduðu için filtre uygulandý. Ýkinci olguda ise kafa travmasý (subdural hematom+subaraknoidal kanama) ve multipl alt ekstremite fraktürleri mevcuttu.Filtre uygulamasý Ýstanbul Týp Fakültesi Radiodiagnostik ABD'nda gerçekleþtirildi. (Resim 1). Kalýcý filtrelerde (LGM Venatech (B.Braun)) giriþ yolu olarak sað femoral ven kullanýldý. Geçici filtreler (Proliser Cordis (Johnson and Johnson Company)) ise sað internal juguler ven yolu ile uygulandý. Kalýcý filtre uygulanan iki politravma hastasý sepsis ve multiorgan yetmezliði gibi PE dýþý nedenlerle kaybedildi. Diðerlerin ortalama 7,6 aylýk takiplerde VKF uygulanmasý ile ilgili komplikasyon veya pulmoner emboli geliþmedi. Daha geniþ olgu serisine ve uzun sureli takibe ihtiyaç olmakla birlikte, PE'yi önlemede VKF'nin etkili ve güvenli bir seçenek olduðunu düþünmekteyiz.

The most serious and fatal complication of deep venous thrombosis (DVT) is still accepted as pulmonary embolism (PE). One of the methods used for PE prophylaxis is inferior vena cavafilter (VCF). Between 1999 and 2000, VCF is used in 12 patients (8 male, 4 female) who were hospitalized in Trauma and Surgical Emergency Service of Istanbul Medical Faculty. 10 of the VCF used were permanent and 2 of them were temporary filters. 8 permanent filter were applied to patients with life-long paraplegia or quadriplegia due to spinal cord injury. Two patients to whom permanent filters were applied had malignancy. Patient who had the diagnosis of late stage cervical carcinoma, had DVT. In this patient, because of the high bleading risk, we applied permanent filter. In the other patient, who had the diagnosis bladder carcinoma, had DVT despite the usage of low moleculer weight heparin. In two patients who needed short term PE prophylaxis, had temporary VCF. In one of these patients, primary diagnosis was subarachnoidal hemorrhage due to head trauma. In the 8. day of hospitalization, DVT occured. Because of high risk of intracranial bleedy, VCF was performed. The second patient had the diagnosis of subdural hematom and subarachnoidal hemorrhage due to head trauma and multiple lower extremity fractures. VCF were applied in Istanbul Medical Faculty, Department of Radiology. For canmdation line of permanent VCF (LGM Venatech - B.Braun) right femoral vein was used. For temporary filters (Proliser Cordis -Johnson and Johnson Company), right internal juguler vein was the preferred way. Two multitravma patients who had permanent filters died due to sepsis and multiorgan failure. In the follow up of other patients during the average period of 7,6 months, any problem due VCF application or by related complication and PE did not occur. Although larger patient groups with follow up period are necessary to evaluate better, we think that in PE prophylaxis, VCF is safe and effective modality.

Ýzmir Atatürk Eðitim ve Araþtýrma Hastanesi II. ve III. Cerrahi Kliniklerinde Ocak 1990-Aralýk 1999 tarihleri arasýnda opere edilen ve travmatik karýn içi büyük damar yaralanmasý saptanan 47 olgu retrospektif olarak incelendi. Çalýþmanýn amacý mortaliteyi etkileyen faktörler araþtýrmaktý. Baþvuru sýrasýnda hemoglobin düzeyi (p<0.05), hematokrit (p<0.05), Glasgow Kamu Skalasý (p=0.01), tansiyon arterial (p < 0.05), düzeltilmiþ travma skoru (p=0.01), süre (p=0.01) ve yaralanan yandaþ organ sayýsý (p < 0.05), mortaliteyi etkileyen faktörler olarak belirlendi. Mortalite oraný %46.8, morbidite oram %41 olarak saptandý.

The records of 47 patients who underwent surgery with traumatic intraabdominal vascular injury at 2. and 3. Surgical Clinics of Ýzmir Atatürk Training and Research Hospital between January 1990 and December 1999 were studied. The aim of this study was to investigate the prognostic factors effecting the mortality. Hemoglobin (p<0.05), hematocrit (p<0.05), Glasgow Coma Score (p=0.01), blood pressure (p < 0.05), Revised Trauma Score (p=0.01), prehospital time (p=0.01) and associated organ injury (p< 0.05) were the significant factors effecting the mortality. Our overall mortality was 46.8 % and morbidity 41 %.

Amaç: Büyük cerrahi iþlem geçirmiþ hastalarýn da tromboemboli profilaksisinde kullanýlan yöntemlerin etkinliklerini karþýlaþtýrmak. Hastalar ve Metod: Atatürk Üniversitesi Genel Cerrahi Anabilim Dalý'nda Eylül 1998 ile Eylül 1999 tarihleri arasýnda elektif koþullarda büyük ameliyat geçiren hastalar randomize edilerek üç gruba ayrýldý. Grup 1'deki hastalara varis çorabý giydirildi. Grup 2'deki hastalara düþük molekül aðýrlýklý heparin (LMWH) olan nadroparine calcium 0,3 ml 2850 lUAXa (Fraxiparine(r)) subkutan uygulandý. Grup 3' deki hastalara LMWH+ çorap kombinasyonu uygulandý. Bütün hastalara preoperatif dönemde ve klinik yakýnmasý yoksa postoperatif 7. günde doppler sonografi ile alt ekstremite venleri kontrol edildi. Pulmoner emboli (PE) þüphesi olan hastalara akciðer perfüzyon sintigrafisi yapýldý. Bulgular: Grup 1, 2 ve 3'deki hastalar sýrasýyla 91, 91 ve 92 hastadan oluþmaktaydý. Her üç grupta yaþ ortalamasý sýrasýyla 57,25± 13,12; 54,53± 13,54 ve 53,65± 13,28 idi. Cinsiyet daðýlýmý E/K sýrasýyla 51/38,56/35 ve 62/30 idi. Risk faktörü taþýyan hasta sayýsý gruplara göre sýrayla 27, 26 ve 37 idi. Postoperatif?. günde yapýlan doppler ultrasonografide grup 1 'de 10, grup 2'de 8 ve grup 3'de 3 hastada derin ven trombozu (DVT) saptandý. Postoperatif dönemde grup Vde 6, grup 2 ve 3'de birer hastada yapýlan akciðer perfüzyon sintigrafisinde PE ile uyumlu bulgular saptandý Gruplardaki hastalarýn yaralarýnda hematom sýrasýyla 1, 8 ve 3 iken karýn konan dreninden kanama 0, 2 ve 1 hastada geliþti. Grup 1'de 4 ve grup 2'de 2 olmak üzere toplam 6 (%2,2) hasta postoperatif dönemde tedavisi devam etmekteyken öldü. Ýstatistiksel olarak postoperatif PE ve yarada hematom grup 1 ile grup 2 arasýnda, postoperatif DVT ve PE geliþmesi grup 1 ile grup 3 arasýnda, risk faktörlerinde ise grup 2 ile grup 3 arasýnda fark vardý (p<0,05). Grup 2 ile grup 3 arasýnda postoperatif DVT, PE ve yarada hematom geliþmesi açýsýndan sýnýrda bir fark saptandý. Ancak bu sonuç istatistiksel olarak anlamlý deðildi. Sonuç: Ne tür profilaksi uygulanýrsa uygulansýn tromboembolik komplikasyonlar tamamen önlenememektedir. Çalýþmamýzda kombine profilaksinin daha etkili olduðu kanýsýna varýldý.

Purpose: To investigate the efficacy of prophylaxis modalities after major abdominal surgery. Patients and methods: Patients who underwent major abdominal surgery between October 1998 and October 1999 were randomly divided into 3 grups. The patients in Group 1 received compression stockings, in Group 2 0.3 ml low-molecular weight heparin (nadroparine calcium 0,3 ml, 2850 IU AXa LMWH) subcutaneously and in Group 3 compression stockings and 0.3 ml LMWH. All symptomless patients evaluated with low extremity deep venous doppler ultrasonography (DUSG), and patients who had pulmonary embolus (PE) suspicion evaluated with pulmonary scintigraphy. Results: There were 91 patients in Group 1, 91 patents in Group 2 and 92 patients in Group 3. The mean age was 57.25±13.12, 54.53±13.54, and 53.65±13.28 respectively. Male /female ratio was 51/38, 56/35 and 62/30, in Grup 1, 2 and 3 respectively. Twenty-seven patients in Group 1, 26 patients in Group 2 and 37 patients in Group 3 had risk factors. DUSG showed deep venom trombosis (DVT) on the 7 th postoperative day in 10 patients in Group 1, in 8 patients in Group 2 and in 3 patients in Group 1 Pulmonary scintigraphy showed PE suspicion in 6 patients in Group 1, 1 patient in Group 2 and 1 patients in Group 3. Wound hematoma and hemorrhage from abdominal drains were developed in 1/0, 8/2 and 3/1 patients in Groups 1,2 and 3 respectevly. Four patients in Group 1 and 2 patients in Group 2 died during the treatment (2.2%). Statistical analysis showed significant differences in PE and wound hematoma between Grups 1 and 2, in DVT and PE between Groups 1 and 3, in risk factors between Groups 2 and 3 (p<0.05). The differences in DVT and PE and hematoma between group 2 and 3 were not significant. Conduction: All treatment modalities could not prevent all tromboembolic complications. In our study combinated treatment was the most effective one.

Amacýmýz on yedi Aðustos 1999' da meydana gelen Marmara Depremi'nde Kartal Eðitim ve Araþtýrma Hastanesinin deneyimini aktarmaktýr. Deprem sonrasý 30 günlük zaman diliminde hastanemize baþvuran 698 yaralý, yaralanma þekilleri, yapýlan tedavi yaklaþýmlarý, morbidite ve mortalite açýsýndan analiz edildi. Yatan 273 hasta yaralanan majör organ sistemine göre sýnýflandýrýlýrken; crush yaralanmalar ayrý bir grupta sýnýflandýrýldý. En sýk görülen yaralanmalar crush yaralanma (%23.1), ekstremite kýrýklarý (%16.8) ve pelvis ve omurga kýrýklarý (%16.1) idi. En fazla yandaþ yaralanmanýn olduðu gruplar abdominal yaralanmalar (%45.5), crush yaralanmalarý (%24.4) ve pelvis ve omurga yaralanmalarý (%27.3) idi (p<0.05). Toplam mortalite % 7.3 idi. En sýk mortalite görülen gruplar abdominal yaralanmalar (%27.3) ve crush yaralanmalar (%20) oldu (p<0.05). Crush sendromlu hastalarýn %61.9'una daha sonra geliþen kompartman sendromuna baðlý olarak fasiyotomi yapýldý. 31 hastaya hemodializ uygulandý. Depremlerle ilgili olarak en önemli sorun, deprem sahasýnda, hastaneler arasýnda ve hastane içi organizasyon problemleridir. Yüksek oranda yandaþ travmasý olan hastalarda mortalite daha yüksek olmaktadýr. Depremde en fazla görülen yaralanma türü crush yaralanmadýr Erken taný, uygun ve hýzlý tedavi sað kalýmý artýrmaktadýr.

This study describes the experience of Kartal Research and Training Hospital in the Marmara Earthquake. We reviewed medical records of 698 patients admitted to our hospital in a 30 days' period after the earthquake and analysed the types of injuries, treatment, morbidity and mortality rates. The hospitalized 273 patients were grouped according to the major injury; patients with crash syndrome were analysed separately. The most frequent injuries were crush injury (23.1 %), extremity fractures (16.8 %) and pelvis and spine injuries (16.1%). More than two system injuries were seen most frequently in the abdominal injury (45.5%), crush injury (24.4%), and pelvis and spine injury (27.3%) groups (p < 0.05). Overall mortality rate was 7.3 %. The highest mortality rates were seen in the abdominal injury (27.3%) and crush injury (20%) groups (p<0.05). 61.9% of the patients with crush syndrome underwent fasciotomy due to the compartment syndrome; hemodialysis was performed in 31 patients. The most serious problem with earthquake is organization in the earthquake area, between hospitals and in hospitals. Crush injury is the major injury seen earthquakes. Early diagnosis and proper treatment should be done to improve survival,

Akut grade III akromioklavikular çýkýklarýn tedavisinde kullanýlan yöntemler ve sonuçlarý üzerinde farklý görüþler vardýr. Bu çalýþmada Atatürk Üniversitesi Týp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalý'nda Neviaser yöntemi ile cerrahi olarak tedavi edilen ve takip edilebilen 10 hastanýn sonuçlarý deðerlendirilmiþtir. Hastalarýn hepsi erkek olup, yaþlarý 25 - 44 (ortalama 36.5) yýldýr. Çýkýk 5 olguda (%50) omuz üzerine düþme, 4 olguda (9640) trafik kazasý, 1 olguda (%W) ise direk omuz travmasý sonucu oluþmuþtur. Çýkýk oluþmasý ile ameliyat zamaný arasýnda geçen süre 5 20 (ortalama 10.2) gündür.6 ay 2 yýl (ortalama 13.1 ay) takip edilen olgularýn hiç birinde komplikasyon gözlenmemiþ ve 9 olguda (%90) çok iyi ve iyi sonuç elde edilmiþtir. Bu çalýþmanýn sonucunda akut grade III akromioklavikular çýkýklý hastalarda Neviaser yönteminin iyi sonuçlar verdiði kanaatine varýlmýþtýr.

There are the different opinions on the methods used in the treatment of acute grade III acromioclavicular dislocations and their results. In this study, the results of 10 patients treated with Neviaser's method and followed in The Department Orthopaedics and Traumatology of Atatürk University Medical School were evaluated. All patients were males and the average age was 36.5 (25 to 45) years. The causes of dislocations were falls on the shoulder in 5 cases (50%), traffic accidents in 4 cases (40%) and direct trauma to the shoulder in 1 case (10%). The mean interval between injury and operation time was 10.2 (5 to 20) days. The cases were followed up with an average period of 13.1 months (6 months 2 years). The excellent and good results were obtained in 9 cases (90%) and the complication was observed in not one of the patients. We consider that Neviaser's method is a good alternative in the treatment of acute grade III acromioclavicular dislocations that operation is indicated.

Çalýþma; Mart 1996 Mart 2000 tarihleri arasýnda cerrahi tedavi uygulanan 20 hasta ile yapýldý. Hastalarýn 13'ü erkek, 7'si kadýn ve yaþ ortalamasý 39.5 idi. Transvers kýrýðý olan 10 hastaya modifiye tension band, vertikal kýrýðý olan 3 hasta ile distal pol kýrýðý olan 2 hastaya lag screw veya mini spongioz vida ile fiksasyon, parçalý kýrýðý olan 5 hastaya ise K teli + periferik sirküler serklaj ile tespit uygulandý. Ortalama 24 ay süreyle takip edilen hastalar radyolojik bulgulara ve Levack tarafýndan tanýmlanan kriterlere göre deðerlendirildiler. Vakalarýn %55'inde iyi, %35'inde orta ve %10'unda kötü sonuç elde edildi. En iyi sonuçlar modifiye tensiyon band yöntemi ile tedavi edilen transvers kýrýklarda elde edilirken, en kötü sonuçlar, periferik sirküler serklaj uygulanarak patellanýn korunmaya çalýþýldýðý parçalý kýrýklarda elde edildi. Çalýþmanýn sonucunda, cerrahi olarak tedavi edilen patella kýrýklarýnda; kýrýðý oluþturan travmanýn þiddeti, kýrýk tipi, uygulanan cerrahi teknik ve ameliyat sonrasý rehabilitasyonun sonuç üzerinde önemli etkileri olduðu saptandý. Ayrýca, patella eklem yüzü bütünlüðünün korunamadýðý çok parçalý kýrýklarda patellektominin ciddi bir tedavi seçeneði olarak düþünülmesinin uygun olacaðý sonucuna varýldý.

Twenty patients were treated surgically between March 1996 and March 2000. The mean age was 39.5 (18-68) and whom 13 were male and 7 were female. Surgical treatment methods as follows; modified tension band wiring in 10 of the patients with transverse fractures, mini cancellous screw and lag-screw fixation in 7 with vertical fractures and in 2 with distal pol fractures, combination of K wire and circumferential cerclage wire fixation in 5 with comminuted fractures. The average follow-up time was 24 months (6-54 months) and findings were evaluated radiologically and according to scale of Levack. Results were rated as good in 55%, moderate in 35% and poor in 10% of the patients. It was found that modified tension band wiring technique gave the best results. We concluded that majority of the trauma, type of the fracture, surgical technique and post operative rehabilitation were affected the results of patellar fractures treated surgically. In addition to this, patellectomy may be performed in severely comminuted fractures where no major fragments containing of articular surface of the patella exist.

Amaç: En sýk yaralanan eklemlerden biri olan diz travmalarýnda, fizik muayene bulgularý ve direkt grafiler tanýda sýnýrlý kalmaktadýr. Manyetik rezonans görüntüleme (MRG) ise, kemik yapýlara ek olarak menisküs ve baðlar gibi yumuþak doku patolojilerinin deðerlendirilmesinde önemli bir fayda saðlamaktadýr. Çalýþmamýzda, diz travmalarýndaki MRG bulgularýný deðerlendirdik ve literatürle kýyasladýk. Gereç ve yöntem: Ortopedi servisine diz travmasýyla gelen olgular arasýndan aperatif, artroskopik ve klinik korelasyonu olan 49 olguya ait 50 diz seçildi ve deðerlendirildi. Fizik muayene ve direkt grafilerin tanýda yetersiz kaldýðý olgulara MRG uygulandý. Bulgular: En sýk rastladýðýmýz bulgu kemik kontüzyonu oldu (n: 33). Daha sonra sýrasýyla, 17 olguda ön çapraz bað (ÖÇB) lezyonlarý, 12 olguda menisküs yýrtýklarý, 9 olguda osteokondral fraktür, 7 olguda kollateral bað lezyonu ve 5 olguda kemik fraktürü tespit edildi. Sonuç: Diz travmalarýnda, MRG bulgularý tanýya büyük katký saðlamakta ve hastayý gereksiz tanýsal artroskopi uygulamalarýndan korumaktadýr.

Purpose: The knee is the most frequently injured joint that physical examination and plain radiographies are limited to diagnose precisely the knee injuries. Magnetic resonance imaging (MRI) has been contributed great benefits to the accurate diagnosis by determining the injuries of menisci and ligaments in addition to bone structures. We evaluated MRI findings in traumatic knees and compare them to literature. Materials and methods: The patients with the knee injury who were admitted to orthopedic surgery service were reviewed. Of them, 49 patients (50 knees) correlated operatively, arthroscopicly and clinically were included in our study population. If the diagnosis was not sufficient by using plain films and clinical evaluation, the patients underwent MRI examination. Results: Bone contusions were the most common finding in the injuries (n: 33). The other findings were respectively, the anterior cruciate ligament injuries in 17 patients, meniscal tears in 12 patients, osteochondral fractures in 9 patients, collateral ligament injuries in 7 patients and bone fractures in 5 patients. Conclusion: MR imaging plays a major role in decisions 0,7 evaluation and management of traumatic knees, improves clinician diagnostic certainty and reduces the need for arthroscopy.

Kardiak travmalar, politravmatize hastalarýn takibinde önemli bir klinik problemdir. Politravmatize hastalarda hastane öncesi ölümlerin üçte birini kardiotorasik travmalar oluþturmaktadýr. Kardiak yaralanmalar, hastaneye canlý ulaþan hastalarýn ölüm nedenlerinin de büyük bir çoðunluðunu oluþturmaktadýr. Bu ölümler sýklýkla multi-disipliner yaralanmalarý olan politravmatize hastalarýn acil birimlerde eksik deðerlendirme ve tanýlarý neticesinde olmaktadýr. Burada, araç içi trafik kazasý sonucu kalça kýrýklý çýkýðý (Pipkin Tip-IV) ve ayrýþmamýþ sternum kýrýðý tanýlarý ile yatýrýlan, klinik takibi ve Ortopedik ameliyat hazýrlýklarý sýrasýnda travmatik aort kapak rüptürü tanýsý konan bir olgu sunulmaktadýr.

Traumatic aortic valve rupture with resultant aortic insufficiency is a rare complication of blunt trauma. Here reported is a case with a posterior fracture-dislocation of the hip (Pipkin type-IV) and an undisplaced sternum fracture who developed hemodynamic instability in the clinical follow-up and was diagnosed having a traumatic aortic valve rupture using echocardiography. He first was treated with a biological valve replacement. Two weeks later a total hip arthroplasty combined with the osteosynthesis of the posterior wall of the asetabulum was performed. Sternum fracture healed conservatively. In multiply injured patients especially with a blunt thorax trauma hemodyanamic instability despite appropriate fluid replacement should rise the suspicion of cardiac injuries, especially traumatic aortic valve rupture. Echocardiography is a simple but reliable method for the diagnosis.

Amaç: Dilde devamlý olarak meydana gelen travmayý önlemek üzere aðýz açýcý apareyin kullanýmý Dizayn: Ýki vaka raporu. Araçlar: aðýz açýcý aparey Sonuç: Aðýz açýcý apareyin erken kullanýlarak, travmatik makroglossi'li 16 yaþýnda erkek ve 22 yaþýnda bayan hastanýn, diline gelen travmanýn önlenmesi ve dildeki ödemin hýzla giderilmesi.

Objective: To describe the use of a bite guard to avoid continued tongue trauma and edema Design: Two case reports. Interventions: bite raiser. Conclusion: Muscle relaxation and a bite guard were used in a 16 years old male and 22 years old female with traumatic macroglossia, which allowed for rapid resolution of edema and prevented additional trauma to the tongue.

A 17 years old male with symptoms of acute abdomen was operated. The preoperative diagnosis was peptic ulcus perforation but at the operation there were multipl perforations throughout the small bowels, multiple lymphadenopaties in the mesentery of the jejenum. 60 cm small bowel resection- end to end anastomosis, raphe omentoplasty, primary repair with suture were performed. The patient got well after the operation and discharged postoperative 14th day. The pathological diagnosis was diffuse grand cell lymphoma. We conclude that, this rare condition which we could be able to find only one case in the literature must be thought among the reasons of acute abdomen.