AMAÇ: Bu çalýþma, akut radyasyon proktiti (ARP) sýçan modelinde hyaluronik asit ve kondroitin sülfat kombinasyonunun (HA/CS) profilaktik ve terapötik etkilerini araþtýrmak için tasarlandý.
GEREÇ VE YÖNTEM: Sýçanlar beþ gruba ayrýldý: SHAM; radyasyon (IR) + salin (5. ve 10. gün boyunca 1 mL); IR + HA/CS (5. ve 10. gün boyunca 1 mL). Her sýçana 17.5 Gy’lik tek bir fraksiyon RT verildi. HA/CS, ýþýnlamadan sonra her gün rektal yoldan uygulandý. Her sýçan, proktit belirtileri açýsýndan günlük olarak gözlendi. Mukozal deðiþiklikler makroskopik ve patolojik olarak deðerlendirildi.
BULGULAR: Klinik bulgulara göre IR + salin grubundaki beþ sýçan 10. günde 3-4 derece semptomlar izlendi. IR+ salin ve IR + HA/CS gruplarý arasýnda 5. gündeki makroskopik bulgu skorlarýnda anlamlý bir fark gözlenmedi. Patolojik incelemede, salinle tedavi edilen sýçanlarda ýþýnlamadan 10 gün sonra radyasyona baðlý mukozal hasar en belirgin bulguydu. IR + HA/CS 10. gün grubunda 1-2 derece patolojik bulgulara karþýlýk gelen hafif inflamasyon ve hafif kript deðiþiklikleri gösterdi.
TARTIÞMA: Radyasyon sistitinde kullanýlan HA/CS, radyasyon proktitinde de faydalý olabileceði düþünmekteyiz.

BACKGROUND: This study was designed to investigate the prophylactic and therapeutic effects of hyaluronic acid and chondroitin sulfate combination (HA/CS) on a model of acute radiation proctitis.
METHODS: Rats were divided into five groups: SHAM; irradiation (IR) + saline (1 mL for 5th and 10th day); IR + HA/CS (1 mL for 5th and 10th day). A single fraction of 17.5 Gy was delivered to each rat. HA/CS was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanized on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically.
RESULTS: According to the clinical findings, five rats in the irradiation + saline group showed grade 3–4 symptoms on the 10th day. No significant difference in the macroscopic finding scores on the 5th day was observed between the irradiation + saline and irradiation + HA/CS groups. In the pathological examination, radiation-induced mucosal damage was the most prominent finding 10 days after irradiation in saline-treated rats. On the 10th day, the irradiation + HA/CS group showed mild inflammation and slight crypt changes, which corresponded to grade 1–2 pathological findings.
CONCLUSION: We think that HA/CS used in radiation cystitis can be beneficial for radiation proctitis.

AMAÇ: Torakal ve abdominal bilgisayarlý tomografi taramalarý acil serviste travma hastalarý için yaygýn olarak kullanýlmaktadýr. Bununla birlikte, yüksek maliyet, aþýrý radyasyon maruziyeti gibi sýnýrlamalar nedeniyle alternatif taný ve takip araçlarýna da ihtiyaç vardýr. Bu çalýþma, stabil künt torakoabdominal travmasý olan hastalarda acil hekimi tarafýndan yapýlan travma için tekrarlanan geniþletilmiþ odaklanmýþ abdominal sonografinin (rE-FAST) yararlarýný araþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu prospektif, tek merkezli tanýsal doðruluk çalýþmasýydý. Künt torakoabdominal travma sonrasý acil servise baþvuran hastalar çalýþmamýza dahil edildi. Çalýþmaya alýnan hastalara geliþinde (0’ýncý saatte) ve takipleri sýrasýnda 3’üncü ve 6’ncý saatte E-FAST yapýldý. E-FAST ve rE-FAST tanýsal doðruluk ölçümleri hesaplandý.
BULGULAR: Torakoabdominal patolojilerin belirlenmesinde E-FAST’in duyarlýlýðý ve özgüllüðü sýrasýyla %75 ve %98,7 olarak bulunmuþtur. Spesifik patolojiler için duyarlýlýk ve özgüllük pnömotoraks için sýrasýyla %66.7 ve %100, hemotoraks için %66.7 ve %98.8, hemoperitoneum için %66.7 ve %100’idi. Stabil hastalarda torakal ve/veya abdominal kanamanýn belirlenmesinde rE-FAST’ýn duyarlýlýðý ve özgüllüðü sýrasýyla %100 ve %98.7 olarak bulunmuþtur.
TARTIÞMA: E-FAST, yüksek özgüllüðü ile künt travmalý hastalarda torakoabdominal patolojilere baþarýyla taný koyabilir. Bununla birlikte, stabil has-talarda ancak rE-FAST travmatik patolojileri dýþlamak için yeterli duyarlýlýða sahiptir.

BACKGROUND: Thoracic and abdominal computed tomography scans are widely used modalities for trauma patients in emergency department (ED). However, alternative diagnostic and follow-up tools are also needed, due to limitations such as high cost and exces-sive radiation exposure. This study aimed to investigate the utility of repeated extended focused abdominal sonography for trauma (rE-FAST) performed by the emergency physician in patients with stable blunt thoracoabdominal trauma.
METHODS: This was a prospective, single-center diagnostic accuracy study. Patients with blunt thoracoabdominal trauma admitted to the ED were included in the study. The E-FAST was performed on the patients included in the study at the 0th h, the 3rd h, and the 6th h during their follow-up. Then, the diagnostic accuracy metrics of E-FAST and rE-FAST were calculated.
RESULTS: The sensitivity and specificity of E-FAST in determining thoracoabdominal pathologies were found to be 75% and 98.7%, respectively. The sensitivity and specificity for specific pathologies were 66.7% and 100% for pneumothorax, 66.7% and 98.8% for hemothorax, and 66.7% and 100% for hemoperitoneum, respectively. The sensitivity and specificity of rE-FAST in determining thoracal and/or abdominal hemorrhage in stable patients were found to be 100% and 98.7%, respectively.
CONCLUSION: E-FAST successfully rules in thoracoabdominal pathologies in patients with blunt trauma, with its high specificity. However, only a rE-FAST might be sensitive enough to exclude traumatic pathologies in these stable patients.

AMAÇ: Koronavirüs pandemisinin önemli bir sorunu, yoðun bakým ünitesi (YBÜ) desteðine ihtiyaç duyan hastalarýn son derece sýnýrlý bir süre içinde artmasýdýr. Sonuç olarak, çoðu ülke yoðun bakým ünitelerinde (YBÜ) COVID-19 bakýmýna öncelik vermiþ ve acil servis ve yoðun bakým ünitelerinde hastane kapasitesini artýrmak için yeni düzenlemeler yapmýþtýr. Bu çalýþmada, COVID-19 pandemisi döneminde (pandemi öncesi dönem) COVID-19 dýþý yoðun bakýmlarda yatan hasta sayýsý, klinik ve demografik özelliklerindeki deðiþikliklerin bir önceki yýla göre deðerlendirilmesi ve pandeminin etkilerinin ortaya konulmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 11 Mart 2019-11 Mart 2021 tarihleri arasýnda hastanemizin COVID-19 dýþý yoðun bakým ünitelerinde yatan hastalar çalýþmaya dahil edildi. Hastalar COVID döneminin baþlama tarihine göre iki gruba ayrýldý. Hasta verileri geriye dönük olarak hastane bilgi sistemi ve YBÜ deðerlendirme formlarýndan taranarak kaydedildi. Demografik bilgiler (yaþ ve cinsiyet), komorbiditeler, COVID 19 PCR sonucu, yoðun bakým yatýþ yeri, yoðun bakýma yatan hastalarýn tanýlarý, yoðun bakýmda kalýþ süreleri, Glasgow koma skalasý ve ölüm oranlarý ile APACHE II skoru toplandý. BULGULAR: Pandemi öncesi dönemde (Grup 1) 1011 hasta (413 kadýn, 598 erkek) ve pandemi döneminde (Grup 2) 1281 hasta (572 kadýn, 709 erkek) olmak üzere toplam 2292 hasta analiz edildi. YBÜ’ye baþvuran hastalarýn tanýlarý gruplar arasýnda karþýlaþtýrýldýðýnda, postoperatif, spontan dolaþýmýn geri dönüþü (ROSC), zehirlenme, multitravma ve diðer nedenler arasýnda istatistiksel olarak anlamlý fark vardý. Pandemi döneminde hastalarýn yoðun bakýmda kalýþ süresi istatistiksel olarak anlamlý þekilde daha uzundu.
TARTIÞMA: COVID-19 dýþý yoðun bakýmlarda yatan hastalarýn klinik ve demografik özelliklerinde deðiþiklikler gözlendi. Pandemi döneminde hastalarýn yoðun bakýmda kalýþ sürelerinin arttýðýný gözlemledik. Bu durum nedeniyle pandemi döneminde yoðun bakým ve diðer yataklý servislerin daha etkin yönetilmesi gerektiðini düþünüyoruz.

BACKGROUND: A major problem of the coronavirus pandemic is the increase of patients requiring intensive care unit (ICU) sup-port in an extremely limited period of time. As a result, most countries have prioritized coronavirus disease 2019 (COVID-19) care in ICUs and take new arrangements to increase hospital capacity in emergency department and ICUs. This study aimed to evaluate the changes in the number, clinical and demographic characteristics of patients hospitalized in non-COVID ICUs during the COVID-19 pandemic period compared to the previous year (pre-pandemic period), and to reveal the effects of the pandemic.
METHODS: Hospitalized patients in non-COVID ICUs of our hospital between 11 March 2019 and 11 March 2021 were included in the study. The patients were divided into two groups according to date of the start of the COVID period. Patient data were scanned and recorded retrospectively from hospital information system and ICU assessment forms. Information regarding demographics (age and gender), comorbidities, COVID 19 polymerase chain reaction result, place of ICU admission, the diagnoses of patients admitted to ICU, length of ICU stay, Glasgow coma scale and mortality rates, and the Acute Physiology and Chronic Health Evaluation II score were collected.
RESULTS: A total of 2292 patients were analyzed, including 1011 patients (413 women and 598 men) in the pre-pandemic period (Group 1) and 1281 patients (572 women and 709 men) in the pandemic period (Group 2). When the diagnoses of patients admitted to ICU were compared between the groups, there was a statistically significant difference between post-operation, return of spon-taneous circulation, intoxication, multitrauma, and other reasons. In the pandemic period, the patients had a statistically significant longer length of ICU stay.
CONCLUSION: Changes were observed in the clinical and demographic characteristics of patients hospitalized in non-COVID-19 ICUs. We observed that the length of ICU stay of the patients increased during the pandemic period. Due to this situation, we think that intensive care and other inpatient services should be managed more effectively during the pandemic.

AMAÇ: Akut apandisit, çocuk acil servisine baþvuran çocuklarda akut karýn aðrýsýnýn en önemli nedenlerinden biridir. Bu çalýþma, pediatrik hastalarda komplike apandisiti öngörmede sistemik immün-inflamasyon indeksinin yararlýlýðýný belirlemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Akut apandisit tanýsý ile ameliyat edilen hastalar geriye dönük olarak incelendi. Akut apandisit ve kontrol grubu oluþturuldu. Akut apandisit, nonkomplike ve komplike apandisit grubu olarak ikiye ayrýldý. C-reaktif protein, beyaz küre sayýsý, mutlak nötrofil sayýsý, mutlak lenfosit sayýsý, nötrofil/lenfosit oraný, trombosit/lenfosit oraný ve sistemik immün-inflamasyon indeks deðerleri kaydedildi. Sistemik immün enflamasyon indeks trombosit sayýsý x nötrofil/lenfosit formülü ile hesaplandý. Biyobelirteçlerin komplike apandisiti öngörmedeki etkinliði karþýlaþtýrýldý.
BULGULAR: Çalýþmamýza 1072 akut apandisit ve 541 kontrol hasta dahil edildi. Nonkomplike apandisit grubunda %74.3 hasta, komplike apandisit grubunda %25.7 hasta vardý. Akut apandisit ve kontrol grubu, komplike ve nonkomplike apandisit grubu laboratuvar parametreleri açýsýndan kar-þýlaþýrýldýðýnda C-reaktif protein, beyaz küre, mutlak nötrofil sayýsý, nötrofil/lenfosit oraný, trombosit/lenfosit oraný ve sistemik immün-inflamasyon indeks düzeyi akut apandisit ve komplike apandisit grubunda daha yüksek tespit edildi. Nonkomplike apandisit hastalarýnda sistemik immün-inflamasyon indeks deðeri 2164.91±1831.24 iken komplike apandisit hastalarýnda 3132.59±2658.73 idi (p<0.001). Eðri altýndaki alana göre kestirim deðerleri belirlendiðinde, komplike apandisit öngörüsünde en iyi biyobelirteçler C-reaktif protein ve sistemik immün-inflamasyon indeksi bulundu. TARTIÞMA: Nonkomplike ve komplike akut apandisit ayýrýmýnda, klinik deðerlendirme ile birlikte enflamasyon belirteçleri faydalý olabilir. Fakat bu parametreler tek baþýna komplike apandisiti öngörmede yeterli deðildir. Çocuklarda komplike apandisiti tahmin etmek için C-reaktif protein ve sistemik immün-enflamasyon indeksi en iyi biyobelirteç tespit edilmiþtir.

BACKGROUND: Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients.
METHODS: The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared.
RESULTS: Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA.
CONCLUSION: Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.

AMAÇ: Korozif madde yutma, özofagus cerrahisi, reflü özofajiti çocuklarda benign özofagus darlýðýnýn baþlýca sebepleridir. Özofagus dilatasyonu ilk tedavi seçeneðidir. Bujiler ve balonlu kateterler en sýk kullanýlan dilatasyon araçlarýdýr. Özofagus dilatasyonunun etkin ve güvenli olduðu belirtilmesine raðmen, özofagus dilatasyonu yöntemlerine ve sonuçlarýna dair literatür bilgisi daha çok eriþkin yaþ grubuna iliþkindir. Bu çalýþmada, buji ve balon dilatasyon yöntemlerinin karþýlaþtýrýlmasý; benign özofagus darlýðý sebeplerinin, dilatasyon sonuçlarýyla iliþkisinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bir üniversitenin iki adet 3. derece saðlýk merkezinde, 2001-2009 arasýnda, Çocuk Cerrahisi Anabilim Dalý’nca özofagus dilatasyonu uygulanmýþ benign özofagus darlýðý olgularý, retrospektif olarak; özofagus darlýðý sebepleri, tedavileri ve sonuçlarý, balon ve buji dilatas-yonlarýnýn karþýlaþtýrmasý temelinde deðerlendirilmiþtir.
BULGULAR: Elli dört benign özofagus darlýðý olgusuna 447 dilatasyon seansý uygulanmýþtýr. Darlýklar, olgularýn %72.2’sinde korozif madde yutma ve anastomoz nedenlidir. Dilatasyonlarýn %52.6’sý Savary-Gilliard bujilerle, geri kalaný balonla gerçekleþtirilmiþtir. Bujiyle yapýlmýþ dilatasyon seanslarýnýn %53.2’sinde kýlavuz tele ihtiyaç olmamýþtýr. Balonla dilatasyonlarda, iþlemin olaðan bir parçasý olarak fluoroskopiden yararlanýlmýþ, bujiyle dilatasyonlarda sadece ihtiyaç halinde, kýlavuz telin yerini kontrol etme amaçlý fluoroskopi kullanýlmýþtýr. Balon ve buji dilatasyonlarýnda komplikasyon oranlarý sýrasýyla %2.4 ve %2.1’dir. Bujiyle ve balonla yapýlmýþ seanslar, sýrasýyla ortalama 26.2±11.8 dakika ve 42.6±13.7 dakika sürmüþtür. Seanslarýn baþarý oranlarý balonla %93.7; bujiyle %98.2’dir. Balonlar tek kullaným için üretilmiþtir.
TARTIÞMA: Dilatasyon aracý olarak Savary-Gilliard bujiler, balonlara göre daha az fluoroskopi ihtiyacý, daha kýsa iþlem süresi, daha düþük maliyetle daha avantajlýdýr. Her iki yöntem, komplikasyon oranlarý açýsýndan birbirine denktir.

BACKGROUND: Corrosive substance ingestion, history of esophageal surgery, and reflux esophagitis are the main causes of benign esophageal strictures in children. Esophageal dilation is the first treatment option. Bougies and balloons are the most frequently used dilation tools. The literature record on esophageal dilation methods and their results is mostly composed of data gathered from adults, who differ from children in many terms, including etiology, indications, and results. This study aims to evaluate esophagial dilation in children; comparing the two mentioned modalities; and considering the impact of different diseases on dilation success.
METHODS: The benign esophageal stricture cases who had undergone esophageal dilation between 2001 and 2009, at two tertiary health-care centers of a university were evaluated retrospectively with regard to stricture etiology, treatment methods, and their results. In addition, balloon and bougie dilations were compared.
RESULTS: Fifty-four cases were dilated in 447 sessions. The strictures were due to corrosive ingestion or anastomoses in 72.2% of the cases. Of the dilation sessions, 52.6% were performed with Savary-Gilliard bougies, and the rest with balloon dilators. No guidewire was needed in 53.2% of the bougie sessions. Fluoroscopy was used during balloon dilation sessions as a routine part of the method, while it was needed only to check the guide location when needed during the bougie dilation sessions. The complication rates of balloon and bougie dilation sessions were 2.4% and 2.1%, respectively. The mean session length was 26.2±11.8 and 42.6±13.7 min, for bougie and balloon, respectively. Success rate was 93.7% for the balloon, while 98.2% of the bougie sessions. Balloon catheters used were disposable.
CONCLUSION: Savary-Gilliard bougies have advantages over balloon catheters with less need of fluoroscopy, shorter duration of sessions, and lower cost. Both methods are equivalently safe with close complication rates.

AMAÇ: Bu çalýþmanýn amacý, akut kolesistitin (AK) yönetiminde, perkütan safra kesesi aspirasyonu (PA) ile perkütan kolesistostostomi’nin (PK) tedavideki etkinliklerini, komplikasyon oranlarýný karþýlaþtýrak 3. basamak tek bir merkezin tecrübelerini sunmaktýr.
GEREÇ VE YÖNTEM: 2015 ve 2020 tarihleri arasýnda hastanemize baþvuran AC’li hastalardan konservatif tedaviye cevap vermeyen, LC uygulana-mayan PA ve PC prosedürleri uygulanan 159 hastanýn sonuçlarý geriye dönük incelendi. PC ve PA prosedüründen önceki ve iþlemden sonra 3. günde klinik ve laboratuvar verileri, teknik baþarý, komplikasyon, tedaviye yanýt, hastanede kalýþ süreleri, reverse transcriptase–polymerase chain reaction (RT-PCR) testinin sonucu kaydedildi.
BULGULAR: Toplam 159 hastanýn 22’sine (8 erkek,14 kadýn) PA ve 137’sine (57 erkek, 80 kadýn) PC prosedürü uygulandý. PA ve PC gruplarý arasýnda 72 saatte klinik iyileþme (p=0.532) ve hastanede kalýþ süreleri (p=0.138) açýsýndan anlamlý farklýlýk saptamadý. Her iki prosedürünin teknik baþarýsý %100 idi. PA uygulanan 22 hastanýn 20’sinde belirgin düzelme olurken sadece birine 2 kez yapýldý ve tamamen iyileþme görüldü (%4.5). Komplikasyon oranlarý her iki grupta düþük bulundu ve istatistiksel olarak anlamlý deðildi (p=1.00).
TARTIÞMA: Ýçinde bulunduðumuz pandemi döneminde saðlýk çalýþanlarý için güvenli, hastalar için düþük riskli minimal invaziv prosedurler olan PA ve PC cerrahiye uygun olmayan AK’li kritik hastalarda yatak baþýnda uygulanabilen etkin, güvenilir baþarýlý bir tedavi yöntemidir. Komplikasyon geliþtirmemiþ AK li hastalarda PA uygulanmalý tedaviye cevap alýnamaz ise PC bir kurtarma prosedürü olarak saklanmalýdýr. Komplikasyon geliþtirmiþ cerrahiye uygun olmayan AK li hasta ise PC prosedürü uygulanmalýdýr.

BACKGROUND: The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center.
METHODS: The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded.
RESULTS: Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00).
CONCLUSION: In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

AMAÇ: Perfore akut apandisitin erken radyolojik tahmini ve teþhisi hala tartýþmalýdýr. Bu çalýþmada, multidedektör bilgisayarlý tomografi (MDBT) bulgularýnýn perfore akut apandisitte prediktif deðerinin incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2019 – Aralýk 2021 arasýnda apendektomi ameliyatý yapýlan hastalar (n=542) retrospektif olarak deðerlendirildi. Hastalar non-perfore ve perfore olmak üzere iki gruba ayrýldý. Preoperatif abdominal MDBT bulgularý, apendiks sferisite indeksi (ASÝ) ve laboratuvar bulgularý deðerlendirildi.
BULGULAR: Non-perfore grupta 427, perfore grupta 115 olgu vardý ve tüm olgularýn yaþ ortalamasý 33.88±12.84 idi. Baþvuruya kadar geçen ortalama süre 2.06±1.43 gündü. Perfore olan grupta apendikolit, serbest sývý, duvar defekti, apse, serbest hava ve retroperitoneal alan (RPA) tutulumu oraný non-perfore gruba göre anlamlý ölçüde daha yüksek bulundu (p<0.001). Perfore grubun ortalama uzun aks, kýsa aks, ASÝ deðerleri non-perfore gruba göre daha yüksek bulundu (sýrasýyla; p<0.001; p=0.004; p<0.001). Perfore grupta CRP anlamlý ölçüde yüksek iken (p=0.008) ortalama WBC her iki grupta benzerdi (p=0.613). MDBT bulgularýndan serbest sývý, duvar defekti, apse, CRP yüksekliði, uzun aks ve ASÝ’nin perfo-rasyon için prediktif deðerler olduðu gözlendi. ROC analizi ile ASÝ’nin kestirim deðeri 1.30, sensitivitesi %80.87, spesifitesi %93.21 idi.
TARTIÞMA: Multidedektör BT bulgularýndan apendikolit, serbest sývý, duvar defekti, apse, serbest hava ve RPA tutulumu perfore apandisitte anlamlý bulgulardýr. Apendiks sferisite indeksi yüksek sensitivite ve spesifisite ile akut apandisit perforasyonunda önemli bir prediktif parametredir.

BACKGROUND: Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis.
METHODS: The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated.
RESULTS: The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%.
CONCLUSION: MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

AMAÇ: Son yýllarda kullanýcý paylaþýmlý, ayakta durularak sürülen e-scooter iliþkili kazalardaki artýþýn nedenleri özellikle yoðun trafiðin olduðu met-ropollerde gençler arasýnda e-scooter kullanýmýnýn yaygýnlaþmasý ile birlikte trafik kurallarýna uyulmamasý ve yasal düzenlemelerin yetersizliði olabilir. Biz bu çalýþmada, hastanemizin acil servisisine getirilen binici paylaþýmlý e-scooter iliþkili yaralanmalarýn tipik özeliklerini güncel literatür ýþýðýnda detaylý olarak analiz ettik.
GEREÇ VE YÖNTEM: 2020-2020 yýllarý arasýnda e-scooter kazasý nedeniyle hastanemizin acil servisine getirilen 60 hastanýn kaza ve klinik özellikleri cerrahi gereksinimleriyle birlikte geriye dönük olarak istatistiksel yöntemler kullanýlarak incelendi.
BULGULAR: Kurbanlarýn çoðunluðu üniversite öðrencisi iidi ve erkek cinsiyet hafifçe fazla ve yaþ ortalamasý 25.3±13.0 olarak bulundu. E-scooter ile ilgili kaza maðdurlarýnýn çoðunluðu minör travma grubundaydý (ISS<9), aðýrlýklý olarak ekstremite ve yumuþak doku yaralanmasý ve radyolojik muayene ihtiyacý (44 hasta, %73.3), sadece 8 kurban (%13.3) cerrahi operasyon gerektirdi ve ayrýca tüm e-scooter kurbanlarý tamamen iyileþmiþ olarak taburcu edildi.
TARTIÞMA: Daha yaygýn görülen travma ciddiyet skoru daha düþük veya minör olan çarpýþmasýz e-scooter iliþkili kazalarda, tek organ yaralanmalarý, çoklu sistem yaralanmalarýndan ve radial ve nazal kemik aðýrlýklý tekli kýrýklar ise çoklu kýrýklardan daha sýk görülür. Ayrýca e-scooter iliþkili kazalarýnýn önlemesi için yasal düzenlemelerle birlikte etkili önlemler alýnmalýdýr.

BACKGROUND: The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature.
METHODS: The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively.
RESULTS: The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed.
CONCLUSION: Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

AMAÇ: Travma nedenleri arasýnda harp yaralanmalarý normal yaþamdaki olgulara göre farklýdýr. Harp yaralanmasýna baðlý multitravma hastalarý sepsis veya septik þok gibi enfektif komplikasyonlar geliþtirmeye yatkýndýr. Septik komplikasyonlar, multitravma hastalarýnda geç ölümlerin önde gelen nedenlerinden biridir. Sepsisin hýzlý, uygun ve etkili yönetiminin multiorgan disfonksiyonunu önleyebileceði, mortaliteyi ve klinik sonuçlarý iyileþtirebi-leceði gösterilmiþtir. Ancak, sepsisi öngörebilecek ideal bir biyomarker bulunmamaktadýr. Bu çalýþmada, ateþli silah yaralanmasý (ASY) olan hastalarýn hemostatik kan parametreleri ile sepsis tablosu arasýnda korelasyon olup olmadýðýnýn belirlenmesi amaçlandý.
GEREÇ VE YÖNTEM: Tanýmlayýcý nitelikteki bu çalýþma, bir eðitim ve araþtýrma hastanesinin eriþkin acil servisine 01.10.2016 ve 31.12.2017 tarihleri arasýnda ASY tanýsý ile sevk edilen ve takiplerinde sepsis geliþen (n=56) ve geliþmeyen (n=56) olgularýn retrospektif olarak incelenmesi þeklinde yapýldý. Her olgunun yaþ, cinsiyet gibi demografik verileri ile hastane bilgi sisteminden acil serviste alýnan kan parametreleri alýnarak kayýt edildi. Sepsis geliþen ve geliþmeyen iki grup arasýnda hemostatik kan parametreleri açýsýndan istatistiksel olarak fark olup olmadýðý SPSS 20.0 ile deðerlendirildi.
BULGULAR: Hastalarýn yaþ ortalamasý 26.9±6.67 idi. Hastalarýn tamamý erkekti. Sepsis geliþen hastalarýn %57’sinin (n=32) el yapýmý patlayýcý (EYP) ile %30’unun (n=17) ateþli silahla yaralandýðý ve anatomik olarak yaralanma bölgelerine bakýldýðýnda %64’ünde (n=36) çoklu yaralanma olduðu tespit edildi. Sepsis geliþmeyen hastalarýn ise %48’inde (n=27) EYP, %43’ünde (n=24) ASY olduðu ve anatomik bölge olarak %48’inde (n=27) çoklu yara-lanma, %32’sinde (n=18) ekstremite yaralanmasý olduðu bulunmuþtur. Hemostatik kan parametrelerinden PLT, PTZ, INR ve Ca deðerlerinde sepsis geliþen ve geliþmeyen olgular arasýnda istatistiksel olarak anlamlý fark saptanmýþ ve ROC eðrisi ile incelendiðinde ise PTZ ve INR, test edilen deðerler arasýnda en iyi taný performansýný göstermiþtir.
TARTIÞMA: ASY olan hastalarda PTZ, INR deðerlerinde artýþ ile Ca ve PLT deðerlerinde azalma olmasý klinisyenleri sepsis açýsýndan uyarabilir ve antibiyotik tedavisini baþlatmaya veya deðiþtirmeye yönlendirebilir.

BACKGROUND: War injuries are different among the causes of trauma compared to cases in normal life. Patients with multi-trauma due to war injury are prone to develop infective complications such as sepsis or septic shock. Septic complications are one of the leading causes of late death in multi-trauma patients. Prompt, appropriate, and effective management of sepsis has been shown to prevent multiorgan dysfunction and improve mortality and clinical outcomes. However, there is no ideal biomarker to predict sepsis. The aim of this study was to determine whether there is a correlation between hemostatic blood parameters and sepsis in patients with gunshot wounds (GSW).
METHODS: This descriptive study was conducted as a retrospective analysis of patients who were referred to the adult emergency department of a training and research hospital between October 1, 2016, and December 31, 2017, with a diagnosis of GSW and who developed sepsis (n=56) and did not develop sepsis (n=56) during follow-up. Demographic data such as age, sex, and blood parameters obtained from the hospital information system in the emergency department were recorded for each case. The statistical difference in hemostatic blood parameters between the two groups with and without sepsis was evaluated with Statistical Package for the Social Sciences 20.0 program.
RESULTS: The mean age of the patients was 26.9±6.67. All of the patients were male. Of the patients who developed sepsis, 57% (n=32) were injured with improvised explosive devices (IEDs), 30% (n=17) were injured with firearms and when the anatomical injury sites were analyzed, 64% (n=36) had multiple injuries. In patients who did not develop sepsis, 48% (n=27) had IED, 43% (n=24) had GSW and 48% (n=27) had multiple injuries and 32% (n=18) had extremity injuries. Among the hemostatic blood parameters, platelet count (PLT), PTZ, INR, and Ca values showed a statistically significant difference between patients with and without sepsis, and when analyzed with the receiver operating characteristics curve, PTZ and INR showed the best diagnostic performance compared to the tested values.
CONCLUSION: Increased PTZ and INR values and decreased Ca and PLT values in patients with GSW may alert clinicians to sepsis and direct them to initiate or change antibiotic therapy.

AMAÇ: Akut apandisit, cerrahi akut karýn olgularýnda ilk sýrada yer almaktadýr. Tedavisi açýk veya laparoskopik appendektomidir. Apendiks güdüðünü kapatmak için farklý yöntemler mevcuttur. Özellikle imkanlarýn daha kýsýtlý olduðu devlet hastanelerinde güdüðü kapatmak için el yardýmlý loop uygulamasý ile laparoskopik apendektomi daha yapýlabilir hale gelmiþtir. Bu yazýda, apendiks güdüðünün el yapýmý loop ile kapatýldýðý laparoskopik appendektomi uygulanan olgularýn sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Hastanemiz genel cerrahi kliniði’nde Haziran 2014-Aralýk 2018 tarihleri arasýnda apendiks güdüðünün el yapýmý loop ile kapatýldýðý laparoskopik appendektomi uygulanan 50 olgu deðerlendirildi. Hastalarýn yaþý, cinsiyeti, yatýþ süresi, komplikasyonlar ve histopatolojik inceleme sonuçlarý retrospektif olarak toplandý. Laparoskopik appendektomi üç port ile yapýldý. Apendiks güdüðü iki adet el yardýmý ile yapýlan loop kullanýlarak kapatýldý. Loop literatürde güvenilirliði kanýtlanmýþ olan Roeder’s loop’ un modifiye edilmesi ile yapýldý. Tüm olgularda ilk port batýna açýk yöntemle girildi. Ýstatistiksel deðerlendirme için SPSS 26,0 istatistik programý kullanýldý.
BULGULAR: Hastalarýn 31’i (%62) erkek, 19’u (%38) kadýn idi. Ortalama yaþ 32.2±11.9 olup yaþ aralýðý 19-74 idi. Hastalarýn ortalama yatýþ süresi 1.12±0.47 gündü. Olgulardan biri 21 haftalýk gebe idi. Ameliyat sonrasý dönemde bir hastada cerrahi alan enfeksiyonu meydana geldi. Antibiyoterapi ile düzelme saðlandý. Hiçbir olguda appendiks güdüðünden kaçak veya çekal fistül saptanmadý.
TARTIÞMA: Laparoskopik appendektominin maliyetinde en önemli parametrelerden biri güdüðün kapatýlma tekniðidir. Özellikle kýsýtlý imkanlara sahip devlet hastanelerinde maliyet daha fazla önem kazanmaktadýr. El yapýmý loop ile apendiks güdüðünün kapatýlmasý kolay, güvenli ve ucuz bir yöntemdir.

BACKGROUND: Acute appendicitis is the leading emergency condition among surgical abdominal diseases. The treatment of choice for appendicitis is open or laparoscopic appendectomy. There are different methods for appendiceal stump closure. Laparoscopic ap-pendectomy became more applicable with hand-made endo-loop applications to close the appendiceal stump, especially in state hospi-tals where the resources were limited. This article aims to evaluate the outcomes of patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop.
METHODS: Fifty patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop in the General Surgery Department of our hospital between June 2014 and December 2018 were evaluated. The ages, genders, length of stay in the hospital, complications, and histopathological investigation results of the patients were gathered retrospectively. Lapa-roscopic appendectomy was performed with three ports. The appendiceal stump was closed using two hand-made endo-loops. The loop was made with a modification of Roeder’s loop whose safety was proven in the literature. The first port was introduced to the abdomen with the open method. SPSS 26.0 statistical program was used for statistical analysis.
RESULTS: Thirty-one (62%) of patients were males and 19 (38%) of them were females. The mean age was 32.2±11.9 years. The age ranged between 19 and 74 years. The median length of stay in the hospital of the patients was 1.12±0.47 days. One of the patients was 21 weeks pregnant. A surgical site infection occurred in one patient during the post-operative period. Recovery was obtained with antibiotherapy. No leakage through the base of the appendix or cecal fistula was determined in none of the patients.
CONCLUSION: One of the most important parameters in the cost of laparoscopic appendectomy is the closure technique of the stump. The cost comes into question much more especially in state hospitals where the resources are limited. Appendiceal stump closure using a hand-made endo-loop is an easy, safe, and cost-effective method.

AMAÇ: Hasar kontrol laparotomisi, mortaliteyi iyileþtirerek resüsitasyona ve koagülopatinin tersine çevrilmesine olanak sunar. Kanamayý sýnýrlamak için genellikle karýniçi tampon kullanýlýr. Geçici batýn kapama, müteakip batýn içi enfeksiyon oranlarýnýn artmasýyla iliþkilidir. Uzamýþ antibiyotik süresi-nin bu enfeksiyon oranlarý üzerindeki etkisi bilinmemektedir. Bu çalýþmada, antibiyotiklerin hasar kontrol cerrahisindeki rolünü belirlemeye çalýþtýk.
GEREÇ VE YÖNTEM: 2011-2016 yýllarý arasýnda ACS onaylý bir birinci düzey travma merkezine kabul edildikten sonra hasar kontrol laparotomisi gerektiren tüm travma hastalarýnýn retrospektif analizi yapýldý. Komplikasyon oranlarýnýn yaný sýra, primer fasiyal kapanma aþamasýna ulaþma durumu ve süresi dahil olmak üzere demografik ve klinik veriler kaydedildi. Birincil sonuç ölçütü, hasar kontrol laparotomisini takiben karýniçi apse oluþu-muydu.
BULGULAR: Çalýþma süresi boyunca 239 hastaya hasar kontrol cerrahisi uygulandý. Çoðunluðuna tampon yerleþtirildi (141/239, %59.0). Gruplar arasýnda demografik bilgiler veya yaralanma þiddeti açýsýndan fark yoktu ve enfeksiyon oranlarý benzerdi (%30.5’e karþý %38.8, p=0.18). Enfeksiyonu olan hastalarda komplikasyon olmayanlara göre mide hasarý geliþme olasýlýðý daha yüksekti (%23.3’e karþý %6.1, p=0.003). Çok deðiþkenli regresyon analizinde süreden baðýmsýz olarak gram negatif ve anaerobik (OR 0.96, %95 CI 0.87-1.05) veya antifungal tedavi (OR 0.98, %95 CI 0.74-1.31) ve enfeksiyon oranlarý arasýnda anlamlý bir iliþki yoktu.
TARTIÞMA: Çalýþmamýz, antibiyotik süresinin hasar kontrol cerrahisi sonrasý karýniçi komplikasyonlar üzerine etkisinin ilk derlemesidir. Mide hasarý, karýniçi enfeksiyon geliþen hastalarda daha yaygýn olarak tanýmlanmýþtýr. Hasat kontrol cerrahisi sonrasý tampon yerleþtirilen hastalarda antimikrobiyal tedavinin süresi enfeksiyon oranýný etkilememektedir.

BACKGROUND: Damage control laparotomy allows for resuscitation and reversal of coagulopathy with improved mortality. In-tra-abdominal packing is often used to limit hemorrhage. Temporary abdominal closure is associated with increased rates of subse-quent intra-abdominal infection. The effect of increased duration of antibiotics is unknown on these infection rates. We sought to determine the role of antibiotics in damage control surgery.
METHODS: A retrospective analysis of all trauma patients requiring damage control laparotomy on admission to an ACS verified level one trauma center from 2011 to 2016 was performed. Demographic and clinical data including ability and time to attain primary fascial closure, as well as complication rates, were recorded. The primary outcome measure was intra-abdominal abscess formation following damage control laparotomy.
RESULTS: Two-hundred and thirty-nine patients underwent DCS during the study period. A majority were packed (141/239, 59.0%). No differences existed in demographics or injury severity between groups, and infection rates were similar (30.5% vs. 38.8%, P=0.18). Patients with infection were more likely to have suffered gastric injury (23.3% vs. 6.1%, P=0.003) than those without complication. There was no significant association between gram negative and anaerobic (Odds Radio [OR] 0.96, 95% confidence interval [CI] 0.87–1.05) or antifungal therapy (OR 0.98, 95% CI 0.74–1.31) and infection rate, regardless of duration on multivariate regression
CONCLUSION: Our study offers the first review of the effect of antibiotic duration on intra-abdominal complications following DCS. Gastric injury was more commonly identified in patients who developed intra-abdominal infection. Duration of antimicrobial therapy does not affect infection rate in patients who are packed following DCS.

AMAÇ: Bu çalýþmada, plak vida ile tespitin en sýk kullanýldýðý grup olan üç parçalý proksimal humerus kýrýklarýnýn morfolojik farklýlýklarýnýn belirlenmesi ve farklý vakalarda uygulanan yöntemlerin fonksiyonel ve radyolojik sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Üç parçalý proksimal humerus kýrýðý olan 29 hasta (6 erkek-23 kadýn) deðerlendirildi. Ortalama yaþ 64 idi. Hastalar kýrýk tiplerine göre 3 gruba ayrýldý. Grup 1, valgus impaksiyon kýrýðý olan sekiz hastayý içeriyordu. Grup 2, redüksiyon sonrasý kolayca stabilite saðlanan 11 hastayý içeriyordu. Grup 3, prokurvatum varus açýlanmasý, fragmanlar arasýnda önemli yer deðiþtirmesi olan ve fiksasyon olmadan medial kortikal devamlýlýðýn saðlanamadýðý on hastadan oluþuyordu. Tüm hastalar minimal invaziv deltoid split yaklaþým yöntemi ve kilitli anatomik plak vida oste-osentezi ile ameliyat edildi. Grup 1 hastalarda baþýn valg olduðu alan kortiko-kansellöz allogreft ile dolduruldu. Grup 2 hastalarýna greftleme veya metafizer basý uygulanmadý. Grup 3 hastalarda kemik defekti bölgesine metafizyal kompresyon tekniði uygulandý. Ameliyat sonrasý ve son takipte sefalodiyafiz açýlarý ölçüldü. Fonksiyonel deðerlendirme için Constant Murley skoru kullanýldý.
BULGULAR: Hastalar ortalama 27.6 ay takip edildi ve ortalama 3.6 ayda tüm hastalarda kaynama görüldü. Üç hastada erken vida migrasyonu, bir hastada geç vida migrasyonu izlendi. 24 mükemmel ve 5 iyi sonuç gözlendi. Sefalodiyafiz açýlarý 139.42 dereceden 136.13 dereceye düþtü. Son kont-rol sefalodiyafiz açýlarýnýn gruplara daðýlýmýnda grup 2 ve grup 3 deðerleri arasýnda istatistiksel olarak anlamlý fark gözlendi.
TARTIÞMA: Bu çalýþmada, greftleme stabil valgus impakte kýrýklarýn fonksiyonel skorlarýnýn ve medial desteði yetersiz olan stabil olmayan kýrýklarýn metafizyal kompresyonunun stabil 3 parçalý kýrýklar kadar iyi olduðunu bulduk. Neer tip 3 kýrýklar alt gruplarý ile birlikte deðerlendirilmeli, gruplara özel tespit ve stabilite artýrýcý çözümler düþünülmelidir.

BACKGROUND: This study aimed to determine the morphological differences of three-part proximal humerus fractures, the group in which plate screw fixation is most frequently used, and to evaluate the functional and radiological results of the methods applied for different subgroups.
METHODS: Twenty-nine patients (6 males and 23 females) with three-part proximal humerus fractures were in the study, with an average age of 64. The patients were in three groups according to their fracture types. Group 1 included eight patients with valgus impaction fracture. Group 2 included eleven patients with easily achieved stability after reduction. Group 3 consisted of ten patients with procurvatum varus angulation, a significant displacement between fragments, and in whom medial cortical continuity was not maintained without fixation. All patients underwent surgery with a minimally invasive deltoid split approach method and locked ana-tomic plate screw osteosynthesis. In group 1 patients, the space in the area where valgization is present in the head was filled with cortico-cancellous allografts. No grafting or metaphyseal compression took place in Group 2 patients. In group 3 patients, the metaphyseal compression technique was applied to the bone defect area. Cephalodiaphyseal angles (CDA) were measured at the postoperative and final follow-up. The constant Murley score made the functional evaluation.
RESULTS: The patients were followed for an average of 27.6 months, and the union was present in all patients for an average of 3.6 months. Early screw migration was present in three patients, and late screw migration was in one patient. There were twenty-four excellent and 5 good results. CDA decreased from 139.42° to 136.13°. A statistically significant difference was present between the values of Groups 2 and 3 in the final control CDA of the groups.
CONCLUSION: In this study, the functional scores of grafting stable valgus-impacted fractures and metaphyseal compression of unstable fractures with insufficient medial support were as good as stable 3-part fractures. Considering neer type 3 fractures should be evaluated with their subgroups, and fixation and stability-enhancing solutions specific to the groups are essential.

Abdominal içeriðin obturator foramenden protrüzyonu, nadir görülen bir karýn duvarý fýtýðý türüdür. Genellikle tek ve sað taraflý görülmektedir. Predispozan faktörler yaþlýlýk, yüksek karýn içi basýncý, pelvik taban disfonksiyonu ve multiparitedir. Obturator herni, en deneyimli cerrahlar için bile yanýltýcý olabilen zorlu bir taný süreci ile tüm karýn duvarý fýtýklarý arasýnda en yüksek ölüm oranlarýndan birine sahiptir. Bu nedenle obturator herniden þüphelenmek ve kolayca teþhis etmek için özelliklerini anlamak önemlidir. BT taramasý en yüksek hassasiyete sahip en iyi taný aracý olmaya devam etmektedir. Obturator herni vakalarýnda konservatif yaklaþým önerilmez. Taný konulduktan sonra, daha fazla iskemi, nekroz ve peritonit, septik þok ve ölüme yol açabilecek perforasyon riskini önlemek için acil cerrahi onarým endikedir. Açýk onarým, obturator dahil karýn fýtýklarýnýn azaltýlmasýnda yaygýn olarak kullanýlan ve etkili bir yöntem olmasýna raðmen, laparoskopik onarýmlar tarif edilmiþ ve tercih edilir hale gelmiþtir. Bu çalýþmada, bilgisayarlý tomografide obturator herni tanýsý ile ameliyat edilen 86, 95 ve 90 yaþlarýndaki kadýn hastalarý sunuyoruz. Özellikle yaþlý bir kadýnda akut mekanik intestinal obstrüksiyon bulgularý varlýðýnda obturatuvar herni tanýsý her zaman akýlda tutulmalýdýr.

Protrusion of abdominal contents through the obturator foramen is a rare type of abdominal wall hernia. It is usually seen unilaterally and right-sided. Predisposing factors are old age, high intra-abdominal pressure, pelvic floor dysfunction, and multiparity. Obturator hernia has one of the highest mortality rates of all abdominal wall hernias, with a difficult diagnostic process that can be misleading even for the most experienced surgeons. Therefore, to suspect and easily diagnose an obturator hernia, it is important to understand its characteristics. Computerized tomography scanning remains the best diagnostic tool with the highest sensitivity. Conservative ap-proach is not recommended in obturator hernia cases. Once diagnosed, urgent surgical repair is indicated to prevent further ischemia, necrosis, and risk of perforation that can lead to peritonitis, septic shock, and death. Although open repair is a widely used and effective method for reducing abdominal hernias, including obturator, laparoscopic repairs have been described and become preferred. In this study, we present female patients aged 86, 95, and 90 years who were operated with the diagnosis of obturator hernia on computed tomography. The diagnosis of obturatory hernia should always be kept in mind, especially in the presence of acute mechanical intestinal obstruction findings in an elderly woman.

Ýktiyozis, Mendel kornifikasyon bozukluklarýndan kaynaklanýr. Kalýtsal iktiyozlar, sendromik olmayan ve sendromik iktiyozlar olarak ikiye ayrýlýr. Amniyotik bant sendromu, en sýk el ve bacak halkalarýna neden olan doðumsal anomalileri içerir. Bantlar geliþmekte olan vücut kýsýmlarýný sarabilir. Bu çalýþmada, konjenital iktiyozis olgusuna eþlik eden amniyotik bant sendromuna acil yaklaþýmýn sunulmasý amaçlandý. Yenidoðan yoðun bakým ünitesi tarafýndan bir günlük erkek bebek vakasý için konsültasyon istendi. Fizik muayenede her iki elde doðuþtan bantlar mevcuttu, ayak parmaklarý rudimenterdi, tüm vücutta ciltte pullanma ve cilt sertliði mevcuttu. Sað testis skrotumda deðildi. Diðer sistem muayeneleri normaldi. Ancak bandýn distalindeki parmaklardaki kan dolaþýmý kritik hale gelmiþti. Sedasyon yardýmý ile parmaklardaki bantlar eksize edildi ve iþlem sonrasýnda parmaklar-daki dolaþýmýn iþlem öncesine göre daha rahat olduðu gözlemlendi. Konjenital iktiyozis ve amniyotik bant birlikteliði oldukça nadirdir. Bu hastalara acil yaklaþým, ekstremitenin kurtarýlmasý ve ekstremitede büyüme geriliðinin önlenmesi açýsýndan çok önemlidir. Prenatal tanýlar açýsýndan geliþmeler yaþandýkça erken taný ve tedavi ile bu vakalarýn önüne geçilebilecektir.

Ichthyosis is caused by Mendelian cornification disorders. Hereditary ichthyoses are divided into non-syndromic and syndromic ichthy-oses. Amniotic band syndrome involves congenital anomalies that most frequently cause hand and leg rings. The bands can wrap around the developing body parts. In this study, it is aimed to present an emergency approach to amniotic band syndrome accompanying a case of congenital ichthyosis. We were asked by the neonatal intensive care unit to consult on the case of a 1-day-old baby boy. On physical examination, congenital bands were found to be present on both hands, the toes were rudimentary, skin scaling was present on the entire body, and the consistency of the skin was stiff. The right testicle was not in the scrotum. Other system examinations were normal. However, the blood circulation in the fingers in the distal of the band had become critical. With the help of sedation, the bands on the fingers were excised, and after the procedure, it was observed that the circulation in the fingers was more relaxed than it had been before the procedure. Coexistence of congenital ichthyosis and amniotic band is very rare. Emergency approach to these patients is very important in terms of saving the limb and preventing growth retardation in the limb. As further developments take place in terms of prenatal diagnoses, these cases will be able to be prevented through the early diagnosis and treatment.

Wunderlich sendromu, nadir görülen bir spontan böbrek kanamasý olarak tanýmlanýr. Çoðunlukla travma olmaksýzýn zemininde eþlik eden has-talýklarla ortaya çýkar. Genellikle Lenk triadý ile prezente olur ve acil servislerde ultrasonografi, BT veya MRG taramasý gibi geliþmiþ görüntüleme yöntemlerinin etkin kullanýmý ile teþhis edilir. Wunderlich sendromunun tedavisinde konservatif tedavi, giriþimsel radyoloji veya cerrahi prosedürler kullanýlarak, hastanýn durumuna göre karar verilir ve uygun yöntemle tedavi edilir. Taný da stabil olan hastalarda konservatif takip ve tedavi düþünül-melidir. Geç teþhis edilirse, progrese olmasý halinde hayat tehdit edici olabilir. Ýlginç bir Wunderlich Sendromu olgusu olarak, 19 yaþýnda üretero-pelvik bileþke (UPJ) obstrüksiyonuna baðlý hidronefroz hastasýnda, travma öyküsü olmayan spontan böbrek kanamasý sunulmaktadýr. Ani baþlayan yan aðrýsý, kusma ve makroskopik hematüri þikayetleri ile acil servise baþvuran hastanýn bilgisayarlý tomografisi çekildi. Ýlk üç gün konservatif olarak takip ve tedavi edilen hasta, 4. günde genel durumu bozulmasý üzerine hastaya selektif anjiyoembolizasyon ve ardýndan laparoskopik nefrektomi uygulandý. Wunderlich sendromu, benign hastalýklar zemininde genç hastalarda dahi ciddi, yaþamý tehdit eden bir acil durumdur. Erken teþhis önem arzeder. Tanýdaki gecikmeler ve enerjik olmayan yaklaþýmlar yaþamý tehdit eden durumlara yol açabilir. Hemodinamik olarak stabil olmayan benign vakalarda da, anjiyoembolizasyon ve cerrahi gibi acil tedavi kararý tereddüt etmeden alýnmalýdýr.

Wunderlich syndrome (WS) is defined as a rare spontaneous renal hemorrhage. It mostly occurs with concomitant diseases without trauma. It usually presents with the Lenk triad and is diagnosed in emergency departments with the effective use of advanced imaging modalities such as ultrasonography, computerized tomography, or magnetic resonance imaging scanning. In the management of WS, conservative treatment, interventional radiology, or surgical procedures are decided according to the patient’s condition and treated appropriately. Conservative follow-up and treatment should be considered in patients whose diagnosis is stable. If diagnosed late, the progression can be life-threatening. As an interesting case of WS, a 19-year-old patient was presented with hydronephrosis due to ure-teropelvic junction obstruction. Spontaneous renal hemorrhage without a history of trauma is presented. The patient, who presented to the emergency department with the sudden onset of flank pain, vomiting, and macroscopic hematuria was imaged by computed tomography. The patient could be followed and treated conservatively for the first 3 days, and on the 4th day, his general condition deteriorated, and he underwent selective angioembolization and then laparoscopic nephrectomy. WS is a serious, life-threatening emer-gency, even in young patients with benign conditions. Early diagnosis is mandatory. Delays in diagnosis and non-energetic approaches can lead to life-threatening situations. In hemodynamically unstable non-malignant cases, the decision for immediate treatment, such as angioembolization and surgery, should be taken without hesitation.

Karýn aðrýsý, acil servis baþvurularýnýn en sýk sebeplerinden birisidir. Akut apandisit ise bu hastalarda karþýlaþýlan en sýk cerrahi patolojilerden birisidir. Yabancý cisim yutulmasý, akut apandisitin en nadir görülen ayýrýcý tanýlarýndan birisidir. Bu olguda, zeytin yapraðý yutulmasýna baðlý geliþen akut tabloyu sunuyoruz.

Abdominal pain is one of the most frequent causes of emergency room admissions. Acute appendicitis is the most common surgical pathology in these patients. Foreign body ingestion is a quite rare pathology that takes place in list of differential diagnosis of acute appendicitis. We presented a dry olive leaf ingestion case in this paper.