AMAÇ: Travmatik beyin yaralanmasý (TBY) vakalarýnýn çoðu erken dönemde ölümle sonuçlanýr; etkilenen hastalarýn kýsa vadeli prognozunu tahmin etmek bu durumu engellemek için gereklidir. Bu çalýþma, TBY’nin erken döneminde kabul anýndaki laktat/albümin oraný (LAO) ile sonuçlar arasýn-daki iliþkiyi incelemeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Bu retrospektif gözlemsel çalýþma, Ocak 2018 ile Aralýk 2020 tarihleri arasýnda acil servisimize baþvuran TBY’li hastalarý içermiþtir. TBY, baþ kýsaltýlmýþ yaralanma skalasý (AYS) skoru 3 veya daha yüksek ve diðer AYS skoru 2 veya daha düþük olarak kabul edildi. Birincil ve ikincil sonuçlar sýrasýyla 24 saatlik mortalite ve masif transfüzyon (MT) idi.
BULGULAR: Toplam 460 hasta dahil edildi. 24 saatlik mortalite %12.6 (n=28) ve MT 31 (%6.7) hastada gerçekleþtirildi. Çok deðiþkenli analizde, LAO’nun 24 saatlik mortalite (odds oraný [OO], 2.021; %95 güven aralýðý [GA], 1.301-3.139) ve MT (OO, 1.898; %95 GA, 1.288-2.797) ile iliþkili olduðu bulundu. LAO’nun 24 saatlik mortalite ve MT için eðri altýnda kalan alan deðerleri sýrasýyla 0.805 (%95 GA, 0.766-0.841) ve 0.735 (%95 GA, 0.693-0.775) idi.
TARTIÞMA: LAO, TBY’li hastalarda erken dönem sonuçlarýyla, 24 saat içinde 24 saatlik mortalite ve MT dahil olmak üzere iliþkili bulunmuþtur. LAO, TBY’li hastalarda bu sonuçlarý tahmin etmede yardýmcý olabilir.

BACKGROUND: The majority of traumatic brain injury (TBI) cases result in death in the early phase; predicting short-term progno-sis of affected patients is necessary to prevent this. This study aimed to examine the association between the lactate-to-albumin ratio (LAR) on admission and outcomes in the early phase of TBI.
METHODS: This retrospective observational study included patients with TBI who visited our emergency department between January 2018 and December 2020. TBI was considered as an head abbreviated injury scale (AIS) score of 3 or higher and other AIS of 2 or lower. The primary and secondary outcomes were 24-h mortality and massive transfusion (MT), respectively.
RESULTS: : In total, 460 patients were included. The 24-h mortality was 12.6% (n=28) and MT was performed in 31 (6.7%) patients. In the multivariable analysis, LAR was associated with 24-h mortality (odds ratio [OR], 2.021; 95% confidence interval [CI], 1.301–3.139) and MT (OR, 1.898; 95% CI, 1.288–2.797). The areas under the curve of LAR for 24-h mortality and MT were 0.805 (95% CI, 0.766–0.841) and 0.735 (95% CI, 0.693–0.775), respectively.
CONCLUSION: LAR was associated with early-phase outcomes in patients with TBI, including 24-h mortality and MT. LAR may help predict these outcomes within 24 h in patients with TBI.

AMAÇ: Yanýk hastalarýnda mortalitenin sebeplerinin baþýnda sekonder enfeksiyonlar yer almaktadýr. Bu çalýþmanýn amacý, açýk ve kapalý yanýk yara pansuman uygulamalarýnýn sekonder enfeksiyon geliþimi üzerindeki etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Aralýk 2022 ve Ocak 2023 tarihleri arasýnda yanýk ünitesine baþvuran yaþlarý 18-65 arasýnda olan 56 hastanýn yanýk yarasýndan baþvuru anýnda, 3. ve 7. günlerde doku kültürleri alýndý. Hastalarýn demografik özellikleri, yanýk yarasýnýn özellikleri, pansuman tipi ve yanýk yarasýna yapýlan ilk müdahale yöntemleri incelenerek yara yeri enfeksiyonu geliþimindeki etkileri deðerlendirildi.
BULGULAR: Açýk ve kapalý pansuman yapýlan hasta gruplarýndan alýnan yanýk yara kültürleri deðerlendirildiðinde kültür pozitifliði açýsýndan gruplar arasýnda anlamlý bir fark bulunmadý (p>0.05). Yanýk sonrasýnda yapýlan ilk müdahale olarak yara yeri ýlýk su ile yýkananlarda kültür pozitifliði diðer gruplardan daha düþük bulundu, gruplar arasýnda istatistiksel olarak anlamlý fark saptandý (p=0.019).
TARTIÞMA: Klasik bilgilerimize göre yara yeri enfeksiyonu geliþimi açýsýndan hastaya ait faktörlerin dominant etkileri bilinmesine raðmen, yanýk yarasýnda doðru ve etkin yapýlan ilk müdahalenin de oldukça önemli olduðu görülmüþtür.

BACKGROUND: Secondary infections are the leading cause of death in burn patients. The purpose of this study is to evaluate the effects of open and closed burn dressings on the development of secondary infections.
METHODS: Tissue cultures were obtained from the burn sites of 56 patients between the ages of 18 and 65 who were admitted to our burn unit between December 2022 and January 2023, on days 3 and 7. The impact of the demographic features of the patients, the characteristics of the burn wound, the dressing type, and the first intervention strategies given to the burn wound on the development of wound infection were evaluated.
RESULTS: There was no statistically significant difference between the open- and closed-dressing groups in terms of cultural positiv-ity (P>0.05). A statistically significant difference (P=0.019) was found between the groups in terms of culture positivity among those whose wounds were cleansed with warm water as the initial intervention after a burn and those whose wounds were not.
CONCLUSION: Even though the main impacts of the patient’s variables on the development of a wound infection are recognized, it has been found that the appropriate and successful first intervention in a burn wound is also quite important.

AMAÇ: Parmak ucu amputasyonlarý, acil servise baþvuran yaygýn yaralanmalardýr. Ancak tüm amputasyonlarýn replantasyon þansý yoktur ve bu durumda kompozit greft kurtarma tedavileri arasýndadýr. Bu tedavi hem uygulamasý kolay hem de ekonomiktir. Çalýþmamýzda acil serviste ve ameli-yathanede kompozit greftlemenin baþarýsýný ve maliyetini karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Kabul ölçütlerini karþýlayan 36 hasta çalýþmaya alýndý. Tamir yeri kararý hasta uyumuna ve acil servisin yoðunluðuna göre cerrah tarafýndan verildi. Hastalarýn demografik ve hastalýk bilgileri kaydedildi. Anlamlýlýk düzeyi olarak p<0.05 kabul edildi.
BULGULAR: Yirmi iki olgu pediatrik hastaydý. Acil serviste 18 ezilme yaralanmasý ve 22 vaka tedavi edildi. Acil serviste ve ameliyathanede yapýlan giriþimlere göre komplikasyonlar, ek giriþim gereksinimi ve parmak kýsalýðý açýsýndan anlamlý fark yoktu. Acil servisteki müdahaleler, maliyet açýsýndan önemli ölçüde daha düþük ve hastanede kalýþ süreleri daha kýsaydý. Hasta memnuniyeti açýsýndan anlamlý bir fark yoktu.
TARTIÞMA: Kompozit greft parmak ucu yaralanmalarýnda basit ve güvenilir bir yöntemdir ve hasta memnuniyeti açýsýndan yüz güldürücü sonuçlar vermektedir. Ayrýca acil serviste parmak ucu yaralanmalarýnda kompozit greft uygulamasý hem maliyeti düþürecek hem de hastane yatýþlarýnýn azal-masý nedeniyle oluþabilecek hastane enfeksiyonlarýný önleyecektir.

BACKGROUND: Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms.
METHODS: Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level.
RESULTS: Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction.
CONCLUSION: Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.

AMAÇ: Akut kolesistit en sýk yapýlan acil ameliyatlardan biridir. Zorlu operasyonlarda güvenli bir alternatif olarak laparoskopik subtotal kolesis-tektomi (LSC) yaygýn olarak kullanýlmaktadýr. Akut kolesistit olgularýnda ERCP öyküsü ile sonuçlarýn deðiþip deðiþmediðini sorguladýk. Literatürde doðrudan akut kolesistitte subtotal kolestektomi sonuçlarýna odaklanan bir çalýþmaya rastlamadýk. Çalýþmamýzda akut kolesistitte ERCP öyküsünün subtotal kolesistektomi oranlarýný etkileyip etkilemediðini araþtýrmayý amaçladýk.
GEREÇ VE YÖNTEM: 2016-2019 yýllarý arasýnda kliniðimizde akut kolesistit nedeniyle ameliyat edilen hastalarýn (n=470) sonuçlarý retrospektif olarak deðerlendirildi. Hastalar preoperatif ERCP öyküsü olup olmamasýna göre ERCP grubu ve standart grup olarak iki gruba ayrýldý. Birincil sonuç subtotal kolesistektomi oranýydý. Ýkincil sonuçlar ise açýða dönüþ, ameliyat sonrasý komplikasyonlar, ciddi komplikasyonlar, ameliyat süresi ve hasta-nede kalýþ süresi idi.
BULGULAR: Standart grupta 437 hasta, ERCP grubunda ise 33 hasta tespit edildi. Standart grupta 15 ve ERCP grubunda 1 olmak üzere toplam 16 hastaya subtotal kolesistektomi yapýldýðý tespit edildi. Gruplar arasýnda subtotal kolesistektomi oranlarý açýsýndan anlamlý fark yoktu (p= 0.902). Standart grupta 4 olguda açýða geçiþ ile ameliyat tamamlanýrken, ERCP grubunda herhangi bir açýða geçiþ görülmedi (p=0.581). Gruplar arasýnda komplikasyonlar, ciddi komplikasyonlar, operasyon süresi, hastanede kalýþ süresi ve mortalite açýsýndan anlamlý fark saptanmadý.
TARTIÞMA: Bu çalýþma, ERCP’nin akut kolesistit tanýsý ile acil ameliyat edilen hastalarda artan subtotal kolesistektomi ve açýða geçiþ oraný ile iliþkili olmadýðýný göstermiþtir. Akut kolesistitte laparoskopik kolesistektomi, ERCP öyküsü olan hastalarda da güvenle uygulanabilir. Laparoskopik subtotal kolesistektomi, zorlu hastalarda güvenli bir prosedürdür ve bu gibi durumlarda tehlikeli sonuçlardan kaçýnmak için Hartmann poþunu açýk býrakmak tercih edilebilir.

BACKGROUND: Acute cholecystitis is one of the most common emergent surgeries. As a safe alternative in challenging operations, laparoscopic subtotal cholecystectomy (LSC) is widely used. We questioned whether the results in acute cholecystitis cases changed with a history of endoscopic retrograde cholangiopancreatography (ERCP). When we searched the literature, we could not find a study focusing on the subtotal cholestectomy results in acute cholecystitis. In our study, we aimed to investigate whether the history of ERCP affects the rates of subtotal cholecystectomy (SC) in acute cholecystitis.
METHODS: The results of patients (n=470) who underwent surgery for acute cholecystitis at our clinic between 2016 and 2019 were retrospectively evaluated. The patients were divided into two groups according to their history of ERCP. The primary outcome was the SC rate. The secondary outcomes were conversion to open, postoperative complications, serious complications, operative duration, and length of hospital stay.
RESULTS: The standard group included 437 patients, whereas the ERCP group included 33 patients. A total of 16 patients underwent SC, with 15 in the standard group and 1 in the ERCP group. There was no significant difference in terms of SC rates between groups (P=0.902). While four cases of operation were completed with conversion to open in the non-ERCP group, no conversion was seen in the ERCP group (P=0.581). No significant differences were detected between the groups in terms of complications, serious compli-cations, operation duration, length of hospital stay, and mortality.
CONCLUSION: The results of this study showed that ERCP is not related to an increased rate of SC and conversion in patients with acute cholecystitis. Laparoscopic cholecystectomy for acute cholecystitis can be safely performed in patients with a history of ERCP. LSC is a safe procedure in challenging patients, and fenestrating SC can be preferred to avoid hazardous consequences in such cases.

AMAÇ: COVID-19 pandemisi, COVID-19 dýþý þikayetlerle acil servisten týbbi yardým isteyen hasta sayýsýný deðiþtirmiþ, farklý týbbi ve cerrahi durumlarýn ertelenmiþ baþvurularýna neden olmuþtur Akut üriner taþ hastalýðý da bu durumlardan biridir ve COVID-19’un acil servise geliþine etkisi açýsýndan araþtýrýlmasý gerekmektedir.
GEREÇ VE YÖNTEM: Bu gözlemsel, retrospektif ve tek merkezli çalýþmada, acil serviste olasý akut ürolitiyazis için istenen her abdominopelvik bil-gisayarlý tomografiyi COVID-19 pandemisinden önceki ve sonraki 1 yýlý ele alarak taradýk. Uygulanan abdominopelvik bilgisayarlý tomografi sayýsýný ve üriner taþ pozitifliðini doðrulayan sayýyý belirledik. Hastalarýn cinsiyetini, yaþýný, taþýn yerini ve taþ boyutunu kaydettik. Ayrýca C-reaktif protein, lökosit sayýsý ve kreatinin deðerlerini kaydettik ve hastalarýn ne kadar süredir aðrý çektiðini, müdahaleye kadar geçen süreyi ve her vaka için seçilen tedavi metodunu not ettik.
BULGULAR: Yapýlan toplam abdominopelvik bilgisayarlý tomografi sayýsý 1089 idi. Bunlardan 517’si pandemi öncesi dönemde, 572’si pandemi sü-recindeydi. Pandemi öncesi ve sýrasýnda taþ pozitifliði sýrasýyla 363 (%70.2) ve 379 (%66.2) idi (p=0.643). Kadýnlarýn COVID-19 dönemindeki oraný (%37.2), pandemi öncesi dönemden (%54.3) anlamlý derecede düþüktü (p=0.013). Pandemi öncesi ve pandemi süreci gruplarýndaki üreter taþlarýnýn medyan boyutu sýrasýyla 4.8 mm ve 3.9 mm idi ve anlamlý bir fark göstermedi (p=0.197). Pandemi öncesinde ve sýrasýnda gruplar arasýnda taþýn yerleri, kan parametreleri, aðrý süresi, tedavi seçenekleri ve müdahale süresi açýsýndan anlamlý bir fark görülmedi.
TARTIÞMA: COVID-19 pandemisi, acil servise akut üreterik kolik vakalarý ile baþvuran daha az veya daha ciddi hasta ile sonuçlanmadý.

BACKGROUND: The COVID-19 pandemic has changed the number of patients seeking medical help from the emergency service (ES) with non-COVID complaints, consequencing in postponed presentations of different surgical and medical situations. Acute urinary stone disease is one of these situations and needs to be investigated in terms of the effect of COVID-19 on its presentation to the ES.
METHODS: In this observational, retrospective, and single-center study, we scanned each abdominopelvic computed tomography requested in ES for possible acute urolithiasis during 1 year before and after the outbreak of COVID-19. We searched to state the number of abdominopelvic computed tomographies applied and the number of ratifying urinary stone positivity. We enrolled patients’ gender, age, stone location, and stone size. We also recorded C-reactive protein, leukocyte count, and creatinine and noted how long the patients suffering from pain, the duration until the intervention, and the management option selected for each case.
RESULTS: Total number of abdominopelvic computed tomographies performed was 1089. Of these, 517 were pre-pandemic and 572 were peri-pandemic. The number of pre and peri-pandemic stone-positive scans were, respectively, 363 (70.2%) and 379 (66.2%) (P=0.643). The females’ percentage in the COVID-19 period (37.2%) was significantly lower than in the pre-pandemic period (54.3%) (P=0.013). The median size of ureter stones of the pre and peri-pandemic groups were, respectively, 4.8 mm and 3.9 mm depicting no significant difference (P=0.197). No significant difference was sighted between the pre and peri-pandemic groups concerning stone locations, blood parameters, painful duration, treatment options, and time to intervention.
CONCLUSION: The COVID-19 pandemic resulted in neither sicker nor fewer patients suffering from acute ureteric colic in the ES.

AMAÇ: Þok indeksi (SI), nabýzýn (HR) sistolik kan basýncýna (SBP) oraný; modifiye þok indeksi (MSI), HR nin ortalama arter basýncýna oraný; yaþ þok indeksi (ASI), yaþýn SI ile çarpýmý; rivers þok indeksi (rSI), SBP nin HR ye oraný; rSIG, rSI nýn Glasgow Koma Skoru (GCS) ile çarpýmýdýr. Yapýlmýþ çalýþmalarda þok indekslerinin mortaliteyi öngörmede iyi araçlar olduðu kanýtlanmýþtýr. Bu çalýþmanýn amacý yanýk hastalarýnda SI, MSI, ASI, rSI, rSIG þok indekslerinin mortaliteyi öngörmedeki duyarlýlýðýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu çalýþma retrospektif kesitsel bir çalýþmadýr. Hastalarýn acil servise baþvuru anýndaki vital bulgularý alýndý ve þok indeksleri hesaplandý. Çalýþmaya alýnan yanýk hastalarýnda SI, MSI, ASI, rSI, rSIG þok indekslerinin mortaliteyi öngörmedeki etkinliði karþýlaþtýrýldý. BULGULAR: Toplam 913 hasta çalýþmaya alýndý. Yanýk hastarýnda mortaliteyi öngörmede eðri altýnda kalan alan (AUC) deðeri en yüksek olan þok indeksleri rSIG ve MSI idi. Deðerleri sýrasýyla rSIG (AUC: 0.829, %95 CI: 0.739-0.919, p<0.001) ve MSI (AUC: 0.740, %95 CI: 0.643-0.838, p<0.001) idi.
TARTIÞMA: Yanýk hastalarýnýn acil servise baþvuru anýndaki vital bulgularý ile þok indekslerinin hesaplanmasý basittir ve mortaliteyi öngörmede etkilidirler. Çalýþmadaki þok indeksleri içinde mortaliteyi öngörmede en iyisi rSIG ve MSI’dýr.

BACKGROUND: Shock index (SI) is the ratio of heart rate (HR) to systolic blood pressure (SBP); modified SI (MSI) is the ratio of HR to mean arterial pressure; age SI (ASI) is age multiplied by SI; reverse SI (rSI) is the ratio of SBP to HR; and rSIG is rSI multiplied by Glasgow Coma Scale Score (rSIG). Studies have proven that shock indices are good tools in predicting mortality. This study aimed to evaluate the sensitivity of the shock indices SI, MSI, ASI, rSI, and rSIG in predicting mortality in burn patients.
METHODS: This is a retrospective cross-sectional study. The vital signs of the patients were recorded and their shock indices were calculated at the time of emergency department admission. The effectiveness of the shock indices SI, MSI, ASI, rSI, and rSIG in predict-ing mortality was compared in the burn patients included in the study
RESULTS: A total of 913 patients were enrolled. rSIG and MSI were the shock indices with the highest area under the curve (AUC) values in predicting mortality in the burn patients. The AUC values of rSIG and MSI were 0.829 (95% CI: 0.739–0.919, P<0.001) and 0.740 (95% CI: 0.643–0.838, P<0.001), respectively.
CONCLUSION: Vital signs are easily recorded and shock indices are easily calculated at the time of admission of burn patients to the emergency department; they also effectively predict mortality. rSIG and MSI are the best mortality predictors among the shock indices examined in this study.

AMAÇ: Deprem gibi aniden geliþen yýkýmýn ve yaralanmalarýn çok yüksek olduðu durumlarda arama kurtarma ekipleri ve hastaneler insanlarýn yaþamla ölümü arasýnda en önemli belirleyici faktörler olabilmektedir Çalýþmamýzda 2023 Kahramanmaraþ merkezli depremler sonrasý hastanemize baþvuran depremzedelerin analizlerini ve tecrübelerimizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Kahramanmaraþ depremleri nedeniyle hastanemize getirilen veya baþvuran yaralýlarýn týbbi veri kayýtlarýný geriye dönük ola-rak inceledik. Hastalarýn baþvuru zamanlarý, tanýlarý, demografik verileri, triaj kodlarý, týbbi müdahaleler, hemodializ ihtiyaçlarý, ezilme sendromu ve mortalite oranlarý incelendi.
BULGULAR: Hastanemize deprem sonrasý ilk 5 günde depremle iliþkili 247 hasta baþvurusu oldu. Acil servise baþvurunun en yoðun olduðu dönem ilk 24 saatti. Cerrahi iþlemlerin en yoðun uygulandýðý dönem 24-48 saat aralýðýydý. En sýk olarak Ortopedik cerrahi iþlemlerin uygulandýðý görüldü. En sýk mortalite nedeni ezilme sendromuydu.
TARTIÞMA: Depremlere hazýrlýklar açýsýndan özellikle deprem bölgesinde olan hastanelerde; hastane afet planý hazýr olmalýdýr ve bu amaçla tecrübelerin paylaþýmý önem taþýmaktadýr.

BACKGROUND: In such cases where sudden destruction and injury are very high, search and rescue teams and hospitals can be the most important determining factors between people’s lives and deaths.
METHODS: This study was conducted retrospectively, after the two catastrophic earthquakes (Türkiye-Syria Earthquakes) by taking the records of the patients who admitted to our hospital. Patients’ admission times, diagnoses, demographic data, triage codes, medical interventions, hemodialysis needs, crush syndrome and mortality rates were analyzed.
RESULTS: In the first 5 days after the earthquake, 247 earthquake-related patients were admitted to our hospital. The most intense period of admission to the emergency department was the first 24 h. The most intensive period of surgical procedures was 24–48 h. It was observed that Orthopedic surgical procedures were applied most frequently and the most common cause of mortality was crush syndrome.
CONCLUSION: In terms of preparations for earthquakes, especially in hospitals in the earthquake zone it will be beneficial for each hospital to make hospital disaster plans. For this reason, we thought it would be useful to share our experiences during this disaster.

AMAÇ: Kolonun taþlý yüzük hücreli adenokarsinomu yetiþkin hastalarda iyi tanýnmaktadýr, ancak son derece nadirdir ve çocuklarda o kadar iyi belgelenmemiþtir. Çalýþmamýz bu nadir hastalýk ve uzun vadeli sonuçlarý hakkýnda farkýndalýk yaratmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Taþlý yüzük hücreli kolon adenokarsinomlu hastalarýmýzý retrospektif olarak inceledik.
BULGULAR: Barsak obstrüksiyonu bulgularý ile baþvuran ve taþlý yüzük hücreli kolon adenokarsinomu tanýsý alan ortalama yaþlarý 14.83 (daðýlým 13-17) olan üç erkek ve üç kýz olmak üzere altý hastamýz vardý. Tüm hastalarýn karýn grafisinde hava-sývý seviyeleri mevcuttu. Abdominal ultrasonog-rafide tüm hastalarýn subileus saptandý. Acil giriþim öncesinde beþ hastaya karýn bilgisayarlý tomografisi, iki hastaya preoperatif kolonoskopi yapýldý. Hastalarýn tamamýna akut karýn ön tanýsý ile acil eksploratuvar laparotomi uygulandý. Ýki hastada kitle küçültme ameliyatý ardýndan stoma açýldý. Kalan dört hasta intestinal rezeksiyon sonrasý anastomoz ile tedavi edildi. Tüm kýzlarýn yumurtalýklarýnda metastaz vardý. Hastalardan biri erken dönemde multipl metastaz yükü nedeniyle, üçü ise postoperatif altýncý yýlda kaybedildi. O zamandan beri kalan iki hastayý takip etmekteyiz.
TARTIÞMA: Taþlý yüzük hücreli karsinomlar nadir görülmekle birlikte akut karýn ve barsak obstrüksiyonu olan pediatrik hastalarýn ayýrýcý tanýsýnda akýlda tutulmalýdýr. Erken taný ve tedaviye raðmen pediatrik popülasyonda prognozu kötüdür.

BACKGROUND: Signet-ring cell adenocarcinoma of the colon is well-recognized in adult patients who are extremely rare and not well-documented in children. Our study aims to raise awareness about this rare disease and its long-term outcomes.
METHODS: We retrospectively evaluated patients with signet-ring cell colon adenocarcinoma.
RESULTS: Six patients, three boys and three girls, with a mean age of 14.83 (range, 13–17 years), presented with signs of intesti-nal obstruction and were diagnosed with signet-ring cell colon adenocarcinoma. All patients had air-fluid levels on abdominal X-ray. Abdominal ultrasonography of all patients revealed subileus. Abdominal computed tomography was performed in five patients, and pre-operative colonoscopy was conducted in two patients before the emergency intervention. All of the patients underwent emergent exploratory laparotomy with the preliminary diagnosis of acute abdomen. In two patients, debulking surgery followed by a stoma was performed. The remaining four patients were treated with anastomosis following intestinal resection. All girls had metastases on the ovary. One of the patients died due to the burden of multiple metastases in the early period, and three died in the sixth post-operative year. We have been following the remaining two patients since then.
CONCLUSION: Although signet-ring cell carcinomas (SRCCs) are rare, they should be considered in the differential diagnosis of acute abdomen and intestinal obstruction in pediatric patients. Despite early diagnosis and treatment, SRCC has a poor prognosis in the pediatric population.

AMAÇ: Hartmann’ýn prosedürü, kolon týkanýklýðý veya perforasyonu olan çoðu vakada akut klinik durumlarý çözmek için yaygýn olarak uygulanýr. Hartmann prosedürü ve uç kolostominin kapatýlmasý yüksek morbidite-mortalite oranlarý ile iliþkilidir. Çalýþmamýzda Hartmann prosedüründeki klinik deneyimimizi bildirmeyi amaçladýk.
GEREÇ VE YÖNTEM: 2015-2023 yýllarý arasýnda gerçekleþtirilen Hartmann iþlemlerinin demografik verileri ve sonuçlarý retrospektif olarak ince-lendi.
BULGULAR: Çalýþmamýzýn ortanca yaþý 63 (18-94) idi; hastalarýn 65’i kadýn, 97’si erkekti. Hartmann prosedürü uygulanan hastalarýn %50’sinde kolorektal maligniteler birincil etiyolojiydi, %70’inde obstrüksiyon ve %30’unda perforasyon vardý. Hastalarýn üçte ikisi ASA-2 veya daha yüksekti. Hastalarýn %74.7’sinde postoperatif komplikasyon geliþmedi. Mortalite oranýmýz %33.3 idi. Ortalama iki yýllýk takipte 59 hastada kolostomi kapatýldý. Ortalama kapanma süresi 311 (57-1319) gündü. Kapatma sýrasýnda hastalarýn %89.8’inde zýmba kullanýldý. Sadece iki hastada saptýrýcý ileostomi açýldý. Medyan hastanede kalýþ süresi 8 (5-70) gündü. Hastalarýn %25.4’ünde postoperatif komplikasyon geliþmezken, dört hasta kaybedildi. TARTIÞMA: Toplumumuzda Hartmann prosedürü daha çok kolorektal kanser için uygulanmaktaydý. Ostominin prosedürü ve kapatýlmasý, düþük stoma kapanma oranlarý, yüksek morbidite ve mortalite oranlarýnýn yaný sýra cerrahi zorluklarla sonuçlanýr.

BACKGROUND: Hartmann’s procedure (HP) is commonly applied to resolve acute clinical conditions in most cases with colonic obstruction or perforation. HP and the closure of the end colostomy are associated with high morbidity-mortality rates. In our study, we aimed to report our clinical experience in HP.
METHODS: Demographic data and outcomes of Hartmann procedures performed between 2015 and 2023 were retrospectively reviewed.
RESULTS: The median age of our study was 63 (18–94) years; 65 of the patients were female, and 97 were male. Colorectal malig-nancies were the primary etiology in 50% of patients who underwent HP, with 70% presenting with obstruction and 30% with perfora-tion. Two-thirds of the patients were American Society of Anesthesiologists-2 or higher. Postoperative complications did not develop in 74.7% of patients. Our mortality rate was 33.3%. The colostomy was closed in 59 patients during an average 2-year follow-up. The median closure time was 311 (57–1319) days. A stapler was used in 89.8% of patients during the closure. A diverting ileostomy was created in only two patients. The median hospital stay was 8 (5–70) days. Post-operative complications did not develop in 25.4% of patients, while four patients died.
CONCLUSION: In our population, HP was more commonly performed for colorectal cancer. The procedure and closure of the ostomy result in low stoma closure rates, high morbidity, and mortality rates, as well as surgical difficulties.

AMAÇ: Bu çalýþmada, suprakondiler humerus kýrýðý (SKHK) cerrahisi sonrasý rotasyonel deformitenin kübitus varus deformitesi (KVD) komplikas-yonu geliþimine etkisini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: Distal humerus ossifikasyonu tamamlanmamýþ, Gartland Tip II ve daha ciddi kýrýðý olan ve kapalý redüksiyon perkütan pinleme (KRPP) ile tedavi edilen hastalar çalýþmaya dahil edildi. Hastalarýn deðerlendirilmesinde demografik veriler ve ameliyat sýrasýnda çekilen radyografiler tarandý. Rotasyonel deformite ölçümü, Henderson ve ark. tarafýndan tanýmlanan yönteme göre yapýldý. Rotasyonel deformitesi >10° olan hastalar grup 1’e, deformitesi <10° olan hastalar grup 2’ye alýndý. KVD geliþimi açýsýndan hastalar taþýma açýsýnda yapýlan Baumann açý ölçümleri ve son kont-rol grafileri ile deðerlendirildi. KVD geliþen hastalar iki gruba ayrýldý; Grup A, KVD geliþen hastalarý, grup B ise KVD geliþmeyen hastalarý içermektedir. Kozmetik ve fonksiyonel sonuçlar Flynn kriterleri kullanýlarak deðerlendirildi.
BULGULAR: Kabul edilme kriterlerini karþýlayan 88 hasta çalýþmaya alýndý, 32’si kadýn, 56’sý erkekti. Ameliyat anýndaki ortalama yaþ 6.0±2.8, ortala-ma takip süresi 5.1±2.5 yýldý. Ölçümlere göre grup 1’de 13 hasta, grup 2’de 75 hasta vardý. 88 kiþiden sadece dördünde KVD geliþmiþti. Bu hastalarýn üçünde ≥20° rotasyonel deformite vardý. Grup A’daki hastalarýn ortalama yaþý 2.1 ve ortalama taþýma açýsý 5.7°±1.5 varus idi (p<0,001). Flynn kozmetik kriterlerine göre, grup A ve grup 1 önemli ölçüde daha kötü sonuçlara sahipti (p<0.001).
TARTIÞMA: Sonuç olarak, distal fragmanýn rotasyonda sabitlenmesi KVD ile iliþkili olabilir, intraoperatif deðerlendirme, uzun süreli deformite ve kozmetik bozulmayý önlemek için büyük deðer taþýr.

BACKGROUND: We aimed to show the effect of rotational deformity on the development of cubitus varus deformity (CVD) com-plication after supracondylar humerus fracture surgery.
METHODS: Patients with Gartland type II, and more severe fractures treated with Closed reduction and percutaneous pinning alone were included in the study. Rotational deformity was assessed with the formula described by Henderson et al. Patients with rotational deformity >10° were included in Group 1, and patients with deformity <10° in Group 2. In terms of CVD development, patients were evaluated with the Baumann angle measurements made on the carrying angle and final follow-up radiographs. Patients who developed CVD were divided into two groups: Group A included patients who developed CVD and Group B included patients who did not develop CVD. The cosmetic and functional results were evaluated using Flynn criteria.
RESULTS: Eighty-eight patients who met the inclusion criteria were enrolled in the study, 32 were female and 56 were male. The mean age at the time of surgery was 6.0±2.8 years and the mean follow-up time was 5.1±2.5 years. Based on measurements, Group 1 had 13 patients and Group 2 had 75 patients. Only four of the 88 had developed CVD. Three of these patients had a rotational defor-mity of ≥20°. The mean age of patients in group A was 2.1 years and the mean carrying angle was 5.7°±1.5° varus (P<0.001). According to the Flynn cosmetic criteria, Group A and Group 1 had significantly worse outcomes (P<0.001).
CONCLUSION: In conclusion, fixation of the distal fragment in rotation may be associated with CVD and intraoperative assessment is of great value to avoid long-term deformity and cosmetic degradation.

AMAÇ: Bu çalýþmada, tek taraflý femur baþý epifiz kaymasý (FBEK) tanýsý ile takip edilen hastalarda baþlangýçta etkilenmemiþ olan karþý taraf femur baþý epifizinin kayma riski ile iliþkili radyolojik parametrelerin belirlenmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþma grubu, Haziran 2007 ile Aðustos 2018 arasýnda tedavi edilen tek taraflý FBEK hastalarýný içermektedir. Yaþ, cinsiyet, taraf, stabilite, posterior eðim açýsý, kayma derecesi, modifiye Oxford Kemik Yaþý Skoru (MOKYS), Risser sýnýflandýrmasý ve triradiat kýkýrdak gö-rünümü retrospektif olarak deðerlendirildi. Hastalar takipleri sýrasýnda kontralateral kayma geliþen hastalar (SCFESC) ile iskelet olgunluðuna kadar kontralateral kayma geliþmeyen hastalar (SCFEU) olarak iki grupta deðerlendirildi. Gruplar arasýnda risk faktörlerini karþýlaþtýrmak için tanýmlayýcý istatistikler kullanýldý.
BULGULAR: Bu çalýþmaya 48 hasta alýndý ve SCFESC grubunda 6 hasta (%12.5) mevcut idi. Sadece MOKYS gruplar arasýnda anlamlý derecede farklýydý. SCFESC grubunda MOKYS 2 hastada (%33.3) 18, 4 hastada 19 (%66.7) idi. SCFEU grubunda ise MOKYS skorlarý 1 hastada 18 (%2.4), 24 hastada 19 (%57.1) ve 17 hastada >20 (%40.5) idi. SCFESC grubundaki tüm hastalarda Risser skoru 0 ve triradiat kýkýrdak açýk olarak izlendi. TARTIÞMA: Tek taraflý FBEK hastalarý, takiplerde kontralateral FBEK geliþmesi açýsýndan risk altýndadýr ve MOKYS, risk deðerlendirmesinin en iyi öngörücüsüdür. MOKYS 16,17 veya 18 olan hastalarýn kontralateral kalçalarýnýn profilaktik olarak pinlenmesi konusunda literatürü destekleyen so-nuçlar elde ettiðimizi söyleyebiliriz. Ayrýca, göreceli olarak yüksek kontralateral kayma riski taþýyan MOKYS 19 hastalarýnýn pinlenmesini ya da kayma açýsýndan yakýn takibini öneriyoruz.

BACKGROUND: This study evaluates the radiological parameters of developing subsequent contralateral slips in unilateral slipped capital femoral epiphysis (SCFE) patients at the time of initial presentation.
METHODS: The study group included the review of unilateral SCFE patients treated between June 2007 and August 2018. Age, gen-der, side, stability, posterior slope angle, grade of slip, modified Oxford bone age score (mOBAS), the Risser classification, and the ap-pearance of the triradiate cartilage were evaluated retrospectively. Data were analyzed between two groups: subsequent contralateral SCFE (SCFESC) patients that developed contralateral slip during follow-up and unilateral SCFE (SCFEU) patients that did not develop contralateral slip up to skeletal maturity. Descriptive statistics were used to compare risk factors between groups.
RESULTS: This study included 48 patients and 6 patients (12.5%) developed a SCFESC. Only mOBAS was significantly different be-tween groups. The mOBAS scores in SCFESC were 18 in 2 patients (33.3%), 19 in 4 patients (66.7%). The mOBAS scores in SCFEU were 18 in 1 patient (2.4%), 19 in 24 patients (57.1%), and >20 in 17 patients (40.5%). In the SCFESC group, all patients had a Risser score of 0 and all had open triradiate cartilage.
CONCLUSION: Patients with unilateral SCFE are at risk for SCFESC, and the mOBAS is the best predictor of risk assessment. We agree that mOBAS score of 16,17 or 18 patients’ contralateral hips can be prophylactically pinned. We also suggest pinning or close screening of mOBAS 19 patients that some carry relatively high risk of subsequent contralateral slip.

AMAÇ: Çalýþmanýn amacý, literatürde fikir birliði olmayan cerrahi boyun proksimal humerus kýrýklarýnýn (PHK) cerrahi tedavisinde kullanýlan plak yöntemi ile intramedüller çivi (ÝMÇ) yönteminin klinik ve radyolojik olarak karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: Ocak 2013-Aralýk 2017 yýllarý arasýnda PHK nedeniyle baþvuran 248 olgu retrospektif olarak incelendi. Altmýþ iki olgu çalýþmaya dahil edildi. Sonuçlar klinik olarak kan kaybý miktarý, cerrahi süre, kaynama süresi açýsýndan karþýlaþtýrýldý. Radyolojik olarak ise Intraope-ratif Neck-Shaft Açýsý(NSA), final NSA, American Shoulder and Elbow Surgeons(ASES), Constant ve Visuel Analog Scale(VAS) skorlarý açýsýndan karþýlaþtýrýldý.
BULGULAR: Plak ve ÝMÇ olarak iki grup oluþturuldu. Gruplar yaþ, cinsiyet, operasyon tarafý, takip süresi açýsýnda benzerdi. NSA, final NSA, ASES, Constant ve VAS skorlarý bakýmýndan gruplar arasýnda fark yoktu. IMÇ grubunda intraoperatif kan kaybý miktarý, cerrahi süre ve kaynama süresi daha kýsa idi.
TARTIÞMA: Cerrahi boyun PHK cerrahi tedavisinde plak veya IMÇ iyi klinik sonuçlar gösteren yöntemlerdir. Bu çalýþmaya göre; intraoperatif daha az kan kaybý ortaya çýkmasý, daha kýsa sürede cerrahinin tamamlanmasý ve daha kýsa sürede kaynama görülmesi plak yöntemine göre ÝMÇ yönteminin avantajýdýr.

BACKGROUND: The aim of this study is to compare clinically and radiologically the plate osteosynthesis method and the in-tramedullary nail (IMN) method, which is currently used in the surgical treatment of surgical neck proximal humerus fractures (PHFs) in which there is no consensus
METHODS: A total of 248 patients who underwent PHF between January 2013 and December 2017 were retrospectively reviewed. Sixty-two patients were included in the study. The results were clinically compared in terms of the amount of blood loss, operative time, and union time. Radiologically, it was compared in terms of intraoperative neck–shaft angle (NSA), final NSA, the American Shoulder and Elbow Surgeons (ASES), and Constant and Visual Analog Scale (VAS) scores.
RESULTS: Two groups were formed: plate and IMN. The groups were similar in terms of age, sex, operation side, and follow-up time. There was no difference between the groups in terms of NSA, final NSA, ASES, Constant, and VAS scores. The amount of intraoper-ative blood loss, operative time, and union time was shorter in the IMN group.
CONCLUSION: In surgical neck PHF surgery, plate and IMN are methods that show good clinical outcomes. According to this study, the advantages of the IMN method compared with plate osteosynthesis in Neer type II PHF treatment can be listed as less intraoper-ative blood loss, shorter operative time, and union time.

Herpetik stromal keratit gibi bulgu gösteren, ön kamara açýsýnda yerleþmiþ metalik intraoküler yabancý cisim (IOFB) olgusunu sunuyoruz. Sol gözünde 3 gündür bulanýk görme þikayeti olan 41 yaþýnda, inþaat iþçisi erkek hasta herpetik stromal keratit tanýsý ile merkezimize sevkedildi. Hastanýn anamnezinde travma öyküsü yoktu. Yapýlan muayenede en iyi düzeltilmiþ görme keskinliðinin sað gözde 10 /10, sol gözde 8/10 olduðu görüldü. Biyomikroskopik ön segment muayenesinde sað göz doðaldý. Sol gözde korneal ödem ve skar, ön kamarada +2 hücre, lens ön kapsülde noktasal kesafet izlendi. Seidel testi negatif idi. Fundus muayenesi bilateral doðaldý. Hastadan mesleði nedeniyle travmadan þüphelenilerek çekilen orbita bilgi-sayarlý tomografisinde intraoküler yabancý cisim saptandý. Takibinin 2. gününde kornea ödemi gerileyen hastanýn yapýlan gonyoskopik muayenesinde inferior iridokorneal açýda yabancý cisim görüldü. Hasta operasyona alýnarak Barkan lensi yardýmýyla açýdaki yabancý cisim çýkarýldý. Travma öyküsü olmasa bile travma açýsýndan þüpheli hastalarda kornea ödemi, lens kesafeti gibi muayene bulgularý olduðunda intraoküler yabancý cisim varlýðý düþü-nülmeli ve mutlaka ekarte edilmelidir. Riskli meslek grubunda olan kiþiler koruyucu gözlük kullanýmý konusunda bilinçlendirilmelidir.

We report a case of a metallic intraocular foreign body (IOFB) retained in the anterior chamber (AC) angle that was masquerading as herpetic stromal keratitis. A 41-year-old male construction worker was referred to our ophthalmology clinic with the complaint of consistent blurred vision for 3 days in his left eye. He had no history of ocular trauma. The best-corrected visual acuity was found to be 10/10 in the right eye and 8/10 in the left eye. On slit-lamp examination of the anterior segment, the right eye was normal, while the left eye showed unilateral corneal edema and scarring, anterior lens capsule opacification, +2 cells in the AC, and the Seidel test was negative. Fundus examination was normal bilaterally. Despite there not being history of it, we still suspected ocular trauma considering the patient’s occupational risk. Consequently, an orbital computed tomography imaging was performed which revealed a metallic-IOFB in the inferior iridocorneal angle. On the second follow-up day, the corneal edema regressed, and a gonioscopic examination of the affected eye was performed, showing a small foreign body embedded in the inferior iridocorneal angle of the AC. Subsequently, the IOFB was surgically removed using Barkan lens, and excellent visual results were achieved. This case emphasizes the importance of considering IOFB in the differential diagnosis of patients with unilateral corneal edema and anterior lens capsule opacification. Fur-thermore, the presence of IOFB should be definitely excluded in patients with occupational risk of ocular trauma even if there is no history of trauma. More awareness about the proper use of eye protection should be raised to circumvent penetrating ocular-trauma.

Künt boyun travmasýndan sonra yumuþak doku zedelenmeleri nispeten yaygýndýr. Boyun bölgesinin içeriðinden dolayý bu durum birçok hayati yapý için tehlike oluþturabilir. Tiroit üzerinde izole travma oldukça nadirdir ve literatürde çok az vaka rapor edilmiþtir. Bir motorlu araç kazasýnda 61 ya-þýnda normalde saðlýklý bir kadýnýn boynunun sol ön yarýsý, emniyet kemeri yaralanmasý nedeniyle künt travmaya maruz kaldý. Dispne ile iliþkili olacak þekilde boyun anteriorunda aðrýlý bir þiþlik olduðunu bildirdi. Bilgisayarlý tomografiden (BT) bakýldýðýnda tiroit bezinde aktif bir kanamayý anýmsatan özelliklerle birlikte sol tiroit lobunda yýrtýlmalar olduðu görüldü. Sol tiroidektomi ile cerrahi eksplorasyon yapýldý ve hasta sorunsuz bir þekilde iyi-leþti. Ýzole tiroit bezi yaralanmasý nadiren görülür ve vakalarýn yaklaþýk %1-2’sinde mevcuttur. Ayrýca rapor edilen vakalarýn çoðunda bezin içerisinde vurgulanmasý gereken bir patoloji bulunmaktadýr. Hastalarýn boyun kýsmýnda þiþlik, aðrý, solunum bozukluðu ve yutma güçlüðü olabilmektedir. Künt boyun travmasýna maruz kalan hastalar ATLS® prensiplerine göre deðerlendirilmeli ve stabil duruma getirilmelidir. Öncelikle hayati yapýlardaki yaralanmalar elenmelidir. Bu vakalar nadir olsa da, doktorlar künt boyun travmasýndan sonra ya da boyunda þiþlik belirtilmiþse tiroit yaralanmasý ihtimalini deðerlendirmelidir.

Soft-tissue injuries are relatively common after blunt neck trauma. Due to neck content, several vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon, and few cases are reported in the literature. A 61-year-old otherwise healthy woman sustained blunt trauma to the left frontal half of the neck caused by seatbelt injury in a motor vehicle accident. She presented with a painful anterior neck swelling associated with dyspnea. Computed tomography showed the left thyroid lobe lacerations with features suggestive of thyroid gland active bleeding. She underwent surgical exploration with left thyroidectomy and recovered un-eventfully. Isolated thyroid gland injury is infrequent and is present in about 1–2% of the cases, and in most reported cases, there is an underlining pathology within the gland. Patients can be present with neck swelling, pain, respiratory distress, and dysphagia. Patients who sustained blunt neck trauma should be assessed and stabilized according to the ATLS® principles. Injury to vital structures should be ruled out first. Although these cases are rare, physicians should consider the possibility of thyroid injury after blunt neck trauma or neck swelling is noted.

Apandisit günümüzde yapýlan acil abdominal cerrahilerin en sýk sebebidir. Sýk görülen komplikasyonlarý iyi bilinmesine raðmen, retroperitoneal abse ve skrotal abse nadir görülen ve daha az bilinen komplikasyonlardýr. Bu çalýþmada apendektomi sonrasý retroperitoneal abse ve skrotal fistül ile komplike olan hastamýzý ve PubMed üzerinden yaptýðýmýz literatür taramasýný sunduk.
69 yaþýnda erkek hasta yaklaþýk 7 gündür devam eden karýn aðrýsý, bulantý-kusma ve son 24 saat içinde ateþ ve mental durum deðiþikliði þikayetleri ile acil servise baþvurdu. Perforasyon ve retroperitoneal abse ön tanýsý ile acil ameliyata alýndý. Laparotomide perfore apandisit ve buna baðlý retro-peritoneal abse görüldü. Apendektomi yapýldý ve abse boþaltýldý. Sepsis nedeniyle 4 gün yoðun bakým ünitesinde kalan hasta postoperatif 15. günde taburcu edildi. Taburcu olduktan 15 gün sonra skrotumdan kötü kokulu akýntý nedeniyle tekrar baþvurdu. Tomografisinde retroperitoneal alandan sol skrotuma uzanan abse tespit edilen hastaya perkütan drenaj uygulandý. Absesi gerileyen hasta yatýþýndan 17 gün sonra þifa ile taburcu edildi. Apandisit ile iliþkili bu nadir komplikasyonlar, erken ve doðru taný koyabilmek için mutlaka cerrahlarýn aklýnda olmalýdýr. Tedavide gecikme morbidite ve mortalitenin artmasýna neden olabilir.

Appendicitis is the most common emergency abdominal surgery today. Although its common complications are well-known, retroperi-toneal abscess and scrotal abscess are rare and less known complications. In this study, we presented our patient who presented with appendicitis complicated with retroperitoneal abscess and scrotal fistula after appendectomy, and the literature review we conducted through PubMed. A 69-year-old man was admitted to the emergency department with complaints of abdominal pain, nausea-vomiting continuing for about 7 days, and fever and mental status change in the last 24 h. He was taken to emergency surgery with the pre-liminary diagnosis of perforation and retroperitoneal abscess. At laparotomy, perforated appendicitis and associated retroperitoneal abscess were seen. An appendectomy was performed, and the abscess was drained. The patient, who stayed in the intensive care unit for 4 days due to sepsis, was discharged on the 15th postoperative day with full recovery. He was admitted 15 days after his discharge because of an abscess from the scrotum. Percutaneous drainage was performed in the patient, whose tomography revealed an abscess extending from the retroperitoneal area to the left scrotum. The patient, whose abscess regressed, was discharged with recovery 17 days after hospitalization. These rare complications associated with appendicitis should be on the minds of surgeons to make an early diagnosis. Delay in treatment may lead to increased morbidity and mortality.