AMAÇ: Sýçanlarda hipertermik intraperitoneal tedavi çalýþmalarýnda kullanýlabilecek standart bir týbbi cihaz ve yöntem bulunmamaktadýr. Bu çalýþmada, tasarýmýný ve klinik çalýþmasýný yaptýðýmýz kendi algoritmasý ile çalýþan hipetermi cihazýmýzý ve sýçanlarda hipertermik intraperitoneal tedavi çalýþma protokolümüzü sunuyoruz. Cihazýn ve algoritmasýnýn sýçanýn batýný içerisinde istenilen sýcaklýðý oluþturulabilmesi, cihazýn yarattýðý komplikasyona baðlý sýçan kaybýnýn olmamasý, cihazýn otonom olarak çalýþabilmesi ve acil durumlarda kendisini durdurarak operatöre uyarý vermesinin gösterilmesi ile, tasarlanan cihazýn, algoritmasýnýn ve hipertermi protokolünün etkinliðinin gösterilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 6 adet diþi 8 haftalýk (280-310 gram) albino Wistar sýçan için kapalý yöntemle intraperitoneal hipertermi protokolü oluþtu-ruldu. Sýçan abdomeninde, ksifoid ile mesane arasýnda 1 cm’lik veritikal insizyondan sývý giriþ, çýkýþ hortumlarý ve ýsý probu yerleþtirildi ve cilt sirküler sütüre edildi. 60 dakika süre ile 100 ml/dakika akým hýzýnda ve sýçanýn batýn içerisinde 41°C±0.5 sýcaklýkta saðlanacak þekilde salin solüsyonu ile intraperitoneal hipertermik tedavi protokolü oluþturuldu.
BULGULAR: Çalýþma sýrasýnda 100 ml/dakika ±5 akým hýzýnda tüm sýçanlarýn batýný içerisinde 41°C±0.5 sýcaklýk 60 dakika süre ile oluþturuldu. Hipertermi protokolü sýrasýnda 3 sýçanýn rektal ýsý ölçümü 38.5°C üzerine çýktýðý için sýçanlarda kuyruk altýna buz uygulamasý ile eksternal soðutma yapýldý. Sýçanlarda postoperatif 72. saate kadar kayýp olmadý ve çalýþma baþarý ile sonuçlandýrýldý.
SONUÇ: Sýçanlarda intraperitoneal hipertermi tedavisi çalýþmalarýnda hayvan refahýný ön planda tutan, hýzlý, güvenli ve yüksek doðruluk hassasiyetiyle çalýþabilen ayný zamanda otonom olarak çalýþabilen cihaz tasarýmýmýz ve algoritmamýz baþarýlý olmuþtur. Sýçanlarda hipertermik intraperitoneal çalýþmalarýnda standart bir yöntem ve uygulama olarak kullanýlabileceðini düþünüyoruz.

BACKGROUND: There is currently no standard medical device and method available for hyperthermic intraperitoneal therapy studies in rats. In this study, we present our designed device and algorithm that operates based on our own protocol for hyperthermic intraperitoneal treatment in rats. The aim was to demonstrate the effectiveness of the designed device, algorithm, and hyperthermia protocol by showing that the device can achieve the desired temperature inside the rat’s abdomen, does not cause rat loss due to complications, operates autonomously, and provides warnings to the operator in case of emergencies.
METHODS: A closed method for intraperitoneal hyperthermia protocol was established for 6 female 8-week-old (280–310 g) albino Wistar rats. Fluid inlet and outlet tubes and a temperature probe were inserted through a 1 cm vertical incision between the xiphoid and bladder in the rat’s abdomen, and the skin was sutured in a circular manner. A protocol for intraperitoneal hyperthermic treat-ment was established using a saline solution at a flow rate of 100 mL/min for 60 min, maintaining a temperature of 41°C±0.5 inside the rat’s abdomen.
RESULTS: During the study, a temperature of 41°C±0.5 was successfully achieved in the abdomen of all rats at a flow rate of 100 mL/min±5 for 60 min. Due to three rats reaching a rectal temperature above 38.5°C during the hyperthermia protocol, external cooling was applied to the rat’s tail base using ice. There were no losses until the postoperative 72nd h, and the study was successfully completed.
CONCLUSION: Our designed device and algorithm, which prioritize animal welfare, operate rapidly, safely, and with high accuracy sensitivity, have been successful in hyperthermic intraperitoneal treatment studies in rats. We believe that they can be used as a stan-dard method and approach in hyperthermic intraperitoneal studies in rats.

AMAÇ: Biyoelektrikal impedans analazi (BIA) vücut komponentlerinin karþýlaþtýrýlmasý, safra kesesi taþý oluþumunu engellemeye yardýmcý olabilecek prediktif faktörlerin ortaya konulmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Safra kesesinde ultrasonografi ile taþ saptanan hastalar vaka grubu olarak seçilirken, taþ saptanmayan katýlýmcýlar kontrol grubuna seçildi. Her iki gruptaki katýlýmcýlarýn vücut komponentleri BIA ile ölçüldü. Katýlýmcýlarýn demografik özellikleri, günlük ortalama su tüketim miktarlarý (MWÝD), BIA ile ölçülen vücut kitle indeksi (BMI), total yað aðýrlýðý (TBFM), total vücut yað oraný (BFP), total vücut su miktarý (TBW), göv-de yað aðýrlýðý (BFM gövde) ve iç organ yað düzeyi (VFL) kaydedildi. Safra taþý oluþumunda prediktif risk faktörleri istatiksel analiz ile ortaya konuldu. BULGULAR: Safra kesesinde taþ saptanan grupta 83, saptanmayan grupta 108 katýlýmcý olmak üzere toplamda 191 katýlýmcýnýn verileri incelendi. Her iki grup yaþ ve cinsiyet açýsýndan istatiksel olarak benzerdi (p>0.05). Tek deðiþkenli analizde BMI, TBFM, BFP, BFM gövde ve VFL safra kesesinde taþ saptanan grupta istatiksel anlamlý olarak daha yüksek iken (sýrasýyla p=0.007, p=0.004, p=0.003, p=0.003, p=0.005) MWÝD miktarý daha düþük idi (p<0.001). Çok deðiþkenli analizde ise MWÝD (ref: ≥1.5 OR: 7.786 95%CI: 3.612-16.781) ve BFP (ref: ≥0.24 OR: 3.102 95%CI: 1.207-7.972) safra taþý oluþumunda baðýmsýz faktörler olarak karþýmýza çýkmaktadýr.
SONUÇ: Günlük ortalama su tüketim miktarý ve kolay uygulanabilir, non-invaziv bir yöntem olan BIA tekniði ile ölçülen BFP düzeyi safra taþý oluþu-munda baðýmsýz risk faktörleridir.

BACKGROUND: We aimed to compare bioelectrical impedance analysis (BIA) body composition and to reveal predictive factors that may help prevent gallstone formation.
METHODS: Patients with gallstones by ultrasonography were selected as the case group, while participants without stones were selected as the control group. The body composition of the participants in both groups was measured by BIA. Demographic charac-teristics, mean water intake daily of the participants (MWID) and body mass index (BMI), total body fat mass (TBFM), total body fat percentage (BFP), total body water (TBW), body fat mass of trunk (BFM of trunk), and visceral fat level (VFL) measured by BIA were recorded. Predictive risk factors for gallstone formation were revealed by statistical analysis.
RESULTS: The data of a total of 191 participants, including 83 participants in the group with gallstones and 108 participants in the group without gallstones, were analyzed. Both groups were statistically similar in terms of age and sex (P>0.05). In univariate analysis, BMI, TBFM, BFP, BFM of trunk, and VFL were statistically significantly higher (P = 0.007, P=0.004, P=0.003, P=0.003, and P=0.005, respectively) while MWID was lower (P<0.001) in the group with gallstone. In multivariate analysis, MWID (ref: ≥1.5 odds ratio [OR]: 7.786 95% confidence interval [CI]: 3.612–16.781) and BFP (ref: ≥0.24 OR: 3.102 95%CI: 1.207–7.972) were independent factors in gallstone formation.
CONCLUSION: The MWID and BFP level measured by the BIA technique, which is an easily applicable, noninvasive method, are independent risk factors for gallstone formation.

AMAÇ: Bu çalýþmayý, beyin tomografisinin yorumlanmasýnda doðruluk ve süre açýsýndan gördüðümüz eksikliklerin yapay zeka (AI) yöntemi ile doldurularak en azýndan sorumlu doktoru hýzlýca uyaracak þekilde, uygun patolojilerde yardýmcý olabileceðini düþünüp akut subduraller açýsýndan ilk deðerlendirmeyi yapmak için planladýk.
GEREÇ ve YÖNTEM: Ýki seviyeli AI tabanlý bir hibrit yöntem geliþtirildi. Önerilen model, hemorajik bölgenin maske oluþturma aþamasýnda bir derin öðrenme modeli olan maske-bölge evriþimli sinir aðý (Mask R-CNN) tekniðini ve ikili sýnýflandýrma aþamasýnda bir makine öðrenimi modeli olan probleme özel, optimize edilmiþ destek vektör makineleri (SVM) tekniðini kullanýr. Ayrýca SVM algoritmalarýnýn parametrelerinin optimizasyonu için arý kolonisi algoritmasý kullanýldý.
BULGULAR: Ýlk aþamada kullanýlan Mask R-CNN mimarisi ile kesiþim üzeri birleþme (IOU) deðeri 0.5 alýndýðýnda ortalama ortanca kesinlik (mAP) deðeri 0.754 olarak elde edildi. Ayný zamanda 5 kat çapraz doðrulama uygulandýðýnda mAP deðeri 0.736 olarak elde edildi. Hem Mask R-CNN hem de SVM algoritmasý için hiper parametre optimizasyonu ile iki seviyeli sýnýflandýrma iþleminin doðruluðu %96.36 idi. Ayrýca nihai yanlýþ negatif oran ve yanlýþ pozitif oran deðerleri sýrasýyla %6.20 ve %2.57 olarak elde edildi.
SONUÇ: Önerilen model ile iki boyutlu görüntüler üzerinde hem kanama tespiti hem de þüpheli alanýn hekime sunulmasý, benzer çalýþmalara ve günümüz tele týp teknikleri ile yorumlamalara göre düþük maliyet ve yüksek doðrulukla daha baþarýlý bir þekilde gerçekleþtirilmiþtir.

BACKGROUND: The article was planned to make the first evaluation in terms of acute subdural hemorrhages, thinking that it can help in appropriate pathologies by tomography interpretation with the artificial intelligence (AI) method, at least in a way to quickly warn the responsible doctor.
METHODS: A two-level AI-based hybrid method was developed. The proposed model uses the mask-region convolutional neural network (Mask R-CNN) technique, which is a deep learning model, in the hemorrhagic region’s mask generation stage, and a problem-specific, optimized support vector machines (SVM) technique which is a machine learning model in the binary classification stage. Furthermore, the bee colony algorithm was used for the optimization of SVM algorithms’ parameters.
RESULTS: In the first stage, the mean average precision (mAP) value was obtained as 0.754 when the intercept over union (IOU) value was taken as 0.5 with the Mask R-CNN architecture used. At the same time, when a 5-fold cross-validation was applied, the mAP value was obtained 0.736. With the hyperparameter optimization for both Mask R-CNN and the SVM algorithm, the accuracy of the two-level classification process was obtained as 96.36%. Furthermore, final false-negative rate and false-positive rate values were obtained as 6.20%, and 2.57%, respectively.
CONCLUSION: With the proposed model, both the detection of hemorrhage and the presentation of the suspicious area to the physician were performed more successfully on two dimensional (2D) images with low cost and high accuracy compared to similar studies and today’s interpretations with telemedicine techniques.

AMAÇ: Bu çalýþmanýn amacý, beyaz küre sayýsý normal aralýkta olan akut apandisit tanýlý hastalarda, komplike ve komplike olmayan apandisit ayýrýcý tanýsý için kolayca elde edilebilecek yeni bir belirteci araþtýrmaktýr.
GEREÇ VE YÖNTEM: Ocak 2021-Ekim 2022 tarihleri arasýnda histopatolojik olarak kanýtlanmýþ akut apandisit nedeniyle ameliyat edilen hastalar geriye dönük olarak deðerlendirildi. Hastalar cerrahi ve histopatolojik bulgulara göre komplike olmayan ve komplike apandisit olarak iki gruba ayrýldý. Gruplar hastaneye yatýþ anýndaki laboratuvar parametreleri açýsýndan karþýlaþtýrýldý.
BULGULAR: Çalýþma süresi boyunca 2589 hastaya apendektomi yapýlmýþtýr. Bu hastalardan baþvuru anýnda beyaz küre sayýsý normal sýnýrlar içerisinde olan 612 hasta analiz edildi. Hastalarýn %79.6’sýnda komplike olmayan apandisit, %20.4’ünde komplike apandisit saptandý. Komplike apandisit grubundaki hastalarda nötrofil yüzdesi, nötrofil/lenfosit oraný (NLR), C-reaktif protein ve total bilirubin düzeyleri anlamlý olarak daha yüksek, lenfosit yüzdesi, lenfosit sayýsý, lenfosit/monosit oraný (LMR), serum sodyum düzeyi ve LUC yüzdesi anlamlý olarak daha düþük bulundu. Lojistik regresyon analizinde, düþük LUC yüzdesi (OR: 0.45; %95 CI: 1.08-2.09; p=0.01) ve yüksek total bilirubin düzeylerinin (OR: 1.50; %95 CI: 1.08-2.09; p=0.01) komplike apandisit için baðýmsýz risk faktörleri olduðu gösterildi.
SONUÇ: Beyaz küre sayýsýnýn normal olduðu akut apandisit tanýlý hastalarda, tam kan sayýmýndan elde edilen LUC yüzdesi, komplike apandisit tanýsýný öngören yeni bir parametre olarak kullanýlabilir.

BACKGROUND: The aim of this study was to investigate the ability of a new marker that could be easily obtained to differentiate between complicated and uncomplicated appendicitis in a patients with a white blood cell (WBC) count within the normal range.
METHODS: The patients who underwent surgery with histopathologically proven acute appendicitis (AA) between January 2021 and October 2022 were evaluated retrospectively. Patients were classified into two groups as uncomplicated and complicated appendicitis, based on the surgical and histopathological findings. Groups were compared in terms of laboratory parameters at the time of hospital admission.
RESULTS: During the study period, 2589 patients underwent an appendectomy, among these 612 patients who had a WBC count within the normal range at the time of admission were analyzed. Uncomplicated appendicitis was detected in 79.6% of the patients and complicated appendicitis in 20.4%. Neutrophil%, neutrophil-to-lymphocyte ratio, C-reactive protein, and total bilirubin levels were significantly higher, whereas lymphocyte%, lymphocyte count, lymphocyte-to-monocyte ratio, sodium levels, and large unstained cells (LUC)% were significantly lower in patients with complicated appendicitis. Multiple logistic regression analysis revealed that lower LUC% (Odds Ratio [OR]: 0.45; 95% Confidence Intervals [CI]: 1.08–2.09; P=0.01) and higher total bilirubin levels (OR: 1.50; 95% CI: 1.08–2.09; P=0.01) were independent risk factors for complicated appendicitis.
CONCLUSION: In patients with a diagnosis of AA with a normal WBC value, LUC% obtained from the complete blood count can be used as a new parameter predicting the diagnosis of complicated appendicitis.

AMAÇ: Alt ekstremite defektleri travma, periferik arter hastalýðý, diyabetik ayak enfeksiyonlarý, tümör rezeksiyonu, ateþli silah yaralanmalarý ve yanýklar gibi birçok etiyolojik nedene baðlý olarak ortaya çýkabilir. Alt ekstremite defektleri, etkilenen anatomik lokalizasyona, doku miktarýna ve doku içeriðine göre geniþ bir klinik görünüm gösterir. Bu çalýþmada, serbest flep gibi mikrocerrahi onarýmlarýn mümkün olmadýðý durumlarda basit ve güvenilir bir kurtarma yöntemi olarak bipediküllü fleplerin kullanýmýnýn sunulmasý amaçlandý.
GEREÇ VE YÖNTEM: Mart 2018-Eylül 2021 tarihleri arasýnda alt ekstremitelerinde yumuþak doku defekti olan hastalar dosya üzerinden geriye dönük olarak tarandý. Bu hastalardan bipediküllü flep ile rekonstrüksiyon yapýlan hastalar çalýþmaya alýndý. Hastalar en az 12 ay düzenli olarak takip edildi. Takiplerde hastalarýn fotoðraflarý çekildi, flep viabilitesi, dehisens, yumuþak doku enfeksiyonu açýsýndan fizik muayene yapýldý ve veriler kayýt altýna alýndý.
BULGULAR: Alt ekstremitede defekt saptanan ve randomize bipediküllü flep ile onarým yapýlan 23 hasta geriye dönük olarak incelendi. Defekt yeri 4 hastada bacaðýn orta 1/3’ünde, 19 hastada ise bacaðýn 1/3 distalindeydi. Flep tasarýmý 22 hastada vertikal, 1 hastada transvers olarak yapýldý. Defekt onarýmý için 14 hastada 1 adet, 9 hastada 2 adet bipediküllü flep kullanýldý. Hastalarýn 16’sýnda donör alan onarýmý için cilt greftleri kullanýlýrken, 7’sinde donör alan primer olarak onarýldý. Postoperatif dönemde 5 hastada lokal yumuþak doku enfeksiyonu, 3 hastada yara yerinde ayrýlma tespit edildi ve antibiyotik tedavisi, resütürasyon ve uygun yara bakýmý ile sorunsuz iyileþme saðlandý. Hiçbir hastada flep veya greft kaybý gibi majör komplikasyon yaþanmadý.
SONUÇ: Sonuç olarak, orta ve distal alt ekstremite defektlerinin rekonstrüksiyonunda randomize bipediküllü flepler güvenilir bir seçenektir. Diyabetes mellitus ve periferik arter hastalýðý gibi yara iyileþmesini olumsuz etkileyen komorbiditeleri olan hastalarda bile kullanýlabilmesi nedeniyle alt ekstremitenin küçük ve orta büyüklükteki defektlerinde güvenle uygulanabilecek bir rekonstrüksiyon seçeneði olduðunu düþünüyoruz.

BACKGROUND: Lower extremity defects may occur due to many etiological causes such as trauma, peripheral arterial disease, diabetic foot infections, tumor resection, gunshot injuries, and burns. Lower extremity defects show a wide clinical presentation ac-cording to the affected anatomical localization, amount of tissue, and tissue content. In this study, it is aimed to present the use of bipedicled flaps as a simple and reliable salvage method in cases where microsurgical repairs such as free flaps are not possible.
METHODS: Patients with soft-tissue defect in their lower extremities between March 2018 and September 2021 were scanned retrospectively over the file. Among these patients, patients who were repaired with a bipedicle flap were included in the study. The patients were followed up regularly for at least 12 months. During the follow-ups, the patients were photographed, a physical examination was performed in terms of flap viability, wound dehiscence, and soft-tissue infection, and the data were recorded.
RESULTS: In this study, 23 patients with a defect in the lower extremity who were repaired with randomized bipedicled flap were retrospectively analyzed. In four patients, the location of the defect was located in the middle 1/3 of the leg, while in 19 patients, it was located in the distal 1/3 of the leg. The flap design was done vertically in 22 patients, and the flap design was done transversely in one patient. One bipedicled flap was used for defect repair in 14 patients, and two bipedicled flaps were used for defect repair in nine patients. While skin grafts were used for donor site repairs in 16 patients, the donor site was primarily repaired in seven patients. In the post-operative period, local soft-tissue infection was detected in five patients and dehiscence at the wound site in three patients, and uneventful healing was achieved with antibiotic therapy, resuturation, and appropriate wound care. No major complications such as flap or graft loss were experienced in any of the patients.
CONCLUSION: Randomized bipediculated flaps are a very reliable option for the reconstruction of middle and distal lower extremity defects. We think that it is a reconstruction option that can be safely applied in small and medium-sized defects of the lower extremity, since it can be used even in patients with comorbidities such as diabetes mellitus and peripheral arterial disease that adversely affect wound healing.

AMAÇ: Subdural hematom (SDH) beyin cerrahisinde genellikle acil bir klinik durumdur. SDH ve epilepsi arasýndaki iliþki iyi kurulmamýþtýr. Bu nedenle SDH’li hastalarda antikonvülzif tedavinin kullanýmý tartýþmalýdýr. Bu çalýþmanýn amacý, SDH nedeniyle ameliyat edilen hastalarda nöbet varlýðýný analiz etmektir.
GEREÇ VE YÖNTEM: 2016-2021 yýllarý arasýnda kliniðimizde SDH nedeniyle ameliyat edilen hastalar geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, baþvuru anýndaki Glasgow koma skalasý (GKS), SDH’nin tipi, yerleþimi, etiyolojisi, cerrahi giriþimin tipi, nöbet varlýðý ve reoperasyon gibi faktörler deðerlendirildi.
BULGULAR: SDH nedeniyle ameliyat edilen 175 hasta incelendi. Nöbet sýklýðý ile SDH tipi arasýnda istatistiksel olarak anlamlý fark saptanmýþtý. Akut SDH’de diðerlerine göre daha fazla nöbet gözlendi. GKS skoru ile nöbet sýklýðý arasýnda da istatistiksel olarak anlamlý bir fark vardýr. Baþvuru anýnda GKS skoru 12’nin altýnda olan hastalar, 12 veya daha yüksek olan hastalara göre daha sýk nöbet geçirmiþlerdi. Etiyoloji, reoperasyon, hematom yerleþimi ve nöbet geliþimi gibi faktörler arasýnda istatistiksel olarak anlamlý fark bulunmadý.
SONUÇ: Akut SDH ve baþvuru anýnda GKS skoru düþük olan hastalarda antikonvülsif tedavi önerilebilir. SDH’li hastalarda en uygun antikonvülzif ajanýn belirlenmesi için daha geniþ serili ileri çalýþmalara ihtiyaç vardýr.

BACKGROUND: Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH.
METHODS: Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated.
RESULTS: There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures.
CONCLUSION: Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.

AMAÇ: Bu çalýþma, akut kolesistit nedeniyle kolesistektomi ameliyatý geçirmiþ süper-yaþlý hastalarda (≥85 yaþ) kolesistektomi morbiditesini öngör-mede nötrofil lenfosit oraný (NLO), trombosit lenfosit oraný (TLO), prognostik beslenme indeksi (PBÝ) ve serum albümin düzeyinin kullanýlabilirliðini deðerlendirmeyi amaçladý.
GEREÇ VE YÖNTEM: Bu retrospektif çalýþmaya Ocak 2010 ile Ocak 2021 tarihleri arasýnda üçüncü basamak bir saðlýk merkezinde akut kolesistit nedeniyle kolesistektomi uygulanan süper yaþlý hastalar alýndý. Hastalar postoperatif komplikasyon (morbidite) varlýðýna göre iki gruba ayrýldý. Ýki grup arasýndaki farklar deðerlendirildi. Ek olarak, süper yaþlý hastalarda akut kolesistit için kolesistektomi morbiditesini öngörmede NLO, TLO, PBÝ ve serum albümin düzeyinin rolü ROC analizi ile deðerlendirildi.
BULGULAR: Çalýþma kriterlerini karþýlayan 30 hastanýn 22’si (%73.3) kadýndý ve tüm hastalarýn yaþ ortalamasý 87.43±2.66 (daðýlým 85-94) yýl idi. Yedi (%23.3) hastanýn ameliyat öncesi dönemde en az bir ek hastalýðý vardý. Ortalama NLO, TLO, albümin ve PBÝ sýrasýyla 8.31, 153.76, 3.45 ve 48.37 idi. Çalýþmanýn morbidite oraný %23.3 idi. NLO için eðri altýndaki alan (EAA) 0.466 ([95% CI: 0.259-0.672]; p=0.787) ve TLO için EAA 0.429 ([95% CI: 0.201-0.656]; p=0.573) idi. Bu iki faktör morbiditeyi öngörmek için uygun deðildi. PBÝ için EAA 0.780 ([%95 CI: 0.568-0.991]; p=0.027) ve albümin için EAA 0.894’tür ([95% CI: 0.770-1.000]; p=0.002). 3.05 g/dL kesme deðerinde albüminin sensitivitesi %91.3 ve spesifitesi %71.4 iken, PBÝ’nin 41.70 kesme deðerinde sensitivitesi %82.6 ve spesifitesi %71.4 idi.
SONUÇ: Bu çalýþma, süper yaþlý hastalarda akut kolesistit için kolesistektomi morbiditesini öngörmede PBÝ ve albüminin yüksek duyarlýlýk ve özgüllük ile prediktif faktörler olarak kullanýlabileceðini bulmuþtur. Ancak NLO ve TLO’nun kolesistektomi morbiditesini öngörmede önemi yoktu.

BACKGROUND: This study aimed to evaluate the usability of neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and serum albumin level in predicting cholecystectomy morbidity in elderly patients (85 years and older) who underwent cholecystectomy for acute cholecystitis.
METHODS: This retrospective study included super-elderly patients who underwent cholecystectomy due to acute cholecystitis at a tertiary health centre between January 2010 and January 2021. The patients were divided into two groups according to the presence of postoperative complications (morbidity). The differences between the two groups were evaluated. In addition, the role of NLR, PLR, PNI, and serum albumin level in predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients was assessed via ROC analysis.
RESULTS: Of 30 patients who met the study criteria, 22 (73.3%) were female, and the mean age of all patients was 87.43±2.66 years (range 85–94 years). 7 (23.3%) patients had at least one comorbid disease during the preoperative period. The mean value of NLR, PLR, albumin, and PNI were 8.31, 153.76, 3.45, and 48.37, respectively. The morbidity rate of the study was 23.3%. The area under the curve (AUC) for NLR was 0.466 ([95% confidence interval [CI]: 0.259–0.672]; P=0.787), and the AUC for PLR was 0.429 ([95% CI: 0.201–0.656]; P=0.573). These two factors were not suitable for predicting morbidity. The AUC for PNI was 0.780 ([95% CI: 0.568–0.991]; P=0.027), and the AUC for albumin was 0.894 ([95% CI: 0.770–1.000]; P=0.002). At the cut-off value of 3.05 g/dL, the sensitivity and specificity of albumin were 91.3% and 71.4%, respectively, while the sensitivity and specificity of PNI at the 41.70 cut-off value were 82.6% and 71.4%, respectively.
CONCLUSION: This study found that PNI and albumin can be used as predictive factors with high sensitivity and specificity for predicting cholecystectomy morbidity for acute cholecystitis in super-elderly patients. However, NLR and PLR had no significance in predicting cholecystectomy morbidity.

AMAÇ: Acil servise baþvuran geriatrik hastalarda düþme risk faktörlerini ve kýrýlganlýk indekslerini deðerlendirdik.
GEREÇ VE YÖNTEM: Bu prospektif çalýþma, acil servise baþvuran 65 yaþ ve üstü 264 ardýþýk hastayý içermektedir. Katýlýmcýlar düþenler ve düþmeyenler olarak ikiye ayrýldý. Hasta gruplarý yaþ, cinsiyet, baþvuru þikayetleri (düþme ve diðerleri), komorbiditeler, ilaçlar, kýrýlganlýk deðerlendirme araçlarý ve ortostatik hipotansiyon (OH) açýsýndan karþýlaþtýrýldý.
BULGULAR: Çalýþmaya düþen 129 (%48.8) ve düþmeyen 135 (%51.2) olmak üzere toplam 264 hasta alýndý. Düþen ve düþmeyen hastalarýn ortalama yaþlarý sýrasýyla 80.48±8.38 ve 79.42±7.94 idi. Ayrýca hastalarýn %62.01’i (n=80) ve %51.85’i (n=70) kadýn idi. Gruplar arasýnda yaþ ve cinsiyet açýsýndan istatistiksel olarak anlamlý fark yoktu (sýrasýyla, p=0.290 ve p=0.096). Düþen hastalarýn %89.92’sinin (n=116) en az bir kronik hastalýðý vardý. Gruplar arasýnda OH’li hasta oranlarýnda anlamlý bir fark vardý. Edmonton Kýrýlganlýk Ölçeði, Kýrýlgan Olmayan Engelli Anketi, PRISMA-7 anketi, Risk Altýndaki Yaþlýlarýn Belirlenmesi testi ve Rockwood Klinik Kýrýlganlýk Ölçeði puanlarý gibi kýrýlganlýk puanlarý da gruplar arasýnda anlamlý derecede farklýydý. Baþvuruda daha yüksek bir PRISMA-7 skorunun, düþme riskinin baðýmsýz bir göstergesi olduðu bulundu.
SONUÇ: Düþmeler yaþlý popülasyonda ve kadýnlarda daha sýk görülür. Ayrýca, FRESH Kýrýlganlýk Ölçeði dýþýndaki kýrýlganlýk deðerlendirme puanlarý, geriatrik hastalarda düþmelerle iliþkilendirilmiþtir. Anlamlý olmayan deðiþkenlerin elenmesinden sonra çok deðiþkenli regresyon analizinde baþvuru sýrasýndaki yüksek PRISMA-7 anket puaný, düþme riskinin baðýmsýz bir göstergesi olarak tanýmlandý.

BACKGROUND: We evaluated risk factors and frailty assessments to identify fall-prone geriatric patients in the emergency department (ED).
METHODS: This prospective study included 264 consecutive patients aged ≥65 years who presented to the ED. The participants were divided into those who had fallen or not. The patient groups were compared in terms of age, sex, presenting complaints (falls vs. others), comorbidities, medications, frailty assessment tools, and orthostatic hypotension (OH).
RESULTS: In total, 264 patients were included: 129 (48.8%) patients who had fallen and 135 (51.2%) who hadn’t fallen. The mean ages of patients who had fallen and those who had not fallen were 80.48±8.38 and 79.42±7.94 years, respectively. In addition, 62.01% (n=80) and 51.85% (n=70) of patients were females. There were no statistically significant differences between the groups in terms of age or sex (P=0.290 and P=0.096, respectively). In total, 89.92% (n=116) of patients who had fallen had at least one chronic medical condition. There was a significant difference in the proportion of patients with OH between the groups. Frailty scores such as the Edmonton Frail Scale, Frail Non-Disabled Questionnaire, PRISMA-7 questionnaire, Identification of Seniors at Risk test, and Rockwood Clinical Frailty Scale scores were also significantly different between the groups. A higher PRISMA-7 score at admission was found to be an independent predictor of fall risk.
CONCLUSION: Falls occur more frequently in the older population and in females. In addition, the frailty assessment scores, except for the FRESH Frailty Scale, were associated with falls in geriatric patients. After elimination of non-significant variables in multivariate analysis, a high PRISMA-7 questionnaire score at admission was identified as an independent predictor of fall risk.

AMAÇ: Biz bu çalýþmada, laparoskopik kolesistektomi ve kist hidatik cerrahisi sonrasý görülen safra yolu kaçaðýnýn taný ve tedavisinde, endoskopik retrograd kolanjiopankreatografi (ERCP), sfinkterotomi, balon ile safra yolu taramasý ve plastik stent uygulamasýnýn etkinliðini ve güvenliliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada ameliyat sonrasý safra kaçaðý sebebi ile ERCP, sfinkterotomi, stent iþlemi yapýlan hastalar deðerlendirildi. Hastalar ERCP iþleminde saptanan safra kaçaðý yerine göre 4 grup altýnda (sistik kanal güdüðü, kese yataðý, kist hidatik içi, koledok) toplandý. ERCP iþlemi sonrasý iþlem baþarýsý, dren çekim süresi, ERCP iþlemine baðlý, kanama, pankreatit ve perforasyon gibi erken komplikasyon geliþip, geliþmediði, ERCP de obstrüktif patoloji varlýðý açýsýndan deðerlendirildi.
BULGULAR: Baþarýlý ERCP iþlemi yapýlan 65/73 hastada (%89) klinik iyileþme saptandý ve drenleri çekilebildi. Ortalama dren çekme süresi 32.69±23.32 gün saptandý. Laparoskopik kolesistektomi sonrasý safra kaçaðýnýn en sýk sistik kanal güdüðünden olduðu görüldü. Gruplar arasýnda iþlem baþarý oranlarý açýsýndan fark saptanmadý. Sistik kanaldan kaçak olan hasta grubunda dren çekim süresinin diðer 3 gruba göre daha kýsa olduðu görüldü (p<0.05). ERCP iþlemi sonrasý 5/73 (%6.9) hastada medikal tedavi ile düzelen, minör ERCP komplikasyonu izlendi. Major ERCP komplikasyonu görülmedi. Ayrýca, 25/73 hastada (%34.2) safra yolunda taþ ve kist hidatik membraný gibi obstrüktif bir patoloji saptandý.
TARTIÞMA: Laparoskopik kolesitektomi ve kist hidatik cerrahisine baðlý biliyer kaçak hastalarýnda, ERCP, sfinkterotomi, balon ile tarama ve plastik stent uygulamasý yöntemi hem oldukça etkin, hem de güvenilir bir seçenektir. Bu hasta grubunda ilk tercih edilecek tedavi yaklaþýmý olarak deðerlendirilmelidir.

BACKGROUND: We evaluated the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, balloon biliary tract scanning, and plastic stenting in diagnosing and treating bile duct leakage after laparoscopic cholecystectomy and hydatid cyst surgery in this study.
METHODS: The study evaluated patients who underwent ERCP, sphincterotomy, and stenting for post-operative bile leakage. The patients were grouped under 4 groups (cystic duct stump, sac bed, hydatid cyst, and choledochal) according to the bile leakage de-tected in the ERCP procedure. The success of the procedure after the ERCP was evaluated by drain extraction time, whether early complications such as bleeding, pancreatitis, and perforation developed due to the ERCP procedure and the presence of obstructive pathology in ERCP.
RESULTS: Clinical improvement was observed in 65/73 (89%) patients who underwent successful ERCP procedures, and their drains could be removed. The mean drain removal time was 32.69±23.32 days. After laparoscopic cholecystectomy, bile leakage was most frequently from the cystic duct stump. There was no difference between the groups in procedural success rates. Drain removal time was shorter in the patient group with leakage from the cystic duct compared to the other three groups (P<0.05). After the ERCP procedure, 5/73 (6.9%) patients had minor ERCP complications, which improved with medical treatment. No major ERCP complication was observed. In addition, 25/73 patients (34.2%) had obstructive pathology such as biliary stone and hydatid membrane.
CONCLUSION: In patients with biliary leak due to laparoscopic cholecystectomy and hydatid cyst surgery, ERCP, sphincterotomy, balloon scanning, and plastic stenting are both highly effective and reliable options. They should be considered as the first-choice treat-ment approach in this patient group.

AMAÇ: Sekonder spontan pnömotoraks, altta yatan akciðer hastalýðý olan kiþilerde geliþen pnömotoraksý tanýmlamak için kullanýlan terimdir. Önemli morbidite, yüksek saðlýk harcamalarý ve ölüm olasýlýðý ile dünya çapýnda önemli bir saðlýk sorunudur. Bu çalýþma, sekonder spontan pnömotoraksýn epidemiyolojik özelliklerini, mortalite ve morbidite ile iliþkili risk faktörlerini ve tedavi seçeneklerini deðerlendirmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Sekonder spontan pnömotorakslý 133 hastanýn tedavi yöntemleri, morbidite ve mortalite sonuçlarý ve iliþkili faktörler geriye dönük olarak deðerlendirildi. Altta yatan akciðer hastalýðý kanýtý bulunan veya 50 yaþýn üzerinde sigara içme öyküsü olan spontan pnömotorakslý hastalar sekonder spontan pnömotoraks olarak kabul edildi. Sigara içme durumu için Brinkman indeksi ve fiziksel performans durumu için Eastern Cooperative Oncology Group performans ölçeði kullanýldý. Konservatif tedavi, göðüs tüpü, video yardýmlý torakoskopik cerrahi ve torakotomi uygulanan tedavi yöntemleriydi.
BULGULAR: Ortalama yaþ 50.50±20.374, yaþ aralýðý 16-95 idi. Hastalarýn 93’ü (%69.9) sigara kullanmaktaydý. En sýk klinik bulgu 77 (%57.9) hastada dispne idi. En sýk altta yatan hastalýk 62 hastada (%46.6) kronik obstrüktif akciðer hastalýðý idi. Altý (%4.5) hastaya konservatif tedavi uygulandý, 89 (%66.9) hastaya göðüs tüpü takýldý ve 38 (%28.6) hastaya cerrahi tedavi uygulandý. Operatif giriþim olarak 24 (%18) hastaya akciðer kama rezeksi-yonu, 6 (%4.5) hastaya bül rezeksiyonu uygulandý. Hastalarýn 27’sine (%20.3) parietal plörektomi uygulandý. Aksiller mini-torakotomi veya torako-tomi, büyük pnömotorakslarda, sigara içenlerde ve obstrüktif akciðer hastalýðýnda daha sýk uygulandý. Tüp torakostomi, zayýf fiziksel performans, komorbiditeler ve enfeksiyöz hastalýklarda daha sýk kullanýldý. Hastalarýn 55’inde (%41.4) bir veya daha fazla komplikasyon görüldü. En sýk görülen komplikasyon 18 (%13.5) hastada inatçý hava kaçaðýydý. Komplikasyonlar, büyük pnömotoraks (p=0.003), zayýf fiziksel performans (p=0.009), en-feksiyöz hastalýklar (p=0.030) ve mesleki risk faktörleri (p=0.032) ile iliþkiliydi. Hastalarýn 12’sinde (%9) nüks geliþti. Ameliyat sonrasý 1 hastada nüks görüldü. Dört (%3) hasta hayatýný kaybetti. Fiziksel performansý kötü olan hastalarda (p=0.027), ek hastalýðý olanlarda (p=0.008) ve komplikasyon geliþen hastalarda (p=0.027) mortalite daha yüksekti. Hastanede kalýþ süresi mini aksiller torakotomi/torakotomi (p<0.001) ve VATS (p<0.001) gruplarýnda yüksekti. Hastanede kalýþ süresi açýsýndan mini aksiller torakotomi/torakotomi ile VATS arasýnda anlamlý bir fark yoktu.
TARTIÞMA: Büyük pnömotoraks, zayýf fiziksel performans ve komorbidite morbidite ve mortalite ile iliþkilidir. Küçük pnömotoraks için konservatif tedavi, büyük pnömotoraks için göðüs tüpü en uygun baþlangýç tedavisidir. VATS veya mini-aksiller torakotomi yolu ile büllöz bölgenin rezeksiyonu en uygun cerrahi tekniktir.

BACKGROUND: Pneumothorax in patients with underlying lung pathology is called secondary spontaneous pneumothorax (SSP). It is an important health problem worldwide, with significant morbidity, high health-care expenses, and possibility of mortality. This study aimed to evaluate the epidemiological characteristics, risk factors for mortality and morbidity, and treatment options of SSP.
METHODS: Outcomes of 133 patients with SSP were evaluated retrospectively. Patients with SP with evidence of underlying lung disease or a smoking history over 50 years of age were considered SSP. The patients were analyzed in terms of epidemiological fea-tures, underlying diseases, treatment methods, complications, and mortality. The treatment options included thoracotomy (T), video-assisted thoracoscopic surgery (VATS), tube thoracostomy, and conservative treatment.
RESULTS: The mean age was 50.50±20.374 years, and the age range was 16–95. Ninety-three (69.9%) of the patients were smokers. The most common clinical finding was dyspnea in 77 (57.9%) patients. The most common underlying disease was chronic obstructive pulmonary disease in 62 patients (46.6%). Six (4.5%) patients received conservative treatment, a chest tube was placed in 89 (66.9%) patients, and 38 (28.6%) patients were treated with surgery. As an operative procedure, lung wedge resection was performed in 24 (18.0%) patients and bulla resection was performed in 6 (4.5%) patients. Parietal pleurectomy was performed in 27 (20.3%) patients. Axillary mini-T or T was performed more frequently in large pneumothorax, smokers, and in obstructive pulmonary disease. Tube thoracostomy was used more frequently in poor physical performance, comorbidities, and infectious diseases. Complications were ob-served in 55 patients (41.4%). The most common complication was persistent air leakage in 18 (13.5%) patients. Complications were associated with large pneumothorax (P=0.003), poor physical performance (P=0.009), infectious diseases (P= 0.030), and occupational risk factors (P=0.032). Recurrence was developed in 12 (9.0%) patients. Postoperative recurrence was observed in 1 patient. Four (3%) patients died. Mortality was higher in patients with poor physical performance (P=0.027), comorbidities (P=0.008), and patients with complications (P=0.027). The length of stay in the hospital was high in mini-axillary T (AT)/T (P<0.001) and VATS (P<0.001). There was no significant relationship between the mini-AT/T and VATS in terms of length of hospital stay.
CONCLUSION: Large pneumothorax, poor physical performance, and comorbidity are associated with morbidity and mortality. Conservative treatment for small pneumothorax and chest tube for large pneumothorax is the most appropriate initial treatment. Resection of the bullous region through VATS or mini-AT/T is the most appropriate surgical technique.

AMAÇ: Ayak bileði burkulmasý acil servise sýk baþvuru nedenidir. Mevcut tedavi modaliteleri arasýnda Koruma, Optimal Yükleme, Buz uygulama, Kompresyon ve Elevasyon (POLICE) ve Koruma, Dinlenme, Buz uygulama, Kompresyon ve Elevasyon (PRICE) yer alýr. Bu çalýþma PRICE ve POLICE tedavi protokollerinin etkilerini karþýlaþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu randomize kontrollü çalýþma, 15 Ekim 2020 ile 15 Ekim 2021 tarihleri arasýnda Ankara Üniversitesi Acil Týp Anabilim Dalý’nda gerçekleþtirildi. Hastalarý POLICE veya PRICE tedavi gruplarýna atamak için çift kör randomizasyon kullanýldý.
BULGULAR: Toplam 109 hasta alýndý. POLICE grubunda, baþvuru anýndaki ve yaralanmayý takip eden 14. gündeki Amerikan Ortopedik Ayak ve Ayak Bileði Skorlarý (AOFAS) arasýndaki medyan fark 34.5 (IQR: 27.25–41.75), PRICE grubununki ise 24 (IQR: IQR: 15.5–35). POLICE grubunda baþvuru anýndaki ve yaralanmayý takip eden 14. gündeki Ayak ve Ayak Bileði Özürlülük Ýndeksi (FADI) skorlarýndaki farkýn ortanca deðeri 42 (IQR: 35.25–50), PRICE grubununki ise 31 olarak saptandý (IQR: 22–41.5).
SONUÇ: POLICE tedavi protokolü, PRICE tedavi protokolüne göre daha etkili ve hýzlý iyileþme saðladý.

BACKGROUND: Ankle sprain is a frequent reason for presentation to the emergency department. Current treatment modalities include Protection, Optimal Loading, Ice, Compression, and Elevation (POLICE) and Protection, Rest, Ice, Compression, and Elevation (PRICE). This study aimed to compare the effects of PRICE and POLICE treatment protocols.
METHODS: This randomized controlled study was conducted between October 15, 2020, and October 15, 2021, at Ankara University’s Department of Emergency Medicine. Double-blind randomization was used to assign patients to either the POLICE or PRICE treatment groups.
RESULTS: In total, 109 patients were included. In the POLICE group, the median difference between the American Orthopedic Foot and Ankle Scores on admission and the 14th day following the injury was 34.5 (IQR: 27.25–41.75), while that of the PRICE group was 24 (IQR: 15.5–35). In the POLICE group, the median value of the difference in the Foot and Ankle Disability Index scores on admission and the 14th day following the injury was 42 (IQR: 35.25–50), while that of the PRICE group was 31 (IQR: 22–41.5).
CONCLUSION: The POLICE treatment protocol provided more effective and faster recovery than the PRICE treatment protocol.

AMAÇ: Tespit edebildiðimiz kadarý ile literatürde lidokain ve etofenamatýn sprey formlarýnýn kot kýrýðýndaki analjezik etkinliðine dair bir araþtýrmaya rastlamadýk. Bu çalýþmada amacýmýz, ampirik olarak travmaya sekonder izole kot kýrýðýna baðlý aðrý yönetiminde etofenamat sprey, lidokain %10 sprey ve plasebo spreyin analjezik etkinliklerini karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Araþtýrma tek merkezli, prospektif, randomize, plasebo kontrollü çift kör araþtýrma modeline göre tasarlandý. Her 3 grup için 30’ar kapalý zarf hazýrlanmýþ ve her gruba 30 hasta alýndý. Çalýþmaya alýndýktan sonra çalýþmadan çýkarýlan vakalar sonrasýnda toplam 84 olgu çalýþmaya alýndý [üç grup: 27, 28, 29].
BULGULAR: Üç grup arasýnda baþvurudaki ve 15-30-60-120. dakikalardaki NRS dereceleri benzer bulundu [p>0.05]. Baþlangýçtaki NRS düzeyi ile 15-30-60-120. dakikalardaki NRS düzeyleri farklarý analiz edildiðinde 0-120. dakika NRS farký lidokain sprey grubunda daha fazla olmakla beraber bu dört parametrenin hiçbiri için 3 grup arasýnda istatistiksel olarak anlamlý bir farklýlýk saptanmadý.
SONUÇ: Kot kýrýðýnýn aðrý yönetiminde standart uygulanan deksketoprofen 50 mg intravenöz tedavi ile birlikte kullanýlan lidokain %10 sprey, eto-fenamat sprey ve plasebo spreyin analjezik etkinlikleri birbirlerine benzer çýktý ve 120. dakikada bir fark oluþsa da bu fark istatistiksel olarak anlamlý bulunmadý.

BACKGROUND: As far as we could detect, we could not find any study in literature on the analgesic efficacy of spray forms of lidocaine and etofenamate in rib fractures. In this study, our aim is to empirically compare the analgesic efficacy of etofenamate spray, lidocaine 10% spray and placebo spray in the management of pain secondary to trauma secondary to isolated rib fractures.
METHODS: The study was designed according to a single-center, prospective, randomized, placebo-controlled double-blind study model. About 30 sealed envelopes were prepared for each of the 3 groups and 30 patients were included in each group. A total of 84 cases were included in the study (three groups: 27, 28, 29).
RESULTS: Numeric rating scale (NRS) grades at admission and at 15-30-60-120 min were similar between the three groups (P>0.05). Analysis findings of NRS perception differences between the initial NRS level and the 15-30-60-120th min NRS difference at the 0–120th min showed more lidocaine spray organs, and it was not clearly perceived that these four parameters went between the 3 groups for the outline.
CONCLUSION: The analgesic efficacy of lidocaine 10% spray, etofenamate spray, and placebo spray used together with standard dexketoprofen 50 mg intravenous treatment in the pain management of rib fractures were similar to each other and although there was a difference at the 120th min, this difference was not statistically significant.

AMAÇ: Akut Aþil tendon rüptürlerinin (AATR) tedavisinde cerrahi tedavi, daha az re- rüptür oranlarý, daha iyi fonksiyonel sonuçlar ve fiziksel ak-tivitelere erken dönüþ gibi avantajlarý nedeniyle yaygýn olarak tercih edilen tedavi yöntemidir. Çalýþmamýzýn temel amacý, yaygýn olarak kullanýlan iki minimal invaziv cerrahi yöntem olan, sýnýrlý açýk ve perkütan yaklaþýmlarý klinik sonuçlar açýsýndan karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: 1. seviye travma merkezine Mart 2019 ile Mayýs 2020 arasýnda AATR nedeni ile baþvuran, sýnýrlý açýk (Grup 1: 30 hasta) ve perkütan (Grup 2: 23 hasta) yaklaþýmlarla tedavi edilen toplam 53 hasta (19 kadýn ve 34 erkek) geriye dönük olarak deðerlendirildi. Hastalarýn komplikasyonlarý (yumuþak doku/cilt sorunlarý, re-rüptür ve sural sinir yaralanma oranlarý), ameliyat süreleri, günlük aktivitelere dönüþ süreleri, Aþil Tendon Toplam Rüptür Skoru (ATRS) ve Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (AOFAS) birinci ve altýncý aylarýndaki skorlarý deðerlen-dirildi. Hastalarýn aktivite düzeyleri Tegner Aktivite Skalasý (TAS) kullanýlarak karþýlaþtýrýldý.
BULGULAR: Çalýþma grubunda yer alan hastalarýn yaþ ortalamasý 45.1±14.1 idi. Ameliyat sonrasý ortalama takip süresi grup 1’de 36.9±8.81 hafta iken grup 2’de 35.4±8.73 hafta olarak bulundu (p=0.24). Ortalama yaþ (p=0.47), cinsiyet daðýlýmý (p=0.41) ve vücut kitle indeksi (p=0.29) her iki grup için benzerdi. Ortalama ameliyat süreleri (grup 1: 47.1±5.4 ve grup 2: 44.4±6.1, p=0.06) ve günlük aktivitelere dönüþ süreleri (grup 1: 49.2±7.4 ve grup 2: 48.5±9.7, p=0.38) de her iki grup için benzerdi. Fonksiyonel sonuçlar açýsýndan gruplar arasýnda birinci ay sonuçlarýnda (ATRS: grup 1: 79.9±3.2 ve grup 2: 79.5±3.9, [p=0.35] ve AOFAS: grup 1: 80.9±3.1 ve grup 2: 82.1±3.2, [p=0.10]) ve altýncý ay sonuçlarýnda (ATRS: grup 1: 85.0±3.8 ve grup 2: 83.7±4.4, [p=0.13] ve AOFAS: grup 1: 86.6±3.6 vs grup 2: 86.7±4.2, [p=0.46]) istatiksel olarak anlamlý bir fark saptanmadý. Preoperatif ve son kontrol TAS skorlarýna göre gruplar arasýnda istatistiksel olarak anlamlý bir fark saptanmadý (sýrasýyla, p=0.94, p=0.46). Grup 1’de postoperatif komplikasyon gözlemlenmezken, Grup 2’de üç hastada komplikasyon (%13.1) izlendi. Bir hastada (%4.4) tekrar rüptür, iki hastada ise (%8.7) sural sinir yaralanmasýna rastlandý.
SONUÇ: Çalýþmamýzda yer alan her iki grupta da benzer fonksiyonel sonuçlar olmasýna raðmen, sýnýrlý açýk yaklaþým perkütan yaklaþýma göre komplikasyon sonuçlarý açýsýndan daha iyi klinik sonuçlar göstermiþtir.

BACKGROUND: Surgical treatment is the commonly preferred method for treating acute Achilles tendon ruptures (AATRs) due to advantages such as less re-rupture rates, better functional results, and an early return to physical activities. The main aim of our study is to compare two common minimally invasive surgical methods, the limited open and the percutaneous approaches, regarding clinical outcomes.
METHODS: A total of 53 patients (19 females and 34 males) who were treated with limited open (Group 1: 30 patients) and percutaneous (Group 2: 23 patients) approaches for AATRs were retrospectively evaluated between March 2019 and May 2020 in a level 1 trauma center. The evaluation included complications (soft tissue and skin problems, re-rupture, and sural nerve injury rates), the operation time, the duration of return to daily activities, The Achilles Tendon Total Rupture Score (ATRS), and the American Ortho-pedic Foot and Ankle Society (AOFAS) scores of the patients at the first and 6th months of follow-up. Patients’ activity levels were compared with the Tegner Activity Scale (TAS).
RESULTS: The mean age of all patients in this cohort was 45.1±14.1. The mean postoperative follow-up period for group 1 was 36.9±8.81 weeks, whereas, for group 2, it was 35.4±8.73 weeks (P=0.24). The mean age (P=0.47), gender distribution (P=0.41), and body mass index (P=0.29) were similar for both groups. The mean operation time (group 1: 47.1±5.4 vs. group 2: 44.4±6.1, P=0.06) and the duration of return to daily activities (group 1: 49.2±7.4 vs. group 2: 48.5±9.7, P=0.38) were also similar. There was no statistical difference between groups regarding functional results at first (ATRS: group 1: 79.9±3.2 vs. group 2: 79.5±3.9, [P=0.35], and AOFAS: group 1: 80.9±3.1 vs. group 2: 82.1±3.2, [P=0.10]) and 6th months (ATRS: group 1: 85.0±3.8 vs. group 2: 83.7±4.4, [P=0.13], and AO-FAS: group 1: 86.6±3.6 vs. group 2: 86.7±4.2, [P=0.46]). There were no statistically significant differences between groups regarding preoperative and last follow-up TAS scores (P= 0.94 and P=0.46, respectively). We observed no postoperative complications in group 1. There were three complications (13.1%) in group 2. One patient (4.4%) had a re-rupture, and two patients (8.7%) had sural nerve injuries.
CONCLUSION: Although both groups had similar functional results, the limited open approach yielded better clinical outcomes according to the complication results than the percutaneous approach.

Greft ve cerrahiye baðlý komplikasyonlar böbrek nakli cerrahisinde hala sorun teþkil etmektedir. Ameliyata baðlý vasküler komplikasyonlar ciddi olabilir ve hem greft hem de alýcýnýn yaþamýný tehdit edebilir. Perioperatif ve postoperatif taný konulan vasküler komplikasyonlar için literatürde çeþitli tedavi yaklaþýmlarý tanýmlanmýþtýr. Ancak, hangi yaklaþýmýn hangi dönemde ve hangi koþullarda uygulanacaðý konusunda uzun vadeli sonuçlar veren çalýþmalar sýnýrlýdýr. Bu olgu sunumunda, renal transplantasyona baðlý eksternal iliak arter diseksiyonunun internal iliak arter transpozisyonu ile onarýlmasý ve 6 yýllýk hasta takip deneyimimizi paylaþtýk.

Graft and surgery-related complications still pose a problem in kidney transplant surgery. Vascular complications due to surgery can be severe, threatening both graft and recipient life. Various treatment approaches have been described in the literature for vascular complications diagnosed peri-operatively and post-operatively. However, studies that provide long-term results on which approach will be applied in which period and in which conditions are limited. In this case report, we share our 6-year patient follow-up experience and repair of external iliac artery dissection related to renal transplantation with internal iliac artery transposition.