Hava yolu ile hasta/yaralý taþýnmasý savaþ-barýþ döneminde ve tabiat olaylarý (deprem, sel baskýnlarý v.b.) sonrasý ayný temel hedefi olan bir görevdir. Günümüzde hava yolu ile taþýma sistemleri acil hasta bakýmýnýn bir parçasý olmuþtur. Bu sistemler hasta/yaralýlarýn hastaneler arasýnda güvenli olarak taþýnmasýný saðlamaktadýr. Hava yolu ile taþýmanýn ana öðelerini anlamak, taþýma sýrasýnda yüksek irtifanýn yaratmýþ olduðu fizyolojik deðiþikliklerin hasta üzerindeki etkilerini kavramak, hasta/yaralý taþýmasýnýn daha güvenli ve uygun olmasýný saðlayacaktýr.

The mission of aeromedical evacuation of patients, whether in peacetime, wartime or under unexpected conditions (earthquake, flood etc) will remain the same. Aeromedical evacuation systems have become an integral part of the practice of critical care medicine. These systems provide interhospital transport of critically ill or severely injured patients. Understanding the medical aspects of flights and the capabilities of the aeromedical environment will help to evacuate patients in a safe and a proper manner.

AMAÇ
Maksillofasiyal çarpma yaralanmalarý sonucunda genellikle komþu doku ve organlar da dolaylý olarak yaralanýrlar. Ancak, diþ pulpasýnýn dolaylý yaralanmasý konusunda fazla çalýþma yoktur. Çalýþmamýzda köpeklerin mandibulalarýnda çarpma sonucu diþ pulpasýnda dolaylý olarak geliþen yaralanmanýn özelliklerini belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM
On sekiz köpek rastlantýsal olarak altý eþit gruba ayýrýldý. Her köpeðin sað mandibulasýna çarpma travmasý uygulandý. Ancak, diþler doðrudan yaralanmadý. Hayvanlar belirli zamanlarda öldürüldü ve her bir köpeðin diþ pulpasýndaki ultrastrüktürel deðiþiklikler transmisyon elektron mikroskobu kullaný larak incelendi.
BULGULAR
Sað mandibuladaki dördüncü premolar diþin pulpasý aðýr bir þekilde yaralanmýþtý, fakat sonuçta geri dönüþümsüz bir nekroz oluþmadý. Sað mandibuladaki ikinci premolar diþin pulpasý ndaki yaralanma daha az aðýrdý ve geri dönüþümlüydü. Sol mandibuladaki ikinci premolar diþin pulpasý ise hafif ve geçici bir þekilde yaralandý.
SONUÇ
Çarpma þeklindeki maksillofasiyal yaralanmalar diþ pulpasýnýn dolaylý olarak yaralanmasý açýsýndan incelendiðinde, oldukça geniþ bir alanýn yaralandýðý görülür. Travmanýn etkisi çarpma sahasýndan uzaklaþýldýkça giderek ve hýzla azalýr. Sinir hasarýna ait ultrastrüktürel deðiþiklikler erken dönemde oluþur.

BACKGROUND
Indirect injuries of adjacent tissues and organs usually accompany maxillofacial impact injuries. However, studies on indirect dental pulp injury are rare. This study was designed to determine the characteristics of indirect dental pulp injury caused by impact injury of mandible in dogs.
METHODS
Eighteen dogs were divided equally into six groups with random allocation. Right mandible of each dog was impacted but teeth were not injured directly. Then, the animals were killed at appointed time points and ultrastructural changes in dental pulp of assigned teeth of each dog were investigated with transmission electron microscope.
RESULTS
Dental pulp of the fourth premolar of right mandible was injured very severely, but irreversible necrosis did not occur in the end. Dental pulp of the second premolar of right mandible was injured less severely and reversibly. Dental pulp of the second premolar of left mandible was injured mildly and temporarily.
CONCLUSION
In the indirect injury of dental pulp caused by maxillofacial impact injury, the injured area is relatively extensive. The effect of the trauma decreases progressively and sharply as the distance to the impact site increases. Ultrastructural changes in the damaged nerves take place early.

AMAÇ: Postoperatif dönemde total enteral beslenmenin erken uygulanmasý ve beslenme protokolüne glütamin eklenmesinin deneysel kolon anastomoz iyileþmesine etkisini araþtýrmak.
GEREÇ-YÖNTEM: 40 Wistar-albino rat eþit sayýda denek içeren 4 gruba ayrýldý. Tüm deneklere distal sol kolon transseksiyonu ve anastomozu uygulandý. Grup 1 ve 2; geç total enteral beslenme (postoperatif 4. günden itibaren) uygulandý. Grup 3 ve 4; erken total enteral beslenme (postoperatif 6. saatten itibaren) uygulandý. Grup 2 (geç) ve 4 (erken)’te enteral beslenme protokolüne glütamin eklendi. Postoperatif 7. gün sonunda anastomoz içeren kolon segmenti çýkarýlarak anastomoz patlama basýncý ve doku hidroksiprolin deðerleri belirlendi.
BULGULAR: Anastomoz patlama basýncý deðerleri erken grupta 111.6, geç grupta 95.8 cm/su (p=0.022) bulundu. Geç enteral beslenme gruplarý (1 ve 2) karþýlaþtýrýldýðýnda glütaminli grup lehine anlamlý fark (95.8’ e 138.5 cm/su; p<0.0001) saptandý. Gerek erken, gerekse geç dönemde glütaminli enteral beslenmenin uygulandýðý gruplarda en yüksek patlama basýncý deðerleri (139 ve 138.5 cm/su) elde edildi.
Doku hidroksiprolin miktarý erken beslenme grubunda (2440.3 µg), geç beslenme grubuna (1509.6 µg)
göre anlamlý yüksek (p=0.024) bulundu. Diðer gruplar arasý farklar istatistik açýsýndan anlamsýzdý. Geç enteral beslenme gruplarý (1 ve 2) karþýlaþtýrýldýðýnda glütaminli grup lehine anlamlý olmamakla (p=0.276) birlikte sayýsal fark (1509.6 ya 1981.6 µg) saptandý.
SONUÇLAR: Postoperatif dönemde total enteral beslenmenin erken uygulanmasý anastomoz direnci ve kollajen sentezini anlamlý olarak desteklemektedir. Anastomoz direnci açýsýndan enteral yolun geç kullanýldýðý durumda beslenme protokolüne glütamin eklenmesi, geç beslenme olumsuzluklarýný azaltmakta ve geri döndürmektedir. Glütaminin benzer olumlu etkisi daha zayýf olmakla birlikte kollajen sentezi üzerinde de görülmektedir.
Anahtar Kelimeler: Kolon anastomozu, enteral beslenme, glütamin, patlama basýncý, hidroksiprolin.

BACKGROUND: To investigate the effects of postoperative early enteral, and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis.
METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at distal left colon was performed on all animals. Groups 1 and 2; Animals received late (after 4th day postoperatively) enteral feeding. Groups 3 and 4; Animals received early (after 6th hours postoperatively) enteral feeding. Glutamine was added in enteral nutrition protocol in groups 2 (late) and 4 (early). The colonic segment including the anastomosis was excised at the end of 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined.
RESULTS: Bursting pressures levels were measured as 111.6 and 95.8 cm/water (p=0.022) in early and late nutrition groups respectively. Comparison of late enteral feeding groups (1 and 2) showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cm/water; p<0.0001). Highest bursting pressure levels (139 and 138.5 cm/water) were measured in both early and late feeding groups with glutamine.
Tissue hydroxyproline level in early enteral feeding group (2440.3 µg) was significantly (p=0.024) higher than late enteral feeding group (1509.6 µg). The differences were not statistically significant between other groups. Comparison of late enteral feeding groups (1 and 2) showed a considerable difference in favor of group with glutamine (1509.6 vs 1981.6 µg) but not statistically significant (p=0.276).
CONCLUSION: Postoperative early enteral feeding significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses disadvantages of late enteral feeding in point of the resistance of anastomosis. Similar positive and useful, but weaker effects of glutamine supplementation are also valuables on collagen synthesis

AMAÇ
Bu çalýþmada, beyin cerrahisi yoðun bakým servisimizde tedavi gören hastalarýn bazýlarýnda aniden geliþen nörojenik pulmoner ödem tablosunun nedenleri ve klinik seyri deðerlendirildi.
GEREÇ VE YÖNTEM
Beyin cerrahisi yoðun bakým servisinde çeþitli nedenlerle tedavi gören 223 hasta (116 erkek; 107 kadýn; ort. yaþ 44.4±19.5) incelendi. Bu hastalardan 5 tanesinde nörojenik pulmoner ödem meydana geldiði belirlendi. Pnömoniye baðlý olarak benzer klinik bulgular görülen hastalar çalýþmaya dahil edilmedi. BULGULAR Hastalýðýn, nörolojik durumun ani kötüleþmesi ve beraberinde kan oksijenlenme düzeyinde bozulma þeklinde ortaya çýktýðý saptandý. Nörojenik pulmoner ödem tanýsý koyulan 5 hastadan 3'ünde akut hidrosefalinin, 1 hastada ise beyin anevrizmasýnýn yeniden kanamasýnýn bu duruma neden olduðu düþünüldü; 5. hastada sebep bulunamadý. Dört hasta 24 saat içerisinde düzelme göstererek yoðun bakým servisinden çýkarýldý.
SONUÇ
Nörolojik bir sorun nedeniyle tedavi görmekte olan bazý hastalarda, saatler içerisinde nörojenik pulmoner ödemin oluþabileceði ve nörolojik sorunun düzelmesiyle tablonun gerileyebileceði akýlda bulundurulmalýdýr.

BACKGROUND
In this study, we evaluated the cause and the clinical course of neurogenic pulmonary edema which has developed abruptly in some of the patients in the neurosurgical intensive care unit.
METHODS
We evaluated 223 patients in the neurosurgical ICU (116 males; 107 females; mean age 44.4±19.5). Five of these had worsening in neurological evaluation and oxygenation and were diagnosed as having a neurogenic pulmonary edema. Patients with pneumonia were excluded from the study.
RESULTS
We identified acute hydrocephaly in three patients and re-bleeding of an aneurysm in one as the cause of neurogenic pulmonary edema. No cause could be identified in the remaining patient. Although four patients could be discharged from the ICU, one died due to multiorgan failure.
CONCLUSION
Physicians should be careful about neurogenic pulmonary edema, a life-threatening clinical condition, that develops within hours of a neurologic event and usually resolves with neurologic recovery.

AMAÇ
Bu çalýþmada akut nekrotizan pankreatit nedeniyle cerrahi ve konservatif tedavi uygulanan hastalar deðerlendirildi. GEREÇ VE YÖNTEM Akut nekrotizan pankreatitli 38 hasta (22 erkek, 16 kadýn; ort. yaþ 51.3; daðýlým 16-79) uygulanan tedavi yöntemlerinin sonuçlarý açýsýndan retrospektif olarak incelendi. Konservatif tedavi uygulanan grupta 15, ameliyat edilen grupta ise 23 hasta vardý.
BULGULAR
En sýk (17 hasta) nekrotizan pankreatit nedeni safra taþý idi. Yirmi beþ hastada steril nekroz ve 13 hastada enfekte nekroz olduðu belirlendi. Yirmi beþ steril nekrozlu pankreatit hastasý- nýn 15'ine sadece konservatif tedavi, 10'una ise önce konservatif ve takiben cerrahi tedavi (altýsý þüpheli taný, üçü organ yetersizliði, bir hasta da semptomatik psödokist nedeniyle) uygulandý. Steril nekroz oluþan hastalarda ameliyatta nekrozlu bölge çýkarýldý ve sonra altýsýnda sürekli lavaj, dördünde pasif drenaj yöntemleri uygulandý. Hastalarýmýzda mortalite oraný, her iki grubun toplamýnda %23.7, steril nekrozlu pankreatit grubunda %24.0, enfekte nekrozlu pankreatit grubunda ise %23.1'dir. Mortalite oraný, konservatif tedavi uygulanan hasta grubunda %26.7, ameliyat edilenlerde %21.7 olarak saptandý. Mortalite oraný yönünden gruplar arasýnda istatistiksel olarak anlamlý bir fark bulunmadý (p>0.05). Yaþayan 29 hastanýn 11'inde (%38.0) çeþitli komplikasyonlar görüldü.
SONUÇ
Steril nekrozlu pankreatitin tedavisi tartýþmalýdýr. Öncelikle konservatif tedavi uygulanmalýdýr. Steril nekrozlu pankreatitte ameliyat endikasyonu, yoðun konservatif tedaviye raðmen sepsis veya organ yetmezliði bulgularýnýn devam etmesi ya da þiddetlenmesi durumunda ortaya çýkar. Enfekte nekrozlu pankreatit ise cerrahi yöntemle tedavi edilmelidir. Ameliyat, nekrozun demarkasyon hattý tamamlandýktan sonra gerçekleþtirilmelidir.

BACKGROUND
We evaluated the patients who underwent surgical or nonoperative treatment for acute necrotizing pancreatitis.
METHODS
The study included 38 patients (22 males, 16 females; mean age 51.3 years; range 16 to 79 years) with acute necrotizing pancreatitis. Surgical treatment was performed in 23 patients, while 15 patients were treated conservatively.
RESULTS
Gallstone (in 17 patients) was the most common cause of pancreatitis. Twenty-five patients had sterile necrotizing pancreatitis, while 13 patients had infected necrotizing pancreatitis. Fifteen of the 25 cases with sterile necrosis were treated conservatively. The other 10 patients were initially treated by conservative methods, and were later treated surgically (due to six incorrect diagnosis, three organ failures, and one symptomatic pseudocyst). We applied continuous lavage to six of those patients and conventional drainage to four of them. Mortality rate was 23.7% globally; 24.0% in the sterile necrosis group and 23.1% in the infected necrosis group. Mortality rate was 21.7% in the surgical treatment group, and 26.7% in the conservative treatment group. There were no statistically significant differences between those groups (p>0.05). Eleven of the 29 patients who survived had some complications.
CONCLUSION
The management of sterile pancreatic necrosis is still a matter of debate. Most patients with sterile necrosis can be treated with conservative methods. Indication for surgery in sterile necrosis should be based on persisting or advancing organ complications and sepsis signs despite intensive care therapy. The patients with infected necrosis should be treated surgically. Surgical intervention is best deferred until the demarcation of necrosis is complete.

AMAÇ
Künt karaciðer travmasý nedeniyle ameliyat edilen hastalar, cerrahi yöntem, mortalite ve morbidite açýsýndan deðerlendirildi.
GEREÇ VE YÖNTEM
Künt karaciðer travmasý nedeniyle ameliyat edilen 159 hasta (116 erkek; 43 kadýn; ort. yaþ 33.6; daðýlým 15-67) travma etkeni, karaciðer yaralanma þiddeti, taný yöntemleri, yandaþ yaralanmalar, tedavi þekli, mortalite ve morbidite yönünden retrospektif olarak incelendi. Küçük karaciðer yaralanmalarýnda (evre I ve II) minör tedavi teknikleri uygulandý. Büyük karaciðer yaralanmasý (evre III, IV, V) olan 40 hastaya debridman, selektif ligasyon, omental tamponad (DSO), 12 hastaya rezeksiyonel debridman ve Pringle manevrasý ile birlikte karaciðer içinde kanayan damarlarýn direkt kontrolü (RD), 23 hastaya derin matress sütür (DMS) ve 9 hastaya perihepatik packing (PP) uygulandý.
BULGULAR
Travma oluþturan etkenler 102 hastada trafik kazasý, 43 hastada yüksekten düþme ve 14 hastada darp idi. Yüzelli dokuz hastaný n 84'ünde büyük ve 75'inde küçük karaciðer yaralanmasý mevcuttu. Yandaþ organlarda yaralanma 104 hastada vardý ve en sýk dalak yaralanmasý saptandý. Ortalama kan transfüzyonu miktarý DSO'da 4.3 ünite, DMD'de 6.2 ünite, RD'de 5.5 ünite ve PP'de 9.5 ünite idi. Karaciðer onarýmý için geçen ortalama cerrahi süre, DSO, RD, DMS ve PP için 34.7, 38.1, 26 ve 18.2 dk idi. Karaciðer yaralanmasýna baðlý komplikasyonlar sonucu DMD grubundaki morbidite oranýnýn, DSO ve RD gruplarý na göre daha yüksek olduðu belirlendi ve sonuç istatistiksel anlamlýydý (p<0.001). Büyük karaciðer yaralanmalý hastalarý n %29.4'ü, küçük karaciðer yaralanmalý hastalarýn %12'si kaybedildi. Mortalite oraný %21.3'tü.
SONUÇ
Künt karaciðer travmasýnda uygulanan DSO ve RD yöntemleri, kan transfüzyonu miktarýný ve ameliyat süresini artýrmamýþtýr ve DMD yöntemi ile tedavi edilen gruba göre düþük mortalite ve morbidite oranýna sahiptir.

BACKGROUND
We evaluated the surgical methods, morbidity and mortality in patients who had surgery for blunt liver trauma.
METHODS
We retrospectively reviewed 159 patients (116 males, 43 females; mean age 33.6; range 15 to 67 years) with blunt hepatic trauma regarding the cause and severity of liver injury, diagnostic procedures, associated injuries, management, morbidity, and mortality. Simple hepatorrhaphy was done in minor liver injuries (Grade I, II). To manage severe liver trauma (Grade III-V), debridement, selective hepatic artery ligation and omentum packing of the laceration (DSO) in 40; resectional debridement (RD) with direct control of bleeding vessels within the liver by the Pringle maneuver in 12; deep matress suture (DMS) in 23; and perihepatic packing (PP) in 9 patients were performed.
RESULTS
The causes of trauma were motor vehicle accidents in 102, falls from height in 43 and violence induced blunt trauma in 14 patients. Among 159 patients, 84 had severe liver injuries and 75 had minor liver injuries. Associated organ injuries were present in 104 patients and splenic injury was the most common. Mean units of blood transfusions in DSO, DMS, RD and PP were 4.3, 6.2, 5.5 and 9.5 respectively. Mean time for liver surgery in DSO, RD, DMS and PP were 34.7, 38.1, 26 and 18.2 minutes respectively. Morbidity rate was higher in DMS group than in DSO and RD groups, and the difference was statistically significant (p<0.001). Twenty-five patients (29.4%) died of severe liver injuries and 9 (12%) died of minor liver injuries. The overall mortality rate was 21.3%.
CONCLUSION
DSO, and RD methods don’t increase operation time and amount of blood transfusion. They cause less morbidity and mortality when compared to DMS.

AMAÇ
Batýn yaralanmalarýnda cerrahi dýþý yaklaþýmlar; mortalite riskini artýrmadan, hastalarýn cerrahi giriþim uygulanmadan tedavisini amaçlar. Bu çalýþmada invaziv olmayan tedavi stratejisiyle tedavi edilen hastalar sunuldu.
GEREÇ VE YÖNTEM
Bu çalýþmada 1 Haziran 2000 ile 1 Haziran 2001 (invaziv olmayan tedavi yaklaþýmý uygulamasýnýn ilk yýlý) tarihleri arasýnda baþvuru anýnda hemodinamik olarak anstabil olan 63 batýn travmalý hasta (50 erkek; 13 kadýn; daðýlým 8-61 yaþ) deðerlendirildi. Olgular erken cerrahi, geç cerrahive konservatif yaklaþýmla tedavi edilenler olmak üzere üç grupta incelendi.
BULGULAR
Baþvuru anýnda instabil 63 künt batýn travmalý hasta saptandý. Grup 1 (n=14) ve Grup 2'deki (n=10) hastalar erken veya geç [ortalama 7 saat (2 ile 20 saat) gözlem süresi sonrasý] ameliyata alýndý. Grup 3 (n=39) hastalarýna cerrahi giriþim gerekmedi.
SONUÇ
Travma hastalarýnýn çoðu baþvuru anýnda instabil olsalar da baþlangýç sývý replasmanýna cevap verirler ve cerrahi tedavi gerektirmezler. Bu hastalarda solid organ yaralanmalarýný, bilinci açýk hastalarda ise içi boþ organ yaralanmalarýný gösteren en önemli teknik olmasada yakýn monitörizasyon ve tekrarlayan batýn muayeneler içeren invaziv olmayan tedavi stratejisi cerrahi giriþim gerekecek hastalarýn seçiminde uygun bir yöntem olabilir.

BACKGROUND
Non-operative management in abdominal injuries may reduce non-therapeutic laparatomies without increasing mortality. The aim of this study is to evaluate the results of a recently used non-invasive management strategy, in trauma patients in our institution.
METHODS
A retrospective chart review was performed. The sixty-three patients (50 males; 13 females; range 8 to 61 years) with abdominal injuries who were unstable during their admissions to our institution between July 1st, 2000 and July 1st, 2001 (the first year of the NIMS implementation) were identified and divided into three groups according to the presence or absence of surgical intervention and the timing of the operation.
RESULTS
There were 63 blunt abdominal trauma patients who were unstable during admission. Patients in Group 1 (n=14) and Group 2 (n=10) had urgent laparotomy during the resuscitation therapy or after a median observation period of 7 hours (range, 2 to 20). Group 3 patients (n=39) did not require surgical intervention.
CONCLUSION
Most of the trauma patients who respond to initial fluid replacement do not require surgery. Close monitoring and repeated abdominal examinations (NIMS) can be the main criteria for surgical intervention, although they are not the most reliable techniques in the diagnosis of solid organ injuries in all patients and of hollow organ injuries in conscious patients.

AMAÇ
Akut apandisiti olan çocularýn düz karýn radyografisi (DKG) bulgularýnýn derlenmesi ve bu bulgularýn her birinin tanýsal deðerini ortaya koyarak; konuyla ilgili yayýnlamýþ çalýþmalar ýþýðýnda yorumlanmasý amaçlandý.
GEREÇ VE YÖNTEM
Apandisit öntanýsý ile ameliyat edilen 424 çocuðu içeren grup (278 erkek; 146 kýz; ortanca yaþ 10; daðýlým 11 ay - 17 yýl) önceden belirlenmiþ sekiz DKG bulgusu ile deðerlendirmeye alýndý. Her bir bulgu için duyarlýlýk, seçicilik, pozitif ve negatif sonucu belirleme deðerleri ayrý ayrý hesaplandý.
BULGULAR
Ameliyat bulgularý ve patolojik deðerlendirme ile hastalarýn 378'inde (%89) apandisit mevcuttu, 46 (%11) hastada ise appendiks normaldi. Bunlarýn 20'sinde (%5) baþka karýn içi patolojik bulgu saptandý. DKG bulgularý içinde, kalsifiye fekalit, sað alt kadranda kitle görünümü, psoas silinmesi ve lokalize lümen dýþý hava bulgularýnýn seçiciliði çok yüksekti; appendiks normalse bu bulgularýn görülme olasýlýðý çok zayýftýr. Deðerlendirilen DKG bulgularýnýn hepsinin duyarlýlýðý düþük bulunmakla beraber, apandisiti olan olgularda geniþlemiþ tranvers kolon ve/veya sað alt kadranda tek hava-sývý seviyesi bulgularýnýn görülme olasýlýðý diðerlerinden daha yüksektir.
SONUÇ
Ayýrýcý tanýda apandisit olasýlýðýný tamamen ortadan kaldýrabilecek tek bir DKG bulgusu olmamakla beraber, olasý DKG bulgularýna yönelik temel bilgilere sahip olmak, çocuklarda akut karýn aðrýsý ile ilgilenen hekimlerin karar mekanizmasýnda etkide bulunabilir.

BACKGROUND
This study was conducted to collect the results of the plain abdominal radiography (PAR) signs, to determine their individual diagnostic values, and to discuss them under a brief literature review.
METHODS
Eight predetermined PAR signs were individually interpreted in a series of 424 consecutive children (278 males; 146 females; median age 10 years; range 11 months to 17 years) who underwent an operation for appendicitis. The sensitivity, specificity, and positive and negative predictive values for the signs were determined.
RESULTS
Appendicitis was confirmed in 378 (89%) patients. Among the remaining 46 (11%) patients with a normal appendix, 20 (5%) had other intraabdominal pathologies. Calcified fecalith, mass image in right-lower-quadrant (RLQ), psoas obscuration, and localized extraluminal air signs were all highly specific and therefore, unlikely to be present if the appendix is normal. On the other hand, the sensitivity values were low, in general, for all the PAR signs investigated. Yet, presence of dilated transverse colon and/or single air þuid level in the RLQ has the highest percentage occurrence with appendicitis.
CONCLUSION
Although the there is no single PAR finding capable of ruling the diagnosis of appendicitis out, basic knowledge on PAR findings could have an impact on decision making process for clinicians dealing with pediatric acute abdominal pain.

AMAÇ
Bu çalýþmada, 112 Acil Saðlýk Hizmetleri'nde görevli doktorlarý n temel yaþam desteði (TYD), ileri kardiyak yaþam deste- ði (‹KYD) ve doktorlarýn adli sorumluluðu (DAS) hakkýndaki bilgi düzeyleri ve bunu etkileyen faktörler deðerlendirildi.
GEREÇ VE YÖNTEM
112 Acil Saðlýk Hizmetleri'nde görevli 53 doktor (43 erkek; 10 kadýn; ort. yaþ 39; daðýlým 28-50), demografik veriler ve bilgi düzeylerini etkileyebilecek verilerden oluþan anket formunu doldurup, TYD, ‹KYD ve DAS ile ilgili 25 adet çoktan seçmeli soruyu yüz yüze görüþme yöntemi ile yanýtladýlar. ‹statistiksel hesaplamalarda Mann-Whitney U-testi ve Kruskal-Wallis Varyans Analizi testleri kullanýldý.
BULGULAR
Bilgi düzeyi ortalamasý 100 puan üzerinden 45.4 olarak bulundu. Birden fazla kurs gören ve 112 Acil Saðlýk Hizmetleri'nde bir yýldan uzun süredir görevli doktorlarýn bilgi düzeyleri diðerlerine göre yüksek idi (p=0.012; p=0.015).
SONUÇ
112 Acil Saðlýk Hizmetleri'nin geliþmesi için bu sistemde çalýþan doktorlara yönelik hizmet içi eðitim programlarý geliþtirilmeli ve bilgi düzeyleri yükseltilmelidir.

BACKGROUND
We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors.
METHODS
Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test.
RESULTS
Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015).
CONCLUSION
In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care.

Ýntratorasik splenozis, torakoabdominal bir yaralanmadan sonra görülen asemptomatik bir hastalýktýr. Göðüs boþluðunda yer iþgal eden bir kitledir ve malign lezyonlar baþta olmak üzere diðer kitlelerden ayýrt edilmesi gerekir. Bu yazýda, 25 yýl önce geçirilmiþ penetran sol torakoabdominal travma öyküsü olan ve kliniðimize nonspesifik solunum sistemi þikayetleriyle baþvuran 50 yaþýndaki erkek hasta sunuldu. Akciðer grafisi ve toraksýn manyetik rezonans incelemeleri ile diyafragma hernisine baðlý göðüs boþluðunda kitle teþhisi koyulan hastada, ameliyat sýrasýnda intratorasik splenozis tespit edildi. Diyafram hasarý, dalak dokularý çýkarýldýktan sonra onarýldý.

Although intraperitoneal splenosis is a very common disease, intrathoracic splenosis is very rare. It is generally an asymptomatic disease that occurs after thoracoabdominal trauma, and is diagnosed as an intrathoracic mass that leads to unnecessary investigations to be differentiated from other benign or malignant lesions of the chest. We present a patient with an intrathoracic mass which was preoperatively diagnosed as a diaphragmatic hernia on chest X-ray and magnetic resonance imaging. We have intraoperatively recognized that many pieces of splenic tissue have been herniated through a diaphragmatic defect, and formed intrathoracic splenosis. We repaired the diaphragmatic hernia defect after excision of fragments of the spleen.

On yaþýndaki bir kýz çocuðunda hidatik kist rüptürüne baðlý travmatik hidropnömotoraks geliþti. Hastaya þüpheli bronþial rüptüre baðlý, uzun süreli masif hava kaçaðý nedeniyle sað posterolateral torakotomi yoluyla kistotomi yapýldý. Hastanýn ameliyat sonrasý 13. ayýnda dispne ve göðüs röntgeniyle belirlenen akciðer çöküntüsü Heimlich valfi kullanýlarak tedavi edildi. Akciðer kist hidatiði komplikasyon ortaya çýkmadýkça uzun süreli asemptomatik kalabilir. Ülkemizde hidatik hastalýðýn görülme sýklýðý yüksek olduðu için, bu durum hidropnömotoraks olan hastalarda göz önüne alýnmalýdýr. Heimlich valfi kullanýmý persistan hava kaçaðýnýn tedavisinde iyi bir seçenek olabilir ve cerrahiye olan ihtiyacý azaltabilir.

We present a case of traumatic hydropneumothorax due to hydatid cyst rupture in a 10 year-old girl. The patient was suspected to have a bronchial rupture because of prolonged massive air leak and she underwent cystotomy via right posterolateral thoracotomy. The patient was readmitted with dyspnea and chest X-ray revealed a lung collapse 13 months postoperatively. Lung collapse was treated by using a Heimlich valve.
Pulmonary hydatid cyst can be asymptomatic for a long time unless a complication occurs. Because of the high incidence of hydatid disease in our country, this condition should be considered in cases with hydropneumothorax. The use of a Heimlich valve may be a good choice in the management of persistent air leak and may reduce the need for surgery.

Rektus kasý kýlýfý hematomlarý, epigastrik damarlarýn veya rektus kasýnýn yýrtýlmasý sonucu meydana gelen ve nadir görülen durumlardýr. Genellikle infraumblikal bölgede oluþur ve kolaylýkla karýn içi enþamasyonlu hastalýklar ve tümörleri ile karýþtýrýlýrlar. Bu yazýda þiddetli karýn aðrýsý, bulantý, kusma þikayetleriyle kliniðimize baþvuran 70 yaþýndaki kadýn hasta sunuldu. Ultrasonografi ve karýnýn bilgisayarlý tomografisinde rektus kýlý- fý hematomu saptandý. Hasta yatak istirahati, kan transfüzyonu, sývý ve analjezik ilaç tedavisi ile sorunsuz iyileþti. Kesin taný için bilgisayarlý tomografi yöntemi seçilmelidir. Ýdeal tedavi konservatiftir.

Rectus sheath hematomas are uncommon and are being caused by the injuries of the epigastric vessels and the rectus muscle. They are usually located infraumblically and often misdiagnosed as inþammatory diseases or tumours of the abdomen. We present a 70-year-old woman who had complaints of severe abdominal pain on the left side, nausea and vomiting after heavy lifting. Rectus sheath hematoma was detected by abdominal ultrasonography and computerized tomography. The patient recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Computerized tomography must be chosen for definitive diagnosis. Ideal treatment is conservative.

Ankilozan spondilitte omurgayý oluþturan kemik ve bað yapý- lardaki kýrýlganlýk sonucu küçük travmalarda bile omur kýrýðý oluþabilir. Kýrýklar sýklýkla torakolomber bölgede, nadiren servikal bölgede meydana gelir. Bu yazýda ankilozan spondiliti olan ve yüksekten düþme sonrasý alt ekstremitede güçsüzlük ve yürüme güçlüðü þikayetleriyle kliniðimize baþvuran 52 yaþýnda erkek hasta sunuldu. Nörolojik muayenede giderek artýþ gösteren motor fonksiyon kaybý vardý. Manyetik rezonans görüntülemede servikal beþinci ve altýncý omurlar seviyesinde Chance kýrýðý saptandý. Ameliyatta tek seanslý anterior füzyon, stabilizasyon ve posterior dekompresyon yapýldý. Ameliyat sonrasý nörolojik tabloda giderek artan düzelme görüldü. Hasta ameliyat sonrasý yedinci günde akciðer yetersizliði nedeniyle kaybedildi.

Spinal fractures can occur after minor traumas due to the fragility of osseous or ligamentous structures of the spine in patients with ankylosing spondylitis. They are usually seen in the thoracolumbar region of the spine. However, the cervical region is an extremely rare location for these fractures. We present a 52-year-old male with ankylosing spondilitis who had complaints of weakness in the lower extremities and difficulty with walking after a fall from height. Neurologic examination revealed a progressive loss of motor function. Magnetic resonance imaging showed a Chance fracture at the fifth and sixth cervical vertebrae. We performed a one-stage anterior cervical fusion and stabilization with posterior decompression. Postoperatively, there was a progressive neurologic improvement. However, the patient died due to pulmonary failure at the seventh day postoperatively.