Travmalý olgularda hastane öncesi dönemde uygulanmasý gereken tedavinin “Ýleri Travma Yaþam Desteði” (ÝTYD) ya da “Temel Yaþam Desteði” (TYD) þeklinde olmasý gerektiði üzerindeki tartýþmalar sürmektedir. Bu derlemede travma hastalarýna hastane öncesi dönemde uygulanan ÝTYD ve TYD tedavileri üzerine olan literatür gözden geçirildi; ÝTYD ve TYD içeren toplam 76 çalýþma deðerlendirildi. Ýntravenöz katater uygulamasý, hastane öncesi sývý tedavisi, hasta transport süresi, entübasyon ve ölüm oranlarý gibi deðiþkenler incelendi. Literatürdeki bilgilerin sahada travma hastalarýna rutin olarak ÝTYD uygulanmasýnýn gerekliliði konusunda net olmadýðý sonucuna varýldý. Bu konudaki eksikliðin giderilmesi için travma hastalarýnda ÝTYD ve TYD’yi karþýlaþtýran prospektif, kontollü çalýþmalara gereksinim vardýr.

The controversy between Advanced Trauma Life Support (ATLS) and Basic Life Support (BLS) in the prehospital care of trauma patients has not been resolved yet. The purpose of this study was to examine the literature with respect to the type of prehospital care applied to the trauma patients. A total of 76 papers on ATLS and/or BLS for trauma were reviewed regarding the variables such as intravenous catheter application, prehospital fluid resuscitation, transport time, intubation and mortality. As a conclusion, the data in the literature do not support the routine use of on-field ATLS in trauma patients. Prospective randomized trials comparing ATLS and BLS in prehospital management of trauma patients are needed to clarify this issue.

AMAÇ: Hemoraji ile birlikte taþikardi ve hipotansiyonu olan hastada hemorajik þok teþhisinin konulmasýnda bir zorluk yoktur. Esas zorluk hastaya uygun tedavinin verilmesinde ortaya çýkar. Bu çalýþmada köpeklerde kanatýlarak oluþturulan derin hemorajik þok sonrasý ayrý sývý miktarý ile tedavi edilen gruplardaki koagülasyon parametreleri incelendi. Tedavide verilecek en uygun sývý miktarýnýn saptanmasý amaçlandý.
GEREÇ-YÖNTEM: Çalýþmada 30 adet melez köpek kullanýldý. Köpekler rastgele üç gruba ayrýldý; her grup 10 köpekten oluþtu. Kontrol grubuna hiçbir tedavi uygulanmadý. Hýzlý infüzyon yapýlan gruba 60 cc/kg dozunda yarým saatte Ringer laktat solüsyonu verildi. Yavaþ infüzyon yapýlan gruba ise 30 cc/kg dozunda yarým saatte Ringer laktat solüsyonu verildi.
BULGULAR: Tedavi edilen her iki grupta da laktat deðerleri düþtü. Trombosit ve fibrinojen yavaþ infüzyon yapýlan grupta fazla düþmedi; hýzlý infüzyon yapýlan grupta önemli derecede düþtüðü gözlendi.
SONUÇ: Þokta en kýsa zamanda kanama kontrol altýna alýnmalý ve sývý resüstasyonunda saldýrgan davranýlmamalýdýr. Verilen sývý miktarý ne kadar fazla olursa koagülasyon parametreleri o derecede dilüe olacaktýr. Hemorajik þoktaki hastalarýn tedavi etkinliðinin deðerlendirilmesinde kan laktat seviyesi yol gösterici bir tetkik olarak kullanýlabilir.

BACKGROUND: The diagnosis of hemorrhagic shock in a patient with tachycardia and hypotension is generally straightforward. The difficulty lies in the selection of optimal approach for the patient. In this study on a canine model of deep hemorrhagic shock induced by bleeding, we used various amounts of fluid infusion to determine the most appropriate amount of fluid resuscitation. METHODS: The study included 30 mongrel dogs. Mongrel dogs were randomized to three equal groups of 10. The control group received no treatment. The rapid infusion group received 60 mL/kg of lactated Ringer's solution in half an hour whereas the third group received 30 mL/kg during the same time period. RESULTS: The lactate decreased in the two treatment groups. The platelet and fibrinogen levels did not vary in the slow infusion group but decreased markedly in the rapid infusion group.
CONCLUSION: In conclusion, fluid resuscitation should not be unnecessarily aggressive. The coagulation parameters are diluted in proportion with the amount of fluid given. Blood lactate level can be used as a guiding marker in evaluation of treatment effectiveness of hemorrhagic shock patients.

AMAÇ: Ameliyat sonrasý periton içi yapýþýklýk oluþumunda baðýrsak kan akýmý deðiþikliklerini incelemek ve Endotelin-1 (ET-1) reseptör blokajýnýn rolünü araþtýrmaktýr.
GEREÇ-YÖNTEM: Çalýþmada 250-300 gr aðýrlýðýnda 28 adet Wistar-Albino eriþkin sýçan eþit olarak dört gruba ayrýldý. Kontrol grubuna (grup 1; n=7) ameliyat uygulanmadý. Sham grubuna (grup 2; n=7) sadece laparotomi yapýldý. Yapýþýklýk grubuna (grup 3; n=7) sað karýn duvarýndan 1x1 cm’lik peritoneal yama eksizyonu ve çekal abrazyon, “yapýþýklýk model ameliyatý” olarak uygulandý. Tedavi grubuna (grup 4; n=7); bir non-selektif ET-1 reseptör blokeri olan bosentan (30 mg/kg, IP) periton içi yoldan dört gün süreyle günde bir kez verildi. Ameliyat sonrasý yedinci gün, superior mezenterik arterin beslediði baðýrsak kan akýmý ölçüldü. Yapýþýklýk þiddeti ve yaygýnlýðý ile yapýþýklýktaki miyeloperoksidaz (MPO) aktivitesi ölçüldü.
BULGULAR: Ortalama baðýrsak kan akýmý grup 1 (65.5±1.2 ml/100 gr) ile kýyaslandýðýnda yapýþýklýk grubunda (81.9±5.6 ml/100 gr) belirgin olarak artmýþtý. Grup 1 ve grup 2 ile karþýlaþtýrýldýðýnda bosentanýn (44.3±6.9 ml/100 gr) baðýrsak kan akýmýnda belirgin azalmaya neden olduðu görüldü. Sham grubunun (62.2±1 ml/100 gr) kan akým seviyeleri kontrol grubundakilerle (65.5±1.2 ml/100 gr) benzerlik gösterdi. Yapýþýklýk skorlarý, yapýþýklýk ve bosentan gruplarýnda benzer bulundu. Sham grubunda neredeyse hiç yapýþýklýk görülmedi. Bosentan grubunda yapýþýklýk dokusu MPO aktivitesi belirgin olarak artmýþtý.
SONUÇ: Non-selektif ET-1 reseptör blokajýnýn periton içi yapýþýklýk oluþumunun önlenmesinde bir etkisi yoktur ancak, baðýrsak kan akýmýnda azalmaya neden olur. Yapýþýklýk oluþumu baðýrsak kan akýmýný arttýrýr. Yapýþýklýk oluþumu, bosentan tedavisine raðmen artmýþ polimorfonükleer (PMN) infiltrasyonu ile birliktedir.

BACKGROUND: The current study was planned to investigate intestinal blood flow alterations and the role of ET-1 receptor blockade in the formation of postoperative intraperitoneal adhesion formation.
METHODS: Twenty-eight adult Wistar Albino rats weighing between 250 g and 300 g were divided into four groups. Control group (group 1; n=7) did not undergo any operation. Sham group (group 2; n=7) had only laparotomy. In the adhesion group (group 3; n=7), peritoneal patch (1x1 cm) excision from the right abdominal wall and cecal abrasion were done as "adhesion model operation". One week following this, treatment group (group 4; n=7) received a non-selective ET-1 receptor blocking agent bosentan (30 mg/kg, IP) intra-abdominally, once a day for four days. Intestinal blood flow through the superior mesenteric artery was measured, on postoperative seventh day. Adhesion severity and extension as well as myeloperoxidase activity in the adhesion were calculated.
RESULTS: Mean intestinal blood flow significantly increased in adhesion group (81.9±5.6 ml/100 g) when compared to group 1 (65.5±1.2 ml/100 g). Bosentan caused a significant decrease (44.3±6.9 ml/100 g) in intestinal blood flow when compared to group 1 and group 2. Sham group (62.2±1 ml/100 g) had similar blood flow level with the control group (65.5±1.2 ml/100g). Adhesion scores were similar in adhesion and Bosentan groups. Sham group had almost no adhesions. Myeloperoxidase activity in adhesion tissue was significantly higher in bosentan group.
CONCLUSION: Non-selective ET-1 receptor blockade has no effect on prevention of the formation of intra-abdominal adhesion, but causes a decrease in intestinal blood flow. Adhesion formation increases intestinal blood flow. Adhesion formation is accompanied by increased polymorphonuclear infiltration despite bosentan treatment.

AMAÇ: Bu çalýþmada travmatik subaraknoid kanamalarda (tSAK) prognozu etkileyen faktörlerin incelenmesi amaçlandý.
GEREÇ-YÖNTEM: Bu prospektif çalýþmaya 2001-2003 yýllarý arasýnda tedavi edilen 58 tSAK’lý hasta (44 erkek, 14 kadýn; ort. yaþ 39.2; daðýlým 17-79 yýl) alýndý. Çalýþmamýza travma sonrasý ilk altý saat içerisinde baþvuran hastalar dahil edildi; ateþli silah yaralanmalarý, multitravmalý ve ameliyat edilen hastalar çalýþma dýþýnda tutuldu. Hastalarýn nörolojik deðerlendirmesi Glasgow Koma Ölçeði’ne (GKÖ), sonuçlar Glasgow Sonuç Ölçeði’ne (GSÖ), bilgisayarlý tomografi (BT) incelemeleri ise Hijdra ve Fisher kriterlerine göre deðerlendirildi.
BULGULAR: Travmatik subaraknoid kanamalarýn etyolojisini en sýk trafik kazalarý (%73) ve düþme (%20) oluþturuyordu. Olgularýn hastaneye ilk geliþ durumlarý GKÖ’ne göre %9’u hafif, %39’u orta, %52’si þiddetli travma olarak deðerlendirildi. Hijdra derecelendirmesine göre BT’deki kan miktarý ve daðýlýmý: 21 hastada 1. derece (az miktarda kan), 17 hastada 2. derece (orta miktarda kan), 20 hastada 3. derece (aþýrý miktarda kan); Fisher kriterlerine göre pýhtý kalýnlýðý: 6 hastada 1. derece (kan yok), 21 hastada 2. derece (diffüz kanama), 15 hastada 3. derece (pýhtý kalýnlýðý 1 mm veya daha fazla kan), 16 hastada 4. derece (ventriküler kanama) olarak saptandý. GSÖ’ne göre hastalarýn %59’unda sonuçlar kabul edilebilir (tam iyileþme, orta derece sakatlýk), %41’inde ise kötü (ciddi derecede sakatlýk, vejetatif tablo, ölüm) bulundu.
SONUÇ: Çalýþmamýzda; giriþ GKÖ skoru düþük olanlarda, sistern ve fissürlerde kanamasý olanlarda, tSAK ile birlikte serebral kontüzyon veya akut subdural hematomu bulunanlarda, Hijdra kriterlerine göre aþýrý miktarda kan birikmesi olanlarda (13 puan ve üzeri) ve Fisher derecelendirmesine göre 3. ve 4. derecede olanlarda prognozun daha kötü olduðu sonucuna varýldý.

BACKGROUND: We evaluated the prognostic factors in traumatic subarachnoid hemorrhage (tSAH).
METHODS: This study was conducted with 58 patients (44 males, 14 females; mean age 39.2; range 17 to 79 years) with tSAH, between 2001 and 2003. The patients who were admitted to the hospital within in the first 6 hours of head injury were included, whereas patients with gun shot wounds, multiple injured patients and postoperative patients were excluded. Fifty-eight patients with tSAH were prospectively followed. The neurological status of the patients and the outcomes were evaluated using Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), respectively and computed tomography (CT) examinations were done according to the grading criteria by Hijdra and Fisher.
RESULTS: The etiology of tSAH included traffic accidents (73%), falls (20%) and others (7%). The GCS scores of patients at admission were mild (9%), moderate (39%) and severe (52%). In the CT scans, the amount and distribution of bleeding was grade 1 (small SAH) in 21 patients, grade 2 (moderate SAH) in 17 patients, and grade 3 (extensive SAH) in 20 patients according to Hijdra grading system and according to Fisher's criteria. The thickness of blood layer was grade 1 (no blood) in 6 patients, grade 2 (bleeding layer less than 1 mm) in 21 patients, grade 3 (bleeding layer more than 1 mm) in 15 patients and grade 4 (ventricular bleeding) in 16 patients. Neurological outcomes of patients were favorable (good recovery or moderate disability) in 59%, and unfavorable (severe disability, persistent vegetative state or death) in 41% according to GOS.
CONCLUSION: We have found in our series that the prognosis was poor in patients with poor admission scores of GCS, cysternal or fissural hemorrhage, tSAH with cerebral contusion or acute subdural hematoma, higher than 13 points according to Hidjra's classification and patients of grade 3 or 4 in Fisher's criteria.

AMAÇ: Sistemik komplikasyonlarý ile karakterize þiddetli akut pankreatitin tedavi planlanmasýnda hastalýðýn erken tehisi ve yoðun bakým ihtiyacýnýn belirlenmesi önemlidir. Bu çalýþmada, sistemik enflamasyon belirleyicisi prokalsitoninin ödematöz ve þiddetli akut pankreatit ayýrýcý tanýsýndaki yeri tartýþýldý.
GEREÇ-YÖNTEM: Prospektif olarak akut pankreatitli hastalar ödematöz ve þiddetli form olarak iki gruba ayrýldý. Ranson ve APACHE II skorlarý ve prokalsitonin seviyeleri baþvuruda ve takipte karþýlaþtýrýldý.
BULGULAR: Akut pankreatit tanýsý alan toplam 65 hastanýn 46’sý ödematöz 19’u þiddetli form idi. Prokalsitonin 0.5 ng/dl, Ranson skoru 3 ve APACHE II skoru 8 cut-off seviyelerinde duyarlýlýk ve özgüllükleri sýrasýyla %100, %84, %89 ve %84, %63, %89 idi.
SONUÇ: Prokalsitonin, þiddetli akut pankreatitin erken tanýsý ve klinik prognozunun takibinde kullanýlabilen basit ve pratik bir belirteçtir.

BACKGROUND: Early identification of patients who develop severe acute pancreatitis and those who can benefit from intensive care is important. We studied whether procalcitonin, a marker of systemic inflammation, is important in the differential diagnosis of patients with mild and severe acute pancreatitis. METHODS: Patients were divided into two groups (mild and severe form) prospectively. Procalcitonin levels and the Ranson's and Acute Physiology and Chronic Health Evaluation II scores were determined both at admission and during the follow-up.
RESULTS: Of the 65 patients with acute pancreatitis, 46 had mild and 19 had severe pancreatitis. Sensitivity and specificity values for patients calculated using procalcitonin level at 0.5 ng/ml, Ranson's score at 3 and APACHE II score at 8 cut-off levels, were 100%, 84% and 89%; and 84%, 63% and 89% respectively. CONCLUSION: Procalcitonin is a practical, simple parameter that can be used in order to diagnose severe acute pancreatitis earlier and to monitor the clinical prognosis of the disease.

AMAÇ: Ekstremitelere uygulanan replantasyon, revaskülarizasyon ve amputasyon ameliyatlarýndan sonra 99mTc-HMPAO SPECT
analizi kullanýlarak motor ve somatosensoriyel korteksteki somatotropik reorganizasyon açýsýndan araþtýrýldý.
GEREÇ-YÖNTEM: Çalýþmaya 12 hasta (11 erkek, 1 kadýn; ort. yaþ 38.9±14.7 yýl) ve 5 saðlýklý erkek (ort. yaþ 32.2±7.9 yýl) kontrol grubu olarak alýndý. Rekonstrüksiyon sonrasý presentral ve postsentral kesitlerle birlikte alt, orta ve üst orbitomeatal kesitlerde ölçümler yapýldý. Tüm görüntüler görsel ve yarý kantitatif olarak deðerlendirildi. Ýstatistiksel analizlerde Mann-Whitney U-testi kullanýldý.
BULGULAR: Revaskülarizasyon ve replantasyon hastalarýnda dominant hemisferde presentral ve postsentral hipoperfüzyon vardý. Amputasyon hastalarýnda, nondominant hemisferde presentral hipoperfüzyon ve postsentral hipoperfüzyon (dört olgunun üçünde) bulunurken; dominant hemisferde ise dört olgunun birinde postsentral hipoperfüzyon vardý. Olgularýmýzda beyin bölgesel kan akýmýnda belirgin fark posterior parietal kortekste bulundu (somatik iliþkili alan).
SONUÇ: Ekstremite replantasyon-revaskülarizasyon ameliyatlarý sonrasý beyinde presentral ve postsentral kortekste görülen deðiþiklikler somatotropik reorganizasyonun iyi bir göstergesi olabilir.

BACKGROUND: We wanted to investigate the somatotropic reorganization occurring in the motor and somatosensory cortex by using 99mTc-HMPAO SPECT analyses, after the extremity revascularization, replantation or amputation. METHODS: Twelve patients (11 men, 1 female; mean age 38.9±14.7 years) and controls (5 men, mean age 32.2±7.9 years) were enrolled in this study. After reconstruction, lower, middle and upper orbitomeatal slices with precentral and postcentral slices were obtained. All images were visually and semi-quantitatively evaluated. Mann-Whitney U-test was used for statistical analysis.
RESULTS: In the revascularization and replantation patients, postcentral and precentral hypoperfusions were seen at dominant hemisphere. In the amputated patients, postcentral (in 3 of 4 cases) and precentral hypoperfusions were seen at non-dominant hemisphere and postcentral hypoperfusion (in 1 of 4 cases) was seen at dominant hemisphere. In our patients, most significant difference in regional cerebral blood flow was found in posterior parietal cortex (somatic associated area).
CONCLUSION: Changes that take place in precentral and postcentral cortical areas subsequent to the extremity replantation-revascularization of the organ is a good indicator of somatotrophic reorganization.

AMAÇ: Bu çalýþmada akciðer ve/veya sistemik yað embolisi geliþen olgularda yað embolisinin yaygýnlýðý ile yaþ, cins, travmanýn aðýrlýðý ve travma sonrasý yaþam süresi, arasýndaki iliþkiler sorgulandý.
GEREÇ-YÖNTEM: Adli Týp Kurumu Morg Ýhtisas Dairesi’nde otopsileri yapýlan, akciðer ve/veya diðer yaþamsal organlarýnda histopatolojik olarak, yað embolisi saptanan 31 olgu geriye dönük olarak deðerlendirildi.
BULGULAR: Travma ve travmaya baðlý komplikasyonlar nedeni ile hayatýný kaybeden 28 olgunun (%90) 19’unu (%61) araç içi ve araç dýþý trafik kazalarý oluþturmaktaydý. Travma sonrasý yaþam süresi 0-384 saat (61.6±86.2) arasýnda deðiþmekteydi. Olgularda saptanan travmatik deðiþiklikler kýsaltýlmýþ yaralanma cetveli (AIS) ve yaralanma aðýrlýk cetveline (ISS) göre deðerlendirildi; AIS deðeri 8.1±3.9 (SD), ISS deðeri 26.5±19.7 (SD) olarak bulundu. Olgularýn histopatolojik deðerlendirmesinde 24 olguda (%77) izole akciðer yað embolisi, 7 olguda (%23) sistemik yað embolisi saptandý. Yað embolisinin yaygýnlýðý ile yaþ, cinsiyet, travma derecelendirmesi, travma sonrasý yaþam süresi arasýndaki iliþkiler istatistiksel olarak, Ki-kare ve Spearman korelasyon testleri ile araþtýrýldý.
SONUÇ: Yaþ, cinsiyet ve ISS deðerleri ile akciðer yað embolisinin derecelendirilmesi arasýnda anlamlý iliþki saptanmadý. Travma sonrasý yaþam süresi ve ISS deðerleri arasýnda ise istatistiksel anlamlýlýk olmadýðý halde negatif bir iliþki olduðu belirlendi.

BACKGROUND: The aim of this study was to evaluate the possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time.
METHODS: Thirty-one cases with pulmonary and/or systemic fat embolism, auotopsied at the Morgue Department of Council of Forensic Medicine were evaluated retrospectively.
RESULTS: Twenty-eight cases (90%) died due to trauma and its complications. Nineteen cases (61%) were injured in motor vehicle-related accidents. Post-traumatic survival time varied between 0-384 hours (61.6 ± 86.2 hours). Abbreviated injury scale (AIS) was 8.1 ±3.9 and injury severity score (ISS) was 26.5±19.7 SD. Twenty-four (77%) cases were determined as isolated pulmonary fat embolism and 7 (23%) cases as systemic fat embolism on histopathological examination. Possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time were evaluated statistically with using Chi-square and Spearman's correlation tests. CONCLUSION: There were no correlations between the grade of fat embolism and age, gender, the severity of trauma. Post-traumatic survival time and the severity of trauma had a very weak negative correlation without any statistical significance.

AMAÇ: Bu çalýþma, elektrik çarpmalarýnýn epidemiyolojik özelliklerini belirlemek, mortalite ve morbiditeye etkili olan faktörleri saptamak için planlandý.
GEREÇ-YÖNTEM: Dicle Üniversitesi Týp Fakültesi Acil Kliniðine Ocak 2003-Nisan 2004 tarihleri arasýnda elektrik çarpmasý þikayetiyle baþvuran 165 hasta (126 erkek; 39 kadýn; ort. yaþ 21.1; daðýlým 2.5-62) yaþ, cinsiyet, elektik kaynaðý ve gücü, yanýk derecesi ve yüzdesi, oluþan komplikasyonlar, yapýlan müdahaleler, eðitim durumu ve meslekleri bakýmýndan deðerlendirildi.
BULGULAR: Hastalarýn, 60’ý (%36.4) 12 yaþýn altýnda, 95’i (%57.6) genç ve eriþkin yaþta ve 10’u (%6) ileri yaþta idi. Yirmi dokuz (%17.6) hasta okuryazar deðil, 36’sý (%21.8) okuryazar ve 97’si (%58,8) halen eðitim görmekte idi. Yanýklarýn 99’u (%60) kaza, 66’sý (%40) ise dikkatsizlik ve ihmal sonucu oluþmuþtu. Hastalarýn 69’u (%41.8) yüksek, 96’sý (%58.2) düþük voltaja maruz kalmýþtý. On altý hastada birinci derece, 96 hastada ikinci derece ve 86 hastada üçüncü derece yanýk meydana gelmiþti. En sýk görülen komplikasyonlar, ekstremitelerde kontraktür (%10.9) ve kompartman sendromu (%3.6) idi. Hastalarýn 10’una eskarotomi, 16’sýna fasyotomi, 9’una amputasyon uygulanmýþtý. Mortalite oraný %9.1 (n=15) idi ve bu olgularýn %80’i yüksek elektrik voltajýna maruz kalmýþtý. Gözlenen komplikasyonlar ile mortalite arasýnda pozitif bir korelasyon saptandý (p<0.001).
SONUÇ: Elektrik sistemlerinin doðru kullanýmý ile ilgili toplumsal eðitimin verilmesi, ev içi ve ev dýþý elektrik hatlarýnýn gizli döþenmesi gibi basit önlemlerin alýnmasý ile kazalar en aza indirilebilecektir.

BACKGROUND: In this study, we planned to determine the factors affecting the mortality, and morbidity of electrical injuries.
METHODS: Medical records of 165 patients (126 males; 39 females; mean age 21.1 years; range 2.5 to 62 years), who were admitted to the Emergency Department of Dicle University School of Medicine for electrical injuries, between January 2003 and April 2004, were retrospectively reviewed.
RESULTS: Among these patients, 60 (36.4%) were children, under 12 years old; 95 (57.6%) were adolescents and adults, and 10 (6%) were aged. Of the victims of electrical accidents, 29 (17.6%) were illiterate and 36 (21.8 %) were educated. Ninety-seven (58.8 %) patients were either graduates or still students of elementary, secondary or high school. The cause of exposure to electricity was accident in 99 (60%), and carelessness and parents' negligence in 66 (40%). Sixty-nine (41.8%) patients were exposed to high voltage, and 96 (58.2 %) to low voltage. Because of electrical injury 16 patients had first degree, 96 patients had second degree, and 86 patients had third degree burns. The most frequent complications were contractures of extremities (10.9%) and compartment syndrome (3.6%). Mortality rate was 9.1% (n=15). Eighty percent of the deaths were due to exposure to high voltage. A positive correlation was demonstrated between mortality and complications (p<0.001). Escarotomy was performed in 10 patients, fasciotomy in 16, and amputation in 9. Two of 5 patients who had intraabdominal hemorrhage underwent surgery.
CONCLUSION: A serious education of the society with respect to conscious use of of electricity is the most efficient method to decrease electrical accidents.

AMAÇ: Evre 3 ve evre 4 basý yaralarý nedeniyle ameliyat edilen hastalarda uygulanan cerrahi tedavi yöntemleri ve sonuçlarý retrospektif olarak deðerlendirildi.
GEREÇ-YÖNTEM: 1984-2002 tarihleri arasýnda toplam 66 hastada (45 erkek, 21 kadýn; ortalama yaþ 39.4; daðýlým 13-80) 100 basý yarasý, fasyokütan flep, muskülokütan flep, kýsmi kalýnlýkta deri greftlemesi ve primer onarým teknikleriyle tedavi edildi.
BULGULAR: Altmýþ altý hastanýn 40’ý (%61) paraplejik, 5’i (%7) kuadriplejik, 9’u (%14) uzun süredir yataða baðýmlý ve 5’i (%7) debilizan hasta, 7’si (%11) ise multipl skleroz ve spina bifida hastasý idi. Ameliyat sonrasý uzun süreli izlemde hastalarýn %24’ünde (16/66) ve tedavi edilen basý yaralarýnýn %22’sinde (22/100) nüks saptandý. Nükslerin %23’ü (10/43) iskiyon, %21’i (8/37) sakrum ve %20’si (4/20) trokanter bölgesinde idi; %42’si eksizyon ve primer onarým, %17’si (6/34), fasyokütan flep cerrahisi ve %12’si (5/39) müskülokütan flep cerrahisi yöntemi sonrasýnda meydana geldi.
SONUÇ: Greftleme ve primer onarým gibi yöntemlerde nüks oranlarýnýn daha yüksek olduðu, fasyokütan veya muskülokütan fleplerin tedavide kullanýmýyla bu nüks oranlarýnýn belirgin düzeyde azaltýldýðý belirledik.

BACKGROUND: We reviewed the outcome of 66 patients with 100 pressure sores between 1984 and 2002.
METHODS: In the current study, 100 pressure sores in 66 patients (45 male, 21 female; mean age 39.4; range 13 to 80 years) who underwent surgical repair of presure sores reconstructed using myocutaneous or fasciocutaneous flaps, skin grafts, excision and closure.
RESULTS: The risk factors for pressure sores included acute trauma-induced spinal cord injury in 40 (61%) patients with paraplegia and in 5 (7%) patients with quadriplegia; congenital spina bifia and multiple sclerosis in 7 (11%) patients and prolonged immobilization in 14 (21 patients) patients. We achieved an overall pressure sore recurrence rate of 22% and overall patient recurrence of 24% in a-3-year follow-up. The recurrence rates according to anatomic sites; 23% (10 of 43) for the ischial pressure sore, sacral 21% (8 of 37), and trochanteric 20% (4 of 20). Fasciocutaneous and myocutaneous flap reconstructions were the most durable, as they were associated with 17% (6 of 34) and 12% recurrence rates (5 of 39).
CONCLUSION: To reduce the recurrance rates the authors advocate the use of myocutaneous and fasciocutaneous flaps instead of skin grafts or direct closure for the coverage of pressure sores.

AMAÇ: Bu çalýþmada apendiksin karsinoid tümörlerinin klinik ve histopatolojik özellikleri ve tedavi yöntemleri deðerlendirildi.
GEREÇ-YÖNTEM: Apendiksin karsinoid tümörü olan hastalarýn týbbi kayýtlarý ve patoloji piyesleri retrospektif olarak incelendi. Çalýþma verileri tanýmlayýcý istatistiksel metodlar (ortalama, SD, frekans) kullanýlarak deðerlendirildi.
BULGULAR: Akut apandisit tanýsýyla ameliyat edilen 6777 hastanýn 11’inde (%0.16) histopatolojik incelemede karsinoid tümör saptandý. Altý hasta (%54.54) erkek, 5 hasta (%45.45) kadýndý; hastalarýn yaþ ortalamasý 20.2±6.7 (13-35) idi. Tümör 10 hastada 1/3 distal bölgede, 1 hastada ise 1/3 proksimalde yerleþimliydi. Ortalama tümör çapý 0.73±0.36 cm (0.3-1.5) idi. On hastada klasik tip karsinoid tümör saptanýrken, bir hastada goblet hücreli karsinoid tümör görüldü. Hastalarýn hiçbirinde geniþletilmiþ rezeksiyon yapýlmadý. Hastalarýn ortalama takip süresi 28.5±15.2 (6-48) ay olup hiçbir hastada nüks görülmedi.
SONUÇ: Tümör çapý 1-2 cm olan olgularda uygun tedavi yöntemi apandektomidir. Basit apandektomi ile 2 cm’nin altýndaki tümörlerde kýsa sürede nüks saptanmamaktadýr.

BACKGROUND: The aim of this study is to evaluate the clinical and histopathological features and the treatment of carcinoid tumors of the appendix.
METHODS: A retrospective review of medical records and pathology specimens of patients with carcinoid tumor of the appendix has been done. The data derived from this study has been evaluated by descriptive statistical methods (mean, SD, frequency).
RESULTS: The histopathological examination of the appendices revealed carcinoid tumor in 11 out of 6777 (0.16%) patients operated for acute appendicitis. Six (54.54%) patients were male, 5 (45.45%) were female and the mean age was 20.2±6.7 years (13-35). The tumor was localized in the distal 1/3 region in 10 patients and in the proximal 1/3 region in 1 patient. The mean tumor diameter was 0.73±0.36 cm (0.3-1.5). Ten patients had classical type carcinoid tumor whereas goblet cell carcinoid tumor was only seen in one patient. None of the patients underwent an expanded resection. The mean follow up of the patients is 28.5±15.2 months (6-48), and no recurrences were seen.
CONCLUSION: In tumors with a diameter of 1 to 2 cm, appendectomy is the treatment of choice. No recurrence was detected with tumors smaller than 2 cm with simple appendectomy.

Cerrahlar “kýsmi intestinal obstrüksiyon” nozolojik antitesine aþinadýr. Ýntussusepsiyon bu antite için ender olarak rastlanan bir etyolojik faktördür, ancak genellikle ameliyat öncesi taný koyulamamaktadýr. Ýntussusepsiyon tanýsýna yönelik birçok görüntüleme tekniði önerilmiþtir, fakat bunlardan hiçbiri belirgin bir duyarlýlýk ve özgüllük göstermemiþtir. Bu yazýda yer alan kýsmi intestinal obstrüksiyon olgusunda, spiral karýn BT taramasý yapýlmýþtýr. Kullanýlan yöntem, kusursuz bir doðrulukla, kýsmi intestinal obstrüksiyonun doðasýný (intussusepsiyon) ve yerleþimini (çýkan kolon) ortaya koymuþtur. Bu yöntemi, klasik BT taramasýna göre ekstra avantaj olarak daha kýsa bir inceleme süresi olmasýna dayanarak, spiral BT'yi kýsmi intestinal obstrüksiyonu olan hastalarýn ameliyat öncesi deðerlendirmesinde alternatif bir tanýsal modalite olarak önermekteyiz.

Surgeons are familiar to the nosological entity "partial intestinal obstruction". Intussusception constitutes a rare etiologic factor for this entity but usually remains undiagnosed preoperatively. Several imaging techniques have been proposed as useful in the diagnosis of intussusception but none of these has a remarkable sensitivity and specificity. In the following case of partial intestinal obstruction, we performed an helical CT scan of the abdomen. The method revealed with an excellent accuracy the nature (intussusception) and the location (ascending colon) of the partial intestinal obstruction. Having the extra advantage of the shorter examination time than the classical CT scan, we propose the helical CT as an alternative diagnostic modality for preoperative evaluation of patients with partial intestinal obstruction.

Bronþ rüptürü, trakeobronþiyal travma sonrasý nadir görülen patolojilerdendir. Erken dönemde yeterli deðerlendirme yapýlmadýðýnda fibrozis ve bronþ stenozu gibi geri dönüþsüz deðiþikliklerin oluþmasý kaçýnýlmazdýr. Travma sonrasý oluþan hemopnömotoraks, pnömomediastinum, subkutan amfizem ve atelektazilerde bronþiyal laserasyonlar göz önünde bulundurularak acil bronkoskopi ve gereðinde erken cerrahi uygulanmalýdýr. Bu yazýda, iki yýl önce araç dýþý künt göðüs travmasý sonrasý hemopnömotoraks meydana gelen ve akciðer enfeksiyonu ile kliniðimize baþvuran 15 yaþýnda erkek hasta sunuldu. Hastada radyolojik ve bronkoskopik deðerlendirme sonucu sað üst lob giriþinde oluþan fibrotik dokuya baðlý sað üst lob atelektazisi saptandý. Hasta ameliyat edilerek lobektomi uygulandý.

Bronchial rupture due to tracheobronchial trauma is a very rare condition. Early evaluation is neccessary in order to avoid irreversible changes such as fibrosis and bronchial stenosis. Cases with post-traumatic hemo-pneumothorax, pneumomediastinum, subcutaneous emphysema and atelectasis require consideration of bronchial laceration with urgent bronchoscopy and early surgery, if needed. A 15 year-old patient with a history of blunt chest trauma two years ago presented with symptoms of pulmonary infection. Radiological and bronchoscopic evaluation revealed right upper lobe atelectasis secondary to fibrosis. Patient underwent right upper lobectomy.

Bu yazýda, kronik, kemikleþmiþ epidural hematomu olan altý yaþýnda bir olgu sunuldu. Hastanýn herhangi bir þikayeti yoktu ve nörolojik muayenesi normaldi. Sunulan olgu, kronik kemikleþmiþ bir epidural hematomda, bilgisayarlý beyin tomografisinde belirgin beyin basýsý saptanmasýna raðmen hiçbir klinik bulgu görülmemesi açýsýndan önem taþýmaktadýr. Hastaya, beyin basýsý nedeniyle ileride oluþabilecek hasarý önlemek için koruyucu dekompresif cerrahi uygulandý.

A 6-year-old boy presented with an asymptomatic ossified chronic epidural hematoma. He was neurologically intact and had no complaints. This is the first report with a computed tomography image of cerebral compression due to an asymptomatic ossified epidural hematoma. Computed tomography indicated an ossified epidural hematoma in the left frontal region. In children, surgery for asymptomatic ossified chronic epidural hematoma with significant cerebral compression should be considered to relieve cerebral compression and prevent possible future brain damage.

Hepatik portal vende gaz (HPVG) çok ender görülür. Mezenterik iskemi, künt karýn travmalarý, baðýrsak týkanýklýðý ve karýniçi enfeksiyonlar sonucu oluþabilir. Acil servise baþvuran 58 yaþýnda erkek hasta akut karýn bulgularý ile deðerlendirilirken ayakta çekilen direkt karýn grafisinde intrahepatik olabileceði düþünülen gaz saptandý. Bilgisayarlý tomografi incelemesinde ana portal ven ve dallarýnda gaz, pnömatozis intestinalis, süperior mezenterik ven ve arterde oklüzyon saptandý. Cerrahi riski yüksek olan hasta ameliyattan önce kaybedildi. Bu yazýda, HPVG’nin hastalýðýn taný, tedavi ve seyri hakkýnda yüksek doðrulukta yardýmcý olabileceði, gereksiz cerrahi tedaviyi önleyebileceði, erken cerrahi tedaviye karar vermede yardýmcý olabileceði vurgulandý.

Gas in hepatic portal vein is a rare entity. This may be apparent after mesenteric ischemia, blunt abdominal trauma, intestinal obstruction, and intra-abdominal infection. Intrahepatic gas was detected by direct abdominal graphy in a 58 year-old man who was admitted to our emergency service with acute abdomen. On computed tomography; portal vein gas, pneumatosis intestinalis, and occlusion of superior mesenteric vein and artery were detected. The patient who had had significant concomittant operative risks, died prior to surgery. Gas in portal vein is a good predictive factor for diagnosis, management, and prognosis. This sign may avoid unnecessary surgery and also it may help to make an early decision for surgery.