AMAÇ: Bu çalýþmada, metilprednizolon, koenzim Q10 ve metilprednizolonla birarada koenzim Q10 tedavilerinin deneysel spinal kord yaralanmasýndaki etkinlikleri karþýlaþtýrýldý. GEREÇ-YÖNTEM: Sprague-Dawley cinsi 32 erkek sýçan (200-250 gr) dört gruba ayrýldý. Spinal kord hasarlanmasý ekstradural olarak T4-5 seviyesine yerleþtirilen anevrizma klibi ile uygulandý. Travmanýn ardýndan, grup K’ya (kontrol grubu) soya yaðý, grup M’ye (metilprednizolon grubu) 30 mg.kg-1 ardýndan idamede saatte 5,4 mg.kg-1 dozunda metilprednizolon, grup Q’ya (koenzim Q10 grubu) 10 mg.kg-1 koenzim Q10, grup MQ’ya (metilprednizolon ve koenzim Q10 grubu) 30 mg.kg-1 ardýndan idamede saatte 5,4 mg.kg-1 dozunda metilprednizolon ile 10 mg.kg-1 koenzim Q10 intraperitoneal olarak verildi. Travmadan 24 saat sonra sýçanlarýn spinal kord örnekleri alýnarak histopatolojik ve biyokimyasal inceleme yapýldý. BULGULAR: Histopatolojik incelemelerde grup K’da grup M, grup Q ve grup MQ’ya göre ödem þiddeti anlamlý olarak yüksekti (p<0,001). Grup M, grup Q ve grup MQ arasýnda ödem ve kanama açýsýndan anlamlý farklýlýk yoktu (p>0,05). Ortalama süperoksit dismutaz deðerleri diðer gruplarýn tümünde grup K’ya göre, grup MQ’de grup M’ye göre anlamlý olarak daha düþüktü (p<0,05). Malonildialdehidin ortalama deðerleri grup M, grup Q, grup MQ’da grup K’ya göre düþük olmasýna raðmen arada anlamlý fark yoktu (p>0,05). SONUÇ: Sonuç olarak metilprednizolon, koenzim Q10 ve bu iki ajanýn birlikte kullanýmýnýn ödemi azaltmada faydalý olduðu, koenzim Q10’un deneysel spinal kord hasarýnda, ikincil hasarýn önlenmesinde faydalý olabileceði sonucuna varýldý.

In this study, we aimed to compare the efficacy of methylprednisolone, coenzyme Q10 and combined methylprednisolone and coenzyme Q10 treatments on experimental spinal cord injury. METHODS: Thirty-two male Sprague-Dawley rats (200-250 g) were divided into four groups. Spinal cord injury (SCI) was performed by placement of an aneurysm clip, extradurally at the level of T4-5. After the trauma, group K (control group) received soybean oil, group M (methylprednisolone group) received 30 mg.kg-1 methylprednisolone and 5.4 mg.kg.hour-1 maintenance dose of methylprednisolone, group Q (coenzyme Q10 group) received 10 mg.kg-1 coenzyme Q10, group MQ (methylprednisolone and coenzyme Q10 group) received 30 mg.kg-1 methylprednisolone and 5.4 mg.kg.hour-1 maintenance dose of methylprednisolone and 10 mg.kg-1 coenzyme Q10 intraperitoneally. Twenty-four hours after the trauma spinal cord samples of the rats were obtained and tissue samples had been harvested for both biochemical and histopathological evaluation. RESULTS: In histopathological examination, the edema pattern was significantly more severe in group K than the group M, group Q and group MQ (p<0.001). There was no statistically significant difference between group M, group Q and group MQ regarding edema and bleeding (p>0.05). Mean superoxide dismutase (SOD) scores were significantly low while comparing the group K with all remaining groups and the group MQ comparing with the group M (p<0.05). Mean malondialdehyde (MDA) scores were low in the group M, Q and MQ in comparison with the group K, but there was no statistically significant difference between all groups (p>0.05).
CONCLUSION: Methylprednisolone, coenzyme Q10 and combined methylprednisolone and coenzyme Q10 treatments were found to be effective as they decrease the edema and coenzyme Q10 could be effective for prevention of secondary injury at experimental SCI.

AMAÇ: Periton, adezyonlarý yýkan bir fibrinolitik aktiviteye sahiptir. Ýskeminin eþlik ettiði periton yaralanmalarý bu fibrinolitik aktiviteyi bozar. Pantotenik asitin (B5 vitamini) alkol þekli olan dekspantenol lokal uygulamalarda mitoz bölünmeyi artýrarak yaranýn iyileþmesini hýzlandýrýr. Hipotezimiz dekspantenolün peritoneal adezyon oluþumunu azaltabileceðidir. GEREÇ-YÖNTEM: Sýçanlarda çekumun antimezenterik kýsmý gazlý bez ile silindi. Kontrol grubuna tedavi uygulanmadý. Deney gruplarýna dekspantenol intraperitoneal (ÝP) (n=15, 25 mg/kg) ya da intravenöz (ÝV) olarak (n=15, 25 mg/kg, iþlem sonrasý 9 gün boyunca) verildi. Postoperatif 10. günde adezyonlar derecelendirildi; doku plazminojen aktivatörü (tPA) aktivitesi ve düzeyleri, plazminojen aktivatör inhibitör tip 1 (PAI-1), tPA/PAI-1 kompleks ve hidroksiprolin düzeyleri peritonda ölçüldü.
BULGULAR: Adezyon formasyonu ÝP dekspantenol grubunda, kontrol grubuna göre azalmýþtý (p=0,034). Kontrol grubuyla karþýlaþtýrýldýðýnda, deney gruplarýndaki tPA aktivite ve konsantrasyon düzeyleri, tPA/PAI-1 kompleks düzeylerinde artýþ saptandý. PAI-1 düzeyleri her üç grup arasýnda da benzerdi. Peritoneal hidroksiprolin seviyelerinde, kontrol grubuna göre, ÝP dekspantenol grubunda deðiþme saptanmazken ÝV dekspantenol grubunda azalma görüldü (sýrasýyla p=0,84, p=0,009).
SONUÇ: Bu sonuçlara göre, dekspantenol intraperitoneal olarak uygulandýðýnda muhtemelen peritoneal fibrinolitik aktiviteyi etkileyerek adezyon oluþumunu azaltabilmektedir.

BACKGROUND: Peritoneum has an intrinsic fibrinolytic activity that breaks the peritoneal adhesions. Ischemic peritoneal injuries interfere with this fibrinolytic activity. Local application of dexpanthenol, the alcohol form of pantothenic acid (vitamin B5) accelerates wound healing by increasing mitosis. We hypothesized that dexpanthenol would decrease peritoneal adhesions. METHODS: In rats, antimesenteric border of cecum was abraded with gauze. No medication was given to the control group (n=15). Dexpanthenol was administered intraperitoneally (IP) (n=15, 25 mg/kg, before abdominal closure) or intravenously (IV) (n=15, 25 mg/kg, for 9 days after operation) in the experiment groups. On postoperative day 10, adhesions were graded; activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), tPA/PAI-1 complex and hydroxyproline contents were determined in peritoneum. RESULTS: Adhesion formation was decreased in IP dexpanthenol group compared with control group (p=0.034). tPA concentration and activity and tPA/PAI-1 complex levels were increased in the treated groups compared to controls. PAI-1 levels were similar among the three groups. Peritoneal hydroxyproline levels were lower in animals receiving IV dexpanthenol compared with control animals and in addition, they remained unchanged in IP dexpanthenol treated group (p=0.009, p=0.84, respectively).
CONCLUSION: Our results suggest that dexpanthenol administration through IP may reduce peritoneal adhesion formation probably by altering peritoneal fibrinolytic activity.

AMAÇ: Omurilik yaralanmalý olgularda paralitik bölgelerde hareketsizlik nedeniyle osteoporoz meydana gelir. Yaralanma sonrasý kemik mineral yoðunluðunda (KMY) hýzlý bir kayýp gözlenir. KMY kaybý kýrýlma eþiðine ulaþabilir. Bu çalýþma, hareket kabiliyetini yitirmiþ olgularda erken aksiyel yüklenme ile osteopororozun engellenebileceði düþüncesini araþtýrmak amacý ile planlandý. GEREÇ-YÖNTEM: Travma düzeyleri T4-L1 arasýnda deðiþen 15 komplet paraplejik olgu ile kontrol grubu olarak 15 normal olgu incelendi. Olgularda KMY dýþýnda, yaralanma zamaný, þekli, mekanizmasý ile serum kalsiyum, fosfor ve alkali fosfataz deðiþken olarak alýndý. KMY ölçümü; femur boynu, trokanter, T1 ve L3 omurlarýndan “Dual Energy X-ray Absorptiometry” (DEXA) cihazý kullanýlarak yapýldý. BULGULAR: Kemik mineral yoðunluðunun paraplejik olgularda femur boynu ve trokanterde azaldýðý, buna karþýlýk T1 ve L3 omurlarýnda anlamlý bir deðiþiklik olmadýðý görüldü. SONUÇ: Femur boynu ve trokanterde hareketsizliðe baðlý olarak KMY azalmaktadýr. Çalýþma ve kontrol gruplarý arasýnda, T1 ve L3 omurlarýnda KMY’da anlamlý bir deðiþiklik olmamasý olgularýn erken rehabilitasyonundan kaynaklanabilir. Stabilizasyon sonrasý baþlanan oturma egzersizleri omurlarda aksiyel yüklenme ile KMY’nun azalmasýný engelleyebilir; böylece osteoporoz ve patolojik kýrýk komplikasyonu önlenebilir.

BACKGROUND: Osteoporosis occurs in paralyzed extremities secondary to immobilization following spinal cord injury (SCI). Bone mineral density (BMD) is rapidly lost after SCI. Loss of BMD may reach fracture threshold although it slows with time. This study was planned to investigate the option of impediment of osteoporosis by early axial loading in immobilized patients. METHODS: Fifteen patients with complete paraplegia having spinal cord lesion between T4-L1 and 15 normal volunteers were included into the study. Time, mechanism and type of injury, BMD, serum calcium, phosphorus and alkaline phosphatase levels were undertaken as variables. BMD was measured by dual energy X-ray absorbtiometry (DEXA) in the femoral neck, trochanteric region and T1 and L3 spine. RESULTS: The BMD values were lower in the femoral neck and trochanteric region, but there were no significant differences at T1 and L3 spine in paraplegics.
CONCLUSION: BMD decreases in the femoral neck and trochanteric region, secondary to immobilization. Absence of significant differences of BMD values at T1 and L3 spine in the study and control groups might be due to early rehabilitation. Sitting exercises early after stabilization might impede of the loss of BMD by axial loading to the spine. Thus, complications such as osteoporosis and pathological fractures can be prevented.

AMAÇ: Çalýþmamýzda akut aortik disseksiyonun acil tanýsýnda manyetik rezonans ( MR ) görüntülemenin yararlýlýðýný ortaya koymaya çalýþtýk. GEREÇ-YÖNTEM: Bu çalýþmada klinik olarak aortik disseksiyon þüphesi olan 15 hastanýn 1.5 tesla MR cihazý ile hem MR görüntüleri ve hem de 3 boyutlu kontrastlý MR anjiografi görüntüleri elde edildi.
BULGULAR: MR görüntüleme ile 11 hastaya aortik disseksiyon tanýsý konuldu. Tüm olgularda hem intimal flebin gösterilmesi ve hem de disseksiyonun A veya B tipinde olduðunun belirlenmesi mümkün oldu. Tüm olgulara anjiografi yapýldý ve 3 hasta opere edildi. MR sonuçlarý gold standart olarak kabul edilen anjiografi ve operasyon sonuçlarý ile kýyaslandý. SONUÇ: Sonuç olarak, MR görüntülemenin aortik disseksiyonlu hastalarda hem baþlangýçta taný amaçlý olarak ve hem de bu hastalarýn uzun dönemli takiplerinde kullanýlabilecek bir modalite olduðunu söyleyebiliriz.

BACKGROUND: In our study, we aimed to demonstrate the utility of MR imaging in the emergency diagnosis of acute aortic dissection. METHODS: Herein, 15 patients who were clinically suspected as having aortic dissection were assessed with both magnetic resonance imaging and 3D contrast enhanced MR angiography by means of a 1.5 tesla magnet. RESULTS: Eleven patients were diagnosed as having aortic dissection by means of MRI. We were able to show the intimal flap in all of the aortic dissection patients and we also determined whether the dissection type was A or B. Although the dissections in three patients were found to be in proximal location (type A), eight patients showed a distally located (type B) dissection. All patients were subjected to angiography and 3 patients were operated. Our results were compared with the results of the angiography and operation, which were regarded as the gold standards. CONCLUSION: Consequently, we can state that MR imaging may be used as an initial diagnostic modality for the patients with aortic dissection and this method can also serve as an useful method in the long term follow-up of these patients. It is a non-invasive and sensitive modality that is easy to perform and can be applied instead of other diagnostic modalities such as conventional angiography.

AMAÇ: 6-12 yaþ arasý çocuklarda femur cisim kýrýklarýnýn tedavisinde farklý tedavi yöntemleri uygulanmaktadýr. Titanyum elastik çivi de bunlardan biridir ve çalýþmamýzda kliniðimizin bu uygulamayla ilgili sonuçlarý araþtýrýldý.
GEREÇ-YÖNTEM: Kliniðimizde retrograd titanyum elastik çiviyle tespit uygulanan femur cisim kýrýklý 21 hasta incelendi. BULGULAR: Hastalar 5,1-14,7 yaþlarýnda ortalama 9,6±2,4 yaþta ve bütün kýrýklar femur diyafizinde idi. Kýrýklarýn dokuzu (%42,9) transvers, yedisi (%33,3) oblik, beþi de (%23,8) spiraldi. Kýrýk redüksiyonu 9 hastada (%42,9) kapalý, 12 hastada (%57,1) lateralden mini insizyonla açýk olarak yapýldý. Çivilerin biri medial diðeri ise lateralden olmak üzere iki adet ve retrograd yöntemle gönderildi. Ameliyat sonrasý dönemde 8 hastaya (%38) alçý atel uygulandý. Hastalarýn ortalama takip süresi 29±11,6 ay (9-48) olarak gerçekleþti. Ortalama 13±11,9 haftada (4-52) tam kaynama saptandý. Ortalama 7±2,2 ayda (6-16) implantlar çýkarýldý. Ameliyat sonrasý birinci yýlda tüm hastalarýn kalça ve diz hareket geniþlikleri tamdý ve klinik olarak rotasyonel veya açýsal deformite saptanmadý. Radyolojik olarak 8 hastada ortalama 11±1,7 (10-15) derecelik varus-valgus deformitesi görülmesine raðmen iki yýllýk takip sonucunda bu açý ortalama 5±1,9 (3-9) dereceye düþtü. SONUÇ: 6-12 yaþ arasý çocuklardaki femur cisim kýrýklarýnýn tedavisinde titanyum elastik çiviyle tespitin sonuçlarý, bu grup hastalarýn tedavisinde ilgili yöntemin ilk tercih olabileceðini düþündürmektedir.

BACKGROUND: Various methods are being used in the treatment of femur diaphysial fractures in children aged between 6 to 12 years. Titanium elastic nailing is one of the alternatives. We evaluated our experience in flexible intramedullary nailing.
METHODS: We investigated 21 patients with femur diaphysial fractures who were with titanium elastic nailing. RESULTS: The mean age of the patients was 9.6±2.4 (range between 5.1-14.7 years) and all the fractures were at the diaphyisis. The fracture pattern was as following: 9 (42.9%) transverse, 7 (33.3%) oblique, 5 (23.8%) spiral. Fixations were performed with two nails which were implanted in retrograde manner. The average time of follow-up was 29±11.6 months (range; 9-48 month). The mean time to fracture union was 13±11.9 weeks (4-52). Implant removal was performed after a mean time of 7±2.2 months (range; 6-16 month). Patients’s hip and knee range of motions were complete and clinically there were no angular or rotational deformity at postoperative one year. There were radiologically 11±1.7 (range; 10-15) degrees of varus valgus malalignment in 8 patients; these angles were reduced to 5±1.9 (range; 3-9) degrees at the follow of two years. CONCLUSION: The results of the flexible titanium nailing in femur diaphysial fractures of the children, aged between 6 to 12 years, suggest that this method may be a first choice therapy in this particular group of patients.

AMAÇ: Çocuklarda 30 dereceden fazla açýlanma gösteren radius boyun kýrýklarýnýn tedavisi sorunludur. Amacýmýz bu kýrýklarýn tedavisinde Metaizeau tarafýndan 1980 yýlýnda tanýmlanan kapalý redüksiyon ve intramedüller tespitin etkinliðini belirlemektir.
GEREÇ-YÖNTEM: Genel anestezi altýnda ve floroskopi kontrolünde, radius distal metafizi radial tarafýnda 1 cm boyunda insizyon yapýldý. Bir Kirþner teli þekillendirilip, 3-5 mm’lik uç bölümü yaklaþýk 30 derece kadar büküldü. Bu tel medüller kanala sokulup, proksimale doðru kýrýlmýþ olan epifizin altýna ulaþana kadar ilerletildi. Telin epifize doðru kaldýrýlmasý ve döndürülmesi ile anatomik redüksiyon elde edilmeye çalýþýldý. Bu teknik 1996 ile 2003 yýllarý arasýnda dokuz hastada kullanýldý. BULGULAR: Çalýþmaya katýlan bir olgu dýþýndaki tüm olgularda çok iyi sonuçla, tam bir fonksiyonel iyileþme gözlendi. Herhangi bir komplikasyona rastlanmadý. SONUÇ: Tekniðin basit olmasý ve yüz güldürücü sonuçlar vermesi nedeniyle, çocuklardaki ayrýlmýþ radius boyun kýrýklarýnda bu kapalý tedavi yöntemini öneriyoruz.

BACKGROUND: The treatment of radial neck fractures in children is difficult when the angular displacement exceeds 30 degrees. The authors report their experience with closed reduction of this fracture and intramedullary pinning which was described and popularized by Metaizeau et al. in 1980. METHODS: Under general anesthesia and guidance of an image intensifier, a 1 cm incision was made on the radial side of distal radial metaphysis. A Kirschner wire was contoured and then the last 3-5 mm were bent approximately 30 degrees. It was introduced into the medullary canal of the radius and by pushing it proximally until its point reaches the inferior aspect of the epiphysis to elevate and rotate to achieve an anatomic reduction. This technique was used in nine patients between 1996 and 2003. RESULTS: Full functional recoveries with excellent results were observed in all cases but one at the last follow-up. No complication was encountered. CONCLUSION: We recommend this closed technique as it is relatively simple and associated with encouraging results.

AMAÇ: Akut trakeobronþiyal yaralanmalarýn erken ve geç dönem sonuçlarý deðerlendirmektir. GEREÇ-YÖNTEM: Aralýk 1997 ve Aralýk 2004 tarihleri arasýndaki yedi yýllýk sürede akut trakeobronþiyal yaralanma tanýsýný alan ve tedavi edilen 12 hasta (10 erkek, 2 kadýn; ort. yaþ 28; daðýlým 10-65 yaþ) geriye dönük olarak incelendi. Klinik deðerlendirme, taný, eþ zamanlý travmalar, cerrahi tedavi ve sonuçlar 1 ile 7 yýllýk sürede deðerlendirildi. BULGULAR: Hastalarýn tamamýna cerrahi debridman ve primer anastomoz uygulandý. Lezyonlar olgularýn birinde larengotrakeal, üçünde trakeal ve sekizinde bronþiyal sistemde idi. Eþ zamanlý travmalar ayný seansta tedavi edildi. Kontrol bronkoskopileri ameliyattan sonra bir hafta ile bir ay sonra yapýldý. Bir olgu kalýcý trakeostomi ile taburcu edildi. Beþ yýl sonra sol alt akciðer lobunda bronþektazi saptanan olguya lobektomi yapýldý. Bir olgu yapýlan primer tamirden sonraki 23. gün kaybedildi. Diðer 10 olguda herhangi bir sorun saptanmadý. SONUÇ: Trakeobronþiyal yaralanma þüphesi olan tüm olgularda uzman hekimler tarafýndan vakit geçirilmeden bronkoskopi yapýlmalýdýr. Erken taný ve uygun cerrahi yolla onarým potansiyel olarak ölümcül olan bu olgularda hayat kurtarýcýdýr. Eþ zamanlý yaralanmalar mortaliteyi etkileyen en önemli faktördür.

BACKGROUND: To evaluate the early and long-term outcomes of acute tracheobronchial injuries (TBI). METHODS: Twelve patients (10 males, 2 females; mean age 28; range 10 to 65 years) diagnosed as tracheobronchial injury and managed during between December 1997 and December 2004 were evaluated retrospectively. Clinical presentation, diagnostic evaluation, associated traumas, surgical management and outcome were reviewed. Follow-up ranged from 1 to 7 years. RESULTS: All patients underwent surgical debridement and primary repair (anastomosis). There were three tracheal, eight bronchial and one laryngotracheal injury. Accompanying simultaneous traumas were treated at the same session in all cases. One case was discharged from the hospital with permanent tracheostomy. Control bronchoscopies were performed one week and one month after the surgical repair. Bronchiectasia developed in one case after five years and left lower lobectomy was performed. One case died 23rd day after the primary repair. In the remaining ten cases no complication was determined. CONCLUSION: In all cases with a suspicion of TBI, bronchoscopy should be performed immediately by specialist physicians. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are lifesaving in these potentially lethal injuries. Concomitant injuries are the most important mortality factor.

AMAÇ: Bu çalýþmada penetran kalp yaralanmasý olan hastalar deðerlendirildi.
GEREÇ-YÖNTEM: Mayýs 1994 ile Eylül 2005 tarihleri arasýnda kalp yaralanmasý þüpesiyle hastanemize gönderilen 25 hastanýn 22’sinde kardiyak yaralanma vardý. Hastalarýn tetkikleri ile fiziksel ve cerrahi bulgularý retrospektif olarak deðerlendirildi.
BULGULAR: Ekokardiyografi, hemodinamisi stabil olan 11 hastaya yapýlabilmiþ ve bir yanlýþ pozitif hariç tümünde perikardiyal efüzyon gösterilmiþtir. Bir hastada sol internal torasik arter ve ven yaralanmasý vardý. 17 hastada (%77) kalp tamponadý vardý. Hastalarda sað ventrikül (n=10, %45,5), sol ventrikül (n=7, %31,8), sol ön inen arteri içeren sol ventrikül (n=2, %9,1), sað atriyum (n=1, %4,5) perikardiyal hematom (n=2, %9,1) yaralanmasý vardý. Hastalarýn ortalama fizyolojik indeksi (PI) 10,68±5,63, penetran kardiyak travma indeksi 14,09±6,3, penetran torasik travma indeksi (PTTI) 17±8,84 ve Amerikan Travma Cerrahisi Birliðinin sýnýflamasýna göre ortalama organ hasarý skoru (AAST/OIS) 3,86±1,25 idi. Altý olgu kaybedildi (mortalite %27,3). Bu hastalarýn PI, PCTI, PTTI ve AAST/OIS skorlarý kurtulanlara göre daha yüksekti (p<0,05). Tamponat mevcudiyeti ve karýn yaralanma sýklýðý bakýmýndan fark yokken, sol ventrikül ve sol ön inen arter ve akciðer yaralanmasý kaybedilen hastalarda daha sýk bulundu.
SONUÇ: Penetran kalp yaralanmasý nedeniyle kaybedilen hastalar, saðkalanlara göre daha aðýr yaralanmalara ve daha yüksek PI, PCTI, PTTI ve AAST/OIS skorlarýna sahip olmaktadýr.

BACKGROUND: This study was planned to evaluate patients with penetrating cardiac injury. METHODS: Twenty-two patients had cardiac injury among twenty-five patients who had been referred to our hospital with a suspicion of this diagnosis. Data of the patients were retrospectively evaluated. RESULTS: Echocardiography could be performed in 11 patients with stable haemodynamics and pericardial effusion was established in all of them with one false positive result. The patient with false positive result had left internal thoracic artery and venous injury. Cardiac tamponade was seen in 17 (77%) patients. Injury sites were right ventricle 10 (45.5%), left ventricle 7 (31.8%), left ventricle consisting left anterior descending artery 2 (9.1%), right atrium 1 (4.5%) and pericardial injuries and hematoma 2 (9.1%). The mean physiologic index (PI) of the patients was 10.68±5.63, penetrating cardiac trauma index was (PCTI) 14.09±6.3, penetrating thoracic trauma index (PTTI) was 17±8.84 and organ injury scale according to the American Association for the Surgery of Trauma (AAST/OIS) was 3.86±1.25. Mortality rate was 27.3% with 6 out of 22 patients. PI, PCTI, PTTI and AAST/OIS scores of the non-survivors were significantly higher than those of the survivors (p<0.05). While there was no difference between survivors and non-survivors regarding the presence of tamponade and the frequency of the associated abdominal injury, left ventricular and left anterior descending artery injuries and associated lung injuries were more common in non-survivors (p<0.05). CONCLUSION: Non-survivors with penetrating cardiac injury have higher PI, PCTI, PTTI and AAST/OIS scores and they are more severely injured patients comparing to the survivors.

AMAÇ: Pediyatrik olgularýn aksine eriþkinde ileal intussussepsiyon nadir görülmektedir. Bu yazýda ileal intussussepsiyonlu eriþkin dört olguya ait sonuçlarý sunmayý amaçladýk.
GEREÇ-YÖNTEM: Akdeniz Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalýnda ileal intussussepsiyon tanýsýyla ameliyat edilen eriþkin hastalara ait bilgiler retrospektif olarak hasta dosyalarýndan edinildi. Baþvuru bulgularý, taný, tedavi ve patoloji ile ilgili bilgiler kaydedilerek sonuçlar deðerlendirildi. BULGULAR: Ýleal intussussepsiyon nedeniyle dört hasta ameliyat edildi. Üç hasta mekanik intestinal obstrüksiyon tablosuyla, bir hasta kronik gastrointestinal þikayetlerle baþvurdu. Ýki hastada neden idyopatik intussussepsiyon, bir hastada ileal polip, diðer hastada da ileal lipom idi. Tedavide tüm hastalara rezeksiyon uygulandý. SONUÇ: Ýleal intussussepsiyon klinik bulgularýn çeþitlilik göstermesi ve spesifik olmamasý nedeniyle zor taný konulan bir hastalýktýr. Mekanik baðýrsak týkanýklýðý olan hastalarda ayýrýcý tanýda düþünülmesi gereklidir. Ýntussusepsiyon sýklýkla benin ya da malin ileal bir lezyona baðlý olduðu için tedavide cerrahi giriþime öncelik verilmelidir.

BACKGROUND: Ileal intussusception is rare in adults, in contrast to the incidence in children. In this article we discuss the disease by evaluating four patients with ileal intussusception. METHODS: A retrospective review was performed at Deparment of Surgery of Akdeniz University School of Medicine to identify adult patients who had been operated with diagnosis of ileal intussusception. Data related to presentation, diagnosis, treatment and pathology were analyzed. RESULTS: Four patients were operated with a diagnosis of ileal intussusception. Three of them presented with signs and symptoms of mechanical intestinal obstruction and one of them presented with chronic gastrointestinal symptoms. In a patient, the intussusseption was associated with an ileal lipom, whereas in another patient an ileal polyp was the etiological factor. Two patients had intussusseption without any lesion. All of patients were treated operatively and en bloc resection was performed. CONCLUSION: Ileal intussussepitoin presents with a variety of non-specific gastrointestinal symptoms, thus the preoperative diagnosis is difficult. It must be considered in patients who presents with mechanical intestinal obstruction. Surgical resection of the intussusseption without any reduction is the preferred surgical treatment, regarding that most of ileal intussusseptions are associated with benign or malign lesions.

Kemik, brakiyal pleksus, ven ve yumuþak doku hasarý olmadan ani ve tek künt travmaya baðlý olarak aksiller arterin intimal hasarý çok nadirdir. Arteriyel yaralanmanýn kalýcý hasar býrakmamasý için erken taný ve uygun tedavi gereklidir. Klinik belirtiler genelde belli belirsizdir ve kollateral dolaþýma baðlý olmak üzere yaralanma sonrasý, uzun iskemik dönem geçtikten sonra belirginleþmektedir. Yirmi yaþýndaki erkek hasta, kolu hiperabdüksiyon ve hiperekstansiyon pozisyonda buzdolabý taþýrken sol kolunu incinme ve bundan 1,5 ay sonra sol kolundaki aðrý ve uyuþukluk þikayetleriyle baþvurdu. Hastanýn hastaneye yatýþýndan sonra yapýlan aksiller arter dijital substraksiyon anjiyografisinde aksiller arterin oklüzyonu izlendi ve oklüzyonun distalinde kollaterallerle dolum gözlenmedi. Ameliyatta, aksiler ve brakiyal arter safen ven ile baypas edildi. Üst ekstremitenin künt travmasýnýn erken döneminde kollateral dolaþým nedeniyle vasküler yetersizlik distal nabýzlar olsa bile tanýnamayabilmekte ve üst ekstremitenin anjiyografisi doðru taný ve tedavi için kaçýnýlmaz olmaktadýr. Bu olgu bizim ikinci tecrübemizdir; birinci olgudaki tecrübemize dayanarak bu olguda olduðu gibi kronik durumlarda revaskülarizasyon sonrasý greft trombozu söz konusuysa oral antikoagülasyona en az altý ay devam edilmesi gerektiðini düþünmekteyiz.

The intimal damage of the axillary artery due to an acute, single blunt trauma is very rare without concomitant bone, brachial plexus, venous and soft tissue injuries. Early diagnosis and appropriate management of the arterial injury is essential to avoid permanent disability. The clinical signs are usually occult and do not become manifest until a long ischemic interval following injury, owing to the extensive collateral network. A twenty-year-old male patient had injured his left arm in a hyperabduction and hyperextension position while he was carrying a refrigerator with his arm. An increase in the intensity of pain and numbness reappeared in his left arm 1.5 months after the trauma. Digital subtraction angiography of the axillary artery performed after his hospitalization showed an occlusion of the axillary artery and no reconstitution of distal part of the occlusion via collateral vessels. During the operation, the axillary and brachial arteries were bypassed with a saphenous graft. As shown in this case report, in the early period after blunt trauma of the upper limb, progressive signs of vascular compromise may disappear because of collateral circulation even if the distal pulses are absent. Then an angiography of the upper limb becomes essential for correct diagnosis and treatment. This is our second experience. On the basis of our first experience that was reported, in such a chronic case, oral anticoagulation must be carried out at least six months whenever a graft thrombosis after revascularization is encountered.

Peliosis hepatis (PH), karaciðer parankiminin kistik, içi kan dolu boþluklardan oluþan, seyrek bir durumudur. Cerrahi giriþim kaçýnýlmaz ise, dikkatli bir kanama kontrolü altýnda yapýlmalýdýr. Bu yazýda, klinik olarak taný konulamamýþ bir PH olgusunun kötü sonuçlarý sunuldu. PH, özellikle karýnda meydana gelen ani þiþlikle baþvuran tüm karaciðer kitlelerinde akýlda tutulmasý gereken bir tanýdýr. Endemik bölgelerde hidatik kist gibi diðer kistik durumlarýn ayýrýcý tanýsýnýn yapýlmasýna çalýþýlmalýdýr.

Peliosis hepatis (PH) is a rare condition characterized by the presence of cystic, blood filled cavities within the hepatic parenchyma. Regardless of the reason, surgery should be performed under meticulous control of hemorrhage, if it is thought to be unavoidable. In this case report, ominous results of clinically misdiagnosed PH have been presented. PH should be kept on mind in all patients with hepatic mass, especially presented by sudden onset distention of the abdomen. Every effort should be done for the differential diagnosis with other cystic conditions like hydatid cyst in endemic areas.

Abdominal aorta ve duodenum arasýnda primer fistül oluþumu nadir görülen ve yüksek mortaliteye sahip bir durumdur. Ateroskleroz en sýk görülen fistül nedenidir; bildirilen olgularýn üçte ikisinden fazlasýnda sorumludur. Kanserler, ülser, radyasyon, aortit ve yabancý cisimler diðer etyolojik nedenlerdir. Burada dikiþ iðnesi yutulmasý sonucu oluþan aortoduodenal fistüle baðlý masif üst gastrointestinal sistem kanamasý nedeniyle ameliyat ettiðimiz 17 yaþýndaki olgu sunuldu. Ameliyatta dikiþ iðnesi içeren kronik aortoduodenal fistül bulunarak onarýldý. Olgumuz iðne yutma nedeniyle Ýngilizce literatürde sunulan dördüncü aortoenterik fistül olgusudur.

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. Other etiologies include carcinoma, ulcers, radiation, aortitis and foreign bodies including sewing needle, cocktail stick, open safety pin and fishbone. We report a case of a 17 year-old girl who underwent surgical treatment because of severe upper gastrointestinal bleeding which was related to an aortoduodenal fistula caused by a swallowed sewing needle. At operation, a chronic aortoduodenal fistula that contained the sewing needle was found and repaired. This is the fourth case in the literature in which a needle was found to be associated with the development of an aortoenteric fistula.

Künt travmalardan sonra oluþabilen gözden kaçmýþ damar yaralanmalarý yaþamý tehdit eden ve acil giriþim gerektiren klinik tablolarý ortaya çýkarýr. Aort transeksiyonu (AT) bu gözden kaçabilecek vasküler yaralanmalarýn en ölümcül olanýdýr. Bu yazýda künt travma sonrasý meydana gelen bir AT olgusu sunuldu. Üç yýl önce künt travmaya maruz kaldýðýný bildiren hasta eforla gelen nefes darlýðý ve çarpýntý þikayetiyle baþvurdu. Telegrafisinde üst mediastende geniþleme, torakal manyetik rezonans anjiyografi ve bilgisayarlý tomografisinde transeksiyon ve inen aortada anevrizmatik geniþleme saptandý. Cerrahi tedavide Dakron greft interpozisyonu yapýldý. Ameliyattan sonra hastanýn yakýnmalarý ve bulgularý dramatik olarak geriledi. Künt travmalardan sonra geliþebilen AT, yaþamý tehdit eden ve mutlaka araþtýrýlmasý gereken bir tablodur.

Missed vascular injuries following blunt traumas can lead to fatal clinical conditions that require an emergency intervention. Aortic transection (AT) is the most fatal complication of these missed vascular injuries. In this case report an AT that developed following a blunt trauma is presented. The patient was admitted with effort dyspnea and tachycardia. He had a history of blunt trauma three years ago. There was an enlargement of the upper mediastinum on X-ray studies. Thoracal magnetic resonance imaging and computed tomography revealed aneursym of the descending aorta. Dacron graft interposition was performed as surgical treatment. The symptom and signs disappeared dramatically after the operation.

Servikal ve torakal vertebralarýn izole spinöz proses kýrýklarý, Clay-shoveler kýrýðý olarak adlandýrýlýrlar. Bu yazýda, servikal omurgada çoklu izole spinöz proses kýrýðý olan 32 yaþýnda erkek hasta rapor edilmiþtir. Olguya boyunluk ile konservatif tedavi uygulanmýþtýr. Bu tip kýrýklar, daha ciddi omurga yaralanmalarýnýn uyarýcýsý olabilir.

Fractures of isolated spinous processes of cervical and thoracic vertebrae are called as Clay shoveler’s fracture. In this report, a case of 32-year-old male with multiple isolated spinous process fracture of cervical spine is reported. The patient treated conservatively with a cervical collar. These fractures may be a warning sign of more severe spinal injuries.

Anterior longitudinal ligament perforation and abdominal vascular injury is one of the most critical complications that may develop during lumbar disc surgery. The vascular injury-related symptoms that warns the surgeon may be late to appear; they usually turn out to be mortal. The hypotension during the operation, tachycardia and pulsatile unstoppable hemorrhage observed in the disc space are the major findings. Urgent detection of this complication and the repair of the vascular injury prevent the case from turning out to be fatal. In the present study, three patients who underwent surgical treatment of abdominal vascular injuries that had developed during lumbar disc surgery, were presented.

Lomber disk hernisinin cerrahi tedavisi sýrasýnda anterior longitüdinal ligamanýn perforasyonu ve abdominal vasküler yaralanma, oluþabilecek en ciddi komplikasyonlardan biridir. Cerrahý uyaran vasküler hasara ait belirtiler gecikebilir ve genellikle ölümcül seyreder. Ameliyat sýrasýnda geliþen hipotansiyon, taþikardi ve disk mesafesinde görülen pulsatil, durdurulamayan kanama belirgin bulgulardýr.
Bu yazýda lomber disk cerrahisi sýrasýnda abdominal vasküler hasar geliþen ve vasküler cerrahiyle tedavi edilmiþ üç olgu sunuldu.