Travma hastalarýnda ikinci darbenin oluþmasý enflamatuvar yanýtýn þiddetlenmesine ve çoklu organ geliþmesine neden olmaktadýr. Yanýk hasarý sonrasý oluþan enfeksiyon iki darbeli travma çalýþmalarý için uygun bir modeldir. Bu çalýþmada, ardýþýk yanýk ve sepsisten oluþan iki darbeli travma modelinde N-asetilsistein’in (NAS) etkinliði araþtýrýldý. GEREÇ VE YÖNTEM: Kýrk beþ sýçanda %30’luk oranda haþlanma yanýðý oluþturulduktan 72 saat sonra çekal baðlama ve delme yöntemi ile peritonit oluþturuldu. Grup I’de herhangi bir tedavi uygulanmadý. Grup II’deki sýçanlara peritonit sonrasýnda 150 mg/kg/gün dozunda intraperitoneal NAS tedavisi verildi. Grup III’e yanýk sonrasý 6 gün boyunca 150 mg/kg/gün dozunda NAS tedavisi uygulandý. Yedinci gün doku malondialdehit (MDA) ve glutatyon (GHS) düzeylerinin tayini ve histopatolojik hasarýn deðerlendirilmesi için örnekler toplandý. BULGULAR: Gruplar arasýnda mortalite farký yoktu. Tedavi gruplarýnda karaciðer ve ileum doku MDA düzeylerinde anlamlý azalma (p=0,01, p=0,02) saptandý. Grup II’de akciðer GSH düzeylerinin anlamlý olarak arttýðý (p=0,02) ve akciðer dokusunda histopatolojik hasar skorunun azaldýðý saptandý (p=0,005). SONUÇ: N-asetilsistein tedavisi çalýþýlan iki darbeli travma modelinde doku oksidatif stres düzeyini ve uzak organ hasarýný hafifletmiþtir. Bu konuda daha ileri deneysel ve klinik çalýþmalara ihtiyaç vardýr.

BACKGROUND: The second hit in trauma leads to an exaggerated inflammatory response and multiple organ failure. Infection following burn injury is a useful model for two-hit trauma studies. The aim of this study was to investigate the effect of N-acetylcysteine (NAC) treatment as an antioxidant in a two-hit trauma model. METHODS: 30% scalding burn injury was performed in 45 rats and cecal ligation-puncture (CLP) was performed 72 hours later. Groups were allocated as follows: Group I: No treatment was performed; Group II: Rats were treated with 150 mg/kg/day i.p. NAC for 72 h following CLP; Group III: Rats were treated with 150 mg/kg/day i.p. NAC for 6 days following thermal injury. Tissue samples were collected to study the tissue malonyldialdehyde (MDA) and glutathione (GSH) levels, and for histopathological examination on day 7.
RESULTS: No difference in mortality between groups was detected. Tissue MDA levels significantly decreased in the liver (p=0.01, p=0.02) and ileum (p=0.01, p=0.02) in the treatment groups. Lung tissue GSH levels were found to be significantly increased in Group II (p=0.02). Lung injury scores were decreased in Group II (p=0.005) compared to the control group. CONCLUSION: NAC attenuated tissue oxidative stress level and remote organ injury in two-hit trauma. Further experimental and clinical studies on this subject are necessary.

AMAÇ: Kontrolsüz kanamalar ölümlerin en sýk nedenlerindendir. Çalýþmada domuz femoral arteri yaralanmasý sonucu kan kaybýyla oluþan fizyolojik deðiþikliklere karþý zeolite mineralin (QC-ACS) etkisi deðerlendirildi. GEREÇ VE YÖNTEM: On altý domuz kullanýldý. Oblig bir kasýk kesisi sonrasýnda femoral arter bulunup 5 mm’lik kesi yapýldý. Denekler gruplara ayrýldý; altý domuzdan oluþan kontrol grubu’nda (KG) kanayan bölgeye gaz kompres konularak elle baský uygulandý. QC uygulanan gruptaki 10 domuzda ise kanayan alana doðrudan QC yerleþtirildi ve elle baský uygulandý. Çalýþma sürecinde ortalama arteriyel basýnç, kan kaybý ölçümleri gerçekleþtirildi. Histolojik inceleme için örnekler alýndý. BULGULAR: QC uygulanýmý sonrasýnda kan basýncýnda düþüþün tedricen azaldýðý saptandý. 60. dk’dan sonra serum laktat düzeyinde KG’ye göre anlamlý þekilde yükselme saptandý. Protrombin zamaný KG için 60 dk’da anlamlý uzamýþ bulundu. QC uygulamasýnýn kan kaybýný durduramadýðý ancak azalttýðý saptandý. Hematokrit deðerleri, QC uygulanan grupta KG’ye göre daha anlamlý idi. QC uygulamasý sonrasýnda ortaya çýkan yüksek ýsýya baðlý histopatolojik deðerlendirme sonucunda özellikle nöral dokuda orta derecede ödem ve vakuolar deðiþiklikler saptandý. SONUÇ: Çalýþmadaki fizyolojik parametreler deðerlendirildiðinde; zeolitin kanamaya baðlý kan kaybýný azaltma eðilimi gösterdiði ancak tam olarak durduramadýðý saptandý. Bu tür deneysel çalýþma sonuçlarýnýn rutin kullanýma sokulabilmesi için klinik çalýþmalarla desteklenmesi gerektiði kanýsýndayýz.

BACKGROUND: Uncontrolled hemorrhage is the leading cause of fatality. The aim of this study was to evaluate the effect of zeolite mineral (QuikClot - Advanced Clotting Sponge [QC-ACS]) on blood loss and physiological variables in a swine extremity arterial injury model. METHODS: Sixteen swine were used. Oblique groin incision was created and a 5 mm incision was made. The animals were allocated to: control group (n: 6): Pressure dressing was applied with manual pressure over gauze sponge; or QC group (n: 10): QC was directly applied over lacerated femoral artery. Mean arterial pressure, blood loss and physiological parameters were measured during the study period.
RESULTS: Application of QC led to a slower drop in blood pressure. The control group had a significantly higher increase in lactate within 60 minutes. The mean prothrombin time in the control group was significantly increased at 60 minutes. The application of QC led to decreased total blood loss. The QC group had significantly higher hematocrit levels. QC application generated a significant heat production. There were mild edematous and vacuolar changes in nerve samples. CONCLUSION: According to the physiological parameters, we observed that zeolite tends to reduce blood loss, however could not stop bleeding completely. We believe that further clinical trials are needed to conclude that zeolite could be used in the routine practice.

AMAÇ: Organ yetersizliðini öngören mikroalbüminüri, muhtemelen mekanik ventilasyon gereksinimi ile birlikte mekanik ventilasyon süresini de öngörmektedir. Bu çalýþmanýn baþlýca amacý, travma yoðun bakým ünitesi hastalarýnda mikroalbüminüri ile mekanik ventilasyon süresi arasýndaki bir iliþkinin varlýðýný ve insidansýný belirlemek olmuþtur.
GEREÇ-YÖNTEM: Bu gözlemsel çalýþmada, 60 kritik travma hastasý, mekanik ventilasyon süresine göre grup A (≤7 gün) ve grup B (>7 gün) olarak iki gruba ayrýldý. Yoðun bakým ünitesine kabul edilme sýrasýnda (ACR-1), yatýrýldýktan sonraki 24., 72. ve 120. saatler ile mekanik ventilasyonun baþladýðý ve kesildiði günlerde (sýrasýyla, ACR-2 ve ACR-3) seri spot idrar mikroalbümin-kreatinin oranlarý (ACR) ölçüldü. BULGULAR: Yoðun bakým ünitesine kabul edilme sýrasýnda, hastalarýn %70’i mikroalbüminüriye ve %63,3’ü de ≥100 mg g-1 seviyesinde bir ACR deðerine sahip oldu. Sýrasýyla A ve B grubu hastalarda ACR-1 [ortalama (SE)] 30 (6) ve 63 (16) mg g-1 (p=0,0002); ACR-2, 40 (4) ve 52 (8) (p=0.007); ACR-3 de 30 (11) ve 44 (11) (p=0,023) oldu. Bütün hastalar için ortalama (SE) ACR-2, mekanik ventilasyonun kesildiði gün 37 (4) mg g-1 seviyesinden 34 (8) mg g-1 seviyesine düþtü (p<0,01). SONUÇ: ACR, kritik travma hastalarýnýn yoðun bakým ünitesine kabul edildiði ilk günde bile uzamýþ mekanik ventilasyon riskinin tahmin edilmesinde kullanýlabilir.

BACKGROUND: Microalbuminuria, which predicts organ failure, probably predicts the necessity of mechanical ventilation as well as its duration. The primary goal of this study was to determine the incidence and presence of a relationship between microalbuminuria and duration of mechanical ventilation in trauma intensive care unit (ICU) patients.
METHODS: Sixty admitted critically ill trauma patients were categorized by duration of mechanical ventilation to group A (≤7 days) or group B (>7 days) in this prospective observational study. We measured serial spot urine micro-albumin-creatinine ratios (ACR) on admission to the ICU (ACR-1), at 24, 72, and 120 hours after admission, and on the days of beginning and discontinuation of mechanical ventilation (ACR-2 and ACR-3, respectively). RESULTS: Seventy percent of the patients had microalbuminuria and 63.3% had an ACR ≥100 mg g-1 at admission. ACR-1 [mean (SE)] in patient groups A and B was 30 (6) and 63 (16) mg g-1 (p=0.0002); ACR-2 was 40 (4) and 52 (8) (p=0.007); and ACR-3 was 30 (11) and 44 (11), respectively (p=0.023). For all patients, mean (SE) ACR-2 fell from 37 (4) to 34 (8) mg g-1 on the day of discontinuation of mechanical ventilation (p<0.01). CONCLUSION: The ACR can be used in estimating the risk of prolonged mechanical ventilation, even on the first day of admission of critically ill trauma patients.

Heterojen nüfustan elde edilen POSSUM (The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) skorlama sistemi, bir denetim gereci olarak baþarýyla kullanýlmýþ ancak düþük risk gruplarýnda, mortaliteyi olduðundan daha fazla öngörür gibi görünmüþ ve bu nedenle de bu grup hastalar için alternatif olan P-POSSUM (Portsmouth predictor equation for mortality) skorlama sistemi tasarlanarak baþarýyla kullanýlmýþtýr. Bu prospektif çalýþmada, üçüncü basamak bir hastanede acil laparotomi uygulanan hastalarda bu iki denklem, ölümü öngörmede karþýlaþtýrýldý ve bunlarýn morbidite ile mortaliteyi öngörme geçerliliði test edildi. GEREÇ-YÖNTEM: Bu çalýþmaya acil laparotomi uygulanan 82 hasta kaydedildi. Gerçek morbidite ve mortalite oranlarý, lineer regresyon ve eksponansiyel analiz yöntemleri yoluyla POSSUM ve P-POSSUM denklemleri kullanýlarak, öngörülen mortalite ve morbidite oranlarý ile karþýlaþtýrýldý.
BULGULAR: POSSUM denklemi lineer regresyon analizi kullanýldýðýnda mortalite ve morbidite oranýný anlamlý þekilde olduðundan fazla öngördüyse de eksponansiyel analiz yöntemi kullanýldýðýnda baþarýlý bir þekilde öngördü. P-POSSUM ile mortalitenin öngörülmesi, lineer regresyon ve eksponansiyel analiz yöntemi kullanýldýðýnda iyi sonuç verdi; bununla beraber eksponansiyel analiz yöntemi lineer regresyon analizinden daha iyi sonuç verdi. SONUÇ: P-POSSUM skorlama sistemi mortaliteyi öngörmede POSSUM skorlama sisteminden daha iyi sonuç vermektedir; eksponansiyel yöntem ise lineer regresyon analizinden daha iyidir. Her iki denklem de acil laparotomi uygulanan hastalarýn riske dayalý cerrahi denetimi bakýmýndan yararlý gereçlerdir.

BACKGROUND: The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) scoring system, derived from a heterogeneous population, has been used successfully as an audit tool, but it has appeared to over-predict mortality in low-risk groups for which an alternative system, the Portsmouth predictor equation for mortality (P-POSSUM) was designed and used successfully. In this prospective study, we compared these two equations in predicting death and tested their validity in predicting morbidity and mortality in patients undergoing emergency laparotomy in a tertiary hospital. METHODS: Eighty-two patients who underwent emergency laparotomy were included in this study. Actual morbidity and mortality rates were compared with the predicted mortality and morbidity rates using both POSSUM and P-POSSUM equations by linear regression and exponential methods of analysis.
RESULTS: POSSUM equation significantly over-predicted both morbidity and mortality when linear regression analysis was used, but predicted well when exponential analysis was used. Prediction of mortality by P-POSSUM was good using both linear and exponential analyses, and exponential method was better than linear regression analysis.
CONCLUSION: P-POSSUM is a better equation than POSSUM in predicting mortality, and exponential method is better than linear regression analysis. Both equations are useful tools for risk-adjusted surgical audit of patients undergoing emergency laparotomy.

AMAÇ: Bu prospektif çalýþmada, künt abdominal travmanýn neden olduðu böbrek yaralanmalarýnýn saptanmasýnda sonografinin doðruluðu deðerlendirildi. GEREÇ-YÖNTEM: Bu çalýþmaya, yakýn zamanlarda künt karýn travma öyküsü olan, hem sonografi hem de bilgisayarlý tomografi (BT) alacak kadar stabil durumda olan 164 hasta (131 erkek, 33 kadýn) dahil edildi. Olgularýn hepsi renal görüntüleme endikasyonunu kabul etti. Ultrason, bütün hastalarda ilk görüntüleme yöntemi olarak, simültane gri skala B-mod tarama ve renkli Doppler çalýþmasý þeklinde gerçekleþtirildi. Travmanýn neden olduðu böbrek yaralanmalarýnýn deðerlendirilmesinde BT’nin seçkin görüntüleme yöntemi olduðu göz önünde bulundurularak, sonografi bulgularý BT sonuçlarý ile karþýlaþtýrýldý. BULGULAR: Böbrek sonografisi ve BT taramasý için gönderilen 164 hastanýn 103’ünde (%63), BT görüntüleme ile böbrek yaralanmasý saptandý; 14 hastada (%13,5), bilateral böbrek yaralanmasý saptandý. Amerikan Travma Cerrahisi Birliði (AAST) tarafýndan önerilen grade sýnýflamasý göz önünde bulundurularak, böbrek yaralanmalarýnýn %57’si, %24’ü, %9,5’i, %6’sý ve %3,5’ine BT tarama ile sýrasýyla grade I, II, III, IV ve V olarak taný konuldu. Yüz altmýþ dört hastanýn 66’sýnda (%40) ultrason bulgularý, böbrek yaralanmalarýyla uyumlu bulundu. Bu hastalarda, internal ekojenite ile birlikte olan parankimal hematom, perinefrik hematom ve pelvokaliektazi en yaygýn ultrason bulgularý idi. Böbrek yaralanmalarýnýn saptanmasýnda sonografinin genel duyarlýlýðý ve özgüllüðü, 0,8’lik bir pozitif öngörme deðeri, 0,57’lik bir negatif öngörme deðeri ve %79’luk bir genel doðrulukla birlikte sýrasýyla %48 ve %96 olarak bulundu. SONUÇ: Travmalý olgularýn deðerlendirilmesinde sonografinin kullanýlabilirliði ve uygulanmasýnýn kolay olmasýna karþýn, bu görüntüleme yöntemi, böbrek yaralanmalarýnýn saptanmasýnda düþük duyarlýlýða sahiptir ve önemli hasarlarý gözden kaçýrýr. BT görüntüleme, hemodinamik olarak stabil olan ve böbrek görüntülemesi bakýmýndan açýk endikasyonu bulunan böbrek travmalý kiþilerde taný yöntemi olarak göz önünde bulundurulmalýdýr.

BACKGROUND: This prospective study was conducted to evaluate the accuracy of sonography in detection of renal injuries caused by blunt abdominal trauma. METHODS: One hundred sixty-four patients (131 M, 33 F) with a history of recent blunt abdominal trauma who were stable enough to undergo both sonography and CT scan were included in this study. All of the cases had accepted indications for renal imaging. Ultrasound, as simultaneous gray scale B-mode scan and color-Doppler study, was achieved in all of the patients as the first imaging modality. Considering CT scan as the imaging modality of choice in evaluation of renal injuries caused by trauma, sonography findings were compared with CT scan results. RESULTS: Of the 164 patients referred for kidney sonography and CT scan, renal damage was detected in 103 cases by CT scan (63%). In 14 patients (13.5%), bilateral renal injuries were identified. Considering grading classification proposed by the American Association for the Surgery of Trauma (AAST), 57%, 24%, 9.5%, 6% and 3.5% of renal injuries were diagnosed as grade I, II, III, IV and V, respectively, by CT scan. Of the 164 patients, ultrasound results were consistent with renal damages in 66 cases (40%). Of these patients, signs of parenchymal hematoma, perinephric hematoma and pelvocaliectasis associated with internal echogenicity were the most prevalent ultrasound findings. Overall sensitivity and specificity of sonography in detection of renal injures were 48% and 96%, respectively, with a 0.8 positive predictive value, a 0.57 negative predictive value and an overall accuracy of 79%. CONCLUSION: In spite of the availability and ease of performance of sonography in evaluation of trauma victims, this imaging modality has low sensitivity in detection of renal injuries and overlooks significant damages. CT scan should be considered as the diagnostic modality in victims of kidney trauma who are hemodynamically stable and have clear indications for renal imaging.

AMAÇ: Nörotravma merkezleri, literatür analizi ve kendi deneyimlerinden elde edilen kanýt esasýna göre tedavi protokolleri geliþtirmiþtir. Bu yazýda, Bogota’nýn kuzey bölgesindeki kýrsal kesime yönelik bir travma merkezi olan Simòn Bolivar Hastanesi’ndeki ciddi travmatik beyin yaralanmasý (TBY) tedavisi ile ilgili kendi deneyimi gözden geçirildi. GEREÇ-YÖNTEM: Bu çalýþma, ciddi TBY’ye yönelik olarak Ocak 2002 ile Temmuz 2004 tarihleri arasýnda merkezin kendi protokolü gereði erken dekompresif kranyektomi (DK) uygulanan bir grup hastayý (n=16), böyle bir protokol uygulamaya sokulmadan önce tedavi edilen tarihi bir kontrol grubu (n=20) ile karþýlaþtýran bir olgu kontrol çalýþmasýdýr. Baþlýca sonuç deðiþkenleri olarak, altýncý aydaki mortalite ve Glasgow Sonuç Skoru (GOS) kullanýlmýþtýr. BULGULAR: Ciddi izole TBY’si olan 16 hastada uygulanan erken bir DK protokolü ile yaralanmadan itibaren 12 saatten daha kýsa bir süre içinde III ve IV arasýnda kalan bir Marshall skoru, tek baþýna ventrikülostomi ve Yoðun Bakým Ünitesi (YBÜ) tedavisi ile birlikte olan konvansiyonel yaklaþýma göre daha düþük bir mortaliteye neden olmuþtur. GOS, kontrol grubuna göre DK grubunda anlamlý þekilde daha iyi olmuþtur (p=0,0002). SONUÇ: Kolombiya Simòn Bolivar Hastanesinde, þiddetli TBY hastalarýna (Glasgow Koma Skalasý <9) yönelik olarak erken bir DK protokolünün kullanýlmasý, klinik sonuçlarý tek baþýna ventrikülostomi ve YBÜ tedavisi ile birlikte olan konvansiyonel yaklaþýma göre belirgin þekilde iyileþtirmiþtir.

BACKGROUND: Neurotrauma centers have developed management protocols on the basis of evidence obtained from literature analysis and institutional experience. This article reviews our institutional experience in the management of severe traumatic brain injury (TBI) at Simòn Bolivar Hospital, the district trauma center for Bogotá’s north zone.
METHODS: This is a case control study comparing a group of patients (n: 16) operated for severe TBI between January 2002 and July 2004 according to an institutional management protocol characterized by an early decompressive craniectomy (DC) approach versus a historical control group (n: 20) managed before the implementation of such protocol. Mortality and Glasgow Outcome Score (GOS) at 6 months were used as the main outcome variables. RESULTS: An early DC protocol implemented within 12 hours from injury in 16 patients with severe isolated TBI and a Marshall score between III or IV was associated with a lesser mortality than the conventional approach with ventriculostomy and Intensive Care Unit (ICU) management alone. The GOS was significantly better in the DC group (p=0.0002) than in the control group. CONCLUSION: The use of an early DC protocol for severe TBI patients (Glasgow Coma Scale <9) had a significantly improved outcome compared with the conventional approach with ventriculostomy and ICU management in Simòn Bolivar Hospital in Bogotá, Colombia.

AMAÇ: Aminoasit infüzyonu ile enerji tüketimi ve termojenezdeki artýþ arasýnda güçlü bir ilinti vardýr. Bu çalýþmada, yoðun bakýmda beyin ölümü tanýsý almýþ hastalarda termojenez ve enerji tüketimindeki artýþa aminoasit solüsyonlarýnýn etkisi araþtýrýldý.
GEREÇ-YÖNTEM: Çalýþmaya 26 beyin ölümü olgusu dahil edildi. Hastalara dört saat boyunca aminoasit solüsyonu verildi. Ýstirahat enerji tüketimleri endirekt kalorimetrik yöntemle ölçüldü. Ýstatistiksel analizler için ANOVA ve Bonferroni testleri kullanýldý.
BULGULAR: Yirmi dört hastada, tahmin edilen (hesaplanan) enerji tüketimi deðerleri (TET) ölçülen istirahat enerji tüketimi (ÝET) deðerlerinden daha yüksek bulundu. TET ile karþýlaþtýrýldýðýnda, tüm hastalarýn ortalama ÝET/TET deðerleri, ÝET’de %29 deðerinde bir azalma olduðunu gösterdi. Vücut ýsýsý ve enerji tüketimi deðerleri parenteral aminoasit infüzyonu sýrasýnda artmadý. Çalýþma boyunca herhangi bir zamanda, metabolik ölçümler ve baþlangýç deðerleri arasýnda istatistiksel herhangi bir fark bulunmadý. SONUÇ: Aminoasit solüsyonlarýnýn enerji tüketimi ve termojeneze olan uyarýcý etkilerinin beyin ölümü olgularýnda görülmediði (yok olduðu) kanýsýna varýldý. Bu sonuç, enerji tüketimi ve termojenezdeki artýþtan merkezi yollarýn sorumlu olabileceðini göstermektedir.

BACKGROUND: There is a strong correlation between amino acid infusion and increase in energy expenditure and thermogenesis. In this study, the effects of amino acid solutions on thermogenesis and energy expenditure were investigated in intensive care patients who were diagnosed as brain death. METHODS: Twenty-six brain-dead patients were included in the study. The patients received a 4 h infusion of standard amino acid solution. Energy expenditure was measured by indirect calorimetric method. ANOVA and Bonferroni tests were used for statistical analysis. RESULTS: The predicted energy expenditure (PEE) values were higher than the resting energy expenditure (REE) values in 24 patients. The mean REE/PEE value in all patients indicated that there was a 29% decrease in REE when compared to PEE. Body temperature and energy expenditure values were not increased during the parenteral infusion of amino acid solutions. There was no statistically significant difference between mean metabolic measurements and basal values at any time interval during the study period. CONCLUSION: We conclude that the stimulatory effect of amino acid solution on energy expenditure and thermogenesis is abolished in brain-dead patients. This result may indicate a possible central pathway responsible for the increase in energy expenditure and thermogenesis.

AMAÇ: Ýnce baðýrsak yaralanmalarýnda ek organ yaralanmasý varlýðýnýn komplikasyon ve mortalite üzerine etkileri deðerlendirildi. GEREÇ VE YÖNTEM: 2000-2005 yýllarý arasýnda kliniðimizde penetran karýn yaralanmasý sonucu ince baðýrsak yaralanmasý olan hastalar iki gruba ayrýlarak deðerlendirildi. Grup I’de izole ince baðýrsak yaralanmalarý, grup II’de diðer karýn organlarý ile birlikte ince baðýrsak yaralanmasý olan hastalar toplandý. Bu iki gruptaki hastalarýn verileri karþýlaþtýrýldý. BULGULAR: Yaþ ortalamasý 38,1±8,86 (daðýlým 17-53) olan 38 hastada (34E, 4K) ince baðýrsak yaralanmasý saptandý; olgularýn 20’si grup I’de, 18’i grup II’de yer aldý. Ýki grubun sýrasý ile PATI (penetrating abdominal trauma index) deðerleri 6,2±2,58, 17±6,36 idi, grup II’de anlamlý olarak daha yüksekti (p<0,001). Toplam komplikasyon oraný %23,68 bulundu; grup I’de %5, grup II’de %44,8 olup anlamlý olarak yüksekti (p<0,01). Yatýþ süresi grup II’de anlamlý olarak yüksekti (grup I: 5,95±4,63 gün, grup II: 9,38±3,8 gün) (p<0,01). Mortalite oraný %2,63 olup, ince baðýrsak yaralanmasýna baðlý deðildi. SONUÇ: Ýzole ince baðýrsak yaralanmalarý düþük komplikasyon oranlarý ile tedavi edilebilir. Ýnce baðýrsak yaralanmalarýnda ek organ yaralanmasýnýn varlýðý komplikasyon geliþimini arttýrmaktadýr. Yaralanma Þiddeti Ölçeði (ISS) ve PATI skorlarý komplikasyon geliþimi riskini tahmin etmede kullanýlabilir.

BACKGROUND: We aimed to evaluate the effects on morbidity and mortality of additional organ injuries obtained concurrently with penetrating small bowel injuries. METHODS: Between January 2000 and March 2005, patients in whom penetrating small bowel injuries occurred as a result of abdominal injuries were allocated into two groups and assessed. The first group included patients with isolated small bowel injuries, while those in the second group had small bowel injuries together with other intra-abdominal organ injuries. RESULTS: Small bowel injury was identified in 38 patients (34 M, 4 F) with an average age 38.1±8.86 (17-53) years (Group I: 20 patients; Group II: 18 patients). The PATI (penetrating abdominal trauma index) values of the first and second groups were 6.2±2.58 and 17±6.36, respectively, and the difference was statistically significant (p<0.001). Complication rates were 23.68% for the whole group, 5% in group I and 44.8% in group II. The rate was significantly higher in group II (p<0.01). Mortality was 2.63% and it was not related to intestinal injury. CONCLUSION: Isolated penetrating small bowel injuries are amenable to treatment with lower complication rates. Additional organ injury increases the development of complications. Injury severity score (ISS) and PATI may be useful for estimating the risk of development of complications.

AMAÇ: Bu çalýþmada, sekonder peritonitli hastalarýn tedavisinde, Bogota bag ile geçici karýn kapatmanýn etkinliði ve sað kalýmdaki risk faktörleri deðerlendirildi.
GEREÇ-YÖNTEM: Sekonder peritonit nedeniyle Bogota bag kullanýlarak geçici olarak karýn kapatýlmasý uygulanan 37 hasta (22 erkek, 15 kadýn; ort. yaþ 63,5; daðýlým 44-83) ele alýndý. Hastalýðýn þiddetinin belirlenmesinde Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Mannheim Peritonit Ýndeksi (MPI) skorlarý kullanýldý. APACHE II’nin sonuçlarý ve etkililiði ve MPI deðerleri, geriye dönük olarak deðerlendirildi.
BULGULAR: Mortalite oraný %43,2 olarak belirlendi. Yaþayan ve hayatýný kaybeden hastalarýn, baþvuru APACHE II (r=0,81, p=0,001) ve MPI (r=0,39, p=0,02) skorlarý ve ameliyat sayýlarý (1,6’ya karþýn 4,7 ameliyat) arasýnda yaþayanlarýn lehine anlamlý fark saptandý. Beþ hastada laparostomi primer olarak kapatýlýrken, yaþayan diðer hastalar sekonder iyileþmeye býrakýldý. SONUÇ: Sekonder peritonitli hastalarda Bogota bag ile geçici karýn kapatýlmasý, ucuz ve basit bir yöntem olup, þeffaflýðýyla altýndaki organlarýn ve enfeksiyonun gözlenmesine olanak saðlar. Yüksek APACHE II ve MPI skorlarý ve fazla sayýda relaparotomi uygulanmasý, daha yüksek mortalite oraný ile sonuçlanmaktadýr.

BACKGROUND: The aim of this study was to evaluate the effectiveness of laparostomy with the Bogota bag for the management of patients with severe secondary peritonitis and the risk factors for survival. METHODS: Thirty-seven patients (22 males, 15 females; mean age 63.5; range 44 to 83 years) with secondary peritonitis were treated by laparostomy and temporary closure with Bogota bag. APACHE II scores and Mannheim Peritonitis Index (MPI) were used to calculate the disease severity. The outcomes and effectiveness of APACHE II and MPI values were analyzed retrospectively. RESULTS: The mortality rate was 43.2%. Significant differences were noted between survivors and non-survivors according to initial APACHE II and MPI scores and the number of operations. The non-survivors had higher APACHE II (r=0.81, p=0.001) and MPI (r=0.39, p=0.02) scores. The patients who survived were re-operated 1.6 times and those who died were re-operated 4.7 times. In five patients, laparostomy was closed primarily, while in the others, the wound was left open to heal secondarily. CONCLUSION: Patients with higher APACHE II and MPI scores and number of operations had higher rates of mortality due to their major risk factors. Temporary abdominal closure using the Bogota bag in patients with secondary peritonitis is an inexpensive-simple method, permitting evaluation of underlying viscera and recognition of infection.

AMAÇ: Geniþ alanlý yanýklarý olan hastalarda, yanýk olmayan bütün deri kýsýmlarý donör alaný olarak kullanýlabilir. Donör saha problemlerini engellemek için, sünnet derisi kullanýmý düþük yanýk yüzdesi olan hastalarda iyi bir seçenek olabilir. GEREÇ-YÖNTEM: Ocak 1997 ile Aðustos 2007 tarihleri arasýnda yanýk merkezimizde tedavi edilen ve greft uygulanan 12 hasta geriye dönük olarak deðerlendirildi. BULGULAR: Sünnet derisi üç hastada tek baþýna, dokuz hastada diðer donör alanlardan alýnan greftlerle birlikte greft olarak kullanýldý. Ýki hastada sünnet derisi hiperpigmentasyonla sonuçlanan iyileþmenin tercih edildiði periareolar bölgede, diðer hastalarda vücudun farklý bölgelerinde kullanýldý. Sünnet derisi grefti için baþarý oraný %100 idi. Donör alan morbiditesi gözlenmedi. SONUÇ: Sünnet derisi oldukça esnek ve alýnmasý kolay olan tam kat bir grefttir. Greft ihtiyacý olan bütün erkek yanýklý çocuklarda uygulanmasý düþünülmelidir.

BACKGROUND: In patients with extensive burns, all unburned areas can be used as donor sites. In male patients with small burns, preputial skin graft may be a good choice in order to avoid donor site problems. METHODS: We retrospectively reviewed 12 patients treated in our burn center from January 1997 to August 2007 with preputial skin grafting. RESULTS: In three patients, preputial skin was the only graft source. In nine patients, other donor sites were also used for split-thickness graft harvesting. In two patients, preputial skin graft was used for periareolar grafting where hyperpigmented healing was preferred. In the rest of the patients, preputial skin graft was used on various parts of the body. Overall success rate for preputial skin graft was 100%. There was no early donor site morbidity. CONCLUSION: Preputial skin is a full-thickness, highly elastic and easy-to-harvest graft that should be considered in all burned male children in whom grafting is needed.

AMAÇ: Bu çalýþmada, erken laparoskopik kolesistektomi (LK) ile tedavi edilen akut kolesistitli (AK) hastalarýn klinik sonuçlarý deðerlendirildi. GEREÇ VE YÖNTEM: Selçuk Üniversitesi Meram Týp Fakültesi’nde Ocak 1994 ile Aralýk 2006 yýllarý arasýnda 3876 hastaya LK yapýldý. Bunlardan 182 hastaya (101 kadýn, 81 erkek) semptomlarýn baþlamasýndan itibaren ilk üç gün içinde kolesistektomi uygulandý. Hastalarýn dosyalarý klinik, biyokimyasal, radyolojik ve ameliyat bulgularý, ameliyat sonrasý komplikasyon ve morbiditeye etkisini saptamak için geriye dönük olarak deðerlendirildi.
BULGULAR: Akut kolesistli olgularda açýða geçme oraný 31 (%17,03) idi. Ameliyat sonrasý hastanede kalýþ süresi baþarýlý LK grubunda 4, açýk kolesistektomiye geçilen grupta 7 gün olarak saptandý. Laparoskopik tamamlanan ve açýða geçilen kolesistektomi gruplarý arasýnda hastanede yatýþ süresi ve safra kesesi duvar kalýnlýðý yönünden istatistiksel olarak anlamlý fark bulundu. Çalýþmamýzda açýða geçme ile ilgili faktörler; erkek cinsiyeti, ultrasonografide perikolesistik sývý gözlenmesi, gangrenöz tip kolesistit ve safra kesesi duvar kalýnlýðýnýn 1 cm ve üzerinde olmasý idi. SONUÇ: LK, seçilmiþ AK’li hastalarda güvenli bir yaklaþýmdýr. Erkek cinsiyeti, ultrasonografide perikolesistik sývý gözlenmesi, gangrenöz kolesistitler ve safra kesesi duvar kalýnlýðýnýn 1 cm ve üzerinde olmasý yüksek açýk cerrahiye dönme riski ile beraberdir.

BACKGROUND: The aim of this study was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS: Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS: The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION: LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

AMAÇ: Tüm ölümlerin yaklaþýk %14’ünden sorumlu olan travmalarýn %10’u genitoüriner sistemi etkilemektedir. Bu çalýþmada, kliniðimizde genitoüriner travma nedeni ile yatýrýlarak takip edilen hastalar geriye dönük olarak deðerlendirildi. GEREÇ VE YÖNTEM: 2003-2007 tarihlerinde kliniðimize yatýrýlarak takip edilen genitoüriner travmalý olgular geriye dönük olarak incelendi. Toplam 108 hasta (92 erkek, 16 kadýn; ort. yaþ 35,8±17,5; daðýlým 6-87) yaþ, cinsiyet, travmanýn meydana geliþ tipi, etkilenen organ türü, travma evrelemesi, eþlik eden diðer organ yaralanmalarý, radyolojik görüntüleme yöntemleri ve uygulanan tedavi yöntemleri deðerlendirildi. BULGULAR: Olgularýn 68’inin (%63) künt, 25’inin (%24) penetran, 12’sinin (%11) iyatrojenik travmaya ve 3’ünün (%3) spontan organ yaralanmasýna maruz kaldýðý saptandý; 34’ünde (%32) böbrek, 11’inde (%10) üreter, 18’inde (%17) mesane, 27’sinde (%25) üretra, 6’sýnda (%6) testis ve 12’sinde (%10) penis travmasý meydana geldiði görüldü. Böbrek travmalý olgular incelendiðinde, 17’sinde (%50) evre 3, 11’inde (%32) evre 4, 6’sýnda (%18) evre 5 böbrek hasarý saptandý; bu olgularýn 6’sý (%18) ameliyat edildi. SONUÇ: Travmanýn oluþ biçimi ve derecesi açýsýndan sonuçlarýmýz literatür bilgisi ile paralellik göstermektedir. Ülkemizde ürogenital travma oranlarýyla ilgili yeterli bilgi bulunmamasý nedeniyle, referans merkezlerinin travma kayýt bilgilerini derleyip yayýnlamasýnda yarar olduðu düþünülmüþtür.

BACKGROUND: Ten percent of all traumas, responsible for 14% of all deaths, involve the urogenital system. We retrospectively evaluated the patients with genitourinary trauma who underwent any kind of management modality in our clinics. METHODS: We retrospectively evaluated 108 patients (92 males, 16 females; mean age 35.8±17.5 years; range 6 to 87 years) with urogenital trauma between 2003 and 2007 according to age, gender, type of trauma, affected organ, grade of trauma, accompanying other-organ injuries, radiological imaging techniques, and treatment. RESULTS: Sixty-eight patients (63%) had blunt, 25 (24%) had penetrating, and 12 (11%) had iatrogenic trauma, and 3 patients (3%) had spontaneous organ injury. When we considered the affected organ, renal trauma was determined in 34 patients (32%), ureteral trauma in 11 (10%), bladder injuries in 18 (17%), urethral trauma in 27 (25%), testicular trauma in 6 (6%), and penile trauma in 12 (10%) patients. Seventeen patients (50%) had grade 3, 11 (32%) had grade 4 and 6 (18%) had grade 5 renal injury; 6 patients of these cases underwent surgical treatment. CONCLUSION: Our results were parallel to those available in the literature. Due to the lack of sufficient information about urogenital trauma rates in our country, it would be highly useful for reference centers to evaluate and publish their own data.

AMAÇ: Travmatik diyafram yýrtýðý (DY) olgularý deðerlendirildi; taný zorluðu ve tanýdaki gecikmenin önemi vurgulandý, tedavi yöntemi ve sonuçlarý irdelendi. GEREÇ VE YÖNTEM: Cerrahi uygulanan travmatik DY’li 13 hasta (11 erkek, 2 kadýn; ort. yaþ 34,6; daðýlým 7-52 yaþ) demografik özellikler, travma þekli ve zamaný, bulgular, taný yöntemleri, yerleþim, cerrahi tedavi, morbidite ve mortalite yönünden deðerlendirildi. BULGULAR: Travma, olgularýn sekizinde (%61,6) künt, beþinde (%38,4) penetran þekildeydi. Radyolojik olarak 11 olguda karýn içi organlarýn toraks içine doðru yer deðiþtirdiði saptandý. Taný konma süresi altý olguda (%46,1) 2-20 yýl arasýnda deðiþiyordu. Bunlarýn üçü penetran, üçü künt travma grubundaydý. Üç olguda ek organ yaralanmalarý nedeniyle baþka bir merkezde yapýlan torakotomi ve laparotomiye raðmen taný atlanmýþtý. Yýrtýk yeri 12 olguda sol, bir olguda sað hemidiyaframdaydý. Tüm olgulara torakotomi ile yaklaþýlarak primer onarým yapýldý. Ameliyat sonrasý bir olguda morbidite geliþirken, mortalite izlenmedi. SONUÇ: Travmalý hastada akut dönemde kolaylýkla atlanabilmesi nedeniyle DY þüphesi akýlda tutulmalý, eþlik eden patolojiler nedeniyle yapýlan torakotomi ve laparotomilerde diyafram dikkatli þekilde incelenmelidir. Gecikmiþ taný morbidite ve mortaliteyi arttýracaktýr.

BACKGROUND: We aimed to emphasize the importance of delay in diagnosis of traumatic diaphragmatic ruptures and to investigate the results of treatment methods. METHODS: The records of 13 patients (11 males, 2 females; mean age 34.6; range 7 to 52 years) with traumatic diaphragmatic ruptures were evaluated with respect to demographic data, type and time of trauma, symptoms, diagnostic methods, localization, surgical therapy, morbidity and mortality. RESULTS:
Blunt trauma was present in 8 cases (61.6%) and penetrating trauma in 5. Migration of abdominal organs into hemithorax was detected in 11 cases radiologically. The duration between diagnosis and the event was 2-20 years in 6 patients (46.1%). Three of them were penetrating and 3 were blunt trauma. In 3 cases, diagnosis had been overlooked despite exploratory thoracotomy and laparotomy in another center. Right hemi-diaphragm was injured in 1 patient and the left in 12 cases. Primary repair through posterolateral thoracotomy was performed in all cases. Morbidity occurred in 1 patient. No mortality was observed. CONCLUSION: Diaphragmatic ruptures should be remembered in trauma cases because of the probability of their being missed, and ruptures should be explored during thoracotomy or laparotomy performed for other organ injuries. Delayed diagnosis will increase morbidity and mortality.

AMAÇ: Bu çalýþmada, skorlama sistemlerinden Ohmann ve Eskelinen skorlarý, lökosit sayýsý ve ultrasonografinin (USG) akut apandisit tanýsýndaki yeri saptanmaya çalýþýldý. GEREÇ VE YÖNTEM: 01.05.2004-01.09.2005 tarihleri arasýnda akut apandisit ön tanýsý ile ameliyat edilen 186 hasta (105 erkek, 81 kadýn; ort. yaþ 29,94±12,70; daðýlým 6-70), geriye dönük olarak tarandý; Ohmann, Eskelinen skorlarý, lökosit sayýsý ve USG’nin tanýdaki önemi ve cinsiyetler arasýnda fark olup olmadýðý saptanmaya çalýþýldý. BULGULAR: Ohmann ve Eskelinen skorlarý deðerlendirildiðinde, genel hasta grubunda ve kadýn hastalarda apandisit olan ve olmayanlar arasýnda anlamlý fark saptandý (tüm gruplar için p=0,01); erkek hastalar için apandisit olan ve olmayanlar arasýnda fark saptanmadý (sýrasý ile p=0,341 ve p=0,217). Lökosit sayýsýnda artýþ ve USG deðerlendirilmesine bakýldýðýnda, kadýn hastalarda apandisit olan ve olmayanlar arasýnda lökosit sayýsýnda artýþ ve pozitif USG bulgusu arasýnda anlamlý fark saptandý (sýrasý ile p=0,001 ve p=0,001); erkek hastalarda anlamlý fark saptanmadý (sýrasý ile p=0,480 ve p=0,732). SONUÇ: Ohmann ve Eskelinen gibi skorlama sistemlerinin apandisit tanýsýnda veya tanýdan uzaklaþmak için kullanýlmasý, özellikle birinci basamak saðlýk hizmeti verilen ünitelerde kullanýlabilir. Apandisit tanýsýnýn güç olduðu özellikle üreme çaðýndaki kadýnlarda ise lökosit sayýsýndaki artýþýn tek baþýna belirleyici olabileceði ve USG’nin de ayýrýcý tanýda deðerli olduðu düþüncesindeyiz.

BACKGROUND: The purpose of this study was to demonstrate the diagnostic value of Ohmann and Eskelinen scores, leukocyte count and ultrasonographic (USG) evaluations in acute appendicitis. METHODS: This is a retrospective presentation of 186 patients (105 males, 81 females; mean age 29.94±12.70; range 6 to 70 years) operated with the diagnosis of acute appendicitis between May 1, 2004 and January 1, 2005. The diagnostic value of Ohmann and Eskelinen scores, leukocyte counts, and USG evaluations and the differences between the sexes were studied. RESULTS: According to the evaluation of Ohmann and Eskelinen scores, there were significant differences in positive and negative appendectomy between the total patient population and female patients (p=0.01), but no significant difference was found for men (p=0.341 and p=0.217, respectively). The leukocyte count increase and USG evaluations also demonstrated significant differences between negative and positive appendectomy in female patients (p=0.001 and p=0.001, respectively). However, no significant differences in the leukocyte count increase and USG evaluations between positive and negative appendectomy were determined in male patients (p=0.480 and p=0.732, respectively). CONCLUSION: Ohmann and Eskelinen scores could be useful in definitive diagnosis of appendicitis especially in primary care units. The leukocyte count increase alone or with the help of USG evaluation could be helpful in the diagnosis of appendicitis especially in females during the reproductive period.

Toraks ve karýn bölgesinde, künt veya penetran travmalara baðlý olarak diyafram yýrtýðý meydana gelebilir. Belirgin iþaretleri, fiziksel inceleme bulgusu ve radyografik görüntüsü bulunmayan olgularda diyafram yýrtýðýnda taný kolaylýkla atlanabilir. Torako-abdominal bölge travmasý ile baþvuran hastalarda diyafram yýrtýðý olabileceði akla getirilmelidir. Taný konulamayan olgularda semptomlar geç dönem ortaya çýkabileceði gibi hiç bulgu vermeyebilir. Travmatik diyafram yýrtýðýnýn tedavisi cerrahidir. Bu yazýda, travmadan yýllar sonra tanýsý konan iki gecikmiþ diyafram yýrtýðý olgusu sunuldu.

Ruptured diaphragm as a result of blunt thorax or abdominal trauma can present acutely or late in the disease. Symptoms may be nonspecific and diagnosis can easily be missed. Patients may present with dyspnea, chest pain or cough. Chest radiograph, CT scan, and MRI are the primary diagnostic tools. Clinicians must have a high index of suspicion for prompt diagnosis, especially in patients with a history of trauma to the abdomen or thorax. The only treatment in diaphragm rupture is surgery. We report two cases of traumatic diaphragm ruptures presenting years after the trauma.

Glomus tümörleri genellikle ekstremitelerde görülen, selim seyirli yumuþak doku tümörleridir, gastrointestinal sistem (GÝS), ürogenital ve solunum sistemi gibi vücudun diðer kýsýmlarýnda daha seyrek rastlanýlýr. GÝS’de görülen glomus tümörlerinin çoðu midenin antrum kýsmýnda yerleþim gösterir. Çoðu küçüktür (genellikle <4 cm) ancak bazen daha büyük olabilir. Bu yazýda, 2 aydan beri aralýklý olarak bulantý, kusma, hematemez ve melena yakýnmalarý ile baþvuran 31 yaþýndaki kadýn hastada saptanan, bir mide glomus tümör olgusu sunuldu. Üst GÝS endoskopisinde prepilorik bölgede, üzeri ülsere, submukozal lezyon olarak taný konuldu. Hastaya, lezyonu içerecek tarzda parsiyel gastrektomi ameliyatý uygulandý. Glomus tümörünün tanýsý immünohistokimyasal deðerlendirme ile de teyit edildi. Glomus tümörü iyi huyludur ve radikal bir cerrahi prosedür gerektirmediðinden en önemli yaný histolojik tanýsýnýn konulmasý ve midenin sýk görülen diðer lezyonlarýndan özellikle de kötü huylu tümörlerinden ayýrt edilmesidir.

Glomus tumors are benign soft tissue neoplasms that usually arise in the skin of the extremities; however, those tumors are sometimes located in other sites such as gastrointestinal (GIS), respiratory, and genital tracts. Gastrointestinal glomus tumors are mostly located in the gastric antrum. The most are small (<4 cm), but a few can be enormous. Herein, we report a case of a glomus tumor of the stomach in a 31-year-old female patient who presented with intermittent nausea, vomiting, hematemesis and melena for 2 months. On upper GIS endoscopy, submucosal lesion with ulceration was found in the prepyloric area. Partial gastrectomy including the lesion was performed. Immunohistochemical examination showed the glomus tumor. Since the glomus tumor is essentially benign and does not need a radical surgical procedure, the most important aspect of this tumor is its histologic identification and differentiation from more common gastric lesions, especially from malignant tumors.

Ascaris lumbricoides dünyadaki en yaygýn helmintik hastalýklardan biri olup birçok komplikasyon oluþturabilir. Helmintin safra yollarý içinde varlýðýnýn gösterilmesi, özellikle çocuklarda, nadir bir durumdur. Bu yazýda, cerrahi akut karýn bulgularýna benzer þikayetlerle baþvuran ve safra yollarý içinde askaris helminti gösterilen bir olgu sunuldu. Ultrasonografik deðerlendirme ile tanýsý konan hastaya, tedavide mebendazol ve antispazmolitik verilerek tedavi saðlandý. Biliyer askariazis çocuk yaþ gurubu hastalar dahil olmak üzere endemik bölgelerden gelen hastalarda görülen akut karýn aðrýsý tablosunda ayýrýcý tanýda düþünülmelidir.

Ascaris lumbricoides is one of the most common helminthic diseases worldwide and it can cause various complications. The presence of this worm in the biliary tree, however, is a rare condition, especially in children. We describe a child with biliary ascariasis who was presenting clinical symptoms mimicking surgical acute abdomen. The diagnosis was made by ultrasound. The child was successfully treated with mebendazole and anti-spasmolytic. Biliary ascariasis should be added to the differential diagnosis of acute abdominal pain in patients, even in children, from endemic areas.

Delici ve kesici aletle olan penetran spinal kord yaralanmalarý seyrek görülür. Bu yaralanmalarda spinal kordun nöral elamanlarýnýn doðrudan hasarý, kord infarktý ve nadiren de intardural veya epidural hematoma olabilir. Bu yazýda, býçakla spinal kord ve L4 kök yaralanmasý olan iki olgu sunuldu. Birinci olgu 22 yaþýndaki erkek hasta, sýrt bölgesinin ortasýndan býçakla yaralanma þikayeti ile acil polikliniðimize baþvurdu. Nörolojik muayenesinde paraplejik olan hastanýn spinal MRG incelemesi ile T7-T8 seviyesinde total spinal kord lezyonu saptandý. Yara primer dikilmesine edilmesine raðmen, takibinde beyin omirilik sývýsý sýzýntýsýnýn olmasý nedeniyle ameliyata alýndý. Ameliyatta T7-T8 total laminektomi yapýlarak yýrtýlmýþ olan duramater primer olarak dikildi. Ýkinci hasta, belinde býçakla yaralanma sonrasý acil polikliniðimize baþvurdu. Hastanýn L3 seviyesindeki yara yerinde sap kýsmý kýrýlmýþ býçak 2-3 cm’lik derinlikte görüldü. Hasta acil olarak ameliyata alýnarak kýrýlan ve metalik kýsmý içeride kalmýþ olan býçak çýkartýdý.

Penetrating spinal cord injuries caused by stab wounds are rare. Such injuries may result from a direct lesion of the neural elements of the spinal cord, cord infarcts or, more rarely, intradural or epidural hematoma. In the present study, two cases with spinal cord and L4 root injuries caused by a knife are presented. The first case, a 22-year-old male, referred to our emergency outpatient clinic with a stab wound injury at the mid-section of his back. Neurological examination of this patient showed paraplegia, and spinal MRI displayed a total spinal cord lesion at the T7-T8 level. The wound was primarily sutured; however, during follow-up, CSF (cerebrospinal fluid) leakage continued and the patient was operated. The ruptured dura mater was primarily sutured in a surgical intervention that involved T7-T8 total laminectomy. The second patient referred to our emergency outpatient clinic with a torso injury caused by a sharp knife. The knife was embedded 2-3 cm deep at the wound site at the L3 level and the handle was broken. The patient was immediately operated and the broken and embedded metallic part of the knife was extracted.

Kronik subdural hematomun spontan rezolüsyonu literatürde nadir olarak bildirilmektedir. Bu yazýda, otuz beþ yaþýndaki bir erkek olgunun manyetik rezonans görüntüleme incelemesinde hacmi yaklaþýk olarak 76,5 ml ölçülen geniþ bir kronik subdural hematomun spontan rezolüsyonu sunuldu. Hastanýn nörolojik incelemesinde patolojik bulguya rastlanmadý, serebral anjiyografi ve EEG incelemeleri normal bulundu. Kronik subdural hematomlarýn fizyopatogenezindeki olasý mekanizmalar, spontan rezolüsyonu diðer literatür bilgileri eþliðinde tartýþýldý.

Spontaneous resolution of a chronic subdural hematoma has been reported rarely in the literature. We present herein the case of a 35-year-old patient with spontaneous resolution of a large chronic subdural hematoma, the volume of which was measured as approximately 76.5 ml on magnetic resonance imaging. No pathology was determined on neurological examination. Neither cerebral angiography nor EEG showed any abnormality. We discuss the possible relation between mechanisms of physio-pathogenesis and spontaneous resolution of chronic subdural hematomas, and also present the patient characteristics together with the other literature data.

Doðum travmasýna baðlý meydana gelen distal humerus epifiz ayrýlmasý oldukça seyrek görülen bir durumdur ve sýklýkla dirsek ekleminin arkaya çýkýðý ile karýþtýrýlýr. Acil týp ve ortopedi doktorlarý, yenidoðanlardaki dirsek travmalarýný deðerlendirirken distal humerus epifiz ayrýlmasý konusunda son derece dikkatli davranmalýdýrlar. Manyetik rezonans görüntüleme (MRG) ayýrýcý tanýda önemli yer tutar. Bu yazýda, yenidoðanda ultrasonografi ve MRG tekniklerinden yararlanarak distal humerus epifiz ayrýlmasýnýn tam olarak görüntülenmesi ve orta dönem cerrahi sonucunun verilmesi amaçlandý.

Traumatic separation of the distal humeral epiphysis during delivery is an uncommon injury in neonates and usually mimics elbow dislocation. Emergency medicine physicians and orthopedic surgeons must have a high index of suspicion for distal humeral epiphysis separation when evaluating elbow trauma in neonates. Magnetic resonance imaging (MRI) scan is an important diagnostic tool for this purpose. We report a case in which fracture-separation of the distal humeral epiphysis in a newborn was diagnosed with the help of ultrasonography and MRI scan, which provided a clear delineation of the injury.