AMAÇ: Periferik sinir yaralanmalarýnda tedavi, interfasiküler onarým beklentisiyle lezyon tipine odaklanýr. Sinir kesiðinin daha iyi veya daha hýzlý büyümesine yardým etmek üzere, bazýlarý da aþaðýda belirtilen deðiþik faktörle birlikte birçok deney gerçekleþtirilmiþtir: Sinir büyüme faktörü (NGF), plak büyüme faktörü (PGF) hiyalüronik asit, lösemi inhibitör faktör, GABA, vb. Glisin; beyin sapýnda ve spinal kordda görev yapan bir inhibitör nörotransmitter olup, ayný zamanda bir NMDA reseptör modülatörü olarak da önemli bir rol oynamaktadýr. Glisinin olasý rejeneratif etkisi, farklý uygulama zamanlarýnda araþtýrýldý ve sonuçlarý kontrol grubuyla karþýlaþtýrýldý. GEREÇ-YÖNTEM: Wistar cinsi sýçanlarýn siyatik sinirleri ortaya konuldu ve elektrofizyolojik iþlem gerçekleþtirildi: Sinir enine olarak kesildi ve kesik kýsýmlar dört adet izole temel 9/0 naylon dikiþ ile yeniden yerlerine dikildi. Çalýþma gruplarýna 15, 30 ve 60 gün süreyle, günlük 40 mM/kg glisin uygulanýrken, kontrol gruplarýna ayný zaman zarfýnda serum fizyolojik verildi. Her çalýþma döneminin sonunda elektrofizyolojik çalýþma tekrarlandý. Denekler cerrrahi sonrasý 15., 30. ve 60. günlerde öldürülerek siyatik sinirleri çýkarýldý ve histolojik çalýþmalar için hazýrlandý. BULGULAR: Glisin, Wistar sýçanlarýndaki deneysel yaralanma sonrasýnda gerçekleþtirilen bir ay süreli uygulama boyunca siyatik sinirin morfolojik rejenerasyonu ve fonksiyonel düzelmesi üzerine etkili oldu. SONUÇ: Glisin uygulamasý ile birlikte oluþan sinir histolojisinin normal sinirlerdekine çok benzer olduðunu gözlemledik.

BACKGROUND: Treatment of peripheral nerve injuries focuses on lesion type, from expectant to interfascicular repair. Many experiments have been undertaken using different factors to facilitate better or faster nerve stump growth: nerve growth factor (NGF), plaque growth factor (PGF), hyaluronic acid, leukemic inhibiting factor, and GABA, etc. Glycine is an inhibitory neurotransmitter in the brain stem and spinal cord, and it also plays a critical role as a modulator of NMDA receptors. We studied the potential regenerative effect of glycine administered for different periods of time and compared results with a control group. METHODS: The sciatic nerve of Wistar rats was exposed and the electrophysiology procedure was performed: the nerve was cut transversally and stitched back in place with four isolated cardinal 9/0 nylon stitches on each end. Study group rats were administered glycine 40 mM/kg daily for 15, 30, and 60 days, while control group rats were medicated with isotonic saline solution 0.9% for the same time periods. At the end of each study time period, the electrophysiological study was repeated. Animals were sacrificed on the 15th, 30th and 60th postoperative day and the sciatic nerve was exposed and prepared for histological studies. RESULTS: According to our results, glycine was effective in the morphologic regeneration and functional recovery of the sciatic nerve post-injury in Wistar rats with one month administration. CONCLUSION: We observed that nerve histology with glycine administration was more similar to that of normal nerves.

AMAÇ: Abdominal býçak yaralanmalarýnda (ABY) laparoskopik eksplorasyon ve lavajýn (LELA) birarada uygulaným rolü deðerlendirildi. LELA’nýn negatif çýkmasý durumunda periton penetrasyonun (PP) tanýsal laparotomi (TL) için bir endikasyon olmadýðý varsayýldý. GEREÇ-YÖNTEM: Ocak 2002 ile Aralýk 2003 tarihleri arasýnda birinci düzey travma merkezimizde ileriye dönük bir çalýþma yürütüldü. Yapýlan yara incelemesinde ön fasya penetrasyonu olan ve sistolik kan basýncý ≥90 mmHg bulunan hastalar çalýþmaya dahil edildi. Sýrt ve böðür yaralanmasý bulunan, evisserasyon olan ve altý saatten sonra baþvuran hastalar çalýþma dýþýnda býrakýldý. Lavajda safra, aþikar kanama, gýda lifi veya dýþký bulunmaksýzýn eritrosit deðerinin >5000 ve lökosit deðerinin >150 olmasý durumunda, LELA pozitif olarak kabul edildi. BULGULAR: Çalýþmaya 89 anterior ABY olgusu dahil edildi. PP’yi ekarte etmek üzere, 28 hastaya laparoskopi uygulandý. Laparoskopi, hastalarýn 17’sinde PP ve 8’inde acil TL uygulanmasýný gerektiren yaralanma bulunduðunu ortaya koydu; geriye kalan 9 hastada LELA gerçekleþtirildi; 4 hastada yaralanma bulunduðunu ortaya koyan pozitif LELA (sigmoid, sað kolon, 2 tane ince baðýrsak) sonucuna sahip oldu. Beþ hastada, negatif bir LELA saptandý ve gereksiz bir TL önlendi. SONUÇ: Anterior ABY’de uygulanan LELA, esas olarak içi boþ organ yaralanmalarýný ekarte etmeye yönelik umut vericidir. Bu teknik, gözden kaçýrýlan abdominal yaralanmalarýn sayýsýný artýrmaksýzýn, tedavi amaçlý olmayan laparotomilerin sayýsýný, hastanede kalma süresini ve hastane giderlerini azaltabilir.

BACKGROUND: To determine the role of a combined laparoscopic exploration and lavage (LELA) in abdominal stab wounds (ASW). We hypothesized that peritoneal penetration (PP) is not an indication for exploratory laparotomy (EL) if LELA is negative. METHODS: A prospective study (Jan 2002-Dec 2003) was carried at our Level I Trauma Center. Patients with anterior fascia penetration in wound exploration and with systolic blood pressure greater than 90 mmHg were included. Patients with back and flank injuries, evisceration and presentation after six hours were excluded. LELA was considered positive if red blood cell count was >5000 and white blood cell count was >150 in a lavage without the presence of bile, gross blood, food fibers or stool. RESULTS: Eighty-nine patients with anterior ASW (AASW) were included. Twenty-eight patients underwent laparoscopy to rule out PP. Seventeen patients had PP and 8 demonstrated injuries that required immediate exploratory laparotomy. The remaining 9 underwent LELA. Four patients had positive LELA that demonstrated injuries (sigmoid, right colon, and small bowel [n: 2]). Five patients had a negative LELA and avoided an unnecessary EL.
CONCLUSION: LELA in AASW shows a promising role to rule out mainly hollow viscus injuries. This technique could decrease the number of non-therapeutic laparotomies, length of stay and hospital costs without increasing the incidence of missed abdominal injuries.

AMAÇ: Faktör V (FV) [G1691A], metilentetrahidrofolat redüktaz (MTHFR) [C677T] ve protrombin [G20210A] gen mutasyonlarýnýn venöz tromboz riskini artýrdýðý bilinmektedir. Bu mutasyonlarýn, koroner arter hastalýðýndaki sýklýklarý tartýþmalý olmasýna karþýn, tek tek veya birlikte periferik arteriyel tromboz’lardaki (PAT) sýklýklarý bilinmemektedir. Bu çalýþmada, normal saðlýklý bireylerde ve PAT’si olan hastalarda bu mutasyonlarýn sýklýðý araþtýrýldý. GEREÇ-YÖNTEM: Yaþ ortalamasý 31 yýl (daðýlým 20-73) olan 90 (52K) saðlýklý bireyden ve yaþ ortalamasý 63 yýl (daðýlým 16-88) olan 30 (8K) hastadan kan örnekleri alýndý. Klasik proteinaz K / fenol-kloroform yöntemi ile DNA ayrýþtýrýmýný takiben, PCR ürünü spesifik endonükleazlar (Hind III, Hinf I) kullanýlarak kesildi. Elde edilen ürün, agaroz jel elektroforez de yürütülüp etidium bromid ile boyanarak ultraviole ýþýðý altýnda transulliminasyon yöntemi ile görüntülendi. BULGULAR: PAT’si olan hasta grubunda MTHFR ve protrombin gen mutasyon sýklýðý kontrol gurubundan farklý deðildi. Ancak FV G1691A mutasyon sýklýðý anlamlý ölçüde yüksekti. Yine arteriyel trombozlu olgularýn %67’sinde FV ve MTHFR gen mutasyonu birlikte bulunduðu, kontrol gurubu ile karþýlaþtýrýldýðýnda aradaki farkýn anlamlý olduðu ve FV pozitif olgularda MTHFR gen mutasyonu varlýðýnýn riski artýran sinerjistik bir faktör olduðu görüldü. Protrombin gen mutasyonunun tek baþýna ya da diðer gen mutasyonlarý ile birlikte, riski artýran önemli bir faktör olmadýðý görüldü. SONUÇ: PAT’li hastalarda FV ve MTHFR mutasyonlarýnýn artmýþ sýklýðý ve birlikteliðinin, bu hastalarda tromboz oluþumundan sorumlu risk faktörlerinden birisi olabileceði kanaatine varýldý.

BACKGROUND: Factor V (FV) [G1691A], methylenetetrahydrofolate reductase (MTHFR) [C677T] and prothrombin (PT) [G20210A] mutations are all well-recognized genetic risk factors for venous thrombosis. Although their prevalence in coronary artery disease has been established through debate, their role in patients with arterial thrombosis remains to be clarified. We investigated the prevalence rates of FV, MTHFR and PT gene mutations in patients with arterial thrombosis and in healthy controls. METHODS: All subjects and controls were from Central Anatolia. Thirty (8F) patients with median (range) age of 63 (16-88) years and 90 (52F) healthy controls with median (range) age of 31 (20-73) years were studied. DNA was extracted using conventional methods (proteinase K/phenol-chloroform) followed by PCR amplification and restriction endonuclease digestion (using Hinf I and Hind III). Digested PCR products were identified using agarose gel electrophoresis and stained with ethidium bromide. RESULTS: The prevalence rates of MTHFR and PT gene mutations were not significantly different between the groups. The prevalence rate of FV mutation was significantly higher in patients with arterial thrombosis. Coinheritance of FV and MTHFR was found in 67% of patients, which was significantly higher in arterial thrombosis, suggesting the MTHFR mutation as a synergistic risk factor for thrombosis in patients with FV mutation. PT gene mutation has no effect on arterial thrombosis. CONCLUSION: The increased prevalence rate and coexistence of both FV and MTHFR found in this group of patients suggest that these mutations might increase the risk of arterial thrombosis.

AMAÇ: Bu çalýþmanýn amacý, hipoalbüminemi veya hipergliseminin, vantilatör gereksinimi ve vantilatörden ayýrma iþleminin baþarýsýnýn göstergeleri olarak deðerini saptamaktýr.
GEREÇ-YÖNTEM: Yoðun bakým ünitesine üç gün veya daha uzun süreyle yatýrýlan ≥16 yaþýndaki travmalý 600 hastada tek merkezli ve retrospektif bir çalýþma yürütüldü. Hastalar, solunum yetersizliði nedenine göre oluþturulan beþ ayrý grupta sýnýflandý. Daha sonra þu parametreler kaydedildi: Serum albümin ve glukoz konsantrasyonu, Akut Fizyoloji ve Kronik Saðlýk Deðerlendirmesi III skoru, vantilatör gereksinimi, vantilatör günü ve sývý dengesi. BULGULAR: Baþlangýçtaki ortalama serum glukoz konsantrasyonu 9,3 (167,4) ± 0,2 (3,6 mg/dL) mmol/l ve serum albümin konsantrasyonu 30,2 (3,02) ± 0,02 (0,2 g/dL) g/L oldu. Yoðun bakým ünitesinde (YBÜ) sað kalanlara göre hayatýný kaybedenlerde, dolaþýmdaki serum albümin konsantrasyonu kayda deðer ölçüde düþük ve serum glukoz konsantrasyonu anlamlý þekilde yüksek olmasýna karþýn, YBÜ’ye yatýrýlma sýrasýndaki albümin konsantrasyonu (r=-0,031, p=0,23) ile kan glukoz konsantrasyonu (r=0,050, p=0,11) mekanik vantilasyon süresine iliþkin birer gösterge olmadý. Albümin ve glukoz deðiþiklikleri, mekanik vantilasyondan ayrýlan ve mekanik vantilasyona baðýmlý olan hastalar arasýnda farklýlýk gösterdi. Serum albümin konsantrasyonunda gerçekleþen 5 g/L (0,5 g/dL) seviyesinde bir artýþ, görece baþarý olasýlýðýný 1,10 oranýnda artýrdý; 30,3 (3,03 g/dL) g/L seviyesinden daha düþük serum albümin konsantrasyonuna sahip olan hastalarýn normoalbüminemik hastalara göre vantilatöre gereksinim duyma olasýlýklarý, 1,2 kez daha fazla oldu (göreceli risk 1,2, % 95 güven aralýðý 1,06 ile 1,31). Mekanik vantilasyon gereksinimi riski, 11 mmol/l (200 mg/dL) seviyesinden daha yüksek kan glukoz konsantrasyonu ile artmadý.
SONUÇ: Bu sonuçlar, albümin veya kan glukozunun, muhtemelen, travma hastasýnýn metabolik durumuna iliþkin ve ayný zamanda uzayan zaman periyodu boyunca mekanik olarak vantilasyon uygulanan hastalarýn vantilatör gereksinimine veya ayrýlabilirliðine karar vermede temel bir gösterge olacaðýný göstermektedir.

BACKGROUND: The aim of this study was to evaluate the value of hypoalbuminemia or hyperglycemia as predictors for need ventilator and for weaning success in critically ill trauma patients. METHODS: A single center, retrospective trial was done on 600 trauma patients ≥16 years old admitted for three or more days to the intensive care unit. Patients were classified into five different groups according to the reason for respiratory failure. The subsequent parameters were noted: serum albumin and glucose concentration, Acute Physiology and Chronic Health Evaluation III score, need ventilator, ventilator days, and fluid balance. RESULTS: The initial mean serum glucose concentration was 9.3 (167.4) ± 0.2 (3.6 mg/dl) mmol/L and the initial mean serum albumin concentration was 30.2 (3.02) ± 0.02 (0.2 g/dl) g/L. Even though the circulating albumin concentration was considerably lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, neither albumin (r=-0.031, p=0.23) nor blood glucose concentration (r=0.050, p=0.11) on ICU admission was a predictor of the duration of mechanical ventilation. The profile of albumin and glucose concentration changes was dissimilar between weaned and mechanical ventilation-dependent patients. An increase of 5 g/L (0.5 g/dl) in serum albumin concentration multiplied the relative success probability by 1.10. Patients with serum albumin concentration less than 30.3 (3.03 g/dl) g/L were 1.2 times more likely to need ventilator than normo-albuminemic patients (relative risk 1.2, 95% confidence interval 1.06-1.31). The risk of need mechanical ventilation did not increase with blood glucose concentration more than 11 mmol/L (200 mg/dl). CONCLUSION: These results suggest that albumin and blood glucose are possible indexes of the metabolic status of the trauma patient, which could be essential in deciding the need ventilator and weanable status of the patients who are mechanically ventilated for extended periods of time.

AMAÇ: Kaþmir eyaletinde vahþi yaþamýn ve vahþi yaþamsal alanlara tecavüzün sýký bir þekilde korunmasý, vahþi hayvan kaynaklý yaralanmalarda ve ölümlerde bir artýþa yol açmýþtýr. Bu yazýda, ayý saldýrýlarýndan kaynaklanan yaralanmalar ve sekellerin tedavisindeki düzenlemeler deðerlendirildi. GEREÇ-YÖNTEM: Ocak 2003 ile Haziran 2007 tarihleri arasýnda, Kaþmir Üniversitesi Srinagar Devlet Týp Fakültesi, Ortopedi ve Travmatoloji Bölümü’nde retrospektif bir çalýþma yürütüldü; 54 aylýk bir sürede, ayý saldýrýsý hikayesi bulunan toplam 254 olgu (186 erkek, 68 kadýn) kaydedildi. BULGULAR: Kurbanlarýn %80’inin mýsýr tarlalarý ile elma bahçelerinde ve %20’sinin de sýk ormanlýk alanda odun toplarken veya sýðýr otlatýrken saldýrýya uðradýðý öðrenildi. Baþ-boyunda laserasyonlar, üst ekstremite kýrýklarý, yüz ve kafatasý kemiði kýrýklarý dikkat çeken gözlemlerdi. Hastalarýn çoðundaki uzun süreli sekeller þöyleydi: Kalýcý yüz þekil bozukluðu, iþitme kaybý, parmak kaybý, kalc nörolojik bozukluk ve süreðen psikolojik morbidite. SONUÇ: Vahþi hayvan kaynaklý yaralanmalar, travmanýn ihmal edilen bir konusudur. Altta yatan ciddi kemik veya yumuþak doku hasarýnýn gözden kaçýrýlabileceði gerekçesiyle, bu yaralanmalar tedavi edilirken kuþku düzeyi yüksek tutulmalýdýr. En iyi fonksiyonel sonucu elde etmek üzere, bu yaralanmalarýn tedavisi travmanýn tüm alt uzmanlýk dallarýný kapsamaktadýr.

BACKGROUND: Strict conservation of wildlife and encroachment into its habitat have led to an increase in the number of wild animal-inflicted injuries and fatalities in Kashmir. The aim of this study was to report injuries inflicted during bear attacks and discuss their management and sequelae. METHODS: A retrospective study was conducted in the Department of Orthopedics Government Medical College Srinagar, University of Kashmir, from January 2003 to June 2007. A total of 254 cases (186 males, 68 females) with history of bear attacks were recorded over a period of 54 months. RESULTS: Eighty percent of victims were attacked in the maize fields and apple orchards and 20% in the dense forests while collecting firewood or tending to the cattle. Lacerations of the head and neck and fractures of the upper limbs and facial and skull bones were the striking observations. Permanent facial disfigurement, hearing loss, loss of digits, residual neurodeficit, and persistent psychological morbidity were the long-term sequelae in most of the patients. CONCLUSION: Wild animal-inflicted injuries are a neglected part of trauma. There should be a high index of suspicion when treating these injuries, as serious underlying bone or soft-tissue damage can be overlooked. Management of these injuries involves all subspecialties of trauma to achieve the best functional outcome.

AMAÇ: Yýllardan beri yanýklar, iyileþme elde edilinceye kadar serum fizyolojikle ýslatýlmýþ pansumanlarla günlük olarak tedavi edilmiþtir. Günümüzde, yaralar greft teknikleri yoluyla veya sentetik ve biyolojik pansumanlar kullanýlarak kapatýlmaktadýr. Bu yazýda, geliþmekte olan ülkelerde biyolojik pansuman kullanýmý ile ilgili daha az deneyim ve ilgi bulunmasý nedeniyle, büyük çaplý yanýklarý bulunan hastalarda konvansiyonel tedaviye karþý biyolojik sargýlarýn tedavi sonucu karþýlaþtýrýldý. GEREÇ-YÖNTEM: Ekim 2002 ile Haziran 2006 tarihleri arasýnda, alev veya haþlanma yoluyla %30 ile %75 arasýndaki oranlarda total vücut yüzeyi alaný (TVYA) yanýðý oluþan 118 hasta incelemeye alýndý. Hastalar iki gruba ayrýldý; konvansiyonel tedavide olan birinci grup (n=53), biyolojik pansuman (Xenoderm) ile tedavi edilen ikinci grup (n=65). BULGULAR: Konvansiyonel grup ile biyolojik pansuman grubundaki mortalite oranlarý sýrasýyla 19 (%35) ve 7 (%10,8) olarak bulundu (p=0,001). Ortalama hastanede kalma süresi 31,3 güne karþý 18,2 gün ve pansuman sayýsý 22,1’e karþý 9,9 oldu (p=0,0005). SONUÇ: Bu çalýþma sonucunda, biyolojik pansuman (Xenoderm) daha iyi bir sonuç ve daha düþük bir mortalite oraný vermiþtir. Bununla birlikte, ameliyat sayýsý ile ince kalýnlýkta deri grefti gereksiniminin azalmasýný karþýlaþtýran randomize bir klinik çalýþma yapýlmasý gerekmektedir.

BACKGROUND: For many years, burns were treated by daily saline-soaked dressings until the burns healed primarily. Today, wounds are closed via grafting techniques, or by using synthetic and biological dressings. Due to less experience and interest in the use of biological dressing in developing countries, the aim of this study was to compare the outcome of biological dressings versus ‘conventional’ treatment in patients with massive burns. METHODS: One hundred eighteen patients with total body surface area (TBSA) burns of 30% to 75%, by flame or scalds, were investigated from October 2002 to June 2006. The patients were divided into two groups. Those in the first group received conventional treatment (n=53) and those in the second group (n=65) received treatment with a biological dressing (Xenoderm). RESULTS: Mortality rates in the conventional group and biological group were 19 (35%) and 7 (10.8%), respectively (p=0.001). The mean hospital stay was 31.3 days vs 18.2 days and the number of dressings was 22.1 vs 9.9, respectively (p=0.0005). CONCLUSION: The results of this study indicate that a biological dressing (Xenoderm) gave a better outcome and lower mortality. However, a randomized clinical trial that compares the number of operations and decreasing need for split thickness skin grafts is warranted.

AMAÇ: Yüksekten düþenlerin demografik bilgileri, mortalite oranlarý, düþme nedenleri ve ölüm sonrasý bulgularý deðerlendirildi. GEREÇ-YÖNTEM: Bu çalýþmaya, kaza sonucu yüksekten düþmeye maruz kalan 538 hasta alýndý. Olgular Batman’da yedi ay içerisinde prospektif olarak derlendi. BULGULAR: Ortalama yaþ 12,4±3,22 yýl (daðýlým 3 ay-98 yýl) idi. Hastalarýn %56,5’i altý yaþ altý, %83,5’i de 20 yaþýndan küçük idi. Ortalama düþme yüksekliði 3,2±2,4 m olarak saptandý. Mortalite oraný %2,2 bulundu. Mortalite oraný damdan düþenlerde en yüksek idi. En çok yaralanma kafada meydana gelmiþti ve ölenlerin tamamýnda (%100) kafa yaralanmasý vardý. Altý hasta karýn kanamasý nedeniyle, 141 hasta da ekstremite kýrýklarý nedeni ile takip edildi. Hastalarýn %6,7’si ameliyat edildi; %83,8’i acil serviste tedavi edildi. SONUÇ: Bu çalýþmanýn sonuçlarý literatür bilgileri arasýnda uyuþmazlýk yoktu. Yüksekten düþmeler en fazla 0-5 yaþ grubu olanlarda meydana gelmiþti. Kranyoserebral travma ölümcül düþmelerin en yaygýn yaralanmasý idi. Erkeklerde yüksekte düþme oranlarý kadýnlara göre daha yüksek bulundu.

BACKGROUND: We evaluated the demographic data, mortality rates, fall causes, and post-mortem findings of individuals who fell from heights. METHODS: Five hundred thirty-eight patients who sustained injuries after an accidental fall from heights were entered into the study. Our cases were collected prospectively in Batman over a seven- month period. RESULTS: The mean age was 12.4±3.22 years (3 months-98 years); 56.5% of patients were under 6 years old and 83.5% were under 20 years old. The mean fall height was 3.2±2.4 m. The mortality rate was 2.2%, and was highest among the patients who fell from flat-roofed houses. The most common injuries were to the head, and 100% of those who died had a head injury. Six patients were followed because of abdominal bleeding and 141 patients due to extremity fractures; 6.7% of patients were operated on and 83.8% of patients were treated in the emergency department. CONCLUSION: The results of this study were at variance with literature data with respect to the following: falls from heights were most common in the 0-5 years of age group. Craniocerebral trauma is the most common injury in fatal falls. Males had a higher rate of falls from height than females.

AMAÇ: Distal femoral kýrýklarýn (DFK) tedavisi önemli bir cerrahi sorundur. Distal femoral kýrýklarýn rijit fiksasyonu ile birlikte kemik greftlemesine genellikle gereksinim duyulmaktadýr. Dinamik kondiler vida (DKV) ve retrograd intramedüller suprakondiler çivi (RÝSÇ) kullanan biyolojik osteosentez, kan akýmýný korur ve kemik greftlemesine yönelik gereksinimi sýnýrlandýrýr. GEREÇ-YÖNTEM: Eylül 2002’den Aralýk 2004 tarihine kadar, 68 adet kapalý distal femur kýrýðý, 31 tanesinde DKV ve 37 tanesinde de RÝSÇ kullanýlan köprü plak osteosentezi ile tedavi edildi. Hastalar, rasgele yöntemle iki gruba ayrýldý ve 24-36 ay (ortalama 30 ay) süreyle takip edildi. BULGULAR: Operasyon zamaný ile ilgili olarak, DKV grubu RÝSÇ grubuna göre anlamlý þekilde daha iyi sonuçlar gösterdi (p=0,000). Bununla birlikte kan kaybý, DKV grubunda anlamlý þekilde daha fazla oldu (p=0,000). Kümülatif kýrýk oraný (p=0,855), diz hareket geniþliði (p=0,727), genel sonuçlar (p=0,925) ve komplikasyonlar (p=0,927) bakýmýndan iki grup arasýnda bir fark saptanmadý. SONUÇ: DFK’yla ilgili olarak, implant veya cerrahi tekniðin hiçbiri, her koþulda, bir diðerine üstün deðildir. DFK’nýn tedavisinde, RÝSÇ uygulanmasý standart tedavidir ancak dinamik kondiler vida kullanan biyolojik osteosentez de çok iyi bir alternatiftir.

BACKGROUND: The treatment of distal femoral fractures remains a significant surgical challenge. With the rigid fixation of the distal femoral fractures, bone grafting is frequently needed. Biological osteosynthesis using dynamic condylar screw (DCS) and retrograde intramedullary supracondylar nail (RIMSN) preserve the blood supply and limit the need for bone grafting. METHODS: From September 2002 to December 2004, 68 closed fractures of the distal femur were treated by bridge plate osteosynthesis using DCS in 31 and RIMSN in 37. The patients were allocated to one of the two groups randomly and followed for 24-36 months (average: 30 months). RESULTS: With respect to operation time, the DCS group presented significantly better results than the RIMSN group (p=0.000). However, the blood loss was significantly more in the DCS group (p=0.000). There were no significant differences in terms of cumulative rate of union (p=0.855), range of motion of the knee (p=0.727), overall results (p=0.925) and complications (p=0.927) between the two groups. CONCLUSION: No implant or surgical technique is superior to any other under all circumstances for distal femoral fracture. RIMSN is standard care, yet the biological osteosynthesis using DCS is a very good alternative for the treatment of distal femoral fractures.

AMAÇ: Eriþkinlerde invajinasyon nadir görülen bir klinik durumdur, çocuk olgulardan etyolojik farklýlýklar gösterir. Çalýþmamýzda, eriþkinlerde saptanan invajinasyon nedenlerinin tanýmlanmasý ve tedavi özeliklerinin deðerlendirilmesi amaçlandý.
GEREÇ-YÖNTEM: 1986 ile 2006 yýllarý arasýnda invajinasyon tanýsý alan olgular geriye dönük olarak deðerlendirildi. Tüm olgular 18 yaþýn üzerinde olup; rektal, gastroenterostomiye baðlý ve stomal prolapsusu olan olgular çalýþma dýþý tutuldu.
BULGULAR: Toplam 28 invajinasyon olgusu belirlendi; ortalama yaþ 38,6±16,7 idi. Ameliyat öncesi taný olgularýn %53,5’ünde gerçekleþtirildi. Olgularýn 23’ünde ince baðýrsak, üçünde kolon, ikisinde ise ileokolik invajinasyon saptandý. Ýnvajinasyon nedeni 25 (%89,3) olguda belirlendi. Ýnvajinasyon nedenleri 19 olguda selim, altý olguda habis ve üç olguda ise idyopatikti. Ameliyat sonrasý üç (%10,3) olguda komplikasyon görüldü.
SONUÇ: Bu serideki yaþ ortalamasý literatür verilerinden daha düþük bulundu. Sýklýkla ince baðýrsak invajinasyonlarýna rastlanýrken, selim/habis oranýnda, selim aðýrlýkta idi. Eriþkinde görülen invajinasyon nadir görülmesine karþýn, geniþ bir etyolojik açýlýmý ve deðiþken klinik tablosu nedeniyle, özellikle akut karýn tablosuyla karþýlaþan her hekim için ayýrýcý tanýda göz önünde bulundurulmasý gereken bir durumdur.

BACKGROUND: Adult intussusception is an unusual entity, and its etiology differs from that in pediatric patients. The purpose of this study was to determine the causes and management of intussusception in adults. METHODS: A retrospective review of patients with a diagnosis of gastrointestinal intussusception between 1986 and 2006 was conducted. All patients under the age of 18 and cases with rectal, ostomy, or gastroenterostomy prolapse were excluded. RESULTS: There were 28 cases of adult intussusception. Mean age was 38.6±16.7 years. A preoperative diagnosis of intussusception was made in 53.5% of the cases. There were 23 enteric, three colonic and two ileocolic intussusceptions. A lead point was identified in 25 patients (89.3%). Invagination was due to benign causes in 19 patients, malignant causes in six patients and idiopathic in three patients. Complication was seen in three (10.3%) cases.
CONCLUSION: In this series, the mean age of the patients was younger than in the literature. Since intussusception was due to small bowel pathologies, the proportion of benign/malignant lesions favored benign lesions. Although it is encountered rarely in adults, physicians should be aware of invagination and consider it in each case of acute abdomen because of the wide spectrum of the clinical settings.

AMAÇ: Bu çalýþmanýn amacý, travma ve acil cerrahi polikliniðimize baþvuran kafa travmalý hastalar üzerinde, hastane temelli epidemiyolojik bulgularýn belirlenmesidir.
GEREÇ-YÖNTEM: 01.01.2006 ile 31.12.2006 tarihleri arasýnda kafa travmasý nedeniyle tedavi edilen 430 olgunun (284 erkek [%66], 146 kadýn [%34]; ort. yaþ 30±19) hastane kayýtlarý geriye dönük incelenerek deðerlendirildi. BULGULAR: Kafa travmasýyla sýklýkla çocuklarýn (%22) ve genç eriþkinlerin (%30) karþýlaþtýðý, nedenler arasýnda ise düþme (%40) ve trafik kazalarýnýn (%37) en sýk nedenler olduðu belirlendi. 2006 yýlý içerisinde kafa travmasý nedeniyle yatýrýlan hastalarda mortalite %11, aðýr sakatlýk oraný %2, acil cerrahi kliniðindeki tüm ölümler arasýndaki oraný ise %30 olarak saptandý. SONUÇ: Bu bilgiler sonucunda, ölüme sebep olabilecek kafa travmasý nedenleri arasýnda en sýk 0-16 yaþ grubunda düþmeler, 16-35 yaþ grubunda ise özellikle erkek nüfusta araç dýþý trafik kazasý ve kraniyal ateþli silah yaralanmalarýnýn olduðu gözlenmiþtir. Kafa travmalý hastalarda geliþ Glasgow Koma Skoru prognoz açýsýndan önemli bir göstergedir. Öncelikle, yaþ gruplarýna göre travma nedenlerine yönelik kafa travmasýnýn olmasýný engelleyecek önlemler alýnmalýdýr. Ýlk giriþim, taný ve tedavi yöntemlerinin geliþtirilmesi ile travmatik beyin yaralanmalarýnda mortalite ve morbidite oranlarýnýn düþürülebileceði kanýsýndayýz.

BACKGROUND: The aim of this study was to determine the hospital-based epidemiological data of the head injury patients who admitted to our Emergency Surgery Department. METHODS: The records of the patients (284 males [66%], 146 females [34%]; mean age 30±19) with head injury who admitted to our Emergency Surgery Department between 01.01.2006 - 31.12.2006 were analyzed retrospectively. RESULTS: Among the age groups, most head injuries occurred in children (22%) and young adults (30%). The most common trauma types were due to falls (40%) and motor vehicle accidents (37%). The mortality rate in head injury patients was 11%, serious morbidity was 2%, and the rate of deaths from head injury among all deaths in 2006 was 30%.
CONCLUSION: According to these data, the most common causes of death in head-injured patients are falls (0-16 years of age) and outside vehicle traffic accidents and cranial gunshot wounds (16-35 years of age), especially for males. Admission Glasgow Coma Score is an important prognostic factor in head-injured patients. Primary precautions for head injury must be taken according to each age group. Further development of the diagnosis and treatment options will help to lower the mortality and morbidity of patients with traumatic brain injury.

AMAÇ: Bu çalýþmada, aðýr hasarlý el yaralanmalý hastalarda yapýlan iþlemler ve bu iþlemlerin tedavi sonuçlarýnýn deðerlendirilmesi amaçlandý. GEREÇ-YÖNTEM: 2000-2005 yýllarý arasýnda baþvuran, 130 aðýr hasarlý el yaralanmasý olan hasta geriye dönük olarak deðerlendirildi. Bu hastalardan 25’inin geç dönem takibi ve analizi yapýlabildi. Hastalarýn kavrama gücü, eklem hareket açýklýklarý ölçüldü. Fonksiyonel deðerlendirme için Minnesota manipülasyon hýzý testi ve Purdue Pegboard testi kullanýldý. BULGULAR: Eklem hareket açýklýðý deðerlendirmesinde en düþük hareket yüzdesi %17,5, en iyi hareket yüzdesi %96 idi. Ortalama hareket saðlam elin %64,7’si olarak hesaplandý. Kavrama gücü deðerleri en zayýf %15, en kuvvetli %80 ortalamayla kaydedildi; ortalama kaba kavrama gücü saðlam elin %52’si olarak hesaplandý. Yan tutma gücünde ölçümler karþý tarafýn %66’sý (%25-%81), uç tutmada %53’ü (%12-%68), üçlü tutmada %52’si olarak kaydedildi. Minnesota manipülasyon hýzý testinde; hastalarýn %92’sinde el becerisi, kuvvet ve koordinasyon açýsýndan tatminkâr sonuçlara ulaþýldý. Purdue Pegboard testinde ameliyatlý elin ince parmak becerilerinde azalma olduðu görüldü. SONUÇ: Aðýr hasarlý el yaralanmalarýnda tedavi stratejisi, hastanýn temel günlük ihtiyaçlarýný saðlayacak bir ekstremite kazanmak için planlanmalý, hastanýn iþine geri dönmesi amaçlanmalýdýr.

BACKGROUND: The aim of this study is to report the surgical procedures performed in patients with mutilating hand injuries and evaluate the outcomes of treatment. METHODS: A retrospective evaluation of 130 patients operated between 2000 and 2005 for mutilating hand injuries is presented. Twenty-five of the patients could be followed until the end of rehabilitation. The grip power and ranges of motion in affected joints were determined. Minnesota manipulation speed test and Purdue Pegboard Test were used for evaluation of functional results. RESULTS: Mean range of motion was 64.7% (minimum: 17%, maximum 96%) of the uninjured extremity. Mean grip strength was 52% (15-80%) of the uninjured extremity. Lateral pinch was 66% (25%-81%) of the contralateral hand and the results were 53% (12%-68%) for key pinch and 52% for tripod pinch. Minnesota manipulation speed test showed satisfactory results in 92% of the patients in hand skill, strength and coordination. A decrease in fine motor skills was observed in Purdue Pegboard Test. CONCLUSION: The main treatment purposes in mutilating hand injuries are obtaining an extremity that is useful in daily activities and if possible that facilitates a return to work.

AMAÇ: Penetran kalp yaralanmalarý hýzlý taný ve acil cerrahi giriþim gerektiren yüksek düzeyde ölümcül yaralanmalardýr. Bu yazýda, penetran kalp yaralanmalarýna iliþkin deneyimimizi sunmak ve tartýþmak amaçlandý. GEREÇ-YÖNTEM: 1985-2007 yýllarý arasýnda, hastanemizin kalp ve damar cerrahisi kliniðinde penetran kalp yaralanmasý nedeniyle ameliyat edilen 16 olgu geriye dönük olarak deðerlendirildi. Hastalarýn yaþlarý 6 ile 71 arasýnda deðiþiyordu ve yaþ ortalamasý 45,1 idi. Yaralanmanýn etyolojisi; hastalarýn 8’inde (%50) kesici-delici cisim yaralanmasý, 6’sýnda (%37,5) iyatrojenik nedenler ve 2’sinde (%12,5) ateþli silah yaralanmasý idi. BULGULAR: Kalbe ulaþýlmasý, hastalarýn 12’sinde (%75) medyan sternotomiyle, 4’ünde (%25) sol anterolateral torakotomi ile gerçekleþtirildi. Yaralanan bölgeler; olgularýn 7’sinde sað ventrikül (%43,75); 3’ünde sol ventrikül (%18,75), 1’inde sol atriyum (%6,25) ve 1’inde sol ventrikül+sol atriyum (%6,25) idi; 4 olguda (%25) koroner arter yaralanmasý söz konusuydu. Kalp yaralanmalarý, teflon ve perikardiyal yama destekli basit dikiþ tekniði ile onarýldý. Ýki hasta (%12,5) erken dönemde kaybedildi. SONUÇ: Penetran kalp travmasýnýn baþarýlý yönetiminin esasý, etkin destekleyici önlemlerin alýnmasýný izleyerek erken tanýnýn konup kesinleþtirilmesi ve yaralanmanýn acilen cerrahi onarýmýnýn yapýlmasýdýr.

BACKGROUND: Penetrating cardiac injuries have a rather high mortality and require a rapid diagnosis and emergency surgical intervention. The aim of this study was to present and discuss our experience with penetrating heart wounds. METHODS: Sixteen patients with penetrating cardiac injury underwent surgical treatment at the Department of Cardiovascular Surgery between 1985-2007. The patients ranged in age from 6 to 71 years (mean age 45.1 years). The cause of cardiac injury was stab wounds in 8 patients (50%), iatrogenic reasons in 6 patients (37.5%) and shotgun wounds in 2 patients (12.5%). RESULTS: Exposure to the heart was accomplished by a median sternotomy in 12 patients (75%) and a left-sided anterolateral thoracotomy in 4 patients (25%). The right ventricle (RV) was injured in 7 patients (43.75%), left ventricle (LV) in 3 patients (18.75%), left atrium (LA) in 1 patient (6.25%), LV+LA in 1 patient (6.25%), and coronary arteries in 4 patients (25%). Cardiac wounds were treated by simple suture technique over Teflon or pericardial pledgets in all patients. Two patients died in the early postoperative period. CONCLUSION: The basis for successful management of penetrating cardiac trauma is effective resuscitative measures followed by early detection and definition and emergency surgical treatment of the injury.

AMAÇ: Bu çalýþmada, Gazi Üniversitesi Týp Fakültesi’nde görevli öðretim üyelerinin emniyet kemeri (EK) kullaným oranlarý araþtýrýlmýþtýr. GEREÇ-YÖNTEM: Gazi Üniversitesi Týp Fakültesi’nde görevli olan öðretim üyelerinin otoparka geliþ, giriþ-çýkýþ süreçleri içerisinde, EK takma oranlarý beþ iþ günü boyunca gözlemlendi ve bulgular öðretim üyelerinin akademik statülerine, yaþ, cinsiyet ve çalýþtýklarý kliniklere göre kayýt edildi. BULGULAR: Çalýþma sýrasýnda toplam 392 öðretim üyesine (253 erkek [%64,54], 139 kadýn [%35,46]) ait veriler kayýt edildi. Öðretim üyelerinden 306’sý (%78) yüksek akademik seviyeye (Profesör veya Doçent) sahipti ve 40 yaþ üstü idi. Yardýmcý Doçent ve Öðretim Görevlisi seviyesinde ve 40 yaþ altý toplam 86 (%22) öðretim üyesi bulunmakta idi. Gözlem süresi boyunca 50 öðretim üyesinin (%12,7) EK takmayý alýþkanlýk haline getirmediði gözlemlendi. Emniyet kemeri takmayan öðretim üyelerinden 40’ý (%80) erkekti, 40’ý (%80) yüksek akademik seviyeye sahip ve 40 yaþ üstü öðretim üyesi idi; takmayan öðretim üyelerinden 46’sý (%92) Klinik Bilimlerde görevli idi. Emniyet kemeri takmayan ve Klinik Bilimlerde öðretim üyesi olan akademisyenlerin büyük kýsmý (30 akademisyen - %65,2) Cerrahi Bilimlerde (Genel Cerrahi, Beyin Cerrahisi, Ortopedi ve Travmatoloji, Anesteziyoloji, vb.) öðretim üyesi idi. SONUÇ: Türkiye’de EK kullanma oraný düþüktür. Eðitim seviyesi arttýkça EK kullanma oraný artmaktadýr. Öðretim üyeleri arasýnda da EK kullanma oraný yüksektir (%87,24). Kaza sonrasý hastaneye baþvuran hastalarla tedavi aþamasýnda daha sýk karþýlaþan cerrahi hekim grubunun EK takmayý ihmal etmesi oldukça dikkata deðer bulunmuþtur.

BACKGROUND: We aimed to determine the ratio of seatbelt (SB) usage among professors of Faculty of Medicine (Gazi University Faculty of Medicine - GUFM). METHODS:
Lecturers of GUFM were observed for five working days during their proceeding to, and entrance and exit from the parking lot, and their SB usage ratio was noted. The data were recorded according to their academic status, age and gender as well as the clinics in which they work. RESULTS: A total of 392 teaching staff (253 males [64.54%], 139 females [35.46%]) were enrolled in the study and their data were recorded. Three hundred and six lecturers (78%) were of high academic level (Professor or Associate Professor), and were over 40 years. A total of 86 teaching staff (22%) held an academic level of Assistant Professor and Instructor and were younger than 40 years. We observed that 50 lecturers (12.76%) did not have a habit of wearing a SB. Among the lecturers not regularly using a SB, 40 (80%) were men, and again, 40 lecturers (80%) were of a high academic level (Professor or Associate Professor) and over 40 years. Of the lecturers driving without a SB, 46 (92%) were employed in Clinical Sciences. Most of the lecturers (30 academicians - 65.2%) driving without a SB and on staff in Clinical Sciences were the teaching staff of the Surgical Science Departments (General Surgery, Neurosurgery, Orthopedics, Anesthesiology, etc). CONCLUSION: The SB usage rate is low in Turkey. It shows an increase with higher educational level. The ratio of SB usage habit is high amongst the lecturers (87.24%). It is noteworthy that the physicians working in surgical departments, who face post-accidental cases in their practice more often than other physicians, ignore the use of a SB.

AMAÇ: Bu çalýþmada, yargý sürecinin saðlýklý þekilde iþlemesine katký saðlayacak adli raporlarýn düzenlenmesinde yapýlan hata ve eksikliklerin saptanmasý amaçlanmýþtýr.

GEREÇ-YÖNTEM: Tanýmlayýcý nitelikteki bu çalýþmada; Ondokuz Mayýs Üniversitesi Acil Servisine 01.01.2005 - 31.12.2005 tarihleri arasýnda baþvuran adli olgulara ait 351 adli rapor incelenerek hata ve eksiklikler deðerlendirilmiþtir.

BULGULAR: Adli raporlarýn %6,0’sýnda yaþ, %71,8’inde muayene saati, %30,5’inde travmatik lezyon bulunup-bulunmadýðý, %58,7’sinde þuur durumu, %2,6’sýnda yaþamsal tehlike varlýðý bilgisinin kayýtlý olmadýðý saptanmýþtýr. Raporu düzenleyen hekimin adý ve soyadý raporlarýn %8,0’inde bulunmamaktadýr. En büyük eksiklik ise düzenlenen raporu teslim alan kiþinin adý, soyadý ve imzasýnýn raporlarýn hiç birinde olmamasýdýr.

SONUÇ: Kiþilerin adli yargýlama sürecinde hak kaybýna uðramamalarý için, hastayý tedavi etmek kadar, adli rapor yazma sorumluluðu da bulunan hekimlerin lisans eðitimleri sonrasýnda meslek içi eðitimlerine devam edilmesi, bu eðitimlerde adli olgulardaki sorumluluklarýnýn vurgulanmasý gerekmektedir.

In this study we have aimed at determining mistakes and defects made while preparing judicial reports which will contribute to the judicial process properly.

In this study, which is supposed to have definitive quality, we have taken 351judicial reports on judicial facts of victims who applied to Emergency Service of Ondokuz Mayýs University between January 1, 2005 and December 31, 2005 as samples and examining them we have evaluated the mistakes and defects.

We have found out that, of the judicial reports, in the 6.0% age, in the 71.8% examination time, in the 30.5% traumatic lesion or not, in the 58.7% the state of being conscious, in the 2.6% life-threatening risks or not, had no registers. The name of the physician who prepared the report is not given in the 8.0% of the reports. The most important defect is that none of the reports had the name, surname and signature of the person who had taken the prepared report.

We have come to a conclusion that, after graduating, it is necessary for the physician who has the responsibility for both treating the patients and writing a judicial report, to attend in service training programs and that, there, they have to be warned about the resposibilities for the judicial cases.

Künt abdominal travmaya ikincil olarak geliþen travmatik ince baðýrsak darlýklarý, rapor edilmiþ birkaç olgu dýþýnda oldukça nadirdir. Bildiðimiz kadarýyla, travmatik ileal darlýðýn bir sonucu olarak geliþen gecikmiþ ileal perforasyon literatürde henüz bildirilmemiþtir. Bu yazýda, yüksek hýzda gerçekleþen bir karayolu kazasýný takiben karýn aðrýsý, distansiyon ve kusma geliþen 28 yaþýnda bir politravma olgusu sunuldu. Seri bilgisayarlý tomografi (BT) görüntülemesine raðmen, taný hastanýn yatýþýndan itibaren ateþin geliþtiði sekizinci haftaya kadar belirsiz kaldý. Dördüncü bir BT filmi, olasý apandisiti düþündürecek þekilde sað ilyak fossada bir koleksiyon olduðunu ortaya koydu. Bununla birlikte, daha sonra gerçekleþtirilen laparotomide, proksimalinde ince baðýrsak dilatasyonu olan ileal darlýk ve kronik apse kavitesine drene olan perforasyon saptandý. Apendiks, normal olarak deðerlendirildi. Darlýðýn olduðu ince baðýrsak segmenti rezeke edildi ve uç ileostomi uygulandý. Olgumuz, karýn belirtileri ve özellikle travmatik ince baðýrsak darlýklarý geliþen politravma hastalarýnýn tedavilerinin düzenlemesindeki olasý tehlikelere dikkat çekmektedir. Bu yazýda, BT'nin bu tanýyý koymadaki kýsýtlýlýklarýný ve özellikle dikkati baþka yöne çeken yaralanmalarýn varlýðýnda klinik olarak kuþku duymanýn önemi vurgulamak istedik.

Traumatic small bowel strictures secondary to blunt abdominal trauma are extremely rare, with few cases reported. Delayed ileal perforation as a result of a traumatic ileal stricture remains, to the best of our knowledge, unreported. We herein report a case of a 28-year-old polytrauma patient admitted following a high speed road traffic accident who developed abdominal pain, distension and vomiting. Despite serial computerized tomography (CT) scanning, the diagnosis remained unclear until eight weeks into his admission by which time he had developed pyrexia. A fourth CT scan at this time revealed a collection in the right iliac fossa suggestive of possible appendicitis. Subsequent laparotomy, however, revealed an ileal stricture with upstream small bowel dilatation and perforation into a chronic abscess cavity. The appendix was normal. The patient underwent resection of the strictured segment and end ileostomy. Our case highlights the potential pitfalls in managing polytrauma patients who develop abdominal symptoms and in particular, traumatic small bowel strictures. We would like to highlight the limitations of CT in making this diagnosis and the importance of having a high index of clinical suspicion, particularly in the presence of distracting injuries.

Yirmi yaþýndaki erkek hasta, þiddetli göðüs aðrýsý, oral gýda alýmýnda güçlük ve karýnda þiþlik yakýnmalarýyla acil servise baþvurdu. Hastanýn þikayetleri 15 gün önce zorlu bir yüzme egzersizi ve yaklaþýk yarým metre yükseklikten denize atlama sonrasý baþlamýþtý. Direkt göðüs radyografisinde sol diyaframda elevasyon ve bilgisayarlý tomografide sol diyaframda yýrtýk saptandý. Yýrtýk cerrahi olarak onarýldý. Hasta düzenli olarak takip edildi ve altý aylýk kontrolünde herhangi bir komplikasyonu yoktu.

A 20-year-old male patient with complaints of severe chest pain, difficulty in oral feeding, and a feeling of swelling in the abdomen was admitted to the Emergency Clinic. His complaints had begun 15 days prior to admission after strenuous swimming and a jump into the sea from a height of half a meter. Elevation of the left diaphragm was observed on the chest radiography and computerized tomography revealed a rupture in the left diaphragm. Surgical repair was done. The patient attended regular follow-ups and appeared to have no complications as of the sixth month after the treatment.

Kiþilerin kendini savunma gerekliliði için üretilen ve zararsýz olduðu düþünülen kurusýký tabancalar ilgili yasal kurallarýn bulunmamasý nedeniyle eriþkinler tarafýndan kolayca satýn alýnabilmektedir. Kurusýký tabancalarýn neden olduðu yaralanmalar ölümcül olduðu ve nadiren acil servise geldiði için bu olguyu sunuyoruz. Kurusýký tabanca atýþý ile karnýndan yaralanan 15 yaþýndaki bir erkek çocuðu acil servise getirildi. Fiziksel incelemede, sol kot kavsinin hemen 2 cm altýnda ön koltuk altý çizgisi üzerinde 1 cm çapýnda giriþ yarasý ve bu yaranýn çevresinde 4 cm çapýnda halka þeklinde abrazyon ve kontüzyon alaný olduðu görüldü. Karnýn tüm kadranlarýnda defans muskuler ve ribaund hassasiyeti vardý. Hastaya eksploratif laparotomi yapýldý. Ameliyatta, proksimal jejunumda antimezenterik kenarda yaklaþýk 1 cm çapýnda perforasyon ve sol tarafta büyük omentumda hematom saptandý. Perfore jejunum ansýna kama rezeksiyon ve uç uca anastomoz ve parsiyel sol omentektomi yapýldý. Bu tip silahlarýn tehlike ve zararlarýna iliþkin kitle eðitimi ve kullanýmýnýn kýsýtlanmasýna iliþkin yasal kurallarýn gerekli olduðu görünmektedir. Doktorlarýn kurusýký tabancalarýn ölümcül yaralanmalara neden olabildiðini unutmamalarý gerekir.

Blank cartridge pistols, which are produced for self-defense needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by blank cartridge pistol shots may be fatal and are rarely encountered in emergency departments. A 15-year-old boy was brought to the emergency department with a wound on his abdomen caused by a blank cartridge pistol shot. Physical examination revealed an entrance wound, 1 cm in diameter, with a ring-shaped abrasion, 4 cm in diameter, and a surrounding area of contusion, just 2 cm caudal to the left arcus costarum on the anterior axillary line. Muscular defense and rebound tenderness were present in all quadrants of the abdomen. The patient underwent an exploratory laparotomy. At the time of surgery, a proximal jejunal perforation on the antimesenteric side, approximately 1 cm in diameter, and left-sided hematoma of the greater omentum were identified. A wedge resection of the perforated jejunal loop with end-to-end anastomosis and partial left-sided omentectomy were performed. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary. Physicians should keep in mind that blank cartridge guns can cause fatal injuries.

Transmediastinal ateþli silah yaralanmalarý hasta hayatýný tehdit eden kalp, büyük damar, özofagus ve/veya akciðer gibi organlarýn yaralanmasý ile sonlanabilir. Hemodinamik açýdan stabil olan hastalarda, tanýya yönelik incelemeler ve seçilecek tedavi yöntemleri tartýþmalý noktalar içermektedir. Bu yazýda, hemodinamik açýdan stabil, transmediastinal ateþli silah yaralanmasý bulunan ve tanýsal testler sonucunda üçü ameliyata alýnan beþ olgudaki deneyimlerimizi sunduk. Ameliyata karar vermeden önce hemodinamik açýdan stabil transmediastinal ateþli silah yaralanmasý olan olgularda tanýsal testler sistematik olarak yapýlmalýdýr.

Transmediastinal gunshot wounds may result in damage to the heart, large blood vessels, esophagus or lung. In hemodynamically stable patients, diagnostic examinations have critical importance and the preferred therapies still have unresolved points. In this paper, we present our experience with five patients, three of whom were operated for transmediastinal gunshot wounds after diagnostic tests; all were hemodynamically stable. Before deciding on operation, diagnostic tests should be performed in hemodynamically stable patients with transmediastinal gunshot wounds.

ve ventriküler cerrahi sonrasý geliþirler. Bu yazýda, toraks ön duvarýnda pulsasyonu kolayca görülebilen bir sol ventrikül psödoanevrizmasý sunuldu. Elli beþ yaþýndaki kadýn hasta, koroner arter baypas (CABG) ve sol ventrikül gerçek anevrizma onarým ameliyatý sonrasý altýncý haftada kliniðe sol toraks ön duvarýnda kolaylýkla görülen ve trill alýnan pulsatil kitle ile baþvurdu. Kontrastlý toraks tomografisinde, sol toraks ön duvarýnda interkostal mesafeyi aþýp cilt altý yað dokusuna yakýnlýk gösteren yumuþak doku kitlesi görüldü. Sol ventrikülografide geniþ bir sol venrikül apikal psödoanevrizmasý saptandý. Femoral kanülasyon ile kardiyopulmoner baypasa girilen hastada, endo-anevrizmorafi ve CABG x 1 ameliyatý gerçekleþtirildi. Hasta 15. gün þifa ile taburcu edildi. Kontrol ekokardiyografisinde baþarýlý anevrizma tamiri rapor edilen hasta, ameliyat sonrasý beþinci ayda olup takibi devam etmektedir. Sol ventrikül psödoanevrizmasý sýklýkla kalp yetersizliði ile kendini gösterir, ancak bazý hastalar nükseden taþiaritmi, tromboembolizm, progresiv dispne, non-spesifik göðüs aðrýsý ya da hafif þikayetlerle baþvurabilirler. Kalp cerrahisi geçirmiþ ve göðüs ön duvarýnda pulsatil kitle þikayetiyle baþvuran bir hastada mutlaka sol ventrikül psödoanevrizmasý ayýrýcý tanýda düþünülmelidir.

Left ventricular pseudoaneurysms (LVPA) develop after myocardial infarction, trauma, infection and either valvular or ventricular surgery. We present here an unusual case of LVPA appearing like a pulsatile mass, which was easily seen from the chest wall. A 55-year-old woman was admitted to our clinic with a pulsatile mass and trill, easily seen on the anterior chest wall 6 weeks after coronary artery bypass graft (CABG) surgery and endoaneurysmorrhaphy operation. Contrast-enhanced tomography showed a soft tissue mass detected close to the subcutaneous fat tissue of the anterior chest wall located in the left hemithorax. Left ventriculography was consistent with a large pseudoaneurysm in the apical wall of the left ventricle. Cardiopulmonary bypass was established with femoral cannulation, and endoaneurysmorrhaphy and CABG x 1 operations were carried out. The patient was discharged home on postoperative day 15. Follow-up echocardiography showed successful repair and shrinkage of the aneurysm, and the patient remained asymptomatic without any clinical event during our follow-up. LVPA usually present with heart failure. However, some patients may have recurrent tachyarrhythmia, progressive dyspnea, nonspecific chest pain, or thromboembolism, or remain clinically silent. When a patient is seen after cardiac surgery with a pulsatile mass detected on the chest wall, LVPA should be considered in the differential diagnosis.

Kliniðimize baþvuran 50 yaþýndaki diyabetik kadýn hasta, yaklaþýk 15 gün önce kocasý tarafýndan sol elinden ýsýrýldýðýný bildirdi. Baþvurduðu diðer bir merkezde ilk olarak oral antibiyotik ve lokal pansuman, ardýndan intramuskuler antibiyotik tedavisi verilmiþ, ancak enfeksiyonun ilerlemesi üzerine hastanemize sevk edilmiþti. Acil olarak yatýrýlan ve debridman yapýlan hastadan alýnan kültürlerde grup F streptokok üremesi oldu ve bu etkene yönelik uygun intravenöz (ÝV) antibiyotik tedavisine baþlandý. Verilen tadaviye raðmen ikinci parmak dolaþýmýnda kötüleþme olmasý nedeniyle, karpometakarpal eklem seviyesinden amputasyon uygulandý. Amputasyon sonrasý tedaviye cevap veren hasta tamamen iyileþti ve poliklinik kontrollerinde yara yerinde herhangi bir enfeksiyon bulgusu görülmedi. Bir yýl sonraki kontrolünde fonksiyonel kýsýtlýlýðý minimal, tüm eklem hareket açýklýklarý tamdý. Sonuç olarak, risk faktörleri taþýyan ve tedavisi gecikmiþ hastalarda ÝV olarak olasý etkenlere yönelik antibiyotik tedavisi baþlanmalý, etkili debridmanlar uygulanmalý ve en önemlisi hastalar hastaneye yatýrýlarak takip ve tedavi edilmelidir.

A 50-year-old female patient presented to our institution with a human bite wound on her left hand. Her complaints started 15 days ago after her husband bit her hand. Oral antibiotics and local wound treatment had been given by another medical center to which she first presented. The treatment was changed to intramuscular antibiotics after her complaints worsened. The patient was neither hospitalized nor immobilized. She then presented to our clinic with deep wound infection. After hospitalization, intravenous (IV) antibiotics were given and open debridement was performed. F b hemolytic streptococci were isolated in cultures and IV antibiotic therapy was revised. The wound care and circulation of the second digit worsened despite the new therapy. As a result, ray-amputation through the second proximal metacarpal was performed. After amputation, the wound responded well to antibiotics and infection was resolved at the wound site. After one-year follow-up, she had minimal functional disability and all hand joints had full range of motion. In conclusion, hospitalization, IV antibiotic therapy and effective debridement should be performed in elderly patients who are at risk to achieve a favorable outcome.