Acil týp’ta da acil müdahalelerin etik ve yasal geçerliliði için aydýnlatýlmýþ onam ön koþuldur. Çünkü aydýnlatýlmýþ onam hasta-hekim arasýndaki güven iliþkisinin, iliþkinin temelini oluþturan dürüstlük ilkesinin, bireyin kendi hakkýnda karar verme hakkýný gözeten özerklik ilkesinin ve bireye saygý ilkesinin korunmasýnda asýl rol oynamaktadýr. Acil hastasý için öngörülen acil giriþimin yapýsý, yararlarý ile olasý zararlarý, tedavisiz kalýnmasý halinde ortaya çýkabilecek olumsuzluklarý içermesi gereken aydýnlatýlmýþ onam, acil týbbýn hasta yapýsýna göre baþkalaþmaktadýr. 1. Hastanýn bilinçli olduðu durumda, 2. Hastanýn bilincinin yerinde olmadýðý durumda ve 3. Hastanýn çocuk ya da genç eriþkin olmasý durumunda deðiþiklik gösteren aydýnlatýlmýþ onam; gerçek onam, açýk onam, örtülü onam, ima edilen, varsayýlan onam, vekil ve ebeveyn onam gibi isimlerle anýlmaktadýr. Hastanýn týbbi, psikolojik, hatta sosyal durumuna göre de farklýlaþabilen aydýnlatýlmýþ onam elde edilmeden acil müdahalenin yapýlabildiði istisnai durumlar bulunmaktadýr. Yaþam kurtarýcý merkezli istisnalardan baþka, hastanýn kendisi için karar veremediði durumda hekimin hastanýn en iyi yararý ile çocuðun üstün yararýný gözeterek acil müdahalede bulunmasý imtiyaz hakkýna dayanmaktadýr. Etik açýdan savunulabilen bu hak, katý paternalistik yaklaþýmlara zemin hazýrladýðý için hastanýn özerkliðine saygýnýn çiðnenmemesi için özen gerektirmektedir.

Informed consent is a prerequisite for the ethical and legal validity of the emergency intervention in emergency medicine, since it protects the fiduciary relationship between the physician and patient; the principle of honesty that grounds this relationship; the principle of autonomy that necessitates right of self-determination; and the principle of respect for persons. Informed consent in emergency medicine, which is supposed to include the nature, benefits and risks of emergency medical intervention, differentiates with respect to definite groups of patients: (1) conscious patients, (2) unconscious patients, and (3) children and mature minors. In addition, informed consent differentiates between medical, psychological and even social circumstances of the patients, referred to as valid consent, expressed-explicit consent, blanket consent, presumed consent, tacit consent, proxy consent, and parental consent. There are a few exceptions in which emergency medical intervention is administered without informed consent. In addition to the exceptions of life-saving interventions, when a patient can not decide for herself/himself, intervention of the physician in the best interest of the patient or children is based on the “therapeutic privilege” of the physician. As an ethically defensible right, since therapeutic privilege may open a door to hard paternalistic approaches, in those situations, emergency physicians should be cautious not to violate a patient’s autonomy.

AMAÇ
Sepsiste yoðun bakým polinöropatisi (YBP) olarak adlandýrýlan nöromusküler ileti bozukluklarýnýn erken dönemde enflamatuvar mekanizmalar ve/veya rölatif hipovolemi ile tetiklendiði ileri sürülmektedir. YBP, klinik bulgulardan önce erken dönemde beliren elektrofizyolojik bulgularla kendini gösterir. Çalýþmamýzda, IVIG ve volüm replasman tedavisinin deneysel sepsisin erken fazýnda görülebilen sinir ileti hýzýndaki (SÝH) deðiþikliklere olan etkisinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Randomize olarak 46 Spraque-Dawley sýçan çalýþmaya dahil edildi. Deneysel sepsis çekal ligasyon ve perforasyon ile oluþturuldu. SÝH, kuyruk sinirindeki ölçümlerle deðerlendirildi.
BULGULAR
Sham grubu, kolloid grubu ve IVIG grubunda hem grup içinde hem de gruplar arasýnda SÝH’nýn deðiþimi açýsýndan anlamlý fark olmadýðý görüldü. Herhangi bir tedavinin uygulanmadýðý sepsis grubunda ise; SÝH’nýn baþlangýç deðerine göre anlamlý azaldýðý görüldü.
SONUÇ
YBP’nin erken elektrofizyolojik bir bulgusu olarak kabul edilebilen SÝH sepsisin erken döneminde azalmaktadýr. Deneysel sepsisin erken döneminde görülen SÝH’deki azalmanýn IgM ile zenginleþtirilmiþ IVIG verilmesi ile veya erken yapýlan volüm replasmaný ile önlenebileceði görülmektedir. IVIG tedavisi uygulanan grupla kolloidle erken volüm replasmaný uygulanan grup arasýndaki sonuçlarýn istatistiksel olarak farklý olmamasý dikkat çekici olarak deðerlendirilmiþ ve konu ile ilgili mekanizmanýn açýða çýkmasý için randomize klinik ve deneysel çalýþmalara ihtiyaç olduðu kanýsýna varýlmýþtýr.

BACKGROUND
Neuromuscular abnormalities in sepsis, termed critical illness polyneuropathy (CIP), have been suggested to be induced by inflammatory mechanisms and/or relative hypovolemia. CIP is characterized by early electrophysiological findings before the clinical symptoms. This study aimed to investigate the effect of intravenous immunoglobulin (IVIG) and volume replacement therapies on the possible nerve conduction velocity (NCV) alterations in the early phase of experimental sepsis.
METHODS
Forty-six Sprague-Dawley rats were randomly assigned to four groups. Cecal ligation/perforation was performed to induce experimental sepsis. NCV was assessed in the tail nerve.
RESULTS
There was no statistically significant difference in NCV levels within and among the Sham-operated, colloid- and IVIG-treated groups. In the sepsis without treatment group, there was a statistically significant decrease in NCV levels.
CONCLUSION
NCV is decreased in the early stage of experimental sepsis and it may be accepted as an early electrophysiological sign in CIP. Treatment with either IgM-enriched IVIG or early volume replacement appears to prevent the decrease in NCV in the early phase of experimental sepsis. Results were statistically indistinguishable between the IVIG- and colloid-treated groups. No statistical difference between these groups is noteworthy. There is a need to clarify the mechanisms of action with further randomized, clinical and experimental trials.

AMAÇ
Çalýþmamýzda, metilprednizolon, N-asetilsistein (NAC) ve metilprednizolonla kombine NAC tedavisininin, sýçanlarda oluþturulan deneysel spinal kord hasarlanmasýndaki biyokimyasal etkinliði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Spraque-Dawley cinsi, ortalama 250-300 gram aðýrlýðýnda 32 erkek sýçan dört gruba ayrýldý. Spinal kord hasarlanmasý ekstradural olarak T4-T5 seviyesine yerleþtirilen anevrizma klibi ile uygulandý. Grup C’ye (Kontrol grubu, n=8) travma uygulanmasý ardýndan hiçbir tedavi uygulanmadý. Travma ardýndan Grup M’ye (Metilprednizolon grubu, n=8) 30 mg.kg-1 ardýndan idamede saatte 5,4 mg.kg-1 dozunda metilprednizolon, Grup N’ye (NAC grubu, n=8) 150 mg.kg-1 NAC, Grup MN’ye (Metilprednizolon ve NAC grubu, n=8) 30 mg.kg-1 ardýndan idamede saatte 5,4 mg.kg-1 dozunda metilprednizolon ile 150 mg.kg-1 NAC intraperitoneal olarak verildi. Travmadan 24 saat sonra sýçanlar anestezi uygulanarak dekapite edildi ve spinal kord örnekleri alýnarak biyokimyasal inceleme yapýldý.
BULGULAR
Gruplarda ortalama malondialdehid (MDA) deðerleri Grup M, Grup N, Grup MN’de, Grup C’ye göre anlamlý olarak düþüktü (p<0,05). Ortalama süperoksit dismutaz (SOD) deðerleri ise, Grup M, Grup N, Grup MN’de, Grup C’ye göre anlamlý olarak yüksekti (p<0,05). Grup M ile Grup N arasýnda ortalama MDA ve SOD deðerleri açýsýndan anlamlý farklýlýk yoktu.
SONUÇ
Metilprednizolon, NAC ve metilprednizolon ile kombine NAC tedavisinin, sýçanlarda deneysel spinal kord hasarýnda, sekonder hasarýn önlenmesinde biyokimyasal olarak faydalý olabileceði düþünüldü.

BACKGROUND
In this study, we investigated the biochemical effectiveness of methylprednisolone, N-acetylcysteine (NAC) and methylprednisolone combined with NAC treatment in experimental spinal cord injury in rats.
METHODS
Thirty-two Sprague-Dawley male rats weighing 250-300 g were divided into four groups. Spinal cord injury was created extradurally with an aneurysm clip at the T4-T5 level. Following the trauma, Group C (Control group, n: 8) was not given any treatment. Group M (methylprednisolone group, n: 8) was treated with 30 mg.kg-1 methylprednisolone followed by a maintenance dose of 5.4 mg.kg-1 per hour. Group N (NAC group, n: 8) was given 150 mg.kg-1 NAC. Group MN (methylprednisolone and NAC group, n: 8) was given 30 mg.kg-1 followed by an hourly maintenance dose of 5.4 mg.kg-1 methylprednisolone and 150 mg.kg-1 NAC intraperitoneally. Twenty-four hours after the trauma, the rats were decapitated under anesthesia, and their spinal cord samples were taken for biochemical examination.
RESULTS
Mean malonyldialdehyde (MDA) values in Groups M, N and MN were significantly reduced compared to Group C. Mean superoxide dismutase (SOD) values in Groups M, N and MN were significantly higher than in Group C (p<0.05). No difference existed between Groups M and N with respect to mean MDA and SOD values.
CONCLUSION
Methylprednisolone, NAC and methylprednisolone plus NAC treatments have potential biochemical benefits in preventing secondary injury in experimental spinal cord injury in rats.

AMAÇ
Akut karýnlý bir hasta hýzlýca deðerlendirilmeyi gerektirir. Bu hastalarda karýn aðrýsýnýn cerrahi bir nedenden mi yoksa cerrahi olmayan bir nedenden mi olduðunu anlamak çok önemlidir. Bu çalýþmada, akut karýn tanýsýnda lökosit sayýsýnýn ve D-dimer testinin doðruluðu karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Bu prospektif çalýþmada, Haziran 2006 ile Kasým 2007 tarihleri arasýnda travmaya baðlý olmayan akut karýn nedeniyle acil servise baþvuran 225 hasta deðerlendirildi. Hastalar iki gruba ayrýldý: grup 1 acil cerrahi giriþim gerektirenler ve grup 2 gerektirmeyenler. Yaþ, cinsiyet, lökosit sayýsý, D-dimer seviyesi, akut karýn aðrýsýnýn nedeni ve ameliyat bulgularý araþtýrýldý. P deðerlerinden 0,05’den küçük olanlar istatistiki olarak anlamlý kabul edildi.

BULGULAR
D-dimer seviyesi ve lökosit sayýsý arasýnda pozitif bir korelasyon bulundu. Acil karýn içi durumlarda D-dimer ve lökosit sayýsý benzer þekilde davrandý. ROC eðrisi altýnda kalan alan ise D-dimer testinde anlamlý olarak daha yüksekti (p<0,0001). Ek olarak, acil laparotomi gereken hastalarda bu testin duyarlýðý %95,7 iken lökosit sayýsýnýnki ise %74,8 olarak saptandý.
SONUÇ
Akut karýnlý bir hastada D-dimer testi lökosit sayýsýna güçlü bir alternatif veya yardýmcý olabilir.

BACKGROUND
A patient with acute abdominal pain requires rapid evaluation. In these patients, it is very important to distinguish between surgical and nonsurgical pathology. Our aim was to compare the accuracy of the leukocyte count and D-dimer test in the diagnosis of acute abdomen.
METHODS
In this prospective study, 225 patients admitted to the emergency unit due to nontraumatic acute abdomen between June 2006 and November 2007 were evaluated. The patients were divided into two groups: Group 1 patients who needed immediate laparotomy and Group 2 patients who did not. Age, gender, leukocyte count, D-dimer level, causes of acute abdominal pain, and operative findings were investigated. P values of <0.05 were considered statistically significant.
RESULTS
There was a positive correlation between the plasma D-dimer level and leukocyte count. D-dimer acted similarly to the leukocyte count in emergency abdominal conditions. The area under the receiver operating characteristic curve was statistically higher with the D-dimer test (p<0.0001). Additionally, in patients needing immediate laparotomy, the sensitivity of the D-dimer test was 95.7% versus 74.8% for leukocyte counts.
CONCLUSION
In a patient with acute abdomen, D-dimer test may be a strong alternative or an adjuvant to the leukocyte count.

AMAÇ
Peritonitli hastalarýn erken prognostik deðerlendirmesi, yoðun bakým açýsýndan yüksek risk taþýyan hastalarýn seçilmesi ve ayný zamanda güvenilir objektif bir þiddet ve operatif risk sýnýflamasý için tercih edilir. Bu çalýþmada, peritonitli hastalarda Akut fizyolojik ve Kronik Saðlýk Deðerlendirme skoru (APACHE II) ile Mannheim peritonit indeksi (MPI) gibi skorlama sistemlerinin kullanýmý deðerlendirildi.
GEREÇ VE YÖNTEM
Ýki yýllýk bir periyot boyunca jeneralize peritoniti olan ardýþýk 101 hasta (69 erkek, 32 kadýn) üzerinde prospektif çalýþma yürütüldü. Laparotomiden önce hastalara her iki skorlama sistemi de uygulandý. Skorlara esas alýnarak, hastalar üç gruba ayrýldý. Hastalarýn sonuçlarý kaydedildi ve her iki skorlama sisteminin doðruluðu deðerlendirildi.
BULGULAR
MPI sisteminde mortalite; 15’den daha düþük bir skoru olan hastalarda 0 olurken, 16-25 seviyesinde bir skoru olan hastalarda %4 ve 25 seviyesinden daha yüksek bir skoru olan hastalarda da %82,3 oldu. Benzer þekilde, APACHE II sisteminde de 10’dan daha düþük bir skoru olan hastalarda hiçbir mortalite kaydedilmedi. Mortalite; 10-20 seviyesinde bir skoru olan gruplar ile 20 seviyesinden daha yüksek bir skoru olan gruplarda, sýrasýyla %35,29 ve %91,7 oldu.
SONUÇ
Her iki skorlama sistemi, mortalitenin öngörülmesinde hassastýr. Bununla birlikte, APACHE II, kesin avantajlara sahiptir ve bu nedenle daha kullanýþlýdýr.

BACKGROUND
Early prognostic evaluation of patients with peritonitis is desirable to select high-risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. This study attempts to evaluate the use of scoring systems such as Acute Physiological and Chronic Health Evaluation score (APACHE II) and Mannheim Peritonitis Index (MPI) in patients with peritonitis.
METHODS
A prospective study was conducted using 101 consecutive patients (69 male, 32 female) having generalized peritonitis over a two-year period. Both scoring systems were applied to patients before laparotomy. Based upon the scores, patients were arranged into three groups. The outcome of patients was noted and the accuracy of the two systems was evaluated.
RESULTS
In the MPI system, mortality was 0 in the group of patients with a score of less than 15, while it was 4% in the patients scoring 16-25 and 82.3% in those with scores of more than 25. Similarly, in the APACHE II system, no mortality was noted in patients with scores less than 10. Mortality was 35.29% and 91.7% in the groups scoring 10-20 and more than 20, respectively.
CONCLUSION
Both scoring systems are accurate in predicting mortality; however, the APACHE II has definitive advantages and is therefore more useful.

AMAÇ
Distal kilit sayýsýnýn kaynamaya, komplikasyon oranýna ve ameliyat süresine etkisi olabilir. Bu çalýþmada, bir veya iki distal kilit vidasýnýn, kapalý veya tip 1 açýk, basit veya kama tipi tibia cisim kýrýklarýnda oymasýz yapýlan intramedüller çivilemede yanlýþ, gecikmiþ kaynama, kaynamama ve vida yetersizliði görünme sýklýðýna etkisi incelendi.
GEREÇ VE YÖNTEM
Elli yedi hasta (39 erkek, 18 kadýn; ortalama yaþ 38,5±10,7) prospektif olarak tek distal kilit veya iki distal kilit gruplarýna ayrýldý. Gruplar yanlýþ, gecikmiþ kaynama, kaynamama ve vida yetersizliði sýklýðý açýsýndan deðerlendirildi. Yirmi dokuz hasta iki vida grubunda, 28 hasta tek vida grubundaydý. Gruplar daha sonra uç kýrýklar (üst uç+alt uç) ve orta cisim kýrýklar olarak ayrýldý ve komplikasyon sýklýðý açýsýndan incelendi. Ýstatistiksel deðerlendirme, Mann-Whitney U, ki-kare ve T testleriyle yapýldý.
BULGULAR
Ortalama takip süresi 2,4 yýldý (daðýlým 1,5-4,7 yýl). Ýki grupta da yanlýþ kaynama yoktu. Gecikmiþ kaynama, kaynamama veya vida yetersizliði gruplar arasýnda farklý deðildi (p>0,05). Fakat, komplikasyon oraný iki vida grubun da uç kýrýklarý için tek vida grubuna göre daha fazla idi (p=0,04).
SONUÇ
Kompleks olmayan, kapalý veya tip 1 açýk kýrýklarda tek distal kilitleme güvenli olup, cerrahi süreyi ve radyasyon maruziyetini azaltmaya yardýmcý olabilir.

BACKGROUND
The number of distal locking screws may have an effect on union, complication rates and operation time. The purpose of this study was to determine the effect of one or two distal locking screws in unreamed intramedullary nailing of closed or grade 1 open, simple or wedge tibial shaft fractures on the incidence of malunion, delayed union, non-union, and screw failure.
METHODS
Fifty-seven patients (39 male, 18 female; mean age 38.5±10.7 years) were randomized to two groups as either one or two distal locking screws and were evaluated prospectively for the incidences of malunion, delayed union, non-union, and screw failure. Twenty-nine patients were included in the two distal screws group and 28 patients in the single distal screw group. Groups were then subdivided to end fractures (proximal+distal end fractures) or mid-shaft fractures and reevaluated for the incidences of complications. Mann-Whitney U, chi-square and T tests were used for statistical analysis.
RESULTS
Mean follow-up was 2.4 years (range, 1.5-4.7 years). There was no case of malunion in either group. The incidences of delayed union, non-union or screw failure were not different (p>0.05). However, complication rate for end fractures in the two screw group was higher than that in the one screw group (p: 0.04).
CONCLUSION
For non-complex, closed or grade 1 open tibial shaft fractures, locking of an intramedullary nail with a single distal screw is safe, and may help to decrease operation time and radiation exposure.

AMAÇ
Bu çalýþmada, akut apandisit tanýsýyla ameliyat edilen hastalarýn demografik özellikleriyle hastalýðýn oluþumundaki mevsim, hava sýcaklýðý, nem ve rakým gibi faktörlerin etkileri araþtýrýldý.
GEREÇ VE YÖNTEM
2004 ile 2007 yýllarý arasý, ameliyat edilen 1871 hasta perfore ve non-perfore apandisitli olmak üzere iki gruba ayrýldý. Demografik özellikler ile mevsim, hava sýcaklýðý, nem, rakým gibi çevresel faktörlerin etkisi araþtýrýldý. Bulgularýmýz, farklý ülkelerin, çevresel koþullarýnýn etkileriyle karþýlaþtýrýldý.

BULGULAR
Apandisit en sýk erkeklerde ve 10 ile 19 yaþlarý arasýnda görüldü. Perfore apandisit ise en sýk 0-9 ve 50 yaþ üstü gruplarý arasýnda görülmekteydi. Kýþ mevsiminde apandisit en sýk fakat perforasyon en az görülüyordu. Yýlýn en soðuk üç ayýnda non-perfore apandisit -8.8°’de en sýk görülürken, perfore apandisit en sýk -11.2°’de görülmekte idi (p<0,01).
SONUÇ
Bulgularýmýz, apandisitin ve perforasyonun oluþumunda yaþ ve cinsiyetin etkili olduðunu göstermiþtir. Mevsim, hava sýcaklýðý ve rakým gibi çevresel faktörler apandisitin sýklýðýnda etkili olabilmektedir.

BACKGROUND
In this study, we present the demographic features of appendicitis and investigate the influence of several factors (season, temperature, humidity, altitude) on the development of the condition.
METHODS
A total of 1871 patients operated between 2004 and 2007 were included and divided into two subgroups as perforated and non-perforated appendicitis. The demographic features and environmental factors were investigated. We compared the effects of environmental conditions with those observed in other countries.
RESULTS
Appendicitis was most frequent among males between 10 to 19 years of age. Perforated appendicitis was mostly seen between 0-9 years and after 50 years of age. The frequency of appendicitis was the highest during winter, but the rate of perforation was at its minimum during this season. During the coldest three months of the year, non-perforated appendicitis was mostly seen at temperatures of -8.8°C; however, perforated appendicitis was mostly seen at -11.2°C (p<0.01).
CONCLUSION
Our findings show that the frequency of appendicitis and perforation rate are influenced by sex and age. Environmental factors like season, temperature and altitude may also influence the frequency of appendicitis.

AMAÇ
Her ne kadar, 1901 yýlýna kadar uzanan bir geçmiþte önerilen yaklaþým olmakla birlikte, apendiküler kitleye yönelik konservatif tedavi halen yaygýn þekilde uygulanmaktadýr. Apendiküler kitle ile ilgili erken apendektominin avantajlarý konusunda bilgi veren son zamanlarda yapýlmýþ az sayýda seriyle birlikte, bu retrospektif çalýþmada hastalara bu tip yaklaþýmýn yapýlabilirliði araþtýrýldý.
GEREÇ VE YÖNTEM
Ocak 2005 ile Aralýk 2007 arasýnda þüpheli apandisit ve apendiküler kitle nedeniyle acil apendektomi uygulanan 506 hasta (240 erkek, 266 kadýn) geriye dönük olarak deðerlendirildi. Subakut/kronik apandisiti bulunan ve interval apendektomi uygulanan hastalar çalýþma dýþýnda tutuldu. Ameliyat sonrasý sonuçlar, apendiküler kitlesi bulunan ve bulunmayan hastalardan oluþan iki grup arasýnda karþýlaþtýrýldý.
BULGULAR
Çalýþmaya, 114’ünde apendiküler kitle bulunan toplam 506 hasta alýndý. Ýki grup karþýlaþtýrýldýðýnda, her iki grupta da hiçbir majör komplikasyon saptanmadý. Apendiküler kitlesi bulunan hastalardan oluþan grupta minör komplikasyon insidansý anlamlý þekilde artarken, yara enfeksiyonu insidansý bakýmýndan iki grup arasýnda anlamlýlýk saptanmadý. Apendiküler kitlesi olan hastalarda, anlamlý þekilde yüksek dren kullanýmý/hastanede kalma süresi olduðu saptandý.
SONUÇ
Düþük morbidite, azalan hastanede kalma süresi, düþük maliyet ve hasta uyumu, Hindistan gibi bir ülkede özellikle yaygýn olan ve benzer bulgularla baþvuran intestinal/peritoneal tüberküloz gibi olgularý atlamaksýzýn, apendiküler kitleye yönelik erken cerrahi tedaviyi desteklemektedir.

BACKGROUND
Although proposed as far back as 1901, conservative management for appendicular mass is still widely practiced. With a few recent series outlining the advantages of early appendicectomy for appendicular mass, we tried to investigate the feasibility of such an approach in this retrospective study.
METHODS
We analyzed retrospectively 506 patients (240 male, 266 female) who underwent emergency appendicectomy for suspected appendicitis and appendicular mass between January 2005 and December 2007. Patients with sub-acute/chronic appendicitis and interval appendicectomy were excluded. The postoperative outcomes were compared between the two groups of patients classified as with or without the mass.
RESULTS
A total of 506 patients were included in the study, of which 114 had appendicular mass. A comparison of the two groups demonstrated no major complications in either group. There was significantly increased incidence of minor complications in the group of patients with mass, although the incidence of wound infection showed no significance difference between the two groups. There was a significantly increased usage of drain / duration of stay in patients with mass.
CONCLUSION
Low morbidity, reduced hospital stay, low cost, and patient compliance favor early operative management for appendicular mass, and it also avoids the possibility of missing entities like intestinal/peritoneal tuberculosis, which have similar presentations and are especially common in a country like India.

AMAÇ
Ýntihar amaçlý ateþli silah ölümlerinin bazý özellikleri önceki çalýþmalarda tanýmlanmýþ ise de, av tüfekleri kullanýlarak gerçekleþtirilmiþ intihar ölümlerine ait seriler, literatürde sýnýrlý sayýdadýr. Bu çalýþmanýn amacý, intihar amaçlý av tüfeði ölümlerinin çeþitli özelliklerini tanýmlamaktýr.
GEREÇ VE YÖNTEM
01 Ocak 1998 ile 31 Aralýk 2007 tarihleri arasýnda Adli Týp Kurumu, Morg Ýhtisas Dairesi tarafýndan düzenlenmiþ, 36971 otopsi raporu geriye dönük olarak gözden geçirildi.
BULGULAR
Yetmiþ üç intihar amaçlý av tüfeði ölüm olgusu deðerlendirildi. Olgularýn 46’sý (%63) erkek, 27’si (%37) kadýndý. Olgularýn çoðu (n=39, %53,4) 16-20 yaþ grubunda yer almaktaydý (p<0,001). Ýntiharlarýn 62’si (%84,9) kurbanýn evinde meydana gelmiþti (p<0,001). Yedi olguda intihar notu (%9,6) bulunmuþtu. Giriþ yaralarý olgularýn büyük çoðunluðunda (n=29, %39,8) kafa bölgesinde iken (p<0,001), kadýn kurbanlarda intihar için genellikle (n=12, %44,4) karýn bölgesinde idi. Atýþ, olgularýn 56’sýnda (%76,7) tam temas halinde, bitiþik atýþ (gevþek temas) mesafesinden gerçekleþtirilmiþti (p<0,001). Olgularýn %17,8’inde (n=13) kanda etil alkol saptanmýþtý.
SONUÇ
Av tüfekleri ile intiharlarýn önlenebilmesi için, av tüfeklerinin elde edilmesi ve kullanýmý sýký olarak kontrol edilmeli, eðitim çabalarý erken ve geç adölesan dönemindeki gençlere ebeveynlerine yönelmeli, psikolojik destek merkezleri kurulmalýdýr.

BACKGROUND
In previous studies, some features of suicidal firearm deaths have been described, but series of suicidal deaths using shotgun are limited in the literature. The aim of the present study was to define several characteristics of suicidal shotgun deaths.
METHODS
In this study, we reviewed retrospectively 36,971 autopsy reports recorded by the Mortuary Section of the Forensic Medicine Council of Istanbul between January 1, 1998 and December 31, 2007.
RESULTS
Seventy-three shotgun-related suicide cases were evaluated. Of the 73 cases, 46 (63%) were male and 27 (37%) were female. Most of the cases (n=36, 53.4%) were aged 16-20 years (p<0.001). Sixty-two of the suicides (84.9%) occurred in victims’ homes (p<0.001). A suicide note was recovered in 7 cases (9.6%). While entry wounds were on the head in the majority of the cases (n=29, 39.8%) (p<0.001), in nearly half of the female victims (n=12; 44.4%), entry wound was in the abdominal region. Fifty-six shots (76.7%) were determined to be from loose-contact range (p<0.001). Ethyl alcohol was detected in 17.8% (n=13) of blood samples of the cases.
CONCLUSION
Handling and usage of shotguns should be under strict control, educational efforts should be directed to early and late adolescents and their parents and psychological support centers should also be founded in an effort to prevent suicidal deaths with shotguns.

AMAÇ
Penetran kardiyak yaralanma nedeniyle cerrahi tedavi gören hastalarda taný ve acil cerrahi yaklaþýmýn önemini vurgulamaktýr.
GEREÇ VE YÖNTEM
Koþuyolu Kalp Eðitim ve Araþtýrma Hastanesi, Haziran 2005 tarihinde Cevizli Kartal’daki yeni hizmet binasýna taþýndý. Bu bölgede hizmet binasýnýn þehrin ana arterlerine yakýn konumlanmasý nedeniyle travmalý olgularýn sayýsýnda artýþ söz konusudur. Bu çalýþmada, Haziran 2005-Eylül 2008 tarihleri arasýnda penetran kardiyak yaralanma tanýsýyla kliniðimize baþvuran olgular retrospektif olarak incelendi.

BULGULAR
Penetran kardiyak yaralanma ön tanýsýyla 26 hasta kliniðimize baþvurdu. Bu hastalarýn 20’sine cerrahi onarým iþlemi uygulandý. Olgularýn birinde (%5) ateþli silah, geri kalanýnda (%95) ise kesici delici alet ile yaralanma mevcuttu. Hastalarýn 4’ü (%20) kadýn, 16’sý (%80) erkekti. Yaþ ortalamasý 24,9±10,1 (12-49) idi. Tanýda klinik bulgulara ek olarak telekardiyografi ve transtorasik ekokardiyografi kullanýldý. Cerrahi onarýmda 14 hastada mediyan sternotomi ve 6 olguda sol anterolateral torakotomi uygulandý. Hastalarýn 12’sinde sað ventrikül, birinde pulmoner arter ve yedisinde sol ventrikül yaralanmasý vardý. Ýlave olarak beþ hastada akciðer, bir hastada brakiyosefalik ven ve bir hastada koroner arter yaralanmasý saptandý. Bir hasta kanama nedeniyle revizyona alýndý. Postoperatif dönemde iki hasta (%10) kaybedildi.
SONUÇ
Penetran kardiyak yaralanma olgularýnda hastalarýn hýzlý transferi, tanýnýn doðru ve çabuk koyulmasý ve agresif cerrahi onarým uygulanmasý ile hayatta kalma oranlarý artacaktýr.

BACKGROUND
Our aim was to express the importance of emergency diagnosis and surgical approach in penetrating cardiac trauma patients.
METHODS
Koþuyolu Heart and Research Hospital moved to its new location in Cevizli Kartal in June 2005. Due to its close proximity to the main roads of the city, the number of trauma cases has increased tremendously. We have retrospectively examined our penetrating cardiac trauma cases treated between June 2005 and September 2008.
RESULTS
Twenty-six trauma cases were admitted to our clinic with penetrating cardiac trauma. Twenty of them were operated on an emergency basis. One (5%) had a gunshot wound while the other 19 (95%) had stab wounds. Four were female (20%) and 16 were male (80%). Average age of the patients was 24.9±10.1 (12-49) years. Telecardiography and transthoracic echocardiography were used for diagnosis. Surgical approaches were median sternotomy in 14 and left anterolateral thoracotomy in 6 cases. The right ventricle was damaged in 12, left ventricle in 7 and pulmonary artery in 1. Additionally, 5 patients had lung injury, 1 had brachiocephalic vein injury and 1 had coronary artery injury. One patient was re-explored for bleeding. There were two mortalities (10%) postoperatively.
CONCLUSION
Rapid transfer to the emergency department, accurate and quick diagnosis and aggressive surgical approach will increase survival in penetrating cardiac trauma.

AMAÇ
Tandýr, Doðu ve Güneydoðu Anadolu Bölgesi’nde, içinde ekmek piþirmek için kullanýlan bir fýrýnýn adýdýr. Tandýr yanýðý, öncelikle kadýn ve küçük çocuklarýn içine düþüp acý veren geniþ ve derin yanýklarýn oluþtuðu özel bir yanýk çeþididir. Bu çalýþmadaki amaç, Diyarbakýr çevresinde meydana gelen tandýr yanýklarýný deðerlendirmektir.
GEREÇ VE YÖNTEM
Mayýs 2003 ve Þubat 2006 tarihleri arasýnda yanýk ünitesinde tedavi edilen, tandýr yanýðý olan 21 hastanýn kayýtlarý incelendi. Tandýr yanýklý hastalar tüm yanýklarýn %2,14’ünü oluþturuyordu. Yaþ ortalamasý 10,7 yýl idi (daðýlým, 1-47 yýl). Hastalarýn %71,43’ü kadýn idi ve %61,90’ý altý yaþýn altýnda idi. Ortalama yanýk yüzey alaný (TBSA) %22,33 idi (daðýlým, 8-75); hastalarýn %71,43’ünde üçüncü derece yanýklar vardý.
BULGULAR
Üç hastaya ekstremite amputasyonu yapýldý. Hastalarýn 8’ine fasiyotomi, 16’sýna eskar eksizyonu yapýldý; beþ hastaya da parsiyel kalýnlýkta deri grefti konuldu. Ortalama yatýþ süresi 16,90 gün idi (daðýlým, 5-34 gün). Hastalarýn beþi (%23,81) hayatýný kaybetti.
SONUÇ
Tandýr yanýðý yüksek morbidite ve mortalitesi olan ciddi bir yanýk çeþididir.

BACKGROUND
Tandir is the name given to a special oven used for baking bread in the eastern and southeastern part of Anatolia. Tandir burn is a unique trauma in that it involves primarily women and young children falling into the in-ground ovens and suffering deep extensive burns. In this study, we aimed to evaluate the tandir burns occurring in the Diyarbakýr region.
METHODS
The records of 21 patients with tandir burn who were treated in our Burn Center between May 2003 and February 2006 were reviewed. Patients with tandir burns accounted for 2.14% of all burned patients. The mean age was 10.7 years (1–47 years). Of the patients, 71.43% were female, and 61.90% were under six years old. The mean total body surface area (TBSA) burned was 22.33% (8-75), and 71.43% of the patients had third-degree burns.
RESULTS
Three patients required amputation of an extremity. Eight patients had fasciotomies, 16 eschar excision, and 5 partial thickness skin grafts. The mean hospitalization period was 16.90 days (5-34 days). Five patients (23.81%) died.
CONCLUSION
Tandir burn is a severe burn with a higher morbidity and mortality.

AMAÇ
Nekroz nedeniyle baðýrsak rezeksiyonu yapýlan akut mezenterik iskemili (AMÝ) hastalardaki deneyimlerimiz sunuldu ve hastane mortalitesi ile ilgili prognostik faktörler deðerlendirildi.
GEREÇ VE YÖNTEM
AMÝ’li hastalarýn klinik kayýtlarý gözden geçirildi ve retrospektif olarak analiz edildi.
Bu çalýþmada, 67 hasta (34’ü kadýn ve ortalama yaþ 66) incelendi.
BULGULAR
Hastalarýn tümünde ince baðýrsak nekrozu, 21’inde (%32,3) kolon tutulumu belirlendi. Olgularýn 59’unda (%88) nekrotik ince baðýrsaklar ilk giriþim sýrasýnda rezeke edildi. Bu hastalardan 2’sine (%3) embolektomi de uygulandý. Olgularýn 22’sine (%32,8) anastomoz yapýldý. Olgularýn 31’ine (%46,3) second look operasyon yapýlarak 8’ine (%11,9) primer rezeksiyon, 11’ine (%16,3) re-rezeksiyon uygulandý. Hastane mortalite oraný %56,7 (n=38) bulundu. Lojistik regresyon testinde semptom süresinin >24 saat olmasýnýn (p=0,000), baþvuru sýrasýnda sepsis saptanmasýnýn (p=0,022) ve ince baðýrsak nekrozuna kolon tutulumunun da eklenmiþ olmasýnýn (p=0,002) hastane mortalitesi için baðýmsýz prognostik faktörler olduðu gösterildi.
SONUÇ
Geç taný konmasý ve sepsis nedeniyle AMÝ’de hastane mortalitesi oraný yüksektir. Diðer bir risk faktörü kolon tutulumudur. Yüksek riskli hastalara erken ve agresif yaklaþým ve sepsis geliþmeden önce nekrotik baðýrsaklarýn olabildiðince erken rezeke edilmesi hastane mortalite oranlarýný düþürebilir.

BACKGROUND
The purpose of this study was to review our experience in patients with acute mesenteric ischemia (AMI) and to identify prognostic factors associated with hospital mortality.
METHODS
Clinical data of patients with AMI were reviewed and analyzed retrospectively. A total of 67 patients (34 female, overall mean age 66 years) were evaluated in the study.
RESULTS
Small bowel necrosis was detected in all patients, while colonic involvement was present in 21 (31.3%). Necrosed small bowels were resected in 59 (88%) in the first intervention. Embolectomy was also performed in 2 (3%) of these cases. Anastomosis was established in 22 (32.8%). Second-look operation was performed in 31 (46.3%) and primary resection and re-resection were performed in 8 (11.9%) and 11 (16.4%) patients, respectively. Hospital mortality rate was 56.7% (n=38). Logistic regression analysis showed prolonged symptom duration (>24h) (p=0.000), sepsis (p=0.022) and colonic necrosis accompanied with small bowel necrosis (p=0.002) as the independent prognostic factors in hospital mortality.
CONCLUSION
AMI has a high hospital mortality rate due to late diagnosis and sepsis. Another risk factor is colonic involvement. Early evaluation in high-risk patients and resection for necrosed intestinal segments as soon as possible prior to sepsis may reduce the hospital mortality rate.

AMAÇ
Fournier gangreni (FG) hýzlý ilerleyen sinerjistik, polimikrobiyal nekrotizan fasiittir. Hastalýðýn mortalitesi halen yüksektir. Çalýþmamýzda hastalarýn prognozuna etki eden risk faktörlerini ve tedavi maliyetini belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM
2003-2007 yýllarý arasýnda FG nedeniyle ameliyat edilen 18 hastanýn dosyalarý retrospektif olarak incelendi. Yaþayan ve ölümcül seyreden hasta gruplarý demografik özellikler, etyolojik faktörler, laboratuvar bulgularý ve tedavi uygulamalarý yaný sýra hastanede kalýþ süresi ve tedavi giderleri yönünden karþýlaþtýrýldý.

BULGULAR
Hastalarýn yaþ ortalamasý 54,5 ve kadýn/erkek oraný 6/12 idi. Mortalite 6 (%33,3) hastada gözlendi ve kadýnlarda (%66,6) anlamlý þekilde fazlaydý (p=0,035). Þikâyet süresi ölümcül seyreden hastalarda (9±3 gün) yaþayanlardan (5±3 gün) fazlaydý (p=0,018). En sýk; yandaþ hastalýk diyabet (%39,2), etyoloji perianal apse (%55,6), enfeksiyonun primer yerleþimi anorektal bölgeydi (%61,1). Hiponatremi yaþayan hastalarda fazlaydý (p=0,039). FG þiddet puaný ortalamasý ölümcül seyredenlerde (6,83) yaþayanlardan (3.17) fazlaydý (p=0,011). Hastalarda en sýk üreyen bakteri E.coli’ydi (%66,6) ve mortal seyreden hastalarda anlamlý þekilde fazlaydý (p=0,012). Hastalarýn debridman sayýsý ortalamasý 4,67 idi. Fekal diversiyon 7 (%38,8) hastaya uygulanmýþtý. Hastanede yatýþ süresi yaþayanlarda (34,17 gün) ölümcül (10,50 gün) olanlardan fazlaydý (p=0,002). Hasta gruplarýnýn tedavi maliyeti farksýzdý (p>0,05).
SONUÇ
Kadýn cinsiyeti, tedavi öncesi geçen þikâyetin süresi, FG þiddet puaný ve kültürde üreyen mikroorganizmanýn (E. coli) mortaliteyi etkileyebileceði düþünülmektedir. FG tedavi süresi uzun ve maliyeti fazla olabilecek bir hastalýktýr.

BACKGROUND
Fournier’s gangrene (FG) is a rapidly progressive, polymicrobial, synergistic necrotizing fasciitis, and the mortality rate is still high. We aimed to determine the risk factors affecting prognosis and treatment cost.
METHODS
Eighteen patients operated for FG during 2003-2007 were investigated retrospectively. Surviving and exitus groups were compared regarding demographic data, etiological factors, laboratory findings, treatment modality, length of hospital stay, and treatment cost.
RESULTS
Mean age was 54.5 years, and the female/male ratio was 6/12. Mortality was observed in 6 (33.3%) patients and was significantly high among females (66.6%) (p=0.035). Mean duration of complaint in the exitus group (9±3 days) was higher than in survivors (5±3 days) (p=0.018). The most frequent comorbid disease was diabetes (39.2%), the most frequent etiology was perianal abscess (55.6%) and the primary location of infection was anorectal region (61.1%). Hyponatremia was significantly high in surviving patients (p=0.039). Mean of FG severity point in the exitus group (6.83) was higher than in survivors (3.17) (p=0.011). The most frequently cultivated microorganism, Escherichia coli (66.6%), was significantly high in the exitus group (p=0.012). The mean number of debridements was 4.67. Fecal diversion was performed in 7 (38.8%) patients. Hospital stay in the surviving group (34.17 days) was higher than in the exitus group (10.50 days) (p=0.002). Treatment cost between groups was indifferent (p>0.05).
CONCLUSION
Female gender, duration of complaint, FG severity point, and cultivated microorganism (E. coli) were thought to affect mortality. FG is a disease that might cause extended hospital stay and high treatment cost.

AMAÇ
Kliniklerimize müracaat eden toraks travmalý hastalar, geliþen toraks duvarý yaralanmalarý açýsýndan deðerlendirildi, bu yaralanmalar sonucu oluþan komplikasyonlar ve uygulanan tedavi yöntemleri gözden geçirildi.
GEREÇ VE YÖNTEM
Ocak 1995-Aralýk 2007 tarihleri arasýnda Yüzüncü Yýl Üniversitesi Týp Fakültesi ve Süreyyapaþa Devlet Hastanesi, Göðüs Cerrahisi Kliniklerinde yatýrýlarak tedavi edilen 668 toraks travmalý hasta retrospektif olarak incelendi. Bu hastalarýn 399’u (%59,7) künt, 269’u (%40,2) penetran travmalý idi. Künt travmalý hastalarýn 303’ünde (%75,9) ve penetran travmalý hastalarýn 58’inde (%21,5) olmak üzere 361 (%54) hastada toraks duvarý yaralanmasý saptandý.

BULGULAR
Toraks duvarý yaralanmalarýnda karþýlaþýlan patolojiler (kontüzyon, hematom, ciltaltý amfizemi, kemik kýrýklarý, yelken göðüs, penetran göðüs duvarý yaralanmasý ve travmatik asfiksi) açýsýndan hastalar sýnýflandýrýldý, komplikasyonlar ve uygulanan tedavi yönünden deðerlendirildi.
SONUÇ
Toraks duvarý yaralanmalarý, göðüs kafesinin kardiyopulmoner sisteme yakýnlýðý nedeniyle morbidite ve mortaliteyi önemli ölçüde artýrabilmektedir. Ýlk deðerlendirmede beraberinde intratorasik bir patoloji bulunmasa dahi, takip eden günlerde geliþebilecek kardiyopulmoner komplikasyonlar açýsýndan bu hastalar dikkatle izlenmelidir.

BACKGROUND
In this study, it was aimed to assess patients who applied to our clinics with the complaints of thorax trauma, consistent thoracal wall injury, complications due to these traumas, and the therapeutical methodology.
METHODS
Records of 668 patients, hospitalized at Süreyyapaþa Training and Research Hospital and Yüzüncü Yýl University Faculty of Medicine between January 1995 and December 2007, were reviewed retrospectively. Three hundred ninety-nine (59.7%) patients had blunt trauma whereas 269 (40.2%) patients had penetrating trauma. Thoracic wall injury was detected in a total of 361 (54%) patients (303 (75.9%) with blunt trauma; 58 (21.5%) with penetrating trauma).
RESULTS
Patients were assessed according to any developed pathology related with thoracic wall injuries (contusion, hematoma, subcutaneous emphysema, bone fractures, flail chest, penetrating chest wall wounds, and traumatic asphyxia), complications and treatment modality.
CONCLUSION
Thoracal wall injuries increase morbidity and mortality due to the close proximity of the chest wall to the cardiopulmonary system. At the initial evaluation, even without any corresponding intrathoracic pathology, these patients must be monitored attentively for a probable cardiopulmonary complication for consecutive days.

Bu yazýda, motorsiklet çarpmasý sonucu subdural hematom, aort rüptürü ve travmatik psödoanevrizma geliþen 11 yaþýndaki olgu sunuldu. Hasta ilk 24 saat süreyle konservatif olarak tedavi edildi ve daha sonra anevrizma boynunun týkanýklýðýný gidermeye yönelik stent yerleþtirme iþlemi için gönderildi. Ýþlem sonrasý dönemde nüks oluþmadý ve hasta 21 gün sonra sekelsiz olarak taburcu edildi. Bu yazý, ayný zamanda pediyatrik hasta grubunun bu ciddi lezyonlarýnýn tedavisi ve travma mekanizmalarýný da irdelemektedir.

We report herein an 11-year-old pedestrian struck by a motorcycle, who suffered subdural hematoma and aortic rupture and developed traumatic pseudoaneurysm. He was treated conservatively for the first 24 hours and submitted to stent placement occluding the aneurysm neck. There were no recurrences in the post-procedure period and the child was discharged after 21 days without sequelae. This report also reviews trauma mechanisms and management of such threatening lesions in the pediatric population.

Künt abdominal travmanýn neden olduðu izole jejunal perforasyon nadirdir ve çoðu kez motorlu taþýt kazalarýndan sonra görülür. Darp edildikten sonra þiddetli karýn aðrýsý ile hastanemize yatýrýlan genç erkek hastaya iliþkin “patlama” þeklinde bir jejunal perforasyon olgusu sunuyoruz. Yaralanma Þiddet Skoru 0 olarak deðerlendirildi. Ayakta çekilen göðüs radyogramýnda serbest hava saptanmadýysa da karýn bilgisayarlý tomografisi taramasý büyük miktarda serbest intraperitoneal hava bulunduðunu ortaya koydu. Tanýsal laparotomide yalnýzca, Treitz ligamanýnýn 20 cm uzaðýnda yer alan 3 cm uzunluðunda bir jejunum perforasyonu belirlendi. Bir travma merkezi olarak, sýnýrlý deneyimlerimiz olmasýna raðmen, klinik kuþku ve zamanýnda gerçekleþtirilen eksplorasyonla, hýzlý cerrahi giriþim uygulanarak baþarýlý bir sonuç elde edildi.

Isolated jejunal perforation caused by blunt abdominal trauma is uncommon and most often seen after motor vehicle accidents. We present a case of “blowout” perforation of the jejunum in a young male who was admitted to our hospital with intense abdominal pain following a physical assault. The Injury Severity Score was 0. Although the erect chest radiograph was negative for free air, abdominal computed tomography scan revealed a large amount of free intraperitoneal air. The exploratory laparotomy that followed revealed only a 3 cm-long perforation of the jejunum, 20 cm from the ligament of Treitz. Although our experience as a trauma center is limited, clinical suspicion and timely exploration in this case led to prompt surgical intervention and a successful outcome.

Ciddi vücut travmalarýndan sonra geliþen iskelet kýrýklarýnýn tedavilerinde genel olarak Kirschner çivileri ortopedik cerrahlar tarafýndan giderek artan biçimde kullanýlmaktadýr. Kirschner (K) çivisine baðlý olarak yara yerinde hematom veya dokularda yýrtýk gibi deðiþik komplikasyonlar literatürde bildirilmiþtir. Ancak, bildiðimiz kadarýyla K-çivisine baðlý olarak popliteal arterde yalancý anevrizma geliþimi Ýngilizce literatürde daha önce bildirilmemiþtir. Bu yazýda, K-çivisi yerleþtirildikten sonraki geç dönemde popliteal arterde yalancý anevrizma geliþen bir çocuk hasta sunuldu.

Kirschner pins are being increasingly used by orthopedic surgeons in the treatment of skeletal fractures after severe bodily injuries. As a result, there have been reports in the literature about the various complications caused by the Kirschner pin, such as wound laceration or hematoma. However, to our knowledge, pseudoaneurysm of the popliteal artery due to Kirschner pin in the late postoperative period has not been reported previously in the English literature. Herein, we present a child with pseudoaneurysm of the popliteal artery after reconstruction of a tibia fracture using Kirschner pin insertion.

Sýklýkla zeka geriliði ve psikiyatrik hastalýðý olan kiþilerde karþýlaþýlan yabancý cisim yutma, sýk görülen ancak nadiren cerrahi giriþim gerektiren bir durumdur. Çoðunlukla yutulan cisimlerin dýþkýyla atýlmasý ile sonlanmaktadýr. Yutulan cismin sayýsý, þekli, boyutu ve yutulma zamaný tedavi þeklini belirlemektedir. Acil polikliniðimize baþvurusundan bir gün önce en büyüðü 4,5 cm’lik yaklaþýk 60 adet taþ yutan 21 yaþýndaki erkek hasta konservatif izlem amacýyla kliniðimize yatýrýldý. Üç günlük konservatif izlemden sonra, akut mekanik baðýrsak týkanýklýðý geliþimi nedeniyle ameliyata alýnan hastanýn çekum ve sigmoid kolonundaki 35 adet taþ transvers kolotomi ile, midesindeki 15 adet taþ ise gastrotomi ile çýkartýldý. Bu olgu sebebiyle, yabancý cisim yutulmasýnda izlenecek tedavi yöntemleri ve literatür bilgiler araþtýrýldý.

Foreign body ingestion is usually encountered in mentally retarded patients and is a common situation in patients with psychiatric illnesses, but it rarely necessitates surgical intervention. The outcome is usually defecation of the ingested materials. The treatment modality is affected by the number, size and shape of the ingested material(s). One day before presenting to our emergency room, a 21-year-old man ingested nearly 60 stones, the largest of which was 45 mm in diameter. We hospitalized the patient for conservative follow-up in our clinic. The patient was operated because of acute mechanical obstruction of the small intestine after three days of conservative follow-up. Thirty-five stones in the cecum and sigmoid colon were removed by transverse colotomy and 15 stones in the stomach were removed by gastrotomy. Because of this case, treatment modality alternatives in foreign body ingestion and the literature data are reviewed.

Yaþlýlarda travmaya baðlý oluþan osteoporotik vertebra çökme kýrýklarýnýn tedavisinde uygulanan kifoplasti yöntemiyle hastalarýn yaþam kalitesinin arttýrýlmasý amaçlanmýþtýr. Bu yazýda travmatik osteoporotik vertebra çökme kýrýðý nedeniyle baþvuran ve tedavilerinde baþarýyla kifoplasti ameliyatý uygulanan iki yaþlý hastanýn özellikleri ve sonuçlarý sunuldu. Osteoporotik vertebra çökme kýrýklarýnýn cerrahi tedavisinde perkütan olarak uygulanan kifoplasti, hastalarýn hastanede kalýþ sürelerini kýsaltmakta, morbidite ve mortalitesini önemli derece azaltmaktadýr.

The aim of the kyphoplasty method for the treatment of traumatic osteoporotic vertebral compression fractures in geriatric patients is to improve the patient’s quality of life. In this report we present two elderly patients who were suffering of traumatic osteoporotic vertebral compression fractures and underwent successful kyphoplasties. Percutaneous kyphoplasty method for the surgical treatment of these fractures decreases the hospitalization, morbidity and mortality in these patients.

Kapalý kafa travmasý sonrasý oluþan dural sinüs trombozlarý nadir görülür, patofizyoloji mekanizmalarý henüz tam olarak bilinmemektedir. On sekiz yaþýnda erkek hasta, araç dýþýna fýrladýðý yüksek enerjili trafik kazasý sonrasý Glasgow Koma Skalasý skoru 4 (Tüp ile)/ 15 saptandý. Bilgisayarlý tomografide diffüz serebral ödemle beraber sað juguler foramene uzanan oksipital lineer kýrýk saptandý. Tedaviye raðmen ÝKB deðerlerinin yüksek seyretmesi üzerine ameliyata alýnarak bilateral fronto-temporo-parietal kraniyektomi yapýldý. Beyin manyetik rezonans venografide sað juguler venin torkula düzeyinden itibaren oblitere olduðu ve sol juguler ven kalibrasyonunun ince olduðu görüldü. Bir dizi tedavi sonrasý hasta Karnofsky performans skalasý 30/90 olarak evine taburcu edildi. Erken dönemde tedavi edilmeyen özellikle dominant dural sinüs trombozlarý, ciddi düzeyde morbid ya da ölümcül seyretmekte ve erken teþhis ve tedaviyi zorunlu kýlmaktadýr.

Dural sinus thrombosis after closed head injury is seen very rarely and its pathophysiological mechanisms are not yet understood. An 18-year-old man who had been crushed in an automobile had closed head injury with Glasgow Coma Score 4. Computerized tomography showed diffuse cerebral edema and right occipital linear fracture extending to the internal jugular foramen. Because of high- level intracranial pressure, he underwent bilateral frontotemporoparietal craniectomy. After surgery, magnetic resonance scan with venography showed that the right internal jugular vein was obliterated from the torcular Herophili and the left internal jugular vein was very thin in calibration. He was discharged home with Karnofsky performance score of 30/90. Dural sinus thrombosis with dominant side can carry high morbidity and mortality if not treated immediately.