AMAÇ
Akut mezenter iskemi (AMÝ) modeli kullanýlarak yapýlan bu çalýþmada, serum prokalsitonin ve fosfor düzeylerinin AMÝ erken tanýsýnda kullanýlabilirliði araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada 21 adet Yeni Zelanda tavþaný kullanýldý. Denekler Kontrol, Sham ve Ýskemi grubu olarak adlandýrýldý. Kontrol grubundaki deneklere herhangi bir giriþim yapýlmadý. Sham ve Ýskemi grubundaki deneklere orta hat insizyonu ile laparotomi yapýldý. Ýskemi grubundaki deneklere ise laparatomi yapýldýktan sonra süperior mezenterik arter bulunarak baðlandý. Her üç gruptaki hayvanlardan 0., 1., 3. ve 6. saatlerde kan alýndý, bu numunelerden prokalsitonin ve fosfor çalýþýldý.
BULGULAR
Ýskemi grubunda, serum fosfor ve prokalsitonin düzeylerindeki yükselme kontrol ve sham gruplarýna göre istatistiksel olarak anlamlý bulundu (p<0,05). Fosfor ve prokalsitonin düzeylerinin, iskemi oluþturulduktan sonra 1. saatten itibaren arttýðý ve bu yüksekliðin 6 saat boyunca devam ettiði saptandý (p<0,05).
SONUÇ
Fosfor ve prokalsitonin’in AMÝ’nin erken tanýsýnda ve prognozunda kullanýlabilecek önemli parametreler olabileceðini düþünüyoruz.

BACKGROUND
In this study, using an animal model of acute mesenteric ischemia (AMI), we investigated the possible use of procalcitonin and phosphorus in the early diagnosis of AMI.
METHODS
In this study, 21 New Zealand rabbits were used. Subjects were allocated into three groups as Control, Sham and Ischemia. No intervention was performed in the subjects in the Control group. In the subjects in the Sham and Ischemia groups, laparotomy was performed with midline incision. In the Ischemia group, the superior mesenteric artery was found and tied after laparotomy. Blood was drawn from the animals in all groups at 0, 1, 3 and 6 hours, and procalcitonin and phosphorus levels were studied in these samples.
RESULTS
In the Ischemia group, the increase in the levels of serum phosphorus and procalcitonin was found to be statistically significant compared to the Control and Sham groups (p<0.05). The levels of phosphorus and procalcitonin were detected to increase from the 1st hour after ischemia onset, and the increase continued for the following 6 hours (p<0.05).
CONCLUSION
Phosphorus and procalcitonin may be important parameters for use in the early diagnosis and prognosis of AMI.

GEREÇ VE YÖNTEM
Çalýþmada toplam 48 adet ortalama 200-350 gram aðýrlýðýnda Sprague-Dawley cinsi diþi sýçan kullanýldý. Her birinde 8 sýçan olan 6 grup oluþturuldu; 1. grup: normotermi + basý, 2. grup: normotermi + Celox®, 3. grup: hipotermi + basý, 4. grup: hipotermi + Celox®, 5. grup: normotermi + varfarin + basý, 6. grup: normotermi + varfarin + Celox®.
BULGULAR
Celox® uygulanan tüm gruplarda etkin kanama kontrolü saðlandý. Basý ve Celox® uygulanan tüm gruplar arasýnda hemostaz açýsýndan istatistiksel olarak anlamlý farklýlýk saptandý (p deðerleri normotermi, hipotermi ve varfarin gruplarý için sýrasýyla; p<0,05, p<0,01 ve p<0,01). Benzer þekilde basý sayýsý, Celox® uygulanan tüm gruplarda sadece basý uygulanan gruplardan anlamlý derecede daha azdý. (p deðerleri normotermi, hipotermi ve varfarin gruplarý için sýrasýyla; p<0,01, p<0,01 ve p<0,001).
SONUÇ
Celox®, sadece normotermide deðil ayný zamanda hipotermide ve bir oral antikoagülan ajan olan varfarin kullanýmýnda da etkin kanama kontrolü saðlamaktadýr.

BACKGROUND
In this study, the hemostatic efficacy of Celox® in rats under hypothermia or warfarin treatment was investigated.
METHODS
A total of forty-eight Sprague-Dawley female rats weighing 200-350 g were used in the study. Six experimental study groups were designed, as follows: Group 1: Normothermia + compression; Group 2: normothermia + Celox®; Group 3: hypothermia + compression; Group 4: hypothermia + Celox®; Group 5: normothermia + warfarin + compression; and Group 6: normothermia + warfarin + Celox®.
RESULTS
Celox® provided effective hemorrhage control in all three tested groups. There was a statistically significant difference between compression and Celox® implementation in all groups in terms of hemostasis (p-values for the normothermia, hypothermia and warfarin groups were p<0.05, p<0.01 and p<0.01, respectively). Furthermore, the compression numbers were significantly lower in all of the groups that received Celox® than in those in which compression alone was applied (p-values for the normothermia, hypothermia and warfarin groups were p<0.01, p<0.01 and p<0.001, respectively).
CONCLUSION
Celox® provides effective hemorrhage control under conditions of normothermia, hypothermia and use of the oral anticoagulant agent warfarin.

AMAÇ
Sýçanlarda oluþturulan kolon duvar hasarý ve fekal peritonit modelinde metilen mavisinin (MM) erken ve geç dönemde adezyon ve apse oluþumu üzerine etkileri incelendi.
GEREÇ VE YÖNTEM
Çalýþmada dört grup vardý; Grup I (yalnýzca laparotomi, n=10), Grup II (peritonit ve MM, n=15), Grup III (kolon insizyonu ve salin, n=15) ve Grup IV (kolon insizyonu ve salin, n=15). Tüm deneklerde mortalite, morbidite, adezyon skorlarý, histopatolojik analiz, serum tümör nekroz faktörü-α (TNF-α) ve doku hidroksiprolin (5-HP) düzeyleri deðerlendirildi. Tanýmlayýcý istatistiksel analiz Kruskal Wallis testi ile, istatistiksel anlamlýlýk saptandýðýnda ise gruplar arasýndaki fark Mann-Whitney U testi ile analiz edildi.
BULGULAR
Grup I, Grup III ve Grup IV’ün adezyon skorlarý Grup II’ye göre anlamlý yüksekti. TNF-α düzeyleri ise Grup I, Grup III ve Grup IV’de yüksek bulundu. 5-HP düzeyleri Grup I ve Grup II’de Grup III ve Grup IV’e göre düþüktü.
SONUÇ
MM’nin peritonit modelinde peritoneal adezyonlarý önlediði, ancak yara iyileþmesini olumsuz etkilediði söylenebilir. Bu ikili karþýt etkinin daha fazla araþtýrýlmasý gerekir.

BACKGROUND
We investigated the effects of methylene blue (MB) on the early and late phases of adhesion and abscess formation in a standard colonic wall injury and fecal peritonitis model in rats.
METHODS
There were four groups: Group I (only laparotomy, n=10), Group II (peritonitis + MB, n=15), Group III (peritonitis + saline, n=15), and Group IV (colon incision + saline, n=15). Mortality, morbidity, adhesion scores, histopathologic analyses, serum tumor necrosis factor-alpha (TNF-α) levels, and tissue hydroxyproline (5-HP) levels were evaluated in all animals. Descriptive statistical methods were used with Kruskal-Wallis test. When a statistical difference was obtained between groups, Mann-Whitney U test was used to confirm the difference between two groups.
RESULTS
Adhesion scores of Groups I, III and IV were significantly higher than in Group II. TNF-α levels were significantly higher in Groups I, III and IV. 5-HP levels were significantly lower in Groups I and II compared to Groups III and IV.
CONCLUSION
Based on these results, it appears that MB may prevent peritoneal adhesions in a peritonitis model, but wound healing could be impaired. MB should be further evaluated because of its dual effect.

AMAÇ
Antikoagülan tedavinin bir komplikasyonu olan ve akut karýn kliniði oluþturan rektus kýlýfý hematomunun (RKH) klinik özelliklerini, tedavisini ve sonuçlarýný sunmayý amaçladýk.
GEREÇ VE YÖNTEM
Antikoagülan tedaviye baðlý geliþen 22 RKH olgusu incelendi. Olgularýn klinik özellikleri, antikoagülan tedavinin þekli ve endikasyonlarý, radyolojik bulgular, tedavi yöntemleri, nüksetme, morbidite ve mortalite bilgileri incelendi.
BULGULAR
Olgularýn %72’si kadýn olup, yaþ ortalamasý 60.6 idi. Tüm olgular (%100) antikoagülan tedavisinin en az bir türünü, %72’si varfarin tedavisi almaktaydý. Olgularýn %45’inde öksürük hikayesi bulunmuþtu. En sýk karþýlaþýlan bulgu ve semptomlar karýn aðrýsý ve kitleydi (%77). Varfarin tedavisi gören olgularda INR (International Normalized Ratio) ortalamasý 3’ün üstünde bulunmuþtu. Tanýlar, abdominopelvik ultrasonografi ve bilgisayarlý tomografi (BT) aracýlýðýyla konuldu, BT %100 duyarlýlýk gösterdi. Olgularýn çoðu (%87) konservatif tedavi aldý. Üç olgu (%13) ameliyat edildi. Ýki olgu (%9) RKH sonucu hayatýný kaybetti, 2 olgu da bir yýl içinde hastalýk tekrarladý.
SONUÇ
Akut karýn kliniðiyle gelen, yaþlý, öksüren ve antikoagülan tedavi alan hastalarda RKH den þüphelenilmelidir. Tercih edilen taný þekli BT’dir. Erken taný, morbiditeyi ve gereksiz cerrahi müdahaleyi önler.

BACKGROUND
This clinical study was conducted to present the clinical features, treatment and outcomes of rectus sheath hematoma (RSH), which is a complication of anticoagulation therapy that can present as acute abdomen.
METHODS
Twenty-two spontaneous RSH cases who were on anticoagulation therapy were reviewed. Patient characteristics, anticoagulant therapy form and indications, clinical presentation, radiologic work-up, treatment modalities, recurrence, morbidity, and follow-up data were analyzed.
RESULTS
The majority of the patients were female (64%), and the mean age was 60.6 years. All of the patients (100%) were receiving at least one form of anticoagulation therapy; most (72%) were on warfarin therapy. History of coughing was found in 45% of the cases. The most common presenting signs and symptoms were abdominal pain and mass (77%). International normalized ratio (INR) was >3.0 in all patients on warfarin therapy. The diagnosis was made by abdominopelvic ultrasonography (US) and computerized tomography (CT). CT showed 100% sensitivity. The majority of patients (87%) were treated conservatively. Three patients (13%) were operated and 2 patients (9%) died as a result of RSH. Two patients experienced recurrence in one year.
CONCLUSION
RSH should be suspected in elderly, coughing patients on anticoagulation therapy, who present with clinical manifestations of acute abdomen. Early diagnosis can help to avoid increased morbidity or unnecessary surgical intervention.

AMAÇ
Selektif non-operatif tedavi, künt solid organ travmalý hastalar ile ilgili standart tedavi haline gelmiþtir ve bilgisayarlý vücut tomografisi (BT) yararlý terapötik ipuçlarý saðlamaktadýr. Biz, bu çalýþmayý künt solid organ travmalý hastalarda atlanan tanýlarýn sýklýðýný ve karakterini belirlemek üzere yürüttük.
GEREÇ VE YÖNTEM
Aðustos 2003 ile Ekim 2006 tarihleri arasýnda solid organ yaralanmalarý (karaciðer, dalak ve böbrek) nedeniyle Chi-Mei Týp Merkezine yatýrýlan ve vücut BT’si çekilen bütün künt travmalý hastalarýn týbbi kayýtlarý gözden geçirildi.
BULGULAR
Hastalar, atlanmýþ bir taný bulunup bulunmamasýna göre atlanan grup (24 hasta) ve deðiþmeyen grup (262 hasta) þeklinde gruplara ayrýldý. Genel atlanan taný oraný %8,4 idi. Yalnýzca tanýmlanmamýþ bir baðýrsak yaralanmasý takip BT’si ile açýða çýkarýldý, atlanan yaralanmalarýn hepsi laparotomi ile ortaya çýkarýldý. Atlanan grup, daha yüksek bir Yaralanma Þiddet Skoru, daha düþük Glasgow Koma Skalasý, daha fazla Yoðun Bakým Ünitesi (YBÜ) tedavisi ve daha uzun hastanede kalma süresine sahip olmuþtur.
SONUÇ
Ciddi travmasý uzun süre devam eden hastalarda, atlanmýþ tanýlarýn ortaya çýkarýlmasý seyrektir. Laparotomi atlanmýþ tanýlarýn hepsini ortaya çýkarmýþ ve takip BT’si tanýmlanmamýþ yaralanmalarýn saptanmasýnda düþük bir yeteneðe sahip olduðunu ortaya koymuþtur. Klinik kötüleþme oluþmasý durumunda, künt solid organ travmalý hastalarýn non-operatif tedavisinde takip BT’si yerine laparotomi yapýlmasýný öneriyoruz.

BACKGROUND
Selective nonoperative management has become the standard care for blunt solid organ trauma patients, and torso computed tomography (CT) provides useful therapeutic clues. We conducted this study to determine the frequency and character of missed diagnoses in blunt solid organ trauma patients.
METHODS
We reviewed the medical records of all blunt trauma patients who underwent torso CT and who were admitted for solid organ injuries (liver, spleen and kidney) at the Chi-Mei Medical Center from August 2003 to October 2006.
RESULTS
The patients were divided into the Missed Group (24 patients) and the Unaltered Group (262 patients) according to the presence or absence of a missed diagnosis. The overall missed diagnosis rate was 8.4%. Only one unidentified bowel injury was disclosed by follow-up CT, and all of the missed injuries were revealed by laparotomy. The Missed Group had a higher Injury Severity Score, lower Glasgow Coma Scale, more Intensive Care Unit (ICU) care, and longer duration of hospitalization.
CONCLUSION
Discovery of missed diagnoses is not uncommon in patients who sustain severe trauma. Laparotomy revealed all of the missed diagnoses, and follow-up CT demonstrated a poor ability to detect unidentified injuries. We suggest laparotomy instead of follow-up CT in the nonoperative management of patients with blunt solid organ injuries if clinical deterioration occurs.

AMAÇ
Bu yazýnýn amacý, normal yanýk travmalý hastalara göre ek morbiditeli hastalarýn gidiþat, mortalite ve morbiditelerinde farklarýn olup olmadýðýnýn saptanmasýdýr.
GEREÇ VE YÖNTEM
Bu çalýþmada, Temmuz 2007 ve Kasým 2009 tarihleri arasýnda Dicle Üniversitesi Yanýk Merkezi’nde yatýrýlan ek morbiditeli 26 olgu (8 erkek, 18 kadýn; ortalama yaþ: 30,8 yaþ; daðýlým 3-74 yýl) deðerlendirildi.
BULGULAR
Yanýk hastalarýnda ek morbiditenin patofizyolojik kaynaðý önem kazanýr. Ek morbiditesi olan yanýk hastalarýnýn tedavisi planlanýrken eþlik eden morbiditeler akýlda bulundurulmalýdýr. Tedavinin neticesini saðlamak için, bu hastalara ciddi dikkat harcanmalýdýr.
SONUÇ
Bu yazý Türk toplumunda ek morbiditeli hastalara ait güncel literatürlerin gözden geçirilmesini saðlamakta ve bu özel konuya dikkati çekmektedir.

BACKGROUND
The aim of this article was to determine whether there are differences in the progression, mortality and morbidity of these premorbid patients compared to normal burn injury patients.
METHODS
In this study, 26 premorbid cases (8 males, 18 females; mean age: 30.8 years; range: 3-74 years) hospitalized in the Dicle University Burn Center between July 2007 and November 2009 were evaluated.
RESULTS
Appreciation of the pathophysiological basis of the premorbidity in burn patients is important. When the treatment for premorbid burn patients is planned, the associated co- or premorbidity must be kept in mind. To improve the outcome of the treatment, considerable attention must be paid to these patients.
CONCLUSION
This article gives an overview of the current literature regarding premorbid patients in the Turkish population and draws attention to this specific topic.

AMAÇ
Penetran kalp yaralanmalarý nadirdir ancak yüksek mortalite gösterir. Yaralanmalarda erken taný ve hýzlý müdahale gereklidir. Penetran kalp yaralanmasý ile görülen hastalarýn karakteristikleri ve bir eðitim hastanesinde acil hizmeti veren genel cerrahlarýn bireysel tecrübeleri dahil bu hastalarda saðkalýmý etkileyen faktörler irdelendi.
GEREÇ VE YÖNTEM
1995-2009 yýllarý arasýnda Ýstanbul Okmeydaný Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde penetran kalp yaralanmasý nedeni ile tedavi edilen 23 hasta retrospektif kohort olarak analiz edildi. Hastaneye ulaþtýðýnda hayat belirtisi olmayan hastalar çalýþma dýþýnda tutuldu.
BULGULAR
Hastalarýn tamamý erkekti. Median yaþ 25 yýl olarak saptandý. On beþ hastada sol 4 hastada sað ventriküler yaralanma saptandý, 4 hastada sað atriyal yaralanma görülürken, 2 hastada karýn içi yaralanma da eþlik etmekteydi. Hiçbir hastada koroner vasküler yaralanma saptanmadý. Yirmi üç hasta arasýndan 10 hasta kaybedildi, bu hastalardan altýsýnýn bu tip yaralanmalarda ilk tecrübesini yaþayan cerrahlar tarafýndan müdahale gördüðü ön plana çýkmýþtýr. Ayrýca kardiyak tamponad sað kalýmda anlamlý fark oluþturmamýþtýr.
SONUÇ
Kurumumuza görülen penetran kardiyak yaralanma özellikleri literatür ile uyumludur. Bu tip yaralanma oranýnýn nispeten az görüldüðü göz önüne alýndýðýnda travma cerrahisi eðitimi almýþ cerrahlarýn ve kapsamlý travma referans merkezlerinin gerekliliði kaçýnýlmaz olarak gereklidir.

BACKGROUND
Penetrating cardiac injuries are rare but represent a high mortality. Early recognition of the injury and rapid intervention are necessary. We analyzed the characteristics of patients with penetrating injury and the factors affecting the outcome, including the experience of the general surgeon.
METHODS
Twenty-three patients suffering penetrating cardiac injury were retrospectively evaluated in the Istanbul Okmeydaný Training and Research Hospital, Department of General Surgery between 1995 and 2009. Patients with no sign of life on admission were excluded.
RESULTS
All patients were male, and the median age was 25 years. Fifteen patients had left ventricular, 4 had right ventricular and 4 had right atrial injuries; in addition, 2 patients had accompanying intra-abdominal injuries. No coronary vascular injury was reported, and pericardial tamponade did not statistically influence the outcome. Ten of 23 patients suffering of penetrating cardiac injury were lost, and in 6 of the 10 cases, the patient represented the first experience for the operating surgeon.
CONCLUSION
The characteristics of the penetrating cardiac injuries seen in our institution are consistent with the literature. However, we believe that the surgeon’s experience is another prognostic factor. Dedicated level 1 emergency services and trained trauma surgeons are invaluable.

AMAÇ
Bu çalýþmanýn amacý, travma ile ilgili yeterli verinin olmadýðý Türkiye’nin doðusundan epidemiyolojik veriler yanýnda hastalarýn çýkýþ durumlarýný sunmaktadýr.
GEREÇ VE YÖNTEM
Muþ Devlet Hastanesi Acil Birimi’ne Ocak 2006 - Aralýk 2007 tarihleri arasýnda baþvuran travma hastalarýnýn kayýtlarý retrospektif olarak incelendi.
BULGULAR
Toplam 6183 hastanýn 5377’si (%87) erkek ve ortalama yaþ 26,2±13,6 idi. Darp-þiddet 3910 (%63,2) hasta ile en sýk travma nedeni idi. Ardýndan trafik kazasý ve düþme sýrasýyla %21,2, %6,5 oranlarýnda idi. En sýk baþ-boyun ve ekstremite yaralanmalarý görülmüþtür. Olgularýn %89,8’inin, darp þiddet olgularýnýn ise %98,7’sinin acil polikliniðinde müdahale sonrasý taburcu edildiði gözlendi. Konsültasyona hastalarýn çoðunda (%81,8) ihtiyaç duyulmadý. Yatýþý yapýlan 258 (%4,2) hastanýn %32,6’sý trafik kazasý, %19’u düþme olgularý idi. Ancak ateþli silahla ve delici-kesici aletle yaralanan olgularýn yatýþ oranlarý (%16,7, %36,1) yüksekti. Hastalarýn %5,3’ü sevk edildi. Sevk edilen hastalarýn %41,5’i trafik kazasý, %24,3’ü düþme olgularý idi. Bununla birlikte yanýk ve ateþli silahla yaralanma olgularý arasýnda sevk daha yüksek oranda (%42,1, %24,1) idi. Yarýsý trafik kazasýndan olmak üzere 48 (%0,8) hasta hayatýný kaybetti. Ancak canýna kastetmeye ve ateþli silahla yaralanmaya baðlý ölüm oraný (%8,3,%6) daha yüksek bulundu.
SONUÇ
Darp þiddet olgularý acil biriminde travma hastasý yoðunluðuna neden olmaktadýr. Yüksek darp þiddet oraný ile ilgili ileri çalýþmalar gerekli gözükmektedir.

BACKGROUND
There is a grey zone about the epidemiology of trauma in eastern Turkey. The present study was aimed at obtaining data on this subject.
METHODS
Trauma patients who applied to the emergency department (ED) between January 2006 and December 2007 were analyzed.
RESULTS
There were 6183 patients, of whom 87% were male. The mean age was 26.2±13.6 years. Assault was the most common cause (63.2%). Motor vehicle injury (MVI) and fall were encountered at frequencies of 21.2% and 6.5%, respectively. The most frequently injured body regions were head-neck and extremities. The majority of patients were managed and discharged from the ED (89.8%) with no consultation (81.8%). Interestingly, the discharge rate of assault cases was 98.7%. Patients were hospitalized (4.2%) mostly for MVI (32.6%) and fall (19%); however, hospitalization rates for firearm and piercing/cutting injury (36.1% and 16.7%) were significantly high. Among the transported patients (5.3%), the rates of MVI and fall were high (41.5% and 24.3%, respectively). In groups, for burn and firearm injuries, these were 42.1% and 24.1%, respectively. Forty-eight patients (0.8%) died, mostly from MVI by number, but by self-infliction and firearm by rate (8.3% and 6%).
CONCLUSION
Assault cases caused an excessive trauma patient density in the ED, as 98.7% were discharged from the ED. Further studies are needed regarding the high rate of assault cases.

AMAÇ
Non-operatif tedavinin dalak travmalý hastalar üzerindeki etkilerini belirlemek üzere, I. Basamak Travma Merkezimizde Ocak 2007 ile Haziran 2008 tarihleri arasýnda retrospektif bir çalýþma yürütüldü.
GEREÇ VE YÖNTEM
Hasta demografisi, dalak yaralanmasý biçimi, bilgisayarlý tomografi (BT) evrelemesi, kan transfüzyon gereksinimi, cerrahi bulgular, hastanede kalýþ ve takip ile ilgili bilgiler toplandý. Splenik yaralanmanýn kanýtý olarak ve yaralanmanýn evresini belirlemek üzere, karýn ultrasonografisi ve BT tarama sonuçlarý kullanýldý. Hastalar splenektomi ve non-operatif gruplarýna ayrýldý. Bulgular non-parametrik Mann-Whitney U testiyle analiz edildi.
BULGULAR
Altmýþ yedi hasta çalýþmaya alýndý. Evre I yaralanmasý olan bütün hastalarla evre II yaralanmasý bulunan 13 hastanýn 12’si non-operatif olarak tedavi edilirken, evre III 16 hastanýn 9’u, evre IV 14 hastanýn 12’si ve evre V bütün hastalar cerrahi yöntemle tedavi edildi. Bu nedenle, ne kadar yüksek yaralanma derecesi söz konusu ise o kadar çok operatif tedavi gerçekleþti. Operatif grubun ortalama Yaralanma Þiddet Skoru (20,12), non-operatif grubun Yaralanma Þiddet Skorundan (11,9) anlamlý þekilde daha yüksek bulundu (p=0,001). Operatif ve non-operatif gruplardaki ortalama hastane kalýþlarý, sýrasýyla 12,8 ve 8,3 gün idi.
SONUÇ
Dalak travmasýnýn non-operatif tedavisi kabul edilebilir sonuçlarla uygulanabilmektedir.

BACKGROUND
A retrospective study was performed to identify the effect of non -operative management on splenic trauma patients and its implications at our Level I Trauma Centrer between January 2007 and June 2008.
METHODS
Data regarding patient demography, mode of splenic injury, computerized tomography (CT) grading, blood transfusion requirement, operative findings, hospital stay, and follow-up were collected. The results of abdominal sonography and CT scan were utilized as proof of splenic injury and to determine the grade of injury. Subjects were divided into splenectomy and non-operative groups. Results were analyzed using non-parametric Mann-Whitney U tests.
RESULTS
Sixty-seven patients were enrolled in this study. All patients with grade I injury and 12 of 13 patients with grade II injury were managed non-operatively, whereas 9 of 16 patients with grade III injuries, 12 of 14 patients with grade IV injuries and all patients with grade V injuries were managed operatively. Thus, the higher the grade of injury, the greater the likelihood of operative management. The mean Injury Severity Score of the operative group was 20.12, significantly higher (p=0.001) than in the non-operative group, at 11.9. Mean hospital stays in the operative and non-operative groups were 12.8 and 8.3 days, respectively.
CONCLUSION
Non-operative management of splenic trauma can be performed with an acceptable outcome.

AMAÇ
Bu çalýþmada, pediyatrik yaþ grubunda trafik kazasýna maruz kalan olgular araþtýrýldý ve risk etmenleri ile ilgili veriler elde edilmeye çalýþýldý.
GEREÇ VE YÖNTEM
Bir üniversite acil servisine beþ yýl süre ile baþvuran 15 yaþ ve altýndaki travma olgularý retrospektif olarak incelendi. Yaþ, cinsiyet, kazanýn oluþ zamaný, kazanýn oluþ þekli, yaralanma bölgesi, yaralanma tipi ve klinik gidiþ verileri araþtýrýldý.
BULGULAR
Çalýþma kriterlerine uyan 812 olgu olduðu belirlendi. Oluþ nedenlerine göre, araç içi trafik kazalarý en büyük grubu oluþturdu (n=479, %59). Yaz aylarýnda tüm baþvurularýn %34’ü (n=236) gerçekleþti. 17: 00-17: 59 (n=94, %11,6) ve 18: 00-18: 59 (n=88, %10,8) saatleri baþvurularýn en yogun olduðu zaman dilimleriydi. Baþ-boyun bölgesinin (n=226, %27,8) ve ekstremitelerin (alt ekstremite: n=144, %17,7; üst ekstremite: n=99, %12,2) en sýk etkilenen vücut bölgeleri olduðu ve olgularda kontüzyon, abrazyon, hematom ve crush tipi yaralanmalarýn daha sýk görüldüðü belirlendi (n=443, %54,6). Hayatýný kaybeden olgularýn büyük çoðunluðu, yayaya araç çarpmasý þeklinde gerçekleþen araç dýþý trafik kazasý olgularýydý (n=19, %59,4).
SONUÇ
Bu çalýþmada, araç dýþý trafik kazalarýnýn pediyatrik yaþ grubu için daha ölümcül olduðu ve bu kazalarýn sýklýkla yaya olarak araç ile çarpýþma sonrasý gerçekleþtiði gözlenmiþtir.

BACKGROUND
In this study, the pediatric age group exposed to road traffic accidents was investigated, and patients with risk factors were studied to obtain relevant data.
METHODS
Trauma patients under the age of 15 who were admitted to the emergency department of this university over five years were analyzed retrospectively. Age, gender, accident time and type, personal injury area, type of injury, and clinical outcome were examined.
RESULTS
When the cases were analyzed with respect to the causes that led to the accidents, in-vehicle accidents formed the largest group (n=479, 59%). More than a quarter of all applications (34%) took place in summer months. Most of the applications were between 17: 00 and 17: 59 (n=94, 11.6%), followed by between 18: 00 and 18: 59 (n=88, 10.8%). The most commonly affected body parts were the head and neck region (n=226, 27.8%) and extremities (lower extremity: n=144, 17.7%; upper extremity: n=99, 12.2%). The most frequently seen injuries were contusions, abrasions, hematomas, and crush (n=443, 54.6%). The majority of patients who died were pedestrians who were hit by a motor vehicle (n=19, 59.4%).
CONCLUSION
In this study, it was observed that in the pediatric age group, traffic accidents involving a pedestrian and vehicle collision have greater fatality.

AMAÇ
Türk acil týbbýnýn kurulduðu günden bugüne uluslararasý literatürde yayýnlanmýþ bilimsel çalýþmalarýnýn genel karakteristik özelliklerini ortaya koymaktýr.
GEREÇ VE YÖNTEM
PubMed veritabaný, Türkiye’deki acil servislerden gönderilen ve 1995-2010 tarihleri arasýnda yayýnlanan makaleleri tespit etmek amacýyla tarandý.
BULGULAR
Çalýþmaya dahil edilen 514 makalenin %77’sinin (n=396) son 5 yýlda yayýnlandýðý, artýþ oranýnýn yýlda 6,2 makale olduðu saptandý. Tüm makalelerin %58,7’lik (n=302) bir oraný acil týp kategorisi dýþýndaki dergilerde yayýnlanmýþtýr. Bu kategide en popüler dergi 27 makale ile Advances in Therapy olurken, acil týp kategorisinde ilk sýrayý 48 makale ile Ulusal Travma ve Acil Cerrahi Dergisi almýþtýr. En sýk toksikoloji %26 (n=134) ve travma %16 (n=86) konularýnda makale gönderilmiþtir. Tüm makalelerin %7,7’sinin (n=40) hayvan çalýþmasý, %6’sýnýn (n=31) randomize kontrollü çalýþma olduðu saptanmýþtýr.
SONUÇ
Türk acil týbbýndaki geliþmelere paralel olarak uluslararasý bilimsel yayýn üretimi de her geçen yýl katlanarak artmaktadýr. Acil týp kategorisi dýþýndaki dergilerin daha çok tercih edilmesi, toksikoloji konulu yayýnlarýn çokluðu, üniversite hastanelerinin katkýsý dikkat çekicidir. Çok merkezli, randomize kontrollü ve etki faktörü yüksek dergilerde yayýnlanan çalýþmalarýn azlýðý yayýn sayýsý kadar yayýn kalitesi konusuna da önem verilmesi gerektiðini düþündürmektedir.

BACKGROUND
The aim of this study was to present characteristics of internationally published articles originating from Turkish Emergency Medicine (EM) departments over the last 15 years.
METHODS
The PubMed database was searched for all articles published from 1995 to 2010 that originated from Turkish EM departments.
RESULTS
A total of 514 articles were included. Of all articles, 77% (n=396) were published in the last five years. Publications were detected to increase at a rate of 6.2 articles per year. 58.7% (n=302) of the articles were published in non-EM journals. Advances in Therapy in the non-EM group, with 27 articles, and the Turkish Journal of Trauma & Emergency Surgery in the EM group, with 48 articles, were the preferred journals. The most popular subjects were toxicology, at 26% (n=134), followed by trauma, at 16% (n=86). 7.7% (n=40) of all articles were animal studies and 6% (n=31) were randomized controlled trials.
CONCLUSION
Significant publication growth was detected related with the development of EM in Turkey. The preference for non-EM journals, toxicology as the most popular subject and the effect of university hospitals were the interesting results of this study. The low number of multicenter, randomized controlled trials and of published articles in high impact factor journals have led us to consider the importance of publication quality, which requires additional effort.

AMAÇ
Proksimal falanks kýrýklarý sýk görülmektedir. Bu çalýþmada proksimal falanks kýrýklarýnýn tedavisinde tercih ettiðimiz yöntemler ve geç dönem objektif sonuçlarý sunuldu.
GEREÇ VE YÖNTEM
Ekim 2001 ve Mart 2010 tarihleri arasýnda Düzce Týp Fakültesi Plastik Rekonstrüktif ve Estetik Cerrahi Bölümü’nde, 23 hastanýn 32 proksimal falanks kýrýðý tedavi edildi. Stabil kýrýklar (n=5) atel ile takip edilirken stabil olmayan kýrýklar (n=27) açýk redüksiyon sonrasý 1,0 mm çaplý perkütan intramedüller Kirschner telleri ile tespit edildi.
BULGULAR
Üç ay ile 9 yýl arasýnda deðiþen takiplerde, hastalar redüksiyonun radyolojik yeterliliði, parmaðýn eklem hareket aralýðý (EHA), parmaðýn total aktif hareketi (TAH) ve parmaðýn kavrama gücü açýsýndan deðerlendirildi. Hastalarýn 20’sinde redüksiyonun iyi saðlandýðý gözlendi. TAH skoru, 20 parmakta mükemmel (D2-5 için ≥220°, D1 için ≥150°), 7 parmakta iyi (D2-5 için 180-220°, D1 için 120-150°) ve 5 parmakta orta veya kötüydü. Kýrýk parmaklarýn kavrama gücü saðlam parmaklarla karþýlaþtýrýldýðýnda fark olmadýðý gözlendi. Majör komplikasyon olarak 1 proksimal falanksta non-union gözlendi.
SONUÇ
Sonuç olarak, Kirschner teli ile tespit yöntemi anstabil kýrýklarýn tedavisinde güvenilir ve teknik açýdan basit bir yöntemdir. Uygun olgularda çok iyi geç dönem sonuçlarý elde edilmektedir. Stabil proksimal falanks kýrýklarýnda ise alçý atel ile tespit yeterli tedaviyi saðlamaktadýr.

BACKGROUND
Proximal phalanx fractures are common. In this study, our preferred methods regarding the treatment of proximal phalanx fractures and their long-term objective results are presented.
METHODS
Between October 2001 and March 2010, in the Plastic Reconstructive and Aesthetic Surgery Department of Düzce Medical Faculty, we treated 23 patients with 32 proximal phalanx fractures. Stable fractures (n=5) were treated with splints, while unstable fractures (n=27) were stabilized with 1.0 mm percutaneous intramedullary Kirschner wires following open reduction.
RESULTS
At follow-ups, ranging from 3 months to 9 years, patients were evaluated with radiologic efficiency, range of motion (ROM), total active movements (TAM), and grip power of the digit. TAM scores of 20 fingers were perfect (≥220° for D2-5, ≥150° for D1), for 7 fingers were good (180-220° for D2-5, 120-150° for D1), and for 5 fingers were either moderate or poor. No difference was observed between grip strength of broken fingers and that of healthy fingers. As a major complication, non-union occurred in one finger.
CONCLUSION
We concluded that Kirschner wire fixation is a reliable and simple method of treating unstable proximal phalangeal fractures, and excellent long-term results can be obtained in suitable cases. In stable proximal phalanx fractures, splints provide sufficient treatment.

AMAÇ
Kapalý redüksiyon ve perkütan vidalama ile tespiti son zamanlarda pelvis kýrýklý hastalarýn çoðunda tedavi seçeneði olmuþtur. Bu çalýþmanýn amacý, anstabil pelvis kýrýklý hastalarda uygulanan perkütan tedavinin uzun dönem sonuçlarýnýn ve hastalarýn yaþam kalitesinin deðerlendirilmesidir.
GEREÇ VE YÖNTEM
Ortalama yaþý 32 (daðýlým 11-66 yaþ) olan 20 hasta (11 kadýn, 9 erkek) çalýþmaya dahil edildi. Sonuçlarýn ve yaþam kalitesinin deðerlendirilmesi macýyla Kýsa Form-36 (KF-36) anketi, Majeed skorlamasý, Iowa pelvik skorlamasý ve pelvik sonuç deðerlendirme skorlamasý kullanýldý.
BULGULAR
En kýsa takip süresi 2 yýl (daðýlým 2-4 yýl) idi. Ortalama yaralanma þiddet skoru 31 (daðýlým 16-50) olarak bulundu. Ortalama KF-36 skorlarý vücut aðrýsý, genel saðlýk ve sosyal fonksiyonlarda normal toplum deðerleri ile benzer bulundu. Ortalama Majeed skoru 93.3 (daðýlým 72-100; 19 mükemmel ve 1 iyi klinik sonuç) ve ortalama Iowa pelvik skoru 86 (daðýlým 82-90) olarak bulundu. Ortalama pelvik sonuç deðerlendirme skoru ise 33 (daðýlým 24-37; en yüksek olasý skor, 40) idi.
SONUÇ
Pelvis kýrýklarýnda perkütan tedavi yöntemi ile iyi sonuçlar elde etmek mümkündür. Geniþ cerrahi yaklaþýmlarýn önlenmesi, kanamanýn, yara problemlerinin az olmasý ve uzun süreli cerrahilerden kaçýnýlmasý tekniðin avantajlarýdýr.

BACKGROUND
Treatment of unstable pelvic fractures has evolved recently, and percutaneous treatment has become the choice of treatment in most cases. The aim of this study was to evaluate the outcome of percutaneous treatment in patients with unstable pelvic fractures.
METHODS
Twenty patients (11 females, 9 males; mean age, 32 years, range, 11-66 years) who had unstable pelvic fractures and were treated percutaneously were enrolled in the study. Short Form-36 (SF-36) scores, Majeed scores, Iowa Pelvic Scores, and Pelvic Outcome Scores were determined for the outcome assessment.
RESULTS
The minimum duration of follow-up was 2 years, (range, 24-48 months). The mean Injury Severity Score (ISS) was 31 (range, 16-50). The average SF-36 scores were comparable with the general population in terms of bodily pain, general health and social function. The mean Majeed functional pelvic score was 93.3 (range, 72-100; 19 excellent and 1 good clinical grades) and the mean Iowa Pelvic Score was 86 (range, 82-90). The mean Pelvic Outcome Score was 33 (range, 24-37; maximum score, 40).
CONCLUSION
We have demonstrated better outcomes in patients with pelvic fractures treated with percutaneous fixation. The technique may be advantageous as it avoids the use of extensive approaches, bleeding, wound complications, and prolonged surgeries.

Güdük apandisiti, nadir bir geç apendektomi komplikasyonudur. Tanýda gecikme olmasý, genellikle daha önceden bir apendektomi öyküsü bulunmasý yüzündendir. Biz, laparoskopik apendektomiden sonra bilgisayarlý tomografi (BT) ile ameliyat öncesi taný konulan bir güdük apandisiti olgusu sunuyoruz. On sekiz yaþýnda bir erkek, bir haftalýk bir alt karýn aðrýsý, bulantý ve kusma öyküsü ile baþvurdu. Hastanýn akut apandisit nedeniyle geçirilmiþ bir laparoskopik apendektomi öyküsü vardý. Fiziksel incelemede alt karýn bölgesinde hassasiyet, defans ve aðrý belirlendi. BT ile, ileoçekal bileþkenin arkasýna yerleþimli yaklaþýk 2,5 cm uzunluðunda ve 0,78 cm çapýnda tübüler bir yapýya sahip serbest pelvik sývý bulunduðu saptandý. Laparoskopik inceleme, bulgularý doðruladý. Rezidüel bir apandiks güdüðü bulundu, yapþýklýklardan ayrýldý ve rezeke edildi. Histopatoloji, multifokal hemorajik nekroz ile birlikte olan transmural nötrofilik infiltrasyona sahip rezidüel bir apendiks bulunduðunu gösterdi. Ameliyat sonrasý sorun çýkmadý. Güdük apandisit tanýsý zor olabilir. BT taramasý, bu nadir durumun tanýsýna yönelik yararlý bir araç olduðunu kanýtlamýþtýr.

Stump appendicitis is a rare delayed complication of appendectomy. The delay in diagnosis is usually because of a prior history of appendectomy. We report a case of stump appendicitis diagnosed pre-operatively with a computerized tomography (CT) scan after laparoscopic appendectomy. An 18-year-old male presented with a one-week history of lower abdominal pain, nausea and vomiting. He had a history of laparoscopic appendectomy for acute appendicitis. Physical examination revealed tenderness and guarding in the lower abdomen. CT scan showed free pelvic fluid with a tubular structure of about 2.5 cm in length and 0.78 cm in diameter located posterior to the ileo-cecal junction. Laparoscopic exploration confirmed the findings. A residual appendiceal stump was found and dissected from the adhesion and removed. Histopathology showed a residual appendix with transmural neutrophilic infiltration associated with multifocal hemorrhagic necrosis. The postoperative period was uneventful. The diagnosis of stump appendicitis can be challenging. CT scan has proven to be a useful tool for the diagnosis of this rare condition.

Travmatik pulmoner psödokistler (TPP) künt toraks travmasýnýn nadir görülen sekelleridir. Çoðunlukla çocuklar ve genç eriþkinlerde görülürler. Bu yazýda, TPP geliþen iki genç olgu sunuldu. Taný için akciðer grafisi genellikle yeterli olmayýp tercih edilen görüntüleme yöntemi bilgisayarlý tomografidir (BT). TPP’ler genellikle spesifik tedaviye gerek göstermeksizin kendini sýnýrlayan iyi huylu lezyonlardýr. Cerrahi tedavi endikasyonu nadir olup yalnýzca komplikasyonlar geliþtiðinde uygulanmalýdýr.

Traumatic pulmonary pseudocysts (TPPs) are rare sequelae of blunt chest trauma. Young adults and adolescents are predominantly affected. In this study, two cases of TPPs in young patients are presented. Chest radiographs are usually insufficient for the diagnosis, and the imaging modality of choice is computed tomography (CT). TPPs are self-limiting, benign lesions that usually require no specific therapy. Surgical treatment is indicated in rare instances and only when complications occur.

Brakiyal ve femoral arterler gibi tek vasküler kaynaðý olan ekstremitelerin damar ve çevresi yaralanmalarýnda, ekstremite kaybý gibi morbidite ya da kanama, sepsis ve vasküler uyuþmazlýða baðlý mortalite riski yüksektir. Ekspoze damar, kemik, tendon ve kýkýrdaklarý kapatacak komþu deri ve subkütan doku yetersizliði durumunda, bu bölgelerin rekonstrüksiyonunda ihtiyaç duyulabilen serbest mikrovasküler doku transferi, vasküler yaralanma sebebi ile beraberinde ek teknik zorluklarý da ortaya çýkarabilir. Bu koþullarda, pediküllü kas ve kas-deri flebi gibi rejyonel flepler (özellikle dolaþýmý iyi hacimli dokuya ihtiyaç varsa) alternatif olabilir. Bu yazýda, vasküler cerrahi kliniðince safen ven grefti ile femoral arter onarýmý sonrasý inferiora baze pediküllü rektus abdominis kasý ile rekonstrüksiyon uyguladýðýmýz iki olgu sunuldu.

Because the extremities are dependent on a single vascular supply, namely the brachial and femoral arteries, injuries around the girdles are challenging, and may contribute to high morbidity rates such as extremity loss, or even mortality due to bleeding, sepsis or vascular compromise. The reconstruction or aided closure of these regions may present additional technical difficulties in the presence of a vascular injury that complicates the use of a microvascular-free transfer, which sometimes may be needed to cover the exposed vessels, bones, tendons, and cartilages whenever the neighboring skin and subcutaneous tissue are inadequate or demised. In these circumstances, pedicled regional flaps of muscular or musculocutaneous consistency (especially if a bulk or rich vascular tissue is needed) would be an alternative. In this report, we present two cases that underwent femoral artery repair via saphenous vein grafting in the vascular surgery clinic followed by our inferiorly based pedicled rectus abdominis muscle flap coverage procedure.

Siyatik herni, büyük veya küçük siyatik foramen içinden geçerek oluþan nadir bir pelvis tabaný hernisidir. Siyatik herniler, özellikle kadýnlarda sýklýkla pelvik aðrý þeklinde belirti verir ve tanýsý güç olabilir. Siyatik herni, ince baðýrsak týkanýklýðýnýn belirti ve semptomlarý olan ilgili taraftaki gluteal bölgede þiþlik veya pelvik aðrý þeklinde belirti verebilen en nadir internal herni formlarýndan birisidir. Laparoskopik onarýmý da içeren transabdominal ve transgluteal operatif yaklaþýmlar rapor edilmiþtir. Biz, içeriði þeklinde de hapsolmuþ ince baðýrsakla birlikte olan bir sol taraflý siyatik herni olgusunu sunuyoruz. Herni, ultrasonografi ve düz abdominal grafi tarafýndan atlanmýþ ve obturator herniyi düþündürmüþtür.

Sciatic hernia is a rare pelvic floor hernia that occurs through the greater or lesser sciatic foramen. Sciatic hernias often present as pelvic pain, particularly in women, and diagnosis can be difficult. Sciatic hernia is one of the rarest forms of internal hernia, which can present as signs and symptoms of small bowel obstruction, swelling in the respective gluteal region or pelvic pain. Transabdominal and transgluteal operative approaches, including laparoscopic repair, have been reported. We present a case of left-sided sciatic hernia with incarcerated small bowel as its contents. The hernia was missed by ultrasonography and plain abdominal radiography, but the clinical features were suggestive of an obturator hernia.

Spontan hemopnömotoraks nadir görülen bir durumdur, genç hastalarda oluþabilecek hemodinamik dengesizliðe baðlý hipovolemik þok nedeniyle yaþamý tehdit edebilir. Hemopnömotoraksýn nadir nedenlerinden biri apikal bölgede var olan aberran sistemik arterin akciðerin sönmesi sonucu gerilerek yýrtýlmasýdýr. Literatürlerde bu durum nadir rastlanýlan bir üçüncü neden olarak gösterilmektedir. Bu yazýda, spontan hemopnömotoraks nedeni olarak belirlenen aberran sistemik arter literatür eþliðinde tartýþýldý.

Spontaneous hemopneumothorax is a rare situation that can be life-threatening in young patients presenting hemodynamic instability due to hypovolemic shock. One of the extraordinary causes of hemopneumothorax is rupture of an apically located aberrant artery after pneumothorax, which is noticed as a third etiological factor in the literature. This case is presented in order to highlight this uncommon etiological factor together with the literature.

Akut epidural hematomlar ciddi ve aðýr klinik tablolardýr. Erken taný ve cerrahi boþaltma standart tedavi yaklaþýmýdýr. Aksi takdirde klinik tabloda hýzla bozulma ve ölüm riski taþýr. Asemptomatik küçük bir hasta grubu, yakýn nörolojik ve radyolojik takip ile konservatif olarak tedavi edilebilir. Bu yazýda, 3 saat gibi kýsa bir süre içerisinde rezolüsyon gösteren travmatik sað temporal akut epidural hematom olgusu sunuldu. Bu olgu saatler içerisinde hýzlý rezolüsyon görülen nadir olgulardan biridir. Çeþitli rezolüsyon mekanizmalarý literatür verileri ýþýðýnda tartýþýlmýþtýr.

Acute epidural hematomas present a serious and urgent condition. Standard management is early diagnosis and immediate surgical evacuation. Otherwise, there is a high risk of quick deterioration and death. Only patients with small asymptomatic epidural hematomas can be managed conservatively with close observation. We present a case of traumatic right temporal epidural hematoma. This is one of the rare cases of rapid spontaneous resolution of epidural hematomas within hours. Various possible mechanisms to explain the rapid resolution are discussed together with a review of the literature regarding the conservative treatment of epidural hematoma.

Yabancý cisimlerin yutulmasý, özellikle çocuklar, alkolikler, psikiyatrik hastalar ve yaþlýlar arasýnda yaygýn bir sorundur. Yuvarlak uçlu yabancý cisimler sýklýkla bir soruna neden olmazken sivri uçlu yabancý cisimler erken dönemde çýkarýlmadýklarý takdirde intestinal duvara penetre olup komplikasyona neden olabilirler. Yutulan yabancý cisimlerin çoðunluðu sorunsuz intestinal kanaldan geçerken sadece %1’den daha azý perforasyona neden olur. Bu yazýda, 73 yaþýnda kadýn hastada yanlýþlýkla yutulan kayýsý çekirdeðine baðlý ince baðýrsak týkanýklýðý ve delinmesi olgusunu sunduk.

Ingestion of foreign bodies can be a common problem, especially among children, alcoholics, and psychiatric and senile patients. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved immediately may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract uneventfully, and perforation occurs in less than 1%. In this study, we report a case of small bowel obstruction with perforation in a 73-year-old female due to the accidental swallowing of an apricot pit.