BACKGROUND
We aimed to test whether hemoperitoneum has adverse effects on colonic anastomosis healing by increasing fibrinolytic activity.
METHODS
After colonic intersection and anastomosis, 20 Wistar Albino rats received intraabdominal injections of either 25 mg/kg blood (10, Group 1) or physiologic saline (10, Group 2). Anastomotic bursting pressures were measured after sacrifice on the fifth day. Following histopathological evaluation of the anastomotic line, hydroxyproline, tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA/PAI-1 complex levels were determined in the omentum, lung and anastomotic colon.
RESULTS
Mean anastomotic bursting pressures of Groups 1 and 2 were 224.5 mmHg and 254.4 mmHg (p=0.121), and mean hydroxyproline levels were 45.89 and 65.959 mg/g protein, respectively (p=0.257). Histopathology was insignificant. There was a significant difference between groups in omental tPA levels (0.962 ng/ml and 0.27 ng/ml, p=0.041), but not in PAI-1 and tPA/PAI-1. Anastomotic line and lung levels of tPA, PAI-1 and tPA/PAI-1 complex were not significantly different between groups. The relation between anastomotic line tPA level and bursting pressure was highly significant in Group 2 (r=0.778; p=0.008).
CONCLUSION
In this first study on the effect of hemoperitoneum on colonic anastomosis, we observed no significant effect on anastomotic healing or fibrinolytic activity, except in the omentum. Further studies with different blood volumes and assessment times are needed.

AMAÇ
Kolon anastomozlarýnda iyileþme ve fibrinolitik aktivite üzerine hemoperitoneumun etkisi araþtýrýldý.
GEREÇ VE YÖNTEM
Wistar Albino cinsi 20 sýçanda, kolon kesilip anastomoz yapýldýktan sonra 10 sýçana (Grup 1) karýn içine verici sýçanlardan alýnan kan (25 ml/kg), 10 sýçana (Grup 2) ise serum fizyolojik verildi. Sýçanlar beþinci gün sakrifiye edilerek anastomoz patlama baçýnçlarý ölçüldü. Anastomoz hattýnýn histopatolojik deðerlendirilmesi yapýlarak, omentum, akciðer ve anastomoz hattýnda hidroksiprolin, doku plazminojen aktivatörü (tPA), plazminojen aktivatör inhibitörü-1 (PAI 1) ve tPA/PAI 1 kompleksi düzeyleri saptandý.
BULGULAR
Anastomoz patlama basýncý Grup 1’de 224,5 mmHg, Grup 2’de 254,4 mmHg idi (p=0,121). Hidroksiprolin deðerleri Grup 1 ve Grup 2’de sýrasýyla 45,89 ve 65,959 mg/gr protein olarak bulundu (p=0,257). Histopatolojik incelemede anlamlý farklýlýk saptanmadý. Omentum tPA deðeri Grup 1’de 0,962 ng/ml, Grup 2’de 0,27 ng/ml olup, fark anlamlý idi (p=0,041). Omentum PAI 1 ve tPA/PAI 1 kompleksi deðerleri, anastomoz ve akciðer dokularý tPA, PAI 1 ve tPA/PAI 1 kompleksi deðerleri açýsýndan gruplar arasýndaki fark anlamlý deðildi. Grup 2’de anastomoz hattý tPA deðeri ile anastomoz patlama basýncý arasýndaki iliþki yüksek düzeyde anlamlý idi (r=0,778; p=0,008).
SONUÇ
Kolon anastomozlarýnda hemoperitoneumun etkisini araþtýran bu ilk çalýþmada, anastomoz iyileþmesinde ve omentum haricinde fibrinolitik aktivitede anlamlý fark gözlenmedi. Farklý kan volümleri ve farklý deðerlendirme zamanlarý ile yapýlacak yeni çalýþmalara ihtiyaç vardýr.

AMAÇ
Çalýþmamýzda çeþitli travma þiddet ölçekleriyle zedelenme oranlarýný belirlediðimiz çoklu travma hastalarýnda; bu þiddet oranlarýnýn kalp etkilenimi üzerine etkilerini yardýmcý taný araçlarý ile birlikte deðerlendirerek kýyaslamayý hedefledik.
GEREÇ VE YÖNTEM
Ýleriye dönük olarak planlanan bu çalýþma, fakülte etik kurul onayý alýndýktan sonra acil servise baþvuran 15 yaþýn üzerinde çoklu travmalý 100 hasta deðerlendirilerek yapýldý. Hastalarda yaralanma þiddeti ölçeði (ISS), Glaskow koma skalasý (GCK), revize edilmiþ travma skoru (RTS) gibi travma þiddet ölçekleri kullanýlarak travmanýn þiddeti belirlendikten sonra, biyokimya ve radyolojik taný araçlarýndan faydalanýlarak kalp etkilenimi deðerlendirildi.
BULGULAR
Çalýþma süresince 100 hasta (78 erkek, 22 kadýn; ortalama yaþ 33; daðýlým 15-70 yaþ) deðerlendirildi. Çoklu travma hastalarýnýn 92’sinin (%92) künt travma, bunlardan da 77’sinin (%77) trafik kazasý sonucu olduðu belirlendi. Hastalarýn %63’ünde çoðunluðu sinüs taþikardisi (%36) olan elektrokardiyogramda (EKG) bozukluðu bulgusu görüldü. Olgularýn 31’inde çoðunluðunu ventrikül iþlev bozukluðunun (n=24) oluþturduðu anormal ekokardiyogram (EKO) bulgularý saptandý. Travma þiddeti yüksek olan 19 olgunun 14’ü trafik kazasý nedeniyle hayatýný kaybetti. Ýki grup arasýnda travma skorlarý istatistiksel olarak anlamlýydý.
SONUÇ
Çoklu travma hastalarýnda kalp etkilenimini en iyi gösteren travma ölçeðinin ISS olduðu belirlendi. Yüksek travma þiddetine sahip çoklu travmalý hastalara, kalp etkilenimi olabileceði düþünülerek, kalp ritm bozukluðu ve hemodinamik bozukluk açýsýndan kalp monitörizasyonu ve yakýn takip yapýlmalýdýr.

BACKGROUND
In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales.
METHODS
After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests.
RESULTS
During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups.
CONCLUSION
The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement.

AMAÇ
Rabat’daki askeri hastanenin yanýk ünitesine yatýrýlan hastalardan ve bunlarýn çevrelerinden 1,5 yýllýk bir süre içinde (Temmuz 2009-Þubat 2011) elde edilen patolojik materyalden izole edilen suþlarýn direnç profiline ait karþýlaþtýrmalý bir prospektif çalýþmanýn sonuçlarý sunuldu.
GEREÇ VE YÖNTEM
Bu çalýþmada, yanýklarý nedeniyle hastaneye yatýrýlan hastalara (40 erkek, 20 kadýn; ort. yaþ 38±14.8; daðýlým, 2-80 yaþ) ait 125 patolojik ürünle çalýþýldý. Birinci periyot süresinde 86, ikinci periyot süresinde de 50 artýksýz bakteriyel suþ izole edildi.
BULGULAR
Baskýn suþlar sýrasýyla, Acinetobacter baumannii (%15,6), Pseudomonas aeruginosa (%13,8) ve Staphylococcus aureus (%11) oldu. Ýkinci periyot süresinde A. baumannii (%15,5), P. aeruginosa (%11,3) ve Klebsiella pneumoniae (% 8,5) suþlarýnýn çok olduðunu saptandý. Yanýklý hastalardan elde edilen 104 çevresel örnekten 139 mikroorganizma izole edildi. Koagülaz-negatif stafilokok, iki çalýþma periyodunda da en fazla görülen suþ oldu (%69,2 ve %64,6).
SONUÇ
Bütün suþlar, test edilen deðiþik antibiyotiklere karþý hemen hemen özdeþ duyarlýlýk göstermiþtir.

BACKGROUND
We present the results of a comparative prospective study of the resistance profile of strains isolated from pathological material of patients hospitalized in the burn unit of the military hospital in Rabat and from their environment over a period of one and a half years (July 2009-February 2011).
METHODS
The study concerned 125 pathological products from patients (40 men, 20 women; mean age 38±14.8 years; range 2 to 80 years) hospitalized with burns. This allowed the isolation of 86 non-redundant bacterial strains during the first period and 50 during the second.
RESULTS
The dominant species were Acinetobacter baumannii (15.6%), followed by Pseudomonas aeruginosa (13.8%) and Staphylococcus aureus (11%). During the second period, we noted the abundance of A. baumannii (15.5%), followed by P. aeruginosa (11.3%) and Klebsiella pneumoniae (8.5%). Of the 104 environmental samples of burn patients, 139 microorganisms were isolated. Coagulase-negative staphylococcus was the most abundant strain in the two study periods (69.2% and 64.6%).
CONCLUSION
All species showed an almost identical sensitivity to the various antibiotics tested.

AMAÇ
Elektrik çarpmasý kazasýyla yaralanan hastalarýn, monitörizasyon ve izlem için acil servise kabulü tartýþmalýdýr.
GEREÇ VE YÖNTEM
Son 20 yýl içinde, elektrik kazasý nedeni ile eriþkin acil servise baþvuran 102 hastanýn (86 erkek, 16 kadýn; ort. yaþ 29.5; daðýlým 18-68 yaþ) kayýtlarý deðerlendirildi.
BULGULAR
Üçü düþük, altýsý yüksek voltaj temasý nedeniyle toplam dokuz olguda ölüm görüldü. Bir sepsis olgusu dýþýnda, diðer olgularýn hepsinde ölüm, olayýn hemen sonrasýnda geliþen erken ritim bozukluklarýna baðlý idi. Yaþayan hastalarda izlenen EKG bulgularý; 70’inde normal, 8’inde sinüs taþikardisi, üçünde sinüs bradikardisi, dördünde ST-T dalga deðiþiklikleri, birinde ventriküler ekstrasistol olup, yedi olguda EKG kayýtlarýna ulaþýlamadý. Olgularýn 72’si tekrarlayan EKG çekimleri ile izlendi. Yaþayan hastalarýn hiçbirinde medikal ya da elektriksel tedavi gerektirecek herhangi bir EKG deðiþikliði izlenmedi.
SONUÇ
Elektrik yaralanmalarýna baðlý kardiyak ritim anomalileri genellikle olay anýnda görülür. Eðer hasta klinik olarak iyi, acil servise kabulünde normal EKG’ye sahip ise, gecikmiþ ciddi bir ritim bozukluðu görülme olasýlýðý pek mümkün deðildir.

BACKGROUND
The necessity of admitting patients exposed to electrocution injuries for monitoring and observation in the emergency department (ED) remains controversial.
METHODS
We evaluated the medical records of 102 patients (86 male, 16 female; median age 29.5; range 18 to 68 years) admitted to the adult ED with electrocution injuries over the past 20 years.
RESULTS
Only 9 deaths were reported: 3 as a result of contact with low-voltage electricity and 6 after contact with high-voltage electricity. With the exception of a case of sepsis, all deaths were related to early rhythm abnormalities immediately following the incident. The ECG findings of surviving patients in the study group were as follows: 70 normal, 8 sinus tachycardia, 3 sinus bradycardia, 4 ST-T wave changes, and 1 ventricular extrasystole. ECG recordings of 7 patients could not be found. 72 cases had been followed up with repeat ECG recordings. There were no observed ECG changes requiring any medical or electrical therapies in the surviving patients.
CONCLUSION
Cardiac rhythm abnormalities related to electrocution injuries are usually observed at the time of the incident. If the patient’s overall clinical condition is good and they have a normal ECG at the time of admission to the ED, the probability of observing any delayed serious dysrhythmia is unlikely.

AMAÇ
Bu çalýþmada, toraks travmasý sonrasý hastanemiz acil servisine (AS) getirilen ve yapýlan giriþim sýrasýnda kalp ve/veya solunumu duran hastalarda, acil serviste uygulanan resüsitatif torakotominin endikasyonlarý, yöntemi ve sonuçlarý tartýþýldý.
GEREÇ VE YÖNTEM
Ocak 2004 ile Aralýk 2010 tarihleri arasýnda toraks travmasý sonrasý AS’de dokuz hastaya resüsitatif torakotomi uygulandý. Hasta verileri geriye dönük olarak incelendi.
BULGULAR
Dokuz hastaya AS koþullarýnda giriþim yapýldý; beþi kesici delici alet yaralanmasý, ikisi trafik kazasý, birer hasta yüksekten düþme ve ateþli silah yaralanmasý nedenliydi. Tüm hastalara sýrtüstü pozisyonda anterolateral torakotomi uygulandý. Üç hastada akciðer parankimal laserasyonu, üç hastada kardiyak laserasyon, diðer iki hastada interkostal damarlar yaralanmasý ve bir hastada ise inen aortada laserasyon vardý. Etyolojisinde künt travma olan dört hasta kaybedildi, penetran travma nedeniyle resüsitatif torakotomi uygulanan beþ hastanýn üçü ortalama sekiz gün izlem sonrasýnda þifa ile taburcu edildi, diðer ikisi ameliyatta kaybedildi.
SONUÇ
AS koþullarýnda resüsitatif torakotomi uygulanan hastalar, travma sonrasý þok halindedir, büyük oranda sývý ve kan infüzyonu yapýlmasýna karþýn hipotansiyonu kontrol altýna alýnamayan ve ameliyat salonuna nakil için vakit kaybýna tahammülü olmayan hastalardýr. Penetran travmalý hastalarýn sonuçlarý künt toraks travmalý hastalara göre daha iyidir.

BACKGROUND
In this article, the outcomes, indications and methods of emergency department service resuscitative thoracotomy in cardiac and/or respiratory arrest patients after thoracic trauma are discussed.
METHODS
Between January 2004 and December 2010, nine resuscitative thoracotomies were performed after thoracic trauma in the emergency department of our hospital. The records of the patients were evaluated retrospectively.
RESULTS
A total of nine patients underwent resuscitative thoracotomy: five stab wounds, two traffic accidents, one fall from height, and one gunshot wound. Anterolateral thoracotomy in supine position was performed in all. Three patients had lung parenchymal laceration, three patients had cardiac laceration, two patients had intercostal vessel injury, and one patient had descending aorta injury. None of the four patients with blunt trauma recovered. Three of five patients with penetrating trauma were discharged after an average of eight days of follow-up, whereas two of them were lost perioperatively.
CONCLUSION
Emergency room thoracotomy can be performed in thoracic trauma cases who are in shock and have unresponsive hypotension despite large volume fluid and blood replacement and no time for transportation to the operating room. The results are better in penetrating trauma patients than in blunt trauma.

AMAÇ
Bu çalýþmada, sol kolonun týkayýcý malign lezyonlarýnda total-subtotal kolektomi anostomoz ile diðer cerrahi tedavi yöntemleri karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmaya Konya Eðitim ve Araþtýrma Hastanesine 2004-2007 yýllarý arasýnda transvers kolon distalinde týkanýklýk bulgularý ile baþvuran ve cerrahi tedavi uygulanan hastalar dahil edildi. Hastalar cerrahi prosedüre göre üç gruba ayrýldý. Bunlar: Grup I: Hartmann prosedürü; Grup II: Rezeksiyon, anostomoz ve saptýrýcý ileostomi; Grup III: Total veya subtotal kolektomi ve primer anastomoz. Hastalarýn dosyalarý geriye dönük olarak incelendi.
BULGULAR
Altmýþ iki hastanýn yaþ ortalamasý 64 (daðýlým, 38-89 yaþ) idi. Birinci grupta 15, ikinci grupta 21, üçüncü grupta 26 hasta vardý. Gruplar arasýnda yaþ ortalamalarý, cinsiyet, ASA skoru ve tümör evresi bakýmýndan anlamlý fark yoktu. Çalýþma gruplarý arasýnda ameliyat süresi ve ameliyat sonrasý morbidite, mortalite ve beþ yýllýk saðkalým açýsýndan anlamlý fark yoktu, ancak hastanede kalma süresi ve tedavi maliyetleri açýsýndan Grup I ve Grup II’ye göre Grup III’de anlamlý olarak düþüktü.
SONUÇ
Deneyimli cerrahlar tarafýndan yapýlan total-subtotal kolektomi ve primer anostomozun diðer bir veya iki aþmalý cerrahi prosedürlere göre daha iyi bir alternatiftir.

BACKGROUND
This study was designed in order to compare the effectiveness of subtotal-total colectomy with other surgical methods in the treatment of malignant obstructive lesions of the left colon.
METHODS
Patients admitting with symptoms of colonic obstruction and treated by emergency surgery in Konya Education and Research Hospital between 2004 and 2007 were enrolled. Patients were divided into three groups according to the surgical procedures (Group I: Hartmann procedure; Group II: resection + diverting ileostomy; Group III: total-subtotal colectomy). Related patient data were evaluated retrospectively.
RESULTS
The mean age of 62 patients was 64 (38-89) years. There were no significant differences between the groups with respect to gender, age, American Society of Anesthesiology scores, and tumor stages. There were no significant differences between the study groups in terms of operative duration, postoperative mortality, and five-year survival; however, the length of hospital stay and hospitalization costs were lower in Group III compared to the other groups.
CONCLUSION
We suggest that subtotal-total colectomy performed by experienced surgeons may be a good alternative to the other procedures.

AMAÇ
Delici göz küresi yaralanmalarýndan sonra fitizis bulbi geliþimine etki eden faktörler araþtýrýldý.
GEREÇ VE YÖNTEM
2000-2006 yýllarý arasýnda delici göz küresi yaralanmasý nedeni ile tedavisi ve takipleri yapýlan 132 hastanýn kayýtlarý derlenerek, bunlar arasýndan fitizis bulbi geliþen 8 olgunun kayýtlarý geriye dönük olarak incelendi. Olgular, yaralanmanýn tipi, niteliði, anatomik yeri, eþlik eden ön/arka segment patolojileri ve fitizis bulbi geliþimi yönünden incelendi.
BULGULAR
Ortalama takip süreleri 2,06±1,47 (daðýlým, 6 ay -5 yýl) olan 5 erkek, 3 kýz toplam 8 fitizis bulbi geliþen olgunun yaþ ortalamasý 7,12±4,70 (daðýlým, 2-16 yaþ) idi. Fitizis bulbi olgularýn 3’ünde (%37,5) kapalý perforasyonu takiben geliþen endoftalmi nedeniyle, 3’ünde (%37,5) sklera gerisine uzanan zon 2-3 skleral perforasyon ve eþlik eden retina dekolmaný nedeniyle, 2 olguda (%25) da travmanýn neden olduðu proliferatif vitreoretinopatiye baðlý geliþmiþti. Ortalama fitizis bulbi geliþme süresi 5,5±2,13 (daðýlým, 3-10 ay) idi.
SONUÇ
Delici göz küresi yaralanmalarýndan sonra, görme prognozu ve fitizis bulbi geliþimini etkileyen en önemli faktörlerin yaralanmanýn büyüklüðü ve anatomik yeri, eþlik eden ön ve arka segment patolojileri ile travmaya ikincil endoftalmi geliþimi olduðunu düþünmekteyiz.

BACKGROUND
We aimed to investigate the factors affecting the development of phthisis bulbi after penetrating eye injuries.
METHODS
The medical records of 132 patients admitted to our clinic between 2000-2006 with the diagnosis of penetrating eye injury were collected. The records of the eight patients who developed phthisis bulbi were evaluated retrospectively. The aspects of anatomic localization, type of trauma, associated events, and development of phthisis bulbi were also investigated.
RESULTS
The mean age of the eight patients (5 males, 3 females) was 7.12±4.70 years (range: 2-16 years) and the mean follow-up time was 2.06±1.47 years (range: 6 months–5 years). Three of eight patients developed post-perforation endophthalmitis. Three patients had zone 2-3 scleral perforation and associated retinal detachment and the remaining two patients had proliferative vitreoretinopathy according to the trauma; all eight patients eventually developed phthisis bulbi. The mean time for the development of phthisis bulbi was 5.5±2.13 months (range: 3-10 months).
CONCLUSION
After penetrating eye injuries, visual prognosis and development of phthisis bulbi were affected significantly by the factors including anatomic localization, size of the injury, associated anterior or posterior segment pathologies, and endophthalmitis secondary to the trauma.

AMAÇ
Bu çalýþmada amacýmýz, taþýnan havai fiþekle ilgili oküler hasar özelliklerini gözden geçirmek ve bu yaralanmalar için oküler travma skorunun (OTS) prognostik deðerini araþtýrmaktýr.
GEREÇ VE YÖNTEM
Bu çalýþmaya, 22 taþýnan hasta (19 erkek, 3 kadýn; ortalama yaþ, 22.6±14.9 yaþ) (25 göz) alýndý. Coðrafya özellikleri, havai fiþek tipleri, yaralanma durumu, terapötik prosedürler ve en iyi düzeltmiþ görme keskinliði (BCVA) ile ilgili karakteristikleri içeren veriler geriye dönük deðerlendirildi. Yaralanan bütün gözler, ilk inceleme sýrasýnda OTS kullanýlarak sýnýflandýrýldý.
BULGULAR
Yirmi göz (%80) OTS kategori 1, üç göz (%12) OTS kategori 2 ve iki göz (%8) OTS kategori 3 olarak deðerlendirildi. Bütün olgular cerrahi tedavi aldý. Altý göz (%24) enükle idi, bunlarýn dördünde (%16) son BCVA’larýnda bir düzelme oldu. OTS kategori 1 ile diðer iki OTS kategorisi arasýnda son BCVA’da istatistiksel olarak anlamlý bir düzelme oldu (p=0,016).
SONUÇ
Taþýnan havai fiþek ile iliþkili oküler yaralanma olgularý, esas olarak genç eriþkinler, erkekler ile aktif katýlýmcýlarda oluþmuþ ve hepsi de ciddi görme kaybý ve körlüðe maruz kalmýþtýr. OTS, taþýnan havai fiþek ile iliþkili oküler yaralanmalarýn durumunun sýnýflandýrýlmasýnda ve prognozunun tahmin edilmesinde oldukça etkindir.

BACKGROUND
Our aim was to review the characteristics of transferred fireworks-related ocular damage and to evaluate the prognostic value of the ocular trauma score (OTS) for these injuries.
METHODS
This study included 22 transferred patients (19 male, 3 female; mean age 22.6±14.9 years) (25 eyes). The data were retrospectively reviewed, including the characteristics of the geography, types of fireworks, status of injuries, therapeutic procedures, and the best-corrected visual acuity (BCVA). All the injured eyes were classified using the OTS at the time of the initial examination.
RESULTS
Twenty eyes (80%) were in OTS category 1, three eyes (12%) were in OTS category 2, and two eyes (8%) were in OTS category 3. All cases received surgical therapy. Six eyes (24%) were enucleated, four (16%) of which achieved an improvement in their final BCVA. There was a statistically significant improvement in final BCVA between OTS category 1 and the other two OTS categories (p=0.016).
CONCLUSION
The aforementioned transferred fireworks-related ocular injury cases occurred mainly in young adults, men and active participants, all of which incurred serious vision loss and blindness. The OTS is quite effective for classifying the status and estimating the prognosis of transferred fireworks-related ocular injuries.

AMAÇ
Bu geriye dönük çalýþma, femur ve tibia kýrýðýna baðlý intramedüller çivileme (ÝMÇ) iþlemi geçiren hastalarda elektif prosedüre karþý acil giriþim sonuçlarýnda bir deðiþiklik olup olmadýðýný belirlemek amacýyla yapýldý.
GEREÇ VE YÖNTEM
Tüm veriler, 1 Ocak 2004 ile 30 Haziran 2009 tarihleri arasýnda ÝMÇ gerektiren femur ve tibia kýrýðý olan erkek hastalarýn kaldýðý ortopedi yatakhanelerinden toplandý. Toplanan veri, acil veya elektif prosedür þeklinde gerçekleþtirilen cerrahiyi, cerrahinin süresini, karþýlaþýlan komplikasyonlarý ve kýrýðýn kaynama durumunu içerdi.
BULGULAR
Tibia, fibula ve femur 431 kýrýk vardý. Femur kýrýðý ile ilgili ameliyat süresi, acil bir prosedür þeklinde gerçekleþtirilmesi durumunda elektif prosedür olarak gerçekleþtirilme durumuna göre anlamlý þekilde daha uzundu (191±79 ve 155±65 dk; p≤0.001, güven aralýðý [GA] -19.54). Tibia kýrýðýnda ameliyat süresi 167.1±62 ve 69.2±35 dk bulundu (p<0.001, GA <-85.4). Enfeksiyon, ikincil cerrahi ve kaynama komplikasyonlarý, elektif cerrahiye göre acil prosedürlerde daha yaygýndý.
SONUÇ
Cerrahi süresindeki artýþ nedeniyle acil cerrahide komplikasyonlar elektif cerrahiye göre daha yüksek bulunmuþtur. Bu durum, acil prosedürler sýrasýnda özel eðitimli ortopedik hasta bakým personeli ve ameliyathanenin bulunmamasýna baðlanabilir. Hastanelerde acil kýrýk tespitleri ve tedavisi icin özel ortopedi travma alanlarý oluþturulmasý gerektiðine inanmaktayýz.

BACKGROUND
This retrospective analysis was done to determine whether there is a change in outcomes of trauma patients undergoing intramedullary nailing (IMN) for femur and tibia fracture as an emergency versus elective procedure.
METHODS
Data were collected for all patients admitted to male orthopedic wards between 1 January 2004 and 30 June 2009 with femur and tibia fractures that required IMN. The data collected included surgery undertaken on as emergency or elective procedure, duration of surgery, complications encountered, and union status of fracture.
RESULTS
There were 431 fractures of the tibia, fibula and femur. Operating time for femur fracture as an emergency procedure was significantly greater than for elective surgery (191±79 versus 155±65 minutes; p≤0.001, confidence interval [CI] -19.54). For tibia fracture, operating times were 167.1±62 versus 69.2±35 minutes (p<0.001, CI <-85.4). Complications of infection, secondary surgery and of union were more common in emergency procedures than elective surgeries.
CONCLUSION
This study shows that complications are higher in emergency surgery than elective surgery due to the increase in the duration of surgery. This is attributed to the non-availability of dedicated trained orthopedic nursing staff and theater during emergency procedures. We believe that it is time to develop dedicated orthopedic trauma theaters in hospitals that treat emergency fracture fixations.

AMAÇ
Ýnhalasyon yaralanmasý yüksek mortalite oranlarýna sahiptir ve belirgin kalýcý pulmoner fonksiyon bozukluðu riski taþýmaktadýr. Ýnhalasyon yaralanmasý ve sonuçlarý, klinik yönetiminde ana rol oynayan solunum terapistlerine, hemþirelere ve doktorlara ciddi zorluklar oluþturur. Çalýþmamýzda inhalasyon yaralanmalý hasta serimizdeki klinik tecrübelerimizi ve noninvazif mekanik ventilatör (NIMV) desteðinin rolünü bildirmeyi amaçladýk.
GEREÇ VE YÖNTEM
Ankara Numune Eðitim ve Araþtýrma Hastanesi Yanýk Yoðun Bakým Ünitesi’nde Mart 2009 - Mart 2011 yýllarý arasýnda yatarak tedavi alan hastalardan inhalasyon hasarý nedeniyle solunum desteðine ihtiyaç duyanlar çalýþmaya alýndý.
BULGULAR
Bu hastalarýn 37’sinde inhalasyon yaralanmasý vardý, mortalite oraný %13,5 olarak bulundu, hastalarýn 16’sýnda zorunlu entübasyon uygulanýrken (altý hastada ilk 6 saatte ve 10 hastada klinik seyir sürecinde) diðer hastalara sadece (%67,8) NIMV desteði uygulandý.
SONUÇ
NIMV desteðinin uygun modlarda uygulanmasý, inhalasyon yaralanmalý olgularda invaziv yöntemlerin gerekliliðini azaltmaktadýr. NIMV desteðinin inhalasyon yaralanmalý yanýk hastalarýnda uygulanmasýný önermekteyiz.

BACKGROUND
Inhalation injury has high mortality and carries a significant risk of permanent pulmonary dysfunction. Inhalation injury and its consequences impose difficulties for the respiratory therapists, nurses and doctors who play a central role in its clinical management. In this study, we aimed to report our clinical experience and the role of non-invasive mechanic ventilatory (NIMV) support in a series of inhalation-injured patients.
METHODS
Patients hospitalized at Ankara Numune Training and Research Hospital’s Burns Intensive Care Unit between March 2009 and March 2011 was reviewed, and patients with required respiratory support due to inhalation injury were included in the study.
RESULTS
Among the patients, 37 had inhalation injury, and their mortality was 13.5%. Of the 37 patients, 16 had mandatory intubation (6 in the first 6 hours and 10 in the clinical course); however, others (67.8%) had only NIMV support.
CONCLUSION
Application of NIMV support with proper modes decreases the need for invasive procedures in inhalation-injured patients. Based on our results, we propose the application of NIMV support in inhalation-injured burn patients.

AMAÇ
Medikal tedavi peptik ülser perforasyon (PÜP) oranlarýnýn azalmasýnda önemli bir rol oynamýþtýr. Bu çalýþmada, Ramazan ayýnýn PÜP üzerine olan etkisi deðerlendirildi.
GEREÇ VE YÖNTEM
PÜP nedeniyle 1999-2009 yýllarý arasýnda ameliyat edilen 229 hastanýn dosyalarý geriye dönük olarak analiz edildi. Hastalar iki gruba ayrýldý. Grup I (n=188) Ramazan ayý dýþýnda ameliyat edilen hastalar, Grup II (n=41) Ramazan ayýnda, müslümanlarýn oruç tutma döneminde ameliyat edilen hastalar. Grup II’deki hastalar oruç tutma sürelerine göre de deðerlendirildi.
BULGULAR
Grup baþýna düþen ameliyat sayýsý Grup II’de daha fazla idi (p<0.05). Bu farkýn oluþmasýnda predispozan faktörler, antiülser ilaç kullanýmý ve demografik özelliklerin rolü olmadýðý saptandý. Oruç tutma süresinin perforasyon üzerine küçük bir etkisi olabileceði görüldü.
SONUÇ
Bu çalýþmanýn verileri Ramazan orucunun günde 12 saatten daha fazla sürdüðü dönemlerde PÜP’nin rölatif olarak daha fazla görüldüðünü göstermektedir. Predispozan faktörü olan hastalarýn oruç kararý öncesi bilgilendirilmesi gerektiði kanýsýndayýz.

BACKGROUND
Medical treatment has played an important role in the reduction of peptic ulcer perforation (PUP). The goal of this study was to evaluate the effect of fasting on PUP.
METHODS
A retrospective analysis of 229 patients who were operated due to PUP between 1999-2009 was made. Patients were divided into two groups. Group I (n=188) included the patients who were operated in other periods of the year, while Group II (n=41) included the patients who were operated during Ramadan, the Muslim period of fasting. Patients in Group II were analyzed in terms of duration of fasting.
RESULTS
The increase in surgeries per group was higher in Group II than Group I (p<0.05). Predisposing factors, anti-ulcer drug usage and demographic variables were seen to have no role in this difference. Duration of fasting may have a minimal effect on the perforation.
CONCLUSION
The results of this study demonstrate that PUP is detected as relatively higher during Ramadan among those who are fasting for more than 12 hours daily. We suggest that people with predisposing factors should be informed before making a decision to fast.

Biz bu olguda, travma sonrasý yüksek flow paternine sahip bir vasküler malformasyon olgusunu sunduk. Cerrahi sonrasý hastada histopatolojik olarak arteriyovenöz malformasyon tanýsý kondu. Bizim düþüncemize göre vücudun herhangi bir yerinde travma sonrasý geliþen progresif olarak geliþme gösteren vasküler malformasyonlarda acil ve hýzlý bir cerrahi uygulanmasý gereklidir.

In this case, we report a vascular malformation with high flow pattern complicated with trauma. A postoperative histopathology examination confirmed an arterio-venous malformation in specimens of surgical excision material. In our opinion, posttraumatic progression of a vascular malformation is an emergency and requires an urgent evaluation with surgery at any localization of the body.

Travmatik karotid arter diseksiyonu eðer erken taný konulup tedavi edilmezse kalýcý nörolojik defisit ve %40’lara varan ölüm oraný yaratabilen ciddi bir sorundur. Bu yazýda, travmatik karotid arter diseksiyonu tanýsý geç dönemde konan 21 yaþýnda kadýn hasta sunuldu. Kabulde çekilen beyin bilgisayarlý tomografisinde (BT) iskemik enfarkt bulgularý yok iken, bilinci açýldýktan sonra yedinci gün sol hemiplejisi fark edildiðinde çekilen ikinci beyin BT’sinde enfarktüs bulgularý saptandý. Hasta acil servise kabul edildi. Kesin taný, arteriyel Doppler ultrasonografi, serebral manyetik rezonans görüntüleme (MRG), difüzyon MRG ve MR anjiyografi ile konuldu. Hastada kalýcý nörolojik hasar geliþtiði ve anjiyografi bulgularýna göre evre IV olduðu için invaziv tedavi düþünülmedi. Hasta fizyoterapi tavsiye edilerek bir hafta içinde taburcu edildi. Tanýsal yöntemlerdeki geliþmelere raðmen travmatik karotid arter diseksiyonunun tanýsý bu olguda olduðu gibi halen atlanmakta veya gecikmektedir. Erken taný kalýcý nörolojik hasarý önleyebilir ya da hafifletebilir. Bununla birlikte erken taný için en önemli faktörler uygun radyolojik incelemeyi yönlendirecek anamnez, ayrýntýlý fiziksel inceleme ve yüksek klinik þüphedir.

Traumatic carotid artery dissection, if not diagnosed and treated early, is a serious problem with permanent neurological deficit and a high mortality rate of up to 40%. We present a case with delayed diagnosis of traumatic carotid artery dissection in a 21-year-old female. While there were no ischemic infarct findings on the admission cerebral computerized tomography (CT), such findings were observed on two cerebral CTs taken because of the left hemiplegia noticed seven days later when the patient regained consciousness. The patient was referred to our emergency service, and definitive diagnosis was achieved with arterial Doppler ultrasonography, cerebral magnetic resonance imaging (MRI), diffusion MRI, and MR angiography. We did not consider invasive treatment since the neurological damage was permanent and dissection grade was IV according to angiography findings. The case was discharged within a week and physiotherapy was advised. Despite the advances in diagnostic methods, diagnosis of traumatic carotid artery dissection is still missed or delayed, as in the case presented here. Early diagnosis can ameliorate permanent neurological damage or even prevent it. However, the vital factors for early diagnosis are the obtained anamnesis leading to appropriate radiological examinations, detailed physical examination and high clinical suspicion.

Meckel divertikülü ince baðýrsaðýn en sýk rastlanan doðumsal anomalisi olup genel nüfusta %1-3 oranýnda görülür. Eriþkinlerde en sýk görülen komplikasyonu baðýrsak týkanýklýðýdýr. Ameliyat öncesi tanýnýn sýklýkla mümkün olmamasý ve ameliyatta gecikilmesi ciddi sorunlara neden olabilir. Bu yazýda, Meckel divertikülü nedeniyle baðýrsak týkanýklýðý olan hastalarýn tanýsý ve tedavi yönetimi sunuldu.

Meckel’s diverticulum is the most common congenital anomaly of the small intestine, with an estimated incidence of approximately 1-3% in the general population. Intestinal obstruction is the most common complication in adult patients. Since accurate diagnosis before the operation is difficult, decision for surgery is delayed, and serious problems may be encountered. Here in, we present the diagnosis and management of our patients with intestinal obstruction due to Meckel’s diverticulum.

Ýki taraflý travmatik kalça çýkýðý nadir görülen bir durumdur. Her iki kalçanýn ayný zamanda öne ve arkaya çýkýðý daha da nadirdir. Bu yazýda, 28 yaþýndaki bir erkek hastada iki taraflý asimetrik kalça çýkýðý ile birlikte görülen iki taraflý asetabulum kýrýðý sunuldu.

Bilateral traumatic hip dislocation is a very rare condition. Simultaneous anterior and posterior traumatic dislocation of both hips is even more unusual. A case report of a bilateral asymmetrical hip joint dislocation with bilateral acetabular fracture in a 28-year-old man is presented.

Yutulan düðme pilin neden olduðu Meckel divertikülü perforasyonu oldukça nadirdir ve literatürde günümüze kadar yalnýzca iki olgu bildirilmiþtir. Bu yazýda, okul öncesi çaðdaki iki çocukta kazayla yutulan düðme pilin yol açtýðý Meckel divertikülü perforasyonu sunuldu. Düðme pil yutan çocuklarda geliþebilecek bu nadir komplikasyon akýlda tutulmalý, olgularýn klinik, radyolojik ve laboratuvar bulgularý dikkatle izlenmelidir.

Ingested button battery perforation of Meckel’s diverticulum is extremely rare, with only two reported cases in the recent literature. Two additional preschool children who accidentally swallowed an alkaline button battery and developed a perforated Meckel’s diverticulum are reported. Surgeons should be aware of this rare complication. Careful clinical, radiologic and laboratory monitoring of children who ingest a button battery is advisable.

Servikofasyal amfizem ve pnömomediasten dental giriþimlerden sonra nadiren geliþen komplikasyonlardýr ve yüksek hýzlý hava türbinli dental matkap kullanýmý ile iliþkilidir. Yaþamý tehdit etme potansiyeli olan bir durum olsa da olgularýn büyük çoðunluðunda kendini sýnýrlar ve tehlike oluþturmaz. Bu yazýda sað alt ikinci molar diþ çekimi sonrasýnda gözle görülür cilt altý amfizemi, pnömomediasten ve parsiyel pnömotoraks geliþen hasta sunuldu. Diþ hekimleri ve hekimler dental iþlemi takiben ani dispne geliþmesini daha çok kullanýlan anesteziklere karþý alerjik reaksiyona baðlama eðilimindedirler. Diþ hekimleri ve hekimler dental iþlem sonrasý alerjik reaksiyonu taklit eden cilt altý amfizemine baðlý servikofasyal bölgede yumuþak dokuda þiþme olabileceði konusunda dikkatli olmalýdýrlar.

Cervicofacial emphysema and pneumomediastinum are rarely observed complications of dental interventions. The complications are associated with the use of a high-speed air-turbine dental drill. It is a potentially life-threatening condition, but the majority of cases are self-limiting and benign. We describe a patient with remarkable subcutaneous emphysema, pneumomediastinum, and partial pneumothorax after right second mandibular molar extraction. Dentists and physicians more often attribute the rapid onset of dyspnea in patients after a dental procedure to an allergic reaction to the anesthesia used during the procedure. Dentists and physicians should be aware that soft tissue emphysema can cause acute swelling of the cervicofacial region after dental procedures, which may mimic an allergic reaction.

Spinal aksesuvar sinir, trapezius ve sternokleidomastoid kaslarýnýn ana motor inervasyonunu saðlar. Spinal aksesuvar sinir yaralanmalarýnýn en sýk nedeni, iyatrojenik olarak arka boyun üçgeninde yapýlan cerrahi giriþimlerdir. Buna ek olarak ise juguler foramendeki kýrýklar, kafa tabaný tümörleri, travmalar da neden olabilir. Klinik olarak trapezius kasýndaki kuvvetsizlik, omuz kuþaðýnda düþme ve skapulanýn aþaðý ve dýþa rotasyonuyla kanatlý skapulaya yol açar. Otuz sekiz yaþýnda erkek hasta, öyküsünde araç içi trafik kazasýndan iki yýl kadar sonra sol kol ve omuzda aðrý, kuvvetsizlik, skapulada deviyasyon yakýnmalarý nedeni ile merkezimize baþvurdu. Yapýlan elektromiyelografi (EMG) incelemesinde sol aksesuvar parsiyel sinir lezyonu tanýsý kondu ve takip önerildi. Cerrahi tedavi yapýlabilecek olan süreci geçirmesi nedeni ile konservatif tedavi önerildi. Bu yazýda, trafik kazasýný takiben iki yýl sonra aksesuvar sinir lezyonu geliþen bir erkek olgu sunuldu. Trafik kazasý sonrasý aksesuvar sinir lezyonu son derece nadirdir.

An injury to the spinal accessory nerve is mostly reported after surgical procedures performed in the posterior triangle of the neck. In addition, it may be caused by fractures in the jugular foramina, traumas or skull base tumors. Clinically, paralysis of the trapezius muscle leads to weakness, downward rotation of the scapulae and falling down of the shoulder girdle. A 38- year-old male with left shoulder pain, scapular deviation and weakness in the left upper extremity, whose symptoms developed over a two-year period following a traffic accident, is presented herein. In the electromyography (EMG) study, partial spinal accessory nerve palsy was detected. The patient was treated conservatively for the nerve palsy since the time elapsed rendered surgical intervention inappropriate. We report a case in which spinal accessory nerve palsy developed two years after a traffic accident. Accessory nerve injury following a traffic accident is very uncommon.