AMAÇ: Bu çalýþma sýçanlarda arka bacak modelinde alfa lipoik asitin iskemi reperfüzyon hasarýný önlemedeki etkinliðini araþtýrmak amacýyla yapýldý.
GEREÇ VE YÖNTEM: Çalýþmada 250–300 gr aðýrlýðýnda 40 adet Sprague Dawley cinsi erkek sýçan kullanýldý. Her grupta 10 hayvan olacak þekilde, randomize dört grup oluþturuldu. Tüm sýçanlarda arka bacak kompozit ada flebi hazýrlandý. Grup 1’de arka bacakta femoral damarlara klemp uygulanýp hemen açýldý ve iskemi oluþturulmadý. Grup 2’de dört saat iskemi uygulandý ve sonrasýnda 24 saat reperfüzyon edildi. Grup 3’te dört saat iskemi sonrasý parenteral olarak serum fizyolojik verildi ve 24 saat reperfüzyon yapýldý. Grup 4’te dört saatlik iskemi sonrasý parenteral olarak alfa lipoik asit verildi ve 24 saat reperfüzyon yapýldý. Tüm sýçanlar 24 saatlik reperfüzyon sonrasý sakrifiye edildi. Biyokimyasal inceleme için kan, karaciðer ve transplante edilen arka bacaktan kas dokusu örneði alýndý. Homogenizasyon sonrasý kanda ve dokularda nitrit, nitrat, glutatyon, MDA, TNF-alfa, plazmada vitamin A, vitamin E, vitamin C düzeyleri test edildi.
BULGULAR: Ýskemi sonrasý alfa lipoik asit eklenen grupta GSH (eritrosit), MDA (karaciðer), vitamin C (plazma),TNF-alfa (kas) deðerlerinde yalnýz iskemi veya iskemi ve serum fizyolojik uygulanan gruplara göre anlamlý farklar görüldü.
TARTIÞMA: Çalýþmamýzda, alfa lipoik asitin iskemi-reperfüzyon hasarýný önlemede olumlu etkilerinin olduðu bulunmuþtur. Ancak klinik uygulama için yeni ve geniþ çalýþmalara ihtiyaç vardýr.

BACKGROUND: This study was performed to evaluate the effect of alpha lipoic acid (ALA) on prevention of ischemia-reperfusion (IR) injury in rat hindlimb ischemia model.
METHODS: Forty male Sprague Dawley rats weighing between 250 and 300 g were divided into 4 groups of 10 rats. Hindlimb composite island flaps were raised in all rats. Clamps were applied to femoral vessels of all subjects, but immediately released without causing ischemia in Group 1. In Group 2, after 4 hours of ischemia, 24 hours of reperfusion was performed. Following 4 hours of ischemia, saline was administered to rats in Group 3 and flaps were reperfused for 24 hours. In Group 4, ALA was administered intraperitoneally after 4 hours of ischemia and flaps were reperfused for 24 hours.
RESULTS: In Group 4, there was a significant decrease of liver malondialdehyde compared to Group 2 and decrease of muscle tumor necrosis factor-alpha compared to Group 3. There was also increase in levels of glutathione in erythrocytes compared to Group 3 and increase of plasma vitamin C compared to all groups.
CONCLUSION: ALA was found to be effective in prevention of ischemia-reperfusion injury. Further studies are needed before clinical application.

AMAÇ: Akut apandisit dünyada genel cerrahlarýn karþýlaþtýðý en sýk akut karýn nedenidir. Bu çalýþmada, akut apandisit oluþturulan tavþanlarda antibiyotik tedavisinin akut apandisitte ortaya çýkan histopatolojik bulgular üzerine etkisinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Çalýþma için 21 adet Yeni Zelenda cinsi (Oryctogaluscuniculus), erkek ve aðýrlýklarý 2050–2450 gram arasýnda deðiþen tavþan kullanýldý. Denekler üç gruba ayrýldý: Grup 1: Apendiks ligasyonu yapýlan ve antibiyotik tedavisi verilen grup (n=7), Grup 2: Apendiks ligasyonu yapýlan ama antibiyotik tedavisi verilmeyen grup (n=7), Grup 3: Apendiks ligasyonu yapýlmayan ve antibiyotik tedavisi verilmeyen grup (sham grubu) (n=7).
BULGULAR: Grup 1 ve Grup 2 arasýnda yapýlan istatistiksel analiz sonucunda Grup 2’de ortaya çýkan histopatolojik deðiþiklikler Grup 1’den anlamlý olarak daha þiddetliydi.
TARTIÞMA: Antibiyotik tedavisi akut apandisitte histolojik olarak enflamasyonun þiddetini azaltmaktadýr.

BACKGROUND: Acute appendicitis (AA) is the most common reason for abdominal surgery in the world. The aim of this study was to evaluate the effect of medical treatment on histological findings in rabbits with AA.
METHODS: Twenty-one male New Zealand rabbits were divided into 3 groups: appendix ligation and medical treatment, appendix ligation and no treatment, and control group, which underwent only laparotomy.
RESULTS: In appendix ligation without treatment group, AA findings were much more severe.
CONCLUSION: Medical treatment reduced inflammation of AA.

AMAÇ: Bu çalýþma, spinal kord travmasý (SCI) oluþturulan sýçanlarda eritropoetin ve tadalafilin etkinliðini araþtýrmak için yapýldý.
GEREÇ VE YÖNTEM: Sprague-Dawley cinsi 35 adet sýçan beþ gruba ayrýldý. Spinal kord travmasý T10 vertebraya laminektomi iþleminden sonra klip kompresyon yöntemi uygulanarak gerçekleþtirildi. Birinci grupta travma yapýlmadý ve normal biyokimyasal deðerler için kullanýldý. Ýkinci grup çözücü grubu idi ve travma sonrasý 1 cc serum fizyolojik verildi. Üçüncü grup travma sonrasýnda tek doz 2000 ü/kg intraperiteneal yol ile eritropoetin verildi. Dördüncü gruba ise travma sonrasýnda tek doz 2 mg/kg oragastrik yol ile tadalafil verildi. Beþinci gruba herhangi bir tedavi verici iþlem yapýlmadan sadece travma uygulandý ve travmadaki biyokimyasal deðerlerin tespiti için kullanýldý. Tüm denekler cerrahi iþlemden 48 saat sonra desakrafiliye edildi. Kan ve doku örneklerinden malondialdehid (MDA) ve toplam antioksidan kapasite (TAOK) deðerleri ölçüldü.
BULGULAR: Eritropoetin verilen grupta diðer tüm gruplara göre en düþük serum ve doku MDA deðerlerine ulaþýlmýþtýr. Tüm gruplara göre serum TAOK deðerleri en yüksek tadalafil verilen grupta bulunmuþ iken doku TAOK deðerleri en yüksek eritropoetin verilen grupta tespit edilmiþtir.
TARTIÞMA: Tadalafil ve eritropoetinin dokudaki oksidatif stresi azaltarak spinal kord travmasýnda ikincil hasarlanmayý engelleyebileceði sonucuna varýldý.

BACKGROUND: This experimental study was an investigation of the efficacy of erythropoietin and tadalafil in rats with induced spinal cord injury (SCI).
METHODS: Thirty-five Sprague Dawley rats were distributed into 5 groups. First group was used for normal biochemical values. Spinal cord injury was induced in 4 remaining groups with clip compression technique after laminectomy process to T10 vertebra. Second group was designated solvent group and received 1 cc physiological serum after injury. Third group was medicated with intraperitoneal 2000 u/kg single dose erythropoietin after injury. Orogastric 2 mg/kg single dose tadalafil was administered to fourth group after injury. Fifth group did not receive any treatment and was used for biochemical values with injury. All subjects were sacrificed 48 hours after application. Malondialdehyde (MDA) and total antioxidant capacity (TAOC) values were evaluated using blood and tissue samples.
RESULTS: Lowest serum and tissue MDA values were found in group with erythropoietin intake. While highest serum TAOC values of all groups were seen in tadalafil group, highest tissue TAOC values were observed in group given erythropoietin.
CONCLUSION: It was concluded that by decreasing oxidative stress, tadalafil and erythropoietin can inhibit secondary damage in SCI.

AMAÇ: Bu çalýþmanýn amacý akut sinir hasarýnda timokinonun akut dönem etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþma sýçan sinirinde siyatik sinirde ezilme modeli geliþtirilerek yapýldý. Sýçanlar kontrol, travma ve timokinon tedavi grubu olmak üzere üç gruba ayrýldý (n=6). Sinir hasarýndan yedi gün sonra hasar yerinden siyatik sinir doku örnekleri alýndý. Bu doku örneklerinde histolojik ve steryolojik çalýþma yapýldý. Akson çapý, myelin kalýnlýðý ve akson yoðunluk ölçümleri yapýldý.
BULGULAR: Gruplar arasýnda akson çapý, miyelin kalýnlýðý ve akson yoðunluðu bakýmýndan anlamlý bir farklýlýk görülmedi.
TARTIÞMA: Timokinon akut sinir hasarý üzerinde akut dönemde iyileþtirici etkiye sahip deðildir.

BACKGROUND: The purpose of this study was to evaluate the acute effects of thymoquinone (TQ) on acute nerve injury.
METHODS: A rat model of crush injury of the sciatic nerve was used. Animals were divided into 3 groups: control, trauma, and TQ treatment groups (n=6 per group). Seven days after injury, sciatic nerve specimens were obtained from the site of the injury and analyzed histologically and stereologically. Axon diameter, myelin thickness, and axon density were measured.
RESULTS: There were no significant differences in axon diameter, myelin thickness, or axon density among groups.
CONCLUSION: TQ has no acute therapeutic effect on acute nerve injury.

AMAÇ: Bu çalýþma, penetran ve künt travmaya baðlý akut periferik ve viseral arteriyel yaralanmasý olan hastalarda endovasküler tedavinin etkinliðini araþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Mart 2010 ve Haziran 2014 tarihleri arasýnda, penetran ve künt travmaya baðlý periferik ve viseral arteriyel yaralanma nedeniyle bölümümüzde endovasküler yolla tedavi edilen yaþlarý 35.8±11.3 yýl (daðýlým: 18–56 yýl) olan 12 hasta (11 erkek) geriye dönük olarak incelendi. Hastalarýn 11’inde selektif koil embolizasyonu, birinde partikül embolizasyonu ile yaralanan arterler embolize edildi. Endovasküler tedavi kriterleri; kontrastlý bilgisayarlý tomografide aktif arteriyel ekstravazasyon veya psödoanevrizma ve hemoglobin seviyelerinde düþüþ veya geçici hemodinamik instabilite idi.
BULGULAR: Arteriyel yaralanma mekanizmalarý dört hastada ateþli silah yaralanmasý, beþ hastada delici kesici alet yaralanmasýna baðlý penetran travma ve üç hastada trafik kazasýna baðlý künt travma idi. Travmatik lezyonlar sað hepatik arterde (n=3), sol hepatik (n=2), sað hepatik ve sað renal (n=1), sol inferior epigastrik (n=2), sol fasiyal (n=1), anteriyor tibial (n=1) ve derin femoral (n=1) arterlerde yer almaktaydý. Tüm olgular iþleme baðlý komplikasyon olmaksýzýn teknik baþarý ile tedavi edildi. Ýki hasta hastane yatýþlarýnýn 29. ve 43. günlerinde eþlik eden yaralanmalarý nedeniyle kaybedildi. Ortanca hastane yatýþ süresi altý gün (1–43 gün) ve ortalama yoðun bakým yatýþ süresi ise 7.7 (0–43 gün) gündü.
TARTIÞMA: Bizim deneyimlerimize göre endovasküler tedavi akut periferik ve viseral arteriyel yaralanmalarýn tedavisinde etkili ve güvenli bir seçenektir.

BACKGROUND: The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma.
METHODS: Twelve patients (11 men) aged 35.8±11.3 years (range: 18–56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability.
RESULTS: Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1–43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0–43 days).
CONCLUSION: In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

AMAÇ: Altmýþ beþ yaþ ve üstü kiþilerde travma önde gelen beþinci ölüm nedenidir. Bu çalýþma geriyatrik travma olgularýnda mortaliteyi öngörmede Gözden Geçirilmiþ Travma Skoru (RTS), Yaralanma Þiddet Derecesi Skoru (ISS) ve Travma ve Yaralanma Þiddet Skorunu (TRISS) karþýlaþtýrmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: 2010 ila 2011 yýllarý arasýnda Rasht, Poursina Hastanesi’ne kabul edilmiþ 352 yaþlý travma hastasýnýn kayýtlarýnda yapýlmýþ enine kesit çalýþmasýdýr. Hastanýn prognozuna iliþkin ROC analizini kullanarak yaralanmayý skorlama sistemleri özgüllük, duyarlýlýk ve kesim deðerleri açýsýndan karþýlaþtýrýldý.
BULGULAR: Hastalar ortalama 71.5 yaþýndaydý. En sýk görülen yaralanma mekanizmasý trafik kazasý olup hastalarýn %13.9’u kaybedilmiþti. Sað kalan yaþlýlara göre ölenlerin ISS’si daha yüksek idi. Ölenlere göre yaþlý sað kalanlarda TRISS ve RTS skorlarý daha yüksek olup farklýlýklar istatistiksel açýdan anlamlý idi (p<0.001). Yaþlý travma hastalarýnda mortaliteyi öngörmede RTS, ISS ve TRISS skorlama sistemlerinin en iyi kesim deðerleri sýrasýyla ≤6, ≥13,5 ve ≤2, duyarlýlýklarý sýrasýyla %99, 84 ve 95, özgüllükleri ise %62, 62 ve 72 idi.
TARTIÞMA: Hem anatomik hem de fizyolojik parametrelerin kombinasyonu olduðu için mortalitenin en güçlü öngördürücü parametresi TRISS idi.

BACKGROUND: Trauma is the fifth leading cause of death in patients 65 years and older. This study is a comparison of results of Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) in prediction of mortality in cases of geriatric trauma.
METHODS: This is a cross-sectional study of records of 352 elderly trauma patients who were admitted to Pour-Sina Hospital in Rasht between 2010 and 2011. Injury scoring systems were compared in terms of specificity, sensitivity, and cut-off points using receiver operating characteristic curve of patient prognosis.
RESULTS: Mean age of patients was 71.5 years. Most common mechanism of injury was traffic accident (53.7%). Of the total, 13.9% of patients died. Mean ISS was higher for patients who did not survive. Mean of TRISS and RTS scores in elderly survivors was higher than non-survivors and difference in all 3 scores was statistically significant (p<0.001). Best cut-off points for predicting mortality in elderly trauma patients in RTS, ISS, and TRISS systems were ≤6, ≥13.5, and ≤2, with sensitivity of 99%, 84%, and 95% and specificity of 62%, 62%, and 72%, respectively.
CONCLUSION: TRISS was the strongest predictor of mortality in elderly trauma patients as result of combination of both anatomical and physiological parameters.

AMAÇ: Kadýn cinsiyet Fournier gangreni (FG) için olumsuz bir prognostik faktör olarak görülmektedir. Ancak literatürde bu konuya özgün yeterli veri yoktur. Bu olgu-eþleme çalýþmasý kadýn cinsiyetin FG prognozuna etkisini incelemek için yapýldý.
GEREÇ VE YÖNTEM: Çalýþmaya alýnan hastalar kliniðimizin 120 hastalýk ileriye yönelik olarak tutulan veritabanýndan çekildi. Otuz iki kadýn hasta aþaðýdaki kriterler baz alýnarak 32 erkek hastayla eþleþtirildi: Semptom süresi, FG severity indeks (FGSI) skoru, hasta yaþý, etiyoloji ve eþlik eden diyabetes mellitus (DM) varlýðý. Daha sonra iki grup hasta klinik sonuçlar açsýndan karþýlaþtýrýldý.
BULGULAR: Medyan yaþ 57 (22–80) idi ve 35 (%54.7) hastada DM vardý. Hastalara ortalama 3 (1–9) debridman yapýldý ve 15 hastaya (%23.4) saptýrýcý stoma açýldý. Mortalite oraný %28.1 (64’te 18 hasta) idi. Kadýnlarda FG daha yaygýndý (p=0.009), daha fazla debridmana ihtiyaç duyulmuþtu (p=0.005), kadýnlar yoðun bakým ünitesinde daha fazla oranda kalmýþtý (p=0.035) ve kadýnlarda split thickness skin graft (STSG) ile rekonstrüksiyon daha fazla oranda yapýlmýþtý (p=0.040), ancak mortalite oranlarý iki grup arasýnda benzerdi (p=0.264).
TARTIÞMA: Fournier gangreni kadýnlarda erkeklere oranla daha yaygýn seyreder. Bu muhtemelen kadýnlarýn anatomik yapýsý ile ilgilidir. Ancak kadýn cinsiyet FG mortalitesini artýran bir faktör deðildir.

BACKGROUND: Female gender is accepted as a poor prognostic factor for Fournier’s gangrene (FG). However, there is a paucity of data in the literature regarding this matter. This case-matched study was designed to investigate the impact of gender on outcomes of FG.
METHODS: Study patient data were retrieved from 120-patient, prospectively maintained database. Thirty-two female patients with FG were case-matched to 32 male patients based on symptom duration (days), FG severity index score, patient age, etiology, and presence of diabetes mellitus (DM) terms. Outcomes of FG were compared between the 2 groups.
RESULTS: Median age was 57 years (range: 22-80 years), and 35 (54.7%) patients had DM. Patients underwent average of 3 debridement procedures (range: 1–9 debridements), and 15 (23.4%) received diverting stoma. Overall mortality rate was 28.1% (18 of 64 patients). Female gender was associated with widespread disease (p=0.009), increased need for consecutive debridements (p=0.005), prolonged length of intensive care unit stay (p=0.035), and increased requirement for split-thickness skin graft reconstruction (p=0.040). However, mortality rates were comparable between genders (p=0.264).
CONCLUSION: FG is often more extensive in females and seems to be associated with anatomical features of female pelvis. However, female gender is not a factor affecting prognosis of patients with FG.

AMAÇ: Hamilelikteki en sýk akut karýn nedeni akut apandisittir. Apandisit bulgularýnýn çoðu normal hamlilelik sürecinde olabileceðinden, gebelerde akut apandisit tanýsý zordur. Çalýþmamýzýn amacý, hamilelik döneminde karþýlaþtýðýmýz akut apandisit olgularýný aktarmak ve bu zor durumda uygun tedaviyi araþtýrmak.
GEREÇ VE YÖNTEM: 2005–2015 yýllarý arasýnda akut apandisit nedeniyle ameliyat edilen 20 hamile kadýn hasta çalýþmaya dahil edildi. Veriler geriye dönük olarak toplandý. Hastalar, yaþ, bulgu ve semptomlar, gestasyon yaþý, fiziksel inceleme bulgularý, ameliyat süresi ve komplikasyon açýsýndan incelendi.
BULGULAR: On altý (%80) hastaya açýk, dört (%20) hastaya laparoskopik apendektomi yapýldý. Ortalama yaþ 29.6±5.6 yýldý. En sýk semptom karýn aðrýsýydý (%95). Altý (%30) hasta 1. üç ayda, dokuz (%45) hasta 2. üç ayda ve beþ (%25) hasta son üç ayda idi. On iki (%60) hastada ultrasonografide akut apandisit bulgusu saptandý. Negatif apendektomi oraný %30’du. Sadece bir (%5) hastada maternal komplikasyon saptandý. Hiç fetal komplikasyon saptanmadý.
TARTIÞMA: Yüksek maternal ve fetal komplikasyon oranlarýndan dolayý, gebelerde akut apandisitin doðru tanýsý ve hýzlý cerrahi tedavisi yapýlmalýdýr.

BACKGROUND: Acute appendicitis (AA) is the most common cause of acute abdomen during pregnancy. Most of the signs of appendicitis are also found during normal pregnancy period, however, and diagnosis of appendicitis during pregnancy remains challenging. The aim of the current study was to report our clinical experience of AA during pregnancy and investigate optimal management of this difficult situation.
METHODS: Records of 20 pregnant women with diagnosis of AA who underwent appendectomy between 2005 and 2015 were included in this study. Data were collected retrospectively. Patients were evaluated according to age, signs and symptoms, gestational age, physical findings, serum white blood cell count, ultrasound (US) findings, pathology reports, surgical technique, operation time, and complications.
RESULTS: Of 20 patients, 16 (80%) underwent open appendectomy and 4 (20%) underwent laparoscopic appendectomy. Mean age of patients was 29.6±5.6 years. Most common symptom was abdominal pain (95%). Six (30%) patients were in first trimester, 9 (45%) patients were in second trimester and 5 (25%) patients in were in third trimester. US findings consistent with AA were found in 12 (60%) patients. Negative appendectomy rate was 30%. Maternal complication was seen in only 1 (5%) patient. No fetal complication was observed.
CONCLUSION: Accurate diagnosis and prompt surgical treatment of AA in pregnant women should be performed due to high rates of maternal and fetal complications.

AMAÇ: Penil fraktür tunika albugineada oluþan rüptür olup acil cerrahi müdahale gerektirir. Olgularýn çoðunluðu klinik deðerlendirme ile taný alabilirse de literatürde belirtildiði gibi %15 gibi bir oranda sadece klinik ile taný konulmasýnda zorlanýlabilir. Bu durumda görüntüleme taný konmasýnda yardýmcý olabilir.
GEREÇ VE YÖNTEM: Bizim çalýþmamýzda tanýsý klinik olarak konulamamýþ 20 hastaya manyetik rezonans (MR) görüntüleme yapýldý. Manyetik rezonans görüntülerinde tunikal bütünlük kaybý ve eþlik edebilecek diðer patolojiler araþtýrýldý. Rüptür izlenen olgularda bu rüptürün lokalizasyonu ve uzunluðu kaydedildi. Hastalarýn tamamý ameliyat edildi. Görüntüleme bulgularý operasyon bulgularý ile karþýlaþtýrýldý.
BULGULAR: Manyetik rezonans görüntülemede 19 tunikal rüptür tanýmlandý. Bir olguda sadece hematom görüntülenebilmiþ olup tunikal rüptür lehine bir bulgu saptanmadý. Hiçbir olguda üretral yaralanma gözlenmedi. Görüntüleme bulgularýnýn tamamý operasyon bulgularý ile doðrulandý.
TARTIÞMA: Klinik olarak tanýsýnda zorlanýlan penil fraktür olgularýnda MR görüntüleme tanýnýn doðrulukla ve güvenle konmasýnda kritik bilgiler saðlayabilir.

BACKGROUND: Penile fracture is a surgical emergency defined as rupture of the tunica albuginea. Although most cases can be diagnosed with clinical evaluation, it has been stated in the literature that diagnosis in as many as 15% of cases can be challenging. In uncertain cases, imaging can help determine diagnosis.
METHODS: Present study included 20 cases where diagnosis could not be made with certainty and magnetic resonance imaging (MRI) was performed. MR images were examined for tunical rupture and accompanying pathologies. When rupture was observed, localization and length of rupture were noted. All patients underwent degloving surgery. All imaging findings were compared to surgical findings.
RESULTS: MRI revealed 19 tunical ruptures. In 1 case, hematoma was seen with no sign of penile fracture. No urethral injuries were found. All MRI findings were confirmed during surgery.
CONCLUSION: Performing MRI in clinically equivocal cases can provide crucial data to make precise diagnosis and improve patient management.

AMAÇ: Bu çalýþmanýn amacý cerrahi olarak tedavi edilen trimalleoler kýrýklarda posterior malleol (PM) fiksasyonunun etkinliði ve önemini deðerlendirmektir.
GEREÇ VE YÖNTEM: 2004 ile 2011 yýllarý arasýnda PM içeren ayak bileði eklemi kýrýklý toplam 57 olgu açýk redüksiyon ve internal fiksasyonla tedavi edildi. Posterior malleol fiksasyonu 46 olguda kanüllü vida ile, 11 olguda plak ise plak ile gerçekleþtirildi. Tüm olgular Amerikan Ortopedik Ayak ve Ayak Bileði birliði Skoru (AOFAS), Amerikan Ortopedik Cerrahlar Akademisi Ayak ve Ayak Bileði Anketi (AOOS), Görsel Analog Skala (VAS) ve saðlam tarafla karþýlaþtýrýlan ayak bileði eklemi hareketliliði ile deðerlendirildi.
BULGULAR: Yaþlarý 23 ile 85 arasýnda (ortalama 55.9) olan, 36’sý kadýn ve 21’i erkek olan olgularýn ortalama takip süresi 44.6 (24–108) aydý. Cerrahiye kadar geçen süre 1.1 (1–3) gündü. AOFAS’a göre 21 olgu mükemmel ve 26 olgu iyi olarak deðerlendirildi. AOOS skoru ortalama 92.4 (32–100) idi. Ortalama VAS istirahatta 1.1 ve yürümede 1.3 idi. Saðlam tarafla karþýlaþtýrýldýðýnda, ayak bileði eklemi plantar fleksiyonunda anlamlý farklýlýk görülmedi (p=0.325) ancak ayak bileði eklemi dorsifleksiyonunda anlamlý farklýlýk görüldü (p<0.001).
TARTIÞMA: Posterior malleolün anatomik redüksiyon ve rijit internal fiksasyonu, yeterli fiksasyon için zayýf kemik kalitesi problem olan yaþlý hastalarda bile tatminkar klinik ve fonksiyonel sonuçlar saðlar. Küçük PM fragmanlarýnýn bile fiksasyonu rehabilitasyona daha stabil bir yapý oluþturabilir.

BACKGROUND: The aim of this retrospective study was to evaluate treatment effect and importance of posterior malleolus (PM) fixation in surgically treated trimalleolar fractures.
METHODS: A total of 57 cases of ankle joint fracture involving PM and treated with open reduction and internal fixation technique between 2004 and 2011 were evaluated. PM fixation was performed with cannulated screws in 46 cases, and in 11 cases, PM plate was used. All patients were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score, American Academy of Orthopedic Surgeons (AAOS) foot and ankle questionnaire, and Visual Analog Score (VAS) pain scale. Ankle joint mobility was also compared with unaffected side.
RESULTS: Mean follow-up period was 44.6 months (range: 24–108 months). There were 36 female patients and 21 male patients between 23 and 85 years of age (mean: 55.9 years). Average time to surgery was 1.1 day (range: 1–3 days). According to AOFAS assessment, result was excellent in 21 patients and good in 26 patients. AAOS score was 92.4 (range: 32–100). Mean VAS score when resting was 1.1, and mean score was 1.3 when walking (range: 0–10). When compared with uninjured side, there was no significant difference in plantar flexion of ankle (p=0.325) but there was significant difference in dorsiflexion of ankle joint (p<0.001).
CONCLUSION: Anatomical reduction and rigid internal fixation of PM provide satisfactory clinical and functional outcomes even in elderly patients where bone quality may make adequate fixation difficult. Fixation of even small PM fragments can facilitate rehabilitation by creating more stable construction.

AMAÇ: Çalýþmamýz üst ekstremite travma öyküsü olan ve olmayan otizmli çocuklarýn el fonksiyonlarýný karþýlaþtýrmak amacý ile planlandý.
GEREÇ VE YÖNTEM: Çalýþmaya otizm spektrum bozukluðu tanýsý ile takip edilen toplam 65 (Grup I, n=28; Group II, n=37) çocuk dahil edildi. Çocuklarýn el fonksiyonlarý 9-Delikli Peg Testi ve Jebsen El Fonksiyon Testi ile deðerlendirildi. Üst ekstremite ve elin somatoduyusal algýsý Duyusal Ýþlemleme ve Praksis Testi’nin somatoduyusal algý alt testleri ile deðerlendirildi. Sonuçlar Student t-testi and Mann-Whitney U-Testi ile SPSS 20 bilgisayar programý ile karþýlaþtýrýldý.
BULGULAR: Her iki el fonksiyon testine ait sonuçlar travma geçmiþi olmayan çocuklar lehine farklý bulundu (p<0.05). Üst ekstremite somatosensoriyel algý ile el fonksiyon testleri arasýndaki iliþki incelendiðinde, çocuklarýn 9-Delikli Peg Testi ve Jebson El Fonsiyonlarý Test puanlarý ile Manuel Obje Algýsý ve Taktil Uyaranýn Lokalizasyonu test puanlarý arasýnda istatistiksel olarak anlamlý iliþkiler bulundu (p<0.05).
TARTIÞMA: Travma öyküsü olan otizm spektrum bozukluðu tanýlý çocuklar zayýf somatoduyusal algý ve el fonksiyonlarýna sahiptirler. Acil servislerde çalýþan profesyonellerin somatoduyusal algý, el fonsiyonlarý ve üst ektremite travma öyküsü arasýndaki kuvvetli iliþki konusunda bilgilendirilip, farkýndalýklarýnýn arttýrýlmasýnýnýn; bu popülasyondaki çocuklarýn rehabilitasyon süreçleri için önemli olduðu düþünülmektedir.

BACKGROUND: The present study was designed to compare hand function in autistic children with history of upper extremity trauma with that of autistic children those who do not have history of trauma.
METHODS: The study group included total of 65 children diagnosed with autism spectrum disorder (ASD) and was divided into 2 groups: children with trauma history (Group I) and control group (Group II) (Group I: n=28; Group II: n=37). Hand function was evaluated with 9-Hole Peg Test and Jebsen Hand Function Test. Somatosensory function was evaluated using somatosensory subtests of Sensory Integration and Praxis Test. Results were analyzed with Student’s t-test and Mann-Whitney U test using SPSS version 20 software.
RESULTS: Hand function and somatosensory perception test scores were statistically significantly better in children without upper extremity trauma history (p<0.05). When association between hand function tests and upper extremity somatosensory perception tests was taken into account, statistically significant correlations were found between all parameters of hand function tests and Manual Form Perception and Localization of Tactile Stimuli Test results (p<0.05).
CONCLUSION: Autistic children with upper extremity trauma history had poor somatosensory perception and hand function. It is important to raise awareness among emergency service staff and inform them about strong relationship between somatosensory perception, hand function, and upper extremity trauma in children with ASD in order to develop appropriate rehabilitation process and prevent further trauma.

Seyrek görülmekle birlikte pankreas yaralanmalarý çeþitli içi boþ ve solid organlara yakýnlýklarý nedeniyle yüksek bir morbiditeyle iliþkilidir. Erken taný koyma zorluðu morbiditeye katkýda bulunmaktadýr. Pankreas kanalýnýn durumu yaralanmayý derecelendirmede ve tedavi kararýnda önemli bir etkendir. Düþük dereceli yaralanmalarda konservatif tedavi uygulanýr. Daha yüksek dereceli pankreas yaralanmalarý genellikle cerrahi yolla tedavi edilir. Son zamanlarda kolanjiyobiliyer ve pankreatik patolojilerin etkili tanýsal ve terapötik bir yöntemi olarak endoskopik retrograd kolanjiyopankreatikografi (ERKP) kullanýlmaya baþlanmýþtýr. Bu yazýda, endoskopik retrograd kolanjiyopankreatikografi kýlavuzluðunda pankreas kanalý stentlenerek baþarýlý bir þekilde tedavi edilen posttravmatik komplet pankreas kanal transeksiyonu olan 12 yaþýndaki bir erkek çocuðu sunuldu. Travma ortamýnda ERKP’nin terapötik avantajlarý ve iliþkin zorluklar vurgulanmaktadýr.

Pancreatic injuries, though rare, are associated with high morbidity because of location of pancreas adjacent to the various hollow and solid organs. Difficulty in early diagnosis adds to morbidity. Condition of the pancreatic duct is an important factor in grading the injury and deciding upon course of management. Conservative management is the line of treatment in lower grade injuries. Higher grades of pancreatic injuries are usually managed surgically. Endoscopic retrograde cholangiopancreaticography (ERCP) has recently emerged as an effective diagnostic as well as therapeutic modality for hepatobiliary and pancreatic pathologies. Presently described is case of a 12-year-old boy who presented with post-traumatic complete transection of pancreatic duct, which was successfully managed by ERCP-guided stenting of the duct. Therapeutic advantages of ERCP in trauma setting and difficulties involved are highlighted.

Pulmoner sekestrasyon seyrek görülen ve genellikle semptomsuz bir doðuþtan anomalidir. Bu rahatsýzlýðýn optimal tedavisi hâlâ tartýþmalý olup cerrahi rezeksiyonlarý veya aberan arterin anjiyografik embolizasyonunu içerir. Perfore apandisitin neden olduðu akut sað alt kadran karýn aðrýsýnýn eþlik ettiði pulmoner sekestrasyonla iliþkili hemoptiziyle gelen 51 yaþýnda nadir görülen bir erkek olguyu sunuyoruz.

Pulmonary sequestration is a rare and usually asymptomatic congenital anomaly. Optimal management of this condition is still a subject of debate, including superiority of surgical resection or angiographic embolization of the aberrant arterial vessel. Presently described is rare case of a 51-year-old male who presented with hemoptysis related to pulmonary sequestration associated with acute right lower quadrant abdominal pain caused by perforated appendicitis.

Bu yazýda, balýk kýlçýðýna baðlý jejunal perforasyon sonrasý üç gündür olan epigastrik aðrý þikayeti ile acil servise baþvuran 52 yaþýnda erkek hasta sunuldu. Yapýlan karýn incelemesinde yaygýn hassasiyet ve rebound mevcuttu. Ayakta direkt karýn grafisinde diafragma altý serbest hava tespit edildi. Hastaya peptik ülser perforasyonu ön tanýsýyla tanýsal laparoskopi uygulandý. Yapýlan eksplorasyonda jejunal anslarda þiddetli enflamasyon, ödem, proksimal ince baðýrsak anslarýnda obstrüksiyona baðlý dilatasyon ve balýk kýlçýðýna baðlý perforasyon odaðý görüldü. Perfore ince baðýrsak ansý laparoskopik stapler ile rezeke edilip karýniçi anastomoze edildi ve perfore segment trokar yerinden karýn dýþýna alýndý. Hastanýn ameliyat sonrasý takiplerinde sorunu olmadý ve dördüncü günde taburcu edildi. Bu örnekte balýk kýlçýðýna baðlý ince baðýrsak perforasyonu ve obstrüksiyon geliþen hastada laparoskopik rezeksiyon ve anastomoz tanýmlanmýþtýr.

Presently described is case of a 52-year-old man who was admitted to the emergency department with 3-day history of epigastric pain. Abdominal examination revealed diffuse tenderness and muscle guarding. Plain abdominal X-ray showed free subdiaphragmatic air. The patient underwent diagnostic laparoscopy with presumptive diagnosis of peptic ulcer perforation. Laparoscopy showed several inflamed, edematous jejunal loops with proximal obstruction and perforation by an impacted fish bone. Completely intracorporeal resection and anastomosis using laparoscopic linear stapler was performed and segment of resected bowel was removed through trocar site. Postoperative period was uneventful, and the patient was discharged on fourth day.

Obturator herni tüm hernilerin yaklaþýk olarak %0.05–1.4’ünü oluþturan nadir bir hastalýktýr. Genellikle zayýf, yaþlý ve düþkün kadýnlarda görülmektedir. Uyluk iç kýsmýndan dize yayýlan aðrý (Howship Romberg bulgusu) hastalýða özgüdür. Bu yazýda, obturator fýtýk tanýsý alan bir hasta ve obturator fýtýðýn tanýsal güçlükleri sunuldu. Yetmiþ üç yaþýnda düþkün bir hasta, bulantý, iþtahsýzlýk ve sol kalçasýndan uyluk iç kýsmýna ve dize yayýlan þiddetli aðrý þikayeti ile acil servise baþvurdu. Öncelikli vertebral disk hernisi düþünülen hastanýn çekilen abdomino-pelvik bilgisayarlý tomografisinde sol obturator fýtýk saptandý. Obturator fýtýk tanýsý güç olan nadir bir hastalýktýr. Hekimler kalça ve diz aðrýsýnýn ayýrýcý tanýsýnda obturator fýtýðý dahil etmelidirler ve lüzüm halinde Howship Romberg bulgusunu sorgulamalýdýrlar. Erken taný konulmasý hem mortalite ve morbiditeyi azaltmaktadýr hem de daha az invaziv yöntemlerle tedavi olanaðý sunmaktadýr.

Obturator hernia is a rare disease usually occurring in debilitated elderly women. Pain radiating down the medial thigh and knee (Howship-Romberg sign) is a specific sign of the disease. Presently described is a case of obturator hernia in a 73-year-old female patient who presented with severe left hip pain radiating down the medial thigh and knee, nausea, and loss of appetite. Initially, vertebral disc herniation was thought to be cause, but abdomino-pelvic computed tomography scan revealed left strangulated obturator hernia. Diagnosis of obturator hernia can be challenging. Physicians should consider obturator hernia in the differential diagnosis of knee and hip pain, and investigate for Howship-Romberg sign. Early diagnosis of the disease not only decreases morbidity and mortality, but also presents opportunity to treat with minimally invasive methods.