AMAÇ: Çalýþmamýzda Hyalobarrier Gel ve Seprafilm’in ezilme tipi yaralanma sonrasýnda tendon yapýþýklýklarýnýn önlenmesi üzerindeki etkisini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Yirmi beþ adet 230–270 gram aralýðýnda ve yedi–dokuz aylýk diþi sýçanlar beþ grup olarak randomize edildi. Grup 1: Kontrol grubu, Grup 2: Hyalobarrier Gel grubu, Grup 3: Seprafilm grubu, Grup 4: Tendon onarýmý ve Hyalobarrier Gel grubu, Grup 5: Tendon onarýmý ve Seprafilm grubu olarak adlandýrýldý. Her deney hayvanýnýn iki gastroknemius kasý tendonu olmak üzere toplamda 50 tendon kullanýldý. Deney hayvanlarý yüksek doz anestezi uygulamasýyla operasyon sonrasý 40. günde sakrifiye edildiler. Yapýþýklýklarýn makroskopik deðerlendirilmesi iki kör araþtýrmacý tarafýndan Tang’ýn yapýþýklýk dereceleme sistemiyle sýnýflandýrýldý. Histopatolojik deðerlendirme için fibroblast sayýlarý, kollajen yoðunluðu ve yapýsý deðerlendirmeye alýndý.
BULGULAR: Grup 2’de ciddi yapýþýklýk saptanmadý; Grup 3, 4 ve 5’te orta ve ciddi yapýþýklýk saptanmadý. Grup 2 ve kontrol grubu arasýnda istatistiksel açýdan anlamlý fark bulunmadý (p=0.737). Grup 3, 4 ve 5; Grup 1 ve 2’den daha az yapýþýklýða sahipti (p<0.05). Grup 4 ve 5 sýrasýyla Grup 2 ve 3’ten daha az yapýþýklýða sahipti (p<0.05). Grup 3 ve 4 arasýnda istatistiksel açýdan anlamlý fark bulunmadý (p=0.342). Histopatolojik bulgular da makroskopik bulgulara paraleldi.
TARTIÞMA: Seprafilm, ezilme tipi yaralanmayý takiben tendon yapýþýklýklarýný önlemede, tendon tamiri yapýlan ve yapýlmayan her iki grupta etkili bulundu. Buna karþýlýk Hyalobarrier Gel’in sadece tendon tamiri yapýlan grupta yapýþýklýðý önlemede etkili olduðu saptandý.

BACKGROUND: In the present study, the aim was to evaluate the effects of Hyalobarrier gel (Anika Therapeutics S.r.l., Abano Terme, Italy) and Seprafilm adhesion barrier (Genzyme Corporation, Cambridge, MA, USA) in the prevention of peritendinous adhesions following a crush-type injury.
METHODS: Twenty five female Wistar Albino rats, weighing 230 to 270 g and 7 to 9 months of age were randomized into 5 groups. Group 1 was the control group, Group 2 comprised the Hyalobarrier gel group, Group 3 was made up of the Seprafilm-treated subjects, Group 4 was the tendon repair and Hyalobarrier gel group, and Group 5 was the tendon repair and Seprafilm group. Two gastrocnemius muscle tendons of each animal, a total of 50 tendons, were used. The animals were sacrificed with the administration of a high dose of anesthetic on postoperative day 40. Macroscopic evaluation of adhesions was classified by 2 blinded researchers according to Tang’s adhesion grading system. The number of fibroblasts and the density and formation of collagen fibers were noted for histopathological examination.
RESULTS: None of the subjects in Group 2 was determined to have a severe adhesion, and moderate or severe adhesions were detected in Groups 3, 4, and 5. There was no statistically significant difference between Group 2 and the control group (p=0.737). Groups 3, 4, and 5 demonstrated fewer adhesions than Groups 1 and 2 (p<0.05). Groups 4 and 5 had fewer adhesions than Groups 2 and 3 (p<0.05). There was no statistically significant difference between Groups 4 and 3 (p=0.342). The histopathological findings were consistent with the macroscopic findings.
CONCLUSION: Seprafilm was found to be effective in the prevention of peritendinous adhesions following a crush-type injury with or without repair of the tendon fibers. In contrast, Hyalobarrier gel was found to be effective only following repair of the tendon fibers.

AMAÇ: Bu çalýþmada lipopolisakkaritle (LPS) indüklenmiþ sýçan sepsis modelinde talidomid ve etanersept’in terapötik etkilerini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Otuz adet erkek Wistar Albino sýçan; Kontrol, LPS, LPS+Talidomid, LPS+Etanersept ve LPS+Talidomid+Etanersept olmak üzere beþ gruba ayrýldý. Kontrol grubuna 1 mL %0.9’luk salin solüsyonu intraperitoneal (i.p.) olarak verildi. Endotoksik tedavi için sýçanlara LPS (Escherichia coli 0111: B4 (5 mg/kg), tek doz) i.p. olarak enjekte edildi. Terapötik gruplarý oluþturmak için talidomid (0.5 mg/kg) ve etanersept (1 mg/kg) i.p. olarak uygulandý. Hepatik doku tümör nekroz faktör-α (TNF-α), interlökin-6 (IL-6), hücreler arasý adezyon molekülü-1 (ICAM-1) ve platelet-türevli büyüme faktörü (PDGF) düzeyleri ELISA yöntemiyle, malondialdehid (MDA) düzeyi ile toplam oksidan kapasitesi (TOS) uygun yöntemler kullanýlarak ölçüldü.
BULGULAR: In vivo sonuçlar, kontrol ile karþýlaþtýrýldýðýnda LPS uygulanmýþ hayvanlarda karaciðer TNF-α, IL-6, ICAM-1, PDGF, MDA ve TOS düzeylerinin arttýðýný gösterdi. Karaciðer dokularýnýn analiziyle, biyokimyasal deðiþiklikler desteklendi ve talidomid ve etanersept’in terapötik rolünü kanýtladý. Septik hayvanlarýn bu tedavi ajanlarýyla tedavi edilmesiyle seçilen proenflamatuvar sitokinler, anjiyogenik faktörler ve reaktif oksijen parametrelerinde kayda deðer bir düþüþ gözlendi.
TARTIÞMA: Seçilen terapötik ajanlarýn tedavisini takiben sitokin dengesinin ve oksidan durumunun normale döndürülmesi, talidomid ve etanersept’in sepsisin yýkýcý etkilerinden kaçýnmaya yardýmcý olabileceðini düþündürmektedir.

BACKGROUND: The aim of this study was to evaluate the therapeutic effects of thalidomide and etanercept on lipopolysaccharide (LPS)-induced sepsis in a rat model.
METHODS: Thirty male Wistar Albino rats were divided into 5 groups: Control, LPS, LPS+Thalidomide, LPS+Etanercept, and LPS+Thalidomide+Etanercept. The control group was given a 1 mL intraperitoneal (i.p.) injection of 0.9% saline solution. For endotoxic treatment, the rats were injected with a single i.p. dose of LPS (Escherichia coli 0111: B4 (5 mg/kg). Thalidomide (0.5 mg/kg) and etanercept (1 mg/kg) were administered i.p. to the therapeutic groups. Hepatic tissue tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1) and platelet-derived growth factor (PDGF) levels were determined by enzyme-linked immunosorbent assay and malondialdehyde (MDA) levels and total oxidant status (TOS) were measured using appropriate methods.
RESULTS: In vivo results exhibited elevated liver tissue TNF-α, IL-6, ICAM-1, PDGF, MDA, and TOS levels in the LPS-treated animals compared with the controls. The analysis of liver tissue supported the findings of biochemical alterations and indicated a therapeutic role for thalidomide and etanercept. Treatment of septic animals with these agents resulted in a remarkable decrease in the selected proinflammatory cytokines, angiogenic factors, and reactive oxygen parameters.
CONCLUSION: Restoration of cytokine balance and oxidant status to normal levels following treatment with selected therapeutic agents suggests that thalidomide and etanercept can help to avoid the potentially devastating effects of sepsis.

AMAÇ: Lomber disk cerrahisi baþta olmak üzere spinal bölgeye yönelik tüm prosedürlerde damar yaralanmalarý nadir görülmekle birlikte hayati öneme sahiptir. Biz çalýþmamýzda abdominal aortaya yönelik bilgisayarlý tomografi anjiyo (BTA) çekilen hastalarda iliak arter ve venin seyrini, intervertebral disk mesafeleri ile olan iliþkilerini morfometrik olarak araþtýrdýk.
GEREÇ VE YÖNTEM: Bu çalýþma geriye dönük olarak yapýldý. Herhangi bir nedenle BTA çekilen 100 hasta çalýþmaya alýndý. Hastalarýn BTA incelemelerinde aort bifurkasyonu (AB), sað ve sol kommon iliak arter (R/LCIA) ve ven (R/LCIV), kommon iliak arter bifurkasyonunun (CIAB) lokalizasyonu araþtýrýldý. Bu vasküler yapýlarýn spinal vertebra body (VB) ve interverteral disk seviyesinde (IDL) lokalizasyonu, anterior longitudinal ligaman (ALL) ile aralarýnda yað plan olup olmadýðý araþtýrýldý.
BULGULAR: L4-5 IDL’de RCIA %51 saat 12 hizasýnda ve %67 oranýnda ALL ile arasýnda RCIV bulunmaktaydý. LCIA %72 saat 1 hizasýnda ve %47 ALL’ye yapýþýk, %11 arada yað planý mevcut iken %14 arada LCIV bulunmaktaydý. RCIV %92 saat 11 hizasýnda yerleþmekte, %97 ALL ile arasýnda yað plan bulunmamaktaydý. LCIV %80 saat 11-12 hizasýnda, %18 transvers olarak saat 12-1-2 boyunca yerleþmekte ve hastalarýn tümünde ALL ile arasýnda yað plan bulunmamakta, ALL’ye yakýn yerleþimliydi. LCIA L4-5 IDL ALL’ye RCIA göre daha uzaktýr (p<0.001). L5-S1 IDL’de RCIA %63 saat 10 hizasýnda ve %63 oranýnda ALL ile arasýnda yað plan bulunmamaktaydý. LCIA, %72 saat 2 hizasýnda, %92 ALL ile arasýnda LCIV bulunmaktaydý. RCIV %95 saat 9-10 hizasýna yerleþmekte, %60 ALL ile arasýnda yað plan bulunmaktaydý. LCIV, %96 saat 1–2 hizasýnda yerleþmekte, %92 ALL arasýnda yað plan bulunmamakta, ALL’ye yakýn yerleþimliydi. RCIA L5-S1 IDS ALL’ye LCIA göre daha uzaktýr (p<0.001). CIV’ler L4-5 IDS ALL uzaklýklarý açýsýndan fark yoktur (p=0.08). L5-S1 IDL RCIV ALL’ye LCIV’ye göre daha uzaktýr (p<0.001).
TARTIÞMA: L4-5 IDL RCIA orta hatta ve saða 30°’lik açý içerisinde yerleþmekte, ALL ile aralarýnda LCIV bulunmakta, bu seviyede olan bir damar yaralanmasý vene veya arter-ven kompleksine baðlý olma olasýlýðý yüksektir. L5-S1 IDL ise LCIA sola 60° hizasýnda, LCIV ile birlikte ALL’ye çok yakýn konumlanmýþtýr. CIA’lar ALL ile aralarýnda yað plan bulunmasý ve ALL’ye uzaklýðý karþýlaþtýrýldýðýnda L4-L5 IDL’de RCIA (p<0.001), L5-S1 IDL’de LCIA (p<0.001) ALL’ye uzak yerleþimliydi ve daha korunaklý bir pozisyonda olduðu söylenebilir. LCIV’nin L4-5 ID seviyesi boyunca ALL’ye yapýþýk ve transvers ilerleyebileceði akýlda tutulmalýdýr.

BACKGROUND: Vascular injuries, which are rarely seen in all spinal area procedures, especially lumbar disc surgery, are vitally important. The relationship between the course of the iliac artery and vein and intervertebral disc distance was studied morphometrically in patients who had undergone computed tomography angiography for abdominal aorta.
METHODS: This study was carried out retrospectively. A total of 100 patients who had undergone computed tomography angiography participated in the study. The aorta bifurcation, right and left common iliac artery (R/LCIA) and vein (R/LCIV), and the location of the common iliac artery bifurcation were investigated. The location of these vascular structures at the level of the spinal vertebral body and at the intervertebral disc level, determination of a fat plane between them, and the anterior longitudinal ligament (ALL) were analyzed.
RESULTS: At the L4-5 intertransversarius dorsalis (IDL), the RCIV was determined to be at the 12 o’clock position RCIA in 51% of cases and between the ratio of 67% ALL. The LCIA was at the 1 o’clock position in 72% and adjacent to the ALL in 47%. The RCIV was located in the 11 o’clock position and there was no fat plane between the RCIV and the ALL in 92%. In 80%, the LCIV was located at the 11-12 o’clock position and in 18% transversely along the 12-1-2 o’clock region. There was no fat plane between the LCIV and the ALL in any patient. At the L5-S1 IDL, the RCIA was observed at the 10 o’clock position in 63%, and there was no fat plane between the RCIA and the ALL. The LCIA was at the 2 o’clock position in 72% and the LCIV was between the ALL and the LCIA in 92%. The RCIV was located at the 9-10 o’clock position in 95% and no fat plane was found between the ALL and the RCIV in 60%. The LCIV was located at the 1-2 o’clock position in 96% and there was no fat plane between the LCIV and the ALL in 92%; it was located close to the ALL.
CONCLUSION: The L4-5 IDL RCIA was located at the midline and at a 30° angle position. The LCIV was located between them. The L5-S1 IDL located at LCIA left at 60° position was quite close to ALL with LCIV. When the distance from the ALL was compared and the frequency of fat planes between the ALL and the CIAs are considered, it can be noted that the RCIA in the L4-L5 IDL (p<0.001) and the LCIA in the L5-S1 IDL (p<0.001) were located remotely and in a more protected position. It should be kept in mind that the LCIV can progress along the L4-5 ID level, adjacent to the ALL, as well as transversely.

AMAÇ: Amacýmýz, elektif alt ekstremite cerrahisi uygulanan hastalarda iki antioksidan ajan, ketamin ve lidokainin küçük doz infüzyonunun iskemi-reperfüzyon hasarý (IRI) üzerine olan etkisini karþýlaþtýrmaktýr. Bu amaçla iskemi modifiye albümin (IMA), laktat ve kan gazý seviyeleri ölçüldü.
GEREÇ VE YÖNTEM: Alt ekstremite cerrahisi uygulanan 100 hasta randomize olarak üç gruba ayrýldý. Spinal anesteziden sonra ketamin grubunda (Grup K, n=33), ketamin infüzyonu, lidokain grubunda (Grup L, n=33), lidokain infüzyonu, kontrol grubunda (Grup C) %0.9 NaCl infüzyonu uygulandý. IMA analizi için kan örnekleri anestezik uygulamadan önce (bazal deðer), 30 dakika turnike enflasyonunda (iskemi) ve turnike deflasyonundan 15 dakika sonra (reperfüzyon) elde edildi. Arteriyel kan gazý ölçümleri anestezi uygulamasý öncesi ve turnike deflasyonundan 15 dakika sonra belirlendi.
BULGULAR: Reperfüzyonda laktat ve IMA düzeyleri kontrol grubu ile karþýlaþtýrýldýðýnda hem ketamin grubunda hem de lidokain grubunda anlamlý olarak düþüktü.
TARTIÞMA: Hem ketamin hem de lidokain infüzyonunun uygulanmasý, iskelet kasý IRI ile iliþkili yüksek laktat ve yüksek IMA düzeylerini anlamlý olarak azaltmýþtýr. Bu sonuçlar, iskelet kasý ile iliþkili IRI’da, ketamin veya lidokain infüzyonlarýnýn klinik uygulanabilme olasýlýðýný düþündürmektedir.

BACKGROUND: The primary aim of this study was to compare the effects of a small-dose infusion of 2 antioxidant agents, ketamine and lidocaine, on ischemia-reperfusion injury (IRI) in patients undergoing elective lower limb surgery. Ischemia-modified albumin (IMA), lactate, and blood gas levels were all measured and assessed.
METHODS: A total of 100 patients who underwent lower extremity surgery were randomized into 3 groups. After spinal anesthesia, the ketamine group (Group K, n=33) was given a ketamine infusion, a lidocaine infusion was administered to the lidocaine group (Group L, n=33), and in the control group (Group C), 0.9% a sodium chloride infusion was performed. Blood samples were obtained for IMA analysis before anesthetic administration (baseline), at 30 minutes of tourniquet inflation (ischemia), and 15 minutes after tourniquet deflation (reperfusion). Arterial blood gas measurements were determined before anesthetic administration and 15 minutes after tourniquet deflation.
RESULTS: The lactate and IMA levels at reperfusion were significantly lower in both the ketamine group and the lidocaine group when compared with the control group.
CONCLUSION: The administration of both ketamine and lidocaine infusions significantly decreased skeletal muscle IRI-related high lactate and IMA levels. These results suggest the possibility of the clinical application of ketamine or lidocaine infusions in cases of skeletal muscle-related IRI.

AMAÇ: Akut apandisit tanýsýyla apendektomi yapýlan hasta topluluðunda apendiks nöroendokrin tümörlerinin (NET) görülme sýklýðýný ve tümörün davranýþ þeklini araþtýrmayý amaçladýk. Ýkincil amacýmýz apandisiyel NET’li hastalarda saðkalýmý araþtýrmaktýr.
GEREÇ VE YÖNTEM: Þubat 2006–Haziran 2018 tarihleri arasýnda Saðlýk Bilimleri Üniversitesi Ýstanbul Okmeydaný Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde akut apendisit tanýsýyla 6518 apendektomi uygulandý. Bu ardýþýk 6518 apendektomi hastasýnýn týbbi kayýtlarý geriye dönük olarak deðerlendirildi. Histopatolojik analizlerden sonra toplam 22 hasta apendiks NET olarak tanýmlandý. Bu hastalar çalýþmaya dahil edildi. Cinsiyet, yaþ, ameliyat sýrasýnda cerrahi bulgular, ameliyat sonrasý takip süresi ve saðkalým süresi, tümör lokalizasyonu, tümör çaplarý, tümör derecesi, invazyon, cerrahi sýnýr ve tümör evresi gibi geriye dönük bir veri tabaný elde edildi.
BULGULAR: Apendiks NET’lerinin görülme sýklýðý %0.33 idi. On bir hastaya Avrupa Nöroendokrin Tümör Derneði Kýlavuzu’na göre primer patolojik evre pT1aN0M0 tanýsý konuldu. Ayrýca bir hastaya primer patolojik evre pT1bN0M0 ve on hastaya primer patolojik evre pT2N0M0 tanýsý konuldu. Ortalama tümör çapý 7.6 mm idi. Tümör çapý 20 mm’den daha büyük olan herhangi bir hasta yoktu.
TARTIÞMA: Çalýþmadaki apendiks NET görülme sýklýðý literatür ile uyumludur. Çalýþmanýn sonuçlarý akut apandisit hastalarýnda rastlantýsal olarak ortaya çýkan NET’ler için daha ileri cerrahi iþlemlerin gereksiz olduðunu göstermektedir. Buna ek olarak, çalýþma hastalýksýz saðkalýmýn (%100), ortalama 59.2 aylýk takipte iyi olduðunu göstermektedir.

BACKGROUND: The aim of this study was to investigate the incidence of appendiceal neuroendocrine tumors (NET) in an acute appendicitis cohort, as well as to investigate the behavioral form of the tumor. Our secondary aim was to investigate survival in patients with appendiceal NET.
METHODS: Between February 2006 and June 2018, 6518 appendectomies were performed for acute appendicitis in the department of surgery, University of Health Sciences, Okmeydaný Education and Research Hospital, Ýstanbul, Turkey. The medical records of these consecutive 6518 appendectomy patients were evaluated retrospectively. After the histopathological analysis, a total of 22 patients were identified as cases of appendiceal NET. These patients were included in the study. A retrospective analysis of data including gender, age, intraoperative surgical findings, duration of postoperative follow-up and survival, tumor localization, the diameter of the tumor, tumor grade, invasion, surgical margin, and stage of the tumor was performed.
RESULTS: The incidence of appendiceal NET was 0.33%. Eleven patients were diagnosed as primary pathological stage pT1aN0M0 according to the European Neuroendocrine Tumor Society guidelines. One patient was diagnosed as primary pathological stage pT1bN0M0, and 10 patients were diagnosed as primary pathological stage pT2N0M0. The median tumor diameter was 7.6 mm. There was no patient with a tumor diameter greater than 20 mm.
CONCLUSION: The incidence of appendiceal NET in our study is consistent with that stated in the literature. The results of our research suggest that further surgical procedures for NETs that occur coincidentally in patients of the AA cohort are often unnecessary. In addition, the study revealed that disease-free survival (100%) was good over a mean follow-up of 59.2 months.

AMAÇ: Çalýþmamýzda perfore ve nonperfore apandisit olgularýnda apendiks sferisite indeksi ve apendiks çaplarýnýn ve perforasyon tespitinde tanýya katkýsýný deðerlendirdik.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2015–Aðustos 2017 arasýnda kliniðimizde yapýlan bilgisayarlý tomografi (BT) sonucu apandisit ile uyumlu olan ve histopatolojik sonucu apandisit olarak kanýtlanmýþ 81 hasta alýndý. Histopatolojik sonuçlarýna göre hastalar perfore ve nonperfore apandisit olmak üzere iki gruba ayrýldý. Hastalarýn BT görüntüleri perforasyon açýsýndan tekrar deðerlendirildi. Uygun BT planýndan apendiks uzun aksý, kýsa aksý ve bunlarýn oranlanmasý ile elde edilen sferisite indeksi hesaplandý. Her bulgunun duyarlýlýðý ve özgüllüðü perforasyon tanýsýnda literatürde tanýmlanmýþ diðer BT bulgularý ile birlikte gruplar arasýnda istatistiksel olarak analiz edildi.
BULGULAR: Perfore grup 20, nonperfore grup 61 hastadan oluþmaktaydý. Duvar defekti, apse, ekstralüminal hava, serbest sývý ve apendikolit bulgularý için sensitivite deðerleri sýrasýyla %25, %15, %25, %55, %50, spesifite deðerleri sýrasýyla %100, %100, %100, %77, %70.5 iken, sferisite indeksi ve apendiks uzun aksý için sensitivite deðerleri sýrasýyla %85 ve %90 spesifite deðerleri sýrasýyla %85.2 ve %73.8 olarak hesaplandý (p<0.001).
TARTIÞMA: Perforasyon tanýsýnda yüksek özgüllüðe sahip çok sayýda bulgu olmasýna raðmen bulgular ayrý ayrý deðerlendirildiðinde duyarlýlýk oldukça düþüktür. Uzun aks ölçümünün yüksek duyarlýlýk; sferisite indeksi deðerlendirilmesinin ise yüksek duyarlýlýk ve özgüllük ile perforasyon tanýsýna önemli katký saðlayabileceðini düþünmekteyiz.

BACKGROUND: The purpose of the present study was to investigate the diagnostic value of the appendiceal sphericity index (SI) and appendix diameters in cases of perforated and non-perforated acute appendicitis.
METHODS: Eighty-one patients who underwent computed tomography (CT) in our clinic and who were diagnosed with acute appendicitis after histopathological assessment between January 2015 and August 2017 were included in the study. According to their histopathological findings, the patients were divided into two groups: perforated and non-perforated appendicitis. The patients’ CT images were re-evaluated with respect to perforation. Long axis and short axis of the appendix and the SI obtained by their proportions were calculated from the appropriate plane on CT. Their parameters and other CT findings as defined in the current literature were analyzed for statistical significance in the detection of perforation.
RESULTS: The perforated and non-perforated appendicitis groups consisted of 20 and 61 patients, respectively. For wall defect, abscess, extraluminal air, free fluid, and appendicolith, the sensitivity values were 25%, 15%, 25%, 55%, and 50%, respectively, and the specificity values were 100%, 100%, 100%, 77%, and 70.5%, respectively. Sensitivity and specificity for the SI and long axis of the appendix were calculated as 85% and 90% and 85.2% and 73.8%, respectively (p<0.001).
CONCLUSION: Although there are many findings with high specificity in the diagnosis of perforation, their sensitivity is very low when evaluated separately. We consider that the measurement of long-axis length with high sensitivity and the evaluation of SI with high specificity and sensitivity will contribute significantly to the diagnosis of perforation.

AMAÇ: Komplike olan ve olmayan akut apandisitin (AA) ameliyat öncesi sýnýflandýrýlmasý zordur. Ancak cerrahi sonuçlardaki farklýlýklar komplike AA’nýn geliþimindeki risk faktörlerinin belirlenmesini zorunlu kýlmaktadýr. Laparoskopik apandektomilerin (LA) klinik sonuçlarýný inceledik ve komplike AA’nýn geliþmesine iliþkin ameliyat öncesi risk faktörlerini saptadýk.
GEREÇ VE YÖNTEM: Polonya ve Almanya’da 18 cerrahi birimde LA uygulanan 4618 hastanýn verileri Polonya Videocerrahi Derneði tarafýndan oluþturulan sanal veri tabanýnda toplandý. Komplike olan ve olmayan hastalarýn cerrahi sonuçlarý karþýlaþtýrýldý. Komplike apandisit geliþmesine iliþkin risk faktörlerini belirlemek için tek ve çok deðiþkenli regresyon modelleri kullanýldý.
BULGULAR: Komplike apandisiti olan 1269 (%27.5) (Grup 1) ve olmayan (Grup 2) 3349 (%72.5) hasta LA oldu. Cerrahiye geçiþ oraný, ameliyat sýrasýnda advers etkiler, yeniden giriþim oraný, ameliyat sonrasý komplikasyonlar ve yeniden hastaneye kabul oranlarý Grup 1’de daha yüksekti. Komplike apandisitle iliþkili ameliyat öncesi risk faktörleri kadýnlarda (OR 1.58), obezite (OR 1.51), yaþ >50 yýl (OR 1.51), semptomlar >48 saat içinde (OR 2.18), daha yüksek Alvarado skoru (OR her noktada 1.29) ve CRP >100 mg/l (OR 3.92) idi.
TARTIÞMA: Komplike AA için birkaç demografik ve klinik risk faktörü tanýmlanmýþtýr. Komplike apandisit için uygulanan LA daha kötü sonlanýmlarla iliþkiliydi.

BACKGROUND: Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA.
METHODS: The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis.
RESULTS: In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were: female sex (Odds ratio [OR]: 1.58), obesity (OR: 1.51), age >50 years (OR: 1.51), symptoms >48 hours (OR: 2.18), high Alvarado score (OR: 1.29 with every point), and C-reactive protein level >100 mg/L (OR: 3.92).
CONCLUSION: Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with poorer outcomes.

AMAÇ: Sýrt ve flank bölge delici alet yaralanmalarýna klinik yaklaþým yýllar içinde deðiþim gösterdi. Bu yazýda, bilgisayarlý tomografi traktografinin sýrt/flank delici alet yaralanmalasý olan hastalardaki potansiyelini tartýþmak istedik.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþmada, sýrt/flank bölgeye sýnýrlý delici alet yaralanmasý olam toplam 25 hasta dahil edildi. Ýlk resüsitasyon ve fizik muayenenin ardýndan, traktografi delici alet yaralanmasýndan yapýldý. Sonrasýnda hastalara intravenöz kontrastlý bilgisayarlý tomografi çekildi.
BULGULAR: Bilgisayarlý tomografi traktografi 15 (%60) hastada laparotomiden kaçýnmaya ve 10 (%40) hastada da periton ihlalini doðru olarak göstermemize yardýmcý oldu. Konservatif olarak takip edilen hiç bir hasta gözden kaçmýþ yaralanma ile tekrar baþvurmadý.
TARTIÞMA: Traktografinin bilgisayarlý tomografiye eklenmesi, sýrt/flank delici alet yaralanmalarýnýn deðerlendirilmesinde güvenilir, hýzlý, para ve zaman tasarruflu bir tekniktir.

BACKGROUND: The clinical approach to back/flank wounds has evolved over the years. The aim of this study was to discuss the potential of computed tomography tractography in patients with a stab wound to the back or flank.
METHODS: A total of 25 stable patients with stab wounds confined to the back/flank region were enrolled in this retrospective study. After initial resuscitation and physical examination, tractography was performed at the site of the stab wound. The patients subsequently underwent computed tomography with intravenous contrast.
RESULTS: Computed tomography tractography helped avoid a laparotomy in 15 (60%) patients and accurately revealed a peritoneal breach in 10 (40%) patients. No missed injuries were reported in the conservatively followed patients.
CONCLUSION: The addition of tractography to computed tomography is a safe, fast, and cost- and time-effective technique to evaluate back/flank stab wounds.

AMAÇ: Enkapsüle periton sklerozu (EPS) periton diyalizi (PD) ile iliþkili, etiyolojisi tam bilinmeyen ve yüksek mortaliteye sahip bir hastalýktýr. Bu çalýþmada amacýmýz EPS olgularýnda tedavi seçeneklerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Ocak 2008–2018 tarihleri arasýnda 169 hastaya böbrek nakli yapýldý. Yüz on dokuzu kadavradan, 50’si canlý donörden nakil yapýldý. Yirmi bir hasta nakil öncesi PD yapmaktaydý. Ortalama PD süresi 6.9 (3–14) yýl idi. Dört hastaya nakil sonrasý geliþen EPS nedeni ile cerrahi tedavi uygulandý. Cerrahi tedavi sonrasý, iki hasta sepsis nedeni ile kaybedildi. Ýki hasta komplikasyonsuz taburcu edildi, ancak birinde geç dönem EPS nüksü geliþti.
BULGULAR: Enkapsüle periton sklerozu uzun süreli PD’nin nadir fakat ciddi bir komplikasyonudur. Mortalite ve mortalite oraný yüksektir. Uzun süreli PD, EPS’yi tetiklemede en önemli faktördür. Týbbi tedavi ve beslenme desteði baþarýsýz olursa, cerrahi müdahale sonraki adýmdýr. Týbbi tedaviye dirençli olgularda hastanýn genel durumu bozulmadan ve gecikmeden cerrahi tedavi yapýlmalýdýr.
TARTIÞMA: Uzun süreli PD öyküsü olan hastalarýn baþarýlý bir nakil sonrasý EPS olmasý özellikle yýkýcý olabilir. Zor bir durum olarak, mortalite ve morbidite oranlarýný azaltmak için EPS yönetimi deneyimli kliniklerde yapýlmalýdýr.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) related to peritoneal dialysis (PD) has a vague etiology and high mortality. In this study, our aim was to determine treatment options for EPS cases.
METHODS: A total of 169 patients underwent kidney transplantation from January 2008 to January 2018 and 119 patients from a cadaveric and 50 patients from a living donor. Twenty-one patients were undergoing PD before the transplantation. The mean PD time was 6.9 (IQR 3–14) years. Four patients received surgical treatment for EPS that occurred after the transplant. After the surgical treatment, 2 patients died because of sepsis. Two patients were discharged without complications, but 1 had late-term EPS recurrence.
RESULTS: EPS is a rare but serious complication of long-term PD. It has a high mortality and morbidity rate. Long-term PD is the most significant factor for triggering EPS. Nutritional support and surgical intervention is the next step if medical treatment fails. Resistant cases should be treated surgically without much delay before the condition deteriorates.
CONCLUSION: It can be especially devastating for patients with a long-term PD history to have EPS after a successful transplant. Because EPS is a challenging condition, its management should be done in experienced clinics to decrease its mortality and morbidity rates.

AMAÇ: Hýzlý taný ve agresif nöroþirürjik müdahalelere raðmen, akut subdural hematom (ASH), yüksek morbidite ve mortalite oranlarýna neden olmaktadýr. Kraniyotomi ve dekompresif kraniyektomi (DK) gibi cerrahi prosedürler etkili görünmemelerine raðmen, ASH’nin tedavisinde tercih edilen yaklaþým halen tartýþmalýdýr. Bu yazýda, DK uygulanan ASH hastalarýnda mortalite ile iliþkili faktörlerin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: 2012’den 2017’ye kadar 60 aylýk bir dönemde ASH tanýlý 93 olgunun mortalite, Glasgow Koma Skoru (GKS), demografik özellikleri, klinik ve radyolojik özellikleri deðerlendirildi. Mortaliteyi öngörmede lojistik regresyon modelleri kullanýldý.
BULGULAR: Yaþ ortalamasý 59.82±19.49 (daðýlým, 16–88) olan 65 erkek ve 28 kadýn olgu alýndý. On altý hasta (%17.2) ameliyatý takiben hayatýný kaybetti. Ýleri yaþ (p=0.007) ve düþük GKS skorlarý (p=0.022) mortalite oranlarý üzerinde anlamlý bulundu. Ortalama hematom kalýnlýðý 15.46±5.73 mm, orta hat kaymasýnýn ortalamasý 9.90±4.84 mm idi. ADSH hastalarýnda mortalite oraný aþýrý orta hat kaymasý (p=0.011, r=0.262) ve yaþ (p=0.022, r=0.237) ile pozitif korelasyon gösterdi. Orta hat kaymasý ≥10 mm olan ve hematom kalýnlýðý ≥15 mm olan hastalarda mortalite oraný ile anlamlý bir iliþki vardý (p=0.014, p=0.039). Ayrýca travma, subaraknoid, epidural ve intrakranial hemoraji komorbiditeleri, kompresyon kýrýklarý ve kontüzyonun etiyolojisi anlamlý olarak korelasyon göstermedi.
TARTIÞMA: Bulgularýmýz, DK’nin 65 yaþ üzeri hastalarda ve GKS skoru <6 olanlarda daha yüksek mortalite oranlarý ile iliþkili olduðunu göstermektedir. Orta hat kaymasýnýn ≥10 mm ve hematom kalýnlýðýnýn ≥15 mm ve üzerinde olmasý mortalite ile anlamlý derecede iliþkilidir. Çalýþmamýz DK’nin ileri orta hat kaymasýný önlemede yardýmcý olabileceði ve kraniotomi ile kýyaslandýðýnda daha düþük bir mortaliteyle birlikte olduðu sonucunu desteklemektedir.

BACKGROUND: Despite rapid diagnosis and aggressive neurosurgical intervention, acute subdural hematoma (ASDH) is a severe type of head injury that can result in high morbidity and mortality. Although surgical procedures, such as craniotomy and decompressive craniectomy (DC), can be effective, the preferred approach for treating an ASDH remains controversial. The aim of this report was to evaluate factors associated with mortality in patients with ASDH and determinants of outcome in those with ASDH who underwent DC.
METHODS: The demographic details and clinical and radiological characteristics of a total of 93 patients with ASDH who underwent DC during a 60-month period from 2012 to 2017 were evaluated to determine the effect on mortality and any association with the Glasgow Coma Scale (GCS) score recorded on arrival.
RESULTS: Sixty-five male and 28 female subjects with a mean age of 59.82±19.49 years (range: 16–88 years) were included in the study. Sixteen patients (17.2%) died following the surgery. Older age (p=0.007) and lower GCS scores (p=0.022) were statistically significantly associated with the mortality rate. The mean hematoma thickness was 15.46±5.73 mm, and the mean midline shift was 9.90±4.84 mm. The mortality rate was positively correlated with an excessive midline shift (p=0.011; r=0.262) and age (p=0.022; r=0.237) in patients with ADSH. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm was significantly associated with mortality (p=0.014; p=0.039). The etiology of the trauma; comorbidities of subarachnoid, epidural, or intracranial hemorrhage; compression fractures; or contusions were not significantly correlated.
CONCLUSION: The results indicated that there was a higher mortality rate among older patients and those with a GCS score of <6 on arrival. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm were significantly related to mortality. Our study supports the conclusion that DC may help prevent further midline shift and be associated with a lower mortality rate compared with a craniotomy.

AMAÇ: Gebe hastalarda akut kolesistit tedavisi zordur. Bu çalýþmanýn amacý merkezimizde akut kolesistit nedeniyle ameliyat edilen gebe hastalarda laparoskopik kolesistektominin etkinliðinin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM: 2010 ve 2018 yýllarý arasýnda merkezimizde akut kolesistit nedeniyle tedavi edilen 20 hasta deðerlendirmeye alýndý. Bu hastalardan sadece bir tanesi merkezimizde takiplerine gelmedi, kalan hastalar çalýþmaya alýndý. Hastalarýn demografik özellikleri, akut olesistit ile iliþkili radyolojik ve laboratuvar parametreleri, hastanede kalýþ, tekrar baþvuru oranlarý ve erken eylem oranlarý geriye dönük olarak analiz edildi.
BULGULAR: Ortanca yaþ 29.5 (21–46) yýldý. Ortanca gebelik haftasý 20 (6–32) hafta idi. Altý (%30) hastaya indeks yatýþta laparoskopik kolesistektomi gerçekleþtirildi. Erken kolesistektomi yapýlan hastalarda safra kesesi duvar kalýnlýðý, lökosit sayýsý, CRP, ALT, AST, ALP, GGT konzervatif izlenen hastalara göre daha fazla idi (p<0.05). Bunun yanýnda erken cerrahi uygulana grupta tekrar baþvuru ve hastanede yatýþ süresi daha az olarak gözlendi(p<0.05). Preterm eylem erken kolesistektomi ve konzervatif izlem grubunda sýrasýyla %0 ve %28.5 olarak bulundu (p>0.05).
TARTIÞMA: Erken cerrahi uygulanan hastalarýn karaciðer fonksiyon ve kolestatik testleri daha fazla olmasýna ve enflamatuvar belirteçleri daha yüksek olmasýna raðmen kolesistektomi güvenle gerçekleþtirilmiþtir. Konzervatif izlem grubunda daha uzun hastanede yatýþ ve daha fazla preterm eylem oraný gözlenmiþtir. Dolayýsý ile gebelerde akut kolesistitte tedavide cerrahi güvenli ve etkindir.

BACKGROUND: This study aimed to present to evaluate the results of two different approaches in the management of acute cholecystitis
during pregnancy: immediate surgery and delayed surgery following conservative management.
METHODS: In this study, 20 pregnant women who were treated in our clinic for acute cholecystitis between 2010 and 2018 were included
in the analysis. Demographic characteristics, parameters related with acute cholecystitis (gallbladder wall thickness, laboratory
data), duration of hospitalization, readmission rates, and preterm labor rate were retrospectively evaluated.
RESULTS: The median age was 29.5 years. The median gestational week was 20 (6–32) weeks. Laparoscopic cholecystectomy was
performed in 6 (30%) patients on admittance. When compared with the conservative management group, patients who received immediate
surgery had higher gallbladder wall thickness. WBC count, and CRP, ALT, AST, ALP, and GGT levels (p<0.05). Furthermore,
readmission rate and duration of hospitalization were lower in the patients who underwent immediate surgery (p<0.05). The preterm
labor rate in conservative management and immediate surgery groups were 28.5% and 0%, respectively (p>0.05).
CONCLUSION: In this study, even though these patients had thicker gallbladder wall and higher inflammatory markers suggesting
severe inflammation, the outcome of early surgery was better than conservative management. Although the characteristics of the
conservative management group was more favorable, complication rate seemed to be high.

AMAÇ: Üst gastrointestinal sistemde gýda takýlmasý ve yabancý cisim yutulmasý dikkatli bir deðerlendirme ve zamanýnda müdahaleyi gerektirir. Bu çalýþma üst gastrointestinal sistemde gýda takýlmasý ve yabancý cisim yutma öyküsü ile gelen hastalarýn geriye dönük olarak deðerlendirilmesini amaçlamaktadýr.
GEREÇ VE YÖNTEM: Çalýþma Ocak 2012 ve Ocak 2018 arasýnda bir üniversite hastanesine yabancý cisim yutma ve gýda takýlmasý þikayeti ile baþvuran yetiþkin hastalarý içermektedir. Yaþ, cinsiyet, baþvuru semptomlarý, baþvuruya kadar geçen süre, yabancý cismin niteliði, iliþkili hastalýklar, endoskopik yöntem ve giriþimin tipini içeren demografik ve klinik veriler önceden hazýrlanan bir dosyaya kaydedildi; tanýmlayýcý istatistik yöntemleri ki-kare testi kullanýlarak incelendi.
BULGULAR: Çalýþmaya alýnan 122 hastanýn %53.2’si erkekti ve ortalama yaþ 46.68±18.64 olarak bulundu. Hastalarýn 84’ünde (%68.8), alýnan obje gýdaydý. Otuz hastada laringoskopi yeterli iken, 61 hastada fleksibl endoskopi uygulandý (%50). Yutulan madde 23 hastada düz garfide saptandý (%30.2). Yabancý cisim yutan hastalar gýda takýlan hastalara göre daha yaþlý idi (yaþ ortalamasý; 51.3±17.4 ve 36.5±17.4; p<0.001) ve düz grafide cismin saptanma oraný daha yüksek idi (%36.8 ve %10.7; p<0.001). Ýki hastaya yabancý cisime baðlý perforasyon tanýsýyla cerrahi uygulandý. Mortalite saptanmadý.
TARTIÞMA: Acil þartlarda üst gastrointestinal sistemde takýlan gýda ve yabancý cisim yutulmasý algoritmik bir yaklaþýmla tedavi edilebilir.

BACKGROUND: The management of food impaction and foreign body ingestion in the upper gastrointestinal tract requires
careful evaluation and timely intervention. This study was a retrospective evaluation of the management of adult patients with such
a history.
METHODS: This study included adult patients admitted to a tertiary medical center with foreign body ingestion or food impaction
between January 2012 and January 2018. The demographic and clinical data were recorded pro forma for statistical analysis.
RESULTS: Of the 122 patients included in this study, 53.2% were male, and the mean age was 46.68±18.64 years. In 84 of the patients
(68.8%), the ingested object was food. Thirty patients were managed solely through laryngoscopy, while 61 patients (50%) underwent
a flexible endoscopy. The patients with a foreign body ingestion were older than those with a food impaction (mean age: 51.3±17.4 vs.
36.5±17.4 years; p<0.001) and a plain radiograph showed the ingested material more often in those patients (36.8% vs 10.7%; p<0.001).
Two patients underwent surgery due to perforations caused by the impacted material. No mortality was observed.
CONCLUSION: The management of a foreign body ingestion or food impaction in an emergency setting requires a stepwise, algorithmic
approach.

AMAÇ: Motosiklet kazalarýna baðlý yaralanmalar, genel travma açýsýndan çeþitli çalýþmalarda incelenmiþtir. Bununla birlikte, merkezi sinir sistemi yaralanmalarýna iliþkin ayrýntýlý bir çalýþma yoktur. Bu çalýþma motosiklet kazalarý ile iliþkili merkezi sinir sistemi yaralanmalarýna odaklanmýþtýr.
GEREÇ VE YÖNTEM: 2008 ile 2016 yýllarý arasýnda motosiklet kazasý nedeniyle acil servise baþvuran 540 hastanýn týbbi kayýtlarý geriye dönük olarak deðerlendirildi. Veriler elektronik týbbi kayýtlardan, takip formlarýndan ve radyolojik görüntülerden elde edildi. Hastalarýn yaþý, cinsiyeti, yaralanma tipi ve yeri, kask kullanýmý, alkol düzeyleri, Glasgow Koma Skorlarý, yoðun bakým ünitesinde kalýþ süreleri, taburcu olurken ve takiplerde nörolojik durumlarý gibi bilgiler toplanmýþtýr.
BULGULAR: Çalýþmaya alýnan 540 olgunun 486’sý (%90) erkek, 54’ü (%10) kadýn, yaþ ortalamasý 31±18 (daðýlým 2–85, medyan 25) idi. Kraniyal yaralanmalar 320 olguda (%59) saptandý. Kraniyal yaralanmalarýn daðýlýmý þöyledir: Epidural kanama (%12.6), subdural hemoraji (%15.2), deprese kýrýk (%10.4), lineer kýrýk (%23), kafa tabaný kýrýðý (%5.5), diffüz aksonal yaralanma (%9.3), subaraknoid kanama (%25.2), intraserebral hemoraji (%13.5), kontüzyon (%26.3). Spinal kýrýklar 52 olguda (%9.6) tespit edildi. Servikal bölgede 22 (%4.07) omurga kýrýðý, torasik bölgede 10 (%1.85) ve lomber bölgede 20 (%3.7) gözlendi. Hastanede kalýþ süresi yoðun bakýmda ortalama 8.2±4 gün, ortalama yedi gündü. Altmýþ sekiz hasta (%12.6) hayatýný kaybetti. Lineer kýrýk hariç diðer tüm kraniyal yaralanmalar yüksek mortalite ile ilþkiliydi. Ayrýca, 6 veya daha düþük Glasgow Koma Skorlarý, önemli mortalite (%68) ile iliþkilendirildi.
TARTIÞMA: Motosiklet kazalarýnýn neden olduðu merkezi sinir sistemi yaralanmalarýnýn ayrýntýlý bir raporu verilmiþtir. Kask gibi koruyucu ekipmanlarýn kullanýlmasý, beyin hasarý ve ölüm oranýný önemli ölçüde azaltýr.

BACKGROUND: Injuries caused by motorcycle accidents have been reported in several studies with an examination from a general trauma point of view. However, to our knowledge, there is no detailed study specific to central nervous system injuries. This research was focused on central nervous system injuries associated with motorcycle accidents.
METHODS: The medical records of 540 patients who were admitted to the emergency department between 2008 and 2016 as the result of a motorcycle accident were retrospectively evaluated. Data were collected from electronic medical records, follow-up forms, and radiological images. Information on patient age, gender, type and site of injury, helmet use, alcohol level, Glasgow Coma Scale score on admission, length of stay in the intensive care unit and hospital, neurological status on discharge, and follow-up was collected and analyzed.
RESULTS: A total of 486 of 540 patients (90%) were male, 54 (10%) were female, and the mean age was 31±18 years (range: 2–85 years, median: 25 years). Cranial injuries were detected in 320 cases (59%). The distribution of cranial injuries was: epidural hemorrhage (12.6%), subdural hemorrhage (15.2%), depressed fracture (10.4%), linear fracture (23%), skull base fracture (5.5%), diffuse axonal injury (9.3%), subarachnoid hemorrhage (25.2%), intracerebral hemorrhage (13.5%), and contusion (26.3%). Spinal fractures were detected in 52 cases (9.6%). Twenty-two (4.07%) of the spinal fractures were observed in the cervical region, 10 (1.85%) in the thoracic region, and 20 (3.7%) in the lumbar region. The mean length of stay in the hospital was 8.2±4 days and 7 days in the intensive care unit. Sixty-eight patients (12.6%) died. Traumatic cranial entities other than linear fracture were associated with an elevated level of mortality. A Glasgow Coma Scale score of 6 or less was associated with significant mortality (68%).
CONCLUSION: A detailed report of motorcycle accident-associated central nervous system injuries is provided. The use of protective equipment, such as helmets, significantly reduced the rate of cerebral injury and death.

AMAÇ: Travma iliþkili korneal perforasyon skarý nedeniyle penetran keratoplasti (PK) uygulamalarýnýn sonuçlarýný deðerlendirmek.
GEREÇ VE YÖNTEM: Çalýþmamýza Mayýs 2010–Haziran 2016 tarihleri arasýnda travmatik korneal skar nedeniyle penetran keratoplasti uyguladýðýmýz 24 hastanýn 24 gözü alýndý. Ameliyat sonrasý hastalar görme keskinliði, greft saydamlýðý ve komplikasyonlar açýsýndan deðerlendirildi. Hastalar iki gruba ayrýldý. Grup 1’de travma ile iliþkili retina dekolmaný ve korneal perforasyon skarý olan 14 göz mevcut olup, bu hastalara PK, pars plana vitrektomi (PPV) ve intravitreal silikon verilmesi geçici keratoprotez (TKP) eþliðinde uygulandý. Grup 2’de 10 gözde sadece travma iliþkili korneal perforasyon skarý olup PK uygulandý.
BULGULAR: Grup 1’deki hastalarýn beþi kadýn, dokuzu erkek olup yaþ ortalamalarý 39.15±13.32 (8–73) yýldý. Beþ gözden intraoküler yabancý cisim çýkarýldý. Ortalama görme keskinliði LogMAR’a göre ameliyat öncesi 3.01±0.013 (3.10–1.00) iken ameliyat sonrasý birinci ayda 1.36±0.23 (3.10–0.80), keratoplasti sütürlerinin alýndýðý birinci yýlýn sonunda 1.18±0.03 (3.10–0.70) idi. Ameliyat sonrasý iki gözde (%14.2) ýþýk hissi kaybý geliþti ve evisserasyon yapýldý. Sekiz gözde (%57.1) týbbi tedavi ile kontrol altýna alýnabilen glokom, dokuz gözde (%64.2) greft rejeksiyonu, bir gözde (%7.1) keratit sonrasý lökom, bir gözde (%7.1) silikona baðlý bant keratopati geliþti. Bant keratopati geliþen gözde EDTA ile kazýma yapýldý. Grup 2’deki hastalarýn ikisi kadýn, sekizi erkek olup yaþ ortalamalarý 29.23±12.03 (11–63) yýldý. Ortalama görme keskinliði LogMAR’a göre ameliyat öncesi 2.98±0.68 (3.10–1.00) iken PK sonrasý birinci ayda 0.58±0.22 (1.80–0.30) ve keratoplasti sütürlerinin alýndýðý birinci yýlýn sonunda 0.50±0.17 (1.80–0.10) idi. Ýridodiyalizi olan bir gözde (%10) týbbi tedavi ile kontrol altýna alýnabilen glokom geliþti. Hiçbir hastada korneal rejeksiyon görülmedi. Her iki grup arasýnda PK sonrasý birinci ay ve 12. ay sonunda görme keskinlikleri ve greft saydamlýðý açýsýndan sýrasýyla fark istatistiksel olarak anlamlýydý (p=0.015, p=0.021, p=0.001).
TARTIÞMA: Göz travmalarýnda, ön ve arka segmenti ilgilendiren ve retina cerrahisi ile birlikte PK yapýlan gözlerde sadece ön segmenti ilgilendiren ve PK yapýlan gözlere göre görme prognozu ve greft saydamlýk oranlarý düþüktür.

BACKGROUND: To evaluate the results of penetrating keratoplasty (PK) due to trauma-related corneal scarring.
METHODS: We evaluated 24 eyes of 24 patients who underwent PK due to trauma-related scarring of the cornea between May 2010 and June 2016. The postoperative visual acuity, graft transparency, and complications were evaluated.
RESULTS: The patients were divided into two groups. In group 1, 14 eyes of patients with traumatic corneal scars and retinal detachment underwent PK, pars plana vitrectomy, and intravitreal silicone administration with the help of temporary keratoprosthesis. Group I included five females and nine males with an average age of 39.15±13.32 (min 8–max 73) years. An intraocular foreign body was removed from five of the eyes. The mean visual acuity was 3.01±0.013 (3.10–1.00) logMAR after the surgery, 1.36±0.23 (3.10–0.80) at the postoperative first month, and 1.18±0.03 (3.10–0.70) at the end of the first year after the removal of keratoplasty sutures. During the follow-up of patients, two eyes (14.2%) lost light sensation, eight eyes (57.1%) developed postoperative glaucoma, nine eyes (64.2%) had graft rejection, and one patient (7.1%) developed keratitis. In one eye (7.1%), the cornea was scraped using ethylenediaminetetraacetic acid due to silicone-related band keratopathy. In group 2, ten eyes with trauma-related corneal scars underwent PK. This group included two females and eight males with an average age of 29.23±12.03 (11–63) years. The mean visual acuity was 2.98±0.68 (3.10–1.00) logMAR before the surgery, 0.58±0.22 (1.80–0.30) at the postoperative first month, and 0.50±0.17 (1.80–0.10) at the end of the first year. One eye (10%) with iridodialysis developed glaucoma. Rejection was not seen in any of the patients. A statistically significant difference was observed in both groups with regard to visual acuity before operation, at 1 and 12 months after operation, and at 12 months for graft transparency rates (p=0.015, p=0.021, p=0.001, respectively).
CONCLUSION: In cases of eye injuries due to trauma, the eyes subjected to combined vitrectomy and PK had poor visual prognosis and high graft rejection rate compared to those subjected to PK as the only treatment.

AMAÇ: Akut nekrotizan pankreatit akut pankreatitin en þiddetli formudur ve yüksek mortalite oranlarýna sahiptir. Bu yüzden bu hastalýkta erken taný ve tedavi prognoz açýsýndan kritik önem taþýmaktadýr. Bu çalýþmanýn amacý immatür granülosit yüzdesinin (IG%), akut nekrotizan pankreatitin erken tahminindeki etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma akut pankreatit tanýsýyla hastaneye yatýrýlan 96 eriþkin hasta üzerinde gerçekleþtirildi. Hastalarýn demografik verileri kaydedildi. Beyaz küre sayýsý, nötrofil/lenfosit oraný, IG%, C-reaktif protein ve amilaz düzeyleri tespit edildi. Ayrýca hastalara kontrastlý bilgisayarlý abdominal tomografi incelemesi yapýldý ve hastanede kalýþ süreleri kaydedildi. Hastalar tomografi sonuçlarýna göre akut ödematöz pankreatit ve akut nekrotizan pankreatit olarak iki gruba ayrýldý. Gruplar arasýndaki farklýlýklar istatistiksel olarak analiz edildi.
BULGULAR: Beyaz küre sayýsý, nötrofil/lenfosit oraný, C-rektif protein ve IG% akut nekrotizan pankreatit tahmininde anlamlý belirteçlerdi. Ancak IG%’nin duyarlýlýk, özgüllük, AUROC, negatif ve pozitif tahmin edici deðerleri diðerlerinden daha yüksek idi (sýrasýyla, %100, %95, 0.982, %78.9, %100).
TARTIÞMA: Artmýþ IG% akut nekrotizan pankreatitin erken tahmininde basit, hýzlý ve etkili bir belirteçtir.

BACKGROUND: Acute necrotizing pancreatitis (ANP) is the most severe form of acute pancreatitis (AP), and it has high mortality rates. Therefore, early diagnosis and treatment are of critical importance for the prognosis. The aim of this study was to investigate the effectiveness of immature granulocyte percentage (IG%) in the early prediction of ANP.
METHODS: This retrospective study included 96 adult patients hospitalized with a diagnosis of AP. Demographic data of the patients were recorded. The white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), IG%, C-reactive protein (CRP), and amylase levels were determined. Furthermore, computed abdominal tomography was applied to the patients, and the length of hospital stay was recorded. Patients were divided into two groups as those with acute edematous pancreatitis and ANP, according to the tomography results. The differences between the groups were analyzed statistically.
RESULTS: The WBC count, NLR, CRP, and IG% were significant markers in the prediction of ANP. However, IG% had higher values with regard to the sensitivity, specificity, AUROC, and negative and positive predictive values (100%, 95%, 0.982, 78.9%, and 100%, respectively).
CONCLUSION: An increased IG% is a simple, fast, and effective marker in the early prediction of ANP.

METHODS: This retrospective study was carried out on 96 adult patients who were hospitalized with a diagnosis of acute pancreatitis. Demographic data of the patients were recorded. White blood cell count, neutrophil/lymphocyte ratio, IG%, C-reactive protein and amylase levels were determined. Furthermore computed abdominal tomography was applied to the patients and the length of hospital stay was recorded. The patients were divided into two groups as acute edematous pancreatitis and acute necrotizing pancreatitis according to the tomography results. The differences between the groups were analyzed statistically.
RESULTS: White blood cell count, neutrophil/lymphocyte ratio, C-reactive protein and IG% were significant markers in the prediction of acute necrotizing pancreatitis. However, IG% had higher values of sensitivity, specificity, AUROC, negative and positive predictive values ( 100%, 95%, 0.982, 78.9%, 100%,respectively).
CONCLUSION: Increased IG% is a simple, fast, and effective marker in the early prediction of acute necrotizing pancreatitis.

AMAÇ: Majör travma hastalarýnda yaralanmalarý atlamak kolaydýr. Yazarlar, kemik taramalarýnýn atlanmýþ yaralanmalarýn sayýsýný azaltacaðý varsayýmýnda bulunmaktadýr. Ancak majör travma hastalarýnda kemik taramalarýna ait yeterli kanýt yoktur. Bu çalýþmanýn amacý kemik taramalarýnýn baþlýca sonuçlarýný tanýmlamaktýr.
GEREÇ VE YÖNTEM: Ocak 2013 ila Aralýk 2013 arasýnda majör travma hastalarýnýn týbbi kayýtlarý gözden geçirildi ve kemik taramalarý yapýlan hastalarýn kayýtlarý incelendi. Daha önce deðerlendirilmemiþ yoðun tutulum gösteren sýcak noktalar direkt radyografiyle kontrol edildi. Daha önceki deðerlendirmelerden farklý olarak kemik taramalarýnda yoðun tutulum gösteren lezyonlar bilgisayarlý tomografi taramalarýyla kontrol edildi. Kemik taramalarýnýn sonuçlarý direkt radyografi ve bilgisayarlý tomografi taramalarýnýn sonuçlarýyla birlikte analiz edildi Duyarlýlýk, özgüllük, pozitif ve negatif öngördürücü deðerler hesaplandý.
BULGULAR: Bu dönem içinde 115 majör travma hastasý kemik taramalarýndan geçirildi. Kemik taramalarýnýn duyarlýlýk ve öngördürücü deðerleri yüksek düzeylerdeydi (sýrasýyla, %98.48–%86.54 ve %96.30–%82.93). Kemik taramalarý atlanmýþ 16 kýrýk olgusuna taný konuldu.
TARTIÞMA: Kemik taramalarý yüksek bir duyarlýlýk ve negatif öngödücü deðere sahiptir. Daha fazla sayýda geniþ çaplý çalýþma majör travma çalýþmalarýnda kemik taramalarýnýn majör travma hastalarýnda kullanýmýna daha fazla geçerlilik kazandýrabilir.

BACKGROUND: It is easy to miss injuries in patients with major trauma (MT). The authors hypothesized that bone scans (BSs) would reduce the number of missed injuries. However, there was not enough evidence on BS in patients with MT. The purpose of the present study was to identify the basic results of BS in patients with MT.
METHODS: The medical records of patients with MT between January 2013 and December 2013 were reviewed. Patients who underwent a BS were enrolled in the study. Hot-uptake lesions without previous evaluation were checked by X-ray. Hot-uptake lesions on BSs that differed from previous evaluations were checked by computed tomography (CT) scans. The results of BSs were analyzed along with the results of X-ray and CT scans. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated.
RESULTS: There were 115 patients with MT who received BS during the study period. The sensitivities were high on average (98.48–86.54). In addition, the NPVs were high (96.30–82.93). There were 16 cases of hidden fracture diagnosed after a BS.
CONCLUSION: BS showed high sensitivity and high NPV. Further large-scale studies might add more validity to the use of BS in patients with MT.

AMAÇ: Alt ekstremite travmatik defektler için erken serbest flep kapsamý birkaç yazar tarafýndan önerilmesine raðmen, hasta veya lojistik ile iliþkili yaralanmalara baðlý olarak genellikle pratik deðildir. Bu çalýþmanýn amacý, subakut ve geç cerrahi zamanlamanýn flep baþarýsý üzerindeki etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: 2007–2012 yýllarý arasýnda alt ekstremite travmasýný takiben mikrocerrahi serbest flep operasyonu geçirmiþ eriþkin hastalarýn geriye dönük analizi yapýldý. Hastalar, yaralanma ve serbest flep operasyonu arasýndaki zaman dilimine göre subakut (yaralanmadan 10 ila 29 gün sonra yapýlan flep) ve gecikmiþ onarým gruplarýna (yaralanmadan 30 gün sonra) ayrýldý. Demografik özellikler, yaralanma mekanizmasý, operasyondan taburculuða kadar geçen süre, minör ve majör komplikasyonlar ve flep baþarýsýzlýk oranlarý deðerlendirildi ve iki grup arasýnda karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 37 serbest flep operasyonu geçiren 35 hasta alýndý. Yirmi hasta yaralanmadan sonra 10 ila 29 gün arasýnda (subakut onarým grubu), 15 hasta ise 30 gün sonra (32–92 gün) yaralanma veya sonrasýnda (geç onarým grubu) ameliyat edildi. Rekonstrüksiyon zamanlamasý, flep baþarýsýzlýðý ve komplikasyon oranlarý arasýnda anlamlý bir iliþki bulunamadý.
TARTIÞMA: Alt ekstremite travmatik defektleri için subakut veya gecikmeli rekonstrüksiyon yapýlabilinir ve uygun yara hazýrlýðý ve iyi ameliyat öncesi planlama ile iyi sonuçlar alýnabilinir.

BACKGROUND: Although early free flap coverage for lower extremity traumatic defects has been recommended by several authors, it is often not practical due to associated patient injuries or logistics. The aim of this study was to evaluate the impact of subacute and delayed surgical timing on flap success.
METHODS: A retrospective analysis of adult patients who underwent a microsurgical free flap operation between 2007 and 2012 following lower extremity trauma was performed. The patients were divided into 2 groups according to the time period between the injury and the free flap operation: a subacute group (flap performed 10 to 29 days after injury) and a delayed repair group (>30 days after injury). The details of patient demographics, the mechanism of injury, timing from operation to discharge, minor and major complications, and flap failure rates were evaluated and compared.
RESULTS: The study included 35 patients who underwent 37 free flap operations. A total of 20 patients were operated on 10 to 29 days after the injury (subacute repair group), and 15 patients were operated on more than 30 days after the injury (32–92 days) (delayed repair group). No significant correlation was found between the timing of the reconstruction, flap failure, and complication rates.
CONCLUSION: Both subacute and delayed reconstruction for lower extremity traumatic defects can be performed with favorable results with appropriate wound preparation and precise preoperative planning.

AMAÇ: Travmatik beyin hasarýnýn enflamatuvar bir süreci de içerdiði anlaþýlmasý üzerine içerisinde sitokinlerin yer aldýðý çalýþmalar artmýþtýr. Bu çalýþmada amaç kafa travmasý geçiren hastalarda interlökin (IL)-8 düzeyinin klinik durum ve radyolojik bulgularla iliþkisinin araþtýrýlmasý ve tartýþýlmasýdýr.
GEREÇ VE YÖNTEM: Hastane verilerinden kafa travmasý nedeniyle baþvurmuþ hastalarýn klinik bulgularý ve yapýlmýþ olan laboratuvar sonuçlarý incelendi. Hastalarýn yaþý, cinsiyeti, mevcut klinik bulgularý, Glaskow Koma Skoru (GKS), travma nedeni, beyin tomografi sonuçlarý, biyokimyasal laboratuvar incelemeleri ile ilgili tüm verileri kaydedildi. Hastalar GKS’ye göre üç gruba ayrýldý; Grup I: GKS ≥13; Grup II: GKS = 9–12; Grup III: GKS = 3–8.
BULGULAR: Çalýþmada yer alan hastalarýn 23’ü (%76.7) erkek, 7’si (23.3) kadýndý. Hastalarýn 17’si (%56.7) düþme, 8’i (%26.7) trafik kazasý ve 5’i (%16.7) darp nedeniyle baþvurmuþ idi. Üç grupta 10’ar hasta yer almaktaydý. GKS arttýkça IL-8 deðerlerinin daha düþük olduðu gözlendi. Gruplar için ortalama IL-8 düzeyleri Grup I = 1.2 pg/mL, Grup II = 6.6 pg/mL ve Grup III = 4.7 pg/mL olarak tespit edildi, ancak istatistiksel olarak anlamlý fark saptanmadý (p=0.147). IL-8 deðerlerinin tomografi bulgularý anormal olan hastalarda anlamlý olarak yükseldiði gözlendi (p=0.023).
TARTIÞMA: Travmatik beyin hasarýnda ortaya çýkan klinik ve radyolojik durumunu izlemekte IL-8’in yararlý bir belirteç olabileceði düþünülmekle birlikte, beyin hasarýnýn tüm aþamalarýnda IL-8 ölçümlerinin deðerlendirildiði ve uzun dönem prognoz takiplerinin kaydedildiði, daha geniþ hasta serileriyle yapýlmýþ çalýþmalara gereksinim bulunmaktadýr.

BACKGROUND: Since understanding the fact that traumatic brain injury includes an inflammatory process, the number of studies of cytokines has increased. The objective of this study was to analyze and discuss the association of interleukin (IL)-8 level with the clinical and radiological status of patients with head trauma.
METHODS: Patients who were admitted to our hospital due to head trauma were included in the study. Findings of clinical and laboratory examinations were analyzed. Data regarding patient age, gender, available clinical findings, Glasgow Coma Scale (GCS) score, trauma cause, brain tomography findings, and biochemical laboratory test results were recorded. The patients were divided into 3 groups according to their GCS score: Group I: GCS ≥13, Group II: GCS = 9–12, and Group III: GCS = 3–8.
RESULTS: A total of 23 (76.7%) patients were male and 7 (23.3%) were female. Overall, 17 (56.7%) patients were admitted due to a fall, 8 (26.7%) due to a traffic accident, and 5 (16.7%) due to assault. Each group comprised 10 patients. As the GCS score increased, the IL-8 level decreased. The mean IL-8 level was 1.2 pg/mL in Group I, 6.6 pg/mL in Group II, and 4.7 pg/mL in Group III; however, there was no statistically significant difference between the groups (p=0.147). Moreover, the IL-8 level was significantly greater in patients who demonstrated an abnormal tomography finding (p=0.023).
CONCLUSION: IL-8 may be a beneficial indicator for monitoring the clinical and radiological status of traumatic brain injury. Nonetheless, studies of larger cohorts in which IL-8 levels are measured at all stages of brain injury and follow-up of long-term prognosis are warranted.

Yýldýrým çarpmasý, yüksek oranda morbidite ve mortaliteye sahip bir çevresel elektrik acilidir. Yýldýrým çarpmasýna baðlý yaralanmalar yüksek voltaj yaralanmalarý olarak isimlendirilir. Yýldýrým çarpmasýyla iliþkili solunumsal yaralanmalar arasýnda pulmoner ödem, pulmoner kontüzyon, akut solunum sýkýntýsý sendromu ve pulmoner hemoraji sayýlabilir. Yüksek voltajla iliþkili birçok farklý mekanizmada olduðu gibi direkt hasarýn yanýnda bu hastalar sekonder travmalara da maruz kalmaktadýr. Dolayýsýyla hastalarýn multitravma hastasý olarak deðerlendirilmesi her zaman akýlcý yaklaþým olacaktýr. Bu yazýda, 19 yaþýnda bir hasta, açýk arazide gerçekleþen yýldýrým çarpmasýna direkt maruziyet sonucu amnezi, oryantasyon bozukluðu, nefes darlýðý ve karýn aðrýsý þikayetleri, akciðer kontüzyonu ve miyopati bulgularý ile acil servise baþvurdu. Vital bulgularýnda; kan basýncý 80/50 mmHg, kalp hýzý 110/dakika, oksijen satürasyonu %85 olarak ölçüldü. Hastanýn akciðer tomografisinde iki taraflý akciðer kontüzyonu ve plevral effüzyon saptandý. Ayrýca hastanýn yapýlan ekokardiyografisinde global kardiyak hipokinezi ve %20–25 ejeksiyon fraksiyonu saptandý. Hastanýn santral sinir sistemi ve abdominal görüntülemeleri doðaldý. Hasta, yoðun bakým ünitesine yatýrýldý ve destek oksijen, intravenöz hidrasyon, antibiyotik, sistemik steroid ve invaziv kardiyak monitörizasyon ile tedavi ve takip edildi. Hastaneye yatýrýlmasýnýn onuncu gününde klinik ve radyolojik iyileþme saðlanan hasta taburcu edildi. Taburculuk sonrasý 20. günde çekilen tomografide toraksta patolojik bulgu kalmadýðý görüldü.

Lightning strike is an environmental electrical injury with high rates of morbidity and mortality. Lightning strike injuries are also considered to be high-voltage injuries. Respiratory injuries associated with lightning strikes include pulmonary edema, pulmonary contusion, acute respiratory distress syndrome, and pulmonary hemorrhage. In addition to direct damage, the affected patients are also exposed to secondary trauma; similarly, many other mechanisms associated with lightning injury have the same risk. It will therefore always be a rational approach to evaluate patients as multiple trauma patients. In this case report, a 19-year-old patient was admitted to the emergency department with amnesia, disorientation, shortness of breath, abdominal pain complaints and lung contusion, and myopathy signs as a result of a lightning strike in open terrain. The patient had a blood pressure of 80/50 mmHg, a heart rate of 110/min, and oxygen saturation of 85%. Bilateral lung contusion and pleural effusion were detected on the computerized tomography of the thorax. In addition, global cardiac hypokinesia and the 20%–25% ejection fraction were detected on echocardiography. The central nervous system and abdominal scans were normal. The patient was admitted to the intensive care unit and treated with supportive oxygen, intravenous hydration, antibiotics, systemic steroids, and invasive cardiac monitoring. On the 10th day of admission to the hospital, the patient was discharged with clinical and radiological improvement. On the 20th day after discharge, tomography scans showed no thoracic pathologic findings.

Travmatik göz küresi luksasyonu pediyatrik acil týpta seyrek görülen bir durumdur. Bazý olgularda travmatik göz küresi luksasyonu görme kaybýna neden olabilmektedir. Bu nedenle acil servislerde kritik bir durum olduðu düþünülür. O halde özellikle acil birimlerde çalýþan doktorlarýn tümü görme kaybý gibi organý tehdit eden komplikasyonlarý önlemek için bu durumu ve tedavisini bilmelidir. Bu yazýda, bisikletten düþtükten sonra travmaya baðlý göz küresi luksasyonu oluþan ve travmadan sonra görme keskinliði (GK) yalnýzca ýþýðýn algýlanmasýna kadar düþen sekiz yaþýndaki bir kýz çocuðu sunuldu. Bu durum acil lateral kantotomi ve inferiyor kantolizle acilen tedavi edildi. Travma sonrasý birinci ayda GK Snellen ölçeðinde 20/20 olup her yöne bakýþta göz hareketleri kýsýtlanmamýþtý.

Traumatic globe luxation is a rare condition in pediatric emergency medicine and can cause vision loss in some cases. Therefore, it is considered a critical condition in emergency rooms, and all physicians, particularly those working in emergency units, should be familiar with this condition and its management to be able to prevent organ-threatening complications, such as vision loss. This study reports the case of an 8-year-old girl with traumatic globe luxation due to falling from her bicycle. Her visual acuity (VA) decreased light perception. The condition was promptly managed with urgent lateral canthotomy and inferior cantholysis. At the one-month post-trauma follow-up, VA was 20/20 on the Snellen chart; no limitations in eye movement in any position of gaze were noted.