AMAÇ: Akut mezenterik iskemi (AMÝ), acil servislere sýk baþvuru nedenlerinden biri deðildir. Ancak tanýsal zorluklar ve bununla iliþkili yüksek mortalite düzeyleri sürmektedir. Görüntüleme yöntemleri yaný sýra birçok biyokimyasal belirteç tanýsal amaçlý araþtýrýlmýþ olmasýna raðmen yeterince özgül ve duyarlý bir belirteç ortaya konamamýþtýr. Bu çalýþmada, enflamasyonun erken safhasýnda rol oynadýðý belirlenen heparin-baðlayýcý proteinin (HBP)AMÝ tanýsýnda yararlý olup olamayacaðý araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmada daha önce yapýlmýþ, AMÝ’nin bir tavþan modelinden elde edilmiþ serum örnekleri kullanýldý. Kontrol, sham ve iskemi grubu olmak üzere üç gruba ayrýlan deneklerden 0., 1., 3. ve 6. saatlerde elde edilen kan örneklerinde HBP, C-reaktif protein (CRP) ve interlökin-6 (IL-6) düzeyleri ölçüldü. Herbir belirtecin zamanla deðiþimi ve biribirleriyle karþýlaþtýrýlmasý istatistiksel olarak deðerlendirildi.
BULGULAR: Çalýþýlan belirteçlerin hiçbirinde 1. saatte gruplar arasýnda anlamlý bir fark belirlenmedi. Üçüncü saatten itibaren iskemi grubunda CRP ve IL-6 düzeyleri, kontrol ve sham gruplarýna göre anlamlý yükselme göstermiþtir (p<0.001). HBP deðerleri ise 6. saatten itibaren iskemi grubunda diðerlerine göre anlamlý yükselme gösterdi (p<0.001).
TARTIÞMA: Heparin-baðlayýcý protein düzeyleri, AMÝ’nin tavþan modelinde CRP ve IL-6’ya göre daha geç yükselme gösterdi. Ancak yine de bir erken taný belirteci olma potansiyel taþýmaktadýr. Yapýlacak klinik çalýþmalarla tanýsal sensitivite ve spesifisitesinin deðerlendirilmesi gerekmektedir.

BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a high mortality rate, yet diagnostic difficulties persist. Although many biomarkers have been investigated for diagnostic purposes, as well as imaging methods, a sufficiently specific and sensitive marker has not been identified. This research was designed to examine whether heparin-binding protein (HBP), which has a role in the early phase of inflammation, could be useful in the diagnosis of AMI.
METHODS: Serum samples obtained from a previously performed rabbit model of AMI were used in the study. HBP, C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured in blood samples obtained at baseline and 1, 3, and 6 hours from subjects that were separated into 3 groups: control, sham, and ischemia. The change in each marker over time and comparisons of the groups were evaluated statistically.
RESULTS: A significant difference was not detected at the first hour in any of the studied markers. At the third hour, the CRP and IL-6 levels in the ischemia group indicated a significant increase in comparison with the control and sham groups (p<0.001). The HBP values showed a significant increase at the sixth hour in the ischemia group in comparison with the others (p<0.001).
CONCLUSION: The HBP level demonstrated a slower increase in a rabbit model of AMI compared with CRP and IL-6. However, it still has the potential to become an early diagnostic biomarker. Diagnostic sensitivity and specificity should be evaluated in further clinical trials.

AMAÇ: Bu çalýþmada, sýçanlarda dapagiflozinin deneysel sepsis modeli üzerindeki olasý koruyucu etkilerinin deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Sprague-Dawley sýçanlara cerrahi operasyonlarýn 5 gün öncesinde serum fizyolojik (1 mL/kg, p.o.) veya dapagliflozin (10 mg/kg, p.o.) verilmeye baþlandý. Sepsis, anestezi altýnda, çekal ligasyon ve perforasyon modeli ile oluþturulurken, sham kontrol gruplarýna sadece laparotomi yapýldý. Serumda BUN, kreatinin ve glukoz düzeyleri; dokularda (böbrek, karaciðer ve akciðer) ise MDA, GSH, MPO, TNF-α, IL-1β, kaspaz 8 ve kaspaz 9 düzeyleri belirlendi. Bu dokularda histolojik deðerlendirme de yapýldý.
BULGULAR: Sepsiste dapagliflozin uygulamasý, böbrek dokularýnda oksidatif stresi (MDA) azalttý, antioksidan düzeyleri (GSH) arttýrdý ve enflamasyonu (MPO) azalttý (p<0.05). Sepsiste dapagliflozin uygulamasý akciðer dokularýnda oksidatif stresi (MDA) azalttý, akciðer ve karaciðer dokularýnda ise enflamasyonu (MPO) azalttý (p<0.05). Ayrýca, böbrek, akciðer ve karaciðer dokularýnda kaspaz 8 ve 9 düzeylerini arttýrdý (p<0.05). Histopatolojik sonuçlara göre, dapagliflozin uygulamasý böbrek dokularýnda orta derece; akciðer ve karaciðer dokularýnda ise hafif iyileþtirdi.
TARTIÞMA: Bu çalýþmada, dapagliflozinin deneysel sepsis modelinde böbrek hasarýný önleyici etkisinin olduðu gösterilmesine raðmen akciðer ve karaciðer dokularý üzerine hafif koruyucu etkisi olduðu bulunmuþtur.

BACKGROUND: The aim of this study was to evaluate the possible protective effects of dapagliflozin in an experimental sepsis model in rats.
METHODS: Saline (1 mL/kg, p.o.) or dapagliflozin (10 mg/kg, p.o.) was administered to Sprague-Dawley rats for 5 days prior to the surgical procedures. Under anesthesia, sepsis was induced by cecal ligation puncture, while sham control groups underwent laparotomy only. Blood urea nitrogen, creatinine, and glucose levels were measured in serum samples and the levels of malondialdehyde (MDA), glutathione (GSH), myeloperoxidase (MPO), tumor necrosis factor alpha, interleukin 1 beta, caspase 8, and caspase 9 were determined in tissue samples (kidney, liver, and lung). Histological evaluation was also performed.
RESULTS: The administration of dapagliflozin in a sepsis model reduced oxidative stress (MDA), increased antioxidant levels (GSH), and reduced inflammation (MPO) in the kidney (p<0.05). Dapagliflozin also decreased oxidative stress (MDA) in lung tissue and decreased inflammation (MPO) in lung and liver tissue (p<0.05). Caspase 8 and 9 levels in kidney, lung, and liver tissue were increased (p<0.05) in the dapagliflozin group compared with the sepsis group. According to the histopathological results, sepsis was moderately improved in renal tissue and slightly attenuated in lung and liver tissue with the administration of dapagliflozin.
CONCLUSION: Dapagliflozin had a preventive effect on sepsis-induced kidney damage, but the protective effect was mild in lung and liver tissue in the present study.

AMAÇ: Çocuklarda komplike ve komplike olmayan apandisitin saptanmasýnda yardýmcý olarak baþlangýç hematolojik parametrelerin olasý klinik faydalarýný deðerlendirmek amaçlandý.
GEREÇ VE YÖNTEM: 2015’ten 2016’ya kadar akut apandisit için küratif cerrahi geçiren 334 pediatrik hasta geriye dönük olarak incelendi. Hastalar histopatolojik raporlara dayanarak komplike veya komplike olmayan apandisit olarak sýnýflandýrýldý. Klinik bulgular ve temel hematolojik parametrelerden lökosit sayýsý, nötrofil yüzdesi, trombosit sayýsý, nötrofil-lenfosit oraný (NLR), trombosit-lenfosit oraný (PLR), ortalama trombosit hacmi, kýrmýzý hücre daðýlým geniþliði, trombosit daðýlým geniþliði gruplar arasýnda karþýlaþtýrýldý.
BULGULAR: Komplike akut apandisit 36 (%10.8) hastada bulundu. Komplike apandisitte WBC (p<0.001), nötrofil yüzdesi (p<0.001), NLR (p<0.001), PLR (p=.004) komplike olmayan gruba göre daha yüksek iken, RDW, MPV, PDW düzeyleri anlamlý fark bulunmadý. ROC eðrilerinin analizi, WBC için 14.870 hücre/mm3 (eðri altýndaki alan [AUC], 0.675; duyarlýlýk, %86.1; özgüllük, %41.6), NLR için 10.4 (AUC, 0.717; duyarlýlýk, %61.1, özgüllük, %73.2), PLR için 284 (AUC, 0.647; duyarlýlýk, %42; özgüllük, %86) komplike akut apandisitin belirlenmesinde en iyi kestirim deðerler olarak bulundu.
TARTIÞMA: Bu çalýþma, daha yüksek NLR ve PLR düzeylerine sahip akut apandisitli hastalarda komplikasyon geliþme olasýlýðýnýn daha yüksek olabileceðini göstermiþtir. Klinisyenlerin acil servisteki yüksek riskli akut apandisit hastalarýný tespit etmelerine yardýmcý olmak için fizik muayene, görüntüleme çalýþmalarý ve diðer laboratuvar testleri ile birlikte NLR ve PLR kullanýlmasýný öneririz.

BACKGROUND: The objective of this research was to evaluate the potential clinical utility of baseline hematological parameters measured on admission as adjuncts in the identification of complicated and uncomplicated appendicitis in children.
METHODS: The records of a total of 334 pediatric patients who underwent curative surgery for acute appendicitis (AA) between 2015 and 2016 were retrospectively investigated. The patients were categorized as complicated or uncomplicated appendicitis based on the histopathological reports. The clinical features and baseline hematological parameters of leukocyte count, neutrophil percentage, thrombocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), and platelet distribution width (PDW) of the groups were compared.
RESULTS: Complicated AA was determined in 36 (10.8%) patients. The white blood cell count (WBC) (p<.001), neutrophil percentage (p<.001), NLR (p<.001), and PLR (p=.004) were higher in the complicated appendicitis group compared with the uncomplicated group, while the RDW, MPV, and PDW levels were uninformative. Analysis of receiver operating characteristic curves yielded the cut­off values of 14.870 cell/mm3 for WBC (area under the curve [AUC]: 0.675; sensitivity: 86.1%; specificity: 41.6%), 10.4 for NLR (AUC: 0.717; sensitivity: 61.1%; specificity: 73.2%), and 284 for PLR (AUC: 0.647; sensitivity: 42%; specificity: 86%) were found to be the best predictive values for the determination of complicated acute appendicitis.
CONCLUSION: The present study demonstrated that AA patients with higher NLR and PLR levels might be more likely to develop a complication. The NLR and PLR values combined with a physical examination, imaging studies, and other laboratory tests may help clinicians to identify high-risk AA patients in the emergency department.

AMAÇ: Akut apandisit (AA), günümüzde hala kesin tanýsýný koymak mümkün deðildir. Tanýdaki gecikmeler, komplikasyon oranlarýný artýrmaktadýr. Alvarado skorlamasý (AS) ve biyolojik belirteçlerin (C-reaktif protein [CRP], prokalsitonin [PCT], neopterin [NP]) tek ve AS ile birlikte kullanýlmalarýnýn tanýya olan katkýlarýnýn araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Ýstanbul Üniversitesi Cerrahpaþa Týp Fakültesi, Genel Cerrahi Kliniði’ne, 04.03.2014–29.07.2015 tarihleri arasýnda, AA ön tanýsýyla, gönüllü 100 hastadan, yatýþ öncesi serumlarý alýnarak -70 derecede saklandý. Hastalar, AA pozitif (n=60), negatif (n=40) gruplandý. AA pozitif grup; komplike (n=11), nonkomplike (n=49) olarak gruplandýrýlarak, AS, CRP, PCT ve NP deðerleri karþýlaþtýrýldý.
BULGULAR: Çalýþmaya alýnan hastalarýn; 45’i erkek (%45), 55’i kadýn (%55),yaþ ortalamalarý 32.8±13.7 18–92) yýl idi. Gruplar arasýnda, yaþ, cinsiyet açýsýndan anlamlý fark yoktu. AS daðýlýmý; AS ≤4 (n=24) üçü, AS 5–7 (no: 35) 22’si, AS 8–10 (no: 41) 38’i ameliyat edildi. Ameliyat edilen 63 hastanýn üçünde normal apendiks saptandý. AA pozitif ve negatif gruplarýn, serum CRP, PCT, NP deðerlerinin tanýda yetersiz olduðu ancak AS’nin sensivite ve duyarlýlýðýný artýrdýðý görüldü. Biyolojik belirteçlerin ortalamasý karþýlaþtýrýldýðýnda; komplike AA grup ayrýmýnda anlamlýydý (p<0.05).
TARTIÞMA: Alvarado skorlamasý, iyi bir skorlama olmasýna karþýn, ek inceleme ve klinik yaklaþýmlara ihtiyaç vardýr. Serum CRP, PCT ve NP deðerleri, tek baþlarýna, AA tanýsýnda yetersizdir. Ancak AS’nin deðerini arttýrmakta ve komplike AA olgularýný ayýrmada yararlýdýr.

BACKGROUND: The determination of a definitive preoperative diagnosis of acute appendicitis (AA) remains a challenge; however, delays in diagnosis increase complication rates. The aim of this study was to investigate the contribution of the Alvarado score (AS) alone and the AS combined with the use of the biological indicators of C-reactive protein (CRP), procalcitonin (PCT) and neopterin (NP) in the diagnosis.
METHODS: Serum was collected from 100 patients who were admitted to the general surgery clinic of Istanbul University, Cerrahpasa Medical Faculty between March 4, 2014 and July 29, 2015 with the pre-diagnosis of AA and who agreed to take part in the study. The serum samples were stored at -70°C. The patients were divided into 2 groups: AA-positive (n=60) and AA-negative (n=40). The AA positive group was divided into subgroups of complicated (n=11), uncomplicated AA (n=49) and the AS, CRP, PCT, NP levels were compared.
RESULTS: The study population consisted of 45 men (45%) and 55 women (55%), with a mean age of 32.8±13.7 years (range: 18–92 years). There was no significant difference between the groups in age and gender. There were 24 patients with an AS ≤4 (3 had surgery), 35 patients with an AS of 5–7 (22 had surgery), and 41 patients with an AS of 8–10 (38 had surgery). Three of the 63 patients who underwent surgery were diagnosed with a normal appendix. The serum CRP, PCT, and NP measures were found to be inadequate to make an AA diagnosis alone, these values increased the sensitivity and specificity of the AS. The biological indicators were also significant in differentiating between the complicated and uncomplicated AA groups (p<0.05).
CONCLUSION: Although the AS is useful, additional testing and clinical approaches are valuable to inform the diagnostic procedure. When considered alone, serum CRP, PCT and NP values are insufficient for a diagnosis of AA. However, they increased the diagnostic value of the AS and can be helpful in distinguishing complicated AA cases.

AMAÇ: Anjiyografik embolizasyon (AE) çocuklarda künt karýn travmasýna baðlý solid organ yaralanmalarýnda sýnýrlý olarak kullanýlmaktadýr. Bu çalýþmada, künt travmaya baðlý karýndaki solid organ hasarýna baðlý kanamalý hastalarda kanamayý kontrol etmek için AE’yi etkin ve güvenilir bir yöntem olarak kullanma deneyimimizi sunuyoruz.
GEREÇ VE YÖNTEM: Çalýþmamýz da künt karýn solid organ yaralanmasý geçirmiþ ve son dört yýl içinde kliniðimize baþvuran 17 yaþ altý hastalarý geriye dönük olarak araþtýrýldý. Veriler istatistiksel olarak analiz edildi.
BULGULAR: Embolizasyon yapýlan hastalarýn (AE) (n=11) yoðun bakým ünitesinde (YBÜ) kalýþ süresi ortalama dört gün olup ortalama hastanede kalýþ süresi 12 gündü. Ortalama hasta organ yaralanma derecesi 4.18±0.40 idi. Ameliyatsýz tedavi uygulanan (embolizasyonsuz) (n=72) yaþ ortalamasý 9.1±3.8 yýl idi. YBÜ’de ortalama kalýþ süresi iki gündü (daðýlým, 2–10 gün) ve ortalama hastanede kalýþ süresi 5.5 gündü (daðýlým, 4–30 gün). Hastalarýn ortalama organ yaralanma derecesi 1.73±0.75 idi. AE gerektiren hastalarda solid organ hasarý daha ciddi derecede yüksekti (p<0.001). Bu nedenle yoðun bakým ünitelerinde (p<0.001) ve hastanede kalýþ süresi uzundu (p<0.001). Hematokritteki düþüþ ortalama -7.33±5.3 (p<0.001) idi. AE sonrasý hematokrit deðiþikliði (%) ile AE sonrasý 72 saatlik ortalama AE sonrasý kan kaybý 2±0.97 (p>0.05) idi. Tüm hastalar þifa ile taburcu edildi.
TARTIÞMA: Anjiyografik embolizasyon, künt karýn travmasýna baðlý solid organ yaralanmasý olan çocuk hastalarda kanama kontrolü için etkili ve güvenilir bir yöntem olarak kullanýlabilir.

BACKGROUND: Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury.
METHODS: This was a retrospective examination of patients <17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed.
RESULTS: The mean length of intensive care unit stay was 4 days for those who underwent embolization (n=11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was −7.33±5.3% (p<0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2±0.97% (p>0.05). All of the patients were discharged with a full recovery.
CONCLUSION: AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.

AMAÇ: Çalýþmanýn amacý, hayatta kalan çoklu travma hastalarýnda basitleþtirilmiþ akut fizyoloji skoru (SAPS) III ve akut fizyoloji ve kronik saðlýk deðerlendirmesi (APACHE) IV’ün mortaliteyi öngörmedeki etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Bu çalýþma üçüncü basamak bir hastanenin 13 yataklý yoðun bakým ünitesinde (YBÜ) gerçekleþtirildi. YBÜ’de tedavi edilen çoklu travma hastalarýnýn geriye dönük bir incelemesi yapýldý. Toplanan veriler yaþ, cinsiyet, yoðun bakým kabul ve yoðun bakýmdaki sonuçlarý içeriyordu. APACHE IV, SAPS III ve öngörülen mortalite oraný web tabanlý bir hesap makinasýyla hesaplandý.
BULGULAR: Doksan hastanýn %20’si (n=18) kadýn, %80’i (n=72) erkekti. Genel mortalite oraný %25.6 idi. APACHE IV, APS ve SAPS III puan ortalamalarý 69.27±34.51, 66.42±33.72 ve 26.36±27.14 bulundu. APACHE IV ve SAPS III’e göre ortalama öngörülen mortalite oraný 26.36±27.14 ve 17.07±24.88 idi. Eðrinin altýndaki alan (EAA) sýrasýyla APACHE IV ve SAPS III için 0.87, 0.93 idi.
TARTIÞMA: Çoklu travmalý yoðun bakým hasta grubunda, SAPS III’ün performansý APACHE IV skoruna göre daha hassas ve ayýrt edicidir.

BACKGROUND: The aim of the present study was to evaluate the effectiveness of the Simplified Acute Physiology Score (SAPS) III and the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the prediction of in-hospital mortality in surviving multi-trauma patients.
METHODS: This study was conducted in the 13-bed intensive care unit (ICU) of a tertiary hospital. A retrospective review of multi-trauma patients whose care was managed in the ICU was performed. Data collection included details of age, gender, ICU admission, and outcome. APACHE IV and SAPS III scores, as well as the predicted mortality rate (PMR), were calculated using web-based calculators.
RESULTS: Of the 90 patients 20% (n=18) were female and 80% (n=72) were male. The overall mortality rate was 25.6%. The mean APACHE IV, Acute Physiology Score (APS) and SAPS III score was 69.27±34.51, 66.42±33.72, and 26.36±27.14, respectively. The mean PMR according to the APACHE IV and the SAPS III was 26.36±27.14 and 17.07±24.88, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.87 for the APACHE IV and 0.93 for the SAPS III.
CONCLUSION: The performance of the SAPS III was more sensitive and discriminative than the APACHE IV scoring system for multi-trauma ICU patients.

AMAÇ: Akut pankreatit, özellikle üçüncü trimesterde veya doðum sonrasý dönemde, 1000–5000 gebelikte yaklaþýk bir oranýnda görülür. Gebeliðe baðlý akut pankreatitin en yaygýn nedeni, olgularýn %65’inden fazlasýný oluþturan kolelitiazistir. Bu çalýþma, gebeliðe baðlý akut biliyer pankreatit olgularýnda tek bir merkezin dört yýllýk deneyiminin detaylý bir analizini sunmayý amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu tek merkez geriye dönük çalýþmada, acil cerrahi kliniðinde 1 Ocak 2014–1 Ocak 2018 tarihleri arasýnda gebeliðe baðlý akut biliyer pankreatit nedeniyle hastaneye yatýrýlan 55 ardýþýk hastanýn týbbi kayýtlarý incelendi.
BULGULAR: Çalýþmaya gebeliðe baðlý akut biliyer pankreatitli elli beþ hasta dahil edildi. Elli beþ kadýndan 13’ü (%24) hamile, 28’i (%51) doðum sonrasý (altý hafta), 14’ü (%25) bir yýl (6 hafta–1) grubuydu. Üç grup arasýnda istatistik olarak anlamlý fark yoktu. Her hasta için en uygun tedavi hedef alýndý. Altý hastada (%10) tekrarlayan akut pankreatit vardý. Anne veya fetal mortalite ve morbidite yoktu.
TARTIÞMA: Gebeliðe baðlý akut biliyer pankreatit sadece hamile kadýnlarý içermez ve bu olgularýn görülme sýklýðý beklenenden daha yüksektir. Gebeliðe baðlý akut biliyer pankreatit konservatif tedavi ile baþarýlý bir þekilde tedavi edilebilir, çünkü genellikle hafif-orta þiddette bir klinik ile seyreder. Ancak, cerrah ilk trimester dýþýndaki hastalar için erken kolesistektomiyi akýlda tutmalýdýr.

BACKGROUND: Acute pancreatitis has an incidence of approximately 1 in 1000 to 5000 pregnancies, and is most often seen in the third trimester or the postpartum period. The most common cause of pregnancy-related acute pancreatitis is cholelithiasis, which accounts for more than 65% of cases. The aim of this study was to present a detailed analysis of 4 years of experience with cases of acute biliary pancreatitis related to pregnancy from a single center.
METHODS: The medical records of 55 consecutive patients who were hospitalized in the emergency surgery clinic for acute biliary pancreatitis related to pregnancy between January 1, 2014 and January 1, 2018 were examined in this single-center, retrospective study.
RESULTS: Fifty-five patients with acute biliary pancreatitis related to pregnancy were included in the study. Of the 55 women, 13 (24%) were in the pregnant group, 28 (51%) in the postpartum (6 weeks) group, and 14 (25%) were in the 1-year (6 weeks-1 year) group. There was no statistically significant difference between the 3 groups. The most appropriate treatment for each patient was targeted. Six (10%) patients had recurrent acute pancreatitis. There was no maternal or fetal mortality or morbidity.
CONCLUSION: Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester.

AMAÇ: Birçok ülkede kiþilerin maruz kaldýðý travmanýn þiddeti ve ortaya çýkan hasarý deðerlendirmek için bazý skorlama sistemleri geliþtirilmiþ ve geliþtirilmeye devam etmektedir. Burada amaç hastanýn hasar oranlarýný en iyi biçimde belirleyerek mortalite ve morbiditeye etki eden faktörleri saptayarak bunlarý en aza indirgemeye çalýþmaktýr. Travmanýn aðýrlýðýnýn tespiti için ortaya konulan kriterlerin ölçülebilir ve karþýlaþtýrýlabilir objektif kriterler olmasý önemlidir. Bu amaçla anatomik ve fizyolojik birçok puanlama sistemleri oluþturulmuþtur. Bu araþtýrmada acil servise ilk kabul anýndaki vital skorlarýn, hemogram deðerlerinin ve yaralanma þiddeti skorunun (ISS) mortaliteyi öngörmeye katkýsýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma geriye dönük kohort çalýþmasý olarak tasarlandý. Aralýk 2015–Mart 2016 tarihleri arasýnda acil servisimize baþvuran ateþli silah yaralanmasý olan hastalar çalýþmaya alýndý. Deðiþkenlerin daðýlýmý açýsýndan sürekli deðiþkenler için t-testi veya Mann-Withney U-testi kullanýlarak ikili deðiþkenler analiz edildi. Acil servise kayýttan sonra baðýmsýz mortalite belirleyicilerini belirlemek için lojistik regresyon ve istatistiksel analiz için SPSS17.0 programý kullanýldý. P<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Toplam 418 hasta alýndý. Sað kalan ve ölen hastalar arasýnda beyaz kan hücresi (WBC), solunum hýzý, Glasgow Koma Skalasý (GCS), Kýsaltýlmýþ Yaralanma Skoru (AIS) ve ISS arasýnda istatistiksel olarak anlamlý bir fark bulundu (p<0.05). Sistolik kan basýncýnýn 90 mmHg’nin altýnda ve kalp atým hýzýnýn 100 atým/dk üzerinde olmasýnýn mortalite açýsýndan baðýmsýz deðiþkenler olduðu belirlendi.
TARTIÞMA: Acil servise kabul anýndaki ISS’nin objektif deðerlendirmesi, hemoglobin gereksinimi, mortalite ve morbiditeyi öngörmek için önemli bir unsurdur.

BACKGROUND: Several scoring systems have been and continue to be developed in numerous countries with the goal of quickly and accurately assessing the severity of trauma injuries. The aim of this study was to identify factors that help to determine the gravity of damage and to minimize it, in order to reduce mortality and morbidity. It is important that the criteria set for the determination of the severity of trauma are objective, measurable, and comparable. This study was an assessment of the contribution of vital signs, hemogram values, and trauma severity scores recorded at initial admission in the prediction of mortality in patients with firearm trauma wounds.
METHODS: This was a retrospective cohort study. Patients with gunshot injuries who were admitted to the emergency department (ED) of a single facility between December 2015 and March 2016 were included in the study. Statistical software was used to perform bivariate analyses using a t-test or the Mann-Whitney U test for continuous variables, depending on the distribution of variables, and logistic regression analysis was utilized to determine independent predictors of mortality after ED admission. A p value of <0.05 was considered statistically significant.
RESULTS: A total of 418 patients were included. A statistically significant difference was found between the white blood cell count, respiratory rate, Glasgow Coma Scale score, Abbreviated Injury Scale score, and the Injury Severity Score (ISS) of the patients who survived and those who died (p<0.05). The analysis also indicated that a systolic blood pressure below 90 mmHg and a heart rate above 100 beats/minute were independent variables in terms of the expectation of mortality.
CONCLUSION: The objective assessment of the ISS at admission to the ED is an important element in the calculation of hemoglobin requirements, mortality, and morbidity.

AMAÇ: Akut mekanik baðýrsak týkanýklýðý (AMBT) acil servisler için halen ciddi bir cerrahi problemdir. AMBT’nin etiyoloji, yönetimi ve sað kalýmý açýsýndan deðerlendirmeyi amaçlamaktayýz.
GEREÇ VE YÖNTEM: Ocak 2014 ile Aralýk 2018 tarihleri arasýnda baðýrsak týkanýklýðý için yatýrýlmýþ hastalar geriye dönük incelendi. Yaþ, cinsiyet, etiyoloji, yönetim ve sað kalým AMBT açýsýndan geriye dönük deðerlendirildi. Adezyonlar, tümörler, herniler ve peritoneal karsinomatoza daha detaylý deðerlendirildi.
BULGULAR: Çalýþmaya 735 hasta dâhil edildi. %60’ý ince baðýrsak %40’ý kalýn baðýrsak týkanýklýðýydý. Yaþ ortalamasý 59.9±16.02 yýldý. %52.9’u erkek, %47.1’i kadýndý. AMBT’nin en sýk nedeni adezyonlar, tümörler ve hernilerdi (sýrasýyla, %43.3, %26.2 ve %6). Ýnce baðýrsak için en sýk neden adezyon (%69.3), kalýn baðýrsaklar için ise tümörlerdi (%61.6). AMBT’nin en sýk yönetimi konservatif yaklaþýmdý (%53.2), cerrahi palyasyon %24.9 ve rezeksiyon %21.9 oranýnda uygulanmýþtý. Konservatif yaklaþým en sýk adezyonlarda (%76.7), cerrahi palyasyon peritoneal karsinomatozada (%65.7), ve rezeksiyon ise volvulusta (%61.9) uygulanmýþtý. Mortalite oraný %8.6 bulundu. Adezyon için kolorektal cerrahi (%51.4), tümör için splenik fleksura distal (%71.3) yerleþimli kolorektal kanserler (%93.8) ve herniler için ise sýklýkla gastrointestinal cerrahi (%57.1) sonrasý geliþen insizyonel herni (%47.7) en sýk nedenlerdi.
TARTIÞMA: Adezyon, tümör ve herniler AMBT’nin sýrasýyla en sýk nedenleridir. En sýk yönetim þekli konservatif yaklaþýmdýr ve çoðunlukla adezyonlar için uygulanýr. Femoral ve inguinal herni sýklýðý azalýrken insizyonel herni sýklýðý artmakta, peritoneal karsinomatoza son yýllarda herni kadar sýk gözlenmektedir.

BACKGROUND: Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival.
METHODS: Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail.
RESULTS: A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9±16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO.
CONCLUSION: Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause.

AMAÇ: Kemiksel çekiç parmak yaralanmalarýnýn tedavisinde popüler bir tedavi yöntemi olan ekstansiyon blok pinleme yönteminde kullanýlan transfiksasyon pininin gerekliliðini araþtýrmak.
GEREÇ VE YÖNTEM: Doyle sýnýflamasýna göre tip 4B çekiç parmak yaralanmasý olan hastalar tariflediðimiz pin-ortez ekstansiyon blok yöntemi ile tedavi edildi. Radyolojik sonuçlar ameliyat sonrasý çekilen röntgenlerle, fonksiyonel sonuçlar Crawford kriterlerine göre deðerlendirildi.
BULGULAR: Yaþ ortalamasý 26 olan 13 hasta (9 erkek, 4 kadýn) çalýþmaya dahil edildi. Yaralanma ile cerrahi arasýnda geçen ortalama süre 3.3 gün, ortalama takip 8.2 ay (daðýlým, 4–12 ay) dý. Tüm hastalarda ortalama 5.1 haftada (daðýlým, 5–6 hafta) radyolojik kemik kaynamasý elde edildi. Son kontrollerde ortalam aktif distal interfalangeal eklem fleksiyonu 76.1° (daðýlým, 65°–80°) ve ortalama ekstansiyon kaybý 3.84° (daðýlým, 0°–15°) di. Crawford kriterlerine göre, sekiz hastada mükemmel sonuç, dört hastada iyi sonuç, bir hastada kötü sonuç elde edildi. Son kontrollerde hiç bir hastada aðrý yoktu.
TARTIÞMA: Kullandýðýmýz pin-ortez ekstansiyon blok tekniðinde tatmin edici klinik ve radyolojik sonuçlar elde ettik. Randomize kontrollü ve ileriye yönelik çalýþmalar ile tekniðin etkinliði teyit edilecektir.

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture.
METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle’s classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford’s criteria.
RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4–12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5–6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°–80°) and an average extension deficit of 3.84° (range: 0°–15°). According to Crawford’s criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up.
CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

AMAÇ: Bu çalýþmada osteosentez sonrasý komplikasyon geliþmiþ veya baþarýsýz olunmuþ kollum femoris kýrýklarýnýn, kurtarýcý total kalça artroplastisi (TKA) ile tedavisinin sonuçlarý araþtýrýldý.
GEREÇ VE YÖNTEM: 1988 ile 2012 yýllarý arasý kollum femoris kýrýðý tedavisinde kapalý repozisyon ve osteosentez sonrasý baþarýsýzlýk geliþen ve kurtarýcý TKA yapýlan 20 hasta (6 erkek, 14 kadýn; ortalama yaþ: 56.7) çalýþmaya alýndý. Kollum femoris kýrýklarý sonrasý osteosentez þekli, baþarýsýzlýk geliþme süresi ve TKA uygulama süreleri kaydedildi. Hastalara sementsiz femoral ve asetabuler komponent kullanýldý. Komplikasyonlar operasyon esnasý ve sonrasý olarak belirlendi. Son kontrolde Haris kalça skorlamasý ile klinik sonuçlar ve çekilen grafiler ile gevþeme varlýðý deðerlendirildi.
BULGULAR: Hastalarýn takip süreleri ortalama 59.4 (daðýlým, 15–178) ay idi. TKA uygulanan 20 hastanýn kollum femoris kýrýklarýnýn sýnýflamasý osteosentez sonrasýnda komplikasyonlar kaynamama 4 (%25), malunion 2 (%10), avasküler nekroz 9 (%45), implant yetersizliði 4 (%20) idi. Komplikasyonlar geliþmesinde kanüle vida ve DHS arasýnda istatistiksel anlamlý farklýlýk bulunmamakta idi (p=0.084). Komplikasyon olarak erken dislokasyon (%5), protez çevresi kýrýk (%5) ve asetabuler protrüzyon (%5) saptandý. Erken dislokasyon geliþen hastada 10. yýlda gevþeme saptanmasý üzerine revizyon yapýldý. TKA öncesi HHS 54.05 iken son kontrolde 86.45 olarak deðerlendirildi ve istatistiksel olarak aralarýnda anlamlý bir fark saptandý (p<0.0001).
TARTIÞMA: Çalýþma bulgularýmýz, kollum femoris kýrýklarýnda baþarýsýz osteosentez sonrasý TKA uygun cerrahi teknik ile baþarýlý ve güvenli bir yöntem olduðunu göstermektedir.

BACKGROUND: This study is an investigation of the outcomes of salvage total hip arthroplasty (THA) to treat collum femoris fractures that resulted in complications or failure after osteosynthesis.
METHODS: Twenty patients (6 male, 14 female; mean age: 56.7 years) who underwent salvage total hip arthroplasty (THA) between 1988 and 2012 due to failure developing after closed reposition and osteosynthesis in the treatment of collum femoris fractures were included in the study. The type of osteosynthesis, and the length of time until failure and before THA application after collum femoris fracture were recorded. Cementless acetabular and femoral components were used in all of the patients. Complications were defined as those occurring during and after surgery. The clinical results were assessed with the Harris Hip Score (HHS) and the presence of loosening was assessed with radiological evaluation in follow-up.
RESULTS: The mean length of the follow-up period was 59.4 months (range: 15–178 months). The collum femoris fractures of the 20 patients were classified as: 5 Garden type II, 13 type III, 2 type IV, and 3 Pauwels type I, 8 type II, and 9 type III. Cannulated screws were used in 13 patients (65%) and dynamic hip screw (DHS) fixation was used in 7 patients (35%). Complications observed after osteosynthesis were nonunion in 4 cases (20%), malunion in 2 (10%), avascular necrosis in 10 (50%), and implant failure in 4 (20%). A mean of 9.66 months (range: 3–54 months) elapsed before osteosynthesis failure and the mean length of time until THA was 31.6±51.7 months. There was no statistically significant difference between cannulated screw and DHS fixation in the development of complications (p=0.084). Early dislocation (5%), periprosthetic fracture (5%) and acetabular protrusion (5%) were recorded as complications. A revision was made upon determination of loosening in the 10th year in the patient who developed early dislocation. While the mean HHS was 54.05±8.22 before THA, it was evaluated to be 86.45±8.73 at the last follow-up, which was a statistically significant difference (p<0.0001).
CONCLUSION: The study findings demonstrated that THA applied with suitable surgical technique is a safe and successful method that may be used after failed osteosynthesis in cases of collum femoris fracture.

AMAÇ: Intramedüller çivi (IMN) uygulanan tibia distal diafiz kýrýðý olgularýnda farklý kompresyon miktarlarýnýn kýrýk yüzeyindeki stres deðerleri ve kaynama süreleri arasýndaki iliþkiyi araþtýrmak.
GEREÇ VE YÖNTEM: 2006–2016 yýllarý arasýnda tibia cisim kýrýðý olan 95 hasta çalýþmaya alýndý. AO sýnýflamasýna göre 43-A1, 43-A2, 43-A3, Gustillo-Anderson sýnýflamasýna göre kapalý kýrýk olan hastalar çalýþmaya alýndý. Yetmiþ sekiz hasta erkek, 17 hasta kadýn olup ortalama yaþ 33.99 (SS± 10.65) idi. Hastalar üç gruba ayrýldý. Grup 1’de (33 hasta) kompresyon yapýlmadý. Grup 2’de (32 hasta) ve 3 (30 hasta) IMN ile dinamik kompressif tespit yapýldý. Kompresyon miktarý Grup 2’de 1 mm, Grup 3’de 1.5 mm olarak uygulandý. Hastalarýn ameliyat sonrasý ve takiplerinde çekilen röntgen grafileri Rust kriterlerine göre, fonksiyonel sonuçlar ise Johner-Wrush kriterlerine göre deðerlendirildi. Ayrýca Grup 2 ve 3’de uygulanan 1 mm ve 1.5 mm kompresyon ile ilgili sonlu eleman çalýþmasý yapýldý. Ýstatistiksel olarak tek yönlü Anova, Fisher kesin testi, Pearson ki-kare, Mann-Whitney U-test ve Student t-testleri kullanýldý.
BULGULAR: Bütün hastalarda kaynama elde edildi. Radyolojik kaynama Grup 1’de ortalama 16.08 (SS±2.02) hafta, Grup 2’de 13.54 (SS±1.52) hafta ve Grup 3’de 12.56 (SS±1.73) haftada saðlandýðý görüldü. Kompresyon uygulanmayan grupta kaynama süresi, kompresyon uygulanan diðer gruplara göre anlamlý düzeyde uzundu (p<0.001). Fonksiyonel sonuçlar Grup 1’de 28 (%85) hasta mükemmel, beþ (%15) hasta iyi-orta, Grup 2’de 27 (%92) hasta mükemmel, beþ (%8) hasta iyi-orta, Grup 3’de 26 (%92) hasta mükemmel, dört (%8) hasta iyi-orta olarak deðerlendirildi. Toplam beþ hastada diz önü aðrýsý mevcuttu. Hiçbir hastada enfeksiyon görülmedi.
TARTIÞMA: Kilitli kompressif çiviler tibia cisim kýrýklarýnda oldukça etkin bir tedavi yöntemidir. Çivi üzerinden uygulanan kompresyon kaynama süresini belirgin þekilde kýsaltmaktadýr.

BACKGROUND: The objective of this study was to investigate the relationship between the stress values on the fracture surface and union periods seen in cases of different compression amounts used to manage distal tibial diaphyseal fractures treated with intramedullary nailing (IMN).
METHODS: Ninety-five patients (mean age: 33.99±10.65 years; male: n=78, female: n=17) with tibial shaft fracture were included in the study. The patients were divided into 3 groups: No compression was used in Group 1 (33 patients), and dynamic compressive fixation was performed with IMN in Group 2 (1 mm, 32 patients) and Group 3 (1.5 mm, 30 patients). A finite element study was performed for Group 2 and Group 3.
RESULTS: The average time to achieve radiological union was 16.08±2.02, 13.54±1.52, and 12.56±1.73 weeks in Groups 1, 2, and 3, respectively. Comparatively, the union period in the non-compression group was significantly longer (p<0.001). The functional results were evaluated as excellent in 28 (85%) patients and good-medium in 5 (15%) in Group 1, excellent in 27 (92%) and good-medium in 5 (8%) in Group 2, and excellent in 26 (92%) and good-medium in 4 (8%) in Group 3.
CONCLUSION: IMN is a highly effective treatment method for tibial shaft fracture.

AMAÇ: Göz içi arka segment yabancý cisimlerinin (GÝASYC) yönetiminde 23-gauge (G) transkonjonktival vitrektomi (TV) sonuçlarýnýn bildirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþmada GÝASYC nedeniyle 23-G TV uygulanan 14 hastanýn 14 gözü incelendi. Tüm olgularda cerrahiye 23-G sistem kullanýlarak baþlandý ve GÝASYC’ler geniþletilmiþ sklerotomilerden çýkartýldý. Çalýþmadaki tüm olgular erkek olup, ortalama yaþ 36.6±11.0 yýldý.
BULGULAR: Yabancý cisim 11 olguda vitreus içerisindeyken, üç olguda retina içindeydi. 23-G TV cerrahisi öncesinde, altý hastada komplike katarakt, beþ hastada vitreus içi kanama ve bir olguda retina dekolmaný tespit edildi. On ikisi metalik ve ikisi cam tipinde olan yabancý cisimlerin boyutlarý 3 mm ile 7 mm arasýnda deðiþmekteydi. Cerrahi tamponat olarak, beþ olguda silikon yaðý kullanýlýrken dört olguda gaz tamponat (C3F8) kullanýldý. Cerrahi sonrasý ortalama takip süresi 8.15±2.9 aydý. Son muayenede, çalýþmaya dahil edilen 14 gözün 10’unda görme keskinliði (GK) 0.1 veya üzerindeyken, dört gözde 0.1’in altýndaydý ki bunlardan ikisinde perimaküler skar, birinde yoðun sub-epiretinal membran ve birinde nüks retina dekolmaný mevcuttu.
TARTIÞMA: Göz içi arka segment yabancý cisimlerinin çýkarýlmasýnda 23-G TV etkin ve minimal invaziv bir yöntem olarak görünmektedir.

BACKGROUND: This study is a report of the outcomes of 23-gauge (G) transconjunctival vitrectomy (TV) performed to treat a posterior segment intraocular foreign body (IOFB).
METHODS: The data of 14 eyes of 14 patients who underwent 23-G TV for the removal of a posterior segment IOFB were reviewed in this study. Surgery was initiated with a 23-G system in each case and the posterior segment IOFB was removed through the enlarged sclerotomy site. All of the patients were male. The mean age of the patients was 36.6±11.0 years.
RESULTS: The foreign body (FB) was located in the vitreous in 11 eyes and in the retina in 3 eyes. Before the 23-G TV, complicated cataract was detected in 6 eyes, vitreous hemorrhage was detected in 5 eyes, and retinal detachment was detected in 1 eye. The size of the FB ranged from 3 mm to 7 mm; 12 of the FBs were metallic and 2 were glass. Silicone oil was used as a tamponade agent in 5 eyes and gas tamponade (C3F8) was used in 4 eyes. The mean follow-up time was 8.15±2.9 months. At the last examination, of the 14 eyes included in the study, the visual acuity (VA) was 0.1 or better in 10 eyes and less than 0.1 in 4 eyes because 2 eyes had peri-macular scar, 1 eye had massive sub-epiretinal membrane and 1 eye had retinal re-detachment.
CONCLUSION: 23-G TV is seen as an effective and minimally invasive technique to remove posterior segment IOFBs.

Göðüs yaralanmalarý ile baþvuran kritik hastalarda acil torakotomi hayat kurtarýcý bir iþlem olabilir. Halen, olay yerinde uygulanan torakotomi için endikasyonlar acil ekip varlýðýnda veya gelmeden 10 dakika önce meydana gelen kalp durmasý nedeniyle göðsün veya karnýn üst bölümünün penetran yaralanmasýdýr. Künt göðüs travmasýnda acil torakotomi için endikasyonlar daha düþük netlikte tanýmlanmýþtýr. Bu olguda bir helikopter acil týbbi servis ekibi olay yerinde acil torakotomi gerçekleþtirmiþtir. Bildiðimiz kadarýyla, Polonya’da böyle bir müdahale ilk kez tarif edilmektedir. Kýrk bir yaþýndaki bir erkek, kazaen traktör altýnda kalarak ezilmiþtir. Tüm mevcut önlemler alýnmýþ olmasýna raðmen, yaralýnýn kalbi aniden durmuþ. Helikopter acil müdahale ekibi hastane öncesi kardiyopulmoner arest tedavisinin ayrýlmaz bir bileþeni olarak olay yerinde acilen torakotomi gerçekleþtirmiþtir. Hasta hayatta kalmýþ ve daha sonra hastaneden iyi bir fiziksel durumda taburcu edilmiþtir. Serebral performans kategorisi 1’e göre nörolojik defisit saptanmamýþtýr. Hasta önceki aktivitelerine herhangi bir komplikasyon veya defisit olmaksýzýn geri dönmüþtür. Tamamen eðitimli bir ekibin varlýðý, olay yerinde potansiyel olarak kritik acil durumda torakotomi yapýlmasýna olanak saðlar. Künt toraks yaralanmasý olan iyi seçilmiþ bir hasta grubunda, hastane öncesi acil torakotomi önemli ve hayat kurtarýcý bir iþlem olabilir.

Emergency thoracotomy can be a life-saving procedure in critically injured patients who present with chest injuries. Currently, the indications for an on-the-scene thoracotomy are penetrating trauma of the chest or upper abdomen with cardiac arrest that has occurred in the presence of an emergency team or within 10 minutes prior to their arrival. The indications for an emergency thoracotomy in blunt chest trauma are less clearly defined. In the present case, a helicopter emergency medical service (HEMS) team performed an emergency thoracotomy at the scene. To the best of our knowledge, it is the first description of such a procedure in Poland. A 41-year-old male was crushed in a tractor accident. Though all available measures were taken, a sudden cardiac arrest occurred. The HEMS team performed an emergency thoracotomy at the scene as an integral part of prehospital cardiopulmonary arrest management. The patient survived, and was later discharged from the hospital in good physical condition. No neurological deficit was identified (cerebral performance category 1). The patient returned to his previous activities with no complications or deficits. The presence of a fully trained crew allows for the performance of a potentially critical on-the-scene emergency thoracotomy. In a well-selected group of patients with blunt thoracic injury, a prehospital emergency thoracotomy may be a significant and life-saving procedure.

Spermatik kord kaynaklý sarkomlar yumuþak doku sarkomlarýnýn %2.1 ve genitoüriner sistemde ise %1–2 oranlarýnda görülen nadir malignitedir. Yetmiþ dört yaþýnda erkek hasta son üç gündür süren kasýk aðrýsý ve þiþlik þikâyeti ile acil polikliniðimize baþvurdu. Fizik muayenede sað inguinal bölgede yaklaþýk 5x5 cm boyutlarýnda sert redükte edilemeyen kitle ve sað inguinal herni tespit edildi. Bilgisayarlý tomografide sað inguinal bölgede büyük bir herni kesesi ve içerisinde 77x55 mm ölçülerinde kitle saptanan hastaya radikal orþiektomi ve herni onarýmý yapýldý. Kitlenin patolojik deðerlendirmesinde paratestiküler leiomyosarkom tanýsý konuldu. Ameliyat sonrasý yedinci ayda lokal nüks veya uzak metastaz izlenmedi. Sonuç olarak paratestiküler leiomyosarkomlar nadir görülmelerine raðmen özellikle inguinal kitle ile baþvuran ileri yaþtaki hasta grubunda akýlda tutulmasý gereken bir durumdur.

Sarcomas that arise from the spermatic cord constitute 2.1% of soft tissue sarcomas and are observed at a rate of 1% to 2% in the genitourinary system. A 74-year-old patient presented at the emergency department with complaints of groin pain and swelling persisting for 3 days. On physical examination, a firm mass that was approximately 5x5 cm in size and could not be reduced was observed at the right inguinal area as well as a right inguinal hernia. Computed tomography revealed a large hernia sac in the right inguinal area and a mass that was 77x55 mm in size within the hernial sac. A radical orchiectomy and hernia repair were performed. A diagnosis of leiomyosarcoma was made based on the pathological evaluation of the mass. At the 7-month postoperative follow-up, no local relapse or distant metastasis was found. To conclude, although paratesticular leiomyosarcoma is rare, it should be kept in mind as one of the possible diagnoses for older patients presenting with an inguinal mass.

Venöz hava embolisi kafa ve göðüs bölgelerine künt travma maruziyeti, torasentez, arteryel kateterizasyon gibi giriþimler, vurgun hastalýðý, kardiyak ve nöroþirürji cerrahi operasyonlarý sonrasý ender olarak geliþebilmekte, geliþmesi halinde ise kardiyovasküler sistemde blokaj meydana getirerek ölüme yol açabilmektedir. Düþük miktarlardaki venöz hava embolileri sýklýkla asemptomatik olup, venöz hava embolisinin ölümcül olabilmesi için 75 cm3 ile 200–300 cm3 arasýnda hacme sahip havanýn dolaþýma geçmesi gerekmektedir. Zedelenmiþ sistemik ven yapýsýnýn içine giren hava dolaþým sisteminde önce sað atriyuma sonra sýrasý ile sað ventrikül ve pulmoner artere ulaþmaktadýr. Çalýþmamýzda üzerine televizyon düþmesi sonucu künt göðüs ve kafa travmasý geçiren, yapýlan incelemelerde kafatasý kemiklerinde deplase kýrýklar ve akut subdural-epidural hematom saptanmasý üzerine operasyona alýnan, ancak operasyon sýrasýnda ani kardiyak arrest geliþmesi üzerine öldüðü bildirilen üç yaþýndaki kýz çocuðu olgusu sunuldu. Küçük çocuðun yapýlan medikolegal otopsisinde saptanan venöz ve serebral hava embolisi ile birlikte diðer otopsi bulgularý sunularak, bu tür olgularda medikolegal otopsi uygulamasýnda dikkat edilmesi gereken noktalarýn ve geliþen ölümün patofizyolojisinin tartýþýlmasý amaçlanmaktadýr.

A venous air embolism can occur as a result of circumstances that include blunt head or chest trauma, thoracentesis, arterial catheterization, neurosurgery, cardiac surgery, and Caisson disease. The formation of a venous air embolism requires an air source, interaction between the air source and the vessel, and a pressure gradient supporting air migration into the vessel. Air enters through the impaired venous structure and travels to the right side of the heart and the pulmonary arteries, and depending on the amount of air, may occasionally be fatal. This report is the description of the case of a 3-year-old child who developed a fatal venous and cerebral embolism during neurosurgery for the treatment of skull fractures with epidural and subdural bleeding due to blunt head and chest trauma resulting from a television falling on her. The pathophysiology of death and notes regarding the medico-legal autopsy procedure in such cases are discussed. Meticulous autopsy techniques must be used to determine the presence of an air embolism in cases of blunt trauma, especially in patients with blunt trauma to the head who die during neurosurgery, and possible future malpractice claims should be kept in mind.