Mermilerde oluþan Ateþli Silah Yaralanmalarýnda, mermiye ait balistik özelliklerin, yaranýn þiddet ve derinliði üzerine etkilerini araþtýrmak amacýyla, düþük hýzlý tabanca ve yüksek hýzlý piyade tüfeði mermilerinin, doku simulanlarý üzerine etkileri deneysel olarak deðerlendirildi. Çalýþmada kullanýlan 7.65 tabanca mermisinin, kütlesi ile kalýcý kavite oluþturduðu, tüfek mermilerinin ise kalýcý kaviteye ek olarak deðiþik boyutlarda geçici kaviteye neden olduklarý gözlendi. Doku simulanlarý olarak %10 jelatin ve literatürde ilk kez parafin blok ve izli mermi kullanýlarak, statik ve dinamik olarak geçici kaviteler gösterildi. Yapýlan çalýþma ile, yüksek hýzlý mermilerle oluþan yaralanmalarda, geçici kavitenin yaptýðý blast etki sonucu, mermi yolunun çevresindeki dokularda, tedavi seçeneklerinde düþünülmesi gereken ek yaralanmalarýn olabileceði sonucuna varýldý.

Effects of low velocity pistol and high velocity rifle projectiles on simulated tissue was evaluated experimentally in order to determine the role of ballistic features of the bullet on severity and depth of the wound in Firearm Wounds made by bullets. It was observed that the 7.65 pistol projectile which was used in the experiment have created a permanent cavity with it mass and rifle projectile have created temporary cavities in different sizes in addition to permanent one. 10% gelatine and paraffin first time in literature was used as simulated tissue and both static and dynamic temporary cavities was shown by using guided bullet. By this study we have conclude that, in wounds resulted from high velocity projectiles, due to the blast effect of temporary cavities, additional injuries on tissues around the guide of bullet should be considered in choices of treatment.

Ameliyat sonrasý erken ve geç dönemde görülen karýn içi yapýþýklýklar, kullanýlan çok sayýda ilaç ve yönteme raðmen büyük sorunlar yaratmakta, morbidite ve mortalitenin artmasýna yol açmaktadýr. Çalýþmamýz, sýçanlarda geliþtirilen peritonit modelinde Piroksikam (Piroxicam) ve Disodyum kromoglikatýn (Disodium cromoglycate)yapýþýklýk oluþumu üzerine olan etkilerini araþtýrmak amacý ile planlandý. Spraque-Dawley cinsi 30 adet sýçan Piroksikam, Disodyum kromoglikat ve kontrol grubu olmak üzere üç gruba ayrýldý. Peritonit oluþturulduktan sonra karýn katlarý kapatýldý. 24 saat sonra karýn peritonit yönünden makroskopik olarak deðerlendirildi, mikrobiyolojik inceleme için kültür alýndý ve karýn sað ön-yan duvarýndan parietal periton ve kas tabakasýný içeren 1 cm2 'lik biopsi alýnarak peritonit oluþtuðu histopatolojik incelemelerle doðrulandý.Piroksikam 0.250 mg/kg, Disodyum kromoglikat 10 mgr/kg, birinci doz intraperitoneal, sonraki dozlar intramuskuler olarak toplam 5 gün uygulandý. Kontrol grubunda ise sadece peritoneal eksuda kuru tamponla silindi ve karýn kapatýldý. Ameliyat sonrasý 15. gün karýn sol kadrandan laparotomi yapýldý ve yapýþýklýklar gözlendi. Yapýþýklýklarýn yerleri ve þiddeti tespit edildi. Yapýþýklýðýn en yoðun olduðu yerdeki periton, visseral organ, ve/veya fibröz bantlar biopsi için alýndý. Mikroskobide iltihabi infiltrasyon, fibroblast aktivasyonu, damarlanma ve yabancý cisim dev hücresi reaksiyonu yönünden deðerlendirildi. Sonuç olarak çalýþmamýzda bir nonsteroid-antiinflamatuar ilaç olan Piroksikam'ýn yapýþýklýklarý önlemedeki etkisi olumlu yönde bulunmuþtur (p<0.001). Piroksikam'ýn immun yanýtý ne ölçüde etkilediði açýk olarak ortaya konulabilirse yapýþýklýk oluþumunun önlenmesinde kullanýlabilmesi mümkün olacaktýr.

In spite of the various drugs and methods that have been used, adhesions are still among the most common causes of morbidity and mortality in postoperative period. In our study, the effects of proxicam and disodium cromoglycate on adhesion formation were observed in an experimental model of peritonitis. Thirty Sprague-Dawley rats were divided into 3 groups as proxicam, disodium cromoglycate and control. After peritonitis was made, abdominal incision was closed. Twenty-four hours later, the abdominal cavity was evaluated macroscopically about the peritonitis. Specimens for culture and histopathological examination were obtained and existence of peritonitis was shown by those examinations. Piroxicam 0.250 mg/kg and, disodium cromoglycate 10 mg/kg were applied by intraperitoneal injection at the end of the operation and then by intramuscular injection. Duration of the treatment was 5 days. At control group peritoneal exudate was swept by gauze pads and abdominal cavity was closed. On postoperative 15th day adhesions were observed along the left lateral incision of laparatomy. The localizations and severity of adhesions were identified. The parts of periton, viscus and/or fibrotic band where the adhesion was dens, were obtained for histopathological examination. The microscopic examination was based on the evaluation of infectious infiltration, fibroblast activation, vascularization and foreign body giant cells reaction. As a result, piroxicam that is a non steroidal anti inflammatory drug was found to be effective on prevention of adhesions (p<0.001). Proxicam could be used in the case of preventing adhesion formation, if its effects on immune response was clearly shown.

Ateþli silah yaralanmalarýnda, mermide oluþan þekil bozukluðu (deformasyon) ve parçalanma (fragmantasyon), sýk karþýlaþýlan bir durumdur. Günümüzde çelik alaþýmýndan yapýlmýþ, sert uçlu tabanca mermilerinin aksine, piyade tüfeði mermileri genellikle yumuþak bakýr uçludur. Her iki tür merminin deformasyon ve fragmantasyon etkisi yapýlan statik ve dinamik deneysel çalýþma ile araþtýrýldý. Bu amaçla 7.65 tabanca ve G3 tüfek mermileri, yassý ve uzun kemikler ve yumuþak yað bloklarý ve jelatin kullanýldý. Çalýþma sonucunda, G3 tüfek mermisinin kolaylýkla þekil bozukluðu gösterdiði ve parçalandýðý, normal yapýdaki mermiye oranla etkisinin arttýðý saptandý.

Deformation and fragmentation of the bullet are frequently observed in firearm wounds. Contrary to hard tipped, steel alloyed pistol bullets, rifle bullets made of copper are comparatively softer. Deformation and fragmentation effects of each type of bullets were researched by static and dynamic experimantel studies. For this purpose bullets of 7.65 pistol and G3 rifle, flat and long bones, soft fat blocks and gelatine were used. After this study we have observed that bullet of G3 rifle could easily be deformed and fragmented, and its effect increased with respect to the normal bullets.

Bu çalýþmada antitrombotik ve fibrinolitik özellikleri olan heparin,düþük molekül aðýrlýklý heparin ve defibrotide'in postoperatif adezyonlar üzerine etkileri araþtýrýldý. Herbiri 7 denekten oluþan 6 çalýþma ve bir kontrol grubundaki deneklere, adezyon oluþturmak için çekum serozasýna 1 cm. insizyon yapýldý ve parietal peritondan 1x 1 cm'lik alan çýkarýlarak oluþan defektler tek tek konulan 4/0 ipek sütürlerle onarýldý. Her 3 ajan intraperitoneal tek doz ve sübkütan 7 gün süreyle uygulandý. Sekizinci gün yapýlan relaparotomilerde adezyonlar makromorfolojik olarak deðerlendirildi. Cilt altý olarak heparin düþük molekül aðýrlýklý heparin ve defibrotide uygulanan gruplarda brid oluþumu kontrol grubuna göre anlamlý olarak daha az bulundu.(p< 0.01 ). Intraperitoneal olarak tek doz uygulanan gruplarda ise, kontrol grubuna göre anlamlýlýk saptanmadý. (p> 0.05).

In this study, we investigated the effects of antitrombotic and fibrinolytic agents- heparine, low molecular weight heparine and defýbrotide on postoperative adhesions. In order to cause adhesion we made incision of 1 cm on ceacum serasa and excised a region of 1x1 cm peritoneum and repaired the defects with 4/0 separeted silk sutures. All 3 agents were given single intraperitoneal dose and 7 days subcuteneously form. Adhesions are assessed macromorphologically after relaparatomies made on the 8 day. Brids occured significantly less in groups that are given heparin, LMWH and defýbrotide subcuteneously compared to the control group, (p < 0.01). 0U groups that these agents were given intraperitoneally, there was no significant difference compared to the control group, (p > 0.05).

Travmaya baðlý inkomplet üretra rüptürleri geç dönemde üretral darlýk geliþmesine neden olabilir. Bu darlýklarýn optik üretrotomla tedavisi yaygýn olarak kullanýlan bir tedavi modelidir. Ekim 1994 Mart 1998 tarihleri arasýnda inkomplet üretra rüptürü nedeniyle sistostomize edilip, optik üretrotomla tedavi edilen 22 hasta, retrospektif olarak, preoperatif ve postoperatif retrograd / voiding sistoüretrografý, üroflowmetri parametreleri açýsýndan deðerlendirildi. Preoperatif üretrografilerde ortalama darlýk uzunluðu 11.82 + 6.12 mm, üroflowmetride ortalama Qmax deðerleri 7.36+ 2.63 ml/sn idi. Hastalarýn tümü optik üretrotomla tedavi edildi. Postoperatif Qmax deðerleri 19.36+6 ml/sn olarak saptandý. Ortalama takip süresi 21.18 + 9.56ay idi ve 16 hasta tek seansta tedavi edildi. 3 hastada rekürran darlýk geliþti ve bu hastalara ikinci seans optik üretrotomi uygulandý. 3 hastaya da benign prostat hiperplazisi için transüretral rezeksiyon yapýldý. Travmaya baðlý oluþan inkomplet üretra rüptürlerinde, iyatrojenik komplet üretra rüptürüne neden olmamak için hastalar baþlangýçta sistostomize edilip, geç dönemde reparasyon uygulanmalýdýr. Bu, yalnýzca tedavinin etkinliðini artýrmakla kalmaz, ayný zamanda komplikasyon oranýný da azaltýr.

Incomplete urethral ruptures due to trauma may lead to urethral stricture development in the late period. Treatment of these strictures by optic urethrotome is a commonly used treatment modality. Between October 1994 and March 1998, 22 patients that were cystostomized due to incomplete urethral rupture and treated by optic urethrotome evaluated retrospectively by preoperative and postoperative retrograde/voiding cystourethrographies and by uroflowmetry. Preoperative urethrographies showed stenosis with a mean length of 11.82 + 6.12 mm and mean Q max in uroflowmetry was 7.36+2.63 ml/sec. All of the patients were treated by optic urethrotome. Postoperative Q max was 19.36 +6 ml/sec.The average follow-up period was 21.18 +9.56 months and 16 patients treated in the first attempt. Recurrent stricture developed in 3 patients and those underwent a repeat optic urethrotome. Transurethral resection applied to 3 patients for benign prostatic hyperplasia. Patients who had incomplete urethral ruptures because of trauma should initially be cystostomized and repair should be applied in late period in order to avoid an iatrogenic complete rupture. This will not only increase the treatment chance, but also decrease the rate of complications.

Bu çalýþma, 1991-1997 yýllarý arasýnda, toraksa travmasý nedeniyle Ege Üniversitesi Týp Fakültesi Göðüs Kalp Damar Cerrahisi Anabilim Dalý'na acil olarak yatýrýlan 270 hastayý kapsamaktadýr. Retrospektif olarak incelenen olgular yaþ, cins, travma etkeni, eþlik eden organ yaralanmalarý, uygulanan tedavi yöntemi,morbitide ve mortalite açýsýndan araþtýrýlmýþtýr. Erkek/kadýn oraný 5.0, yaþ aralýðý ve ortalamasý sýrasýyla 19-68 ve34.8 olarak bulundu. Yaralanmalarýn! 85'i (%69) künt travma sonucu ortaya çýkmýþ olup etyolojide trafik kazalarý ilk sýrayý almaktaydý. Kayýtlara geçen 85(%31) penetre yaralanmadan 57si kesici-delici aletler tarafýndan oluþturulmuþtu. Yandaþ yaralanmalar arasýnda en sýk extremite fraktürleri, majör vasküler yaralanmalar ve batin yaralanmalarý izlendi. Olgularýn 37'sine (%14) torakotomi uygulanmasý gerekti ve bunlardan 19'u acil koþullarda opere edildi. Ortalama yatýþ süresi 8.7 gündü.Mortalite 6 olgu ile %2 oranýnda saptandý. Ateþli silah yaralanmalarýnýn morbiditeye ve yatýþ süresine etkisi istatistiksel olarak anlamlý bulundu (sýrasýyla p < 0.001 ve p < 0.05).

This trial comprises 270 cases of thoracic trauma urgently hospitalized at the Department of Thoracic and Cardiovascular Surgery of Ege University Medical Faculty, between 1991-1997. The cases were retrospectively assessed regarding age, sex, etiology of trauma, accompanying injury, treatment modality, morbidity and mortality. The male/female ratio was 5.0, while the age range and mean age were 19-68 and 34.8, respectively. 185 (69%) of the injuries were due to blunt thoracic trauma, and traffic accidents were the first-line in the etiology. Of the recorded 85 (31%) penetrating injuries, 57 were created with stabbing instruments. Among the associated injuries, extremity fractures, major vascular and abdominal injuries were encountered most frequently. Thoracotomy was required in 37 (14%) of the cases, and of these, 19 were operated under emergency conditions. The mean hospital stay was 8.7 days. The mortality rate was 2%, representing 6 patients, The effect of gunshot wounds to the morbidity and to the length of stay was determined to be statistically significant (p <0.001 and p < 0.05, respectively).

Travmatik diyafragma rüptürlerinin ilk baþvuru anýndaki taný güçlüðü, morbitide ve mortaliteyi arttýran en önemli nedendir. Erken tanýdaki güçlük, taný yöntemlerinin yetersizliði ve ek organ yaralanmalarýna baðlý oluþan klinik tablonun diyafgrama rüptürünü gizlemesine baðlýdýr. Bu çalýþmada, 1990-1996 yýllarý arasýnda Çukurova Üniversitesi Týp Fakültesi Kliniðinde 24 penetren diyafragmatik rüptür (Grup 1), 12 künt travmatik diyafragmatik rüptür taný ve tedavisi 12 saat ile 12 yýl geciken 3 olgu (grup 3) retrospektif olarak deðerlendirilmiþtir. Grup 1 ve Grup 2'deki olgularýn büyük çoðunluðunda ek organ yaralanmasý saptanmýþ ve taný tümünde laparotomi sýrasýnda konulmuþtur. Prolen mesh kullanýlan bir olgu dýþýnda konulmuþtur. Grup 3'teki olgularýn tanýsý akciðer ve bilgisayarlý tomografi ile konulmuþtur. Prolen mesh kullanýlan bir olgu dýþýnda, bütün diyafragmatik rüptürler primer olarak onarýlmýþtýr. Grup 1'de 1 olgu kaybedilmiþ,mortalite % 4; Grup 2'de 2 olgu kaybedilmiþ,mortalite%l6.6 olarak bulunmuþtur. Grup 3'teki olgularda ise mortalite oluþmamýþtýr. Bu çalýþmanýn amacý, göðüs ve karýn travmalý olgularda künt travmada olduðu gibi penetran yaralanmalarda da diafragma rüptürünü düþünmek gerektiðini vurgulamaktadýr. Eksplorasyon tamamlanmadan önce diyafragma rüptürü ekarte edilmelidir. Ayný zamanda, travmayý takiben akciðer grafisinde akciðer bazalinde ve diyafragma sýnýrýnda düzensizlik saptanan olgular, diyafragma rüptürü yönünden araþtýrýlmalýdýr. Diyafragma rüptürlü olgularda uygun tanýsal yaklaþýmlar hastayý geç dönem komplikasyon geliþiminden koruyabilir.

The difficulties in diagnosis of diaphragmatic herniation in the first admission are the common causes of morbidity and mortality. Inadequacy of diagnostic procedures and the severity of additional injured visceras are the main factors of morbidity and mortality. From 1990 to 1996,24 patients with penetrating injury and 15 patients with blunt injury were treated at department of General Surgery, School of Medicine, University of Çukurova. All of the patients with penetrating injury (Group 1) and 12 with blunt injury (Group 2) required emergency laparotomy. In the remaining 3 patients (Group 3), the diagnosis of diaphragmatic injury was delayed from 12hours to 12 years after injury. The vast majority of the Group 1 and Group 2 patients had injury to other organs, the diagnosis of diaphragmatic injury was made in almost all of them during emergency laparotomy. The diagnosis in Group 3 patients was made by chest roentgenogram alone or computed tomography. All diaphragmatic injuries repaired primarily except one which was repaired with prolene mesh. One of the Group 1 patients died, a mortality of %04, and 2 of the Group 2 patients died, a mortality of %16.6. All Group 3 patients recovered. This study suggests that diaghragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen. The presence of such an injury should be excluded before the termination of the exploratory procedure. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasised. Also, diaphragmatic injury should be suspected in patients with roentgenographic abnormalities of the diaphragm and lower lung field following trauma. The presence of diaphragmatic injury in such patients should be excluded with appropriate diagnostic studies to protect the patient from its late complications.

Bu retrospektif çalýþmada, Yüzüncü Yýl üniversitesi Týp Fakültesinde akut apendisit nedeniyle opere edilen 109 açýk, 37 laparoskopik apendektomi olgusunun sonuçlarý karþýlaþtýrýlmýþtýr. Ortalama ameliyat süresi açýk apendektomi (AA) yapýlanlarda 37, laparoskopik (LA) grupta 49 dakika idi. Apendektomi sonrasý oral gýdaya AA' da ortalama 36 saatte, LA'da 18 saatte baþlanabildi. Toplam komplikasyon oraný AA'da %14.7, LA'da %5.4 oldu. Analjezi ihtiyacý LA'da daha az idi. Yoðun yapýþýklýklar ve kanama nedeniyle 2 laparoskopik olguda açýða dönülmek zorunda kalýndý (% 5.4). Hastanede kalýþ süresi LA'da daha kýsa idi. Sonuç olarak, Laparoskopik apendektominin güvenli olduðunu ve hastaya belirgin bir konfor saðladýðýný düþünüyoruz.

Results of 109 open and 37 laparoscopic appendectomy cases which were operated because of acute appendicitis at Medical School Hospital of Yüzüncü Yýl University were compared in this retrospective study. Mean operation time was 37 minutes in those open appendectomies (OA) and 49 minutes in laparoscopic appendectomy (LA) group. Oral diet after appendectomy could be started in 36 hours in OA and in 18 hours in LA. The overall morbidity rate was 14.7%for the OA and 5.4% for the LA. Analgesic requirement was reduced in LA. We had to convert to open surgery in two laparoscpis cases because of intensive appendectomy is dependable and it provides a clear comfort for patient.

Eylül 1996 Haziran 1997 tarihleri arasýnda Çocuk Acil Servisimize baþvuran 78 travma olgusu retrospektif olarak deðerlendirilmiþtir. Olgularýn cinsiyet, yaþ, travma þekli, travmanýn hangi mevsimde olduðu, kazanýn olduðu yer, kazadan sonra ilk müdahale zamaný, yaralanan bölge ve pediatrik travma skoru deðerlendirilmiþtir. Hastalarýn %31'i kýz (%39.7), 47 'si erkek (%60.3) idi. Pediatrik travma skoru 7 12 arasýnda idi. Olgularýn %43.6 sý travma sonrasý ilk bir saat içinde çocuk acil servise getirilmiþti ve %7.7 'si ilk 24 saatten sonra çocuðun þikayeti olmasý nedeniyle getirilmiþti. Hastaneye getiriliþ saati ile hastanede daha uzun kalma arasýnda direkt iliþki saptandý.

Between September 1996-June 1997,78 pediatric trauma cases who were admitted to the Pediatric Emergency Clinic of Pamukkale University Hospital were evaluated according to sex, age, type of trauma, season, location of the accident, first treatment after trauma, injured organ and pediatric trauma score. Thirty one patients (39.7%) were girls and 47 patients (60.3%) were boys. Pediatric trauma score ranged between 7-12 Forty three point six percent of cases were admitted within the first hour after trauma. Seven point seven percent of the patients were brought 24 hours after the trauma due to the complaints of the children. We detected significant importance between hospital stay and time of admittance after trauma.

El yaralanmalarý günlük yaþamda çok sýktýr ve acil servis bölümlerinin iþ yükünde ilk sýralarda yer almaktadýr. Ön kol ve el özel karmaþýk iþlevleri nedeniyle farklý bir anatomiye sahip olduðu için ön kol ve elin yaralanmalarý çoðunlukla kombine yaralanmalar þeklinde olmaktadýr. El yaralanmalarýnýn tedavisinde temel amaç hastaya yaralanmýþ el fonksiyonlarýnýn çoðuna mümkün olduðunca erken zamanda sahip olabilmesini saðlayacak en iyi hizmeti vermektir. Bu nedenle erken primer onarým en uygun yaklaþýmdýr. Bu çalýþmada 2,5 yýl içinde (1.1.1995 - 30.6.1997) kliniðimize baþvuran 1937 el ve ön kol yaralanmasýný etiyoloji, yaralanma tipi ve özellikleri açýsýndan deðerlendirdik.

Hand injuries are very common in routine daily life and have first place in emergency department's workload. Forearm and hand have a distinct anatomy for its specific complex function, therefore its injuries are mostly combined injuries. Primary aim in treatment of hand injuries is to give the patient the best service for having the most of the injured hand' function in the earliest possible time. Therefore, early primary repair is the best option. In this study, we evaluated 1937 forearm and hand injuries presented to our clinic in a year period (1.1.1995 - 30.6.1997) with regard to etiology and type and characteristics of injuries.

Ters akýmlý ulnar önkol flebi, gibi el rekonstrüksiyonu amacý ile kullanýlan ince fasyokutan bir fleptir. Kliniðimizde palman bölge, tenor bölge, el dorsumu ve beþinci parmak rekonstrüksiyonu amacýyla oniki olguda kullanýlmýþtýr. Ters akýmlý ulnar önkol flebi rotasyon arkýnýn parmar bölgede olmasý, uzun pedikülü, yað dokusunun az olmasý ile ince ve kýlsýz deri taþýmasý, güvenilir olmasý ve donor alan özellikleri açýsýndan farklý özellikler taþýmaktadýr. Flep, kompleks el yaralanmalarý rekonstrüksiyonunda bir seçenek olarak sunulmaktadýr.

The reverse ulnar artery forearm flap is thin, pliable, reliable and mobile fasciocutaneous flap for hand reconstruction. We have used this flap in twelve cases for palmar reconstruction, thenar and first web space, dorsum of the hand, and fifth digit reconstruction. The flap differs from the radial forearm one with its rotation point is in the center of the palm, longer pedicle and the donor site caracteristsics. The flap offers a useful alternative in the reconstruction of complex tissue defects in the hand.

Posttravmatik gecikmiþ epidural hematomlarýn patogenezi tartýþmalýdýr. Bu çalýþmada 7 yeni olgu sunulmuþ ve daha önceden rapor edilmiþ 48 olgu gözden geçirilmiþtir. Kliniðimizde 7 yýllýk bir period süresince 74 epidural hematom olgusu arasýnda 7gecikmiþ epidural hematom olgusu saptandý. 5 olgu erkek (%71.4), 2 olgu bayan olup (%28.5) yaþ ortalamasý 16.7 yýldý (yaþ aralýðý: 11-21). Kabul sýrasýnda bir olgu hariç, Glasgow Koma Ölçeði puanlamalarý 11 ve daha üstündeydi. 6 olguda (%85.7) gecikmiþ hematoma komþu alanda fraktür mevcuttu. Hematomlarýn hiç biri ilk bilgisayarlý tomografi tetkikinde mevcut deðildi. Hematomlar travma sonrasý 3. Saat ve 6. günler arasýnda ortaya çýktý, ve en sýk karþýlaþan lokalizasyon frontal bölgeydi. 7 olgunun 3'ünde servikal travma mevcuttu. Hastaneye yatýþlarý ile gecikmiþ hematomun saptanmasý arasýndaki sürede 2 hastanýn nörolojik durumunda deðiþine olmadý, 3 hastada bozulma, 2 hastada düzelme oldu. 5 olgu opere edildi. Serimizde mortalite oraný %14.2 idi. Bize göre, beyin pulsasyonu ve kranial fraktür bu hematomlarýn patogenezindeki en önemli etyolojik faktörlerdir. Gecikmiþ epidural hematomlarýn tanýsý yüksek oranda þüpheyi ve tekrarlayýcý bilgisayarlý tomografik tetkikleri gerektirir. Nörolojik durumda bozulma tek baþýna güvenilir bir taný kriteri deðildir.

The pathogenesis of posttraumatic delayed epidural hematoma formation is controversial. In this study, 7 new cases were presented and 48 previously reported cases were reviewed. In our clinic, seven cases of delayed epidural hematoma were found among 74 patients with epidural hematoma during a seven-year period, Five were male (71.4 %), two were female (28.5 %), with a mean age of 16.7 years (range =11-21). All but 1 Glasgow Coma Scores were 11 or greater on admission. There were skull fractures at the site of delayed hematoma in 6 patients (85.7%). None of these hematomas were present on initial computed tomography scans. The hematomas appeared between 3 hours and 6 days after the trauma, and the most common localization was the frontal region. Of the 7 patients, 3 had cervical trauma. 2 patients remained neurologically unchanged between admission and delayed epidural hematoma detection,3 deteriorated, and 2 improved. 5patients were operated upon. The mortality rate was 14.2 %. In our opinion, skull fracture,and the brain pulsations are the most important etiologic factors in the pathogenesis of these hematomas. Diagnosis of delayed epidural hematomas requires a high index of suspicion and repetetive computed tomography scans. Neurological deterioration alone is not a reliable diagnostic criteria.

1.11.1996-31.10.1997 tarihleri arasýnda Ýstanbul Týp Fakültesi Ýlk ve Acil Yardým Anabilim Dalý'na kranyal-spinal travma nedeniyle baþvuran ve Nöroþirurji Anabilim Dalý'ndan konsültasyon istenerek yatýrýlan hastalar prospektif olarak deðerlendirildi. Acil birimine baþvuran 2520 olgudan 459'u yatýrýldý. Bunlarýn 120'si (%26) kadýn, 339'u (%74) erkekti. Yaþ daðýlýmýna bakýldýðýnda en fazla yoðunluðun 0-16 (%51) yaþ grubunda bulunduðu dikkati çekiyordu. Hastalarýn %44'ü doðrudan acil birime baþvururken, %66'sý baþka bir saðlýk kuruluþundan sevk edilmiþlerdi. Olgularýn %44'ü 08-16, %46'sý 16-24 ve %10'u 24-08 saatlerinde arasýnda baþvurmuþlardý. Travma nedenleri incelendiðinde %45 ile düþmenin ilk sýrada yer aldýðý, bunu %42 ile trafik kazalarýnýn izlediði dikkati çekti. Hastalarýn %15'inde politravma vardý. Giriþ Glasgow koma skalasýna (GKS) göre yapýlan deðerlendirmede %60'ý GKS-.14-15, %26'sý 9-13 ve %14'ü 8 ve altýndaydý. Hastalarýn %9Gsý kranyal, %3'ü spinal ve %1'i kranyal ve spinal birlikte yaralanmalardý. Ameliyat edilen 88 (%19) hastanýn, %34 ü epidural hematom, %20 si subdural hematomdu. Acil birimine giriþ ile tam arasýndaki süre %78'inde 0-2 saat, % l '/sinde 2-4 saat arasýndaydý. Ameliyata alýnan hastalarýn %81'i taný konduktan sonraki ilk dört saat içinde ameliyat edildi. Hastalarýn Glasgow Çýkýþ Skalasýna göre deðerlendirildiðinde %75'inde tam iyileþme, %7sinde orta derecede sakatlýk, %4'iinde ciddi derecede sakatlýk ve %13'ünde ölüm saptandý.

The patients admitted to the Accident and Emergency Department of the Medical Faculty of Istanbul for craniospinal trauma between 1/11/1996 and 31/10/1997 were prospectively evaluated. From 2520 patients that were consultated by Neurosurgery Department at the Emergency Department 459 patients were admitted to the wards. From this group 120 (%26) were women and 339 (%74) were men. Regarding the age distribution the patients between 0-16 ages consisted the major group (%51). %66 of the cases were referred from other medical facilities, whereas %44 of the appliances were directly made to our Emergency Department. %44 of the cases were admitted between the hours 08-16, %46 between 16-24 and%10 between 24-08. Regarding the causes of trauma falls (% 45) were in the first place followed by motor vehicle accidents (%42). %15 of the cases had trauma more than in one system. When the cases were compared regarding the Glasgow Coma Scale (GCS) at admission, %60 were between GCS 14-15, %26 were between GCS 9-13 and%14 were under GCS 8. %96 of the patients had cranial injuries, %3 had spinal injuries and %1 had both. From the operated 88 patients %34 were epidural hematoma and %20 were subdural hematoma. The time interval between admission and diagnosis in %78 of the cases were 0-2 hours and in%17 of the cases 2-4 hours. %81 of the operated patients were operated on in four hours after the diagnosis was made. Regarding the outcome scale %75 were good, % 7 were moderate disabled, %4 were severely disabled and %13 were death.

Trakeobronþiyal travmaya baðlý rüptürler toraks travmalarýnýn %1/2 sinde görülür. Erken tanýsý zordur, mortalitesi yüksektir. 7 ay önce trafik kazasý geçiren ve bilateral hemopnömotoraks tanýsýyla toraks tübü konarak tedavi edilmeye çalýþýlan 8 yaþýnda bir erkek çocuk hasta tarafýmýzdan sað total atelektazi tanýsýyla kliniðimize yatýrýlmýþtýr. Klinik ve radyolojik çalýþmalar sonunda sað ana bronþ rüptürü tesbit edilmiþtir.Tedavi amacýyla yapýlan sað torakotomiyle göðüs boþluðuna girilmiþ ve bronþ, karinaya reanastomoze edilmiþtir. Postoperatif dönemde ortaya çýkan þilotoraks konservatif olarak tedavi edilmiþ ve hasta post op. 16 gün taburcu edilmiþtir. Vaka teþhis ve tedavi açýsýndan örnek oluþu nedeniyle incelenmiþ ve yayýnlanmýþtýr.

Tracheabronchial rupture is a serious and occasional lesion with an incidence of 1/2 %after major chest trauma. It has high mortality and one may have difficulties in its early radiological and clinical diagnosis. An 8-year-oldmale with a 7 months history of traffic accident and tube thoracostomy due to bilateral hemopneumothorax was admitted to our clinic with the diagnosis of right total lung atelectasis. After radiological and clinical diagnostic studies complete right main stem bronchus rupture was diagnosed. We performed right thoracotomy and anastomosed right main bronchus to the carina. Chylothorax, winch developed in the postoperative period, was treated with conservative methods and the patient discharged on the 16th day with cure. We discuss this rare traumatic rupture of the right main bronchus case because of its interesting diagnose and treatment methods.

Ýzole pankreas travmasý seyrek olarak görülür. Bu tür travmalar bazen düþük enerjili kuvvetler tarafýndan oluþturulur. Çalýþmamýzda bisikletten düþmeyle meydana gelen izole pankreas bir travmasý literatür eþliðinde incelenmektedir. Pankreas travmasýnýn tanýsý güçtür. Bu olguda peritoneal lavaj, kan amilaz seviyesi, sonografi ve BT tanýya yardým etmedi. Böylece taný gecikti, ancak baþarýlý bir cerrahi sonrasýnda hasta þifa ile taburcu edildi.

The trauma of pancreas is seen rarely. These kind of traumas, sometimes can be made by low energic forces. In this paper, an isolated pancreatic trauma, by falling from a bicycle, is reviewed by the help of literature. Diagnosis of isolated pancreatic trauma is difficult. Interestingly, in this case peritoneal lavage, blood amilase level, sonografi or CT didn't help the diagnosis. So, the diagnosis is delayed. After a successful surgery, the patient is dismissed by getting well.

Lomber disk cerrahisinde vasküler komplikasyonlar nadirdir. Ortaya çýkan komplikasyonlar akut ve kronik olarak ikiye ayrýlýrlar. Akut komplikasyonlar þok þeklinde daha ameliyat masasýnda kendini gösterirken, kronik belirtiler, pseudoanevrizmaya ait basý semptomlarý yada majör arteryo-venöz fistüle baðlý konjestif kalp yetmezliði þeklinde ortaya çýkabilir. 35yaþýnda bayan ve 24 yaþýndaki erkek hastalarýmýzda lomber disk cerrahisi sonrasý geliþen hemorajik þok tablosunda acil müdahalede bulunulurken 36 yaþýndaki bayan hastamýz lomber disk cerrahisi sonrasý 2. yýlda ortaya konan sað iliak arteryo-venöz fistül nedeniyle elektif þartlarda opere edilmiþlerdir. Vakalarýmýz halen sorunsuz takip edilmektedir. Majör damarlara baðlý komplikasyonlar ne kadar erken ortaya konulup cerrahi tedavisi yapýlýrsa mortalite de o ölçüde azalacaktýr. Lomber cerrahi geçirmiþ ve nedeni ortaya konamayan konjestif kalp yetmezliðinde majör A-V fistül araþtýrýlmalýdýr.

Vascular complications in surgery of lomber disc are very rare. These complications can be either acute or chronic. Acute complications like hemorrhagic shock can be seen peroperatively. Symptoms like pressure of pseudoanevrism or congestive cardiac failure because of major arterio-venous fistula can be seen at postoperative period. 35 year old female and 44 year old male patients had hemorrhagic shock symptoms after the surgery of lomber disc were reoperated in the early postoperative period. 42 year old male patient who had been operated 2 years before was reoperated because of iliac arterio-venous fistula. If major vascular complications can be recognised and treated early the mortality rate will be low. In patient who have congestive cardiac failure with a history of lomber disc surgery, major arterio-venous fistula should always be remembered in the differential diagnosis

Omuriliðin penetran yaralanmalarý sýklýkla ateþli silah yaralanmalarý sonucunda olur. Býçaklanmayla oluþan kesici omurilik yaralanmalarý nadirdir. Bu makalede, býçaklanma sonucunda meydana gelen torakal omurilik yaralanmalý bir olgu bilgisayarlý tomografi (BT) ve manyetik rezonans görüntüleriyle (MRG) birlikte nadir görülmesi nedeniyle yayýnlanmýþtýr.

Penetration injuries of spinal cord are frequently caused by gun-shot wounds but very rare by stab wound. A dorsal spinal cord injury case caused by stab wound is reported with the evolution of computed tomography (CT) and magnetic resonance imaging (MRI) in this manuscript.

Boyun sol ön bölgesinden kesici aletle yaralanma sonucu acil birimimize gelen hastaya yapýlan özofagoskopide servikal özofagusda perforasyon gözlendi. Ameliyata alýnan hasta izole özofagus yaralanmasý görüldü. Primer onarýldý. Postoperatif 7 gün nazogastrik tüp yoluyla enteral beslenme uygulanan hasta postoperatif 10. Gün taburcu edildi.

Patient was admitted to our emergency unit with penetrating stab wound on the left front neck. We performed esophagoscopy and observed the esophageal perforation. Primary repair was done. Patient was followed in the bed for 7 days with nasogastric tube. She was sent home on the tenth day postoperatively.