Majör karaciðer cerrahisinde özellikle karaciðer yaralanmalarý ve karaciðer tümörlerinde per-operatif kan kaybý hem hastanýn mortalitesi hem de morbiditesi açýsýndan önemlidir. Kansýz bir alan insanlarda Pringle manevrasý ile saðlanýr. Pringle manevrasý potansiyel olarak tehlikeli hepatik parankim iskemisine neden olur. Ýskeminin zararlý etkileri iskemi sýrasýnda oluþmakla birlikte, daha büyük hasarýn reperfüzyon sonrasýnda geliþtiði gösterilmiþtir (6-8). Bu çalýþmada karaciðer rezeksiyonu esnasýnda geride kalan karaciðer dokusunda iskemi reperfüzyon hasan karaciðer fonksiyon testleri, serbest oksijen radikalleri ile birlikte histolojik olarak incelendi ve prostaglandin E2'nin karaciðer iskemi-reperfüzyon hasarýný önlemekte yararlý olup olmadýðý araþtýrýldý. Çalýþma Haydarpaþa Numune Hastanesi Deney Hayvanlarý Araþtýrma Laboratuvarý'nda gerçekleþtirildi. Çalýþma 300-350 gr aðýrlýðýnda Albino-Wistar cinsi 24 erkek sýçanda yapýldý. 30 dakikalýk iskemiyi takiben % 70 hepatektomi gerçekleþtirildi. Karaciðer rezeksiyonunda sürekli iskemi ve reperfüzyon yapýlarak PGE2 nin etkisi araþtýrýldý. Karaciðer fonksiyon testlerinden ALT ve AST deðerleri post-op 1. gün hýzla yükseldi. Ý/R+PGE2 grubunda bu yükselme Ý/R grubuna göre çok daha azdý. AST ve ALT 7. gün hýzla normale döndü. Alkalen fosfataz yine Ý/R grubunda daha fazla yükseldi, 7. gün maksimum deðerine yükseldi, her iki grup arasýndaki anlamlý fark kapandý ve 21. gün düþme eðilimine girdi. Serum bilirubin düzeyleri yükselmekle birlikte her iki grup arasýnda anlamlý fark saptanmadý. Gama-GT düzeyleri her iki grupta da yükselmiþ, ancak Ý/R grubunda düþme daha yavaþ olmuþtur. Yine LDH düzeyleri Ý/R grubunda yüksek bulunmuþ, tüm gruplarda 7. ve 21. günlerde düþme eðilimi göstermiþtir. Sonuç olarak, karaciðer rezeksiyonu ile sürekli iskemi reperfüzyon modelinde PGE2 nin iskemi-repefüzyon hasarýný önlemede etkiliði olduðu, karaciðer fonksiyonlarýnýn erken dönemde bozulup hýzla düzeldiði, karaciðer kütlesinin 3 haftada eski düzeylerine yaklaþtýðý görüldü.

In major liver surgery especially in liver trauma and liver tumor, per-operative blood loss is important in patient's mortality and morbidity. A bloodless field is achieved by Pringle maneuver. Pringle maneuver causes potentially dangerous hepatic parenchymal ischemia. Although harmful effect of ischemia occurs during ischemia, it has been shown that much more harm occurs during reperfusion. In this study, ischemia reperfusion injury was examined by liver function tests, free oxygen radicals and with histologic examination in rest of liver tissue during liver resection and also PGE., was investigated if it is useful to prevent the liver ischemia reperfusion injury or not. This study was carried out at Haydarpaþa Teaching Hospital Experimental Animal Laboratory. 24 Albino Wistar male rats weighing 300-350 grs. were used f or the study. Following 30 minutes ischemic period 70 % hepatectomy was done and during liver resection the effect of PGE2 was investigated by doing ischemia and reperfusion. The levels of ALT and AST were rapidly elevated on the first day of post operative period. In IR + PGE2group this elevation was remarkably less if compared to IR group. ALT and AST levels rapidly turned to normal levels on the seventh day of post operative period. Alkaline Phosphatase was also elevated in IR group more and reached to maximum level on the seventh day. The significant difference between groups was disappeared and on the twenty first days declined. Serum bilirubin levels were elevated but there was no significant difference between two groups, gamma GT levels were elevated in both groups but the decrease observed in IR group was slower. Also LDH levels were higher in IR group and inclined to decrease on 7th and 21 st days. In conclusion, PGE2 is assessed to be useful to prevent ischemia reperfusion injury in liver resection. Liver function tests are bad in early period but rapidly become normal. It is seen that liver masses come to normal in three weeks.

Yakýn zamanda yapýlan çalýþmalara göre serbest oksijen radikalleri birçok patolojik süreçte rol oynamaktadýrlar. Yazarla gastrik stres ülserlerinde serbest oksijen radikallerinin patojenik rolünü araþtýrmýþ ve tokoferolün (vitamin E) terapötik potansiyelini deðerlendirmiþlerdir. 40 diþi Wistar Albino rat dört eþit gruba ayrýlmýþtýr (n= 10).Grup 1 de hiçbir iþlem yapýlmamýþ, diðer gruplarda ise stress oluþturulmuþtur. Grup 2 tedavi edilmemiþ, Grup3'e sadece ranitidin verilmiþ, Grup 4'e ise ranitidin ve tokoferol (vitamin E) kombinasyonu uygulanmýþtýr. 24 saat sonra tüm hayvanlar sakrifiye edilmiþ, biyokimyasal analizler, patolojik inceleme ve chemilüminesan ölçümler için örnek alýnmýþtýr. Glukoz düzeyleri dýþýnda biyokimyasal analizler açýsýndan 4 grup arasýnda anlamlý fark bulunamamýþtýr. Grup 3 ve 4 'de grup 2 'ye göre anlamlý olarak düþük ülser indeksleri ve chemilüminesan deðerler bulunmuþ ancak ayný deðerler açýsýndan Grup 2 ve 3 arasýnda anlamlý bir fark bulunamamýþtýr. Bizim çalýþmamýz serbest oksijen radikallerinin ülserojenik etkilerini göstermiþtir ancak tokoferolün gastrik stres ülserinde tedavi edici etkisini göstermek için daha detaylý bilgilere ihtiyaç vardýr.

Recent studies have demonstrated that free oxygen radicals were involved in many pathologic processes and significant improvements were gained by using radical scavengers in numerous human diseases. The authors surveyed the pathogenic role of free oxygen radicals in gastric stress ulceration and evaluated the therapeutic potency of Tocopherol (Vitamin E) as a radical scavenger in the management of this disease. Forty female Wistar albino rats were randomized into four equal groups (n= 10). Nothing was done to group LTlie other three groups were stressed. Group 2 was not treated, group 3 was given ranitidine alone and group 4 was administered a combination of ranitidine and tocopherol (vitamin E). Twenty four hours later, all the animals were sacrificed and samples were taken for biochemical analysis, pathologic-anatomic examination and chemiluminescence measurements. No significant differences were found among the four groups in terms of the results of biochemical analysis except the glucose levels. Significantly lower ulcer indexes and chemiluminescence values were found in both Group 3 and 4 in regard to Group 2, but the difference between Group 2 and 3 was not significant in terms of the same values. Our study has demonsrated the ulcerogenic effects of free oxygen radicals but more detailed data are required for evaluation of the ameliorating potency of tocopherol as a radical scavenger in gastric stress ulceration.

Mayýs - Kasým 1995 tarihleri arasýnda kliniðimize akut karýn ön tanýsý ile yatýrýlarak peritonit bulgularýnýn saptanmasý üzerine acil operasyona alýnan ardýþýk 20 olgu ile kolelithiasis tanýsýyla elektif kolesistektomi uygulanan ardýþýk 20 olgunun lökosit, amilaz, plazma ve periton laktat deðerleri araþtýrýldý. Akut karýn tahmin etmedeki deðerleri açýsýndan diskriminant analizi ile incelendiðinde periton laktatýnýn ve periton- plazma laktat farkýnýn tüm vakalar için anlamlý sonuç verdiði saptandý. Duyarlýlýk ve özgüllüðün % 100 olmasý için periton-plazma laktat farkýnýn 1,5 mMol/L veya fazla olmasý gerektiði sonucuna vardýk. Bulgularýmýz akut karýn tanýsýnýn açýklýk kazanmadýðý hastalarda periton- plazma laktat farkýnýn yararlý tamsal bir indeks olduðunu göstermiþtir.

From May 1995 to November 1995, in our clinic 20 consecutive patients hospitalized with acute abdomen disease and undergone an emergent operation due to peritonitis symptoms and 20 consecutive patients undergone elective cholecystectotmy operations due to cholelithiasis are included in this study. Leucocyte, amylase, plasma and peritoneal lactic acid levels an determined. Peritoneal lactate and peritoneal minus plasma lactate difference are found to be meaningful for all cases when studied with discriminant analysis for their values in assessing acute abdomen disease. We concluded that in order to get 10 percent sensitivity and specificity, periton and plasma lactate difference must be equal to or more than 1,5 mMol/L. Our findings show that when acute abdomen disease cannot be cleared by other means, the difference between periton and plasma lactates is a useful diagnostic index.

Bu çalýþmada yüksek hýzlý mermi (YHM) ile oluþan batýn yaralanmalarýnda, eþlik eden üriner sistem yaralanmalarýna olan yaklaþýmlarýmýz ve organ koruyucu cerrahinin uygulanabilirliði deðerlendirildi. YHM'ye baðlý batýn travmasý nedeniyle opere edilen 42 olgu yaþ, yaralanma ve operasyon arasý süre, eþlik eden organ yaralanmasý, travma skoru, kan transfüzyonu, morbidite ve mortalite yönünden deðerlendirildi. 3 olgu (% 7.1) hipovolemik þok nedeniyle kaybedildi. 9 (% 21.2) olguda böbrek, 2 (% 4.7) olguda üreter ve 1 (% 2.3) olguda mesane yaralanmasý tesbit edildi. 6 (% 66.6) olguya unilateral nefrektorni uygulanýrken böbrek yaralanmalý 9 olgunun 6'sýna (% 33.3), üreter ve mesane yaralanmalý olgularýn ise tümüne (100 %) primer onarým ve rekonstrüksüyon uygulandý. YHM' ye baðlý penetran böbrek yaralanmalarýnda organ koruyucu cerrahi ve vasküler rekonstrüktif cerrahi þansýnýn az olduðu üreter, mesane ve blast etkiye baðlý oluþan minör böbrek yaralanmalarýnda ise bu yöntemlerin daha uygulanabilir olduðu sonucuna varýldý.

In this study, we evaluated the results of surgical treatment of urinary injury due to penetrating abdominal high velocity missile (HVM) and the probability of performing organ preserving surgery. 42 military conscripts who were operated for penetrating abdominal injury with HVM were evaluated for age, trauma and operation interval, trauma score, associated organ injury, mean blood transfusion, morbidity and mortality rates. 3 (7.1 %) patients were lost because of hypovolemic shock Unilateral renal injury was observed in 9 (21.2%) patients while ureteral injuries in 2 (4.7%) and bladder injuries in 1 (2.3 %) patients. Nephrectomy was performed on 6 (66.6%) of 9 renal units while primary repair and reconstruction were performed on 3 (33.3 %) and all (100%) ureteral and bladder trauma patients. It was concluded that although the chance for organ preservation and vascular reconstructive surgery is lower in penetrating renal injuries, but it is higher for ureter, bladder and minor renal injuries due to blast effect of high velocity missile.

Posttravmatik Beyin Omurilik Sývýsý Fistülleri (PBF) kafa travmalarýnýn morbidite ve mortaliteye neden olan ciddi komplikasyonlarýndan biridir. Sýklýkla rinore ve otore þeklinde görülürler ve travmadan sonraki ilk hafta içinde akut olarak baþlayabilecekleri gibi, nadir olarak aylar ve hatta yýllar sonra bile ortaya çýkabilmektedirler. Bu retrospektif çalýþmada, 2850 kafa travmasý olgusundan PBF tesbit edilen 48 (% 0.16) olgu sunuldu. Trafik kazasý 34 (% 70) olgu ile en sýk etyolojik neden idi. Onbeþ (%31.5) olguda temporal kemikte fraktür; bunlardan 8 inde ek olarak petroz kemikte fraktür, 31 (% 64.5) olguda paryetal kemikte fraktür; bunlardan 12 sinde ek olarak ethmoid kemikte fraktür, ayrýca 2 (% 4.1) olguda fronto-paryetal açýk çökme fraktürü ile birlikte ön fossada ve ethmoid kemikte fraktür tesbit edildi. Rinore 35 (% 73) olguda, otore 13 (% 27) olguda tesbit edildi. Travma sonrasý bir aydan geç baþvuran iki olgu (kronik) ve travmadan sonraki 48 saatten sonra baþvuran diðer iki olgu (subakut) hariç tüm olgular travmadan sonraki ilk 48 saat içinde (akut) hastanemize baþvurdular. Konservatif tedaviye cevap vermeyen 10 olguya bifrontal kranyotomi ile ön fossa eksplorasyonu þeklinde ekstradural ve/veya intradural cerrahi giriþim uygulandý. Olgulardan sadece birinde defekt primer olarak onarýlabildi, 8 olguda galea grefti ve bir olguda da serbest fasya lata grefti, ayrýca ek olarak bunlardan 8 inde fibrin doku yapýþtýrýcýsý, birinde siyanoakrilat kullanýldý. Tüm olgularda %100 iyileþme saðlandý, hiç bir olguda postoperatif fistül tesbit edilmedi. Menenjit kabul edilen 2 olgu dýþýnda hiçbir olguda menenjit geliþmedi. Tüm olgular ikili antibiyotik kombinasyonu ile proflaktik tedaviye alýndý. Posttravmatik beyin omurilik sývýsý fistüllerinde konservatif tedavinin ve proflaktik antibiyotik tedavisinin önemi, dirençli olgularýn cerrahi endikasyonlarý ve uygun cerrahi yaklaþým literatür gözden geçirilerek tartýþýldý.

Posttraumatic Cerebrospinal Fistulas (PBF) are serious complications of head trauma which may cause to morbidity and mortality. Usually, they present with rhinorrhea or otorrhea, and they occur acutely in the first week after the trauma, rarely months and years later. In this retrospective study, from 2850 patients suffered head trauma, 48 (% 0.16) of them had PBF. The most frequent etiology was traffic accident in 34 (% 70) cases. Fifteen (%31.5) of all cases had temporal bone fracture; 8 of them had also petrous bone fracture, 31 (% 64.5) cases had parietal bone fracture; 12 of them had also ethmoid bone fracture, 2 (% 4.1) cases had fronto-parietal open depression fracture, also with fracture in the anterior fossa and the ethmoid bone. Rhinorrhea was encountered in 35 (% 73) cases, and otorrhea in 13 (% 27) cases. All patients, except four of them, admitted in 48 hours after the trauma (acute). Ten patients were treated surgically who were unresponded to the conservative treatment. Bifrontal craniotomy with extradural and/or intradural anterior fossa eksploration was performed. Primer repair could be achieved only in one case, eight cases were treated with galea greft, one case with fascia lata greft. Additionally, 8 cases needed the use of fibrin glue, and one case siyanoacrilate. The success of surgical treatment was 100%, and no postoperative fistul formation was observed. Two cases had meningitis on admission. During hospital stay, any case in this series developed meningitis. All patients were treated with prophylactic two combinations antibiotic therapy. For the precise evaluation of PBF, the efficacy of the conservative treatment and prophylactic antibiotic therapy, surgical indications of resistant cases, and appropriate surgical treatment was discussed with literature review.

Travmalar morbidite ve mortalitesi yüksek olan bir halk saðlýðý sorunudur. Tedavi edici hizmetler yanýnda koruyucu önlemlerde önem taþýmaktadýr. Kafa travmalarý ve buna baðlý beyin yaralanmalarý bu yüksek morbidite ve mortalitenin önde gelen sebeplerindendir. Kliniðimizde kafa travmasý tanýsý ile yatýrýlýp tedavisi yapýlan 1680 hasta yaþ, cins, travmanýn sebebi, geliþlerindeki klinik durumlarý ve hastanede kalýþ süreleri açýsýndan deðerlendirildi. Sonuçta hastalarda ilk sýrada trafik kazalarý, sonra da yüksekten düþme en sýk travma sebebi olarak bulunurken, çocukluk yaþ grubunda düþmeler en sýk travma sebebi olarak izlendi. Hastanede yatýþ süresi en uzun olan grup yetiþkin yaþ grubu erkeklerdi. Ateþli silah yaralanmalarý en fazla mortaliteye sebep olan yaralanmalardý. Bu sonuçlara bakýldýðýnda; kafa travmalarýnýn sýk karþýlaþýlan, morbidite, mortalite ve ekonomik kayýplarý yüksek olan bir halk saðlýðý sorunu olduðu, bu sorunu çözmenin sadece tedavi edici hekimlik hizmetleri ile deðil koruyucu ve önleyici halk saðlýðý hizmetleri ile mümkün olabileceði görülmektedir.

Trauma is the leading cause of increased morbidity and mortality of the recent decades. Head trauma and its complications are the major contributors for this high morbidity and mortality. We retrospectively studied 1680 patients who were hospitalized and treated for head trauma and its complications. Their ages, sexes, causes for trauma, initial clinical status, hospitalization times were analysed. As a result it was seen that most frequent cause for head trauma was traffic accidents followed by falls. In the pediatric age group falls was the primary cause of head trauma. The most prolonged hospitalization time was seen in the adult male group. Gunshot wounds of the head were generally mortal. As a result we think that the head traumas are a kind of public health problem and its not possible to manage it just by medical or surgical precautions, but preventive public health precautions are also necessary.

Haziran 1991-Ekim 1998 tarihleri arasýnda kliniðimizde tedavi edilen 15 penis fraktürlü hasta retrospektif olarak deðerlendirildi. Hastalarýn yaþ ortalamasý 29.8 yýl (21-49 yýl) idi. On olguya erken cerrahi, 5 olguya konservatif tedavi uygulandý. Postoperatif komplikasyon oranlarý cerrahi grupta % 10 (yara enfeksiyonu gibi) ve konservatif grupta ise % 40 (penil kurvatür ve fibröz plak gibi) idi. Cerrahi tedavi uygulanan hastalarda hastanede kalýþ süreleri 2-5 gün (ortalama: 4.1 gün), konservatif tedavi uygulanan hastalarda ise 5-14 gün (ortalama: 8.6 gün) olarak tespit edildi. Sonuç olarak penis fraktürü tedavisinde erken cerrahinin uygun, etkili hastanede kalýþ süresi kýsa ve komplikasyon oraný düþük bir tedavi modalitesi olduðu kanaatine varýldý.

Fifteen patients with fracture of the penis were treated conservatively or surgically between June 1991-October 1998 at our clinic. Average age of the patients was 29.8 years, with range from 21 to 49 years. Ten of patients were treated surgically, immediately after the diagnosis was established, whereas 5 were treated conservatively. Postoperative complications were 10% in surgical group such as wound infection and 40 % in conservative group such as penil curvature and fibrous plaque. The duration of hospital stay in surgically treated patients ranged from 2 to 5 days (average: 4.1 days), in conservatively treated patients ranged from 5 to 14 days (average: 8.6 days). In conclusion, we think that early surgical treatment is useful, effective, short hospitalisation duration and has low complication ratio in penil fracture management.

Fleksör tendon ameliyatlarýndan sonra sýklýkla hareket kýsýtlýlýðý ve fonksiyon kayýplarýyla karþýlaþýlýr. Erken rehabilitasyon programlarýnýn uygulanmasýyla kalýcý fonksiyon kayýplarý en aza indirilebilir. Þubat 1996 ile Kasým 1998 tarihleri arasýnda Trakya Üniversitesi Týp Fakültesi Plastik ve Rekonstrüktif Cerrahi Anabilim Dalý'nda el yaralanmasý nedeniyle ameliyat edilen ve fleksör tendon kesisi olan 16'sý erkek, 5'i kadýn toplam 21 hasta bu çalýþmaya dahil edildi. Hastalara ameliyat sonrasý 4. günde Kleinert metoduna göre erken mobilizasyona baþlandý. Üçüncü haftanýn sonunda atel çýkarýlarak rehabilitasyon programý 8. haftaya kadar sürdürüldü. Erken mobilizasyonun etkinliði retrospektif olarak incelendi. Bütün sonuçlar Stringland kriterlerine göre deðerlendirildiðinde 17 olgu mükemmel, 2 olgu iyi, 1 olgu orta ve 1 olgu kötü olarak bulundu.

Motion restriction and functional loss are frequently encountered after flexor tendon operations. Permanent functional loss can be minimized by application of early rehabilitation program. This study includes 16 male and 5 female patients which were operated for flexor tendon injuries in Trakya University School of Medicine between February 1996 and November 1998. Early mobilization with Kleinert technique was begun on the 4th post operative day. After 3 weeks the Kleinert splint was removed and rehabilitation program was continued until the post operative 8th week. Effectiveness of postoperative early mobilization was investigated retrospectively. Overall results by Strickland's criteria 17 cases were excellent, 2 cases were good, 1 case was fair and case was poor.

Batýna penetre delici kesici alet yaralanmalarýnda (DKAY) tedavide gecikmenin morbidite ve mortaliteye etkisini incelemek amacýyla, periton lavajý (PL) yapýlarak takip edilen fakat tedavide 8 saatten fazla gecikilen hastalar retrospektif olarak deðerlendirildi. Batýna penetre DKAY olan ve PL ile takip edilen 66 hastadan 37 (% 55.6) sine konservatif tedavi uygulandý. Geriye kalan 29 (% 44.4) olguda ise içi boþ organ yaralanmasý düþünüldü. Bunlarýn 7sinde tedavi en az 8 saat gecikirken geriye kalan hastalar ilk 6 saat içinde ameliyat edildiler. Tedavide gecikilen 7 hastanýn 2 (% 28.8)'sinde ileum, 2(% 28.8)'sinde kolon ve jejunum, 2 (% 28.8)'sinde kolon ve 1(%1.4.4) inde duodenum yaralanmasý mevcut idi ve hastalarýn hepsinde lezyonlar primer onarým ile tedavi edildi (Duodenum yaralanmasýna primer onarýma ek olarak tüp duodenostomi de eklendi). Bu 7 hastadan birinde yara infeksiyonu geliþti (% 14). Diðer hastalarda postoperatif dönem sorunsuz seyretti. Batýna penetre DKAYlarýnda, olgularýn PL ile takip edilmeleri içi boþ organ yaralanmalarýnýn taný ve tedavisinde gecikmelere neden olabilir. Ancak tedavide belirli bir süre gecikmenin morbidite ve mortaliteyi arttýrmadýðý gözlendi.

The effect of delayed therapy in abdominal stab wound injuries and morbidity and mortality rates were evaluated retrospectively in the patients who were followed diagnostic peritoneal lavage (DPL) and if necessary who were operated on with a minimum delay of 8 hours. There were 66 cases with stab wound injuries in our series. In 37 patients (%55.6) conservative treatment was done after DPL. But the others had hollow organ injuries. 29 patients (% 44.4) were assessed after DPL and performed operation immediately. But 7 of these patients (%24.2), the treatment was performed at least 8 hours delay and 2 of them (%28.8) had ileum ruptures. There were colonic and jejunal ruptures in 2 patients (%28.8), in 2 patients (%28.8) colonic ruptures and duodenum rupture in one patient (% 14.4). All of these injuries were managed with primary sutures. Duodenostomy was added in the duodenal injury. Wound infection was presented in only one patient. There was no complication in the other patients. As a result, it has been observed that conservative therapy can cause delay in diagnosis and treatment of patients with hollow viscus injuries in abdominal stab wound injuries. But there will be no effect on mortality and morbidity rates in these patients if the patients are observed by peritoneal lavage closely.

Bu çalýþmanýn amacý, kliniðimizde tedavi edilen damar yaralanmasý olgularýnýn nedenleri, teþhis metodlarý, tedavisi ve sonuçlarýna ait verileri tartýþmaktýr. Yaklaþýk 45 aylýk dönemde kliniðimize 82 damar olgusu baþvurmuþ olup, bu olgulara ait veriler retrospektif olarak deðerlendirilmiþtir. Olgularýn 10 tanesinde sadece venöz yaralanma mevcuttu. Diðer olgularda ise arteriyel ve/veya venöz yaralanma tesbit edildi. Yaralanma nedenleri arasýnda ilk sýrayý (%47,5) kesici delici alet yaralanmasý almaktaydý. Tanýsal amaçlý giriþimlerden konvansiyonel anjiografi, sadece 10 olguda (%12) kullanýldý. Tedavide ise, 28 (%34) olguda otojen interpozisyonu, 22 (%27)olguda reanastomoz uygulandý. Olgularýmýzýn mortalite ve amputasyon oraný %8.5 idi. Damar yaralanmalarýnda,erken teþhis ile birlikte uygun tedavi hasta yaþamýnýn ve ilgili ekstremitenin fonksiyonlarýnýn korunmasý açýsýndan önemlidir. Yeterli taný imkanlarý olmayan merkezlerde bile, vasküler travma durumlarýnda birçok olguda ayrýntýlý taný teknikleri gereksinimi olmadan, uygun taný ve tedavi uygulanabileceði kanaatindeyiz.

The aim of this study is to discuss the data consisting of the causes, diagnostic methods and outcomes of the patients that we have hospitalized and treated. Through a 45 months of period the data of 82 cases with vascular injury were assessed retrospectively. Ten cases of these 82 cases had venous injuries only. The rest of the cases had arterial and/or venous injury of vascular system. The most frequent type of damages were cutting/penetrating machines(47,5%). Diagnostic conventional angiography was applied in only (12%).Treatment was autogenous vein interpositioning in 28 (34%) cases, reanastomosis in 21 cases (27%). The mortality and amputation rates were (8,5%). Immediate diagnosis and proper treatment were important in vascular injuries in order to protect the patient life and the related extremity functions. In conclusion, in some centers that haw limited facilities, proper diagnosis and treatment may be available, without a detailed assesment.

Yabancý cisim aspirasyonlarý acil tedavi gerektirir. Bu nedenle de her bölge hastanesinde tedavi edilmesi gereken bir antitedir. Yabancý cisim aspirasyonlarýnýn tedavisinin bazý temel prensipleri olmasýna karþýn, her olgunun kendine özgü özellikleri vardýr. Kliniðimizde 61 olguda yabancý cisim aspirasyonu nedeniyle bronkoskopi yapýldý. Genel yabancý cisim aspirasyonu konusu yanýnda bazý özel sorunlar tartýþýldý.

Foreign body aspirations are required emergent treatment. It needs to be treated in every regional hospital because of this reason. Although there are some general principals in the management of foreign body aspirations, every case varies to some extent. Broncoscopy was performed in 61 cases with foreign body aspiration in our clinic. Besides the general principals of the management of foreign body aspiration, some special problems were also discussed.

Bu çalýþmada abdominal büyük damar yaralanmasý nedeniyle cerrahi geçiren hastalardaki morbidite ve mortaliteyi etkileyen faktörleri araþtýrmak için kliniðimizde 1986-1998 yýllarý arasýnda abdominal büyük damar yaralanmasý nedeniyle ameliyat edilen 29 hasta retrospektif olarak incelendi. Hastalarýn 21'i erkek 87 kadýn, genel yaþ ortalamasý 32 idi. Yaralanmanýn nedeni 6 hastada künt, 23 hastada ise penetran idi. Yaralanmadan sonra hastalarýn acil servise geliþ süreleri ortalama 65 dakika iken, acil servisten ameliyata kadar geçen süre ortalama 34 dakika idi. Hastalarýn ortalama travma þiddet skoru 19.7olarak tespit edildi. Hastalara peroperatuvar dönemde ortalama 5500 mL kan transfüzyonu yapýldý. Vena kava inferior, abdominal aorta ve iliak venler en sýk yaralanan damarlar idi. Birden fazla abdominal damar yaralanmasý 8 hastada tespit edilirken, 21 hastada sýklýkla ince barsak ve kolon olmak üzere 34 adet ilave intraabdominal organ yaralanmasý bulundu. Tedavide 31 hastaya basit sütürasyon, 5 hastaya ligasyon ve 3 hastaya dacron greft uygulandý. Abdominal aorta ve vena kava inferior yaralanmalarýnda mortalite diðer yaralanmalara göre daha yüksek olup serideki aperatif mortalite ortalama %41 idi. Sonuç olarak vasküler tamir tekniklerindeki artan tecrübeye, gecikmeksizin uygulanan cerrahi eksplorasyona raðmen hayatý tehdit eden abdominal büyük damar yaralanmalarý hala yüksek operatif mortalite ile sonuçlanmaktadýr.

In this study 29 patients were retrospectively evaluated who were operated for abdominal vascular injuries in our clink between 1986 and 1998 in order to detect the factors affecting morbidity and mortality in patients undergoing surgery due to the abdominal vascular injury. Out of 29 patients 21 were male and 8 female and the average age was 32 years. The cause of the injury was blunt in 6 patients and penetrating in 23 patients. The average time from field notification to patients arrival in the emergency department was 65 minutes, from emergency department to arrival to operating room was 34 minutes. Mean trauma severity score was 19.7. The mean blood requirements in these patients was 5500 ml in the preoperative period. The inferior vena cava, abdominal aorta and iliac veins were injured most frequently. While more than one abdominal vascular injury was determined in 8 patients, 34 associated intraabdominal organ injuries including mostly small intestine and colon were found in 21 patients. Treatment including simple suture (n =31), ligation (n =5), and dacron grafts (n=3). The mortality rate was higher in abdominal aorta and vena cava injuries compared to other vascular injuries. The overall mortality rate was 41%. In conclusion, despite the increasing experience in vascular repair methods and surgical explorations carried out without delay major abdominal vascular injuries threatening the life still result in high operative mortality.

20% of all spine injuries are cervical spine injuries. Surgical treatment of these injuries must take into account the great mobility of this part of the spinal column. Therefore, biomechanical aspects must be considered, especially in the upper cervical spine, C1 and C2 (1). In this paper, a case of a fresh type II fracture, according to Anderson & D'Alonzo classification, of the odontoid process treated firstly with posterior approach and secondly with direct screw fixation is reported. A 52-year-old man complained of severe neck pain and limitations of neck motions following a hit on his forehead incurred in a falling accident in moving vehicle. Neurological examination was normal. Cervical spine x-ray films and axial and tree D-CT and MR scans revealed a fracture at the base of the dens. Five days after the injury, the patient operated with posterior approach, wiring of atlanto-axial bone and grafting with autologue iliac wing bone was performed. 5 month after operative procedures, no fusion was seen and with a second operation, this odontoid fracture was directly fixed with a K screw by an anterior cervical approach. Immediately after the operation, his neck pain disappeared. He returned to his previous job 1 months after second surgery without any limitation of his neck movement. For proper assembly of this method, the following two points are particularly recommended: a screw insertion perpendicular to the fracture plane and the use of an optimal screw with both the desired total and thread lengths.

Büyük villöz adenomlar belirgin olarak rektumda yerleþirler ve sýklýkla rektum karsinomu ile birliktedirler. Çoðu zaman yumuþak ve parçalanabilir olmalarýna karþýn, nadiren tam barsak týkanmasýna da yol açabilirler. Nadir olarak þiddetli sývý ve elektrolit kaybýna yol açan aþýrý diyare ile karakterli ilginç bir sendrom oluþturabilirler. Cerrahi öncesi yoðun replasman tedavisi gereklidir. Artmýþ malignite geliþim sýklýðý nedeniyle, mating dokunun bulunup bulunmadýðýný tam bir eksizyon ile saptamalýdýr. Malignite barýndýran büyük villöz adenomlu bu olgu sönümünün amacý, rektumun bir adenomatöz polipi olan bu özel formunu tanýtmak ve uygun tedavi seçeneklerini tartýþmaktadýr.

Several methods are present for treatment of frontal sinus fractures and those are still controversial. In this article, eight cases with frontal sinus fracture and our treatment modalities were presented. Our treatment methods were compared with the methods which were recommended in the literature are discussed.

Peutz - Jeghers Syndrome is a rare, inherited autozomal dominant disease characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. In this paper we report two cases of Peutz -Jeghers syndrome who were admitted and operated with intussusception. Screening their family members revealed intestinal and extraintestinal manifestations of the disease and no malignancy was detected.

Alt gastrointestinal kanaldan olan akut kanamalarýn etkin tedavisi, tanýsal ve tedavisel hatalarýný önlemek üzere yapýlan ardýþýk araþtýrmalarla belirlenen esnek bir yaklaþým gerektirir. Tanýsal çalýþmalarýn özgül olarak sýralanmasý temel olarak hastanýn klinik durumuna ve kanamanýn hýz ve yapýsýna baðlýdýr. Ýzole sað kolon divertüküler hastalýðýna, þiddetli alt gastrointestinal kanamanýn kaynaðý olarak sýk rastlanmamaktadýr. Sol taraf ile karþýlaþtýrýldýðýnda, izole sað kolon divertüküler hastalýðý divertükülit ve fistülizasyona göre daha sýk oranda þiddetli kanama ile ortaya çýkmaktadýr. Ayrýca, kanama için cerrahi sað kolon hastalýðýnda sola oranla daha çok gerekmektedir. Uygun tedavi için acil ve doðru taný esastýr. Bu olgu sunumunun amacý tekrarlayan ve kendiliðinden duran kanama ile baþvuran bir izole sað kolon divertüküler hastalýðýnýn klinik özelliklerini vurgulamak ve deðerlendirme basamaklarýný ve cerrahi tedavisini tartýþmaktýr.

The effective management of acute bleeding in the lower part of the gastrointestinal (GI) tract requires a flexible approach of sequential investigations to prevent diagnostic and therapeutic errors. The specific sequence of diagnostic studies is determined primarily by the clinical status of the patient and by the rate and pattern of the bleeding. Isolated right-sided diverticular disease (IRSDD) as a source of massive lower GI bleeding is relatively infrequent. In comparison with left-sided (LS), IRSDD tended to present more often with profuse bleeding than with diverticulitis and fistulation. Surgery for bleeding was also required more often for RS than for LS disease. The need for urgent and accurate diagnosis is essential f or proper management. The aim of this case report is to characterize the clinical entity of IRSDD presenting with recurrent self-limited bleeding and to discuss the evaluative steps and surgical treatment.