Hospital records of patients who had extremity injuries caused by high energy gunshots and land-mines and treated in Þýrnak Military Hospital between January 1997 and July 1999 were reviewed retrospectively. Among 236 cases 147 (62.3%) had lover extremity wounds and 89 (37.7%) had upper extremity wounds. The most frequently injured part was hands for the upper extremity and feet for the lower extremity. The most dramatic wounds were caused by slapping on anti personnel mines trapped with anti tank mines. The localization and the extension of the wounds worries with type and power of the gun, the position of the victim at the time of explosion and the distance between the victim and the gun.

Two hundred forty-eight patients were operated for perforated peptic ulcer between 1983 and 1998. Of the patients 112 (45.1%) had chronic, 34 (13.7%) had acute ulcer history and 102 (41.2 %) had no ulcer history. Of the patients 228 (92.0%) had duodenal, 9 (3.6%) had juxtapyloric, 6 (2.4%) had marginal, and 5 (2.0%) had antral ulcer. Forty two patients (16.9%) admitted within 12 hours and 206 patients (83.1%) between 12 hours and six days after perforation. Simple closure and omental patch was performed in 32 patients (12.9%) who had severe concomitant illness and 126 (50.8%) intraabdominal sepsis, truncal vagotomi + pyloroplasty in 32 (12.9%), simple closure + omental patch + truncal vagotomi + gdstroenterostomy in 34 (13.7%), simple closures omental patch + pariatal cell vagotomy in 21 (8.5%), truncal vagotomi + antrectomy in 3 (1.2%). Patients who didn't have definitive procedure received H2 receptor blockers or proton pomp inhibitors. One hundred ninety-three patients (77.8%) underwent endoscopic control. Two of 53 patients with definitive procedure (3.8%) and 34 of 140 patients (24.3%) with simple closure had recurrence. Two patients in simple closure group underwent pariatal cell vagotomy, the others received medical treatment. The recurrence rate was significantly higher in simple closure group (p<0.01).

Traffic accidents, which influence to every age group people, are an important public health. This study to determine which condition it has happened more, which days, months and years it has happened, what things have caused to happen traffic accidents. The study was made in Erciyes University Medical School Emergency Department. 31550 patients applied to emergency department in a period of twelve months in 1998. 7098 (22%) cases of these were traffic accidents. It has done on 710 patients who have been brought to emergency by traffic accidents, and 10% systematic sampling of 7098 people. 504 (71%) of patients were male, 206 (29%) of them were female, the average age was 26.0 (min-max: 1-85). It was observed that traffic accidents occurred during peak times 1200-1800 p.m. The number of traffic accidents was higher during the weekends and in may and June than other times. All the accidents occurred in the same way both within and outside urban area. But the drivers hit the pedestrians more in the urban area. Although it has been seen 'the cars' in the accidents the most. The most mortality has been occurred in bus, minibus and motorbike accidents. The first treatment place of the casualties of 80.5% was at university emergency department. 619 all of the casualties who were admitted the university emergency department was simple injured. They all left the hospital with cure. 52 of casualties lost their life. As a result, some risk factors increase incidence of traffic accidents. Considering these risk factors in taking measures is of great importance in prevention of traffic accidents. Morbidity and mortality are affected by place where accidents occur, time of accident, properties of motor vehicles, and quality of medical care performed following the incident.

21 patients with gunshot wounds were retrospectively evaluated. They were 19 male and 2 female, age range was 9-24. All of the patients underwent a plain x-ray and computed tomography evaluation. 9 patients had intracerebral hematoma, 4 had subdural hematoma, 1 had epidural hematoma and 1 had intraventricular hematoma. 9 patients were observed to have bullet in the cranium. All the patients with glascow coma scale 3-5 at the admittance died. 15 patients underwent surgical treatment. 3 patients had cerebrospinal fluid fistula postoperatively and underwent reoperation. Extensivity of the lacereted brain, localization of the lesion and the glascow coma scale at the admittance affect the outcome in gunshot wounds.

Aim: To determine the diagnostic values of magnetic resonance imaging and computed tomography and characteristics of the lesions in traumatic lesions of the corpus callosum. Cases and methods: In 49 cases with traumatic lesions of the corpus callosum whose Glasgow Coma Scale (GCS) scores were 12 or under, presence and characteristics of the lesions of corpus callosum were evaluated retrospectively. All of the cases had both of MRI and CT scans at early posttraumatic periods. Results: In 20 patients (40.8%) there were 31 lesions. There were lesions in only 7 of 20 patients that had lesions in MRI. Despite most of lesions (87%) were nonhemorrhagic in MRI, 3 of 7 lesions (42.8%) were nonhemorrhagic in CT. Lesions were limited to the splenium in 7 of 20 patients (35%). In other cases there were lesions at anterior regions of corpus callosum with or without splenial lesions. There were more lesions of brain stem and subcortical white matter in patients with corpus callosum trauma than ones without, but differences were not statistically significant. Conclusions: Traumatic lesions of the corpus callosum are frequently seen in moderate and severe head injury. Most of the lesions are nonhemorrhagic and localized in splenium. The diagnostic value of MRI is rather high than of CT in traumatic lesions of corpus callosum.

We have evaluated retrospectively adult trauma patients admitted to the Dokuz Eylül University Hospital Emergency Department (ED) between 1.1.1997 - 30.6.1997 by the aim of contributing epidemiological data about trauma related injuries of Turkey. Among the 1063 study patients, 626 patients were male, 437 patients were female and mean age of the patients was 40.6 ± 18. The most common causes of injury was fall. The revised trauma score lesser than 12 was 75 patients. It has been determined that 90.8% of the patients were brought to ED by the vehicles other than the ambulance. Among all patients, 872 patients (82%) were discharged from ED, 118 patients (11.1%) were admitted, 73 patients (6.9%) were referred to another hospitals and 13 patients (1.2%) were died. We have determined the significantly increased hospital admission rate in the subgrups of the penetrating trauma patients, patients older than 65 years old (p=0.001 and 0.003, respectively) and the significantly increased operative intervention and death in penetrating trauma patients (p=0.000 and 0.009, respectively).

The tracheobronchial injuries are seldom, but life threatening. Their successful diagnosis and treatment require a high level of suspicion. In this report, we reviewed our experience with seven patients with tracheobronchial injuries due to blunt thoracic trauma, treated over the past 10 years. Definitive diagnosis was recognized with bronchoscopy after clinical suspicion. Most injuries were located in the right bonchial tree (five patients), whereas only one patient had an injury located in the left bronchial tree and one in trachea. The majority of the injuries were repaired primarily (five patients) and two required lobectomy. There were no postoperative mortality: but three postoperative complications were noted; one empyema and two partial stenoses on the repair line.

Mechanical intestinal obstructions form important part of pathologies those necessitates emergent surgical intervention. Length of time between symptoms and surgery, preference of surgical procedure and prevention of recurrence are still under discussion. While the most frequent etiological factor is postoperative adhesions in developed countries, strangulated hernias are more common in developing countries. In this study, among 147 cases operated on with the diagnosis of mechanical intestinal obstruction between 1993-1999, 80 strangulate were 50 males (%62,5) and 30 females (%37,5). Mean age was 59 years (range 4-94). The most frequent type of hernia was inguinal hernia and observed in 49 cases. Small intestine was detected most frequently in hernia sac. In 14 cases (%17,5), beside hernia repair, additional surgical interventions were performed. Total morbidity was %22,5 and mortality was %7,5. Patients with mechanical intestinal obstruction should be evaluated for abdominal wall hernias because of high incidence of tried surgical intervention have high morbidity and mortality rates, elective surgery should be recommended when abdominal wall hernia is diagnosed.

The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laseration due to blunt body trauma. In this study there are eight patients with isolated UP J laseration, admitted to Gulhane Military Medicine Academy, Fýrat University Medical Faculty Urology department, and Elazýð Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG (Ultrasonography), IVP(Intravenous Pyelograpy), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.

We treated 19 patients with iatrogenic ureteral injuries during a 10- year period. Gynecologiacal operations were the most common surgical procedures (52.6%). The diagnosis of ureteral injury was made immediately in 6 patients and was delayed 14 to 180 days in 13. Five of the 6 injuries recognized during the operation were repaired successfully at the time of injury; one patient resulted a nephrectomy. Seven of the lately recognized 13 patients were treated with percutaneous nephrostomy and the first treatment. The two patients were made ureteroneocystostomy, one was made ureteroureterostomy and one had ureterolysis in the other five patients. We observed ureteral stenosis in the three patients after the operation follow ups. The treatment was achieved with the endourological approach at these patients. Finally, we recommend percutaneous nephrostomy as a first treatment choice in the lately recognized iatrogenic ureteral injuries, while the immediate diagnosis and treatment of iatrogenic üreteral injuries, are severely important.

Since January 1998, non-operative management of blunt splenic trauma has become the preferred method for the selected paediatric and adult patients in our clinic. Of the 26 patients who were admitted to our clinic because of blunt splenic trauma between January 1998 and May 2000, 20 were elected for non-operative management according to our protocol which was primarily based on hemodynamic status regardless of the age and grading of the injury. Diagnostic computed tomography (CT) was obtained in the patients with non-operative management. Non-operative management rate was 76.9% for patients with blunt splenic trauma (83.3% and 71.4% for the paediatric and adult patients, respectively). All of these cases were managed conservatively without any complication and no mortality was observed. Six patients required emergent surgical exploration based on preoperative evaluation. In all of these 6 cases, associated injuries were present. No significant differences were found with regard to the age of operative and non-operative management groups (p=0.421). The mean operative splenic injury grade was 3 in the patients who underwent surgery, and the mean injury grade based on CT scan was 2.6 in the patients who were managed conservatively (p=0.572). The mean duration of hospitalisation in the patients with operative and non-operative management groups were 7.6 and 8.6 days, respectively (p=0.572). The mean unit of blood transfusion in the patients with operative and non-operative management groups were 1.1 and 0.6, respectively (p=0.453). Our data revealed that hemodynamic stability is the most important factor which could effect the selection of patients for non-operative management outcome regardless of the patient age and computed tomography scan grading of the injury.

Aspiration pneumonia due to gastroesephageal reflux is a frequent complication in ICU. The most commonly chosen method for long-term enteral access is gastrostomy and this method also reduces the risk of aspiration and shortens the hospital stay. We evaluated 31 patients in whom PEG was performed between 1997-98 in our unit. Indication of PEG was long-term ICU stay and coma which necessitate long term enteral nutrition. Mean age of our patients were 60.5 (19.4). We evaluated the aspiration by clinical inspection. Aspiration and interruption of feeding was observed 1.57 (1.43) times before PEG and 0.67 (0.73) times after PEG. Further more positive tracheal aspirate culture were seen 3.14 (1.95) times before PEG and 1.52 (1.47) times after PEG.

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malasia, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionaly, Urinoma is dranied percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrosthomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary-flep and ureteroneocystostomy and at one ureterouretenostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous draniage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

To evaluate our experience in chest trauma we review the records of the patients admitted for chest trauma to our service between December 1994 and April 2000. There were 126 patients (113 males, 89.7%), with an age range of 7 to 96 years (mean 35.3). The most frequent cause of chest injury were traffic accidents 48 cases (38%) and 73 cases (57.9%) were victims of blunt trauma. In 36 cases there was a politrauma. Hemo and/or pneumothorax represented the most common thoracic injury (85.7%). Rib fractures were present in 47 cases (36.2 % with more than 3 rib fractures). Four patients sustained flail chest and 5 defect of thoracic wall. Six patients were pulmonary contusion and 8 intraparenchymal haematom. Pleural drainage was performed in 106 cases (8 cases bilateral) and thoracotomy was indicated in 11 (6 cases emergency). Mortality was 6.9% (n: 8), of which 4 belonged to politrauma group. Mortality is directly related with politrauma. In the patients of the chest trauma, agressive diagnostic and therapeutic approaches in association with intensive care follow-up remains one of the most important points to decrease mortality and morbidity rate.

Acute pancreatitis and hyperlipidemia during pregnancy is a rare but life-threatening condition for both mother and fetus. In this article, we reported two cases suffered from acute pancreatitis and hyperlipidemia; 24 -year old pregnant women and 40 year old non-pregnant women. The risks of the pregnancy in this situation were also discussed.

Ascaris Lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.