AMAÇ: Kompartman içi basýnç (KÝB) monitarizasyonu özellikle tibia cisim kýrýklarýnýn intramedüller çivilemesinden sonra sýkça kullanýlan bir izlem yöntemidir. Ýlizarov sirküler fiksatör (ÝCF) ile tespit yapýlan tibia kýrýklarýndaki KÝB deðerlerinin intramedüller telleme (ÝMT) ile yapýlanlardan daha düþük olabileceði öngörüldü. Bu çalýþmada, ÝCF ve ÝMT ile tespit yapýlan tibia kýrýklarýnda KÝB deðerleri karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: Yirmi Yeni Zelenda Beyaz tavþanlarý rastgele ÝCF (Grup 1) ve ÝMT (Grup 2) olmak üzere iki gruba ayrýldýlar. Anestezi altýnda tavþanlarýn sað tibialarýnýn üst yarýsýnda kýrýk oluþturuldu. Tibia kýrýklarý Grup 1’de ÝCF, Grup 2’de ÝMT ile tespit edildi. Kompartman içi basýnç deðerleri 48 saat boyunca altýþar saat arayla ölçüldü.
BULGULAR: Kompartman içi basýnç deðerlerinde her iki grup içinde önemli farklar vardý (p<0.001). Ayrýca, her iki grupta KÝB deðerleri ameliyat sonra ilk 24 saatte önemli derecede artarken, ikinci 24 saatte azalmýþtý. En önemlisi de, ÝCF grupta KÝB deðerleri ÝMT gruptakine göre, 30, 36 ve 42. saatlarda önemli derecede düþüktü (p<0.05).
TARTIÞMA: Tespitten 24 saat sonra, ÝCF grubundaki KÝB deðerleri ÝMT’ye göre daha düþüktü. Bu sonuçlar tibia kýrýklarýnda ÝCF kullanýmýnýn ön kompartmanda ek dekompresyon saðladýðýný göstermektedir. Bu bulgularýn ýþýðýnda, ÝCF uygulamasý kompartman sendromu riski taþýyan yüksek riskli tibia kýrýklarýn tedavisinde tercih edilebilir.

BACKGROUND: Intracompartmental pressure (ICP) monitoring is a widely used modality, particularly after intramedullary nailing of tibial shaft fractures. It was hypothesized that ICP value in fracture fixed with Ilizarov circular fixator (ICF) might be lower than in fracture fixed with intramedullary pin (IMP). The present study is a comparison of ICP value in tibial fractures in a rabbit model fixed with ICF and IMP.
METHODS: Twenty male New Zealand White rabbits were randomly divided into 2 groups of equal size: ICF group (Group 1) and IMP group (Group 2). Under anesthesia, half of proximal part of the right tibia of all rabbits was fractured. Tibial fractures were fixed with ICF in Group 1 and IMP in Group 2. ICP values were monitored at 6-hour intervals for 48 hours.
RESULTS: There was statistically significant difference in ICP value between groups (p<0.001). While there was statistically significant increase in ICP values 24 hours post surgery, there was statistically significant decrease during second 24 hours following surgery. Most importantly, ICP values of ICF group were significantly lower than those of IMP group at 30, 36, and 42 hours post surgery (p<0.05).
CONCLUSION: At 24th hour after fixation, ICP values measured in ICF group were lower compared with those of IMP group. These results indicate that use of ICF in tibial fractures provides additional decompression in the anterior compartment. In light of these findings, ICF may be preferable for treatment of tibial fractures with high risk for compartment syndrome.

AMAÇ: Kýrýk iyileþmesinin gecikmesi ortopedi ve travmatoloji kliniðinin baþlýca sorunlarýndan biridir ve özellikle defektif kemiklerde iyileþme gecikmesi veya kaynamama görülmektedir. Bu çalýþmamýzda defektif kemik dokunun iyileþmesinde ticari bir ürün olan ve klinik pratikte greft olarak sýkça kullanýlan demineralize kemik matriks (DBM) ve kandan üretilen ve birçok büyüme faktörü içeren trombositten zengin plazmanýn (TZP) defektif kýrýk modelinde kýrýk iyileþmesi üzerine etkileri incelendi.
GEREÇ VE YÖNTEM: Kýrk sekiz adet Albino-Wistar tipi sýçan 12’li gruplar halinde dört gruba ayrýldý ve sað önkollarýnda dorsal insizyon ile radiuslarýna ulaþýlarak radiuslarýnda diafizden kemik çapýnýn iki katý kadar defektif kemik modeli oluþturuldu. Dört adet sýçan ise iþlem öncesi sakrifiye edilerek intrakardiak kanlarý alýndý ve uygun santrifüj iþlemleri sonrasýnda TZP hazýrlandý. Ýlk grup kontrol grubu olarak ayrýldý ve kostatom ile oluþturulan kemik defekti olduðu gibi býrakýlarak primer kapatýldý. Ýkinci grupta defekt alaný TZP ile greftlendi ve primer kapatýldý. Üçüncü grupta defektif alan TZP+DKM kombinasyonu ile greftlenirken son grupta defekt alaný DKM ile greftlendi ve primer kapatýldý. Ýþlem sonrasý onuncu haftada sýçanlar yüksek doz anestezik madde ile sakrifiye edilerek sað önkollarý diseke edildi, defekt alaný radyolojik ve histopatolojik parametreler ile incelendi.
BULGULAR: Radyolojik olarak incelendiðinde TZP grubunda ve daha sonrada DKM grubunda kemikleþmenin daha iyi olduðu gözlendi. Histopatolojik inceleme sonucunda ise kaynama kalitesi açýsýndan kontrol grubuna göre diðer gruplarýn iyi olduðu fakat TZP grubunda kaynama kalitesinin diðer çalýþma gruplarýna göre daha iyi olduðu görüldü. Korteks geliþimi ve yeniden þekillenme açýsýndan incelendiðinde TZP grunbunda sonuçlarýn daha iyi olduðu ve yeni kemik oluþumu açýsýndan deðerlendirildiðinde ise de TZP, TZP-DKM ve DKM gruplarýnýn kontrol grubuna göre daha iyi olduðu gözlendi.
TARTIÞMA: Çalýþmamýz TZP’nin defektif kemik iyileþmesi üzerine olumlu etkilerini gösteren in vitro þartlarda yapýlmýþ bir hayvan deneyidir. Bu bulgular eþliðinde deðerlendirldiðinde defektif kemik iyileþmesinde TZP ve DKM’nin etkisinin ayný olduðu fakat birlikte kullanýmýnda birbirlerinin etkilerini arttýrmadýðý kanaatine varýlmýþtýr. Trombositten zengin plazmanýn otolog kandan ve ameliyathane þartlarýnda dahi üretebiliyor olmasý, ek bir maliyet ve ek morbiditeye neden olmamasý nedeniyle ticari bir ürün olan DKM’nin bir alternatifi olabileceðini düþünmekteyiz.

BACKGROUND: Delayed union of fractured bone is one of the main problems of orthopedics and traumatology practice. It was hypothesized that the beneficial effects of allogeneic platelet-rich plasma (PRP) would be valuable in the treatment of segmental bone defects. This study is a comparison of the effects of demineralized bone matrix (DBM) and PRP in a segmental bone defect model.
METHODS: Total of 48 Wistar albino rats were separated into 4 groups. Segmental bone defect was created at right radius diaphysis in all specimens using dorsal approach. Four additional rats were used as PRP source. Intracardiac blood was withdrawn before the operation for preparation of allogeneic PRP. Group 1 (n=12) served as control group and defects were left untreated. Group 2 (n=12), was PRP group, and received grafting with PRP. Group 3 (n=12) was PRP+DBM combination group, and was treated with grafting and mixture of DBM and PRP. In Group 4 (n=12), defect area was grafted with DBM only. At the end of 10th week, rats were sacrificed, forearms were dissected, and defect areas were examined with radiological and histopathological parameters.
RESULTS: Radiological evaluation revealed that ossification was best in PRP group, followed by DBM group. According to results of histopathological studies, union quality was better than control group in all treatment groups (Groups 2, 3, and 4), and was best in PRP group (p<0.05). Results were also better in PRP group when examined in terms of cortex development and remodeling (p<0.05). When examined in terms of new osteogenesis, results were comparable in Groups 2, 3, and 4, but all were better than control group.
CONCLUSION: It was concluded that PRP and DBM have comparable effect on recovery of defective bones, but there is no synergistic effect when used together. We believe that PRP can be a cost-effective, readily available alternative to DBM with minimal morbidity.

AMAÇ: Akut pankreatitli (AP) olgulardaki sistemik enflamatuvar cevap ve pankreas dýþý vital organ bozukluklarý aktive olmuþ nötrofillerin fonksiyonlarý ve ürünleri olan serbest oksijen radikalleri aracýlýðýyla oluþur. Çalýþmamýzda, deneysel AP süresince sistemik histopatolojik deðiþiklikler ve nötrofil fonksiyonlarý üzerinde antioksidan N-asetilsistein’in (NAC) etkilerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu deneysel çalýþma eþit olarak üç gruba ayrýlmýþ 24 Wistar-albino sýçan üzerinde gerçekleþtirildi. Grup 1: Yalnýz laparotomi grubu, grup 2: Taurokolat infüzyonu ile oluþturulan AP grubu, grup 3: NAC tedavisi yapýlan AP grubu. Lokal ve sistemik etkiler için böbrek, akciðer ve pankreas dokusundaki histopatolojik deðiþiklikler araþtýrýldý. Nötrofil fonksiyonlarý flow sitometri yöntemiyle belirlendi.
BULGULAR: Her iki AP grubunda pankreas enzimlerinin serum seviyeleri yüksek bulundu. Histopatolojik bulgularda asiner hücre hasarý ve pankreas doku nekrozu vardý. Eþ zamanlý olarak renal ve pulmoner dokuda ciddi histopatolojik deðiþiklikler gözlendi. Flow sitometri bulgularý, tedavisiz AP grubunda bozulan nötrofil fonksiyonlarýný göstermekteydi. Akut pankreatitli deneklerde NAC tedavisi nötrofillerin fagositoz, kemotaksis ve opsonizasyon iþlevlerini anlamlý olarak iyileþtirdi (p<0.05). Ayný zamanda NAC tedavisiyle pulmoner ve renal dokudaki hasarlarýn, bütün mikroskobik parametreler için anlamlý olarak düzeldiði gözlendi (p<0.05).
TARTIÞMA: Deneysel AP süresince, bozulan nötrofil fonksiyonlarý ciddi sistemik enflamatuvar cevaplarý uyarabilir. Lokal enflamasyon ve nekroza ek olarak pankreas dýþý vital organlarda ciddi sistemik cevap ve histopatolojik deðiþiklikler oluþur. Antioksidan NAC tedavisi, pankreas dýþý vital organlardaki zararlý sistemik cevaplarý, nötrofil fonksiyonlarýný anlamlý ölçüde iyileþtirerek geri döndürmektedir.

BACKGROUND: Systemic inflammatory responses and extrapancreatic vital organ impairment are mediated by activated neutrophil functions and products, such as oxygen-derived free radicals, in patients with acute pancreatitis (AP). The present study is an examination of effects of an antioxidant, N-acetylcysteine (NAC), on local and systemic histopathological changes and neutrophil functions during AP.
METHODS: This experimental study was performed on 24 Wistar albino rats equally divided into 3 groups: Group 1 comprised sham laparotomy, Group 2 had AP induced with taurocholate infusion, and Group 3 consisted of AP with NAC treatment. Histopathological features in pancreas, kidney, and lung tissues were examined for local and systemic changes during AP. Neutrophil functions were evaluated using flow cytometry.
RESULTS: Serum levels of pancreatic enzymes were elevated, and histopathological parameters showed acinar cell damage and pancreatic tissue necrosis in the 2 groups with AP. Severe histopathological changes were found in pulmonary and renal tissues, and flow cytometry results indicated defective neutrophil functions in the group with AP alone. NAC treatment significantly ameliorated phagocytosis, chemotaxis, and opsonization of neutrophils (p<0.05). NAC treatment also ameliorated systemic changes in pulmonary and renal tissue damage in all microscopic parameters (p<0.05).
CONCLUSION: Uncontrolled and defective neutrophil functions could provoke severe systemic inflammatory responses. In addition to local inflammation and necrosis, severe systemic responses and histopathological changes in extrapancreatic vital organs occur during AP. Treatment with antioxidant NAC significantly reverses detrimental systemic responses in extrapancreatic vital organs by significantly ameliorating neutrophil functions despite ongoing AP.

AMAÇ: Sol torakoabdominal bölge delici kesici alet yaralanmalarý potansiyel olarak diafragma yaralanmasýna neden olabilir. Bu çalýþmanýn amacý, sol torakaoabdominal bölge delici kesici alet yaralanmasý olan hastalarda diafragma yaralanmasýnýn insidansýný belirlemek ve laparoskopinin diafragma yaralanmasýný tespit etmedeki rolünü deðerlendirmek idi.
GEREÇ VE YÖNTEM: Nisan 2009 ve Eylül 2014 tarihleri arasýnda sol torakoabdominal bölge delici kesici alet yaralanmasý nedeniyle kliniðimize baþvuran 81 hasta (75 erkek, 6 kadýn; yaþ ortalamasý 27.5±9.8 yýl; daðýlým 14–60) çalýþmaya dahil edildi. Hemodinamik instabil, peritonit bulgularý ve organ eviserasyonu olan hastalara laparotomi yapýlýrken, diðer hastalar selektif konservatif olarak takip edildi. Laparotomi endikasyonu olmayan ve semptomsuz seyreden hastalara 48 saatlik gözlem sonunda sol diafragmayý deðerlendirmek için tanýsal laparoskopi uygulandý. Takip ve tedavi sonuçlarý ileriye yönelik olarak deðerlendirildi.
BULGULAR: On üç hastaya laparotomi, kalan 68 hastaya tanýsal laparoskopi uygulandý. Laparotomi yapýlan hastalarýn dördünde, tanýsal laparoskopi yapýlan hastalarýn ise 15’inde olmak üzere toplam 19 hastada (%23.5) sol diafragmada yaralanma tespit edildi. Hemopnömotoraks olan ve olmayan hasta gruplarý arasýnda diafragma yaralanmasýnýn insidansýnda fark saptanmadý (p=0.131). Diafragmatik yaralanma açýsýndan sol torakoabdominal bölgede delici kesici aletin giriþ yerleri arasýnda istatistiksel fark saptanmadý (p=0.929).
TARTIÞMA: Sol torakoabdominal bölge delici kesici alet yaralanmalarýnda diafragma deðerlendirilmelidir. Tanýsal laparoskopi, günümüzde hala bu amaçla kullanýlan en güvenli yöntemdir.

BACKGROUND: Stab wounds in the left thoracoabdominal region may cause diaphragmatic injury. The aim of the present study was to determine incidence of diaphragmatic injury and role of diagnostic laparoscopy in detection of injury in patients with left thoracoabdominal stab wound.
METHODS: Total of 81 patients (75 male, 6 female; mean age 27.5±9.8 years; range 14 to 60 years) who presented with left thoracoabdominal stab wound between April 2009 and September 2014 were evaluated. Laparotomy was performed on patients who had hemodynamic instability, signs of peritonitis, or organ evisceration. Remaining patients were followed conservatively. After 48 hours, diagnostic laparoscopy was performed on patients without laparotomy indication to examine the left diaphragm for injury. Follow-up and treatment findings were prospectively evaluated.
RESULTS: Thirteen patients underwent laparotomy while diagnostic laparoscopy was performed on remaining 68 patients. Left diaphragmatic injury was observed in 19 patients (23.5%) in the study group. Four injuries were diagnosed by laparotomy and 15 were diagnosed by laparoscopy. Presence of hemopneumothorax did not yield difference in incidence of diaphragmatic injury (p=0.131). No significant difference was detected in terms of diaphragmatic injury with respect to entry site of stab wound in the thoracoabdominal region (p=0.929).
CONCLUSION: It is important to evaluate the diaphragm in left thoracoabdominal stab injuries, and diagnostic laparoscopy is still the safest and most feasible method.

AMAÇ: Ranson kriterleri akut pankreatit (AP) þiddetini deðerlendirmek için yaygýn olarak kullanýlýr. Eritrosit daðýlým geniþliði (RDW) de bu gibi hastalarda mortaliteyi öngörmede yararlý bir belirteç olarak gösterilmiþtir. Amaç, AP hastalarýnda Ranson skoru ile RDW arasýndaki iliþkiyi araþtýrmaktýr.
GEREÇ VE YÖNTEM: Toplam 202 AP hastasý çalýþmaya alýndý. Hastalar, 48 saatten uzun süren organ yetersizliði ve/veya lokal komplikasyon varlýðýna baðlý olarak, hafif ve þiddetli AP olarak sýnýflandýrýldý.
BULGULAR: Kýrk hastaya (%19.8) þiddetli AP tanýsý kondu. Þiddetli AP’nin belirlenmesinde, baþlangýç RDW ve Ranson skorlarý için hesaplanan ROC eðrisinde yüksek duyarlýlýk ve özgüllük deðerleri elde edildi. Ranson skoru için 4’ten büyük deðerler, RDW için %14 deðeri cutoff deðerler olarak belirlendi. Baþvuru anýndaki RDW deðerinin 48. saat Ranson skoru ile korele olduðu saptandý (r=0.22, p<0.002). Ancak, 0. günde, RDW ile 0. saat Ranson skoru arasýnda korelasyon yoktu (r=0.07, p=0.600).
TARTIÞMA: Akut pankreatit þiddetini deðerlendirmede tek bir ideal yöntem olmasa da, baþvuru anýndaki RDW seviyesi, birden çoklu skorlama sistemlerinin dezavantajlarý dikkate alýndýðýnda, özellikle birinci basamak saðlýk merkezlerinde, AP þiddetinin erken tahmininde yararlý olabilir.

BACKGROUND: Ranson’s criteria are widely used to evaluate severity of acute pancreatitis (AP). Red blood cell distribution width (RDW) has been demonstrated to be useful marker to predict mortality in these patients. The aim of the present study was to investigate correlation between Ranson score and RDW in patients with AP.
METHODS: Total of 202 patients with AP were included in the study. Patients were classified as mild or severe AP, based on presence of organ failure for more than 48 hours and/or local complications.
RESULTS: Forty patients (19.8%) were diagnosed as severe AP. High sensitivity and specificity values were obtained from receiver operating characteristic curve for initial RDW and Ranson score in predicting severe AP. Ranson ≥4 was selected cut-off value for Ranson score and 14% was limit for RDW. RDW at time of admission was correlated with 48-hour Ranson score (r=0.22; p<0.002). However, at day 0, there was no correlation between RDW and 0-hour Ranson score (r=0.07; p=0.600).
CONCLUSION: Although there is no single, ideal method to assess severity of AP, RDW level at admission can be helpful in earlier prediction of AP severity, especially in first-line centers, taking into consideration disadvantages of multifactorial scoring systems.

AMAÇ: Tek damar yaralanmasý sonrasý önkol damar onarýmlarýnda, çalýþan ve týkalý arter onarýmlarýnýn geç dönem sonuçlarýný karþýlaþtýran az sayýda çalýþma vardýr. Bu çalýþmadaki amacýmýz önkol damar onarýmlarýnýn geç dönem sonuçlarýný QuickDASH skoru ve renkli Doppler ultrason ile karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Yüz altmýþ altý ön kol arter yaralanmasý olan hastalar tarandý. Ayný yaralanmasý olan 30 hasta (ulnar arter, ulnar sinir ve fleksör zon beþ tendon yaralanmasý) renkli Doppler ve QuickDASH skorlamasý için geri çaðrýldýlar.
BULGULAR: Hastalar renkli Doppler sonuçlarýna göre iki gruba ayrýldýlar; çalýþan damarý olanlar (grup 1) ve týkalý damarý olanlar (grup 2). Bu iki grubun QuickDASH skorlarý arasýnda istatistiksel analiz yapýldý. Aradaki fark istatistiksel olarak anlamlýydý. Grup 1’de (24.27) grup 2’ye (36.34) göre daha düþük QuickDASH skoru vardý. Bu çalýþan damarý olan hastalarda daha iyi sonuç alýndýðýný göstermekteydi.
TARTIÞMA: Sonuç olarak, vasküler onarým yapýlan hastalarda daha iyi fonksiyonel sonuç alýnabilmektedir.

BACKGROUND: There are few studies of single forearm arterial injury repair that compare long-term results of intact and obliterated forearm arterial repair. Aim of the present study was to compare long-term results of forearm arterial repair using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and color Doppler ultrasound (CDUS).
METHODS: Records of
166 consecutive patients with forearm arterial injury were reviewed, and 30 patients with same injury (ulnar artery, ulnar nerve, and tendon injuries at flexor zone V) were called back for CDUS and QuickDASH scoring. Patients evaluated with CDUS were divided into 2 groups according to results: patent vessels (Group 1) and obliterated vessels (Group 2), and statistical analysis was performed to compare QuickDASH scores of groups.
RESULTS: Difference in QuickDASH scores was statistically significant: Group 1 had lower score (24.27) than Group 2 (36.34), indicating better outcome in patients with patent vessels.
CONCLUSION: Vascular repair that achieved vessel patency led to better functional outcome with lower QuickDASH score and less cold intolerance.

AMAÇ: Ýlerleyen yaþla birlikte inguinal herni insidansý artmaktadýr. Bu hasta grubunda komorbiditelerin de artmasý inguinal herniye yaklaþýmda cerrahiyi arka plana atmakta ve acil giriþim oranlarýný artýrmaktadýr. Bu çalýþmada, inguinal herni nedeniyle ameliyat edilen yüksek riskli geriatrik hastalarda elektif ve acil yaklaþým sonuçlarýný karþýlaþtýrmalý olarak incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2010 ve Aralýk 2014 tarihleri arasýnda kliniðimizde inguinal bölge fýtýklarý nedeni ile ameliyat edilen geriatrik (≥65 yaþ) hastalar arasýndan yüksek riskli (ASA III ve üzeri) 384 hastanýn dosyasý geriye dönük olarak incelendi. Bu hastalar elektif (n=312) ve acil (n=72) operasyon olarak iki grupta incelendi. Tüm hastalarýn demografik özellikleri, ASA skoru, operasyon prosedürleri (insizyon þekli, ek prosedürler, anestezi tipi), yoðun bakým ve hastanede kalýþ süreleri, morbidite ve mortalite parametreleri kaydedildi.
BULGULAR: Demografik özellikler Grup 2’de anlamlý yüksek ASA IV oraný hariç benzerdi. Baðýrsak rezeksiyonu riski %1 ve karþý %21 olarak Grup 2’de anlamlý yüksek izlendi. Hastanede (1.3 güne 7.9 gün, sýrasýyla, p<0.01) ve yoðun bakýmda kalýþ süreleri de Grup 2’de anlamlý uzun bulundu. Ameliyat sonrasý morbidite (%1’e karþý %24, p<0.01) ve mortalite (%0.3’e karþý %11, p<0.01) Grup 2’de anlamlý yüksek saptandý. Ameliyat sonrasý komplikasyon üzerine etki gösteren baðýmsýz parametreler arasýnda böbrek yetersizliði, yoðun bakým ve hastanede kalýþ süreleri bulunurken; mortalite üzerine etkiyen baðýmsýz faktörler arasýnda ASA skoru, böbrek yetersizliði, insizyon þekli (laparotomi) ve anestezi türü (genel anestezi) saptandý.
TARTIÞMA: Elektif inguinal herni ile karþýlaþtýrýldýðýnda, ASA skoru yüksek yaþlý hastalarda acil olarak uygulanan inguinal herni operasyonlarý daha yüksek morbidite ve mortalite ile seyretmektedir. Daha sýk baðýrsak rezeksiyon ihtiyacý ve anlamlý uzun hastanede kalýþ sürelerini de dikkate alarak inguinal herni tanýsý alan yüksek riskli yaþlý hastalarda da elektif operasyon uygulanmasýný öneriyoruz.

BACKGROUND: Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients.
METHODS: Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared.
RESULTS: Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group.
CONCLUSION: Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

AMAÇ: Bizim bu çalýþmamýzda amacýmýz, hastaneye obstrüksiyon veya perforasyon bulgularýyla baþvuran ve ameliyat sonrasý primer intestinal non-Hodgkin lenfoma tanýsý alan hastalarýn klinik bulgularýný, taný, tedavi ve prognozlarýný incelemektir.
GEREÇ VE YÖNTEM: Baþkent Üniversitesi Týp Fakültesi Hastanesi Genel Cerrahi Anabilim Dalý’nda, Ocak 2007–Kasým 2014 yýllarý arasýnda, radyolojik olarak obstrüksiyon veya perforasyon varlýðý kanýtlanmýþ ve ameliyata alýndýktan sonra non-Hodgkin lenfoma tanýsý alan hastalarýn özgeçmiþleri, baþvuru anýndaki semptomlarý, patoloji raporlarý ve cerrahi tedavi sonrasý takipleri geriye dönük olarak incelendi.
BULGULAR: Çalýþmamýza dahil edilen primer intestinal non-Hodgkin lenfoma tanýsý alan 17 hastanýn ortalama yaþý 52±20.2, erkek: kadýn oraný 8.9 idi. Hastalarýn baþvuru anýndaki semptomlarý; karýn aðrýsý, bulantý-kusma, kilo kaybý ve iþtahsýzlýktý. Tüm hastalar cerrahi olarak tedavi edildi ve 12 hastaya ameliyat sonrasý dönemde kemoterapi uygulandý. En sýk rastlanan patolojik alt tip diffüz B-hücreli lenfoma idi (%70.5). Hastalarýn takip süresi 26 (daðýlým, 1–69) ay, saðkalým oraný %64.3 idi.
TARTIÞMA: Primer intestinal non-Hodgkin lenfoma hastalýðýnýn ilk prezentasyonu, hastalarda geliþen intestinal obstrüksiyon ve/veya perforasyon olabileceði için, özellikle 50. dekatta baðýrsak obstrüksiyonu ile gelen hasta deðerlendirilirken non-Hodgkin lenfoma akýlda bulundurulmalýdýr.

BACKGROUND: The aim of this study was to investigate clinical manifestation, diagnosis, treatment, and prognosis of patients with primary gastrointestinal non-Hodgkin lymphoma (PGI NHL), whose initial presentation was bowel obstruction or perforation.
METHODS: Data of patients who underwent surgical intervention due to radiological evidence of perforation or intestinal obstruction and were subsequently diagnosed with intestinal lymphoma at Baskent University hospitals between January 2007 and November 2014 were examined retrospectively. Medical records, clinical history, symptoms, pathological reports, and treatment modalities were analyzed.
RESULTS: Study population comprised 17 patients (8 male, 9 female) with PGI NHL and mean age of 52±20.2 years. Symptoms reported by the patients were abdominal pain, nausea, vomiting, weight loss, and loss of appetite. All 17 patients underwent surgical treatment; 12 also received postoperative chemotherapy. Most common pathological subtype was diffuse large B-cell lymphoma (70.5%). Mean follow-up time was 26 months (range: 1–69 months) and 5-year survival rate was 64.3%.
CONCLUSION: Initial presentation of PGI NHL may be obstruction with or without perforation; clinicians and surgeons should keep this in mind while assessing patient with bowel obstruction, and particularly patient in fifth decade of life.

AMAÇ: Akut apandist tanýsý, genellikle semptomlar ve fizik muayene bulgularý ile konulabilmektedir. Fakat, apandist tanýsýný kesinleþtirmek her zaman kolay olmamaktadýr. Bu çalýþmada, akut apandist tanýsýnda ultrasonografinin (USG), beyaz kan hücresi (WBC) ve C-reaktif protein (CRP) bulgularýyla birlikte kullanýmýnýn apandist tanýsýndaki yerini göstermeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2014–Ocak 2016 arasýnda, merkezimizde akut apandist tanýsý ile ameliyat olan 470 hastanýn bilgileri geriye dönük olarak tarandý. Hastalarýn patoloji sonuçlarý, CRP ve WBC düzeyleri ve USG sonuçlarý istatistiksel olarak karþýlaþtýrýldý. Hastalar patoloji sonuçlarýna göre, lenfoid hiperplazi (LH), komplike olmayan akut apandist (KOAA) ve komplike akut apandist (KAA) olarak üç grubu ayrýldý.
BULGULAR: Üç yüz otuz bir erkek 139 kadýn hastanýn ortalama yaþý 32.29±11.44 olarak saptandý. Ortalama WBC düzeyi, LH grubunda 12.31 103/uL (±4.47), KOAA grubunda 13.3 103/uL (±3.87) iken KAA grubunda 14.08 103/uL (±4.11) olarak saptandý (p=0.016). Ortalama CRP düzeyi LH grubunda 14.27 mg/L (±19.38) iken, KOAA grubunda 36.93 mg/L (±59.44) ve KAA grubunda 40.84 mg/L (±66.68) olarak saptandý (p=0.008). Sonografik olarak ölçülen ortalama apendiks çapý LH grubunda 4.86 (±3.93) iken, KOAA grubunda 6.98 mm (±4.08) ve KAA grubunda 7.63 mm (±3.92) olarak saptandý (p=0.0001). Tüm deðiþkenler altgruplar arasýnda analiz edildiðinde USG bulgularýnýn tüm gruplar arasýnda da anlamlý farka sahip olduðu gözlemlendi.
TARTIÞMA: Akut apandisit tanýsý alan hastalarýn WBC ve CRP deðerlerinin istatistiksel olarak anlamlý oranda yüksek olduðu fakat bu bulgunun kesin taný için yeterli olmadýðý gözlendi. Ultrasonografi bulgularýnýn hem enflamasyonun þiddetini belirlemede hem de apandist tanýsý konulmasýnda etkin olduðu görüldü. Ultrasonografinin akut apandist þüphesi bulunan hastalarda laboratuvar testleri ile kombine edilerek standart görüntüleme incelemesi olarak uygulanmasý gerektiðini düþünmekteyiz. Bu taný sisteminin negatif apendektomi oranýný azaltacaðýna inanmaktayýz.

BACKGROUND: Clinical diagnosis of acute appendicitis is based primarily on symptoms and physical findings. However, diagnosis of appendicitis is not always straightforward. The aim of this study was to demonstrate the diagnostic effectiveness of ultrasonography (US) in these cases in combination with white blood cell count (WBC) and C-reactive protein (CRP) level.
METHODS: Retrospective analysis of data collected on 470 consecutive patients who underwent appendectomy at the same institution between January 2014 and January 2016 was conducted. Data included demographic features, preoperative WBC and CRP levels, and US measurement of diameter of appendix. Patients were divided into 3 groups: lymphoid hyperplasia (LH), non-complicated acute appendicitis (NCAA), and complicated acute appendicitis (CAA), according to postoperative histopathological examination results.
RESULTS: There were 331 male and 139 female patients with mean age of 32.29±11.44 years included in the study. Mean WBC level was 12.31103/μL (±4.47 103/μL), 13.3 103/μL (±3.87 103/μL) and 14.08 103/μL (±4.11 103/μL) in LH, NCAA, and CAA groups, respectively (p=0.016). Mean CRP level was 14.2±19 mg/L, 36.9±59 mg/L, and 40.8±66 mg/L in LH, NCAA, and CAA groups, respectively (p=0.008). Mean outer diameter of the vermiform appendix on US was 4.8 mm (±3.9 mm), 6.9 mm (±4.08 mm) and 7.6 mm (±3.92 mm) in LH, NCAA, and CAA groups, respectively (p<0.01). When all variables were compared with each other, there were statistically significant differences in US findings according to group.
CONCLUSION: WBC count and CRP level were higher in patients with acute appendicitis, but these findings alone were insufficient for definitive diagnosis. US findings were effectual both in diagnosis and demonstration of severe inflammation. US should be combined with laboratory tests and used as standard initial imaging in diagnostic pathway of patients with clinically suspected appendicitis. The authors of this study believe that this diagnostic pathway will reduce negative appendectomy rate.

AMAÇ: Ülkemizdeki ciddi yanýk hastalarýnda erken “resüsite etmeme=DNR” kararý verilip verilemeyeceði sorusuna literatür ve ülkemizin yasal mevzuatýný inceleyerek cevap aramaya çalýþtýk.
GEREÇ VE YÖNTEM: DNR terimi bir hastada solunumsal ya da dolaþým arresti meydana geldiðinde yapýlan kardiyopulmoner resüsitasyon uygulamasýnýn durdurulmasýný ifade eder. Týp literatürüne ilk olarak 1976 yýlýnda girmiþtir. Sýklýkla son dönem kanser hastalarýnda ve geri dönüþümsüz nörolojik hastalýklarý olan hastalarda uygulanýr.
BULGULAR: Ocak 2009 ile Aralýk 2014 tarihleri arasýnda yanýk merkezimize 29 çok ciddi yanýk hastasý kabul edildi (%3.44). Ortalama toplam yanýk yüzey alaný (TBSA) %94.24 (daðýlým, %85–%100) idi ve 10 hastada TBSA oraný %100 dü. Yirmi altý hastada ilave inhalasyon yanýðý mevcuttu (%89.65). Hastalarýn tümü bütün týbbi giriþimlere raðmen kaybedildi. Ortalama sað kalým süresi 4.75 gündü (daðýlým, 1–24). On yedi hasta ilk 72 saat içinde kaybedildi. Yanýk merkezimizin LD50 oraný %62’dir. Prognostik deðerlendirme için hastalarýn Total Baux indeksleri hesaplandý. Ortalama Total Baux Ýndeksi 154.13’tü (daðýlým, 117–183).
TARTIÞMA: Türkiye’de ciddi yanýk hastalarýnýn triyajýnda çeþitli sorunlarla karþýlaþabileceðimiz bir bilinen faktördür. Bu hastalar yanýk merkezlerine yönlendirilir ve hava ambulanslarý vasýtasýyla þehirler arasýnda ve hatta ülkeler arasýnda nakledilirler. Yanýk merkezlerinde entübe edilip mekanik ventilasyon baþlanýr. Bu hastalarý monitörize etmek ve tedavi etmek için birçok giriþim uygulanýr. Eskarotomiler, fasiyotomiler, tanjansiyel ya da fasiyel eskaratomiler, santral venöz kateterizasyonlar, trakeostomiler ve hemodiyaliz uygulamalarý bu hastalarda gerçekleþtirilir. Ancak tüm bu giriþimlere raðmen 48–96 saatlik takip sýrasýnda bu hastalar kaybedilirler. Bu durum da ekipman kullanýmý, yatak iþgali ve iþ gücü kaybý gibi ekonomik kayýplara neden olmaktadýr. Gerçekte hiçbir fayda saðlamayan çok çeþitli giriþimlerle hastalarýn vücut bütünlüðü daha da bozulmaktadýr. Bu nedenle, bu hastalarda alýnabilecek bir erken DNR kararý ya da entübe etmeme kararý ile ekipman kullanýmý, yatak iþgali ve iþ gücü kaybý gibi ekonomik kayýplar azalacaktýr ve bu kaynaklar daha yüksek yaþam beklentisi olan diðer hastalar için efektif olarak kullanýlabilir. Ayrýca yaþamla baðdaþmayacak kadar ciddi yanýðý olan hastalar da daha huzurlu ve rahat bir þekilde hayatlarýný sonlandýrabileceklerdir. Türkiye’de yasal kýsýtlamalar nedeniyle ciddi yanýk hastalarýnda bir DNR kararý almak mümkün deðildir. Bu konu doktorlarýn, hukukçularýn, ekonomistlerin, ilahiyatçýlarýn katýlacaðý büyük toplantýlarda tartýþýlmalýdýr.

BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders.
METHODS: Between January 2009 and December 2014, 29 patients (3.44%) with very severe burns were admitted to burn unit. Average total burn surface area (TBSA) was 94.24% (range: 85–100%), and in 10 patients, TBSA was 100%. Additional inhalation burns were present in 26 of the patients (89.65%). All of the patients died, despite every medical intervention. Mean survival was 4.75 days (range: 1–24 days). Total of 17 patients died within 72 hours. Lethal dose 50 (% TBSA at which certain group has 50% chance of survival) rate of our burn center is 62%. Baux indices were used for prognostic evaluation of the patients; mean total Baux score of the patients was 154.13 (range: 117–183).
RESULTS: It is well known that numerous problems may be encountered during triage of severely burned patients in Turkey. These patients are referred to burn centers and are frequently transferred via air ambulance between cities, and even countries. They are intubated and mechanical ventilation is initiated at burn center. Many interventions are performed to treat these patients, such as escharotomy, fasciotomy, tangential or fascial excision, central venous catheterization and tracheostomy, or hemodialysis. Yet despite such interventions, these patients die, typically within 48 to 96 hours. Integrity of the body is often lost as result of aggressive intervention with no real benefit, and there are also economic costs to hospital related to use of materials, bed occupancy, and distribution of workforce. For these reasons, as well as patient comfort, early do-not-resuscitate or do-not-intubate protocol for these patients is suggested. Resources could then be directed to other patients with high expectancy of life and patients with burns that are beyond treatment can experience more comfortable end of life.
CONCLUSION: At present in Turkey, it is not possible to give DNR order for patient with severe burns that are incompatible with survival due to legal interdiction. This subject should be discussed at high-level meetings with participation of doctors, legal experts, economists, and theologians.

AMAÇ: Tibial rotasyon prosimal eklemin transvers planda distal ekleme göre rotasyonda olmasýdýr. Bu çalýþmanýn amacý minimal invaziv plaklama yöntemi (MÝPO) ile tedavi edilen distal tibia kýrýklarýnda, malrotasyonun bilgisayarlý tomografi (BT) ile tespit edilimesi, rotasyonel farkýn klinik sonuçlar ve Vizüel Analog Skala (VAS) skoru üzerine etkisini araþtýrmaktý.
GEREÇ VE YÖNTEM: 2010–2012 yýllarý arasýnda kapalý distal tibia kýrýðý nedeniyle MÝPO yöntemiyle ameliyat edilen 24 hasta çalýþmaya dahil edildi. On dereceden fazla rotasyon farký malrotasyon olarak kabul edildi. Ameliyat edilen bacak 0.5 mm aralýklarla alýnan üç boyutlu BT kesitleriyle radyoloji bölümü tarafýndan deðerlendirildi. Ýki alt ekstremite arasýndaki 10 dereceden fazla fark malrotasyon olarak kabul edildi. Tüm hastalar son takiplerinde klinik (VAS ve Amerikan Ortopedi Ayak ve Ayak Bileði Topluluðu [AOFAS]) ve radyolojik olarak deðerlendirildi.
BULGULAR: Ortalama takip süresi 20.00±9.46 aydý (daðýlým, 18–51 ay). Ortalama VAS skoru 2.58±0.83 (daðýlým, 1–4) ve ortalama AOFAS skoru 87.50±4.05 (daðýlým, 78–93) idi. Ortalama tibia rotasyon açýsý saðlam tarafta 31.54°±6.00° (daðýlým, 18°–45°) ve ameliyatlý tarafta ise 32.00°±6.24° (daðýlým, 10°–43°) idi. Ýstatiksel olarak anlamlý fark saptanmadý (p>0.05).
TARTIÞMA: Minimal invaziv plaklama yöntemiyle distal tibia kýrýklarýnýn tedavi edilmesinde ameliyat sýrasýnda skopi kullanýlmasý, kablo tekniðinin ve saðlam tarafýn referans olarak kullanýlma yöntemi rotasyonel dizilim sorununu azaltacaðý kanaatindeyiz.

BACKGROUND: Tibial torsion is rotation of the proximal versus the distal articular axis in the transverse plane. This study used computed tomography (CT) to examine rotational malalignment in the crus following use of minimally invasive plate osteosynthesis (MIPO) technique in distal tibial fractures and evaluated effect of rotational difference on clinical outcomes and VAS scores.
METHODS: Analysis of 24 patients who were operated on for closed distal tibial fracture with MIPO technique between 2010 and 2012 was conducted. Malrotation was defined as rotational difference >10°. Operated knees were evaluated with 0.5-mm, fine-cut, 3-dimensional CT scan performed in cooperation with radiology department. Side-to-side difference in tibial torsion angle >10° was considered significant degree of malrotation. All patients were assessed clinically (visual analogue scale [VAS] and American Orthopaedic Foot and Ankle Society [AOFAS] scores) and radiologically at final visit.
RESULTS: Mean follow-up period was 20.00±9.46 months (range: 18-51 months). Mean VAS score was 2.58±0.83 (range: 1–4) and mean AOFAS score was 87.50±4.05 (range: 78–93). Mean tibial rotation angle was 31.54±6.00° (range: 18–45°) on healthy side and 32.00±6.24° (range: 10–43°) on the operated side. No statistically significant difference was determined (p>0.05).
CONCLUSION: Use of intraoperative fluoroscopy, cable technique, and uninjured extremity as reference, can reduce incidence of rotational malalignment of distal tibial fractures treated with MIPO.

AMAÇ: Patella distal ucunun parçalý kýrýðý hem patella kýrýðý hem de patella tendonu avülsiyonunun karakteristik özelliklerini taþýr. Bu nedenle travmanýn her iki bileþeni de tedavi sýrasýnda düþünülmelidir. Ancak geleneksel tekniklerin herhangi biri mahzurlarý olmaksýzýn ayrý ayrý iþe yaramaz. Osteosentez ve patella tendonunun eþ zamanlý onarýmýný göz önüne alan bir teknik varsayýmladýk.
GEREÇ VE YÖNTEM: Patella distal ucu parçalýkýrýðý olan 23 hasta cerrahi yöntemle tedavi edilmiþ ve ileriye yönelik olarak 24 ay izlenmiþtir.
BULGULAR: Hastalarýn tümü ortalama ameliyat sonrasý dördüncü ayda travma öncesi günlük aktivite düzeyine geri döndü. Böstman ve ark. skorlamasýna göre hastalar ortalama 28,1 puan aldý. Kýrýklarýn hepsi ortalama 10 haftada kaynadý. Patella yüksekliði muhafaza edilmiþti, ancak dört hastada patellofemoral eklemde dejeneratif deðiþikliklerde artýþ görüldü.
TARTIÞMA: Bu tekniði kullanarak patella distal uç parçalý kýrýðýnda osteosentezin baþarýsý parsiyel patellektomi olma ihtimalini azaltmakta, böylece ekstensör mekanizmanýn fizyolojik uzunlluðu korunmaktadýr. Bu teknik hemen tam olarak aðýrlýk taþýmaya ve erken dönemde yoðun rehabilitasyon programýnýn uygulanmasýna yol açar.

BACKGROUND: Comminuted fracture of the lower patellar pole has characteristics of both patellar fracture and avulsion of the patellar tendon. Therefore, components of both injury types should be considered during treatment. None of the traditional techniques has proven sufficient alone. Currently described is technique that incorporates principles of osteosynthesis as well as repair of the patellar tendon.
METHODS: Total of 23 patients with comminuted fracture of the lower patellar pole were treated surgically and prospectively followed for 24 months.
RESULTS: All patients returned to pre-injury level of activities of daily living at average of fourth postoperative month. Average score on scale described by Böstman et al. was 28.1 points. All fractures united within average of 10 weeks. Patellar height was preserved. Only 4 patients, all post-menopausal, demonstrated increase in degenerative changes in patellofemoral joint.
CONCLUSION: Successful osteosynthesis of the comminuted lower patellar pole using the present technique reduces potential need for partial patellectomy, and preserves original length of the extensor mechanism. Present technique allows for immediate full weight-bearing and early, extensive rehabilitation program.

AMAÇ: Alman nüfusunda yaþlý hastalarýn oraný giderek artmaktadýr. Bu sonuçla, travma ve özellikle politravma olgularýndaki yaþlý hastalarýn oraný da artmaktadýr. Bu çalýþmamýzýn amacý, klinik bulgularýmýzý sunmak ve bu konuda geriatrik politravma olgularýna bir risk profili oluþturmaktýr.
GEREÇ VE YÖNTEM: Hastane öncesi acil giriþimde bulunulan 140 geriatrik politravma olgusunu kapsayan bir çalýma yürütüldü. Travmanýn þiddeti Hanover Politravma skoruna (HPTS’ye) uyularak geçmiþe yönelik olmak üzere deðerlendirildi. Yaþ, hemoglobin, sistolik kan basýncý, Glasgow Koma Skoru, entübasyona giriþim zamaný ve endikasyonu mortalite ve genç hastalarla karþýlaþtýrmalý olarak analiz edildi.
BULGULAR: Geriatrik politravma olgularýnýn (n=140) mortalite yüzdesi %65 olarak bulunurken, genç politravma hastalarýndaki (n=1468) mortalite oraný sadece yüzde 15.9 olarak tespit edildi. Ýki gruptaki travma þiddeti yaklaþýk olarak ayný olmasýna raðmen (HPTS – yaþ puanlarý), geriatrik hastalarda mortalite dört kat daha fazla idi. Bunun yaný sýra, aðýr kan kaybý (hemoglobin <8 g/dL), orta derece ve hafif kan kaybýna (hemoglobin ≥8 g/dL) oranla da dört kat daha fazla mortalite bulundu. On ikinin altýndaki bir Glasgow Koma Skoru ise bu deðerin üzerindeki olgulara kýyasla iki kat daha fazla mortalite göstermekteydi (%39’a %83).
TARTIÞMA: Politravma hastalarýnda, hasta yaþýnýn, kendi baþýna anlamlý olan bir risk faktörü olduðu ve mortalite artýþýný önceden gösterdiði tespit edilmiþtir. Buna ek olarak düþük Glasgow Koma Skoru; þiddetli kan kaybýnda klinik bir bulgu olan 60 mmHg’nin altýndaki sistolik kan basýncý ve beyin travmasý, diðer risk önemli faktörlerindendir. Bu faktörler, hastane öncesi ve hastane acilinde, erken ve en kýsa sürede tedaviyi gerektirmektedir.

BACKGROUND: In the German population, the percentage of elderly patients is increasing, and consequently there are more elderly patients among trauma cases, and particularly cases of polytrauma. The aim of this study was to present clinical results and a risk profile for geriatric polytrauma patients.
METHODS: Review of 140 geriatric (over 65 years of age) polytrauma patients who received prehospital treatment was performed. Severity of trauma was retrospectively assessed with Hannover Polytrauma Score (HPTS). Age, hemoglobin (Hb) level, systolic blood pressure (BP), Glasgow Coma Scale (GCS) score, timing of and necessity for intubation were analyzed in relation to mortality and in comparison with younger patients.
RESULTS: Geriatric polytrauma patients (n=140) had overall mortality rate of 65%, whereas younger patients (n=1468) had mortality rate of 15.9%. Despite equivalent severity of injury (HPTS less age points) in geriatric and non-geriatric groups, mortality rate was 4 times higher in geriatric group. Major blood loss with Hb <8 g/dL was revealed to be 3 times more fatal than moderate or minor blood loss (Hb ≥8 g/dL). GCS score <12 corresponded to double mortality rate (39% vs 83%).
CONCLUSION: Age by itself is significant risk factor and predictor of increased mortality in polytrauma patients. Additional risk factors include very low GCS score and systolic BP <80 mm Hg, for instance, as potential clinical indicators of massive bleeding and traumatic brain injury. Such parameters demand early and rapid treatment at prehospital stage and on admission.

Yýldýrým düþmesi, ölümcül veya morbit yaralanmalara sebep olabilir. Bu morbit yaralanmalarýn bir kýsmý otolaringolojik semptom ve bulgularla birliktedir. Yýldýrým düþmesine baðlý yaralanmalarda en sýk görülen odyovestibüler lezyon; timpanik membran rüptürüne baðlý iletim tipi iþitme kaybýdýr. Ayrýca çeþitli tiplerde sensörinöral iþitme kaybý ve dizines da görülebilir. Bu yazýda, yýldýrým düþmesine baðlý otolaringolojik lezyonu olan üç hastanýn klinik tablosu sunuldu. Ýlk hastanýn sað kulaðýnda orta-frekans iþitme kaybý varken sol kulaðýnda yüksek frekans sensörinöral iþitme kaybý vardý. Ýkinci hastanýn sað kulaðýnda sadece yüksek frekans sensörinöral iþitme kaybý vardý. Üçüncü hastada ise, yýldýrým çarpmasý sonrasý, periferik fasiyal paralizi ve ayný tarafta perilenf fistülü tespit edildi. Yýldýrým çarpmasý sonrasýnda bir kulaðýnda orta-frekans iþitme kaybý oluþan hastamýz, yýldýrým çarpmasý sonrasý orta-frekans sensörinöral iþitme kaybý meydana gelen literatürde bildirilmiþ ilk hastadýr.

Lightning strike can cause fatal or nonfatal injuries. Some nonfatal injuries are associated with otological symptoms and findings. Conductive hearing loss due to rupture of the tympanic membrane is the most common audiovestibular lesion of lightning strike. Various forms of sensorineural hearing loss and dizziness have also been reported. Presently described are 3 cases of lightning strike injury. First patient had mid-frequency hearing loss in right ear and high frequency sensorineural hearing loss in left ear. Second patient had high frequency sensorineural hearing loss in left ear, and the third had peripheral facial palsy with perilymphatic fistula on same side. This is the first documented case of mid-frequency hearing loss occurring after lightning strike.

Bu yazýda, düðün töreni sýrasýnda ateþlenen mermi ile göz yaralanmasý oluþan 42 yaþýndaki kadýn hasta sunuldu. Mermi çekirdeði, sol göz nazal skleranýn alt kadranýnda, limbusun 7–12 milimetre arkasýný delmiþti. Koroid ve vitreus çekirdeðin etrafýna prolabeydi. Ön kamarada kanama, vitreus prolapsusu ve lens subluksasyonu mevcuttu. Baþvuru anýndaki görme keskinliði el hareketi seviyesindeydi. 14x5 mm büyüklüðündeki mermi çekirdeði gözden dikkatlice çýkarýldý. On beþ gün sonra, giriþ alaný çevresindeki retinaya argon lazer fotokoagülasyon uygulandý. Hastanýn son ziyaretindeki görme keskinliði 20/25 (Snellen) idi. Bu olguda, yabancý cisim büyük, penetrasyon alaný zon 3’de ve baþlangýç görme keskinliði kötü olmasýna raðmen, erken ve uygun cerrahi onarým göz küresinin bütünlüðü ve iyi görme prognozu saðlamýþtýr.

Presently described is case of a 42-year-old woman with eye injury that was result of gunshot fired by a man at a wedding celebration. Bullet penetrated inferior quadrant of nasal sclera of left eye 7–12 mm behind limbus. Choroid and vitreous were prolapsed around bullet. Hemorrhage, vitreous prolapse and lens subluxation were present in anterior chamber. Presenting visual acuity (VA) was hand motion. Bullet 14x5 mm in size was carefully extracted from the eye. Fifteen days later, argon laser photocoagulation was performed on retina in area of bullet entry point. VA was 20/25 (Snellen) at final visit. In this case, although foreign body was large, area of penetration was Zone III, and initial VA was poor, early and appropriate surgical repair achieved integrity of the globe and good vision prognosis.

Süperior vena kava’nýn herhangi bir nedenle týkanmasý, yemek borusunun üst kýsmýnda venöz geniþlemeler ile sonuçlanýr ve bunlar “downhill-aþaðý yönlü” varisler olarak adlandýrýlýr. Nadir olmasýna raðmen, kanamalarý hayatý tehdit edici olabilir. Bu yazýda, Behçet hastalýðý’na baðlý süperior vena kava týkanýklýðý sonucu geliþen ve kanayan üst yemek borusu varisli bir olgu sunuldu.

Obstruction of the superior vena cava (SVC) due to any cause results in development of venous collaterals in the upper part of the esophagus, known as “downhill” varices. Although rare, bleeding can be life-threatening. Presently described is case of Behçet’s disease-related SVC occlusion in a patient who presented with gastrointestinal bleeding from upper esophageal varices.