AMAÇ: Sepsis enfeksiyon sonrasýnda geliþen, enflamasyon ve koagülasyonun birlikte aktive olmasýyla karekterize, morbiditesi ve mortalitesi yüksek, kompleks bir sendromdur. Sildenafil selektif bir fosfodiesteraz Tip 5 (PDE–5) inhibitörü olup, tüm dünyada erektil disfonksiyon tedavisinde etkin olarak kullanýlan bir ilaçtýr. Biz bu çalýþmayla, çekum ligasyonu ve perforasyonu (ÇLP) uygulayarak polimikrobiyal sepsis oluþturduðumuz sýçanlarda, sildenafilin ÇLP’nin indüklediði karaciðer doku hasarýnda, histopatolojik ve biyokimyasal olarak serbest oksijen radikalleri ve antioksidanlara olan etkisine bakarak, koruyucu etkisi olup olmadýðýný araþtýrdýk.
GEREÇ VE YÖNTEM: Sýçanlar dört gruba ayrýldý. 1) 10 mg/kg sildenafil (SLD) verilmiþ çekal ligasyon perforasyon (ÇLP) grubu; 2) 20 mg/kg SLD verilmiþ ÇLP grubu; 3) ÇLP grubu; 4) SHAM operasyon grubu. Çekal ligasyon perforasyon (ÇLP), polimikrobiyal sepsis modeli sýçanlara uygulandý. Çalýþmamýzda bütün gruplardaki sýçanlar 16 saat sonra yüksek doz genel anestezi ile öldürüldü (thiopental sodyum, 50 mg/kg). Sýçanlarýn karaciðer spesmenleri alýnarak histopatolojik ve biyokimyasal olarak analiz edildi. Çalýþmamýzda sepsis sürecinde karaciðer dokusunda oluþan antioksidan aktiviteyi göstermek için süperoksit dismutaz (SOD) ve glutatyon (GSH) parametreleri ölçüldü. Oksidan aktivite ise miyeloperoksidaz (MPO) ve lipit peroksidasyonu (LPO) parametreleri karaciðer dokularýnda ölçülerek deðerlendirildi.
BULGULAR: ÇLP polimikrobiyal sepsis grubunda, SHAM grubuna göre SOD ve MPO aktiviteleri, GSH ve LPO seviyeleri yüksek olarak bulundu (p<0.05) Sildenafil uygulanmýþ bütün gruplarda, ÇLP uygulanmýþ gruplara göre, yüksek GSH seviyeleri bulundu. 20 mg/kg sildenafil dozu uygulanmýþ sýçanlarda, SHAM grubuna göre yüksek GSH seviyeleri gözlendi. Bununla birlikte sildenafilin bütün dozlarý, ÇLP grubuna göre, LPO seviyelerinde anlamlý düþüþ (p<0.05), MPO aktivitesinde anlamlý artýþ gösterdi. 20 mg/kg sildenafil uygulanmýþ sýçanlarda, biyokimyasal parametrelerde iyileþmeler gözlendi. Çalýþmamýzda SHAM grubunda düþük olan SOD ve MPO IV aktiviteleri ÇLP ile uygulanan polimikrobiyal sepsis modelinde artmýþtýr. SLD uygulandýðýnda da MPO aktivitesi hem SHAM grubunda, hem ÇLP grubunda artmýþtýr. Çalýþmamýzda septik karaciðer dokularýnda GSH ve LPO seviyeleri de artmýþtýr. SLD SHAM grubuna uygulandýðýnda da koruyucu GSH miktarýný artýrmýþ ve hasar verici LPO miktarýný azaltmýþtýr. Yapýlan histopatolojik incelemede 10 mg/kg sildenafil uygulamasýnýn kýsmen karaciðer üzerine iyileþtirici etkileri olduðu gözlendi.
TARTIÞMA: Sonuç olarak, bu çalýþmada akut sildenafil uygulamasýnýn, septik sýçanlarda oluþan karaciðer hasarýný doza baðýmlý olarak azalttýðý gösterilmiþtir. Ayrýca septik sýçanlarda bozulmuþ olan oksidan-antioksidan dengesini de düzelttiði gözlenmiþtir. Bu da sildenafilin karaciðerdeki koruyucu etkisine aracýlýk ediyor olabilir. Ancak sildenafilin karaciðer üzerindeki koruyucu etkilerinin daha iyi anlaþýlabilmesi için gelecekte yeni deneysel ve klinik çalýþmalarýn yapýlmasý gerektiði inancýndayýz.

BACKGROUND: Sepsis is a complex syndrome which comes out after infection, characterized by activation of inflammation and infection and has a high morbidity and mortality. Sildenafil (SLD) is a selective phosphodiesterase Type 5 enzyme inhibitor and is used in the treatment of erectile dysfunction effectively all over the world. In this study, we investigated whether SLD had protective effect or not by studying the effect of SLD on reactive oxygen species and antioxidants in cecal ligation and puncture (CLP) polymicrobial sepsis model in rat liver histopathologically and biochemically.
METHODS: Rats were divided into four groups: (1) 10 mg/kg SLD given CLP group; (2) 20 mg/kg SLD given CLP group; (3) CLP group; and (4) SHAM operated group. CLP polymicrobial sepsis model was applied to the rats. All rats in our study were sacrificed by overdose general anesthetic after 16 h (thiopental sodium, 50 mg/kg). Specimens of rat liver were analyzed histopathologically and biochemically. In the study, superoxide dismutase (SOD) and glutathione (GSH) parameters were measured to indicate the antioxidant activity in liver during sepsis. To evaluate the oxidant activity, myeloperoxidase (MPO) and lipid peroxidation (LPO) parameters were measured in liver tissue.
RESULTS: SOD and MPO activities and GSH and LPO levels were high in CLP polymicrobial sepsis model when compared to SHAM group (p<0.05). In all SLD groups, GSH levels were high when compared to CLP group. In 20 mg/kg SLD given sepsis group, high GSH levels were observed according to SHAM group. In addition, while all SLD dose groups had a significant decrease versus CLP group in LPO levels (p<0.05), they had a significant increase in MPO activities. In 20 mg/kg SLD administrated rats, an improvement observed in biochemical parameters. In this study, SOD and MPO activities which were low in SHAM group increased in CLP polymicrobial sepsis model. When SLD administrated, MPO activity increased in both SHAM and CLP groups. In this study, GSH and LPO levels also increase in septic liver tissue. When SLD administrated to SHAM group, it increased VI protective GSH level and decreased detrimental LPO level. In histopathological examination, it was observed that 10 mg/kg SLD administration had a curative effect in liver tissue partly.
CONCLUSION: It was shown that acute SLD administration decreased liver damage in septic rats dose-dependently in this study. In addition, it was observed that it corrected the broken oxidant-antioxidant balance. This might mediate the protective effect of SLD in liver. However, we believe that new experimental and clinical studies should be in the future to understand the protective effect of SLD in liver.

AMAÇ: Çalýþmamýzda deneysel olarak oluþturulan diyabetes mellitusun jel formu uygulanarak kitosanýn oral mukozada yara iyileþmesi üzerine etkilerinin histopatolojik olarak araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Çalýþmamýzda 14–16 haftalýk, 340±20 gram aðýrlýðýnda 42 adet Sprague Dawley cinsi erkek sýçan kullanýldý. Otuz iki olguya 55 mg/kg streptozotosin intraperitoneal (i.p.) uygulanarak diyabet indüksiyonu saðlandý. Ýkinci ve yedinci gün sonunda ölçülen kan þekeri 250 mg/dl’nin üzerinde olanlar diyabetik kabul edildi ve çalýþmaya alýndý. Daha sonra deney hayvanlarýnýn bukkal mukozasýnda tek kullanýmlýk panç biyopsi aleti ile 5 mm çapýnda ve 1 mm derinliðinde yara oluþturuldu. Cerrahi operasyon sonrasý ikinci ve beþinci günlerde yara iyileþmesi deðerlendirildi. Örnekler histopatolojik olarak inflamasyon, fibrozis, epitel rejenerasyonu, nekroz ve yabancý cisim reaksiyonu açýsýndan deðerlendirildi.
BULGULAR: Ýstatistiksel analiz sonucunda ikinci ve beþinci gün enflamasyon düzeyleri açýsýndan gruplar arasýnda anlamlý fark bulundu (p<0.05). Grup içi deðerlendirmelerde diyabet+kitosan grubunda ikinci gün þiddetli enflamasyon oraný beþinci güne göre anlamlý derecede yüksek bulundu (p<0.05). Ýkinci gün fibrozis düzeyleri açýsýndan gruplar arasýnda anlamlý fark bulunmazken (p>0.05), beþinci gün fibrozis düzeyleri açýsýndan anlamlý fark bulundu (p<0.05).
TARTIÞMA: Kitosanýn ikinci ve beþinci günlerde hiçbir grupta yabancý cisim reaksiyonuna neden olmadýðý gözlendi.

BACKGROUND: In our study, it was aimed to histopathologically investigate the effects of chitosan on wound healing in the oral mucosa by applying the gel form of experimentally induced diabetes mellitus.
METHODS: In our study, 42 male Sprague Dawley rats weighing 340±20 g, 14–16 weeks old, were used. Diabetes induction was achieved by administering 55 mg/kg streptozotocin intraperitoneally (i.p.) to 32 of the subjects. Those with blood glucose levels above 250 mg/dl as measured at the end of the 2nd and 7th days were considered diabetic and included in the study. Afterwards, a wound of 5 mm in diameter and 1 mm in depth was created in the buccal mucosa of the experimental animals with a disposable punch biopsy tool. Wound healing was evaluated on the 2nd and 5th days after the surgical operation. The samples were evaluated histopathologically in terms of inflammation, fibrosis, epithelial regeneration, necrosis, and foreign body reaction.
RESULTS: As a result of the statistical analysis, a significant difference was found between the groups in terms of inflammation levels on the 2nd and 5th days (p<0.05). In the intragroup evaluations, the rate of severe inflammation on the 2nd day in the diabetes+chitosan group was found to be statistically significantly higher than the 5th day (p<0.05). While there was no statistically significant difference between the groups in terms of fibrosis levels on the 2nd day (p>0.05), a statistically significant difference was found in terms of fibrosis levels on the 5th day (p<0.05).
CONCLUSION: It was observed that chitosan did not cause foreign body reaction in any of the groups on the 2nd and 5th days.

AMAÇ: Le Fort 1 osteotomileri, orta yüz deformitelerini düzeltmek için yaygýn olarak kullanýlmaktadýr. Maksillanýn kolayca hareket etmesi için pterigomaksiller bileþke ayrýlmalýdýr. Bu osteotomiyi gerçekleþtirirken pterigoid plak saðlam kalmalýdýr. Bu çalýþmanýn amacý, Le Fort 1 osteotomisinde pterigomaksiller bileþkenin anatomik özellikleri ile kýrýk paternleri arasýndaki iliþkiyi deðerlendirmektir.
GEREÇ VE YÖNTEM: Le Fort 1 osteotomi ameliyatý geçirmiþ 41 hastanýn (82 örnek) ameliyat öncesi ve ameliyat sonrasý konik ýþýnlý bilgisayarlý tomografi görüntüleri radyolojik olarak deðerlendirildi. Pterigomaksiller fissür ve pterigoid plaðýn morfolojik ölçümleri yapýldý. Pterigomaksiller ayrýlma, temiz kesim, maksiller sinüs ve pterigoid plak kýrýðý þeklinde ayrýldý.
BULGULAR: Temiz kesim tip kýrýk ve pterigoid plak kýrýðý gruplarýnýn pterigoid proses kalýnlýklarý ile pterigomaksiller bölge kalýnlýklarý arasýnda istatistiksel olarak anlamlý fark gözlendi.
TARTIÞMA: Anatomik varyasyonlar pterigomaksiller bileþkenin düzgün ayrýlmasýný zorlaþtýrmaktadýr. Pterigomaksiller bileþke kalýnlýðýnýn az olmasý istenmeyen kýrýk riskini artýrýr; ancak tecrübelerimize göre yanlýþ açý, aþýrý kuvvet ve deneyimsiz cerrahlar ile osteotom kullanýmý da istenmeyen pterygoid plak kýrýklarýna neden olabilmektedir.

BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy.
METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types.
RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups’ thickness of the pterygoid process and thickness of the pterygomaxillary region.
CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures.

AMAÇ: Deneysel kafa travmasý oluþturulan sýçanlarda, bir immunsupresif ajan olan takrolimus’un (FK506) oluþacak sekonder beyin hasarýna karþý koruyucu etkisini araþtýrmak amaçlandý.
GEREÇ VE YÖNTEM: Kýrk adet Sprague-Dawley tipi 250-350 gr aðýrlýðýnda 10–12 haftalýk sýçanlar cinsiyet seçimi yapýlmaksýzýn kullanýldý. Her grupta sekiz sýçan olacak þekilde beþ gruba (Sham kontrol, Negatif kontrol, Pozitif kontrol, Vehicle kontrol, Tedavi) ayrýlan denekler, uygun þartlarda kafa travmasý oluþturulduktan bir ay sonra sakrifiye edilerek beyinleri en blok olarak çýkarýldý ve histopatolojik olarak deðerlendirildi. Sekonder beyin hasarý, beyin dokusunda oluþacak gliosizin GFAP boyanmasý sonrasý Immun Reaktivite Skoru (IRS) ile deðerlendirildi.
BULGULAR: Tüm gruplarýn histopatolojik IRS deðerleri deðerlendirildiðinde tüm gruplar arasýnda anlamlý istatistiki farklarýn olduðu gözlendi. Daha sonra ikili gruplar þeklinde IRS deðerinin en fazla tedavi grubunda arttýðý (p<0.05) fakat Negatif Kontrol, Pozitif Kontrol ve Taþýyýcý Kontrol gruplarýnda artmasýna raðmen istatistiki anlam ifade etmediði gözlendi. Sham grubunda ileri derece bir histopatolojik reaksiyon skorunun en az oranda görüldüðü tespit edildi.
TARTIÞMA: FK506 verilen grupta travmatik alandaki gliozisin diðer kontrol gruplarýna göre istatistiki olarak belirgin olarak artýþ gösterdiði görüldü. Bu durum FK506’nýn henüz açýklanamayan bir mekanizma ile gliozisi engelleyemediði hatta arttýrdýðýný göstermektedir. Sonuç olarak, FK506 immunosupresif ajanýnýn beklenin aksine beyindeki travma sonrasý hasarý azaltmadýðý, aksine gliozisi arttýrdýðý ortadadýr.

BACKGROUND: This study aimed to investigate the protective effect of tacrolimus (FK506), an immunosuppressive agent, on secondary brain damage in rats with experimental head trauma.
METHODS: 40 Sprague-Dawley rats, aged 10–12 weeks and weighing 250–350 g, were used without gender selection. The subjects that were divided into five groups of 8 rats per group (sham control, negative control, positive control, vehicle control, and treatment) were sacrificed 1 month after head trauma was induced under appropriate conditions, their brains were then removed en bloc and evaluated histopathologically. Secondary brain injury was evaluated with the immunoreactive score (IRS) after Glial Fibrillary Acid Protein staining of gliosis that would occur in brain tissue.
RESULTS: The evaluation of the histopathological IRS values of all groups showed significant statistical differences between all groups. The pairwise group comparison revealed the highest increase in IRS value in the treatment group (p<0.05), with no statistical significance despite the increase in the negative control, positive control, and vehicle control groups. The sham group had the lowest rate of severe histopathological reaction score.
CONCLUSION: It was observed that the group treated with FK506 had a statistically significant increase in gliosis in the traumatic area compared to the other control groups. This shows that FK506 cannot prevent and even increase gliosis by a mechanism that has not yet been clarified. In conclusion, it is obvious that the FK506 immunosuppressive agent does not reduce post-traumatic brain injury; on the contrary, it increases gliosis.

AMAÇ: Tüm dünyaya kabus yaþatan COVID-19 pandemisinden en büyük payý yoðun bakýmlar aldý. Mortalite oranlarýnýn yüksek olduðu COVID-19 pnömonisi olgularýnda, klinik þiddetin hýzlý ve doðru bir þekilde deðerlendirilmesi için pek çok prognostik faktör ve tetkik sýnýflandýrýlmaya çalýþýldý. Yoðun bakýma kabul edilen hastalarda baþlangýçta öngörülen ventilasyon stratejisi ile baþlýca kötü prognostik parametreler ve BT skorlarý arasýnda korelasyon olup olmadýðýný araþtýrmak amacý ile bu çalýþma planladý.
GEREÇ VE YÖNTEM: Çalýþmamýzda, hastanemiz anestezi ve reanimasyon kliniði kohort yoðun bakým ünitelerine 23.03.2020–23.05.2020 tarihleri arasýnda COVID-19 tanýsý ile tedavi edilen ardýþýk 50 noninvaziv mv ve ardýþýk 50 invaziv mv tedavisi yapýlan hasta üzerinden geriye dönük olarak dosya taramasý yapýldý. Klinik ciddiyetine ve P/F oranýna göre baþlangýç ventilasyon stratejisi olarak iki gruba ayrýlmýþ olan hastalar (NIMV ve IMV yapýlanlar) karþýlaþtýrmalý olarak deðerlendirildi. Gruplar arsýnda demografik veriler, kötü prognostik deðer olan giriþ ve en düþük P/F oranlarý, giriþ ve en yüksek SOFA skorlarý, komorbidite durumu ve tanýda çekilen BT’deki skorlar, yoðun bakým ve hastane yatýþ süreleri arasýnda korelasyon olup olmamasý incelendi, mortalite oranlarýna bakýldý.
BULGULAR: Gruplar arasýnda yaþ faktörü açýsýndan tüm hastalarýn %85’inin 46 yaþ ve üstünde olduðu saptandý. Hastalarýn cinsiyetleri ve komordite durumlarý açýsýndan anlamlý fark saptanmadý. Hasta gruplarýnýn mortalite ile karþýlaþtýrýlmasýnda, IMV grubundaki eksitus oranýnýn NIMV grubundan belirgin bir þekilde yüksek olduðu saptandý. IMV grubunun en düþük P/F oraný ortalama deðerinin NIMV grubundan daha düþük olduðu, SOFA giriþ ve en yüksek ortalama deðerlerinin IMV grubunda daha yüksek olduðu saptandý. BT skorlarý ve tutulan lob sayýsý arasýnda anlamlý fark saptanmadý.
TARTIÞMA: Çalýþmamýzda, kötü prognostik deðerleri nispeten az olan hastalar noninvaziv ventilasyonla tedavisine baþlanan hastalardý ve mortaliteleri invaziv ventilasyon grubuna göre azdý. Ancak taný aþamasýnda çekilen BT’nin skorlamasýna göre hastalarýn ciddiyet sýnýflamasýnýn yapýlamayacaðý sonucuna vardýk, IMV yapýlanlarda toplam BT skorunun daha yüksek olmasý beklenirken anlamlý fark bulunmadý. BT sonuçlarý hastanýn kliniði, predispozan faktörleri, yapýlan tedaviye verdiði cevaba göre bir bütün olarak deðerlendirilmelidir.

BACKGROUND: Intensive care workers received the largest share of the COVID-19 pandemic, which caused nightmares to the whole world. In COVID-19 pneumonia cases which had high mortality rates, many prognostic factors and laboratory examinations were tried to evaluate the clinical severity quickly and accurately.This study was planned to investigate a correlation between the initially ventilation strategy and major prognostic parameters and CT scores in patients admitted to intensive care unit (ICU).
METHODS: In our study, we reviewed 50 consecutive non-invasive mv and 50 consecutive invasive mv treatment of COVID-19 pneumonia patients between March 23, 2020,and May 23, 2020, in the ICUs of our hospital. Patients who were divided into twogroups (non-invasive mechanical ventilation [NIMV] and invasive mechanical ventilation [IMV]) as an initial ventilation strategy according to clinical severity and P/F ratios were evaluated comparatively; demographic data, admission and lowest P/F ratios, admission and highest SOFA scores, comorbidity status, scores on CT at diagnosis, length of ICU stays, hospitalization periods, and mortality rates were examined.
RESULTS: About 85% of all patients were 46 years and older. No significant difference was found in terms of gender and comorbidity status. The lowest P/F ratio was significantly lower in IMV group. The admission and highest SOFA values were higher in the IMV group. There was no significant difference between the CT scores and the number of lobes involved. The mortality rate in the IMV group was significantly higher.
CONCLUSION: Patients who started treatment with NIMV had relatively low poor prognostic factors, their mortality was lower. However, the total CT score at diagnosis was expected to be higher in those who were performed IMV, no significant difference was found in our study. We concluded that the severity classification of the patients cannot be made according to CT scores. CT results should be evaluated as a whole according to the patient’s clinic, predisposing factors, and response to treatment.

AMAÇ: Künt abdominal travma insidansý önemli ölçüde artmýþtýr ve karaciðer, en sýk hasar gören organlardan biridir. Bu çalýþmada, cerrahi tedavi gören karaciðer rüptürü olan hastalar için bir nomogram modeli araþtýrdýk ve geliþtirdik.
GEREÇ VE YÖNTEM: Ocak 2011 ile Ekim 2018 tarihleri arasýnda hastanemize karaciðer rüptürü ile baþvuran 66 eriþkin hasta geriye dönük olarak incelendi. Bu hastalar, cerrahi geçirip geçirmemelerine göre cerrahi uygulanan grup (41 olgu) ve cerrahi uygulanmayan grup (25 olgu) olarak iki gruba ayrýldý. Bu iki hasta grubundan aþaðýdaki veriler toplandý: cinsiyet, yaþ, yaralanma mekanizmasý, karaciðer hasarý, laboratuvar test sonuçlarý ve hastaneye yatýþ bilgisi. Cerrahi tedavi gerektiren hastalarýn risk faktörlerini taramak, seçilen göstergelere dayalý bir öngörü modeli oluþturmak ve nomogramý çizmek için çok deðiþkenli lojistik regresyon analizi yapýldý. Modelin öngörü deðerini deðerlendirmek için alýcý iþletim karakteristiði (ROC) eðrileri ve kalibrasyon eðrisi kullanýldý.
BULGULAR: Cerrahi uygulanmayan gruba göre vücut ýsýsýnda düþüþ, kalp atýþ hýzýnda artýþ, yaralanma ciddiyet skorunda (Injury Severity Score-ISS) yükselme, kan üre nitrojeni, kan ürik asit, kreatinin, arteriyel parsiyel oksijen basýncý, alkali fazlalýðý, kan laktik asit ve kreatin kinaz izoenzimlerinde (CK-MB) artýþ ve HCO3- ve Glasgow Koma Skalasý (GCS) skorlarýnda düþüþ saptanmýþtýr (tümü, p<0.05). Lojistik regresyon analizi, kreatinin, arte-riyel kýsmi oksijen basýncý, HCO3-, CK-MB ve GCS’nin karaciðer rüptürüne yönelik cerrahi müdahale için etkili faktörler olduðunu ortaya koymuþtur. Bu beþ göstergeye dayalý olarak geliþtirilen nomogram modeli, iyi derecede diskriminatifti (AUC=0.971, %95 GA: 0.896–0.997) ve iyi derecede doðruluða sahipti.
TARTIÞMA: Kreatinin, arteriyel kýsmi oksijen basýncý, HCO3-, CK-MB, Glascow koma skoru ve diðer parametrelere dayalý olarak oluþturulan bir nomogram modeli, karaciðer rüptürü olan hastalarýn cerrahi tedavisinin doðru bir þekilde öngörülebilmesini saðlayabilir.

BACKGROUND: The incidence of blunt abdominal injury has significantly increased, and the liver is one of the most commonly damaged organs. In this study, we explored and established a nomogram model for patients with liver ruptures undergoing surgical treatment.
METHODS: A retrospective analysis was conducted for 66 adult patients with liver rupture, who were admitted to our hospital from January 2011 to October 2018. These patients were classified into two groups, according to whether the patient had surgery: surgery group (41 cases) and non-surgical group (25 cases). The following data were collected from these two groups of patients: gender, age, injury mechanism, liver damage, laboratory test results, and hospitalization. Multivariate logistic regression analysis was performed to screen the risk factors of patients who require surgical treatment, establish a predictive model based on the selected indicators, and draw the nomogram. Receiver operating characteristic curves and the calibration curve were used to evaluate the predictive value of the model.
RESULTS: Compared to the non-surgical group, the body temperature decreased, the heart rate increased, the injury severity score grade increased, the blood urea nitrogen, blood uric acid, creatinine (Cr), arterial partial pressure of oxygen, alkali excess, blood lactic acid and creatine kinase isoenzymes MB (CK-MB) increased, and the HCO- and Glasgow Coma Scale (GCS) coma scores decreased for patients in the surgical group (all, p<0.05). The logistic regression analysis revealed that Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, and the Glasgow coma score were the influencing factors for surgical intervention for liver rupture. The nomo-gram model constructed based on these five indicators had a good degree of discrimination (area under the curve = 0.971, 95% CI: 0.896–0.997) and accuracy.
CONCLUSION: A nomogram model established based on Cr, arterial partial pressure of oxygen, HCO3-, CK-MB, the GCS, and other parameters can accurately predict the surgical treatment of patients with liver rupture.

AMAÇ: Travma çocukluk çaðý yaralanmalarýn önde gelen bir sebebidir. Çocuklarda künt travmalar penetran travmalardan daha sýk olmasýna raðmen gerek sivil yaþamda gerekse çatýþma alanlarýnýn yakýndaki çocuklar ateþli silah yaralanmalarýndan sýklýkla etkilenebilmektedirler ve ateþli silah yaralanmalarý arasýnda torasik yaralanmalar önemli bir oran oluþturmaktadýr. Çalýþmamýzda, çocuklarda çok detektörlü bilgisayarlý tomografinin reformatlanmýþ görüntülerini analiz ederek toraksa nafiz ateþli silah yaralanmalarýnda mermi yörüngesini tespit ettik.
GEREÇ VE YÖNTEM: Torasik ateþli silah yaralanmasý olan 19 çocuk hasta geriye dönük olarak deðerlendirildi. Bütün hastalar acil service giriþ yaptýktan sonra, önce hemodinamileri stabil hale getirildi. Ardýndan PA-AC grafisi ve toraks bilgisayarlý tomografisi çekildi ve diðer vücut bölgelerinin gerekli görülen görüntüleme çalýþmalarý yapýldý. Bilgisayarlý tomografi çekimleri multi dedektör bilgisayarlý tomografi ile yapýldý.
BULGULAR: Multidedektör bilgisayarlý tomografinin, reformatlanmýþ aksiyal, sagittal ve koranal ve oblik görüntülerini kullanarak %74 hastada akciðer parankiminde mermi yörüngesini tespit ettik. Hastalarýn %26’sýnda ise çok fazla parankimal hemoraji, hemotoraks, pnömotoraks gibi nedenlerle mermi yörüngesi tespit edilemedi.
TARTIÞMA: Çalýþmamýzda kullanýlan ateþli silah çeþitlerinin bilinmemesi, atýþ mesafelerinin tespit edilememesi, farklý yaþlar ve farklý mermi giriþ çýkýþ açýlarý nedeniyle bir standart yapýlamamýþtýr. Ancak, akciðer dokusunda mermi yörüngesini tespit etmek, hekime tedavi planýný yapmasýnda ve hastayý takip etmesinde yardýmcý olacaktýr. Ayrýca elde edilen verilerin deðerlendirilmesi adli týp hekimlerine ve yara balistiði ile ilgilenen bilim insanlarýna faydalý olacaktýr.

BACKGROUND: Trauma is a leading cause of childhood injuries. Although blunt traumas in children are more common in penetrating traumas, children in civilian life and near conflict areas can often be affected by gunshot wounds. Among all gunshot wounds, thoracic injuries constitute a significant proportion. In our study, we detected bullet trajectory in children with gunshot wounds penetrating the thorax by analyzing reformatted images of multidetector computed tomography (CT).
METHODS: Nineteen pediatric patients with thoracic gunshot wounds were evaluated retrospectively. After all patients admitted the emergency service, their hemodynamics were stabilized first. Then, PA-AC radiography and thorax CT were taken and necessary imaging studies of other body parts were performed. CT scans were performed with multi-detector CT.
RESULTS: Using reformatted axial, sagittal, and coronal and oblique images of multidetector CT, we detected projectile trajectory in the lung parenchyma in 74% of patients. In 26% of the patients, the projectile trajectory could not be detected due to excessive parenchymal hemorrhage, hemothorax, and pneumothorax.
CONCLUSION: In our study, a standard could not be made due to the fact that the types of weapons used could not be determined, the firing distances could not be known, different ages and different bullet entry and exit angles. However, detecting the trajectory of the bullet in the lungs will assist the physician in making the treatment plan and following up the patient. In addition, the evaluation of the data obtained will be beneficial to forensic medicine physicians and scientists interested in wound ballistics.

AMAÇ: Acil karýn ön duvarý fýtýðý cerrahisi, acil genel cerrahi pratiðinde çok önemli bir rol oynamaktadýr. Bu çalýþmada, hastalarda strangülasyon ve intestinal rezeksiyonun tanýnmasýnda laboratuvar ve görüntüleme bulgularýnýn yaný sýra demografik bilgilerinin ve komorbiditelerinin prediktif deðeri araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük kohort çalýþmasýna, Ocak 2017 ve Aralýk 2019 tarihleri arasýnda acil karýn ön duvarý fýtýðý ameliyatý endikasyonu ile üçüncü basamak bir hastanede ameliyat edilen 18 yaþ üstü hastalar alýndý. Hasta popülasyonu acil karýn ön duvarý fýtýðý operasyonunda peroperatif bulgulara göre iki gruba ayrýldý. Birinci grup, inkarsere ancak strangüle olmamýþ olgulardan, ikinci grup ise inkarserasyona ek olarak strangüle olgulardan oluþturuldu. Ayrýca intestinal rezeksiyon gereksiniminin varlýðýna göre grup (1 veya 2)a ve grup (1 veya 2)b olmak üzere iki alt grup daha oluþturuldu.
BULGULAR: Ýnkarsere fýtýk nedeniyle acil karýn ön duvarý onarýmý yapýlan toplam 106 hasta çalýþmaya dahil edildi. Sistemik inflamasyonla ilgili indekslerin deðerlendirildiðinde strangüle hastalarda laktat dehidrojenaz/lökosit oranýnýn anlamlý olarak daha düþük olduðu, ancak nötrofil/platelet oraný ve nötrofil/albümin oranlarýnýn anlamlý olarak daha yüksek olduðu gözlendi ve bu sistemik inflamasyon indekslerinin strangülasyonu tespit etmedeki önemini gösterdi (sýrasýyla p=0.027, p=0.035 ve p=0.030). Ayrýca intestinal rezeksiyon gereken hastalar analiz edildiðinde intestinal rezeksiyon yapýlan hastalarda Nötrofil/Albümin oranýnýn anlamlý olarak daha yüksek olduðunu saptandý (p=0.036).
TARTIÞMA: Laktat dehidrojenaz/lökosit oraný, nötrofil/platelet oraný ve özellikle nötrofil/albümin oraný gibi sistemik inflamasyon indeksleri, acil fýtýk cerrahisinde komplikasyonlarý önlemek ve klinik sonuçlarý iyileþtirmek için faydalý olma potansiyeli taþýmaktadýr.

BACKGROUND: Emergency anterior abdominal wall hernia surgery plays a pivotal role in emergency general surgery practice. In this study, the predictive value of laboratory and imaging findings as well as demographic information and comorbidities of the patients for the recognition of strangulation and intestinal resection was investigated.
METHODS: Patients over the age of 18 who were operated consecutively with an indication for emergency anterior abdominal wall hernia surgery between January 2017 and December 2019 in a single tertiary hospital were included in this retrospective cohort study. The patient population was divided into two groups according to the pre-operative findings during the emergency anterior abdominal wall hernia surgery. Group 1 consisted of cases with incarceration but without strangulation, whereas Group 2 consisted of cases with strangulation in addition to incarceration. Moreover, in evaluation for the requirement for intestinal resection, patient Group 2 was divided further into two groups, namely, as Group (1 or 2) a and Group (1 or 2) b, defining the need for intestinal resection.
RESULTS: A total of 106 patients who had emergency anterior abdominal wall repair surgery due to incarcerated hernias were included in the study. The evaluation of the indices related to systemic inflammation revealed that lactate dehydrogenase to white blood cell ratio was significantly lower but neutrophil to platelet and neutrophil to albumin ratios were significantly higher in patients with strangulation, showing the significance of those systemic inflammation indices in detecting strangulation (p=0.027, p=0.035 and p=0.030, respectively). Moreover, the analysis of the patients in whom intestinal resection was required (Group 2a vs. 2b) exposed that neutrophil to albumin ratio was significantly higher in the patients with intestinal resection (p=0.036).
CONCLUSION: Indices of systemic inflammation such as lactate dehydrogenase to white blood cell ratio, neutrophil to platelet ratio, and particularly neutrophil to albumin ratio may be potentially beneficial to prevent complications and improve clinical outcomes in emergency hernia surgery.

AMAÇ: Primer/sekonder omental torsiyon (POT/SOT), izole segmental omental nekroz (ÝSON) ve primer epiploik apandisit (PEA), sýklýkla tanýsal yanýlgýlara neden olan nadir akut karýn aðrýsý nedenleridir. Bu patolojilerde tutulum yerine ve hastalýðýn þiddetine baðlý olarak aðrý lokalizasyonu, þiddeti, bulantý-kusma, ateþ gibi eþik eden semptomlar ve bunlara baðlý olarak da ayýrýcý tanýlarý deðiþiklik göstermekle birlikte aðrý karakteri genellikle benzer ve devamlý tarzdadýr. Lokalizasyonlarýna baðlý olarak akut apandisit, akut divertikülit, ovaryan patolojiler, üriner sistem taþlarý ve akut kolesistit gibi farklý klinik tablolarý taklit edebilir ve sýklýkla cerrahi eksplorasyon sonrasý taný alýrlar. Geliþen teknoloji, bu hastalýklara dair farkýndalýðýn artmýþ olmasý ve belirgin olarak artan bilgisayarlý tomografi kullanýmý ile artýk daha fazla hastada preoperatif süreçte taný konulabilmekte ve gereksiz operasyonlardan kaçýnýlabilmektedir. Özellikle PEA kendi kendini sýnýrlayan lokal enflamatuvar bir hastalýk olup sýklýkla konservatif olarak yönetilebilir. Cerrahi tedavi seçeneði ise tüm tanýlar için ilgili epiploik appendiks veya omental segmentin, tercihen laparoskopik olarak lokal eksizyonudur. En sýk cerrahi endikasyon tanýsal karýþýklýk, ikinci en sýk neden ise persistan aðrý yakýnmasýdýr.
GEREÇ VE YÖNTEM: 2006–2021 yýllarý arasýnda kliniðimizde, primer/sekonder omental torsiyon, izole segmental omental nekroz veya primer epiploik apandisit tanýsý ile takip ve tedavi ettiðimiz hastalarýn verileri geriye dönük olarak toplandý. Hastalarýn demografik verileri, taný ve tedavileri, hastanede yatýþ süreleri deðerlendirilerek literatür eþliðinde sunuldu.
BULGULAR: Çalýþmaya alýnan 42 hastanýn 12’sinin yatýþ ve tedavi nedeni omentumun bir bölümünün nekrozu idi. Bu hastalardan 4’ü POT, 3’ü SOT, 5’i ÝSON ve 30’u PEA tanýsý ile takip ve tedavi edildi. Hastalarýn 33’ü preoperatif, 9’u intraoperatif taný aldý. 22 hasta opere edildi ve PEA’lý 20 hasta konservatif olarak tedavi edildi. Cerrahi veya týbbi tedavi sonrasýnda tüm hastalar komplikasyonsuz olarak taburcu edildi. Hastalar arasýnda yapýlan karþýlaþtýrmada klinik ve laboratuvar bulgularý açýsýndan anlamlý farklýlýk gözlenmedi.
TARTIÞMA: Akut karýn bulgularý olan hastalarýn ayýrýcý tanýsýnda POT, SOT, ISON ve PEA düþünülmelidir. Preoperatif dönemde PEA tanýsý konan hastalarda öncelikle konservatif yaklaþým düþünülmelidir. POT, SOT ve ÝSON tanýsý alan hastalarda hastanýn kliniðine göre cerrahi veya konservatif yaklaþým deðerlendirilmelidir.

BACKGROUND: Primary/secondary omental torsion (POT/SOT), isolated segmental omental necrosis (ISON), and primary epiploic appendagitis (PEA) are rare causes of acute abdominal pain that often lead to misdiagnosis. Although the differential diagnosis may vary according to the localization and severity of the pain, and associated symptoms such as nausea-vomiting and fever, depending on the disease and site of involvement, the character of the pain is generally similar and in a continuous form. Depending on pain localization, it can mimic different clinical pictures such as acute appendicitis, acute diverticulitis, ovarian pathologies, urinary tract stones and acute cholecystitis, and patients are often diagnosed after surgical exploration. With the increased availability of computed tomography and awareness of these diseases, more patients can be diagnosed in the preoperative process and unnecessary operations can be avoided. In particular, PEA is a self-limiting local inflammatory disease and can often be managed conservatively. For all diagnoses, the surgical treatment option is local excision of the relevant epiploic appendix or omental segment, preferably laparoscopically. The most common surgical indication is diagnostic confusion and the second is persistent pain.
METHODS: The data of patients followed up and treated for a diagnosis of POT, SOT, ISON or PEA between 2006 and 2021 were recorded in a specially prepared database. The demographic characteristics of the patients, and the data regarding the diagnosis and treatment process were evaluated retrospectively and discussed in the light of the relevant literature.
RESULTS: The reason for hospitalization and treatment in 12 of the 42 patients included in the study was necrosis of a part of the omentum. Of these patients, 4 were followed up and treated with a diagnosis of POT, 3 with SOT, 5 with ISON and 30 with a diagnosis of PEA. Thirty-three of the patients were diagnosed preoperatively, and 9 intraoperatively, 22 patients were operated on, and 20 patients with PEA were treated conservatively. After surgical or medical treatment, all the patients were discharged without complications. In the comparisons between the patients, no significant difference was observed in terms of clinical and laboratory findings.
CONCLUSION: POT, SOT, ISON and PEA should be considered in the differential diagnosis of patients with acute abdominal findings. In patients with PEA diagnosed in the preoperative period, a conservative approach should be considered first. In patients with a diagnosis of POT, SOT, and ISON, a surgical or conservative approach should be evaluated according to the patient’s clinical condition.

AMAÇ: Laparoskopik apendektomi yapýlan hastalarda spesimen torbasý kullanýlarak veya doðrudan trokar yoluyla spesimen çýkarýlmasýnýn cerrahi alan enfeksiyonu açýsýndan etkilerinin karþýlaþtýrýlmasýný araþtýrmak.
GEREÇ VE YÖNTEM: Toplam 165 hasta rastgele iki gruba ayrýldý. Yetmiþ yedi hastada (grup 1, %46.7) spesimen torbasý kullanýlýrken 88 hastada (grup 2, %53.3) kullanýlmadý. Hastalarýn demografik özellikleri, eþlik eden hastalýklarý, laboratuvar sonuçlarý, ameliyat öncesi apendiks çapý, ameliyat sýrasýndaki bulgular, ameliyat sýrasýnda yapýlan iþlemler, hastanede kalýþ süreleri, cerrahi alan enfeksiyonlarý, patoloji sonuçlarý, kültür sonuçlarý, komplikasyon geliþen hastalarýn bulgularý ve ameliyat sonrasýnda geliþen komplikasyonlar nedeniyle hastalara verilen tedaviler kaydedildi.
BULGULAR: Hastalarýn yaþ ortalamasý 33.95 SD 13.25 (min-maks: 18–78) idi. Demografik özellikler, hastanede yatýþ süreleri, DM insidans oranlarýnýn daðýlýmý, peroperatif perforasyon, peroperatif sývý/apse, dren konulmasý, aspirasyon-irrigasyon, yüzeyel kesi yeri enfeksiyonu, drenaj gereksinimi, güdük kaçaðý, pozitif kültür sonuçlarý, ameliyat sonrasý karýn içi enfeksiyon (p>0.05) açýsýndan gruplar arasýnda anlamlý farklýlýk izlenmedi. Nötrofil ve lökosit deðerleri gruplar arasýnda istatistiksel olarak anlamlý farklýlýk gösterdi (sýrasýyla, p=0.044, p=0.012). Komplike apandisit açýsýndan iki grup arasýnda anlamlý fark vardý (p=0.040). Hem komplike hem de komplike olmayan apandisit gruplarýnda grup 1 ve grup 2’deki hastalar arasýnda pozitif kültür sonuçlarý ve postoperatif karýn içi enfeksiyon insidansý açýsýndan anlamlý fark yoktu (p>0.05). Yüzeyel insizyonel SSI açýsýndan grup 1 ve grup 2’deki hastalar arasýndaki fark komplike olmayan apandisit grubunda anlamlý iken (p=0.037), komplike apandisit grubunda anlamlý deðildi (p=1.000). Çok deðiþkenli modelde, p<0.05 düzeyinde postoperatif karýn içi enfeksiyon üzerinde sadece peroperatif perforasyonun etkili parametre olduðu gözlendi (p=0.045).
TARTIÞMA: Bu çalýþmanýn sonuçlarý, laparoskopik apendektomi yapýlan hastalarda spesimen torbasý kullanýmýnýn mikrobiyal ekimi engellemediðini ortaya koydu, bu nedenle laparoskopik apendektomide spesimen torbasý kullanýmýnýn cerrahi alan enfeksiyonu ile iliþkili olmadýðý sonucuna varýldý.

BACKGROUND: The aim of the study was to investigate the comparison the effects of the extraction of specimen by using a specimen retrieval bag (SRB) or direct extraction through trochar in terms of surgical site infection (SSI) in patients who underwent laparoscopic appendectomy.
METHODS: A total of 165 patients were randomly allocated into two groups. A SRB was used in 77 patients (Group 1, 46.7%) and not used in 88 patients (Group 2, 53.3%). Demographics, comorbid diseases, laboratory results, preoperative diameter of appendix, intraoperative observations, intraoperative procedures, hospitalization times, SSIs, pathology results, culture results, and findings of the patients who developed complications and the treatments given to the patients due to complications during the post-operative period were recorded.
RESULTS: The mean age of the patients was 33.95 SD 13.25 (min-max: 18–78) years. No significant difference was observed in the demographics, hospitalization times, distribution of the incidence rates of diabetes mellitus, perioperative perforation, perioperative fluid/abscess, drain insertion, aspiration-irrigation, superficial incisional SSI, drainage requirement, leakage, positive culture results, and post-operative intra-abdominal infection (p>0.05) between the groups. Neutrophil and leukocyte values were statistically significantly different between the groups (p=0.044 and p=0.012, respectively). There was a significant difference between the two groups in terms of the complicated appendicitis (p=0.040). There was no significant difference in terms of the positive culture results and incidence of post-operative intra-abdominal infection between the patients in Group 1 and Group 2 in both the complicated and uncomplicated appendicitis groups (p>0.05). The difference between the patients in Group 1 and Group 2 regarding the incidence of superficial incisional SSI was significant in the uncomplicated appendicitis group (p=0.037), whereas not significant in the complicated appendicitis group (p=1.000). In the multivariate model, only perioperative perforation was observed to be the effective parameter on post-operative intra-abdominal infection at the p<0.05 level (p=0.045).
CONCLUSION: The results of the present study revealed that the use of SRB does not prevent microbial seeding in patients who underwent laparoscopic appendectomy; therefore, it was concluded that using SRB is not associated with SSI at laparoscopic appendectomy.

AMAÇ: Burun kýrýðýnýn sýnýflandýrýlmasý klinik bulgulara veya radyolojik bulgulara göre yapýlýr. Burun kýrýðýnýn sýnýflandýrma sistemleri genellikle burun kýrýðýnýn tipini belirler. Bir sýnýflandýrmanýn kýrýðýn tipini belirlemekten çok tedavi þekli ve prognozu hakkýnda bilgi vermesi önemlidir. Bu çalýþmanýn amacý, yeni topografik sýnýflandýrmanýn burun kýrýðýnýn prognoz parametrelerini belirleme ve tedavi yöntemine karar verme üzerindeki etkisini göstermektir. GEREÇ VE YÖNTEM: Aralýk 2018 ile Eylül 2020 arasýnda acil servisten sevk edilen burun kýrýðý olan hastalarý incelendi. Lateral nazal radyografi görüntüleri, bilgisayarlý tomografi (BT) yüz görünümü ve/veya üç boyutlu bilgisayarlý tomografi (3D) görüntüleri BT) burun kemiði kýrýðý olan 120 hastayý analiz etmek için incelendi. Burun kemiðinin kraniyalden kaudale olan uzunluðu, burun uzunluðuna dik iki çizgi ile eþit üç seviyeye bölündü. Kýrýk yeri nazal kemiðin kaudal kýsmýndan kraniyal kýsmýna kadar sýrasýyla seviye I, II ve III olarak belirlendi. Hastalarýn demografik özellikleri, kýrýðýn olduðu taraf, kýrýðýn paterni, eþlik eden kýrýklar ve tedavi þekli not edildi.
BULGULAR: Yüz yirmi olguda nazal kýrýklarýn yerleþim sýklýðý I. seviye, II. seviye ve III. seviyede sýrasýyla %44, %28 ve %27 idi. Kalýn kemik kalýnlýðý olan seviyelerde kýrýk sýklýðýnýn düþük olmasý beklenen bir sonuçtu. Ýki taraflý veya tek taraflý olma oranlarýna bakýldýðýnda, nazal kemik kalýnlýðýnýn ince olduðu seviye I grubunda unilateral görülme sýklýðýnýn daha yüksek, seviye III grubunda ise daha az olduðu bulundu (p<0.05). Seviye I grubunda depresif olmayan/minimal depresif kýrýk paterni %92.6 ile en yüksek orana sahipti (p<0.05). Depresif/eleve kýrýk paterni seviye II grubunda daha yaygýndý (p<0.05). Parçalý patern en çok seviye III grubunda gözlendi. Eþlik eden kýrýk oraný ve uygulanan tedavi þekli kýrýk seviyesinin anatomik özelliði ile uyumluydu. TARTIÞMA: Sonuç olarak, yeni topografik sýnýflamanýn, eþlik eden kýrýk, kýrýðýn tarafý ve kýrýk paterni gibi klinik prognoz parametrelerini ve ayrýca kapalý veya açýk redüksiyon gerekliliðini diðer sýnýflamalara göre daha iyi deðerlendirdiðini düþünüyoruz.

BACKGROUND: Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of nasal fracture. It is important that a classification gives information about treatment modality and prognosis rather than determining the type of fracture. The objective of this study was to show the effect of the new topographic classification on determining the parameters of prognosis and deciding on treatment modality of the nasal fracture.
METHODS: We reviewed patients with nasal fracture that was referred from emergency department between December 2018 and September 2020. The views of lateral nasal radiography, the facial view of computed tomography (CT), and/or the views of three-dimensional CT were examined to analyze 120 patients with nasal bone fractures. The length of the nasal bone from the top to the base was divided into equal three levels by two lines perpendicular to the length of the nose. The location of fracture was determined as level I, II, and III, respectively, from caudal part to cranial part of the nasal bone. The demographic features of patients, the side of the fracture, the pattern of fracture, accompanying fractures, and the treatment modality were noted.
RESULTS: The frequencies of location of nasal fractures were 44%, 28%, and 27% at level I, level II, and level III, respectively, in 120 cases. It was an expected result that the frequency of fractures was low in parts with the thick bone. Considering the rates of being bilateral or unilateral, it was found that the frequency of unilateral was higher in group of level I, where the thickness of nasal bone was thin, but it was less in group of level III (p<0.05). Non-depressed/minimal-depressed pattern of fracture in group of level I accounted for 92.6% which was the highest frequency (p<0.05). Depressed/elevated fracture patterns were more common in group of level II (p<0.05). Comminuted pattern was mostly observed in group of level III. The rate of accompanying fractures and the applied treatment modality was consistent with anatomic feature of fracture’s level.
CONCLUSION: We believe that the new topographic classification evaluates the parameters of clinical prognosis such as accompanying fracture, site of fracture and pattern of fracture, and also requirement of closed or open reduction better than other classifications.

AMAÇ: Skapula kýrýklarý yüksek enerjili travmalar sonucunda meydana gelir ve hayatý tehdit eden yaralanmalara eþlik etmesi bakýmýndan önemlidir. Künt toraks travmalý hastalarda skapula kýrýðýnýn mortalite ve morbidite ile iliþkisini ortaya koyan az sayýda çalýþma bulunmaktadýr. Çalýþmamýzýn amacý künt toraks travmasýnda skapula kýrýðýnýn mortalite ve morbidite ile iliþkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Kahramanmaraþ Sütçü Ýmam Üniveristesi Hastanesi Acil Servis’ine Ocak 2019–Nisan 2021 tarihleri arasýnda künt toraks travmasý ile baþvuran eriþkin hastalar hastane kayýtlarýndan geriye dönük olarak tarandý. Hastalarýn yaþý, cinsiyeti, travma mekanizmasý, ek organ yaralanmalarý, yoðun bakým ihtiyacý, hastanede yatýþ süresi, morbidite ve mortalite oranlarý hastane kaydedildi. Ýstatistiksel sonuçlar frekans, yüzde, ortalama±standart sapma (min-maks) olarak ifade edildi. Gruplar arasý karþýlaþtýrmalarda p<0.05 anlamlý kabul edildi.
BULGULAR: Çalýþmamýza 238 olgu alýndý. Seksen altý olguda (%36.1) skapula kýrýðý mevcuttu. Skapula kýrýðý tespit edilen hastalarýn %43’ü yüksekten düþme idi. Buna eþlik eden toraks içi yaralanmalar sýrasýyla kaburga kýrýðý, akciðer kontüzyonu, pnömotoraks, hemotoraks ve sternum kýrýðý olarak tespit edildi (%91.9, %80.2, %41.9, %37.2, %15.1). Skapula kýrýðý ile birliktelik gösteren toraks dýþý yaralanmalar ise sýrasýyla vertebra kýrýklarý, intrakranial yaralanmalar, klavikula kýrýðý, ekstremite kýrýklarý ve karýn içi yaralanmalardý (%18.6, %16.3, %12.8, %10.5, %5.8). Skapula kýrýðýna sahip olan ve olmayan gruplar karþýlaþtýrýldýðýnda, skapula kýrýðý ile kaburga kýrýðý sayýsý, akciðer kontüzyonu, pnömotoraks ve hemotoraks arasýnda istatistiksel olarak anlamlý iliþki saptandý (p<0.001, p<0.001, p<0.001, p<0.001). Toraks dýþý yaralanmalarda ise skapula kýrýðý ile vertebra kýrýklarý, intrakranial yaralanmalar ve klavikula kýrýðý arasýnda anlamlý iliþki izlendi (p=0.004, p<0.001, p=0.005). Sternum kýrýðý, ekstremite kýrýðý ve karýn içi organ yaralanmalarý açýsýndan gruplar arasýnda fark izlenmedi (p=0.288, p=0.682, p=0.261). Skapula kýrýðýnýn eþlik ettiði olgularda hastane yatýþ süresi, yoðun bakým gereksinimi ve mortalite açýsýndan anlamlý fark mevcuttu (p<0.001, p<0.001, p=0.002).
TARTIÞMA: Skapula kýrýklarýna eþlik eden en sýk toraks içi yaralanmalar kaburga kýrýklarý ve akciðer kontüzyonu, toraks dýþý yaralanmalar vertebra kýrýðý ve intrakranial yaralanmalar olarak saptandý. Ayrýca skapula kýrýðýnýn hastanede yatýþ süresi, yoðun bakým ihtiyacý ve mortalite ile yüksek iliþkisi olduðu tespit edildi. En sýk mortalite nedeni ise intrakranial kanama olarak tespit edildi. Skapula kýrýðý tespit edilen olgularda diðer sistemlerin görüntülemesi önemlidir. Özellikle baþ-boyun yaralanmalarý açýsýndan dikkatli olunmalýdýr.

BACKGROUND: Scapula fractures (SFs) occur as a result of high-energy trauma and are significant in terms of life-threatening injuries. There are few studies showing the relationship between SFs and mortality and morbidity in patients with blunt thoracic trauma (BTT). Our study aims to investigate the relationship between SF and mortality and morbidity in BTT.
METHODS: Adult patients admitted to the emergency department of Kahramanmaras Sutcu Imam University, School of Medicine with BTT between January 2019 and April 2021 were retrospectively scanned from hospital records. Patients’ age, gender, trauma mechanism, additional organ injuries, need for intensive care, length of hospital stay, morbidity, and mortality rates were recorded. Statistical results were expressed as frequency, percentage, and mean±standard deviation (min–max). In comparisons between groups, p<0.05 was accepted as the significance level.
RESULTS: Two hundred and thirty-eight cases were included in our study. The scapular fracture was present in 86 cases (36.1%). About 43% of the cases with SFs were falling from a height. Intrathoracic injuries accompanying SF were determined as rib fracture, lung contusion, pneumothorax, hemothorax, and sternum fracture, respectively (91.9%, 80.2%, 41.9%, 37.2%, and 15.1%). Extrathoracic injuries associated with SF were vertebral fractures, intracranial injuries, clavicle fractures, extremity fractures, and intra-abdominal injuries (18.6%, 16.3%, 12.8%, 10.5%, and 5.8%), respectively. When the groups with and without SF were compared, a statistically significant relationship was found between SF and the number of rib fractures, lung contusion, pneumothorax, and hemothorax (p<0.001, p=0.001, p=0.001, p=0.001). In extrathoracic injuries, there was a significant relationship between SFs and vertebral fractures, intra-cranial injuries, and clavicle fractures (p=0.004, p<0.001, p=0.005). There was no difference observed between the groups regarding sternum fractures, extremity fractures, and intra-abdominal organ injuries (p=0.288, p=0.682, p=0.261). In cases with accompanying SF, there was a significant difference in terms of length of hospital stay, need for intensive care, and mortality (p<0.001, p=0.001, p=0.002).
CONCLUSION: The most common intrathoracic injuries accompanying SFs were rib fractures and lung contusion, and the most common extrathoracic injuries were vertebral fractures and intracranial injuries. Moreover, it was found that SF was highly correlated with length of hospital stay, need for intensive care, and mortality. The most common cause of mortality was found to be intracranial hemorrhage. Imaging of other systems is important in cases with SFs. Particular attention should be paid to head-and-neck injuries.

AMAÇ: Ankiloz nüksü, travma sonrasý geliþen temporomandibular eklem (TME) ankilozuna yönelik ameliyat olan hastalarda sýk görülen bir so-rundur. Günümüzde, ankilozan spondilit alevlenmeleri, nötrofil (NLO) ve trombosit (TLO) lenfosit oranlarýndaki artýþlar ile takip edilmektedir. Bu çalýþmada, TME ankiloz nüksü ve bu oranlardaki artýþ arasýnda benzer bir iliþinin olup olmadýðý deðerlendirildi.
GEREÇ VE YÖNTEM: Ocak 2010 ile Aralýk 2019 arasýnda tek veya çift taraflý TME ankilozu nedeniyle ameliyat edilen hastalar çalýþmaya dahil edildi. Her hastaya ayný ekip tarafýndan temporomandibular eklem boþluk artroplastisi ve araya silikon blok yerleþtirilmesi uygulandý. Her hastaya ayný fizyoterapi uygulandý. Çalýþmaya çocuk ve eriþkin hastalar dahil edildi ve cinsiyet ayrýmý yapýlmadý. Çocuk ve eriþkinler arasýnda tam kan sayýmý farký olduðundan 18 yaþ gruplar arasýnda sýnýr olarak belirlendi. Yeniden ameliyat gereksinimi ankiloz nüksü olarak kabul edildi. Ankiloz nüksü olan ve olmayan çocuklarýn NLO ve TLO’larý karþýlaþtýrýldý. Ankiloz nüksü olan ve olmayan eriþkinlerin NLO ve TLO’larý karþýlaþtýrýldý.
BULGULAR: Çalýþmaya 29 çocuk ve 38 eriþkin dahil edildi. Çocuklarýn ortalama yaþý 10.8 iken eriþkinlerin ortalama yaþý 37.2’idi. On bir çocuk ve sekiz eriþkinde ankiloz nüksü saptandý. Yaþtan baðýmsýz olarak, ankiloz nüksü olan olgularýn NLO ve TLO’larý daha yüksekti. Çocuklarda olan nükslerde TLO anlamlý olarak yüksekken eriþkinlerde NLO anlamlý olarak yüksekti.
TARTIÞMA: Temporomandibular eklem kýrýðýna baðlý geliþen ankilozlarýn cerrahisi sonrasý çocuklarda TLO ve eriþkinlerde NLO kullanýlarak ankiloz nüksü öngörüsü yapýlabilir.

BACKGROUND: Reankylosis is a frequent pathology in patients who are operated for post-traumatic temporomandibular joint (TMJ) ankylosis. In the current practice, ankylosing spondylitis attacks are monitored with the increases in neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). In this study, such a relation between TMJ reankylosis and increase in these ratios was evaluated.
METHODS: Patients who were operated between January 2010 and December 2019 for unilateral or bilateral TMJ ankylosis were included in this study. Temporomandibular gap arthroplasty with an interpositional silicone block was performed for each patient by the same operative team. Each patient had standard physiotherapy. All ages and genders were included in the study. Due to the complete blood count differences between children and adults, 18 years of age was used as a cutoff between the groups. A need for reoperation was accepted as reankylosis. The NLR and PLR of children without and with reankylosis and adults without and with reankylosis were compared.
RESULTS: Twenty-nine children and 38 adults were included in the study. Mean age of the children and adults were 10.8 and 37.3 years, respectively. Eleven children and eight adults had reankylosis. In patients with reankylosis, NLR and PLR were high significantly, regardless of age. In children, PLR was significantly higher in reankylosis patients. In adults, NLR was significantly higher in reankylosis patients.
CONCLUSION: PLR and NLR may be utilized for predicting reankylosis, respectively, in children and adults who were operated for ankylosis due to TMJ fractures.

AMAÇ: Bu çalýþmanýn amacý, farklý bir kilitleme seçeneði kullanýlarak yeni, kilitli intramedüller çivi ile tedavi edilen orta þaft klavikula kýrýklarýnýn radyolojik ve fonksiyonel sonuçlarýný geriye dönük olarak incelemekti.
GEREÇ VE YÖNTEM: Ocak 2018 ile Ocak 2020 arasýnda, 24 deplase orta þaft klavikula kýrýðý yeni, farklý kilitleme seçeneði bulunan intramedüller çivi ile ameliyat edildi. Kýrýklar AO/OTA sýnýflamasýna göre sýnýflandýrýldý, buna göre 22 adet 15.2.B (kama), iki adet 15.2.C (parçalý) kýrýk vardý. Ortalama hasta yaþý 35,5±14,2 (daðýlým: 18–63) yýldý. Hastalarýn 18’i (%75) erkek, altýsý (%25) kadýndý.
BULGULAR: Takip verileri en az bir yýl (12–36 ay), ortalama 21.5 aydý (SD±8). Yaralanma ile ameliyat arasýndaki ortalama süre 4.1 (SS±2.3; aralýk: 1–9) gündü. Tüm hastalarda karþý tarafa göre tam omuz hareketleri saðlanmýþtý. Ortalama Constant skoru 95.6 (SD±4.2; aralýk 90–100) ve ortalama VAS skoru 0.8 (SD±0.8; aralýk: 0–3) idi. Tüm hastalarda kaynama saðlandý. Ortalama kaynama süresi, radyografi ile deðerlendirildiði üzere 9.5 (SD±1.8; aralýk 6–12) hafta idi. Klavikulanýn karþý tarafa göre ortalama kýsalmasý %3.4 idi (SD±1.1; aralýk 1.1–6.3). Bir hasta implant irritasyonu yaþadý, implantýn çýkarýlmasý 14 ay sonra gerçekleþtirildi. Ýmplant migrasyonu, donaným gevþemesi, implant kýrýlmasý veya nörovasküler hasar oluþmadý. Bir hipertrofik skar geliþti. Ameliyat sonrasý üçüncü haftada bir yara dekolmaný geliþti.
TARTIÞMA: Bu yeni intramedüller çivinin eriþkin, akut, deplase, orta þaft klavikula kýrýklarýnda kama tipi kýrýklar için iyi bir alternatif olduðunu düþünüyoruz.

BACKGROUND: The aim of this study was to retrospectively examine the radiological and functional results of midshaft clavicle fractures that were treated with a new, interlocking intramedullary nail, and employing a different locking option.
METHODS: Between January 2018 and January 2020, 24 displaced midshaft clavicle fractures were operated with new, interlocking intramedullary nail. Fractures were classified according to the AO/orthopedic trauma association classification, according to which there were 22 15.2.B (wedge) and 2 15.2.C (comminuted) fractures. The mean patient age was 35.5±14.2 (range: 18–63) years. Eighteen (75%) of the patients were male and six (25%) were female.
RESULTS: Follow-up data were recorded at a minimum of 1 year (range 12–36 months), with an average of 21.5 months (SD±8). The mean interval between the injury and surgery was 4.1 (SD±2.3; range: 1–9) days. Full shoulder movements had been achieved by all patients, relative to the contralateral side. The mean constant score was 95.6 (SD±4.2; range 90–100), and the mean visual analog scale score was 0.8 (SD±0.8; range: 0–3). Union was achieved in all patients. The mean union time was 9.5 (SD±1.8; range 6–12) weeks as assessed by radiograph. Average shortening of the clavicle relative to the contralateral side was 3.4% (SD±1.1; range 1.1–6.3). One patient experienced implant irritation, implant removal was performed after 14 months. No implant migration, hardware loosening, implant breakage, or neurovascular damage occurred. One hypertrophic scarring developed. One wound detachment developed at the 3rd post-operative week.
CONCLUSION: We think that this new intramedullary nail is a good alternative for wedge type fractures in adult, acute, displaced, and midshaft clavicle fractures.

AMAÇ: Bu çalýþma, replantasyonlarý geriye dönük olarak analiz etmeyi ve farklý dikiþ tekniklerinin baþarý oranlarýný karþýlaþtýrmayý amaçladý. GEREÇ VE YÖNTEM: Ocak 2016 ile Nisan 2020 arasýnda 82 parmak replantasyonu yapýlan 54 hastanýn verileri geriye dönük olarak incelendi. Travmatik total parmak amputasyonu yapýlan hastalar çalýþmaya dahil edildi. Arterler basit akan dikiþ tekniði ve basit aralýklý dikiþ tekniði olmak üzere iki teknikle onarýldý. Demografik hasta verileri, komorbiditeler, ameliyat verileri, ameliyat sonrasý bakým, hastanede kalýþ süresi, yaralanma mekanizmasý ve yaralanma yeri kaydedildi. Gruplar istatistiksel olarak analiz edildi. Fonksiyonel sonuçlar Quick DASH skoruna göre deðerlendirildi.
BULGULAR: Çalýþmaya parmak replantasyonu uygulanan, yaþ ortalamasý 32.5±18.4 (daðýlým 1–75) olan toplam 54 hasta alýndý. Ortalama takip süresi 30.9±16.1 aydý. Yaralanma mekanizmasý 29 (%35.4) parmakta giyotin tarzý yaralanma, 15 parmakta (%18.3) avülsiyon yaralanmasý ve 38 (%46.3) parmakta ezilme yaralanmasýydý. Kýrk altý parmak basit akan dikiþ tekniði ile, 36 parmak ise basit aralýklý dikiþ tekniði ile onarýldý. Dikiþ teknikleri arasýnda baþarýsýzlýk açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p=0.569). Ayrýca basit akan dikiþ tekniði grubunda travma tipine göre Quick DASH skorlarýnda istatistiksel olarak anlamlý bir fark olmamasýna raðmen (p=0.109), örneklem büyüklüðünün küçük olmasý nedeniyle basit kesintili dikiþ tekniði grubu içinde karþýlaþtýrma yapýlamadý. Ýskemi süresi <6 saat olan olgular ile iskemi süresi 6–12 saat olan olgular arasýnda baþarýsýzlýk oranlarýnda istatistiksel olarak anlamlý fark yoktu (p>0.05). Gruplar arasýnda yaþ, VKÝ, arteriyel hipertansiyon veya diabetes mellitus (DM) açýsýndan istatistiksel olarak anlamlý fark bulunmadý (p>0.05). Basamak baþýna ameliyat süresine, sigara içenlere veya damar onarýmýna göre tek deðiþkenli analizde istatistiksel olarak anlamlý farklýlýklar bulundu (p<0.05). Toplamda 82 parmak replantasyonundan 65’i (%79.3) baþarýlý oldu. Venöz onarýmý yapýlamayan 30 parmaktan toplam 17’si týbbi sülük tedavisi nedeniyle hayatta kaldý.
TARTIÞMA: Parmak replantasyonu, cerrahi endikasyonlarýn dikkate alýnmasý ve deneyimli bir cerrahi ekibin varlýðýnýn gerekli olduðu, uygulanmasý zor bir cerrahi iþlemdir. Parmak amputasyonlarýnda dikiþ tekniði ne olursa olsun, arter anastomozundan sonra venöz anastomoz yapýlmasý dolaþýmýn yeniden saðlanmasý için esastýr.

BACKGROUND: The present study aimed to retrospectively analyze replantations and compared the success rates of different suturing techniques.
METHODS: The data of 54 patients who underwent 82 finger replantations between January 2016 and April 2020 were retrospectively analyzed. Patients who underwent traumatic total finger amputations were included in the study. Arteries were repaired with two techniques, the simple running suture technique and the simple interrupted suture technique. Demographic patient data, comorbidities, operative data, post-operative care, the length of hospital stay, mechanism of injury, and site of injury were recorded. The groups were statistically analyzed. Functional outcomes were evaluated according to the Quick DASH score.
RESULTS: A total 54 patients with a mean age of 32.5±18.4 (range 1–75) who underwent finger replantation were included in the study. The mean duration of follow-up was 30.9±16.1 months. The mechanism of injury was guillotine-style injury in 29 (35.4%) fingers, avulsion injury in 15 (18.3%) fingers, and crush injury in 38 (46.3%) fingers. Forty-six fingers were repaired using a simple running suture technique, and 36 fingers were repaired using a simple interrupted suture technique. There was no statistically significant difference in terms of failure between the suture techniques (p=0.569). Further, although there was no statistically significant difference in Quick DASH scores according to the type of trauma in the simple running suture technique group (p=0.109), a comparison could not be made within simple interrupted suture technique group because of the small sample size. There was no statistically significant difference in failure rates between cases with an ischemia duration of <6 h and those with ischemia duration of 6–12 h (p>0.05). No statistically significant difference was found between the groups according to age, body mass index, arterial hypertension, or diabetes mellitus (p>0.05). Statistically significant differences were found in univariate analysis according to surgery time per digit, smokers, or vein repair (p<0.05). In total, 65 (79.3%) out of 82 finger replantations were successful. A total of 17 out of 30 fingers that could not undergo venous repair survived because of treatment with medicinal leeches.
CONCLUSION: Finger replantation is a difficult-to-perform surgical procedure requiring consideration of the surgical indications and the presence of an experienced surgical team. Regardless of the suture technique in finger amputations, performing venous anastomosis after arterial anastomosis is essential to restore circulation.

AMAÇ: Sakrum kýrýklarý nadir görülür ve uygun tedavinin belirlenmesi için 3 boyutlu kýrýk morfolojisinin detaylý olarak anlaþýlmasý þarttýr. Mevcut çalýþmanýn amacý sakrum kýrýklarýnda tekrarlayan kýrýk paternlerinin ortaya koyulmasý, parçalanma alanlarýnýn belirlenmesi ve bilgisayarlý tomografi (BT) bazlý kýrýk haritalarýnýn oluþturulmasýdýr.
GEREÇ VE YÖNTEM: Travmatik sakrum kýrýðý tanýsý almýþ 72 hastanýn BT görüntüleri incelendi. Her kýrýk için kýrýk hatlarý belirlendi ve dijital ortamda redükte edildi. Tüm kýrýklar bir þablonun üzerine süperpoze edilerek kýrýk haritalarý oluþturuldu. Her kýrýk tipi için ayrýca parçalanma alanlarý ve ýsý haritalarý elde edildi.
BULGULAR: Çalýþmaya 40 erkek 32 kadýn hasta dahil edildi (ort. hasta yaþý 46.5±19.9). Elli üç hastada (%73.6) majör travma, 19 hastada (%26.4) minör travma sonrasý kýrýk oluþmuþtu. Zon 1 kýrýklarda çoðu kýrýk hattý vertikal ve ya oblikti (45°’ye kadar). Zone 2 kýrýklarda kýrýklarýn S1 ve S2 seviyelerinde yoðunlaþtýðý gözlendi. Sað taraflý kýrýklarda anterolateral ve posterolateral kýsýmlar görece daha az etkilenmiþti. Zone 3 kýrýklarda kýrýk hatlarý sakral kanal çevresinde ve S1, S2 ve S3 seviyelerinin etrafýnda yoðunlaþmýþtý. Orta hat ve median sakral krista çoðu zaman korunmuþtu.
TARTIÞMA: Sakrum kýrýklarý her kýrýk tipi için bir takým tekrarlanabilir özellikler göstermektedir. Mevcut bulgular; tedavi planlamasý, fiksasyon materyallerinin yerleþtirilmesi, yeni implantlar geliþtirilmesi ve mevcut sýnýflama sistemlerinin modifikasyonu için faydalý olabilir.

BACKGROUND: Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps.
METHODS: Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; comminution zones and heatmaps were created for each zone.
RESULTS: There were 40 males and 32 females with a mean age of 46.5±19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45°) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected.
CONCLUSION: Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems.

Peptik ülser perforasyonu, akut karýn aðrýsý ve hasta için þiddetli sýkýntý ile kendini gösteren, akut karýnýn önde gelen nedenlerinden biridir. Hastalarýn üçte birinde baþvuru geç olup tanýda önemli gecikmelere neden olur. Burada Covid-19 pozitif bir hastanýn midesinde çift ülser perforasyonu geliþmesi sonucu diffüz pürülan peritonit oluþan ve acil cerrahi tedavi uygulanan çok nadir bir olguyu sunuyoruz.

Peptic ulcer perforation is one of the leading causes of acute abdomen, presenting with acute abdominal pain and severe distress for the patient. In one-third of patients, the presentation is less dramatic, resulting in significant delays in diagnosis. Herein, we present a very rarest case operated on for diffuse purulent peritonitis with double perforation of the stomach in a COVID-19-positive patient, which had a depressing outcome.

Servikal omurilik yaralanmasý, travma hastalarýnda iyi bilinen bir kardiyak arrest nedenidir. Travmadan kesin olarak þüphelenilmedikçe, acil saðlýk hizmetleri ekipleri hastane öncesi aþamada servikal immobilizasyon olmadan resüsitasyon gerçekleþtirir. Ýleri kardiyovasküler yaþam desteði (Advanced cardiovascular life support-ACLS) sýrasýnda, servikal immobilizasyon ile entübasyon hava yoluna eriþimde zorluða neden olur, bu nedenle hasta açýk bir travma vakasý olmadýkça immobilizasyon yapýlmaz. Açýk bir travma olmadan meydana gelen servikal kýrýklar nedeniyle hastane dýþý kardiyak arrest (Out-of-hospital cardiac arrest-OHCA) olan iki hastayý sunuyoruz. Bu vakalarda, önceden var olan servikal omurga lezyonlarý ek olarak bilgilendirildi ve servikal omurga kýrýklarýnýn tanýmlanmasý gecikti. Acil týp doktorlarý, OHCA ile baþvuran bir hastada travma olasýlýðý belirsiz olduðunda servikal omurga yaralanmasýný ihmal etme eðilimindedir. Bu vakalar, doktorlarý minör travma olgularýnda bile servikal yaralanma olasýlýðýný düþünmeye sevk edebilir. Servikal spinal yaralanma olasýlýðý varsa görüntüleme geciktirilmemeli ve ardýndan uygun tedavi uygulanmalýdýr.

Cervical spinal cord injury is a well-known cause of cardiac arrest in trauma victims. Unless trauma is definitively suspected, emergency medical services teams perform resuscitation in the pre-hospital stage without cervical spine immobilization. During advanced cardiovascular life support (ACLS), intubation with cervical spinal immobilization causes difficulty in accessing the airway, thus, immobilization tends to not be performed, unless the patient is a clear case of trauma. We report two patients with out-of-hospital cardiac arrests (OHCA) due to cervical fractures that have occurred without clear trauma. In these cases, pre-existing cervical spine lesions was additional informed and identification of the cervical spine fractures was delayed. Emergency medical physicians tend to neglect cervical spine injury when the likelihood of trauma is unclear in a patient presenting with OHCA. These cases urge physicians to consider the possibility of cervical spinal injuries, even in cases of minor trauma. If there is a possibility of cervical spinal injury, imaging should not be delayed and should be followed by appropriate treatment.