AMAÇ: Bu çalýþmanýn amacý, deneysel bir testis torsiyon modelinde medikal ozon (MO) tedavisi ile hiperbarik oksijen (HBO) tedavisinin etkilerini, oksidan ve antioksidan belirteçleri ölçerek ve histopatolojik doku hasarý bulgularýný inceleyerek karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Otuz iki Wistar sýçan kullanýldý ve dört gruba ayrýldý; (1) sahte grup (SG), (2) sadece testis torsiyonu ile iskemi/reperfüzyon (I/R), (3) HBO uygulanan grup ve (4) MO uygulanan grup. SG’de burulma yapýlmadý. Diðer tüm gruplarda, sýçanlara bir I/R modeli oluþturmak için testis torsiyonu ve ardýndan detorsiyon uygulandý. Ý/R sonrasý HBO grubuna hiperbarik oksijen, MO grubuna intraperitoneal ozon uygulandý. Bir hafta sonunda biyokimyasal analizler ve histopatolojik incelemeler için testis dokularý alýndý. Biyokimyasal olarak oksidan aktivite için malondialdehit (MDA), antioksidan aktivite için süperoksit dismutaz (SOD) ve glutatyon peroksidaz (GSH-Px) seviyeleri ölçüldü. Ayrýca testisler histopatolojik olarak da deðerlendirildi.
BULGULAR: Hem HBO hem de MO, sahte ve I/R gruplarý ile karþýlaþtýrýldýðýnda, oksidasyon etkilerinin azalmasýyla sonuçlanan, MDA seviyelerini önemli ölçüde azaltmýþtýr. HBO ve MO gruplarýndaki antioksidan GSH-Px seviyeleri, sham ve I/R gruplarýna göre anlamlý derecede yüksekti. HBO grubundaki antioksidan SOD seviyeleri sham, I/R ve MO gruplarýna göre anlamlý olarak yüksekti. Bu nedenle, özellikle SDO seviyeleri dikkate alýn-dýðýnda, HBO’nun antioksidan etkisinin MO’dan daha üstün olduðu gözlenmiþtir. Histopatolojik olarak gruplar arasýnda anlamlý fark yoktu (p>0.05).
TARTIÞMA: Çalýþma, hem HBO hem de MO’nun testis torsiyonunda kullanýlabilecek antioksidan ajanlar olduðunu tahmin edebilir. HBO tedavisinin, MO tedavisine göre antioksidan belirteç düzeylerinin artmasý nedeniyle hücresel antioksidan kapasiteyi iyileþtirebileceðini belirledik. Bununla birlikte, daha büyük bir örneklem büyüklüðü ile daha fazla çalýþmaya ihtiyaç vardýr.

BACKGROUND: This study aims to compare the effects of medical ozone (MO) therapy and hyperbaric oxygen (HBO) therapy in an experimental testicular torsion model by measuring the oxidant and antioxidant markers and examining the histopathological tissue damage findings.
METHODS: Thirty-two Wistar rats are used and are divided into four groups; (1) sham group (SG), (2) only ischemia/reperfusion (I/R) by testicular torsion, (3) HBO administered group, and (4) MO administered group. No torsion was conducted in the SG. In all other groups, rats underwent testicular torsion followed by detorsion to create an I/R model. After I/R, HBO was injected in the HBO group, and in the MO group, intraperitoneal ozone was applied. At the end of 1 week, testicular tissues were obtained for biochemical analyzes and histopathological examinations. Biochemically, malondialdehyde (MDA) levels were measured for oxidant activity, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were measured for antioxidant activity. Furthermore, the testicles were evaluated histopathologically.
RESULTS: Both HBO and MO have significantly decreased MDA levels, compared with sham and I/R groups, resulting in decreased oxidation effects. The antioxidant GSH-Px levels in the HBO and MO groups were significantly higher than in the sham and I/R groups. In addition, the antioxidant SOD levels in the HBO group were significantly higher than sham, I/R, and MO groups. Therefore, the antioxidant effect of HBO was observed to be superior to MO, specifically considering SOD levels. Histopathologically, there was no significant difference between the groups (p>0.05).
CONCLUSION: The study may extrapolate that both HBO and MO are antioxidant agents that can be used in testicular torsion. HBO treatment might improve the cellular antioxidant capacity due to increased antioxidant marker levels more than MO therapy. However, further studies are needed with a larger sample size.

AMAÇ: Bu çalýþmada, ileri evre kanser hastalarýnda kullanýlan bir kortikosteroid olan deksametazon (DXM) ve sisplatinin kümülatif doku toksisi-tesini azaltan amifostin’in (AMI), sýçanlarda oluþturulan kardiyak kontüzyon (KK) modelinde kalp ile iliþkili patolojik deðiþiklikler üzerinde iyileþtirici etkilerinin olup olmadýðýnýn incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Toplamda kýrk iki Wistar albino sýçan, eþit olarak altý gruba ayrýldý: K (Kontrol), KK, KK+AMI 400, KK+AMI 200, KK+AMI+DXM and KK+DXM. Travma sonucu oluþan kontüzyon sonrasý tomografi görüntüleri ile elektrokardiyografik analizleri yapýlarak karotid arterden ortalama arteryel basýncý (OAB) ölçülüp, histopatolojik ve biyokimyasal analizler için kan ve doku örnekleri alýndý.
BULGULAR: Künt travma ile kalp kontüzyonunun oluþturulduðu sýçanlarda, kalp dokusu ve serumdaki toplam oksidant status (TOS) ve disülfid parametreleri anlamlý olarak yüksek (p<0.05), toplam antioksidant status (TAS), toplam tiyol (TT) ve native thiol (NT) parametreleri anlamlý olarak daha düþük bulundu (p<0.01). Elektrokardiyografi testlerinde en sýk gözlenen bulgu ST yükselmesi idi.
TARTIÞMA: Histolojik, biyokimyasal ve elektrokardiyografik incelemeler sonucunda sýçanlarda miyokard kontüzyonunun tedavisinde sadece 400 mg/kg dozda amifostin veya DXM’nin etkili olabileceði kanaatindeyiz.

BACKGROUND: This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity induced by cisplatin in advanced-stage cancer patients, have ameliorative effects on pathologic changes associated with cardiac contusion (CC) induced in rats.
METHODS: Forty-two Wistar albino rats were equally divided into six groups (n=7): C, CC, CC+AMI 400, CC+AMI 200, CC+AMI+DXM, and CC+DXM. Tomography images and electrocardiographic analyzes were performed, mean arterial pressure was measured from the carotid artery, and blood and tissue samples were obtained for histopathological and biochemical analyses after trauma-induced CC.
RESULTS: While the total oxidant status and disulfide parameters in the cardiac tissue and serum were significantly higher (p<0.05), the total antioxidant status, total thiol, and native thiol parameters were significantly lower (p<0.01) in rats with trauma-induced CC. The most frequently observed finding in the electrocardiography analyze was ST elevation.
CONCLUSION: According to evaluation based on histological, biochemical, and electrocardiographic examinations, we believe that only 400 mg/kg dose of AMI or DXM can be effective in the treatment of myocardial contusion in rats. Evaluation based on histological findings.

AMAÇ: Sinir iyileþmesi açýsýndan epinöral bütünlüðün saðlanmasý büyük önem taþýmaktadýr. Deneysel olarak oluþturulan sinir defekti modellerinde iyileþmeyi olumlu yönde etkilediði düþünülen maddelerin kullanýmýnýn bildirimi giderek artmaktadýr. Bu çalýþmada epinöral bütünlük korunarak oluþturulan siyatik sinir defekti modelinde subepinöral hyalüronik asid enjeksiyonunun sinir iyileþmesine olan etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Çalýþmada 40 adet Sprague Dawley cinsi sýçan kullanýldý. Her grupta 10 adet sýçan olacak þekilde 1 kontrol ve 3 deney grubu oluþturuldu. Kontrol grubunda, siyatik sinir disseksiyonu dýþýnda iþlem uygulanmadý. Deney grubu 1’de siyatik sinir tam kat kesildi ve primer onarýldý. Deney grubu 2’de epinöryum korunarak 1cm’lik sinir defekti oluþturuldu. Defekt epinöral dokularýn uc uca suture edilmesi ile onarýldý. Deney grubu 3’de deney grubu 2’de uygulanan cerrahi prosedür tekrar edildi, buna ek olarak subepinöral hyaluronik asid enjeksiyonu gerçekleþtirildi.
BULGULAR: Fonksiyonel deðerlendirmede, 12 haftalýk takip süresi boyunca gruplar arasýnda anlamlý istatistiksel fark gözlenmedi. Histolojik deðerlendirmede sinir iyileþmesinin deney grubu 2’ de, deney grubu 1 ve 3’ e oranla daha düþük olduðu saptandý (p<0.05).
TARTIÞMA: Fonksiyonel deðerlendirmede anlamlý fark saptanmamasýna karþýn, bu çalýþmada elde edilen histolojik bulgular hyaluronik asidin antifibrotik ve antiinflamatuar etkileri ile aksonlarýn rejenerasyon kapasitesini artýrdýðýný göstermiþtir.

BACKGROUND: Maintenance of epineural integrity is very important for nerve healing. Reports on the use of substances consid-ered to have positive effects on nerve healing in experimental nerve defect models are increasing. The present study assessed the effects of sub-epineural hyaluronic acid injection in a rat sciatic nerve defect model that was created while maintaining epineural integrity.
METHODS: The study included 40 Sprague Dawley rats. The rats were randomly divided into a control group and three experimental groups (10 rats in each group). In the control group, the sciatic nerve was dissected and no additional surgery was performed. In experimental group 1, the sciatic nerve was transected in the middle, and then, primary repair was performed. In experimental group 2, a 1-cm defect was created while preserving the epineurium, and then, the defect was repaired with end-to-end suturing of the pre-served epineurium. In experimental group 3, the surgical procedure for experimental group 2 was performed, and then, sub-epineural hyaluronic acid injection was carried out. Functional and histological evaluations were performed.
RESULTS: On functional evaluation, there was no statistically significant difference among the groups during the 12-week follow-up period. On histological evaluation, nerve recovery was poorer in experimental group 2 than in experimental groups 1 and 3 (p<0.05).
CONCLUSION: Although the functional analysis did not reveal any significant results, the histological findings suggest that hyaluronic acid increases the regeneration capacity of axons through its anti-fibrotic and anti-inflammatory effects.

AMAÇ: Orta Doðu bölgesinde mesken ortamýnda yüksekten düþme ve aðýr nesnelerin düþmesi nedeniyle oluþan yaralanmalar hafife alýnmaktadýr. Bu yazýda, birinci düzey travma merkezine yatýþ gerektiren evde düþmeye baðlý yaralanmalarý tanýmlamayý amaçladýk.
GEREÇ VE YÖNTEM: 2010 ve 2018 yýllarý arasýnda evde düþmeye baðlý yaralanmalarý takiben merkeze baþvuran hastalarýn retrospektif bir analizini yaptýk. Yaþ gruplarý (<18,19–54, 55–64, ≥65 yaþ), cinsiyet, yaralanma þiddeti ve düþme yüksekliðine göre karþýlaþtýrmalý analizler yapýldý. Düþmeye baðlý yaralanmalarýn zaman serisi analizi yapýldý.
BULGULAR: Toplam 1402 hasta evde meydana gelen düþmeye baðlý yaralanmalar nedeniyle hastaneye kaldýrýlmýþtý (toplam travma baþvurularýnýn %11’i). Yaralananlarýn dörtte üçü erkekti. En çok yaralananlar genç ve orta yaþlý bireylerdi (%41.6); bunu çocuk (%37.2) ve yaþlý bireyler (%13.6) takip etmekteydi. En sýk yaralanma mekanizmasý yüksekten düþme (%94), ardýndan aðýr nesnelerin düþmesi (%6) idi. Kafa travmasý en yaygýn olanýydý (%42); bunu alt ekstremite yaralanmasý (%19) takip etmekteydi. Yaþlý yetiþkinlerde (≥65 yaþ) daha fazla komplikasyon, daha uzun hastanede kalýþ süresi ve daha yüksek hastane içi mortalite görülmüþtür. Yüksekten düþen hastalarda þiddetli daha fazla olan daha fazla göðüs ve omurilik yaralanmasý ve hastanede daha uzun süre kalma gözlendi. Zaman serisi analizi, düþmeyle ilgili hastaneye yatýþta mevsimsel bir deðiþiklik göstermemiþtir. TARTIÞMA: Bu çalýþma, travma nedeniyle hastaneye yatýþlarýn %11’inin evde düþme ile iliþkili olduðunu göstermiþtir. Yüksekten düþme tüm yaþ grup-larýnda yaygýndý; ancak aðýr nesnelerin düþmesi pediatrik grupta daha belirgindi. Önleyici çabalar, kanýta dayalý önleme stratejileri konusunda daha iyi bilgilendirmek adýna mesken ortamýndaki travma koþullarýný ele almalýdýr.

BACKGROUND: Injuries caused by falls from heights (FFH) and fall of heavy objects (FHO) in residential settings are underestimat-ed in the Middle East. We aimed to describe the fall-related injuries at home requiring admission at a level 1 trauma center.
METHODS: We conducted a retrospective analysis of patients who were admitted following fall-related injuries at home between 2010 and 2018. Comparative analyses were performed based on age groups (<18, 19–54, 55–64, and ≥65 years), gender, severity of injuries, and height of fall. Time series analysis of fall-related injuries was performed.
RESULTS: A total of 1402 patients were hospitalized due to fall-related injuries occurred at home (11% of total trauma admissions). Three quarters of victims were male. The most injured subjects were young and middle-aged (41.6%), followed by pediatric (37.2%) and elderly subjects (13.6%). FFH was the most frequent mechanism of injury (94%) followed by FHO (6%). Head injury was most common (42%) followed by lower extremity injury (19%). Older adults (≥65 years) had more complications, longer hospital stay, and higher in-hospital mortality. Patients who fell from greater heights had more chest and spinal injuries with greater severity and longer stay in the hospital. Time-series analysis did not show a seasonal variation of fall-related hospitalization.
CONCLUSION: This study showed that 11% of trauma hospitalizations were related to fall at home. FFH was common in all age groups; however, FHO was more evident in the pediatric group. Preventive efforts should address the circumstances of trauma in the residential settings to better inform evidence-based prevention strategies.

AMAÇ: Bu çalýþma, travmatik beyin hasarý (TBH) sonuçlarý ile hastane öncesi Ulusal Erken Uyarý Skoru (NEWS), Yaralanma Þiddet Skoru (ISS) ve Revize Travma Skoru (RTS) arasýndaki iliþkiyi incelemeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM: Bu geriye dönük gözlemsel çalýþma, Ocak 2019 ile Aralýk 2020 arasýnda hastane öncesi acil saðlýk hizmetleri sistemine baþvu-ran TBH’li yetiþkin hastalarý içermektedir. Kýsaltýlmýþ Yaralanma Skalasý Puaný 3 veya daha yüksek olduðunda TBH kabul edildi. Primer sonuç, hastane içi mortalite idi.
BULGULAR: Çalýþmaya alýnan 248 hasta arasýnda hastane içi mortalite %18.5 (n=46) olarak bulundu. Hastane içi mortaliteyi öngörmeye yönelik çok deðiþkenli analizde, hastane öncesi NEWS (Odss ratio, 1.198; %95 güven aralýðý [CI], 1.042–1.378) ve RTS (OR, 0.568; %95 CI, 0.422–0.766) hastane içi mortaliteyle baðýmsýz olarak iliþkiliydi. ISS, RTS ve hastane öncesi NEWS için eðrinin altýndaki alan (AUC’ler) sýrasýyla 0.731 (%95 CI, 0.672–0.786), 0,853 (%95 CI, 0.802–0.894) ve 0.843 (%95 CI, 0.791–0.886) idi. Hastane öncesi NEWS’in AUC’si, ISS’ninkinden önemli oranda farklýydý, ancak RTS’ninkinden farklý deðildi.
TARTIÞMA: Hastane öncesi NEWS, sahada TBH’li hastalarýn hýzlý bir þekilde sýnýflandýrýlmasýna ve uygun hastanelere nakledilmesine yardýmcý olarak prognozun iyileþtirilmesine katkýda bulunabilir.

BACKGROUND: This study aimed to examine the association between the outcome of traumatic brain injury (TBI) and pre-hospital National Early Warning Score (NEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS).
METHODS: This retrospective and observational study included adult patients with TBI admitted to the pre-hospital emergency medical services system between January 2019 and December 2020. TBI was considered when the abbreviated injury scale score was 3 or higher. The primary outcome was in-hospital mortality.
RESULTS: Among 248 patients included in the study, in-hospital mortality was 18.5% (n=46). In the multivariate analysis for predict-ing in-hospital mortality, pre-hospital NEWS (Odds ratio [OR], 1.198; 95% Confidence interval [CI], 1.042–1.378) and RTS (OR, 0.568; 95% CI, 0.422–0.766) were independently associated with in-hospital mortality. The area under the curves (AUCs) for ISS, RTS, and pre-hospital NEWS were 0.731 (95% CI, 0.672–0.786), 0.853 (95% CI, 0.802–0.894), and 0.843 (95% CI, 0.791–0.886), respectively. The AUC of pre-hospital NEWS was significantly different from that of ISS but not from that of RTS.
CONCLUSION: Pre-hospital NEWS could contribute to improving prognosis by aiding in the rapid classification of patients with TBI in the field and their transportation to appropriate hospitals.

AMAÇ: Splenik arter embolizasyonu (SAE), dalak yaralanmasýnýn ameliyatsýz yönetimi olan bir teknik olarak yaygýn kullanýlmaktadýr. Bununla birlikte, SAE sonrasý takip süresi ve yöntemleri ile dalak enfarktüsünün doðal seyri hakkýndaki bilgiler sýnýrlýdýr. Bu çalýþmada, SAE sonrasý dalak enfarktüsünün komplikasyonlarý ve iyileþme paternlerini analiz etmek ve uygun takip süresi ve yöntemini belirlemek amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2014 ile Kasým 2018 arasýnda Pusan Ulusal Üniversite Hastanesi, Birinci Basamak Travma Merkezi’ne baþvuran künt dalak yaralanmasý olan 314 hastanýn týbbi kayýtlarý, SAE uygulanan hastalarý belirlemek üzere analiz edildi. Takip edilen hastalarda SAE sonrasý elde edilen bilgisayarlý tomografi (BT) görüntüleri, dalakta herhangi bir deðiþiklik olup olmadýðýný ve devam eden kanama, psödoanevrizma, dalak enfark-tüsü veya apse oluþumu gibi komplikasyonlarýn oluþumunu belirlemek için önceki tüm BT taramalarý ile karþýlaþtýrýldý.
BULGULAR: Üç yüz on dört hastadan SAE yapýlan 132’si çalýþmaya dahil edildi. Toplamda, 132 hasta arasýnda 30 komplikasyon kaydedildi; bunlarýn 7’si (%5,30) embolizasyon tekrarý ve 9’u (%6.82) splenektomi gerektirmiþti. Yetmiþ altý hastada %50’nin altýnda dalak enfarktüsü ve 40 hastada total ve totale yakýn enfarktüsler dahil ≥%50 dalak enfarktüsü kaydedildi. Dalak enfarktüsü ≥%50 olan hastalar arasýnda, 3 (%2.27) hastada SAE’den 16 ila 21 gün sonra apse varlýðý kaydedildi ve AAST-OIS derecesi arttýkça enfarktüs geniþliðinin arttýðý saptandý. Splenik arter embolizasyonunu takiben, 75 hastada >14 gün boyunca tekrarlanan abdominal BT taramalarý elde edildi; bunlardan 67’sinde dalak enfarktüsünün iyileþtiði görüldü. Splenik arter embolizasyonundan sonra medyan iyileþme süresi 43 gündü.
TARTIÞMA: Mevcut bulgular, ≥%50 enfarktüslü hastalarýn SAE sonrasý enfeksiyonu ekarte etmek için takip BT taramasý olsun veya olmasýn 3 haftalýk kapalý gözleme ihtiyaç duyabileceðini düþündürmektedir; dalakta iyileþmeyi doðrulamak için SAE’den 6 hafta sonra BT takibi gerekli olabilir.

BACKGROUND: Splenic artery embolization (SAE) is commonly employed as a non-operative management technique for splenic injury. Nonetheless, information on follow-up duration and methods, and the natural course of splenic infarction after SAE is limited. Thus, this study is aimed to analyze the patterns of complications and recovery of splenic infarction after SAE and to determine the appropriate follow-up duration and method.
METHODS: Medical records of 314 patients with blunt splenic injury admitted at the Pusan National University Hospital, Level I Trauma Centre were analyzed to identify patients who underwent SAE between January 2014 and November 2018. Computed tomography (CT) scans that were obtained after SAE in patients who were followed up were compared with all their previous CT scans to identify any changes in the spleen and the occurrence of complications such as sustained bleeding, pseudoaneurysm, splenic infarctions, or abscess formation.
RESULTS: Of the 314 patients, 132 who underwent SAE were included in the study. In total, 30 complications were noted among the 132 patients; of these, 7 (5.30%) required repeat embolization and 9 (6.82%) required splenectomy. Splenic infarction of <50% occurred in 76 patients and that of ≥50% including total and near-total infarctions occurred in 40 patients. Among patients with splenic infarction of ≥50%, 3 (2.27%) patients had abscesses between 16 and 21 days after SAE, and the range of infarctions increased as the AAAST-OIS grade increased. After SAE, repeat abdominal CT scans for >14 days were obtained in 75 patients; among these, 67 pre-sented with recovery of splenic infarction. The median period of recovery was 43 days after SAE.
CONCLUSION: The present findings suggest that patients with ≥50% infarction may need 3 weeks of closed observation, with or without a follow-up CT scan, to rule out infection after SAE, follow-up CT follow-up at 6 weeks after SAE may be necessary to confirm the recovery of the spleen.

AMAÇ: Rektal yabancý cisimler (RYC) son yýllarda artan insidansý ile kolorektal cerrahi pratiðinde nadir görülen klinik prezentasyonlardan biridir. Standart tedavi seçeneklerinin olmamasý nedeniyle, RFB’lerin yönetimi zor olabilir. Bu çalýþma, RFB’lere tanýsal ve terapötik yaklaþýmýmýzý deðerlen-dirmeyi ve bir yönetim algoritmasý önermeyi amaçladý
GEREÇ VE YÖNTEM: Ocak 2010 ile Aralýk 2020 arasýnda hastanede yatan tüm RYC’li hastalar geriye dönük olarak incelendi. Hasta demografisi, RYC yerleþtirme mekanizmasý, yerleþtirilen nesneler, taný bulgularý, yönetim, komplikasyonlar ve sonuçlarýn tümü deðerlendirildi. Merkezin deneyi-mine baðlý olarak klinik yönetim için bir algoritma geliþtirildi.
BULGULAR: Kohort 21 hastadan oluþuyordu, 17’si (%81) erkekti. Ortanca yaþ 33 idi (19–71 arasýnda deðiþiyor). On beþ (%71.4) hastada cinsel tercihler RYC nedeniydi. On yedi (%81) hastada RYC boyutu 10 cm’nin üzerindeydi. Dört (%19) hastada acil serviste RYC’ler anestezi olmadan transanal yolla çýkarýldý; kalan 17’sinde (%81) anestezi altýnda çýkarýldý. Bunlarýn arasýnda iki (%9.5) hastada genel anestezi altýnda RYC transanal yolla çýkarýldý; sekiz (%38) hastada anestezi altýnda kolonoskop yardýmýyla; üç (%14.2) hastada laparotomi sýrasýnda transanal yola saðým yaparak; ve dört (%19) hastada baðýrsak devamlýlýðý saðlanmadan Hartmann prosedürü ile RYC çýkarýlmasý yapýldý. Medyan hastanede kalýþ süresi altý gündü (1–34 gün arasýnda deðiþiyordu). Clavien-Dindo (C-D) derece III-IV komplikasyon oraný %9.5 idi ve ameliyat sonrasý mortalite gözlenmedi.
TARTIÞMA: RYC’ler genellikle ameliyathanede uygun anestezi tekniði ve uygun cerrahi alet seçimi ile transanal yolla baþarýlý bir þekilde çýkarýlabilir.

BACKGROUND: Rectal foreign bodies (RFBs) are one of the rare clinical presentations in colorectal surgical practice, with an increasing incidence over the recent years. Due to the lack of standardized treatment options, the management of RFBs can be chal-lenging. This study aimed to evaluate our diagnostic and therapeutic approach to RFBs and to suggest a management algorithm.
METHODS: All patients with RFBs who hospitalized between January 2010 and December 2020 were retrospectively reviewed. Patient demographics, RFB insertion mechanism, inserted objects, diagnostic findings, management, complications, and outcomes were all evaluated. An algorithm for clinical management was developed depending on the center’s experience.
RESULTS: The cohort consisted of 21 patients, 17 (81%) were males. The median age was 33 years (ranging, 19–71). Sexual prefer-ences were the reason for RFB in 15 (71.4%) patients. In 17 (81%) patients, the RFB size over 10 cm. In 4 (19%) patients, RFBs were removed transanally without anesthesia in the emergency department; in the remaining 17 (81%), they were removed under anesthesia. Among these, RFBs were removed transanally under general anesthesia in 2 (9.5%) patients; with the assistance of a colonoscope under anesthesia in 8 (38%) patients; by milking towards the transanal route during laparotomy in 3 (14.2%) patients; and with the Hartmann procedure without restoration of bowel continuity in 4 (19%) patients. The median hospital stay was 6 days (ranging, 1–34 days). The Clavien-Dindo grade III-IV complication rate was 9.5%, and no post-operative mortality was observed.
CONCLUSION: RFBs can usually be successfully removed transanally in the operating room with appropriate anesthetic technique and proper surgical instrument selection.

AMAÇ: Depremler insan yaþamýný tehdit eden çok kýsa sürede can ve mal kaybýna yol açan doðal afedlerdir. Çalýþmamýzda Ege Denizi depremi sonrasý hastanemize baþvuran depremzedelerin týbbi analizini gerçekleþtirmeyi ve klinik deneyimlerimizi paylaþmayý amaçladýk.
GEREÇ VE YÖNTEM: Ege Denizi depremi nedeniyle hastanemize getirilen depremzedelerin veya deprem nediyle baþvuran yaralýlarýn týbbi veri kayýtlarýný geriye dönük olarak inceledik. Hastalarýn demografik verileri, þikayet ve tanýlarý, baþvuru saatleri, klinik seyirleri, hastane düzenlemeleri (yatýþ, taburculuk, nakil), ameliyata kadar geçen süre, anestezi yöntemleri, cerrahi müdahaleler, yoðun bakým ihtiyaçlarý, ezilme sendromu, akut böbrek yetersizliði varlýðý, diyaliz, mortalite ve morbidite gözden geçirildi.
BULGULAR: Deprem nedeniyle hastanemize toplam 152 hasta getirildi. Acil servise baþvurunun en yoðun olduðu dönem ilk 24–36 saatti. Mortalite oraný yaþ artýþýna baðlý olarak daha yüksek saptandý. Mortal seyreden depremzedelerin en sýk baþvuru nedeni göçük altýnda kalma iken sað kalanlar göçük altýnda kalmanýn dýþýnda düþme gibi baþka nedenlerle de baþvurmuþtu. Sað kalan hastalarda en sýk görülen fraktür þekli alt ekstremite fraktürleriydi.
TARTIÞMA: Epidemiyolojik çalýþmalar, gelecekteki depreme baðlý yaralanmalarýn saðlýk kurumlarý tarafýndan yönetimine ve organizasyonuna önemli katký saðlayabilir.

BACKGROUND: Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences.
METHODS: We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and mor-bidity were reviewed.
RESULTS: A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24–36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures.
CONCLUSION: Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions.

AMAÇ: Bu çalýþmanýn amacý acil servise(AS) baþvuruda hesaplanan immünoinflamatuar indeksin (SII) akut pankreatit (AP) tanýsý konan hastalarýn klinik sonuçlarýnýn öngörülmesi üzerindeki etkisini incelemektir.
GEREÇ VE YÖNTEM: Bu araþtýrma, tek merkezli, kesitsel, retrospektif bir çalýþma olarak tasarlandý. Üçüncü basamak hastanedeki Ekim 2021-Ekim 2022 tarihleri arasýnda acil serviste AP tanýsý alan, veri kayýt sisteminde taný ve tedavi iþlemleri tamamlanmýþ eriþkin hastalar çalýþmaya dahil edildi.
BULGULAR: Hayatta kalmayanlarýn ortalama yaþý, solunum sayýsý ve hastanede kalýþ süresi hayatta kalanlarýn ortalamasýndan anlamlý derecede yüksekti (sýrasýyla t-testi, p=0.042, p=0.001 ve p=0.001). Ölümcül sonucu olan hastalarýn ortalama SII skoru hayatta kalanlardan daha yüksekti (t-testi, p=0.001). Mortaliteyi tahmin etmek için SII skorunun ROC analizi, eðri altýnda kalan alanýn (AUC) 0.842 (%95CI 0.772-0.898) ve Youden indeksinin 0.614 olarak (p=0.001) hesaplandý. Mortaliteyi belirlemede SII puanýnýn kesme deðeri >1243 olduðunda puanýn duyarlýlýðý %85,0, özgüllük %76,4, pozitif prediktif deðer (PPV) %37,0, negatif prediktif deðer (NPV) ise %96,9 olarak bulundu.
TARTIÞMA: Mortalite tahmininde SII skoru istatistiksel olarak anlamlýydý. Acil servise baþvuru sýrasýnda hesaplanan SII, acil servise baþvuran ve AP tanýsý konan hastalarýn klinik sonuçlarýný tahmin etmek için faydalý bir puanlama sistemi olabilir.

BACKGROUND: The aim of this study was to examine the effect of systemic immunoinflammatory index (SII), calculated on presentation to the emergency department (ED), on the prediction of clinical outcomes of patients who were diagnosed with acute pancreatitis (AP).
METHODS: This research was designed as a single-center, cross-sectional, and retrospective study. Adult patients who were diag-nosed with AP in the ED between October 2021 and October 2022 in the tertiary care hospital, whose diagnostic and therapeutic procedures were complete in the data recording system, have been included in the study.
RESULTS: Mean age, respiratory rate, and length of stay of the non-survivors were significantly higher than the mean of the survivors (t-test, p=0.042, p=0.001, and p=0.001, respectively). Mean SII score of the patients with fatal outcome was higher than the survivors (t-test, p=0.001). ROC analysis of the SII score to predict mortality revealed that the area under the curve was found to be 0.842 (95%CI 0.772–0.898), and the Youden index was 0.614, (p=0.001). When the cutoff value of the SII score in determining mortality is 1243, the sensitivity of the score was found to be 85.0%, specificity 76.4%, positive predictive value 37.0%, and negative predictive value 96.9%.
CONCLUSION: SII score was statistically significant in estimating mortality. SII calculated on presentation to the ED can be a useful scoring system to predict the clinical outcomes of patients who were admitted to the ED and were diagnosed with AP.

AMAÇ: Akut böbrek hasarý, yanýk travmalý hastalarda yüksek mortalite ve morbidite ile iliþkili yaygýn komplikasyonlardan biridir. Bu çalýþmada, yanýk hastalarýnda KDIGO kriterlerine göre akut böbrek hasarý geliþme sýklýðý, etkileyen faktörleri ve mortalite oranlarýnýn belirlenmesi amaçlanmýþtýr. GEREÇ VE YÖNTEM: Çalýþmaya en az 48 saat hastanede yatan ve 18 yaþýndan büyük hastalar dahil edilirken, böbrek transplantasyonu olan, kronik böbrek yetersizliði olan, hemodiyaliz uygulanan, 18 yaþýndan küçük, baþvuru sýrasýnda glomerüler filtrasyon hýzý <15 olan hastalar ve toksik epidermal nekroliz tanýlý hastalar çalýþma dýþý býrakýlmýþtýr. Akut böbrek hasarý, KDIGO sýnýflamasýna göre saptandý. Hastalarýn yaþ, cinsiyet, yanýk etiyolojileri, ya-nýk yüzdeleri, inhalasyon hasarýnýn varlýðý, ilk 72 saatte Parkland formülü ile verilen total sývý miktarý, mekanik ventilatör desteði, inotrop/vazopresör ihtiyacý, yoðun bakým kalýþ süresi, mortalite, Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Sequential Organ Failure Assessment (SOFA) deðerleri kaydedildi.
BULGULAR: Çalýþmamýza akut böbrek hasarý geliþen (+) grupta 26 (%54.2), akut böbrek hasarý geliþmeyen (-) grupta 22 (%45.8) olmak üzere toplam 48 hasta dahil edildi. Akut böbrek hasarý (+) grubunda ortalama toplam yanýk yüzey alaný %47.30, akut böbrek hasarý (-) grubunda ise%19.88 idi. Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Sequential Organ Failure Assessment (SOFA), mekanik ventilasyon ve inotrop/vazopresör desteði ve sepsis varlýðýnýn akut böbrek hasarý (+) olan grupta anlamlý olarak daha yüksekti. Akut böbrek hasarý (-) grubunda mortalite saptanmazken, akut böbrek hasarý (+) grubunun mortalite oraný %34.6 olduðu görüldü ve anlamlý derecede yüksekti.
TARTIÞMA: Akut böbrek hasarýnýn, yanýklý hastalarda yüksek morbidite ve mortalite ile iliþkili olduðu görüldü. Kidney Disease Improving Global Outcomes sýnýflandýrmasýnýn günlük takipte kullanýlmasý erken tanýda faydalýdýr.

BACKGROUND: Acute kidney injury (AKI) is one of the common complications, associated with high mortality and morbidity in patients with burn injuries. This study aimed to determine the frequency of AKI development, its affective factors, and mortality rates according to kidney disease improving global outcomes (KDIGO) criteria in the burn patients.
METHODS: The study included patients who are hospitalized for at least 48 h and aged >18 years, whereas patients with a renal transplant, chronic renal failure, undergoing hemodialysis, <18 years of age, with a glomerular filtration rate of <15 on admission, and toxic epidermal necrolysis was excluded from the study. KDIGO criteria were used to evaluate the occurrence of AKI. Burn mech-anism, total body surface area, inhalation injury respiratory tract burn, fluid replacement at 72 h with Parkland Formula, mechanical ventilator support, inotrope/vasopressor support, intensive care unit, lenght of stay, mortality, abbreviated burn severity index (ABSI), acute physiology, and chronic health evaluation II (APACHE II) ve Sequential organ failure assessment (SOFA) were recorded.
RESULTS: A total of 48 patients were included in our study, of which 26 (54.2%) developed AKI (+), whereas 22 (45.8%) did not (−). The mean total burn surface area was 47.30% in the AKI (+) group and 19.88% in the AKI (−) group. Mean scores of ABSI, II (APACHE II), and SOFA, the mechanical ventilation and inotrope/vasopressor support and the presence of sepsis were significantly higher in the AKI (+). No mortality was determined in the AKI (−) group, whereas 34.6% in the AKI (+) group which was significantly high.
CONCLUSION: AKI was related to high morbidity and mortality in patients with burns. Using KDIGOs, classification in daily fol-low-up is useful in early diagnosis.

AMAÇ: Periferik sinir bloðunun baþarýsýný deðerlendiren geleneksel yöntemlerin yerini zamanla objektif deðerlendirmelere izin veren yöntemler almýþtýr. Literatürde periferik sinir bloðu için çoklu objektif teknikler tartýþýlmýþtýr. Bu çalýþma, infraklaviküler blokajýn yeterliliðini deðerlendirmek için perfüzyon indeksi (PI), non-invaziv doku hemoglobin monitörizasyonu (SpHb), doku oksijen satürasyonu (StO2), doku hemoglobin indeksi (THI) ve vücut sýcaklýðýnýn güvenilir ve objektif yöntemler olup olmadýðýný araþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Önkol cerrahisi geçiren 100 hastada ultrason eþliðinde infraklaviküler blok, PI, SpHb, StO2, THI ve Vücut Sýcaklýðý ölçümleri blok prosedüründen 5 dakika önce, iþlemden hemen sonra ve iþlem sonrasý 25. dakikaya kadar 5’er dakikalýk aralýklarla kaydedildi. Bu deðerler, baþarýlý ve baþarýsýz blok gruplarý arasýnda istatistiksel olarak karþýlaþtýrýlýrken, bloke olan ve bloke olmayan uzuvlar arasýnda karþýlaþtýrýldý.
BULGULAR: Bloke ve bloke olmayan ekstremite gruplarý arasýnda StO2, THI, PI ve vücut ýsýsý açýsýndan anlamlý fark olmasýna raðmen, SpHb açý-sýndan bu gruplar arasýnda anlamlý fark yoktu. Ayrýca baþarýlý blok ve baþarýsýz blok gruplarý arasýnda StO2, PI ve vücut ýsýsý açýsýndan anlamlý fark saptanýrken, bu gruplar arasýnda THI ve SpHb açýsýndan anlamlý fark bulunmadý.
TARTIÞMA: StO2, PI ve vücut ýsýsý ölçümleri, blok prosedürlerinin baþarýsýný deðerlendirmek için kullanýlacak basit, objektif ve invaziv olmayan tekniklerdir. StO2 bu parametreler içinde erken dönem etkileri baþlayýp geç dönem devam eden spesifik ve sensivite oraný en yüksek olan parametredir.

BACKGROUND: Traditional methods that evaluate the success of peripheral nerve block have been replaced by methods that allow objective evaluations over time. Multiple objective techniques for peripheral nerve block have been discussed in the literature. This study aims to investigate whether perfusion index (PI), non-invasive tissue hemoglobin monitoring (SpHb), tissue oxygen saturation (StO2), tissue hemoglobin index (THI), and body temperature are reliable and objective methods to evaluate the adequacy of infracla-vicular blockage.
METHODS: Ultrasound-guided infraclavicular block in 100 patients undergoing forearm surgery. PI, SpHb, StO2, THI, and body tem-perature measurements was recorded 5 min before the block procedure, right after the procedure, and until the 25th min after the procedure at 5-min intervals. These values were compared between the blocked limbs and non-blocked limbs while being statistically compared between the successful and failed block groups.
RESULTS: Although there were significant differences between the groups of blocked extremity and non-blocked extremity in terms of StO2, THI, PI, and body temperature, there was no significant difference between these groups in terms of SpHb. Moreover, a sig-nificant difference was detected between the groups of successful block and failed block in terms of StO2, PI and body temperature, while there was no significant difference between these groups in terms of THI and SpHb.
CONCLUSION: StO2, PI, and body temperature measurements are the simple, objective, and non-invasive techniques to be used to evaluate success of block procedures. According to the receiver operating characteristic analysis, StO2 is the specific parameter with the highest sensitivity among these parameters.

AMAÇ: Fasya iliaka kompartman bloðu (FICB), femur ve diz cerrahisi sonrasý postoperatif aðrý kontrolü için uygulanan rejyonel tekniklerden biridir. Bildiðimiz kadarýyla, LA hacmine odaklanan sýnýrlý sayýda rapor bulunmaktadýr. Bu çalýþmadaki amacýmýz femur ve diz cerrahisi geçiren hastalarda postoperatif aðrý kontrolünde US kýlavuzluðunda kasýk altý FICB için literatürde sýklýkla kullanýlan üç farklý LA hacmini karþýlaþtýrarak klinik olarak en etkili hacmi bulmaktý.
GEREÇ VE YÖNTEM: Çalýþmaya ASA I-III fiziksel skorlarý olan toplam 45 hasta dahil edildi. Genel anestezi altýnda cerrahi iþlem tamamlandýðýnda hastalara ekstübasyon öncesi ultrason eþliðinde %0.25 bupivakain ile FIKB uygulandý. Hastalar uygulanacak lokal anestezik miktarýna göre rastgele üç farklý gruba ayrýldý. Grup 1’e 0.3 ml/kg, Grup 2’ye 0.4 ml/kg ve Grup 3’e 0.5 ml/kg bupivakain uygulandý. FIKB sonrasý hastalar ekstübe edildi. Hastalar ameliyat sonrasý 24 saat vital bulgular, aðrý skorlarý, ek analjezik gereksinimi ve olasý yan etkiler açýsýndan takip edildi.
BULGULAR: Ameliyat sonrasý aðrý skorlarý karþýlaþtýrýldýðýnda Grup 1’in skorlarý ameliyat sonrasý 1., 4. ve 6. saatlerde Grup 3’e göre istatistiksel olarak yüksek bulundu (p<0.05). Ek analjezi ihtiyacý karþýlaþtýrýldýðýnda postoperatif 4. saat diðer gruplara göre Grup 1’de en yüksekti (p=0.03). Ameliyat sonrasý 6. saatte ek analjezik gereksinimi Grup 3’te diðer gruplara göre daha azdý ve Grup 1 ile 2 arasýnda fark yoktu (p=0,026). LA hacmi arttýkça ilk 24 saatte tüketilen analjezik miktarý azaldý ancak istatistiksel olarak anlamlý fark yoktu (p=0.051).
TARTIÞMA: Çalýþmamýz, ultrason rehberliðinde uygulanan FIKB, ameliyat sonrasý aðrýyý giderme için multimodal analjezik bileþenleri bir parçasý olarak güvenli ve etkili bir yöntem olduðunu, 0.5 ml/kg hacimdeki %0.25 bupivakainin hiçbir yan etki gözlenmeden diðer iki gruba göre daha etkin analjezi saðladýðýný göstermiþtir.

BACKGROUND: Fascia iliaca compartment block (FICB) is one of the regional techniques applied for post-operative pain control after femoral and knee surgery. To the best of our knowledge, there are limited reports focusing on local anesthetic (LA) volume. Our aim in this study was to find the most clinically effective volume by comparing three different volumes of LA used frequently in the literature for US-guided infra-inguinal FICB for post-operative pain control in patients undergoing femur and knee surgery.
METHODS: A total of 45 patients with ASA I-III physical scores were included in the study. When the surgical procedure was completed under general anesthesia, FIKB was applied with 0.25% Bupivacaine under ultrasound guidance to the patients before extu-bation. Patients were randomly divided into three different groups for the volume of local anesthetic to be administered. Bupivacaine was administered 0.3 mL/kg in Group 1, 0.4 mL/kg in Group 2 and 0.5 mL/kg in Group 3. After FIKB, the patients were extubated. The patients were followed up for 24 h postoperatively in terms of vital signs, pain scores, additional analgesic requirement, and possible side effects.
RESULTS: When the post-operative pain scores were compared, the scores of Group 1 were found to be statistically higher than Group 3 at the post-operative 1st, 4th, and 6th h (p<0.05). When the additional analgesia requirement compared, the post-operative 4th h was highest in Group 1 compared to the other groups (p=0.03). At the post-operative 6th h, additional analgesic requirement was less in Group 3 than in the other groups, and there was no difference between Groups 1 and 2 (p=0.026). As the LA volume increased, the amount of analgesic consumed in the first 24 h decreased, but there was no statistically significant difference (p=0.051).
CONCLUSION: Our study showed that ultrasound-guided FIKB is a safe and effective method for post-operative pain relief as a part of multimodal analgesic components, and 0.25% bupivacaine in 0.5 mL/kg volume provides more effective analgesia than the other two groups without any side effects.

AMAÇ: Çalýþmanýn amacý týkanma ikteri ile kliniðimize baþvuran ve endoskopik retrograd kolanjiyopankreatografi (ERCP) yapýlan hastalarda profilaktik nitrogliserin yama kullanýmýnýn iþlem sýrasýnda ve sonrasýnda meydana gelebilecek pankreatit, kanama, perforasyon gibi komplikasyonlar, iþlem süresi, hastanede yatýþ süresi, precut ve selektif kanülasyon oranlarý ile mortalite üzerine etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Hastalar hastane veri tabaný kullanýlarak geriye dönük olarak taranmýþtýr. Acil þartlarda yapýlan ve çalýþmanýn sonucunu etkileyebilecek ilaç kullanýmý olan hastalar, 18 yaþýndan küçük hastalar, genel durumu bozuk olan hastalar çalýþma dýþý býrakýlmýþtýr. Nitrogliserin yama kullanýlan ve kullanýlmayan hasta gruplarýnda ilacýn morbidite, mortalite, iþlem süresi, hastanede kalýþ süresi ve kanülasyon teknikleri üzerine etkisi araþtýrýlmýþtýr.
BULGULAR: Nitrogliserin kullanmanýn precut olasýlýðýný 2.28 kat azaltýrken [adjOR=2.28, CI95% 1.486-3.514, (p<0.001)], peroperatif kanamayý 3.4 kat azalttýðý (OR=3.4, 95CI%=1.99-5.83, p<0.001) gözlenmiþtir. Nitrogliserin uygulanmayan grupta %75.1 selektif kanülasyon olmuþken nitroderm uygulanan grupta bu oran %87.3 olarak belirlenmiþtir (p<0.001). Regresyon modelinde nitroderm varlýðýnýn selektif kanülasyon olasýlýðýný 2.21 kat arttýrdýðý (adjOR=2.21, 95CI%=1.44-3.41, p<0.001) gözlenmiþtir. Mortalite üzerine nitrogliserin kullanýmý, özgeçmiþinde malignite öyküsü, taþ ve çamur varlýðý, cinsiyet, yaþ, postop pankreatit ve perop kanama deðiþkenlerinin etkisi regresyon analizi ile deðerlendirilmiþ olup yaþýn mortaliteyi 1.09 artýrdýðý (OR=1.09, 95CI%= 1.01-1.17, p=0.023) gözlenmiþtir.
TARTIÞMA: ERCP iþleminde profilaktik selektif kanülasyon oranýný artýrdýðý, precut oranýný, peroperatif kanamayý, hastanede kalýþ süresini ve iþlem süresini kýsalttýðý gösterilmiþtir.

BACKGROUND: The aim of the study was to investigate the use of prophylactic nitroglycerin patch in patients who applied to our clinic with occlusion icter and underwent endoscopic retrograde cholangiopancreatography (ERCP) for complications such as pancreatitis, bleeding, perforation that may occur during and after the procedure, duration of the procedure, length of hospitalization, precut and selective cannulation rates, and mortality.
METHODS: Patients were searched retrospectively using the hospital database. Patients under the age of 18, patients with poor general condition and patients treated under emergency conditions were excluded from the study. The effects of the drug on morbidity, mortality, duration of procedure, length of hospital stay, and cannulation techniques were investigated in patient groups with and without nitroglycerin patch.
RESULTS: It was observed that using nitroglycerin decreased the precut probability by 2.28 times (p<0.001), and decreased periop-erative bleeding by 3.4 times (p<0.001). 75.1% selective cannulation was observed in the group not administered nitroglycerin, this rate was determined as 87.3% in the group administered nitroderm(p<0.001). In the regression model, it was observed that the presence of nitroderm increased the probability of selective cannulation 2.21 times (p<0.001). The effects of nitroglycerin use on mortality, patient’s history of malignancy, presence of stones and mud, gender, age, post-operative pancreatitis, and perioperative bleeding variables were evaluated by regression analysis, and age increased mortality by 1.09 (p=0.023).
CONCLUSION: It has been shown that the use of prophylactic nitroglycerin patch in ERCP procedure increases the prophylactic selective cannulation rate, shortens the precut rate, pre-operative bleeding, hospital stay, and procedure time.

AMAÇ: Þiddetli pankreatit, erken tanýsý klinik pratikte zorluk teþkil etmeye devam eden bir hastalýk olup, mevcut skorlama sistemlerini tamamlayýcý yeni öngördürücülere ihtiyaç vardýr. Bu çalýþmada, Ranson skoru, bilgisayarlý tomografi þiddet indeksi (BTÞÝ) ve C-reaktif protein (CRP) kriterlerinin akut pankreatitte (AP) risk prognostik durum belirlenmesinde kullanýmýnýn incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Bu kesitsel çalýþmaya AP tanýlý 104 hasta (ortanca yaþ: 71.5 (21–102) yýl, %59.6’sý erkek) dahil edildi. Hastalar Ranson skoru ≥3, ultrason veya CT görüntülemede psödokist ve nekrotize sývý birikimi ve CRP düzeyleri >15 mg/L kriterlerinden en az birini karþýlayanlar teme-linde, risk prognostik durumlarýna göre, iyi prognoz (n=67) ve kötü prognoz (n=37) olmak üzere iki gruba ayrýldý. Hastalarýn demografik özellikleri, sigara içme durumu, AP etiyolojisi, kan biyokimya ve hemogram bulgularý ve CRP (mg/L), MPV (fL), nötrofil-lenfosit oraný (NLR), platelet-lenfosit oraný (PLR) olmak üzere enflamatuvar belirteçleri kaydedildi.
BULGULAR: Toplamda, 37 (%35.6) hasta kötü prognoz lehine en az bir kriter mevcuttu. Kötü prognoz grubundaki hastalar, çoðunlukla sadece BTÞÝ (%35.1), BTÞÝ+CRP (%18.9), BTÞÝ+Ranson (%16.2) kriterleri bazýnda saptandý. Tümü kötü prognoz grubunda sýnýflanmýþ 6 (%5.8) hastada ölüm gerçekleþti (p=0.002). Kötü prognoz gurunda iyi prognoz grubuna göre ortanca (min-mak) kreatinine (1 (0.57–10.0) vs. 0.76 (0.5–8.4) mg/dL, p=0.004) ve üre (48.0 (9.0–247.0) vs. 27.0 (10.0–111.0) mg/dL, p<0.001) deðerleri anlamlý olarak daha yüksel, albümin deðerleri (3.5 (2.4–4.3) vs. 3.6 (2.7–4.6) g/L, p=0.021) ise daha düþüktü. Kappa deðerlerine göre, BTÞÝ ile CRP arasýnda orta dereceli (kappa: 0.408), BTÞÝ ile Ranson arasýnda ise ekseriyetle (kappa: 0.312) uyuþma olduðu saptandý. BTÞÝ, ölümle sonuçlanan altý olgunun tümünü, Ranson ve CRP ise sadece ikiþer olguyu öngörebildi.
TARTIÞMA: Bulgularýmýz, AP hastalarýnda risk derecelendirmesinde, BTÞÝ’nin tek baþýna kullanýmýnýn, CRP ve Ranson skorunun tek baþlarýna kulla-nýmýna göre, hastalýk þiddeti ve mortalite riski açýsýndan daha güçlü bir prognostik deðeri olduðunu düþündürmekte ve CRP veya Ranson skorunun BTÞÝ’ye komplementer olarak kullanýmýnýn AP hastalarýnda kötü prognostik durumun daha iyi belirlenmesinde katkýsý olacaðýna iþaret etmektedir.

BACKGROUND: The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP.
METHODS: A total of 104 patients with AP (median age: 71.5 (range, 21–102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded.
RESULTS: Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57–10.0] vs. 0.76 [0.5–8.4] mg/dL, p=0.004) and urea (48.0 [9.0–247.0] vs. 27.0 [10.0–111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4–4.3] vs. 3.6 [2.7–4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality.
CONCLUSION: Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.

AMAÇ: Tümöral lezyonlar akut apandisitin nadir nedenleri arasýnda yer alýr. Böyle bir durumda uygun tedaviyi saðlamak için ameliyat öncesi doðru taný önemlidir. Bu çalýþmanýn amacý, apendektomi yapýlan hastalarda apendiks tümöral lezyonlarýnýn taný oranýný artýrabilecek faktörleri deðerlendirmektir.
GEREÇ VE YÖNTEM: Akut apandisit nedeniyle 2011–2020 arasý apendektomi yapýlan geniþ hasta grubu geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, klinikopatolojik bulgularý ve ameliyat öncesi laboratuvar deðerleri kaydedildi. Apendiks tümöral lezyonlarýný tahmin eden faktörleri belirlemek için tek deðiþkenli ve çok deðiþkenli lojistik regresyon ve ROC analizi yapýldý.
BULGULAR: Çalýþmaya ortanca yaþý 32 (18–88) olan ve %54.4’ü erkek olan toplam 1400 hasta dahil edildi. Genel olarak, hastalarýn %2.9’unda (n=40) apendiks tümöral lezyonu tespit edildi. Çok deðiþkenli analiz, yaþ (OR 1.06, %95 GA 1.03–1.08) ve lökosit sayýsýnýn (OR 0.84, %95 GA 0.76–0.93) apendiks tümöral lezyonlarý için baðýmsýz belirteçler olduðunu ortaya koydu. Yaþýn >37 (EAA: 0,79; duyarlýlýk: %82.0; özgüllük: %62.0) ve lökosit sayý-sýnýn <10×109/L olmasý (EAA: 0.69; duyarlýlýk: %74; özgüllük: %60) tümöral lezyon bulunma ihtimali için eþik deðerler olarak tespit edildi.
TARTIÞMA: Apendiks tümöral lezyonunu ameliyat öncesi olarak tahmin etmek, olumlu bir ameliyat sonrasý sonuç elde edebilmek için kritik öneme sahiptir. Yaþlý hasta ve düþük lökosit sayýlarý apendiks tümöral lezyonlarý için baðýmsýz risk faktörleri olarak tespit edilmiþtir. Þüphe durumunda ve bu faktörlerin varlýðýnda sadece apendektomi yapmak yerine temiz cerrahi sýnýrý saðlayacak þekilde geniþ rezeksiyon sadece apendektomiye tercih edilebilir.

BACKGROUND: Tumoral lesions are a relatively rare cause of acute appendicitis. Accurate pre-operative diagnosis is essential to provide appropriate treatment. The aim of this study was to evaluate factors that may increase diagnostic rate of appendiceal tumoral lesions in patients undergoing appendectomy.
METHODS: A retrospective review of a large cohort of patients who underwent appendectomy for acute appendicitis from 2011 to 2020 was undertaken. Demographics, clinicopathologic findings, and pre-operative laboratory values were recorded. Univariate and multivariate logistic regression and receiver-operating characteristic curve analysis were performed to identify the factors that predict appendiceal tumoral lesions.
RESULTS: A total of 1400 patients were included in the study, with median age of 32 (range, 18–88) years, and of whom 54.4% were male. Overall, 2.9% (n=40) of patients had appendiceal tumoral lesions. Multivariate analysis revealed that age (Odds Radio [OR] 1.06, 95% confidence interval [CI] 1.03–1.08) and WBC count (OR 0.84, 95% CI 0.76–0.93) were independent predictors of appendiceal tumoral lesions. The optimal cutoff age was 37 years old (AUC: 0.79; sensitivity: 82.0%; specificity: 62.0%). WBC count <10×109/L was another independent predictive factor (AUC: 0.69, sensitivity: 74%; specificity: 60%).
CONCLUSION: Predicting an appendiceal tumoral lesion preoperatively is critical to ensure a favorable post-operative outcome. Higher age and low WBC counts appear to be independent risk factors for an appendiceal tumoral lesion. In case of doubt and in the presence of these factors, wider resection should be favored over appendectomy only to provide a clear surgical margin.

AMAÇ: Karýn aðrýsý, çocuk acil polikliniðine en sýk baþvuru nedenlerinden biridir. Doðru tanýya gidebilmek için klinik ve laboratuvar ipuçlarýnýn uygun þekilde deðerlendirilmesi, tedavinin týbbi ya da cerrahi olarak yönlendirilmesi ve gereksiz incelemelerin önüne geçilmesi açýsýndan büyük önem taþýr. Çalýþmamýzýn amacý karýn aðrýlý çocuk hastalarda yüksek volüm lavman uygulamasýnýn klinik ve radyolojik bulgulara katkýsýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Hastanemiz Çocuk Acil Kliniðine Ocak 2020–Temmuz 2021 tarihleri arasýnda karýn aðrýsý þikayeti ile baþvuran çocuk hastalardan; fizik muayenede karýn þiþliði ve direkt karýn grafisinde yoðun gaz, gaita retansiyonu olan ve yüksek volüm lavman tedavisi uygulanan hastalar çalýþmaya dahil edildi. Bu hastalarýn fizik muayene ve radyolojik bulgularý deðerlendiridi.
BULGULAR: Çalýþma tarihleri arasýnda 7819 hasta çocuk acil polikliniðine karýn aðrýsý ile baþvurdu. Direkt karýn grafisinde yoðun gaz, gaita imajý ve karýn distansiyonu olan hastalarýn 3817’sine klasik lavman yapýldý. Klasik lavman yapýlan 3817 hastanýn 3498’inde (%91.6) gaita çýkýþý ve lavman sonrasý þikayetlerinde gerileme oldu. Klasik lavmanla rahatlama olmayan 319 (%8.4) hastaya yüksek volüm lavman uygulandý. Yüksek volüm lavman sonrasý 278 (%87.1) hastanýn þikayet ve bulgularý geriledi. Kalan 41(%12.9) hastaya kontrol ultrasonografi yapýldý, 14 (%34.1) hastaya apandisit tanýsý konuldu. Ultrasonografi tekrarý yapýlan 27 (%65.9) hastanýn ise ultrasonografi sonucu normal olarak deðerlendirildi.
TARTIÞMA: Çocuk acil kliniðinde, klasik lavman uygulamasýna yanýt vermeyen karýn aðrýsý þikayeti olan çocuklarda yüksek volüm lavman tedavisi etkili ve güvenli bir yöntemdir.

BACKGROUND: Abdominal pain is one of the most common reasons for admission to the pediatric emergency clinic. The appropriate evaluation of clinical and laboratory clues to make the correct diagnosis is of great importance in terms of directing the treatment medically or surgically and preventing unnecessary investigations. The aim of our study was to evaluate the contribution of high-volume enema application among pediatric patients with abdominal pain in terms of clinical and radiological findings.
METHODS: Among the pediatric patients who applied to the pediatric emergency clinic of our hospital between January 2020 and July 2021 with abdominal pain, those who had intense gas stool image on abdominal X-ray and abdominal distension on physical examination and who underwent high-volume enema treatment were included in the study. The physical examination and radiological findings of these patients were evaluated.
RESULTS: During the study period, 7819 patients were admitted to the pediatric emergency outpatient clinic with abdominal pain. Classic enema was performed in 3817 of these patients who had a dense gaseous stool image and abdominal distention on abdominal X-ray graphy. Defecation occurred in 3498 (91.6%) of 3817 patients who underwent classical enema, and the complaints regressed after enema. High-volume enema was applied to 319 (8.4%) patients who did not find relief with classical enema. Complaints of 278 (87.1%) patients regressed after the high-volume enema. Control ultrasonography (US) was performed in the remaining 41 (12.9%) patients, 14 (34.1%) patients were diagnosed with appendicitis. US results of 27 (65.9%) patients who had repeated US were evaluated as normal.
CONCLUSION: High volume enema treatment is an effective and safe method in children with abdominal pain who are unresponsive to classical enema application in the pediatric emergency department.

AMAÇ: Gastrointestinal anastomoz kaçaðý (GAK), sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HÝPEC) sonrasý önemli bir morbidite ve mortalite nedenidir. Bu çalýþmanýn amacý peritoneal metastaz (PM) cerrahisinde GAK ile iliþkili risk faktörlerini belirlemektir. GEREÇ VE YÖNTEM: Çalýþmaya gastrointestinal anastomozlu SRC ve HÝPEK uygulanan hastalar dahil edildi. Hastalarýn ameliyat öncesi durumunu deðerlendirmek için Charlson Komorbidite Ýndeksi (CCI) ve Eastern Cooperative Oncology Group (ECOG) performans durumu kullanýldý. GAK klinik, radyolojik veya yeniden ameliyat sýrasýnda teþhis edilen gastrointestinal ekstralüminasyon olarak kaydedildi.
BULGULAR: Analiz edilen 362 hastanýn ortanca yaþý 54 idi. Hastalarýn %72.6’sý kadýn ve en sýk görülen histopatolojiler over kanseri (%37.8) ve kolorektal kanser (%36.2) idi. Medyan Periton Kanser Ýndeksi 11 idi ve hastalarýn %80.1’ine tam sitoredüksiyon uygulandý. Ýki yüz doksan üç (%80.9) hastada tek anastomoz, 51 (%14.1) hastada iki anastomoz ve 18 (%5) hastada üç anastomoz yapýldý. Kýrk üç (%11.8) hastaya saptýrýcý stoma uygulan-dý. Otuz sekiz (%10.5) hastada GAK görüldü. Sigara kullanýmý (p<0.001), ECOG performans durumu (p=0.014), CCI skoru (p=0.009), preoperatif albümin düzeyi (p=0.010) ve rezeke edilen organ sayýsý (p=0.006) GAK ile anlamlý iliþkili faktörlerdi. GAK için baðýmsýz risk faktörleri sigara (OR: 6.223, CI: 2.814–13.760; p<0.001), CCI skoru ≥7 (OR: 4.252, CI: 1.590–11.366; p=0.004) ve preoperatif albümin seviyesi ≤3.5 g/dl (OR: 3.942, CI: 1.534–10.130; p=0.004) idi.
TARTIÞMA: Sigara kullanýmý, komorbidite ve ameliyat öncesi beslenme durumu gibi hasta ile iliþkili faktörlerin anastomoz komplikasyonlarý üzerinde etkisi vardý. Uygun hasta seçimi ve yüksek düzeyde bakým gerektiren prehabilitasyon programý ihtiyacý olan indeks hastanýn tahmini, daha düþük anastomoz kaçak oranlarý elde etmek ve PM cerrahisinde sonuçlarý iyileþtirmek için temel ön koþullardýr.

BACKGROUND: Gastrointestinal anastomotic leak (GAL) is a major cause of morbidity and mortality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to determine the risk factors associated with GAL in peritoneal metastases (PM) surgery.
METHODS: Patients who underwent CRS and HIPEC with gastrointestinal anastomosis were included. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status were used to assess preoperative condition of the patients. GAL was recorded as gastrointestinal extralumination diagnosed clinically, radiologicaly, or during reoperation.
RESULTS: Among 362 patients who were analyzed, the median age was 54 years, 72.6% were female, and the most common histopathologies were ovarian cancer (37.8%) and colorectal (36.2%) cancer. The median Peritoneal Cancer Index was 11 and 80.1% of the patients underwent complete cytoreduction. A single anastomosis was performed in 293 (80.9%) patients, two anastomoses in 51 (14.1%) and three anastomoses in 18 (5%) patients. Diverting stoma was performed in 43 (11.8%) patients. GAL was seen in 38 (10.5%) patients. Smoking (p<0.001), ECOG performance status (p=0.014), CCI score (p=0.009), pre-operative albumin level (p=0.010), and number of resected organs (p=0.006) were significantly associated factors with GAL. Independent risk factors for GAL were smoking (Odds Radio [OR]: 6.223, confidence interval [CI]: 2.814–13.760; p<0.001), CCI score ≥7 (OR: 4.252, CI: 1.590–11.366; p=0.004), and pre-operative albumin level ≤3.5 g/dl (OR: 3.942, CI: 1.534–10.130; p=0.004).
CONCLUSION: Patient-related factors such as smoking, comorbidity, and pre-operative nutritional status had an impact on anasto-motic complications. Proper patient selection and prediction of an index patient requiring a prehabilitation program with a high level of care are essential prerequisites to obtaining lower anastomotic leak rates and improving outcomes in PM surgery.

AMAÇ: Bu çalýþmada, yaþlý hastalarda intertrokanterik femur kýrýklarýnýn proksimal femur çivi (PFN) ile tedavisinde gözlenen cut-out’un önlenme-sinde hidroksiapatit kaplý implantlar ve diðer baþ-boyun implantlarýnýn etkinliði geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM: Ýntertrokanterik femur kýrýðý nedeniyle üç farklý PFN ile tedavi edilen toplam 98 ardýþýk hasta (56 erkek ve 42 kadýn; ortalama yaþ: 79.42 (61–115) yýl) geriye dönük olarak incelendi. Ortalama takip süresi 7.87 (4–48) aydý. PFN’de kullanýlan baþ-boyun implant için 40 hastada yivli lag vidasý, 28 hastada HA-kaplý helikal blade ve 30 hastada ise kaplamasýz helikal blade kullanýldý. Tüm gruplar arasýnda redüksiyon kalitesi, kýrýk tipi ve radyolojik sonuçlar deðerlendirildi.
BULGULAR: AO/OTA sýnýflamasýna göre 50 (%52.1) hastada instabil kýrýk tipi gözlendi. Hastalarýn 87’sinde (%88.8) iyi bir redüksiyon ve/veya kabul edilebilir redüksiyon kalitesi görüldü. Ortalama tip-apeks mesafesi (TAD) 27.61 mm, kalkar referanslý tip-apeks mesafesi (CalTAD) 28.72 mm, baþ-boyun cisim açýsý (CCD) 128°, Parker ön-arka oraný %46.36, Parker lateral oraný %46.82 idi. En optimal implant pozisyonu 49 (%50) hastada göz-lendi. Yedi (%7.14) hastada cut-out, 12 (%12.24) hastada ise10°’den fazla sekonder varus deplasmaný gözlendi. Korelasyon analizi ve çok deðiþkenli lojistik regresyon analizinde cut-out açýsýndan HA-kaplý ve diðer implantlar arasýnda anlamlý bir farklýlýk gözlendi. Ayrýca, implant tipinin çok deðiþkenli lojistik regresyon analizinde cut-out komplikasyonu açýsýndan en güçlü prediktif faktör olduðu gözlendi.
TARTIÞMA: HA-kaplý implantlar, kötü kemik kalitesine sahip intertrokanterik femur kýrýðý olan yaþlý hastalarda artmýþ osteointegrasyon ve kemik içe büyümesi nedeniyle uzun vadede cut-out riskini azaltabilir. Ancak, bu tek baþýna yeterli olmayýp, uygun bir vida konumu, optimum TAD deðerleri ve mükemmel redüksiyon kalitesi cut-out’un önlenmesinde diðer önemli faktörlerdir.

BACKGROUND: This study aimed to retrospectively evaluate the effectiveness of hydroxyapatite-coated (HA-coated) implants and other caput–collum implants in preventing cut-out observed in treatment with proximal femoral nail (PFN) of intertrochanteric femur fractures in elderly patients.
METHODS: A total of 98 consecutive patients (56 males and 42 females; mean age: 79.42 (61–115) years) treated with three differ-ent PFNs for intertrochanteric femoral fractures were retrospectively examined. The mean of the follow-up period was 7.87 (4–48) months. It was used a threaded lag screw in 40 patients, an HA-coated helical blade in 28 patients and a non-coated helical blade in 30 patients for PFN. The reduction quality, fracture type, and radiological outcomes among all groups were evaluated.
RESULTS: Unstable type was seen in 50 (52.1%) patients according to AO Foundation/Orthopedic Trauma Association fracture classi-fication. An acceptable-good reduction quality was seen in 87 (88.8%) of all patients. The average of tip-apex distance (TAD) value was 27.61 mm, calcar-referenced TAD (CalTAD) value was 28.72 mm, caput-collum diaphyseal angle was 128,° Parker’s anteroposterior ratio was 46.36%, and Parker’s lateral ratio was 46.82%. The best suitable implant position was observed in 49 (50%) patients. Cut-out was observed in 7 (7.14%) patients, and secondary varus displacement of more than 10° was observed in 12 (12.24%) patients. Correlation analysis and multivariate logistic regression analysis showed a significant difference between HA-coated and other implants in cut-out. Furthermore, implant type was the strongest predictive factor for cut-out complications in the multivariate logistic regression analysis.
CONCLUSION: HA-coated implants may reduce the long-term cut-out risk due to increased osteointegration and bone ingrowth in elderly patients with intertrochanteric femoral fractures with poor bone quality. However, this alone is not enough; a suitable screw position, optimal TAD values, and excellent reduction quality are other important factors.

AMAÇ: Bu çalýþmada, primer kýsmi artrodez (PKA) veya kapalý redüksiyon ve internal fiksasyon (KRIF) ile tedavi edilen Lisfrank yaralanmalarýnýn sonuçlarý karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: Düþük enerjili travma sonrasý Lisfrank yaralanmasý nedeniyle PKA veya KRIF uygulanan hastalarýn geriye dönük bir incelemesi yapýldý ve radyografik ve klinik sonuçlar deðerlendirildi.
BULGULAR: Ortalama yaþý 38 olan 45 hasta çalýþmaya dahil edildi. Ortalama takip süresi 47 ay idi. Ortalama Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (AOFAS) skoru PKA grubunda 83,6 ve KRIF grubunda 86.2 idi (p>0.05). Ortalama aðrý skoru PKA grubunda 32.9, KRIF grubunda 33.7 idi (p>0.05). KRIF grubunun %78’inde ve PPA grubunun %42’sinde semptomatik implant nedeniyle ikincil cerrahi gerekmiþtir (p<0.05).
TARTIÞMA: Düþük enerjili Lisfrank yaralanmalarýnýn primer kýsmi artrodez veya kapalý redüksiyon ve fiksasyon ile tedavisi iyi klinik ve radyolojik sonuçlar vermiþtir. Toplam AOFAS skorlarý açýsýndan iki grup arasýnda anlamlý fark bulunamadý. Bununla birlikte, KRIF grubunda sekonder cerrahiye daha fazla ihtiyaç duyulurken, kapalý redüksiyon ve fiksasyon ile aðrý ve fonksiyonel skorlar daha yüksek gözlendi.

BACKGROUND: This study reviewed the outcomes of Lisfranc injuries treated by primary partial arthrodesis (PPA) or closed re-duction and internal fixation (CRIF).
METHODS: A retrospective review was made of patients who underwent PPA or CRIF for a Lisfranc injury after low-energy trauma, and follow-up was assessed according to radiographic, and clinical outcomes. A total of 45 patients with a median age of 38 years were followed up for an average of 47 months.
RESULTS: The average American orthopaedic foot and ankle society (AOFAS) score was 83.6 points in the PPA group and 86.2 points in CRIF group (p>0.05). The mean pain score was 32.9 in the PPA group, 33.7 in the CRIF group (p>0.05). Secondary surgery for symptomatic hardware was required in 78% of the CRIF group and in 42% of the PPA group (p<0.05).
CONCLUSION: Treatment of low-energy Lisfranc injuries with either PPA or closed reduction and fixation produced good clinical and radiological outcomes. The total AOFAS scores were comparable between two groups. However, the function and pain scores were seen to improve more with closed reduction and fixation while there was a greater requirement for secondary surgery in the CRIF group.

AMAÇ: Bu çalýþmada kronik travmatik koksidinili hastalara floroskopi yardýmlý interkoksigeal bölgeden kontrast madde verilmeden needle-inside-needle tekniði ile ganglion impar blok uygulanarak yeni bir yaklaþým sunulmaktadýr. Bu yaklaþýmla kontrast madde kullanýmýnýn maliyeti ve olasý yan etkileri önlenebilir. Ayrýca bu yöntemin uzun dönemdeki etkisini de incelemiþ olduk.
GEREÇ VE YÖNTEM: Çalýþma geriye dönük olarak tasarlandý. Belirlenmiþ alana 21 gauge enjektör ile girildi ve lokal infiltrasyon ile 3 cc %2 lidokain subkutan uygulandý. Kýlavuz 21 gauge 50 mm iðne ucuna 25 gauge 90 mm spinal iðne yerleþtirildi. Ýðne ucunun yeri floroskopi altýnda kontrol edilerek 2 ml %0.5 bupivakain ve 1 ml betametazon asetat karýþtýrýlarak uygulandý.
BULGULAR: Çalýþmaya 2018–2020 yýllarý arasýnda toplam 26 kronik travmatik koksidini hastasý katýlmýþtýr. Ortalama iþlem süresi yaklaþýk 3.19 dakikadýr. Aðrýnýn %50’den fazla azalma süresi ortalama 1.25±1.22 (1.dk-72 saat) dakika idi. Ortalama NPRS puanlarý birinci saatte 2.38±2.26, altýncý saatte 2.50±2.30, 24 saatte 2.50±2.21, birinci ayda 3.73±2.20, altýncý ayda 4.46±2.14 ve birinci yýlda 5.23±2.52 idi.
TARTIÞMA: Çalýþmamýz kronik travmatik koksidinili hastalarda alternatif olarak interkoksigeal bölgeden needle-inside -needle yönteminin kontrast madde verilmeden yapýlan uygulamanýn uzun dönem sonuçlarýnýn güvenli ve uygulanabilir olduðunu göstermektedir.

BACKGROUND: This study presents a new fluoroscopy-controlled approach in patients with chronic traumatic coccydynia by applying ganglion impar block using the needle-inside-needle technique from the intercoccygeal region without the administration of contrast material. With this approach, the cost and possible side effects of using contrast material can be prevented. In addition, we examined the long-term effect of this method.
METHODS: The study was designed retrospectively. The marked area was entered with a 21-gauge needle syringe, and 3 cc of 2% lidocaine was administered subcutaneously by local infiltration. A 25-gauge 90 mm spinal needle was inserted into the guide 21-gauge 50 mm needle tip. The location of the needle tip was controlled under fluoroscopy, and 2 mL of 0.5% bupivacaine and 1 mL of be-tamethasone acetate were mixed and administered.
RESULTS: A total of 26 patients with chronic traumatic coccydinia participated in the study between 2018 and 2020. The average procedure time was approximately 3.19 min. The mean time of pain relief of more than 50% was 1.25±1.22 (1st min–72 h) min. The mean Numerical pain rating scale scores were 2.38±2.26 at 1 h, 2.50±2.30 at 6 h, 2.50±2.21 at 24 h, 3.73±2.20 at 1 month, 4.46±2.14 at 6 months 1 and 5.23±2.52 at 1 year.
CONCLUSION: Our study shows that as an alternative in patients with chronic traumatic coccydynia, the long-term results of the needle-inside-needle method from the intercoccygeal region without contrast material are safe and feasible.

AMAÇ: Köstebek tabancalarý, tarým alanlarýnda zararlý kemirgenlerle mücadelede kullanýlan, el yapýmý ve harabiyete yol açabilen aletlerdir. Bu aletlerin kazara yanlýþ zamanda tetiklenmesi, majör el yaralanmalarýna yol açarak el iþlevselliðinde kalýcý bozukluða neden olabilir. Bu çalýþma, köstebek tabancasý yaralanmalarýnýn ciddi el fonksiyon kayýplarýna yol açtýðýna ve bu aletlerin ateþli silahlar kapsamýnda deðerlendirilmesi gerektiðine dikkat çekmeyi amaçlamaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýz geriye dönük, gözlemsel bir kohort çalýþmasýdýr. Çalýþmaya dahil edilen hastalarýn demografik özellikleri, yaralanmanýn klinik özellikleri ve uygulanan cerrahi yöntemler kaydedildi. El yaralanmasýnýn þiddeti, Modifiye El Yaralanmasý Ciddiyet Skoru (MEYCS) ile deðerlendirildi. Hastanýn üst ekstremiteye baðlý fonksiyonel yetersizliðinin belirlenmesinde Kol, Omuz ve El Dizabilite (DASH) Anketi kullanýldý. Hastalarýn el kaba kavrama kuvveti, palmar ve lateral çimdik kuvvetleri ve iþlevsel özürlülük skorlarý saðlýklý kontrollerle karþýlaþtýrýldý. BULGULAR: Köstebek tabancasýyla el yaralanmasý olan 22 hasta çalýþmaya dahil edildi. Hastalarýn yaþ ortalamasý 63.0±16.9 (22–86) idi ve bir tanesi hariç tümü erkekti. Hastalarýn yarýsýndan fazlasýnda dominant el yaralanmasý (%63.6) ve majör el yaralanmasý (%59.1) saptandý. Hastalarýn iþlevsel özürlülük skorlarý saðlýklý kontrollere göre istatistiksel olarak anlamlý derecede yüksek iken, kaba kavrama kuvvetleri ve palmar çimdik kuvvetleri istatistiksel anlamlýlýkla düþüktü.
TARTIÞMA: Yaralanmanýn üzerinden yýllar geçmesine raðmen hastalarýmýzýn ellerinde iþlevsel bozukluk vardý ve el güçleri kontrollere göre daha düþüktü. Kamuoyu köstebek tabancalarý ve yýkýcý etkileri hakkýnda bilinçlendirilmeli, köstebek tabancalarý ateþli silahlar kapsamýnda deðerlendirilmeli ve yasaklanmalýdýr.

BACKGROUND: Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms.
METHODS: Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients’ hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls.
RESULTS: Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22–86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower.
CONCLUSION: Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

AMAÇ: Yanýklar, özellikle düþük ve orta gelirli ülkelerde görülen küresel bir saðlýk sorunudur. Mortaliteyi tahmin etmek için modellerin kullanýmý geliþmiþ ülkelerde daha yaygýndýr. Kuzey Suriye’de iç huzursuzluk 10 yýldýr devam etmektedir. Altyapý eksikliði ve zor yaþam koþullarý yanýk vakalarýný artýrmaktadýr. Kuzey Suriye’deki bu çalýþma, çatýþma bölgelerinde sunulan saðlýk hizmet öngörülerine katkýda bulunacaktýr. Kuzeybatý Suriye’ye özgü bu çalýþmanýn ilk amacý, acil olarak hastaneye kaldýrýlan yanýk maðduru popülasyonundaki risk faktörlerini deðerlendirmek ve belirlemektir. Ýkinci amaç, mortaliteyi tahmin etmek için iyi bilinen üç yanýk mortalite tahmin skorunu bölge özelinde doðrulamaktý: Kýsaltýlmýþ Yanýk Þiddeti Ýndeksi (ABSI) skoru, Belçika Yanýk Yaralanmasýnýn Sonucu (BOBI) skoru ve revize edilmiþ Baux skoru.
GEREÇ VE YÖNTEM: Bu çalýþmada, kuzeybatý Suriye’deki yanýk merkezi veri tabandan yanýk merkezine baþvuran hastalarýn geriye dönük bir analizi yapýldý. Acil olarak yanýk merkezine baþvuran hastalar çalýþmaya dahil edildi. Dahil edilen üç yanýk deðerlendirme sisteminin hastanýn ölüm riskini belirlemedeki etkinliðini karþýlaþtýrmak için iki deðiþkenli lojistik regresyon analizi yapýldý.
BULGULAR: Çalýþmaya toplam 300 yanýk hastasý dahil edildi. Bunlardan 149’u (%49.7) serviste, 46’sý (%15.3) yoðun bakýmda tedavi edildiði gördü; 54’ü (%18.0) öldü ve 246’sý (%82.0) hayatta kaldý. Ölen hastalarýn ortanca revize edilmiþ Baux skorlarý, BOBI skorlarý ve ABSI skorlarý yaþayan has-talara göre anlamlý derecede yüksekti (p=0.000). Revize edilmiþ Baux, BOBI ve ABSI puanlarý için cut-off deðerleri sýrasýyla 105.50, 4.50 ve 10.50 olarak belirlendi. Bu cut-off deðerlerinde mortaliteyi öngörmek için, revize edilmiþ Baux skorunun duyarlýlýðý %94.4 ve özgüllüðü %91.9 ve ABSI sko-runun duyarlýlýðý %68.8 ve özgüllüðü %99.6 idi. Ancak BOBÝ ölçeðinin 4.50 olarak hesaplanan cut-off deðeri (%27.8) düþük bulundu. BOBI modelinin düþük duyarlýlýðý ve negatif öngörü deðeri, diðerlerine göre mortalitenin daha zayýf bir öngörücüsü olduðunu göstermekteydi.
TARTIÞMA: Revize edilmiþ Baux skoru, çatýþma sonrasý bir bölge olan kuzeybatý Suriye’de yanýk prognozunu tahmin etmede baþarýlý oldu. Sýnýrlý fýrsatlarýn olduðu benzer çatýþma sonrasý bölgelerde bu tür puanlama sistemlerinin kullanýlmasýnýn faydalý olacaðý varsayýlabilir.

BACKGROUND: Burns are a global health problem, especially in low- and middle-income countries. The use of models to predict mortality is more common in developed countries. In northern Syria, internal unrest has continued for 10 years. A lack of infrastruc-ture and difficult living conditions increase the incidence of burns. This study in northern Syria contributes to the predictions of health services provided in conflict regions. The first objective of this study specific to northwestern Syria was to assess and identify risk factors in the burn victim population hospitalized as emergencies. The second objective was to validate the three well-known burn mortality prediction scores to predict mortality: the Abbreviated Burn Severity Index (ABSI) score, Belgium Outcome of Burn Injury (BOBI) score, and revised Baux score.
METHODS: This was a retrospective analysis of the database of patients admitted to the burn center in northwestern Syria. Patients who were admitted to the burn center as emergencies were included in the study. Bivariate logistic regression analysis was performed to compare the effectiveness of the three included burn assessment systems in determining the risk of patient death.
RESULTS: A total of 300 burn patients were included in the study. Of them, 149 (49.7%) were treated in the ward, and 46 (15.3%) in the intensive care unit; 54 (18.0%) died, and 246 (82.0%) survived. The median revised Baux scores, BOBI scores, and ABSI scores of the deceased patients were significantly higher than those of the surviving patients (p=0.000). The cut-off values for the revised Baux, BOBI, and ABSI scores were set at 105.50, 4.50, and 10.50, respectively. For predicting mortality at these cut-off values, the revised Baux score had a sensitivity of 94.4% and a specificity of 91.9%, and the ABSI score had a sensitivity of 68.8% and a specificity of 99.6%. However, the cut-off value of the BOBI scale, calculated as 4.50, was found to be low (27.8%). The low sensitivity and negative predictive value of the BOBI model suggest that it was a weaker predictor of mortality than the others.
CONCLUSION: The revised Baux score was successful in predicting burn prognosis in northwestern Syria, a post-conflict region. It is reasonable to assume that the use of such scoring systems will be beneficial in similar post-conflict regions where limited opportunities exist.

AMAÇ: Pelvis tipinin, perkütan superior pubik ramus tespitine etkisini araþtýrmak amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Pelviste anatomik deðiþikliði olmayan 150 pelvis BT(kadýn/erkek: 75/75) üzerinde çalýþýldý. 1 mm kesit geniþliðinde çekilen pelvis BT tetkikleri, görüntüleme sisteminin MPR ve 3D görüntüleme modu kullanýlarak; pelvis tiplendirilmesi, anterior obturator oblik ve inlet kesit görüntüleri oluþturuldu. Bu görüntülerde superior pubik ramus için doðrusal bir koridor elde edilip edilemediði, doðrusal koridor elde edilebilen pelvis BT’lerinde koridor geniþliði, uzunluðu ile transvers ve sagittal düzlemdeki açý deðerleri ölçüldü.
BULGULAR: Örneklemin 11‘inde (%7.3) (grup1) herhangi bir þekilde superior pubik ramus için doðrusal bir koridor elde edilemedi. Bu gruptaki tüm pelvis tipleri gynecoid özellikte idi ve hepsi kadýn hastalara aitti. Android pelvis tipine sahip tüm pelvis BT’lerinde rahatlýkla superior pubik ramusta doðrusal bir koridor elde edilebilmekteydi. Süperior pubik ramus geniþliði ortalama 8.2±1.8 mm, uzunluðu ortalama 116.7±12.8 mm idi. Yirmi (%13.3) pelvis BT görüntüsünde (grup 2) koridor geniþliði 5 mm altýnda ölçüldü. Koridor geniþliði, pelvis tipine ve cinsiyete baðlý istatiksel olarak anlamlý farklýlýk arz etmekteydi.
TARTIÞMA: Pelvis tipi perkutan superior pubik ramus tespitinde etkili bir faktördür. Bu sebeple preoperatif BT tetkikinde MPR ve 3D görüntüleme modu kullanýlarak yapýlacak pelvis tiplendirmesi; cerrahi plan, implant ve cerrahi pozisyon seçiminde etkilidir.

BACKGROUND: The impact of pelvis type on percutaneous fixation of the superior pubic ramus was investigated in this study.
METHODS: One hundred fifty pelvic CTs (female/male: 75/75) without anatomical changes in the pelvis were studied. Pelvis CT examinations with 1mm section width, pelvis typing, anterior obturator oblique, and inlet section images were created using the MPR and 3D imaging mode of the imaging system. In these images, whether a linear corridor could be obtained for the superior pubic ramus, corridor width, length, and angle values in the transverse and sagittal planes were measured in pelvic CT where linear corridor could be obtained.
RESULTS: In 11 samples (7.3 %) (group 1), no linear corridor for the superior pubic ramus could be obtained in any way. All pelvis types in this group were gynecoid, and all belonged to female patients. A linear corridor in the superior pubic ramus could be easily obtained in all pelvic CTs with Android pelvic type. The superior pubic ramus was 8.2±1.8 mm in width and 116.7±12.8 mm in length. The corridor width was measured below 5 mm in 20 (13.3%) pelvic CT images (group 2). Corridor width showed a statistically signif-icant difference depending on the pelvic type and gender.
CONCLUSION: The pelvic type is a determinat factor for the fixation of the percutaneous superior pubic ramus. For this reason, pelvic typing using MPR and 3D imaging mode in preoperative CT examination; is effective in surgical planning, implant, and surgical position selection.

AMAÇ: Bu çalýþma, dirsek bölgesindeki yumuþak doku defektlerinin rekonstrüksiyonunda iki farklý flep tekniðinin tüm yönlerini karþýlaþtýrmayý ve deðerlendirmeyi amaçlamaktadýr: lateral kol flebi (LAA) ve posterior interosseöz arter (PIA) flebi.
GEREÇ VE YÖNTEM: Kliniðimizde 2012–2018 yýllarý arasýnda dirsek bölgesi yumuþak doku defektleri nedeniyle cerrahi tedavi uygulanan 12 hasta geriye dönük olarak deðerlendirildi. Hastalarýn demografik verileri, flep boyutu, operasyon süresi, donör alan ve flep komplikasyonlarý, perforatör sayýsý, fonksiyonel ve kozmetik sonuçlarý incelendi.
BULGULAR: PIA flebi ile tedavi edilen hastalarda defekt boyutu, LAA flebi uygulanan hastalara göre anlamlý olarak daha küçüktü (p<0.001). Ýki grup arasýnda anlamlý fark yoktu (p>0.05). PIA flepleri uygulanan hastalarda QuickDASH skorlarý önemli ölçüde daha düþüktü, bu da daha iyi fonksiyonel sonuçlara iþaret ediyordu (p<0.05). Ameliyat süresi PIA grubunda lateral kol flep grubuna göre anlamlý olarak daha kýsaydý (p<0.05). Dirsek eklemi EHA’sý PÝA flebi uygulanan hastalarda anlamlý olarak daha yüksekti (p<0.05).
TARTIÞMA: Çalýþmamýzýn sonuçlarý, her iki flebin de cerrahýn deneyimine baðlý olarak uygulanmasý kolay, komplikasyon riski düþük, benzer defekt boyutlarýnda benzer fonksiyonel ve kozmetik sonuçlar saðlayan teknikler olduðunu göstermektedir.

BACKGROUND: The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap.
METHODS: The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes.
RESULTS: Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05).
CONCLUSION: The study concludes that both flap techniques are easy to apply depending on the surgeon’s experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Yoðun bakým ünitesinde (YBÜ) takip edilen 526 ünite kan ve kan ürünü transfüzyonu gerektiren gastrointestinal sistem (GÝS) tutulumu olan 37 yaþýnda nadir bir granülomatöz polianjiitisli (GPA) erkek hastayý sunuyoruz. GPA’ya baðlý GÝS tutulumu morbidite ve mortaliteyi artýran nadir gözlenen bir durumdur. Hastalarýn ultramasif kan ürünü transfüzyona ihtiyacý olabilir. Böylece multisistem tutulumuna baðlý masif hemoraji nedeniyle GPA’lý hastalar YBÜ’ye kabul edilebilir ve multidisipliner bir yaklaþýmlý titiz bir bakým ile saðkalým saðlanabilir.

We report a rare case of a 37-year-old man with granulomatosis with polyangiitis (GPA) with gastrointestinal system (GIS) involvement who needed 526 units of blood and blood product transfusions and was followed up in the intensive care unit (ICU). GIS involvement due to GPA is a rare condition that increases morbidity and mortality of patients. Patients may require ultramassive blood product transfusions. Thus, patients with GPA can be admitted to ICUs because of massive hemorrhage due to multisystem involvement, and survival is achievable with meticulous care through a multidisciplinary approach.

Kardiyopulmoner arrest hamilelik sýrasýnda nadir görülen bir durumdur. Gebeliðinin ikinci yarýsýnda annenin arrest olduðu fark edilir edilmez, týbbi ekipler perimortem sezaryen (C/S) için çaðrýlmalýdýr. Olgumuzda 31 haftalýk gebe hasta trafik kazasý sonrasý acil servise (AS) 112 ekibi tarafýndan kardiyopulmoner resüsitasyon (KPR) eþliði ile getirildi. Nabzý olmayan veya spontan solunumu olmayan hasta eksitus olarak kabul edildi. Bununla birlikte, CPR fetüsün saðkalýmýný korumak için sürdürüldü. Nöbetçi kadýn doðum doktoru gelmeden önce, acil servis hekimleri olarak fetusun fetal mortalite ve morbidite riskinin artmasýný önlemek için C/S’yi baþlattýk. 1/5/10 dakikada Apgar skorlarý 0/3/4 ve oksijen satürasyon deðerleri sýrasýyla %35/65/75 idi. Postnatal 11. günde ileri kardiyak yaþam desteðine raðmen yanýt vermeyen hasta exitus olarak kabul edildi. Acil servis ekibi, C/S ve yenidoðan ve bakýmý konusunda bilgili ve donanýmlý olmalýdýr. Bizim olgumuzda ise annenin tahmini saatine göre fetüsun anne rahminden çýkarýlmasý 40 dakika sürmüþtür.

Cardiopulmonary arrest is an occasional occurrence during pregnancy. As soon as maternal arrest is noticed in a woman in the second half of her pregnancy, medical teams should be called for perimortem cesarean (C/S). A 31–week-pregnant female patient was brought to our emergency department by the emergency medical service team with cardiopulmonary resuscitation (CPR) after a traffic accident. The patient, with no pulse or spontaneous breathing, was recognized as exitus. However, CPR was sustained to maintain fetal well-being. Before the arrival of the on-call gynecologist, we as emergency physicians initiated C/S both for fetal well-being and to avoid heighten-ing the risk of fetal mortality and morbidity. The Apgar scores were 0/3/4 and oxygen saturation values were 35/65/75% at 1/5/10 min, respectively. On the postnatal 11th day, the patient did not respond despite the advanced cardiac life support (ACLS) and thus was con-sidered exitus. The ACLS team should be knowledgeable and well-equipped to perform C/S, to do aftercare, to watch for related risks in the infant. In our case, it took 40 min for the fetus to be removed from the mother’s womb, starting from the estimated time of exitus.

Endoskopik retrograd kolanjiyopankreatografi (ERCP), çeþitli pankreatikobilier bozukluklarýn taný ve tedavisinde yaygýn olarak kullanýlan bir prose-dür olmuþtur. Yaygýn olarak güvenli bir prosedür olarak kabul edilmesine raðmen, ERCP morbidite ve nadiren mortalite ile iliþkilidir. En sýk görülen komplikasyonlar arasýnda akut pankreatit, kanama ve duodenal perforasyon bulunur. Portal ven kanülasyonu, ERCP’nin nadir bir komplikasyonudur. Biz, ERCP ve sfinkterotomi sýrasýnda portal vene endoskopik biliyer stent yerleþtirilmesi olgusunu tanýmladýk. Elli dört yaþýnda kadýn hastaya kronik taþlý kolesistit ön tanýsý ile laparoskopik kolesistektomi yapýldý. Ameliyat sonrasý dördüncü gün sarýlýk ve kaþýntý þikayeti ile acil servise baþvurdu. MRCP’de intrahepatik ve ekstrahepatik safra yollarý dilate ve ana safra kanalýnda 7.5x5.5 mm’lik bir taþ vardý. ERCP ile sfinkterotomi yapýldý, taþlar çýkarýldý ve ardýndan 10F 7 cm stent yerleþtirildi. ERCP’nin dördüncü gününde ateþ ve total bilirubin düzeyi 5 mg/dl’de sebat eden hastaya kolanjitik apse ve/veya ERCP komplikasyonu düþünülerek abdominopelvik bilgisayarlý tomografi (BT) çekildi. BT’de koledok içindeki stentin proksimal ucu-nun ana portal vene girdiði ve ucunun tromboze olduðu izlendi. Bu nedenle ameliyathane þartlarýnda stentin endoskopik olarak çýkarýlmasýna karar verildi. Anestezi indüksiyonunun ardýndan stent gastroenteroloji ekibi tarafýndan endoskopik olarak çýkarýldý. Stent çýkarýlýrken hastanýn karýn boþluðu laparoskopik olarak eksplore edildi. Anestezi sýrasýnda hemodinamik instabilite geliþmeyen ve transfüzyon gerektirmeyen hasta, klinik takibinde bir kez melenasý oldu. Hasta düþük molekül aðýrlýklý heparin ve oral sefalosporin ile taburcu edildi ve poliklinik kontrolü önerildi. Kontrolleri sýrasýnda aralýklý ateþ þikayeti olan hastaya yapýlan portal vendeki trombozu deðerlendirmek için Doppler USG yapýldý. Doppler USG’de ana portal vende ve dallarýnda tromboze bir görünüm saptandý. Genel durumu iyi olan, karýn aðrýsý olmayan hastada, yüksek doz düþük molekül aðýrlýklý heparine geçile-rek gastroenteroloji ve genel cerrahi poliklinik kontrolünde takibe alýndý. Nadir görülen hayatý tehdit eden bu komplikasyon özellikle iþlem sýrasýnda ve/veya hastanýn klinik takibinde daima akýlda tutulmalýdýr.

Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphinc-terotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4th post-operative day. On the magnetic res-onance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5×5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient.