AMAÇ: Çalýþmamýzdaki amacýmýz, akut mezenterik iskeminin erken tanýsýnda alkalen fosfataz (ALP) baðýrsak izomeraz enzim düzeyleri ile birlikte LDH ve D-dimer düzeylerinin deðerini belirlemektir.
GEREÇ VE YÖNTEM: Otuz adet wistar cinsi sýçan her grupta altý sýçan olmak üzere beþ gruba ayrýldý. Birinci grup kontrol grubu: Normal sýçandaki ALP-baðýrsak izomeraz, LDH ve D-dimer düzeylerini belirlemek için giriþim yapýlmadan sadece kan alýnan grup. Ýkinci grup sham: Sadece laparotomi yapýlarak kan örneði alýnan grup. Üçüncü grup: Superior mezenterik arter ligasyonu sonrasýndaki ikinci saatte kan örneði alýnan grup. Dördüncü ve beþinci grup; sýrasýyla ligasyon sonrasý dördüncü ve altýncý saatlerde kan örneði alýnan grup. Baðýrsaktaki iskemik hasar patolojik olarak sýnýflandýrýldý. Tüm kan örnekleri parametrelerdeki saatlik deðiþimlerini saptamak amacýyla biyokimyasal olarak deðerlendirildi.
BULGULAR: Ýskemi gruplarý arasýnda D-dimer sonuçlarý belirgin olarak anlamlý bulunmadý (p=0.337). LDH seviyeleri birinci ve dördüncü deney grubu arasýnda anlamlý bulundu (p=0.018). ALP-baðýrsak izomeraz enzim düzeyleri tüm diðer gruplar arasýnda anlamlý deðildi (p=0.077).
TARTIÞMA: Bulgularýmýz ALP-baðýrsak izomeraz enzimi ve D-dimer düzeylerinin, akut mezenterik iskeminin erken döneminde, tanýsal olarak deðerli olmamasýna raðmen 1900 IU/L üzerindeki LDH düzeylerinin kullanýþlý bir tanýsal belirteç olabileceðini göstermektedir.

BACKGROUND: The aim of the present study was to investigate the diagnostic value of alkaline phosphatase (ALP) intestineisomerase, plasma lactate dehydrogenase (LDH), and D-dimer levels in acute mesenteric ischemia.
METHODS: Thirty Wistar rats were divided into 5 groups of 6 rats each. In Group 1, blood samples were obtained to determine normal parameter levels. In the sham group, Group 2, blood samples were obtained following laparotomy. In Group 3, blood samples were obtained 2 hours after ligation. In Groups 4 and 5, blood samples were obtained at 4 and 6 hours after ligation, respectively. Ischemic damage was assessed using a pathological scoring system. Blood samples were analyzed for hourly changes in parameters.
RESULTS: No statistically significant difference in D-dimer levels was found between ischemia groups (p=0.337). A statistically significant difference in LDH levels was found between the control group, Group 1, and Group 4 (p=0.018). ALP intestine-isomerase enzyme levels were not statistically significant in other groups (p=0.077).
CONCLUSION: Findings indicate that plasma LDH levels higher than 1900 IU/L may be a useful marker in the early diagnosis of acute mesenteric obstruction. However, ALP intestine-isomerase enzyme and D-dimer plasma levels were not found to contribute to the diagnosis.

AMAÇ: Sepsis nedenli akut böbrek hasarý sepsisin önemli komplikasyonlarýndan biridir. Sepsisin erken dönemlerinde geliþir ve mortaliteyi artýrýr. Hem erken taný sürecinde hem de tedavi aþamasýnda hala problemler vardýr. Bu çalýþmanýn amacý, genellikle anksiyete ve depresyonda kullanýlan agomelatinin sepsis nedenli akut böbrek hasarýndaki olasý etkilerinin deðerlendirilmesidir.
GEREÇ VE YÖNTEM: Sepsis modeli çekal ligasyon ve delme (CLP) tekniði ile oluþturuldu. Sýçanlar her biri sekizerli dört gruba ayrýldý. Ýlk grup normal, ikinci grup sham grubu olarak belirlendi. Üçüncü grup sepsis modeli oluþturulup sadece salin verilen grup, dördüncü grup ise sepsis modelini takiben agomelatin uygulanan grup olarak belirlendi. Yirmi dört saatin sonunda böbrek doku örnekleri ve kanlar alýnarak histopatolojik ve biyokimyasal yöntemlerle analizleri yapýldý.
BULGULAR: Çalýþmada agomelatine uygulanan grupta sadece salin uygulanan gruba göre TNF-α, MDA, BUN, kreatin ve histolojik böbrek skorlamasý daha düþük olarak bulundu. Ayný zamanda, histopatolojik deðerlendirmede agomelatin tedavisinin böbrek dokularýnda sepsisin oluþturduðu hasarlanmayý düzelttiði görüldü.
TARTIÞMA: Bu çalýþmada, agomelatinin sepsis nedenli akut böbrek hasarýnda faydalý olduðu savunulmaktadýr. Bu hem biyokimyasal hem de histolojik deðerlendirmeler ile gösterilmiþtir. Agomelatinin anti-oksidan ve proenflamatuvar etkilerinin böbreklerdeki bu düzelmeden sorumlu olduðu düþünülmektedir.

BACKGROUND: Sepsis-related acute kidney injury (AKI) is a serious complication of sepsis. Problems persist regarding early diagnosis and treatment of AKI. The aim of the present study was to evaluate the efficacy of agomelatine, which is primarily known for its positive effects on depressive and anxiety disorders in sepsis-related AKI.
METHODS: Sepsis model was created with cecal ligation puncture (CLP). Rats were separated into 4 groups of 8 each: the control group, the sham-operated group, the CLP+saline group, and the CLP+agomelatine group. Agomelatine was administered intraperitoneally in doses of 20 mg/kg.
RESULTS: In the agomelatine group, reductions were observed in levels of tumor necrosis factor α (TNF-α), malondialdehyde (MDA), blood urea nitrogen (BUN), and creatinine, as well as in histological kidney scores, compared to the non-treated group. In addition, it was demonstrated that agomelatine treatment had positive effect on sepsis-induced morphological damage to renal and tubular tissues.
CONCLUSION: Agomelatine showed strong efficacy in sepsis-related AKI, demonstrated with histological and biochemical results in an experimental model. It is believed that antioxidant and pro-inflammatory effects of agomelatine are responsible for the improvement in kidneys.

AMAÇ: Bu çalýþmada, ayný basýnç-zaman ürünlü farklý yeniden kazandýrma manevralarýnýn akciðerden kana bakteri geçiþine ve ventilatör iliþkili akciðer hasarýna etkisi araþtýrýldý.
GEREÇ VE YÖNTEM: Sýçanlara anestezi uygulandýktan sonra trakeotomi açýldý ve basýnç kontrollü ventilasyon modunda ventilasyona baþlandý. Ardýndan Pseudomonas aeruginosa içeren solüsyon trakeotomi kanulünden verilip, ventilasyona bu þekilde 30 dakika devam edildikten sonra sýçanlar rastgele dört gruba ayrýldý. Grup 1: “Sustained inflation” (SI); Grup 2: Düþük basýnç SI (LPSI); Grup 3: Modifiye Sigh; Grup 4: Kontrol grubu. Kan kültürleri bakteri verilmeden önce, ilk bir saat her yeniden kazandýrma manevrasýndan sonra ve son manevradan 75 dakika sonra olmak üzere toplam altý kez alýndý. Daha sonra sýçanlar arter içine verilen sodium tiyopental ile sakrifiye edilerek toraks açýlýp akciðerler çýkarýldý. Sol akciðer yaþ kuru aðýrlýk (WW/DW) oraný için, sað akciðer patolojik inceleme için kullanýldý.
BULGULAR: Kan kültürlerine bakýldýðýnda Grup 3 de daha erken dönemde kan kültürlerinde üreme tespit edildi. Grup 3’de patolojik skorlar daha yüksek bulundu.
TARTIÞMA: Bakteriyel translokasyon ve histopatolojik deðerlendirmelerle modifiye Sigh ile daha ciddi ventilatör iliþkili akciðer hasarý oluþmuþtur.

BACKGROUND: Investigated in the present study were the effects of various recruitment maneuvers (RMs) using the same inflation pressure-time product on bacterial translocation from lung to blood, and ventilator-induced lung injury (VILI).
METHODS: Tracheotomy was performed on anesthetized rats, and ventilation was initiated using pressure-controlled mode. Subsequently, Pseudomonas aeruginosa was inoculated through the tracheotomy tube and ventilated for 30 minutes before rats were randomly separated into 4 groups. Group 1 underwent sustained inflation (SI), Group 2 underwent low-pressure SI, Group 3 underwent modified sigh, and Group 4 was a control group. Blood cultures were taken at baseline, 15 minutes after randomization (after each RM for the first hour), and finally at 75 minutes after the last RM. The rats were euthanized and the lungs were extirpated. The left lung was taken for measurement of wet: dry weight ratio, and the right lung was used for pathologic evaluation.
RESULTS: Positive blood cultures were found to be higher in Group 3 at early study periods. Total pathological scores were also higher in Group 3.
CONCLUSION: Higher severity of ventilator-induced lung injury occurred in the modified sigh group, evidenced by bacterial translocation and results of histopathological evaluation.

AMAÇ: Yeni nesil bir antienflamatuvar ajan olan adalimumab, etkisini makrofaj ve lenfositler gibi hücresel immün yanýt elemanlarýndan salýnan tümör nekrozu faktörü (TNF-α) üzerinden gösterir. Özellikle apoptoz ve demiyelinizasyon gibi süreçlerde önemli rol oynayan TNF-α aktivitesinin önlenmesi ile nöral iyileþmede artýþ gözlenebilir. Bu çalýþmada, sýçan deneysel siyatik sinir hasarý modelinde adalimumabýn nöroprotektif etkinliði elektron mikroskobik ve biyokimyasal olarak incelendi.
GEREÇ VE YÖNTEM: Çalýþmada toplam 40 adet Wistar albino cinsi sýçan sham, travma, düþük doz adalimumab ve yüksek doz adalimumab olmak üzere rastgele dört gruba ayrýldý. Her gruptan altý sýçan biyokimyasal ve dört sýçan elektron mikroskobik analizde kullanýldý. Siyatik sinirleri diseke edilen sýçanlara klip kompresyonu ile periferik sinir hasar modeli uygulandý. Siyatik sinirleri diseke edilen sýçanlara klip kompresyonu ile periferik sinir hasar modeli uygulandý ve eþ zamanlý adalimumab tedavisi uygulandý. Ýki haftalýk adalimumab tedavisi sonrasý sýçanlar sakrifiye edildi.
BULGULAR: Düþük doz ve yüksek doz grubunun her ikisinde de yapýlan incelemelerde adalimumabýn, sinir dokusu lipid peroksidasyon deðerlerini istatistiksel olarak anlamlý biçimde azalttýðý görüldü.
TARTIÞMA: Bu çalýþmanýn sonuçlarý adalimumabýn nöral doku iyileþmesinde özellikle erken döneminde etkili nöroprotektif bir ajan olduðunu göstermiþtir.

BACKGROUND: Adalimumab, a new-generation anti-inflammatory agent, exerts its effect through tumor necrosis factor α (TNF-α), secreted from immune response cells such as macrophages and lymphocytes. TNF-α has been shown to play an important role in the processes of apoptosis and demyelination, and blockage of its activity may improve neural healing. Investigated in the present study is the probable neuroprotective influence of adalimumab in rats using a peripheral nerve injury model with biochemical and electron microscopic methods.
METHODS: Forty adult Wistar albino rats were randomly divided into control, sciatic nerve trauma, low-dose adalimumab, and highdose adalimumab groups. Six rats from each group were assigned biochemical microscopy, and 4 were assigned electron microscopy. Neural injury was induced with clip compression following dissection of sciatic nerves. Adalimumab was simultaneously injected. The rats were sacrificed after 2 weeks of adalimumab treatment.
RESULTS: Nerve tissue lipid peroxidation values were found to be significantly decreased in both the low- and high-dose adalimumab treatment groups, compared to the group subjected only to sciatic nerve trauma.
CONCLUSION: Results demonstrate that adalimumab is an effective neuroprotective agent for neural healing, particularly in the early phase.

AMAÇ: Ýntususepsiyon, çocuklarda akut apandisitten sonra en yaygýn akut karýn sebebidir. Ýntususepsiyon deneyimlerimizi, ileo-kolik ve ince baðýrsak intususepsiyonlarýna yaklaþým seçeneklerini gözden geçirmeyi hedefledik.
GEREÇ VE YÖNTEM: Temmuz 2002–Eylül 2014 yýllarý arasýnda kliniðimizde intususepsiyon tanýsý almýþ olgularýn kayýtlarý tarandý; yaþ, cinsiyet, klinik bulgular, baþvuru süresi, ultrasonografi bulgularý ve uygulanan tedavi seçenekleri ve sonuçlarý deðerlendirildi.
BULGULAR: Toplamda 81 olgunun 52’si erkek, 29’u kýz, ortalama yaþlarý 10.6 aydý. Ýntususepsiyon 52 hastada ileokolik, 26 hastada ileoileal, üç hastada jejunojejunaldi. On dokuz (%23.5) olguda cerrahi, tümü ileokolik 45 (%55.5) olguda hidrostatik redüksiyon uygulandý. Periton irritasyonu bulgusu olmayan 17 (%21) hasta fiziksel inceleme, ultrasonografi ve klinik izleme alýndý. Tamamý ince baðýrsakta olan invajine segmentlerinin uzunluklarý ultrasonografik olarak 1.8–2.3 cm arasýnda ölçülen bu hastalarda komplikasyonsuz spontan redüksiyon izlendi. Cerrahi uygulanan hastalarýn tümünde invajine segment en az 4 cm uzunluðundaydý. Rezeksiyon yapýlan dört hastanýn üçünde cerrahi öyküsü vardý.
TARTIÞMA: Periton irritasyonu bulgularý olan tüm intususepsiyon olgularýnda tedavi cerrahidir. Diðer durumlarda, tedavi yaklaþýmý açýsýndan ince baðýrsak intususepsiyonlarý ileokolik intususepsiyonlardan ayrý deðerlendirilmelidir. Ýnce baðýrsak intususepsiyonu 2.3 cm’den kýsaysa ultrasonografi desteðiyle klinik izlem güvenlidir; 4 cm’den uzun ve geçirilmiþ karýn cerrahisi varsa cerrahi müdahale ön planda düþünülmelidir.

BACKGROUND: Intussusception is the second most common cause of acute abdomen in children, following appendicitis. The aim of the present study was to evaluate the experience of the authors, in an effort to promote intussusception management, especially that of small bowel intussusception.
METHODS: Records of intussusception diagnosed between July 2002 and September 2014 were evaluated in terms of patient age, sex, clinical findings, admission time, ultrasonographic findings, treatment methods, and outcomes.
RESULTS: Eighty-one patients, 52 males and 29 females, were included (mean age: 10.6 months). Intussusceptions were ileocolic (IC) in 52 cases, ileoileal (IL) in 26, and jejunojejunal ( JJ) in 3. Nineteen (23.5%) patients underwent surgery. Hydrostatic reduction was performed in 45 (55.5%) IC cases. Seventeen (21%) patients with small bowel intussusceptions (SBIs), measuring 1.8-2.3 cm in length, spontaneously reduced. All patients who underwent surgery had intussusceptums ≥4 cm. Three of the 4 intestinal resection cases had history of abdominal surgery.
CONCLUSION: If peritoneal irritation is present, patients with intussusception must undergo surgery. Otherwise, in patients with IC intussusception and no sign of peritoneal irritation, hydrostatic or pneumatic reduction is indicated. When this fails, surgery is the next step. SBIs free of peritoneal irritation and shorter than 2.3 cm tend to spontaneously reduce. For those longer than 4 cm, particularly in patients with history of abdominal surgery, spontaneous reduction is unlikely.

AMAÇ: Bu çalýþmada, Türkiye’nin en kalabalýk þehri olan Ýstanbul’da acil týp teknisyenleri ve paramediklerin iþle iliþkili yaralanmalarý tanýmlandý.
GEREÇ VE YÖNTEM: Ýstanbul’da toplam 195 ambulans istasyonu mevcuttur. Çalýþma Ýstanbul Ýl Saðlýk Müdürlüðü tarafýndan onaylandý. Çalýþma anketi 112 saðlýk çalýþanlarýnýn e-posta adreslerine gönderildi ve doldurulmasý istendi.
BULGULAR: Çalýþmaya ortalama yaþlarý 29.5±6.1 (min: 18-maks: 61) olan 901 personel (660 acil týp teknisyeni [ATT] ve 241 paramedik) katýldý. Çalýþanlarýn halk tarafýndan sözel þiddete uðrama oraný %94.9, hasta yakýnlarý tarafýndan fiziksel þiddet oraný %39.8 olarak belirlendi. Bunun yanýnda çalýþanlarýn 112’de çalýþmaktan memnun olup olmadýðý araþtýrýldý. Beþ yüz on (%57.6) katýlýmcý memnun deðildi. Cinsiyete göre kadýn katýlýmcýlar sözel þiddete (p=0.01), fakat erkek katýlýmcýlar da fiziksel þiddete kadýnlardan daha fazla maruz kalmýþtý (p=0.01). Ýþ iliþkili yaralanmalarýn en çoðu motorlu araç kazalarý (%81.4), iðne batma yaralanmalarý (%52.2), kan veya vücut sývýlarý ile göz temasý (%30.9) ve keskin alet yaranmalarý (%22.5) idi. Ýþ iliþkili yaralanmalarýn %10.5’i (n=95) örneðin iðne batma yaralanmalarý ve vücut sývýlarýnýn göze temasý gibi yaralanmalar yönetime rapor edilmiþti ve bildirilmiþti. Katýlýmcýlarýn 488’i (%54.2) olasý iþ iliþkili yaralanmalarý önlemek için hizmet içi eðitimlere katýlmýþtý.
TARTIÞMA: Ülkemizde iþ iliþkili yaralanmalarda ATT ve paramediklerin riski oldukça açýk bir þekilde yüksektir. Bu nedenle acil çaðrý sistemi personeline fiziksel-sözel þiddeti önlemek için daha ileri stratejiler geliþtirilmeli ve iþ kazalarýna yönelik hizmet içi eðitimler artýrýlmalýdýr

BACKGROUND: Evaluated in the present study were locations, descriptions, and results of work-related injuries (WRIs) sustained by emergency medical technicians (EMTs) and paramedics in Turkey’s most crowded city, Ýstanbul.
METHODS: After the present study had been accepted by the urban health authority, a questionnaire was emailed to the healthcare personnel of Ýstanbul’s 195 ambulance stations.
RESULTS: Included in the present study were the responses of 901 members of staff (660 EMTs and 241 paramedics), with a mean age of 29.5±6.1 (min: 18; max: 61). The majority of participants (94.9%) had encountered verbal abuse from the public, and 39.8% had encountered physical violence from patients’ relatives. Levels of satisfaction with work in emergency medical services (EMS) was also evaluated, and 510 participants (57.6%) were unhappy. Regarding gender, female employees were more likely to be verbally attacked (p=0.01), while males were more likely to be physically attacked (p=0.001). It was reported that motor vehicle accidents (MVAs) were the most common cause of WRIs (81.4%), followed by needle-stick injuries (52.2%), ocular exposure to blood and other fluids (30.9%), and sharp injuries (22.5%). Only 10.5% (n=95) of WRIs were reported to authorities; 488 (54.2%) of participants just attended to the practice to prevent possible WRIs.
CONCLUSION: For paramedics and EMTs, risk of WRI is obviously high. Strategies to decrease and prevent verbal and physical violence should be developed.

AMAÇ: Pankreatik psödokistlerinde spontan rezolüsyon oraný %86, ciddi komplikasyon oraný ise %3–9 olarak bildirilmektedir. Bu çalýþmanýn amacý psödokistlerin spontan rezolüsyonunu öngörebilen yeni bir skorlama sistemi geliþtirmektir.
GEREÇ VE YÖNTEM: Yetmiþ hastanýn týbbi kayýtlarý geçmiþe yönelik incelendi. Ýki hasta çalýþma dýþý býrakýldý. Her hastanýn kayýtlarýndan demografik verileri ve laboratuvar deðerleri elde edildi.
BULGULAR: Altmýþ sekiz hastanýn ortalama yaþý 56.6 ve kadýn/erkek oraný 1.34/1 olarak bulundu. Hastalarýn %48.5’inde pankreatitin nedeni safra taþlarý, %26.5’inde kronik alkol kullanýmý, %25’inde ise idiopatikti. Ortalama kist çapý 71 mm idi. Takip esnasýnda 32 hastada (%47.1) psödokist kayboldu. Tek deðiþkenli analizler incelendiðinde kist çapý (>55 mm) ile serum dierkt bilirübin (>0.95 mg/dL) ve kist CEA (>1.5) deðerlerinin spontan rezolüsyon saptanan ve saptanmayan hastalar arasýnda anlamlý derecede farklý olduðu görüldü. Çok deðiþkenli analizler sonrasýnda da ayný deðiþkenlerde istatistiksel anlamlý farklýlýk saptandý. Skorlar bu deðiþkenlere atanan puanlar toplanarak elde edildi. Nihai puanlar ile %80 hastada spontan rezolüsyon tahmin edilebildi.
TARTIÞMA: Basit ve kolay uygulanabilir olan skorlama sistemimiz ile psödokist rezolüsyonunu tahmin etmek mümkün olabileceði kannatindeyiz; yine de geçerlilik ve güvenilirliðinin daha detaylý deðerlendirilmesi gerekmektedir.

BACKGROUND: The spontaneous resolution rate of pancreatic pseudocysts (PPs) is 86%, and the serious complication rate is 3-9%. The aim of the present study was to develop a scoring system that would predict spontaneous resolution of PPs.
METHODS: Medical records of 70 patients were retrospectively reviewed. Two patients were excluded. Demographic data and laboratory measurements were obtained from patient records.
RESULTS: Mean age of the 68 patients included was 56.6 years. Female: male ratio was 1.34: 1. Causes of pancreatitis were stones (48.5%), alcohol consumption (26.5%), and unknown etiology (25%). Mean size of PP was 71 mm. Pseudocysts disappeared in 32 patients (47.1%). With univariate analysis, serum direct bilirubin level (>0.95 mg/dL), cyst carcinoembryonic antigen (CEA) level (>1.5), and cyst diameter (>55 mm) were found to be significantly different between patients with and without spontaneous resolution. In multivariate analysis, these variables were statistically significant. Scores were calculated with points assigned to each variable. Final scores predicted spontaneous resolution in approximately 80% of patients.
CONCLUSION: The scoring system developed to predict resolution of PPs is simple and useful, but requires validation.

AMAÇ: Bu çalýþmada ameliyat öncesi lökosit (WCC), nötrofil/lenfosit oraný (NLR), trombosit (PLT), ortalama-trombosit-hacmi (MPV) ve serum bilirubin düzeyleri gibi basit laboratuvar incelemelerinin akut apandisit tanýsý koymakta veya perfore olgularýn basit apandisitlerden ayýrmýný yapmaktaki etkinliðini ortaya koymayý amaçladýk.
GEREÇ VE YÖNTEM: Apendektomi ameliyatý uygulanmýþ 3392 hasta geriye dönük olarak deðerlendirildi. Hastalar histopatolojik tanýlarýna göre öncelikle iki gruba ayrýldý. Normal appendiks bulgularý olan olgular (Grup 1) ve akut apandisit olan olgular (Grup 2). Daha sonra ikinci gruptaki olgular basit akut apandisit olgularý (Grup 2A) ve perfore apandisit olgularý (Grup 2B) olarak alt gruplara ayrýldý. Gruplar arasýnda ameliyat öncesi WCC, NLR, PLT, MPV ve serum bilirubin düzeyleri karþýlaþtýrýldý. Önce univariate analiz ile baðýmsýz deðiþkenler saptandý, daha sonra bunlardan çok deðiþkenli analizde p deðeri 0.05’den küçük olanlara ROC eðrisi analizi uygulandý. Eðrinin altýnda kalan alan 0.600’den büyük olan parametreler anlamlý paremtetre olarak kabul edilerek eþik deðer hesaplandý.
BULGULAR: WCC, bilirubin ve NLR, akut apandisit tanýsýnda klinik kullanýmda anlamlý parametreler olarak saptandý. Lökositoz için eþik deðer 11.900/mm3 (sensitivite %71.2, spesifisite %67.2, OR: 5.13), bilirubin için 1.0 mg/dl (sensitivite %19.1, spesifisite %92.4, OR: 2.96) ve NLR için 3.0 (sensitivite %81.2, spesifisite %53.1, OR: 4.27) idi. Bilirubin ve NLR, perfore apandisit olgularýnýn ayýrýmýnda anlamlý parametrelerdi. Bilirubin için eþik deðer 1.0 mg/dl (sensitivite %78.4, spesifisite %41.7, OR: 2.6) ve NLR için 4.8 (sensitivite %81.2, spesifisite %53.1, OR: 2.6) idi.
TARTIÞMA: Akut apandisit þüphesi oluþturan bulgularla gelen bir olguda serum lökosit deðerinin 11.900/mm3’den, bilirubin deðerinin 1.0 mg/dl’den, veya nötrofil/lenfosit oranýnýn 3.0’den fazla olmasý akut apandisit tanýsý destekler. Akut apandisit düþünülen bir olguda ise bilirubin deðerinin 1.0 mg/dl’den veya nötrofil/lenfosit oranýnýn 4.8’den büyük olmasý olguda perforasyon geliþtiðini destekler verilerdir. WCC, akut apandisit tanýsýnda anlamlý olmasýna raðmen, perfore olgularýn tanýnmasýnda güçlü bir parametre deðildir. PLT ve MPV akut apandisit þüpheli olgularda tanýsal anlam taþýmamaktadýrlar.

BACKGROUND: The aim of the present study was to examine the efficacy of simple laboratory parameters including neutrophilto-lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), and serum bilirubin level in the diagnosis of acute appendicitis and recognition of perforated appendicitis.
METHODS: Records of 3392 patients who underwent appendectomy in a 10-year period were reviewed retrospectively. Patients were divided into 2 groups according to histopathological examination results: Group 1 had normal appendix, Group 2 had acute appendicitis. Patients with acute appendicitis were divided into subgroups: Group 2A had simple acute appendicitis, while Group 2B had perforated appendicitis. Efficacy of the aforementioned laboratory parameters was evaluated in the diagnosis of acute appendicitis and recognition of perforated appendicitis. Independent variables were determined by univariate analysis and multivariate analysis was performed. Receiver operating characteristic (ROC) curve analysis was used to identify significant parameters in multivariate analysis. Cut-off values, sensitivity, specificity, and accuracy calculations performed for parameters with area under curve (AUC) >0.600 were accepted as “significant parameters.”
RESULTS: White cell count (WCC), bilirubin, and NLR were significant parameters for the diagnosis of acute appendicitis. Cut-off values were 11900/mm3 for WCC (sensitivity: 71.2%; specificity: 67.2%; OR: 5.13), 1.0 mg/dl for bilirubin (sensitivity: 19.1%; specificity: 92.4%; OR: 2.96), and 3.0 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 4.27). Serum bilirubin and NLR were independent variables for the diagnosis of perforated appendicitis. Cut-off values were 1.0 mg/dl for bilirubin (sensitivity: 78.4%; specificity: 41.7%; OR: 2.6) and 4.8 for NLR (sensitivity: 81.2%; specificity: 53.1%; OR: 2.6).
CONCLUSION: Presence of at least 1 of the following findings in a patient suspected of having acute appendicitis was significantly associated with a definite diagnosis: WCC >11.900 mm3, serum bilirubin >1.0 mg/dl, NLR >3.0. In patients with acute appendicitis, serum bilirubin >1.0 mg/dl or NLR >4.8 were significantly associated with the presence of perforation. While WCC is a significant parameter for diagnosis of acute appendicitis, no significant association with perforated appendicitis was found. PLT and MPV were not useful parameters when diagnosing acute appendicitis.

AMAÇ: Perfore akut apandisitin (AA) erken tanýnmasý zor olabilmektedir. Bu çalýþmada, ameliyat öncesi nötrofil-lenfosit oraný (NLR) ve ortalama trombosit hacmi (MPV) ölçümlerinin akut apandisit olgularýnda perforasyonu belirlemedeki rolü araþtýrýldý.
GEREÇ VE YÖNTEM: Dört yüz on üç AA’lý olguya ait geriye dönük veriler ile 100 saðlýklý kontrol çalýþmaya dahil edildi. Akut apandisitli olgulara ait patolojiler flegmonöz apandisit, lokalize peritonitin eþlik ettiði apandisit ve perforasyonlu ve/veya gangrenöz apandisit olgularý olarak üç grupta incelendi. Hastalara ait MPV ve NLR deðerleri gruplar içerisinde ve saðlýklý kontrollere ait sonuçlarla karþýlaþtýrýldý.
BULGULAR: Ortalama MPV deðeri AA grubunda 9.3±8 FL ve saðlýklý kontrollerde 8.5±0.9 Fl idi (p=0.0005). Ortalama MPV deðerleri flegmonöz apandisit grubunda 8.8±5.8, lokalize apandisit grubunda 8.9±5.8 FL ve perforasyonlu ve/veya gangrenöz apandisit grubunda 12.8±9.7 FL olarak saptandý (p=0.005). Perforasyonlu/gangrenöz apandisitli olgularý diðer apandisit olgularýndan ayýrmak için ölçülen eþik MPV deðeri 8.92 Fl idi. Ortalama NPV deðerleri basit apandisit, lokalize apandisit, perforansyonlu/gangrenöz apandisit gruplarýnda sýrasýyla 8.3±5.6, 9.1±6.2 ve 10.6±6.4 olarak saptandý (p=0.023). Perforasyonlu/gangrenöz apandisitli olgularý diðer apandisit olgularýndan ayýrmak için ölçülen eþik NPV deðeri 7.95 idi.
TARTIÞMA: Nötrofil-lenfosit oraný ve MPV ölçümleri akut apandisitin þiddetini belirlemede klinik tanýya yardýmcý olabilir.

BACKGROUND: Early diagnosis of perforation in acute appendicitis (AA) allows surgeons to select the most appropriate treatment. The aim of the present study was to determine whether preoperative neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) could predict perforation in AA.
METHODS: Data collected from 413 consecutive patients with AA and 100 healthy controls were analyzed retrospectively. Patients were categorized as having had phlegmonous appendicitis, appendicitis with localized peritonitis, or appendicitis with perforation and/ or gangrene. MPV and NLR values were compared among the control group and the 3 groups of patients with AA.
RESULTS: Means values of MPV were 9.3±8 fL for the patient group and 8.5±0.9 fL for the healthy control group (p=0.0005). Mean values of MPV by patient subgroup were 8.8±5.8 for phlegmonous appendicitis, 8.9±5.8 for localized peritonitis, and 12.8±9.7 for appendicitis with perforation and/or gangrene (p=0.005). Cut-off value of MPV was set at 8.92 to differentiate AA with perforation and/or gangrene from other types of AA. Mean NLRs of patients with phlegmonous appendicitis, appendicitis with localized peritonitis, and appendicitis with perforation and/or gangrene were 8.3±5.6, 9.1±6.2, and 10.6±6.4, respectively; p=0.023. The cut-off value for NLR was set at 7.95 to differentiate AA with perforation and/or gangrene from other types of AA.
CONCLUSION: Both NLR and MPV can be useful in predicting severity of AA.

AMAÇ: Kolorektal yaralanmalar halen önemli bir mortalite ve morbidite nedenidir. Çalýþmanýn amacý Türk cerrahlarýn tedavi kararý konusunda American Association for the Surgery of Trauma (AAST) kolon/rektum yaralanma skoru, Injury Severity Score (ISS) ve Penetrating Abdominal Trauma Index (PATI) skorlarýný kullanmaya eðilimlerini ve mevcut klinik sonuçlarýný analiz etmektir.
GEREÇ VE YÖNTEM: Dört yýllýk bir periyot içerisinde yüksek kinetik enerjili silahlarýn neden olduðu kolorektal yaralanmalý hastalarýn verileri geriye dönük olarak toplandý. Ýlk ameliyatta ostomi açýlanlar grup 1, açýlmayanalar grup 2, sonradan ostomi açýlanlar grup 2a ve hiç ostomi açýlmayanlar grup 2b olarak belirlendi.
BULGULAR: Otuz dokuz (%66) hastaya ilk ameliyatta ostomi açýlmýþ, 20 (%34) hastaya açýlmamýþtý. Ýlk ameliyatta ostomi açýlmayan altý (%30) hastaya daha sonra ostomi açýlýrken, 14 (%70) hastaya hiç ostomi açýlmamýþtý. Belirgin þekilde AAST skorlarý yüksek olan hastalara ostomi açýldýðý görüldü (p<0.001). Fakat PATI ve ISS skorlarý ostomi açma konusunda belirleyici olmamýþtý (p=0.61, p=0.28). Sivil ve askeri cerrahlarýn ostomi oranlarý sýrasýyla %62 ve %68 olarak bulundu (p=0.47). Receiver operating characteristic (ROC) analizine göre AAST skorunun ostomi açma konusunda daha belirleyici olduðu görüldü.
TARTIÞMA: Yüksek kinetik enerjili silahlarla meydana gelen ateþli silah yaralanmalarýnda diversiyon halen önemini korumaktadýr. Diversiyon uygulamasý ve sonrasýnda gözlenen daha düþük komplikasyon oranlarý AAST skoru yüksekliði ile iliþkili bulundu.

BACKGROUND: Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes.
METHODS: Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients).
RESULTS: Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (p<0.001). However, PATI and ISS scores were not decisive factors in the performance of ostomy (p=0.61; p=0.28, respectively). Ostomy rates of civilian and military surgeons were 62% and 68%, respectively (p=0.47). Receiver operating characteristic (ROC) analysis showed that AAST score was a more accurate guide for performing ostomy, with sensitivity and specificity rates of 80% and 92.9%, respectively.
CONCLUSION: Clinical significance of diversion in HVM-related CRIs remains. Stomas were associated with lower complication rates and significantly higher AAST colon/rectum injury scores.

AMAÇ: Türkiye’de çalýþan acil týp uzman, asistan ve öðretim üyelerinin akut karýn aðrýlý hastalarda analjezik kullanýmý konusundaki tutumlarý, günlük pratik uygulamalarý ve analjezik kullaným kararýný etkileyen faktörleri belirlemektir.
GEREÇ VE YÖNTEM: Kesitsel analitik çalýþma 15 Kasým 2013–25 Ocak 2014 tarihleri arasýnda Türkiye’deki üniversite hastaneleri, Saðlýk Bakanlýðý eðitim ve araþtýrma hastaneleri, devlet hastaneleri ve özel hastanelerde çalýþan acil týp hekimlerine anket formu uygulanarak yapýldý.
BULGULAR: Ýnternet baðlantýsýyla (n=410) ve posta (n=393) yoluyla toplam 803 anket dolduruldu (Katýlým oraný: %47). Katýlýmcýlarýn %59.3’ü (n=470) araþtýrma görevlisi, %35.1’i (n=278) acil týp uzmaný ve %5.7’si (n=45) öðretim üyesiydi. Katýlýmcýlarýn analjezik ilaçlarýn; fizik muayene bulgularýný %49.5’i “baskýladýðýný”, %34.5’inin “sýklýkla” kullandýðý, %50.7’sinin “muayene ve hastanýn planlamasý yapýldýktan sonra” uyguladýðýný, %60.6’sýnýn “cerrah hastayý görmeden”, %56.9’unun da “kesin taný konmadan önce uyguladýðýný” bildirdi. Hastalarýn %47.9’unun “her zaman”, %41.6’sýnýn “sýklýkla” analjezik talep ettiklerini bildirdiler. Cerrahi konsültan hekiminin %34.6’sý “nadiren”, %28.7’si “hiçbir zaman” analjezik kullanýmýný önermediði ve cerrahi bölümlerle oluþturulmuþ ortak politika olmadýðý (%79.1) yanýtýný verdiler. Acil týp uzmanlarýnýn (devlet ve üniversite) analjezik kullanýmý ve hastaya ait faktörler konusunda istatistiksel olarak fark yoktu. Acil týp uzmanlarý ve asistanlarý arasýnda ise, asistanlarýn “hiçbir zaman” analjezik kullanmam diyen grubu, uzmanlara göre fazlaydý (p=0.002), asistanlar “operasyon kararý verildiðinde”, uzmanlar ise “muayene ve hasta yönetim planý yapýldýktan sonra” analjezik uyguladýklarýný (p=0.021), asistanlar analjeziklerin fizik muayene bulgularýný “baskýladýðýný”, uzmanlar ise “netleþtirdiðini” (p<0.0001), asistanlar “cerrah muayene etmeden analjezik uygulamadýklarý”, uzmanlarsa uyguladýklarýný bildirdi (p=0.0001). Hem asistanlarýn hem de uzmanlarýn en sýk narkotik analjezik kullandýklarý, NSAID kullaným oranlarýnýn her iki grup içinde yüksek olduðu görüldü. Asistanlar aðrý þiddeti, fizik muayene bulgularý, inceleme sonuçlarý ve farklý tanýlarda analjezik kullanýmý konusunda da uzmanlara göre istatistiksel olarak anlamlý oranda kararsýz kalmaktaydý. Devlette çalýþan asistanlarýn analjezikleri “hiçbir zaman” ve “nadiren” kullanýrým diyen grubu, üniversitede çalýþanlara göre fazlaydý (p=0.001). Her iki grupta analjezik kullanýmýnýn fizik muayene bulgularýna %57 oranýnda baskýlar yanýtýný verdiler. Kýdemli asistanlar (>24 ay) analjeziði kýdemsizlere göre “sýklýkla” uyguladýklarýný (p=0.034) ve kýdemsiz asistanlarýn daha çok oranda analjezik kullanýmýnýn “fizik muayene bulgularýný baskýladýðýný” inandýklarýný bildirdiler (p=0.002).
TARTIÞMA: Acil týp hekimlerinin akut karýn aðrýlý hastalarda analjezik kullaným oranlarý çok düþüktür ve yýllar içerisinde deðiþiklik olmamýþtýr. Acil týp asistanlarýnýn uzmanlarýna oranla analjezik kullaným oranlarý çok daha düþüktür ve analjeziklerin fizik muayeneyi baskýladýðýna, cerrah hastayý muayene etmeden uygulamamasý gerekliliðine inançlarý yüksektir. Asistanlarýn, analjezik uygulama zamaný daha geçtir. Asistanýn kýdemi arttýkça kullaným oraný ve fizik muayene etkilemediði görüþü artmaktadýr.

BACKGROUND: Use of narcotic analgesics in patients with acute abdominal pain does not cause delayed misdiagnosis, increases patient comfort and does not suppresses physical examination. The purpose of this study was to determine attitudes anddaily practices of emergency medicine (EM) specialists, residents and faculty members in Turkey on the use of analgesics in patients with acute abdominal pain and factors affecting their decisions on the use of analgesics.
METHODS: A cross-sectional study was performed between November 15, 2013 and January 25, 2014 by conducting a questionnaire to EM physicians working in University Hospitals, Education and Research Hospitals of the Ministry of Health, State Hospitals, and Private Hospitals in Turkey.
RESULTS: A total of 803 questionnaires (participation rate: 47%) were completed. 59.3% (n=470) of the participants were research assistants. 49.5% of the participants reported that analgesic drugs “suppressed’’ physical examination findings. They stated that 90% of the patients “always’’ and “often’’ requested analgesics and that 34.6% of surgery consultant physicians “rarely” recommended the use of analgesics, while 28.7% “never” recommended, and that there was no common policy established together with surgical departments (79.1%). According to the comparison between the EM specialists and residents, residents in the group stating that they would “never’’ use analgesics were higher than specialists in number (p=0.002); residents reported that they administered analgesics “upon surgical intervention decision”, while specialists reported that they administered analgesics “after patient’s examination and treatment plan” (p=0.021); residents reported that analgesics “suppressed’’ physical examination findings, while specialists reported that analgesics “clarified’’ physical examination findings (p<0.0001); residents reported that they did not administer analgesics “before examination by surgeon’’, while specialists reported otherwise (p=0.0001). Senior residents (>24 months) reported that they administered analgesics “often’’ compared to junior residents (p=0.034) and that junior residents believed that the use of analgesics would “suppress physical examination findings’’ at a higher percentage (p=0.002).
CONCLUSION: The rates of use of analgesics in patients with acute abdominal pain by EM physicians are very low. The rates of use of analgesics by EM residents are much lower compared to EM specialists, and they highly believe that analgesic drugs suppress physical examination findings. Residents tend to administer analgesic drugs at a later stage. As seniority of residents increases, the rate of analgesics use and the opinion that analgesic drugs have no effect on physical examination findings increases.

AMAÇ: Bu çalýþmada izole radius diafiz kýrýðý nedeniyle yeni dizayn intramedüller radius çivi tedavisi uyguladýðýmýz eriþkin hastalarda intramedüller çivi tedavisinin etkinliðini, fonksiyonel ve kozmetik sonuçlarýný deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Ýzole deplase radius diafiz kýrýðý nedeniyle intramedüller çivi tedavisi uygulanan17 hasta geriye dönük olarak deðerlendirildi. Çalýþmaya kapalý izole radius diafiz kýrýðý olan hastalar dahil edildi. Tüm hastalara kapalý yöntemle tespit uygulandý. Hastalarýn son kontrollerinde gonyometre ile önkol ve dirsek hareket açýlarý ölçüldü. Hidrolik el dinamometresi ile saðlam ve tedavi edilen önkollar için kavrama gücü ölçüldü. Önkol direkt grafide maksimum radial eðim ve lokalizasyonlarý saðlam ve tedavi edilen ekstremiteler için ayrý ayrý ölçüldü. Kaynama ve fonksiyonel sonuçlarýn deðerlendirilmesi Grace-Eversman kriterleri ve Disabilities of the Arm, Shoulder and Hand (DASH) scoreanketine göre yapýldý.
BULGULAR: Ýzole radius diafiz kýrýðý olan 17 eriþkin hasta deðerlendirmeye alýndý. Hastalarýn 11’i (%64.7) erkek, altýsý (%35.3) kadýndý. Yaþ ortalamasý 35.76 (23–61) idi. On bir (%64.7) hastada sað, altý (%35.3) hastada sol tarafta kýrýk vardý. Ortalama kaynama süresi 10.2 (8–20) hafta olarak deðerlendirildi. Ortalama supinasyon 75.35 (67–80) derece, pronasyon 85.18 (74–90) derece idi. Grace-Eversman deðerlendirme kriterlerine göre 16 (%94) olguda mükemmel bir (%6) olguda iyi sonuç elde edildi. Hastalarýn DASH ortalamasý 12.58 (3.3–32.5) olarak deðerlendirildi.
TARTIÞMA: Eriþkin deplase radius diafiz kýrýklarýnýn cerrahi tedavisinde altýn standart tedavi yöntemi plak vida osteosentezidir. Ancak fonksiyonel sonuçlarýnýn çok iyi olmasý ve plak vida osteosentezine benzer kaynama oranlarý nedeniyle intramedüller çivi tedavisinin izole radius diafiz kýrýklarýnda alternatif bir tedavi yöntemi olarak kullanýlabileceðini düþünüyoruz.

BACKGROUND: The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary radius nails for isolated radius diaphyseal fractures.
METHODS: Seventeen adult patients who had undergone intramedullary nailing for radius diaphyseal fractures were retrospectively evaluated. Patients with isolated radius diaphyseal closed fractures were included. Closed reduction was achieved in all patients. Wrist and elbow ranges of movement were calculated at final follow-up. Grip strength was calculated using a hydraulic hand dynamometer. Maximum radial bowing (MRB) and maximum radial bowing localization (MRBL) were calculated for treated and uninjured arms. Functional evaluation was performed using Grace-Eversman evaluation criteria and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score.
RESULTS: Of the 17 patients with isolated radius diaphyseal fractures evaluated, 11 (64.7%) were male and 6 (35.3%) were female, with a mean age of 35.76 years (range: 23–61 years). Fractures were right-sided in 11 (64.7%) and left-sided in 6 (35.3%) patients. Mean time to bone union was 10.2 weeks (range: 8–20 weeks). Mean supination was 75.35º (range: 67º–80º), pronation was 85.18º (range: 74º–90º). According to Grace-Eversman evaluation criteria, results were excellent in 16 (94%) and good in 1 (6%) patient. Mean DASH score was 12.58 (3.3–32.5).
CONCLUSION: The gold-standard treatment of adult isolated radius diaphyseal fractures is plate and screw osteosynthesis. However, intramedullary nailing of isolated radius fractures is a good alternative treatment method, with excellent functional results and union rates similar to those of plate and screw osteosynthesis.

Ýleri veya metastatik kanser hastalarýnýn beslenme, metabolizma ve baðýþýklýk durumlarý risk altýndadýr. Buna raðmen kanser hastalarýnda gastroduodenal perforasyon hakkýnda az miktarda bilgi mevcuttur. Bu yazýda, 41 yaþýndaki evre IV yinelenen larenks kanseri olup homeopatik antikanser tedavisi gören ve cerrahi onarým gerektiren üç adet peptik perforasyonu olan bir kadýn hastayý sunmaktayýz. Üçlü gastrik peptik ülser perforasyonu nadir görülen olaðandýþý bir komplikasyondur. Hastalarýn kendi kendilerine etkinlik ve toksisitesine iliþkin kanýtlara dayalý veriler olmayan homeopatik kanser ilaçlarýný kullanmaktan kuvvetle vazgeçirmek gerekir.

Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Nevertheless, little is known about gastroduodenal perforation in cancer patients. Described in the present report is the case of a 41-year old woman with stage IV recurrent laryngeal cancer, who used homeopathic anticancer therapy and who had triple peptic ulcer perforation (PUP) that required surgical repair. Triple gastric PUP is a rare complication. Self-administration of homeopathic anticancer medication should be strongly discouraged when evidence-based data regarding efficacy and toxicity is lacking.

Hýzlý masif kanamanýn erken yönetimi, kan ürünlerinin erken verilmesi ve hýzlý cerrahi kontrolün saðlanmasýný gerektirir. Periferik hastaneler kaynak kýsýtlýlýðý nedeniyle askeri koþullara benzer. Kan ürünleri bulunmayan periferik bir hastanede masif kanamayla nedeniyle sýcak taze tam kan (TTK) verdiðimiz üç olgu sunuldu. Olgu1: On altý yaþýnda kadýn hasta acil sezaryana alýndý. Uterus atonisi nedeniyle masif kanamasý olan hastanýn Hb deðeri 3.5g/dl’ye kadar düþtü. Cerrahi süresince altý ünite sýcak TTK transfüzyonu yapýldýktan sonra, hemodinamik parametreleri ve tam kan sayýmý normal düzeye geldi. Ýki gün yoðun bakýmda takibi yapýlan hasta, yedinci gün taburcu edildi. Olgu 2: Otuz beþ yaþýnda kadýn hasta acil sezaryana alýndý. Uterus atonisi nedeniyle masif kanayan hastanýn Hb’i 2g/dl, Htc’i %5.4’e kadar düþtü. Dokuz ünite sýcak taze tam kan verilen hastanýn hemodinamik ve laboratuvar deðerleri normal düzeye geldi. Ertesi gün ekstübe edilip üçüncü gün yoðun bakýmdan servise çýkarýlan hasta sekizinci günde taburcu edildi. Olgu 3: Otuz altý yaþýnda erkek hasta býçak yaralanmasý sonrasý hemorajik þokta acil cerrahiye alýndý. Hastada sað renal arter ve böbrek yaralanmasý vardý. Cerrahi süresince kanamaya devam eden hastaya dokuz ünite sýcak TTK verildi. Cerrahi kontrol saðlanan ve kan transfüzyonu yapýlan hastanýn hemodinamik parametreleri düzeldi. Beþinci gününde yoðun bakýmdan çýkarýlan hasta 10. günde taburcu edildi. Kan bileþenlerine ayrýlabildiðinden beri sivil týpta TTK kullanýmý neredeyse yoktur. Ayrýca, kan bankalarýnda tam kan rutin mevcut deðildir. Bu nedenle tam kan kullanýmý sivil týpta azalmýþtýr. Sýcak TTK masif transfüzyonda, kýrmýzý kan hücrelerini, trombositleri, plazma volümünü, koagülasyon faktörlerini etkili bir þekilde yerine koyarken ayný zamanda hipotermiyi ve dilüsyonel koagülopatiyi önler. Kan ürünleri, uzun depolanma süresince biyokimyasal, biyomekanik ve immünolojik deðiþikliklere uðrar. Depolama süresi transfüzyon etkinliðini ve transfüzyonla iliþkili riskleri etkiler. Gelecekte hýzlý ABO uyumluluðu testleri, trombosit koruyucu lökosit filtreleri ve patojenleri azaltan yeni teknolojilerin kullanýmý ile TTK massif transfüzyonda ilk seçim olabilir. Yeni çalýþmalar gelecekte yeni prosedürler ortaya çýkaracaktýr.

Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section. The patient had massive bleeding from the uterus due to atony. Her hemoglobin (Hb) dropped to 3.5 g/dL. Six units of WFWB were transfused during surgery. Hemodynamic parameters and complete blood count (CBC) stabilized. She was transferred from the intensive care unit (ICU) to obstetrics on day 2 and was discharged on day 7. Described second is the case of a 35-year-old female patient who also underwent emergency cesarean section, and for whom massive bleeding was due to uterine atony. Hb dropped to 2 g/dL and hematocrit (HCT) to 5.4%. Nine units of WFWB were transfused, after which hemodynamic and laboratory parameters stabilized. The patient was extubated the following day, transferred from the ICU to obstetrics on day 3, and was discharged on day 8. Described third is the case of a 36-year-old male patient with stab injuries and hemorrhagic shock who underwent emergency surgery. The patient had injuries to the right renal artery and kidney. Nine units of WFWB were transfused due to continued hemorrhage during surgery. Following surgical control of bleeding and transfusion, hemodynamic parameters improved. The patient was transferred from the ICU on day 5 and discharged on day 10. WFWB transfusion nearly disappeared from civilian medicine after blood was separated into components, and whole blood is not usually available at blood banks. In massive transfusions, WFWB effectively replaces red blood cells (RBCs), platelets, plasma volume, and coagulation factors, while preventing hypothermia and dilutional coagulopathy. Blood components go through biochemical, biomechanical, and immunological changes during long storage, the duration of which affects both transfusion efficacy and associated risks. In the future, with the use of fast donor tests, fast ABO compatibility tests, platelet-sparing leukocyte filters, and developments in pathogen-decreasing technology, fresh whole blood (FWB) may be the first choice for massive transfusion. Future studies will reveal new procedures.

Karotit kavernöz fistüller karotis arter ve kavernöz sinüs arasýndaki anormal baðlantýlardýr. Künt ve penetran kafa yaralanmalarý karotikokavernöz fistül ile sonuçlanabilir. Her ne kadar nadir olarak ortaya çýksa da tanýsý acil serviste konabilir. Bu yazýda, 35 gün önce yüzüne ateþli silah yaralanmasýndan sonra sað gözünde kýzarýklýk, aðrý, görmede bulanýklýk, görme kaybý ve yüzün üst yarýsýnda þiþme þikayeti ile acil servise baþvuran 26 yaþýndaki hasta sunuldu.

Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus (CS), and can occur as a result of blunt and penetrating head injuries. While occurrence is rare, diagnosis can be made in the emergency department. Described in the present report is the case of a 26-year-old man who presented with complaints of pain, redness, blurred and loss of vision in the right eye, and swelling of the upper face due to a gunshot injury he had sustained 35 days prior.

Üst ekstremite arter yaralanmalarý, yaygýn görülen ve ciddi bir durumdur ve eðer doðru tedavi edilmezse ekstremiteyi amputasyona kadar götürebilir. Radial ya da ulnar arterin baðlanmasý, vasküler cerahlar tarafýndan sýkça uygulanan bir tedavi metotudur. Eðer radial ve ulnar arterler her ikisi birden yaralanmýþsa, bundan özellikle kaçýnmak gerekir. Bu olguda, birlikte yaralanmýþ radial ve ulnar arterin tamirine yönelik farklý bir yaklaþým sunuldu.

Upper-extremity arterial injury is a common and serious condition that may lead to amputation if improperly treated. Ligation of the ulnar or radial artery is frequently performed by vascular surgeons as a method of treatment, which should be avoided, particularly if the radial and ulnar arteries were both injured. A different approach to reconstruction is described in the present report.