AMAÇ: Staz zonunun kurtarýlmasýný amaçlayan çalýþmalar deneysel yanýk çalýþmalarýnýn önemli bir bölümünü oluþturmaktadýr. Staz zonunun kurtarýlmasýnda deneysel olarak antitrombotik, antienflamatuvar, antikoagülan gibi birçok ilaç araþtýrýlmýþtýr. Bu çalýþmanýn amacý sistemik melatoninin staz zonuna etkisini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmada 20 adet eriþkin Wistar Albino sýçan kullanýldý. Randomize seçilen sýçanlar iki gruba ayrýldý (n=10). Sýçanlarýn sýrtlarý týraþlandýktan sonra 1x2 cm ebadýnda kaynar suda ýsýtýlmýþ metal plak 20 sn bekletilerek yanýk oluþturuldu. Kontrol grubuna tedavi verilmedi. Tedavi grubuna yedi gün süreyle 10 mg/kg/gün dozunda intraperitoneal melatonin enjeksiyonu yapýldý. Her iki grubun günlük dijital fotoðraflarý çekildi. Total nekrotik yanýk alanlarý ve staz zonu Auto CAD ve görüntü analizi programlarýyla deðerlendirildi. Bir hafta sonunda sýçanlar sakrifiye edilerek histolojik inceleme için cilt biyopsisi alýndý. Ödem, konjesyon, enflamatuvar infiltrasyon, vasküler proliferasyon ve fibrozis deðerlendirilen parametrelerdi. Elde edilen veriler ki-kare ve student t-testleri ile deðerlendirildi.
BULGULAR: Experimental gruba ait histopatolojik veriler ile total nekrotik yanýk alanlarý ve staz zonu ölçümlerine ait sayýsal veriler kontrol grubu ile karþýlaþtýrýldýðýnda melatoninin staz zonuna etkinliðini kanýtlayacak þekilde istatistiksel olarak anlamlýydý (p<0.05).
TARTIÞMA: Bu çalýþmanýn sonucuna göre yanýkta staz zonunun kurtarýlmasýnda melatonin etkilidir.

BACKGROUND: Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Many drugs including antithrombotics, anticoagulants, anti-inflammatories have been investigated experimentally for saving the zone of stasis. In this study, the effect of the systemic melatonin on the zone of stasis was evaluated.
METHODS: Twenty Wistar Albino rats were used in the study. Rats were assigned to two groups (n=10). The metal comb 1x2 cm in size was immersed in boiling water and held for 20 seconds on the back of the rats to create burn wounds.No treatment was given to the control group. Melatonin was given at a dose of 10 mg/kg/d by intraperitoneal injection in the treatment group for 7 days. Daily digital photographs of both groups were obtained. Total necrotic burn areas and the zone of stasis were assessed with Auto CAD and Visual Analyzing computer programs. At the end of one week, rats were sacrificed and skin biopsies were taken for histological examination. Edema, congestion, inflammatory infiltration, vascular proliferation and fibrosis were the parameters evaluated. Data were evaluated statistically by Chi-square test and Student-t test.
RESULTS: When histopatologic data and the measured values for total necrotic areas and zone of stasis of the experimental group werecompared to control group, the results were statistically significant (p<0.05).
CONCLUSION: According to the results of this study, melatonin is efficient in saving the zone of stasis in burns.

AMAÇ: Serebral iskemi son derece önemli ve ciddi bir mortalite ve morbidite sebebidir. Serebral dokuyu iskemik zedelenmenin oluþturacaðý hasardan korumak için seçilecek yöntem son derece önemlidir. Bu çalýþmada kullanýlan medikal ve cerrahi tedavi yöntemleri deneysel fare serebral iskemi modeli ile karþýlaþtýrýldý, tek baþýna veya kombine uygulamalarýnda etki düzeyleri araþtýrýldý.
GEREÇ VE YÖNTEM: Eriþkin erkek Sprague-Dawley sýçanlar (n=30) altý gruba ayrýldý, sað kommon karotis arter oklüzyonu ile serebral enfarkt oluþturuldu. Bir gruba iskemiden 12 saat sonra Dekompressif kraniectomi (DC) uygulandý. Diðer bir gruba ise iskemi sonrasý 1, 12 va 24. saatlerde medikal tedavi verildi. Kontrol grubuna serum fizyolojik verilirken, bir gruba %3 hipertonik saline, diðer bir gruba %20 mannitol tedavisi. Sadece kraniyektom yapýlanlar dekompressif kraniektomi grubu (DC), DC+HS grubu ise DC ve hipertonik salin verilenlerden oluþtu. DC+MAN ise DC ve mannitol beraber verilen grubu olurturdu. Sýçanlar 24. saatin sonunda dekapite edildi, beyinleri alýnarak patolojik olarak incelendi ve iskemi sahalarý hesaplanarak tedaviye yanýtlarý deðerlendirildi.
BULGULAR: Kontrol grubunda ortalama enfarkt alaný %27.9, HS grubunda %13.7, MAN grubunda %15.1, DC grubunda %10.6, DC+HS grubunda %8.1, ve DC%+MAN %9.7. Ortalama enfarkt alanlarý hemen tüm gruplarda kontrol grubuna gore düþük görüldü, HS ve MAN gruplarý arasýnda fark bulunamadý, DC grubunda bu iki gruba göre daha iyi sonuç elde edildi fakat en iyi sonuçlar DC+MAN grubunda tespit edildi.
TARTIÞMA: Serebral iskemik enfarkt tedavisinde hem medikal hem cerrahi etkili yöntemlerdir. Medikal tedavi yöntemleri arasýnda fark bulunamadý, halbuki cerrahi tedavi grubunda, medikal tedavi grubuna göre daha iyi sonuç elde edildi. Kombine tedavide diðerlerine göre en iyi sonuç alýndý. Bu sonuçlar iskemik beyin zedelenmesinde en iy sonucun cerrahi ve medikal tedavi kombinasyonu olduðunu göstermektedir.

BACKGROUND: Cerebral ischemia is a cause of serious morbidity and mortality. Strategies that would protect cerebral tissue against ischemic injury are important. The present study aimed to evaluate effects of surgical and medical treatments, either alone or in combination, on infarction area in an experimental rat model of cerebral ischemia.
METHODS: Adult male Sprague-Dawley rats (n=30) were divided into 6 groups, each including 5 experimental animals. Cerebral ischemia was created by right common carotid artery occlusion (CCAO) under anesthesia. Decompressive craniectomy (DC) was performed in the relevant groups at the 12th hour following CCAO, whereas medical treatments were performed in the relevant groups at the 1st, 12th, and 24th hours following CCAO. After CCAO, the control group received 1 mL/kg physiological saline, hypertonic saline (HS) group received 3% hypertonic saline (1 mL/kg), and mannitol (MAN) group received 20% mannitol (1 g/kg). While only DC was performed following CCAO in the DC group, DC+HS group underwent DC together with hypertonic saline treatment and DC+MAN group underwent DC together with mannitol treatment. The rats were decapitated at the end of the 24th hour following ischemia. Cerebral sections were stained with 2% 2,3,5-triphenyltetrazolium chloride (TTC). The ratio of infarction area to the total area of section was calculated as percentage.
RESULTS: Mean infarction areas were 27.9% in the control group, 13.7% in the HS group, 15.1% in the MAN group, 10.6% in the DC group, 8.1% in the DC+HS group, and 9.7% in the DC+MAN group. Mean infarction areas were significantly lower in all groups than in the control group. While the mean infarction area did not differ between the HS and MAN groups, it was lower in the groups undergoing DC as compared to these two groups. The best outcome was observed in the DC+HS group.
CONCLUSION: Both medical and surgical treatments were effective in decreasing cerebral ischemic infarction. There was no difference between medical treatments groups in terms of efficacy, whereas DC led to a substantial decrease in ischemic infarction volume as compared with the medical treatment groups. Combined treatment approaches performed to decrease infarction volume also resulted in favorable outcomes.

AMAÇ: Yaþamsal bulgulara (YB) dayalý hemodinamik stabilitenin (HS) künt dalak travmasýnýn (KDT) baþarýlý cerrahi dýþý tedavisinde (CDT) en yararlý kriter olduðu düþünülürdü. Ancak HS’nin tutarlý bir tanýmý tespit edilememiþtir. Ulusal çapta bir taramayla HS tanýmýný deðerlendirmeyi ve bu farklýlýðý yaratan faktörleri saptamayý istedik.
GEREÇ VE YÖNTEM: Ekim 2012 ile Kasým 2012 arasýnda birinci seviyede bir travma merkezinin travma ve acil cerrahi bölümüne HS tanýmýný içeren bir anket gönderildi. Variyans analizi, t-testi, χ2 testi ve lojistik regresyon analiziyle veriler karþýlaþtýrýldý.
BULGULAR: 563 doktorun 507’si (%90) yanýt vermiþti. Kýrk sekizinin yanýtlarý eksikti ve 459 (%81.5) yanýt incelendi. Kan basýncý (KB), hipotansiyonun kestirim deðeri, KB’yi ölçüm tekniði, hipotansiyonun süresi, HS’nin belirleyicisi olarak kalp hýzýnýn (KH) kullanýlýp kullanýlmadýðý, hastada komorbidite varlýðýna veya çocuk hasta olduðuna göre HS tanýmlarýnda anlamlý farklýlýk mevcuttu. Doktorlarýn %91.5’i HS’yi tanýmlamada kafalarýnýn karýþýk olduðu ve daha somut belirleyicilere gerek duyduklarý yanýtýný verdi. Her halde yanýt verenlerin %90’ý HS’yi tanýmlamak için laboratuvar testlerinden yararlanmamaktaydý.
TARTIÞMA: Birçok travmatoloji uzmaný HS’yi tanýmlamak için yalnýzca YB’yi kullanmaktadýr. Ýþte bu nedenle hangi hastanýn hemodinamik açýdan stabil olduðunu tanýmlamada karmaþa yaþanmaktadýr. Baz eksikliði veya laktat tayini gibi daha somut belirleyiciler daha yararlý ek bilgiler saðlayabilir.

BACKGROUND: Hemodynamic stability (HS) based on vital sign (VS) is thought to be the most useful criteria for successful nonoperative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of HS has not been established. We wanted to evaluate the definition of HS through conducting a nationwide survey and find the factors affectting diversity.
METHODS: The questionnaire regarding the definition of HS was sent to the department of trauma surgery and emergency medicine of level I trauma center between October 2012 and November 2012. Data was compared using analysis of variance, t-test, χ2 test and logistic regression.
RESULTS: Among five hundred and sixty-three doctors, 507 responded (90%). Forty-eight responses were incomplete, and hence, 459 (81.5%) responses were analyzed. There was a significant diversity in the definition of HS on the subject of type of blood pressure (BP), cut off value of hypotension, measuring technique of BP, duration of hypotension, whether or not using heart rate (HR) as a determinant of HS, cut off value of hypotension when the patient has comorbidity or when the patient is a pediatric patient. 91.5% replied that they were confused defining HS and felt the need to have more objective determinants. Nevertheless, 90% of the responders were not using laboratory test to define HS.
CONCLUSION: Many trauma doctors are using only VS to define HS. This is why there is a confusion regarding how to define which patient is hemodynamically stable. More objective determinants such as base deficit or lactate can be useful adjuncts.

AMAÇ: Akut apandisit (AA) en yaygýn görülen cerrahi acillerden birisidir ve apendiks perfore olduðunda ameliyat sonrasý morbidite ve mortalite artar. Apendiks perforasyonuna yol açan faktörlerin belirlenmesi morbiditeyi azaltmada etkili olabilir. Biz akut apandisitte perforasyonla iliþkili faktörleri inceledik.
GEREÇ VE YÖNTEM: Bu çalýþmada 60 hasta ele alýndý ve hastalar eþit sayýda iki gruba ayrýldý: Non-perfore ve perfore grup. Biz, ameliyat öncesi dönemde hastalarýn vücut kitle indeksini (VKÝ) ve baþvuru öncesi gecikme zamanýný, ameliyat esnasýnda apendiks pozisyonunu, apse veya sývý varlýðý ile cerrahi spesmende apendiksin duvar kalýnlýðýný, kök ve uç çapý ile uzunluðunu karþýlaþtýrdýk.
BULGULAR: Hastalarýn 40’ý erkek, 20’si kadýn olup ortanca yaþ 27 idi (min-maks: 16–84). Vücut kitle indeksi perfore grupta non-perfore gruptan belirgin þekilde yüksekti (p=0.039). Sývý varlýðý açýsýndan gruplar arasýnda fark yok iken, apse varlýðý perfore grupta daha yüksekti (p=0.017). Perfore grupta, apendiksin en yaygýn görüldüðü pozisyon retroçekaldi (p=0.007). Apendiks uç çapýna göre gruplar arasýnda fark yokken, kök çapý, duvar kalýnlýðý ve apendiks uzunluðu perfore grupta belirgin olarak daha yüksekti (sýrasýyla p=0.041, p<0.001 ve p=0.037).
TARTIÞMA: Vücut kitle indeksi, baþvuru öncesi gecikme zamaný, retroçekal yerleþimli apendiks, apse varlýðý ile duvar kalýnlýðý, kök çapý ve apendiks uzunluðu akut apandisitte perforasyonu etkileyen risk faktörleridir.

BACKGROUND: Acute appendicitis (AA) is one of the most common surgical emergencies, whosepostoperative morbidity and mortality increase significantly when the appendix perforates. The identification of factors that lead to perforation in these patients might effectively reduce morbidity. In this study, factors associated with perforation in AA were examined.
METHODS: The study included sixty patients divided into equal non-perforated and perforated groups. Preoperative body mass index (BMI) and prehospital delay of the patients, the appendix location, presence of fluid or abscesses during surgery, and the appendix wall thickness, root and end diameters, and length in the surgery specimen were compared.
RESULTS: The patients were comprised of forty males and 20 females, with a median age of 27 (range 16–84) years. BMI was significantly higher in the perforated group than the non-perforated group (p=0.039). There was no difference between the groups in terms of the presence of fluid (p=0.792); the presence of abscess was higher in the perforated group (p=0.017). The most common location of the appendix was retrocecal in the perforated group (p=0.007). While there was no difference in the appendix end diameter, root diameter was significantly higher in the perforated group (p=0.041), as were wall thickness (p<0.001) and appendix length (p=0.037).
CONCLUSION: BMI, prehospital delay, a retrocecally positioned appendix, presence of an abscess, and appendix wall thickness, root diameter, and length are risk factors for perforation in AA.

AMAÇ: Laparoskopik apendektomi sýrasýnda apendiks güdüðünü kapatmak için intrakorporal düðüm, endoloop, stapler ve klips gibi çeþitli yöntemler kullanýlmaktadýr. Bu çalýþmada laparoskopik apendektomide apendiks güdüðünü kapatmak için kullanýlan intrakorporal düðüm ve endoloop yöntemlerinin karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Bu çalýþmaya Adana Numune Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’nde Haziran 2009 ile Temmuz 2013 tarihleri arasýnda akut apandisit ön tanýsý ile laparoskopik apendektomi yapýlan hastalar dahil edildi. Hastalarýn demografik özellikleri, apendiks güdüðünü kapatma tekniði, ameliyat süresi, komplikasyon ve yatýþ süreleri olarak karþýlaþtýrýldý.
BULGULAR: Seksen biri kadýn, 45’i erkek olmak üzere toplam 126 hastaya laparoskopik apendektomi yapýldý. Altmýþ beþ hastada apendiks güdüðünü kapamak amacýyla intrakorporal düðüm (Grup 1), 61 hastada ise endoloop (Grup 2) kullanýldý. Grup 1’deki hastalarýn ameliyat süresi Grup 2’ye göre daha uzun idi (62.0±10.67 dk, 56.80±11.94 dk, p=0.01). Gruplar arasý hastanede kalýþ süreleri arasýnda fark saptanmadý. Her iki grupta dörder hastada yüzeysel cerrahi alan enfeksiyonu görüldü.
TARTIÞMA: Bu çalýþmada intrakorporal düðüm tekniðinde ameliyat süresinin endoloop tekniðine göre daha uzun olduðu, ancak hastanede yatýþ süresi ve komplikasyon açýsýndan birbirinden anlamlý bir fark bulunmadýðý tespit edilmiþtir. Ýntrakorporal düðüm tekniðinin endolooptan daha ucuz olduðu ve ileri laparoskopik cerrahiye baþlayacak olan cerrahlar için el manüpülasyonunu geliþtirdiðinden dolayý tercih edilmesini önermekteyiz.

BACKGROUND: Several appendiceal stump closure tecniques such as intracorporoeal-knotting, endoloop, stapler and clips are used during laparoscopic appendectomy. This study aimed to compare intracorporoeal-knotting and endoloop tecniques used to close appendiceal stump in laparoscopic appendectomy.
METHODS: This study included patients who underwent laparoscopic appendectomy with preliminary diagnosis of acute appendicitis in General Surgery Department of Adana Numune Training and Research Hospital between June 2009 and July 2013. The demographics, appendiceal stump closure tecniques, operation time, complications, and length of hospital stays of the patients were compared.
RESULTS: A total of one hundred and twenty-six patients underwent laparoscopic appendectomy (Female: 81, Male: 45). Intracorporeal- knotting (Group 1) was performed in sixty-five patients; whereas, endoloop (Group 2) was performed in sixty-one patients in order to close appendiceal stump. The operation time was longer in Group 1 compared to Group 2 (62.0±10.67 min., 56.80±11.94 min., p=0.01). The length of hospital stays were nonsignificant between the groups. Four patients were complicated by superficial surgical site infection in both groups.
CONCLUSION: In the present study, the operation time was found to be longer for intracorporeal knotting tecnique compared to endoloop tecnique; however, there was no significant difference regarding the length of hospital stay and complications. Performing intracorporeal-knotting technique is suggested since it is cheaper than endoloops and it may also improve hand manipulations of the surgeons who intend to advanced laparoscopy.

AMAÇ: Kafa travmasý beyin omurilik sývýsý (BOS) fistülü ile önemli bir iliþki gösterir.
GEREÇ VE YÖNTEM: Bu çalýþmada travmaya baðlý geliþen otore, rinore ve oküloresi bulunan 22 hastanýnýn cerrahi yaklaþýmý sunuldu. Hastalarýn büyük çoðunluðu Glaskow Koma Skalasý (GKS) 14 puanýn altýnda olan þiddetli kafa travmalý hastalardýr. Bu hastalarýn 11’inde depresyon fraktürü, altýsýnda epidural hematom ve dördünde ise basýnçlý pnemosefalus eþlik etmekteydi.
BULGULAR: Rinore, en sýk görülen semptom olup 15 hastada, otore yedi hastada ve okülore iki hastada saptandý. Rinoresi olan iki hastada ayrýca otore ve okülore de mevcuttu. On iki hasta tek taraflý yaklaþýmla, 10 hasta ise bifrontal yaklaþýmla opere edildi.
TARTIÞMA: Beyin omurilik sývýsý kaçaðý ile prezente olan travma olgularýnda, konservatif tedavinin aksine yapýlan erken cerrahi giriþimler BOS kaçaðýna baðlý geliþebilecek komplikasyonlarýn engellenmesinde son derece etkili bir yöntemdir.

BACKGROUND: Head trauma is associated with a significant risk of cerebrospinal fluid (CSF) fistula.
METHODS: In this study, it was aimed to report twenty-two cases subjected to operative intervention for otorrhea, rhinorrhea and oculorrhea with associated traumatic lesions. Majority of the cases had moderate to severe head trauma with a Glascow Coma Scale (GCS) score under 14. The study group included eleven cases with depression fractures, 6 with epidural hematomas and 4 with tension pneumocephalus.
RESULTS: Rhinorrhea was the most common presenting symptom encountered in fifteen cases; whereas, otorrhea was prominent in 7 and oculorrhea in 2 cases. Two patients having rhinorrhea also had oculorrhea and otorrhea. The patients were operated with unilateral approaches in twelve and bifrontal approaches in ten of the cases.
CONCLUSION: Early surgical intervention should be performed in cases presenting with CSF fistula and associated traumatic lesions without considering conservative management to provide an effective control of associated complications due to CSF fistulas.

AMAÇ: Açýk karýn; ciddi abdominal travmalar sonrasý ortaya çýkabilecek katastrofilerden kaçýnýlmasý amacýyla uygulanan bir koruyucu prosedürdür. Fakat, açýk karýn olgularýnda yaralanma sonrasý abdominal iyileþme saðlansa bile erken dönemde defekt alanýnýn kapatýlmasý çok kolay olmamaktadýr. Bu nedenle açýk karýn olgularýnýn tedavisinde aþamalý onarým ihtiyacý bulunurken, birinci aþama geçici kapamadýr. Bu aþamanýn sonrasýnda ortaya çýkan dev boyutlu ventral herni ise hem cerrah hem de hasta açýsýndan büyük sýkýntý oluþturmaktadýr. Oluþan bu tablo nedeniyle kalýcý bir onarým kaçýnýlmazdýr. Her ne kadar bu amaçla birçok farklý tedavi yaklaþýmlarý tanýmlanmýþ olsa da ateþli silah yaralanmasý gibi yüksek enerjili travmalar nihai sonucu etkileyebilen, tedavi seçeneklerini kýsýtlayan karmaþýk tablolarýn oluþumuna neden olabilir. Bu çalýþmada abdominal duvar defekti bulunan komplike olgularýn onarýmýnda uyguladýðýmýz aþamalý tedavi yaklaþýmý sunuldu.
GEREÇ VE YÖNTEM: Ateþli silah yaralanmasýna baðlý açýk karýn bulunan dokuz erkek hastada aþamalý tedavi uygulandý. Bütün hastalarda geçici kapatma direkt visera üzerine yerleþtirilen negatif basýnçlý yara bakým uygulamasý ve sonrasýnda gerçekleþtirilen cilt grefti yardýmýyla saðlandý. Geç dönemdeki kalýcý onarým ise ekspanse edilen abdominal duvarýn laminasyonu ve iki taraflý yama sayesinde gerçekleþtirildi.
BULGULAR: Hastalarýn takip süreleri 24 ay ile 4.5 yýl arasýnda (ortalama üç yýl) deðiþmekteydi. Bu periyot dahilinde hiçbir hastada ventral hernide nüks, enterik fistül, abdominal enfeksiyon ve seroma oluþumu gözlenmedi.
TARTIÞMA: Bu çalýþmada yüksek enerjili ateþli silah yaralanmalarýna baðlý açýk karýn olgularýnýn tedavisinde negatif basýnçlý yara terapisi, doku geniþletici ve çift taraflý yama uygulamalarý aþamalý olarak kullanýlmýþtýr. Sonuçlar hastalar açýsýndan son derece memnuniyet verici olup estetik sonuçlar ise kabul edilebilir düzeydedir.

BACKGROUND: Open abdomen is a salvage procedure that prevents catastrophes after severe intraabdominal traumas. However, following this life saving attempt, it is mostly not feasible to close the abdomen immediately after the recovery of intraabdominal injuries. Consequently, a staged reconstruction is required, and the first stage is usually a temporary closing approach. At the end of this stage, resulting giant “ventral hernia” is a burden for both the patient and the surgeon. Therefore a permanent repair is subsequently needed. Although there are many treatment modalities described for this goal, etiologies like high-energy gunshots may cause an exactly nuisance scene which can limit treatment options and reduce final success. Herein, it was the objective of this study to present our staged protocol to restore the abdominal wall defect and strategy for optimizing the results in such conundrum cases.
METHODS: Treatment was performed on nine male patients suffering from severe open abdomen due to high-energy gunshot injury. In all patients, temporary closure was provided by negative pressure wound treatment applied directly to the viscera and followed by skin grafting. Late permanent closure was performed with the lamination of expanded abdominal skin and dual-sided meshes.
RESULTS: The follow-up period ranged between 24 months to 4.5 years (mean, 3 years). During this period, no recurrence of ventral hernia, enteric fistula formation, abdominal infection and seroma formation was observed in any patient.
CONCLUSION: In this study, NPWT, tissue expansion and dual-sided mesh were used together as a staged procedure for optimizing the results in the clinical scenario of an open abdomen due to high-energy gunshot wound. Results were highly satisfactory for patients and acceptable aesthetically.

AMAÇ: Bu çalýþmanýn amacý, otopsiler sýrasýnda görülen resüsitasyon komplikasyonlarýn belirlenmesi ve temel yaþam desteði eðitimi etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Muðla Adli Týp Þube Müdürlüðü’nde gerçekleþtirilen otopsi olgu raporlarý geriye dönük olarak incelendi. Resüsitasyon komplikasyonlarý olan hastalarýn yaþ, cinsiyet, ölüm þekli ve çeþitleri gibi demografik verileri ve komplikasyonlarýn özellikleri kaydedildi.
BULGULAR: Toplam, resüsitasyon komplikasyonlara 100 olgunun 74’ü erkektir. Bu olgularýn çoðunda otopsileri yaz sezonunda yapýldý. Hastalar arasýnda %68 travmatik olmayan nedenlerle öldü. Kaburga kýrýklarý 71 hastada, sternum kýrýklarý 32 hastada tespit edilmiþtir. Ayrýca, perikart (%2) ve akciðer parankim (%4), kalp lezyonlarý (%4) ve karaciðer laserasyon (%2) hasarý tespit edildi. Kaburga kýrýklarý ile ilgili olarak, meydana gelen kýrýklar en yüksek sayýlarda dördüncü kaburga, her iki tarafta ilk ve sekizinci kaburga arasýnda bulundu.
TARTIÞMA: Resüsitasyon komplikasyonlarý önemli, çünkü bu komplikasyonlar otopside travmatik nedenlerle yapýlmýþ sanýlabilir. Travmatik olmayan nedenlerle yapýlan otopsi durumlarýnda görülen resüsitasyon komplikasyonlarý travmatik olaylar olarak algýlanabilir. Onlar, yanlýþ olarak travma belirtileri sanýlabilir. Bu komplikasyonlar saðlýk personelinin iyi resüsitasyon eðitimi ile azaltýlabilir.

BACKGROUND: The purpose of this study was to determine complications of resuscitation seen during autopsies and evaluate the effectiveness of basic life support training.
METHODS: Autopsy case reports conducted in The Forensic Branch Manager of Muðla were retrospectively examined. Demographic data of the patients with resuscitation complications such as age, gender, manner of death, and kinds and features of the complications were recorded.
RESULTS: In total, seventy-fourof the 100 cases with resuscitation complications were males. The autopsies in most of these cases were performed during the summer season. Among the patients, 68% died for non-traumatic reasons. Rib fractures were detected in seventy-one patients and sternum fractures in thirty-two patients. Moreover, damage to the pericardium (2%) and lung parenchymal (4%), heart lesions (4%), and liver lacerations (2%) were detected. Regarding rib fractures, fractures were found between the first and eighth ribs on both sides, with the highest numbers occurring in the fourth rib.
CONCLUSION: Resuscitation complications are important since they can be presumed to have carried out for traumatic reasons. Resuscitation complications seen in autopsy cases with non-traumatic causes can be perceived as traumatic events. They can be assumed incorrectly as trauma symptoms. These complications can be reduced with a good resuscitation training of the health personnel.

AMAÇ: Ýntertrokanterik kýrýklarýn tedavisinde kullanýlan üç farklý intramedüller çivileme yöntemiyle iliþkili sonuçlarýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Bu geriye dönük kohort calismasina A2 ve A3 tip stabil olmayan trokanterik kýrýk nedeniyle opere edilen hastalar dahil edildi. Kullanýlan tekniðe göre hastalar üç gruba ayrýldý: Talon distal sabit çivi/lag screw (n=78, ortalama yaþ: 78.5±6.6), PFNA çivi (n=96, ortalama yaþ: 77.2±6.8) ve ÝnterTan çivisi (n=102, ortalama yas: 76.8±6.7). Son kontrolde Harris kalça skoru kaydedildi, saðkalým telefon görüþmesi ve vatandaþlýk bilgi bankasý kayýtlarýndan elde edildi.
BULGULAR: Gruplarýn temel özellikleri benzerdi. ÝnterTan grubunda ameliyat süresi, floroskopi zamaný ve kan kaybý anlamlý olarak fazlaydý. PFNA grubunda sekiz hastada cut-out oluþtu. Hastane içi mortalite %3.2 idi (dokuz hasta). Hastanede yatýþ süresi ve ameliyat sonrasý tip-apex mesafesi gruplar arasýnda farklý deðildi. Ýyileþme süresi ve Harris kalça skoru gruplar arasýnda benzerdi. Bir yýllýk sað kalým Talon distal sabit çivi/lag screw grubunda %83.1±4.5, PFNA grubunda %84.0±3.8 ve ÝnterTan grubunda 84.4±3.7 bulundu (p=0.33).
TARTIÞMA: Talon distal sabit çivi/lag screw yöntemi daha az cut-out oranýyla PFNA tekniðinden ve daha kýsa ameliyat süresiyle InterTan yönteminden daha iyi olarak bulunmuþtur.

BACKGROUND: The aim of this study was toreport our experience regarding the use of three different methods for intramedullary nailing in the treatment of intertrochanteric fractures.
METHODS: Patients with A2 and A3 type fractures operated on for unstable trochanteric fractures were included into this retrospective cohort study. Patients were divided into three groups based on the technique used; Talon distal fix nail/lag screw (n=78; mean age, 78.5±6.6), PFNA nail (n=96; mean age, 77.2±6.8) or InterTan nails (n=102; mean age, 76.8±6.7). Harris hip scores were recorded at the last outpatient visit and survival information was obtained by phone interview and civil registry database.
RESULTS: Baseline characteristics were similar among groups. Operation time, fluoroscopy time and blood loss were significantly higher in InterTan group. Screw cut-out occurred in eight patients in PFNA group. In-hospital mortality occurred in nine (3.2%) patients. Length of hospital stay and postoperative tip-apex distance was not different among groups. At follow-up, healing time and Harris hip scores were also similar among groups. One-year survival rate was 83.1±4.5% in Talon distal fix nail/lag screw, 84.0±3.8% in PFNA group and 84.4±3.7% in InterTan group (p=0.33).
CONCLUSION: New Talon distal fix nail/lag screw was associated with lower cut-out rates than PFNA and shorter operative times than InterTan. Further study is warranted to clearly establish the potential advantages of Talon distal fix over any other technique described herein.

AMAÇ: Bu çalýþmada künt travmaya baðlý yaralanma nedeniyle kliniðimize yatýrarak tedavi ettiðimiz hastalarýn çok yönlü analizini ve mortaliteye etkili faktörleri belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2009 ile Ocak 2013 tarihleri arasýnda, künt travmaya baðlý yaralanma nedeniyle kliniðimize yatýrarak tedavi ettiðimiz 237 hasta geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, travmanýn þekli, yaralanma bölgeleri, Yaralanma Þiddet Skoru (ISS), Revize Edilmiþ Travma Skoru (RTS), FAST sonuçlarý, hemodinamik durum, transfüzyon gereksinimi, uygulanan tedavi yöntemi, tedavi sonuçlarý ve mortalite yönünden analiz edildi.
BULGULAR: Hastalarýn 187’si (%78.9) erkek, 50’si (%21.1) kadýn, yaþ ortalamasý 36.9±16.9 (3–81 yýl) idi. Hastalarýn 131’inde (%55.3) torakal, 110’unda (%46.4) abdominal, 96’sýnda (%40.5) pelvis ve ekstremite, 34’ünde (%14.3) baþ ve boyun, 26’sýnda (%11) maksillofasyal, 24’ünde (%10.1) ise cilt ve cilt altý yumuþak doku yaralanmasý mevcuttu. Hemodinamik instabilite nedeniyle 33, peritonit bulgularý nedeniyle 12 hasta olmak üzere toplam 45 (%19) hasta ameliyat edildi. Hastalarýn 26’sýnda (%11) mortalite görüldü ve bunlarýn 10’unda (%38.5) instabil pelvis kýrýðý bulunmaktaydý. Packing gereken hastalarda %75, packing gerekmeyenlerde %33.3; hemodinamisi instabil hastalarda %60.6, hemodinamisi stabil olanlarda %8.3 ve FAST (+) hastalarda %20.5, FAST (–) hastalarda %3.4 mortalite belirlendi (p<0.05). Hastalarýn tümünde ortalama ISS deðeri 18.4, RTS deðeri 7.30, transfüzyon gereksinimi 1.6 Ü. olarak hesaplanýrken; ölen hastalarda ise ayný sýrayla 44.6, 4.22 ve 7.8 Ü. olarak hesaplandý (p<0.05).
TARTIÞMA: Künt travmalar genellikle birden fazla anatomik bölgede yaralanmaya neden olmakta; torakal, abdominal ve pelvik bölge yaralanmalarý sýklýkla birbirine eþlik etmektedir. Abdominal solid organ yaralanmalarýnýn büyük kýsmý nonoperatif olarak takip ve tedavi edilebilmektedir. Çalýþma sonuçlarýmýz ISS, RTS, FAST sonucu, hemodinamik instabilite, packing ve transfüzyon gereksiniminin mortalite riskini belirlemede istatistiksel olarak deðerli olduðunu göstermektedir.

BACKGROUND: This study aimed to investigate the signs and prognosis of the patients hospitalized due to blunt trauma injuries and identify possible factors that affect mortality.
METHODS: Between January 2009 and January 2013, a total of 237 patients admitted with blunt trauma injury were retrospectively analyzed. The age and gender of the patients, type of the trauma, injury site, Injury Severity Scores (ISS), Revised Trauma Scores (RTS), Focused Assessment with Sonography in Trauma (FAST) results, hemodynamic status, need for transfusion, treatment modalities, treatment outcomes, and mortality rates were recorded.
RESULTS: Of the patients, 187 (78.9%) were male, 50 (21.1%) were female and mean age was 36.9±16.9 years (3–81 years). Of the patients, 131 (55.3%) suffered thoracic injuries, 110 (46.6%) abdominal injuries, 96 (40.5%) pelvic and limb injuries, 34 (14.3%) head and neck injuries, 26 (11%) maxillofacial injuries, and 24 (10.1%) skin and subcutaneous tissue injuries. Forty-five patients (19%), including 33 patients with hemodynamic instability and 12 patients with peritonitis-related signs, were operated on. Mortality was seen in 26 patients (11%), including 10 (38.5%) with unstable pelvic fractures. Mortality rates; in patients with packing performed was 75%, in patients without any need for packing was 33.3%, in patients with hemodynamic instablity was 60.6%, in hemodynamically stable patients was 8.3% and in FAST (+) patients was 20.5%, in FAST(–) patients was 3.4% (p<0.05).
CONCLUSION: Blunt trauma often presents with multi-trauma involving more than one anatomical structure of the body. Thoracic, abdominal, and pelvic injuries usually accompany blunt trauma. The majority of abdominal solid organ injuries are followed nonoperatively. Our study results show that ISS, RTS, FAST result, hemodynamic unstability, packing requirment, and need for transfusion are statistically invaluable in identifying the mortality risk.

AMAÇ: Sol torakoabdominal delici kesici yaralanmasý olan, tanýsal veya terapotik laparoskopi yapýlan hastalarda bilgisayarlý tomografinin (BT) diyafram yaralanmasýný saptamadaki etkinliðinin deðerlendirilmesi.
GEREÇ VE YÖNTEM: Nisan 2010 ile aralýk 2014 tarihleri arasýnda delici-kesici alet yaralanmasý ile baþvuran sol torakoabdominal yaralanmasý bulunan 108 olgu demografik verileri, býçaklanma bölgesi, ek travma bulgularýnýn varlýðý, hemodinamik parametreleri, baþvuru süresi, taný yöntemleri ve tedavi þekli açýsýndan geriye dönük olarak deðerlendirildi. Tüm hastalarýn ameliyat öncesi bilgisayarlý tomografi görüntüleri geriye dönük olarak cerrahi deðerlendirme sonuçlarý bilinmeden deðerlendirilmiþtir. Hemotoraks, pnömotoraks, batýnda serbest sývý ve solid organ yaralanmalarýnýn diyaframa yaralanmasý ile iliþkisi araþtýrýldý. Cerrahi giriþim öncesinde tüm olgular fizik muayene, hemogram takibi ve hemodinamik deðerlendirme ile takip edildi.
BULGULAR: Fizik muayene bulgusu olarak en sýk anterior sol torakoabdominal yaralanma saptandý. Lateral yaralanmasý olan 25 olgunun %36’sýnda cerrahi olarak yaralanma saptandý. Tüm olgularýn 25’inde (%23.1) diyafragma yaralanmasý saptandý ve olgulara laparaskopik tamir yapýldý. Tüm BT bulgularý cerrahi sonuçlarý ile birlikte deðerlendirildiðinde diyafragma yaralanmasýný göstermede sensitivite %80, spesifite %95, PPV %83, NPV %94 olarak hesaplanmýþtýr. Ortalama hastanede kalýþ süresi tüm olgularda 5.4 gün (1–16) olarak gözlendi.
TARTIÞMA: Bilgisayarlý tomografi ile penetran diyafragma yaralanmalarýný deðerlendirmede halen güçlükler mevcuttur. Buna raðmen bizim çalýþmamýzda BT yüksek spesifite ve negatif prediktif deðere sahiptir. Diyafragma defekti ve yaðlý doku herniasyonunun tespit edilmesi torakoabdominal yaralanmalarda kesin tanýyý koydurmaktadýr. Daha fazla sayýda hasta grubu ile ileriye yönelik çalýþma yapýlmasý, delici kesici alete baðlý torakoabdominal yaralanmasý olan hastalarda diyafram yaralanmasýnýn saptanmasýnda BT’nin rolünü belirlemede faydalý olacaktýr.

BACKGROUND: This study was designed to investigate the diagnostic efficacy of computed tomography (CT) for the detection diaphragmatic injury in cases undergoing diagnostic and therapeutic laparoscopy in left thoracoabdominal penetrating injuries.
METHODS: Demographic properties, stabbed body region, additional injuries, hemodynamic parameters, time to admission, diagnostic examinations, and type of treatment were retrospectively reviewed in one hundred and eight patients presenting with left thoracoabdominal injury after penetrating sharp object injury between April 2010 and December 2014. Preoperative CT scans of all patients were reviewed blind to the results of surgical evaluation. The relationship between diaphragmatic injury and hemothorax, pneumothorax, abdominal free fluid, and solid organ injuries were analyzed. All patients underwent physical examination, complete blood count monitoring, and hemodynamic assessment prior to surgery.
RESULTS: The most common finding on physical examination was anterior left thoracoabdominal injury. The injury was detected surgically in 36% of twenty-five cases with lateral injury. Diaphragmatic injury was present in twenty-five (23.1%) of all cases, all of whom were treated with laparoscopic repair. An analysis of all CT findings in relation to surgical results revealed that CT had a sensitivity of 80%, a specificity of 95%, a PPV of 83%, and a NPV of 94% for the detection of diaphragmatic injuries. Mean duration of hospital stay was 5.4 days (range, 1–16 days) in the entire study population.
CONCLUSION: CT is still associated with diagnostic challenges in penetrating diaphragmatic injuries. Nevertheless, CT showed a high specificity and a negative predictive value in our study. Detection of a diaphragmatic defect and fatty tissue herniation makes the definitive diagnosis of diaphragmatic injury in penetrating thoracoabdominal injuries. Prospective studies with a larger sample size are necessary to further clarify the role of CT in detection of diaphragmatic injuries in thoracoabdominal sharp penetrating object injuries.

AMAÇ: Yanýða baðlý yaralanmalar, yüksek morbidite ve mortaliteyle sonuçlanabilen önemli bir halk saðlýðý sorunudur. Yanýk hastalarýnda mortalite; yaþlýlýk, yanýk alaný yüzdesinin geniþ olmasý ve kronik hastalýklarýn birlikteliði ile iliþkilidir. Yapýlan çalýþmalar, yanýða baðlý ölüm olgularýnda premortem klinik teþhisler ile postmortem bulgularýn farklýlýk gösterdiðini ortaya çýkartmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþmada, 1 Ocak 1994 ile 30 Mayýs 2013 tarihleri arasýnda, Gülhane Askeri Týp Akademisi Adli Týp Anabilim Dalý’nda yapýlan ölü muayenesi ve otopsi raporlarý ile hasta dosyalarý geriye dönük olarak incelenerek, yanýða baðlý ölümlerde saptanan postmortem bulgular ile antemortem klinik bulgularýn karþýlaþtýrýlmasý amaçlanmýþtýr.
BULGULAR: Yaklaþýk 20 yýllýk bir süre zarfýnda, 450 olgunun 31’inin (%6.9) yanýða baðlý ölüm olduðu saptanmýþtýr. Yaralanmalarýn %90.3 oranýnda alev yanýðý sonucu meydana geldiði saptanmýþtýr. Olgularýn yanýk yüzdesi oraný ortalamasý %70.52 olup bu oran arttýkça yaþam süresinin istatistiksel olarak kýsaldýðý saptanmýþtýr (r=-0.491, p=0.005). Otopsi bulgularýna göre; antemortem olarak atlanan en sýk klinik tanýnýn pnömoni olduðu ve mortalitenin sistemik organ yetersizliklerine baðlý olduðu saptanmýþtýr.
TARTIÞMA: Yanýða baðlý ölümler asker popülasyonu açýsýndan önemli bir mortalite nedenidir. Otopsi ile ortaya konulan postmortem bulgularýn, yanýk hastalarýn tedavisini yürüten klinisyenlere önemli katkýlar saðlayacaðýný ve bu baðlamda disiplinlerarasý veri paylaþýmýnýn önemli olduðunu deðerlendirmekteyiz.

BACKGROUND: Burn injuries are an important public health problem resulting in high morbidity and mortality. Mortality in burn patients is associated with age, the extent of the burn surface, and the presence of concurrent chronic diseases. Studies have revealed differences between antemortem clinical diagnoses and postmortem findings in burn-related deaths.
METHODS: In the present study, postmortem examination reports and autopsy reports issued by the Department of Forensic Medicine in Gülhane Military Medical Academy between 1 January 1994 and 30 May 2013 were retrospectively reviewed together with patient charts in an attempt to compare postmortem findings and antemortem clinical findings in burn-related deaths.
RESULTS: In a period of approximately 20 years, thirty-one (6.9%) of the deaths among 450 cases were burn-related. Of the injuries, 90.3% were caused by flame burns. Mean burn percentage was 70.52%, and the survival of these cases was found to decrease significantly with increasing burn percentage (r=-0.491, p=0.005). According to autopsy findings, pneumonia was the most frequently overlooked antemortem clinical diagnosis, and mortality was associated with systemic organ failures.
CONCLUSION: Burn-related deaths are an important cause of mortality among soldiers. We believe that postmortem findings revealed by autopsies could significantly contribute to the treatment of burn cases, and that interdisciplinary data sharing would be important in this respect.

AMAÇ: Arka segment göz içi yabancý cisim (GÝYC) aðýrlýk ve boyut özelliklerinin açýk glob yaralanmalarýndaki etkilerini belirlemek.
GEREÇ VE YÖNTEM: Çalýþmaya arka segment GÝYC bulunan 58 hastanýn 58 gözü dahil edildi. Tüm GÝYC’ler pars plana vitrektomi ile çýkarýldý. Yaþ, cins, en iyi düzeltilmiþ görme keskinliði (EÝDGK), GÝYC niteliði, aðýrlýðý ve çaplarý, baþlangýçtaki göz bulgularý, GÝYC çýkarýlma zamaný, GÝYC giriþ alaný, yapýlan müdaheleler ve komplikasyonlarý içeren faktörler incelendi.
BULGULAR: Hastalarýn ortalama yaþý 32.7±14.2 yýl ve ortalama takip süresi 18±13.3 ay idi. Göz içi yabancý cisim aðýrlýk, boy, en ve kalýnlýklarý baþlangýç ve final EÝDGK seviyeleri ile negatif korele bulundu (p<0.05). Baþlangýçta hifema, vitreus hemorajisi, retina hemorajisi, retina dekolmaný ve üveal prolapsus bulunan olgulardaki GÝYC’ler önemli ölçüde daha aðýr bulundu (p<0.05). Hifema, vitreus hemorajisi, retina hemorajisi, retina dekolmaný ve üveal prolapsus bulunan olgulardaki GÝYC’ler önemli ölçüde daha enli ve kalýn bulundu (p<0.05). Hifemalý gözlerdeki GÝYC’ler anlamlý olarak daha uzun bulundu (p<0.05). Baþlangýçta veya daha sonra retina dekolmanýnýn olmasý düþük final görme ile ilþkili bulundu (p<0.05). Göz içi yabancý cisim çýkarýlma zamaný ile endoftalmi insidansý arasýnda iliþki yoktu.
TARTIÞMA: Daha aðýr ve büyük arka segment GÝYC’leri ile birlikte olan açýk glob yaralanmalarý daha kötü sonuçlara iliþkilidir. Ýþ kazalarýndan korunmak için koruyucu gözlük kullanýmý kritik bir öneme sahiptir. Bizim çalýþmamýzda GÝYC’nin erken veya geç çýkarýlmasýnýn anatomik ve görsel sonuçlar üzerine önemli bir etkisi saptanmamýþtýr. Bu nedenle uygun koþullar elde edilene kadar vitrektomi ertelenebilir.

BACKGROUND: The objective of this study was to identify the effects of weight and size characteristics of posterior segment intraocular foreign bodies (IOFBs) in open globe injuries.
METHODS: Fifty-eight eyes of 58 patients with posterior segment IOFBs were enrolled in the study. All IOFBs were removed by pars plana vitrectomy. Factors including age, gender, best corrected visual acuity (BCVA), nature of IOFBs, weight and dimensions of IOFBs, initial ocular features, timing of IOFB removal, entry site of IOFBs, interventions and complications were evaluated.
RESULTS: Mean age of the patients was 32.7±14.2 years, and mean follow up period was 18±13.3 months. Weight, length, width and thickness of IOFBs were found negatively correlated with initial and final BCVA levels (p<0.05). Weight of IOFBs was significantly greater in eyes with initial hyphema, vitreous hemorrhage, retinal hemorrhage, retinal detachment, and uveal prolapse (p<0.05). Width and thickness of IOFBs were significantly greater in eyes with hyphema, vitreous hemorrhage, retinal hemorrhage and uveal prolapse (p<0.05). Length of IOFBs was significantly longer in eyes with hyphema (p<0.05). Presence of initial or subsequent retinal detachment was associated with poor final BCVA (p<0.05). There was no association between the timing of IOFB removal and incidence of endophthalmitis.
CONCLUSION: Greater weight and size of posterior segment IOFBs were associated with worse outcomes in open globe injuries. Protective eyewear has a crucial importance to avoid work-related injuries. In our study, early or late vitrectomy for an IOFB removal had no significant effect on anatomic and visual outcomes. Therefore, vitrectomy can be postponed until optimal conditions are obtained.

AMAÇ: Çalýþmamýzýn amacý intertrokanterik femur kýrýðý olan yaþlý hastalarda proksimal femur çivisi (PFÇ) ve bipolar hemiartroplasti (BPH) ile tedavinin sonuçlarýný karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2008–Ocak 2012 arasýnda femur intertrokanterik kýrýðý nedeni ile tedavi edilen 143 hasta dahil edildi. Hastalarýn demografik verileri; AO/ASIF (Association for Osteosynthesis/Association for the Study of Internal Fixation) sýnýflamasýna göre kýrýk tipi; ASA (American Society of Anesthesiologists) skorlarý; cerrahi yöntem (PFÇ veya BPH); cerrahinin detaylarý; komplikasyonlar ve takip sonuçlarý (Harris Kalça Skoru, Ortalama Hareketlilik Skoru) kaydedildi.
BULGULAR: Cerrahi öncesi veriler PFÇ ve BPH grubunda benzerdi. Bipolar hemiartroplasti grubunda cerrahi süresi daha uzun; cerrahi sýrasýndaki kan kaybý ve mortalite oranlarý daha yüksekti (p<0.005). 30.4 (10.9) aylýk takip sonucunda Ortalama Hareketlilik Skoru’ndaki azalma ve Harris Kalça Skoru’nda anlamlý fark yoktu (p>0.05).
TARTIÞMA: Cerrahi tedavi uygulanan femur intertrokanterik kýrýklý yaþlý hastalarda PFÇ ve BPH sonuçlarýnýn her ikisi de tatmin edici olsada; daha az cerrahi ile iliþkili travma ve düþük mortalite oranlarý ile PFÇ’nin bu hastalarda daha etkili ve uygun tedavi yöntemi olarak tercih edilebileceðini düþünmekteyiz.

BACKGROUND: The aim of this study was to compare the outcomes of intertrochanteric femur fractures treated with proximal femoral nail (PFN) and bipolar hemiarthroplasty (BPH) in elderly patients.
METHODS: A total of one hundred and forty-three patients with intertrochanteric femur fractures treated surgically between January 2008 and January 2012 were included into the study. Patient demographics, type of fracture according to Association for Osteosynthesis/ Association for the Study of Internal Fixation (AO/ASIF) classification, and the American Society of Anesthesiologists (ASA) classification system scores; type of surgical procedure (BPH or PFN), operative details, complications and follow-up scores (Harris Hip Score [HHS]; Mean Mobility Score [MMS]) were recorded.
RESULTS: The preoperative characteristics of the patients in both PFN and BPH groups were similar. BPH had higher operation times, blood loss in operation and mortality rates (p<0.005). Reoperation times were higher in PFN group (p<0.005). There were no differences with regard to the HHS and the reduction in MMS at the last follow-up with a 30.4 (10.9) months follow-up (p>0.05).
CONCLUSION: Although both PFN and BPH had satisfactory outcomes in surgically treated patients with intertrochanteric femur fractures, we recommend intertrochanteric femur fractures in the elderly tobe treated with PFN; which is an effective and appropriate treatment modality with less surgery related trauma and lower mortality rates.

AMAÇ: Bu çalýþmanýn amacý çocuklardaki açýk redüksiyon ve internal fiksasyon ile tedavi edilen mandibula kýrýklarýnda, emilebilen ve metal plaklarýn etkinliðini karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Yaþlarý 20 ay-14 yýl (ortalama 8.05 yýl) arasýnda deðiþen 31 hasta mandibulanýn farklý yerlerindeki kýrýklar nedeniyle ameliyat edildi (26 [%60.4] simfisiz-parasimfisiz, 12 [%27.9] kondil-subkondil, 5 [%11.6] angulus ve ramus). On iki hasta eriyen plaklarla, 19 hasta ise metal plaklarla (titanyum) tedavi edildi. Ortalama takip süresi metal donaným kullanýlan grupta 41 ay (11–74 ay), eriyen plak kullanýlan grupta ise 22 ay’dý (8–35 ay). Her iki grup primer kemik iyileþmesi, komplikasyonlar, ameliyat sayýsý ve mandibuladaki büyüme açýsýndan incelendi. Bulgular aþaðýda tartýþýldý.
BULGULAR: Her iki grupta primer kemik iyileþmesi saptandý. Her iki gruptaki minör komplikasyonlar benzerdi. Metal donaným kullanýlan grupta pak çýkartýlmasý için ikinci operasyonlar gerçekleþtirildi. Her iki gruptaki mandibula geliþimi tatmin ediciydi.
TARTIÞMA: Eriyen plaklar metal donanýmlý plaklardan daha pahalý olduklarý görüldü. Ýkinci operasyonlarýn maliyeti göz önünde bulundurulduðunda ise eriyen plaklar daha avantajlýydý. Mandibula büyümesi ve komplikasyon parametreleri heriki grupta benzer olduðundan, eriyen plaklar; olasý diþ hasarýnýn önlenmesi, uzun süreli yabancý cisim varlýðýnýn olmamasý ve hýzlý kemik iyileþmesi için gerekli olan yeterli sabitlik saðlamasý gibi hususlara baðlý olarak tercih edilmektedir. Buna raðmen, emilebilir plaklarýn kullanýlmasý hususunda bir öðrenme periyodunun gerekliliði ve metal plaklarla karþýlaþtýrýldýðýnda, çiðneme kaslarýnýn karþýt gücüne karþý düþük sabitlik saðladýklarý gibi endiþeler akýlda tutulmalýdýr.

BACKGROUND: The aim of this study was to compare the efficiency of resorbable and metallic plates in open reduction and internal fixation of mandible fractures in children.
METHODS: Thirty-one patients (mean age, 8.05 years; range 20 months-14 years) were operated on various fractures of the mandible (26 [60.4%] symphysis- parasymphysis, 12 [27.9%] condylar-subcondylar fractures, 5 [11.6%] angulus and ramus fractures). Twelve patients were treated with resorbable plates and 19 patients with metallic plates. Mean follow-up time was 41 months (11–74 months) in the metallic hardware group and was 22 months (8–35 months) in the resorbable plate group. Both groups were investigated for primary bone healing, complications, number of operations, and mandibular growth. The results were discussed below.
RESULTS: Both groups demonstrated primary bone healing. Minor complications were similar in both groups. The metallic group involved secondary operations for plate removal. Mandibular growth was satisfactory in both groups.
CONCLUSION: Resorbable plates cost more than the metallic ones; however, when the secondary operations are included in the total cost, resorbable plates were favourable. As mandibular growth and complication parameters are similar in both groups, resorbable plates are favored due to avoidance of potential odontogenic injury, elimination of long-term foreign body retention and provision of adequate stability for rapid bone healing. However, learning curve and concerns for decreased stability against heavy forces of mastication accompanied with the resorbable plates when compared to the metallic ones should be kept in mind.

AMAÇ: Penetran ve künt toraks travmalarýnda dikkatli incelenmediði ve þüphelenilmediði zaman gözden kaçabilen diyafragma yaralanmalarýný vurgulamak istedik.
GEREÇ VE YÖNTEM: Ocak 2000–Haziran 2013 yýllarý arasý künt ve penetran toraks travmasý ile baþvuran 1349 olgudan travmatik diyafragma rüptürü olan 53 hastanýn dosyalarý incelendi. Hastalarýn yaþý, cinsiyeti, yandaþ yaralanmalarý, cerrahi yaklaþým þekli, ameliyat sonrasý morbidite ve mortalite oranlarý ve hastanede kalýþ sürelerine bakýldý.
BULGULAR: Künt veya penetran toraks travmasý sonucu kliniðimizde tedavi edilen 1349 olgudan, travmatik diyafragmatik yaralanma (TDY) olan 48’i erkek, beþi kadýn olgu deðerlendirildi. Yaþ ortalamalarý 31.06 (4–65 yýl) ve 35.80 (4–50 yýl) idi. Cerrahi yaklaþým olarak torakotomi %66, laparotomi %20.75 ve laparotomi+torakotomi ise %13.20 olguda uygulandý. Torakotomi öncesi taný amaçlý videoyardýmlý torakoskopi (VATS) %15.09 hastada uygulandý. Diyafragma 31 olguda sol ve 22 olguda sað tarafta onarýldý. Morbidite olarak pulmoner komplikasyonlar künt travmalarda daha fazla görüldü (%37.73). Mortalite ise sadece penetran travmalý üç olguda gözlendi. Ortalama hastanede yatýþ süresi 8.75 gündü (daðýlým 4–15 gün). Olgular ortalama 28.13 ay olarak (3–60 ay) takip edildi. Yaralanma türü, cinsiyet ve yaþ açýsýndan gruplar arasýnda istatistik olarak anlamlý farklýlýk saptanmazken (p=0.05); künt travmalý hastalarda morbidite anlamlý bulundu.
SONUÇ: Künt veya penetran olsun toraksý ilgilendiren travmalarda mutlaka diyafragmaya yönelik inceleme yapýlmalý, diyafragma ile ilgili bir þüphe varsa mutlaka deðerlendirilmelidir.

BACKGROUND: The aim of the present study was to emphasize diaphragmatic injuries that can be overlooked in chest traumas.
METHODS: Between January 2000 and June 2013, fifty-three patients with traumatic diaphragmatic laceration were evaluted among 1349 patients who had chest injuries. Patients were examined regarding age, gender, associated injuries, surgical interventions, postoperative morbidity, mortality and length of hospital stays.
RESULTS: Of them, fifty-three cases had diaphragmatic lacerations. There were forty-eight male and five female patients, with a mean age of 31.06 (4–60) years and 35.80 (18–50) years. Thoracotomy in 66%, laparotomy in 20.75% and laparotomy+thoracotomy in 13.20% of the cases were performed. Video-assisted thoracoscopy was carried out in 15.09% of the patients. Diaphragm was repaired on the left in thirty-one cases and in the right in twenty-two cases. Pulmonary complications like morbidity was mostly seen in 37.73% of blunt trauma. Mortality was seen in three cases of penetrating trauma. Mean hospital duration was 8.75 days (range, 4–15 days). Patients were followed for a mean duration of 28.13 months (range, 3–60 months). There was no significant statistical difference between types of injury, ages and gender of cases (p=0.05); whereas, morbidity rate was important in patients with blunt trauma.
DISCUSSION: Diaphragmatic lacerations should be kept in mind when penetrating and blunt injuries to the thorax are evaluated.

Soliter çekum divertikülü benign bir oluþumdur ama enflamasyon, perforasyon ve kanama ile komplike bir hale gelebilir. Çekal divertiküllerin en yaygýn komplikasyonu olan çekum divertiküliti (ÇD), Asyalýlar arasýnda yüksek insidansa sahip, ama Batý dünyasýnda ender bir durumdur. Kolonik divertiküler hastalýðýn insidansý ulusal kökene, kültürel yapý ve beslenme alýþkanlýðýna göre deðiþir. Çekum divertiküliti ülkemizde yaygýn deðildir, ama akut apandisit gibi diðer sýk görülen akut sað taraf karýn hastalýklarýna klinik açýdan çok benzediði için önemli bir durumdur. Cerrahi öncesi tanýsý zordur ve bu nedenle güncel sýklýðý bilinmez. Çekum divertikülitinin tedavisi týbbi tedaviden sað hemikolektomiye kadar deðiþir. Bu çalýþmada son sekiz yýlda acil birimimizde cerrahi rezeksiyon uygulanan 10 ÇD olgusunu sunduk. Amacýmýz cerrahlar arasýnda bu duruma olan farkýndalýðý artýrarak, ilk deneyimlerinin ameliyathanede olmamasý için özen göstermeleridir.

Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

Penetran beyin yaralanmasýna (PBY) düþük veya hýzlý ivmeli nesneler neden olabilmektedir. Býçaklar ve horoz gagasý gibi birkaç nesnenin bu çeþit yaralanmalara neden olduðu bilinmektedir. Ancak literatürde bisiklet anahtarýyla saldýrý sonucu oluþan PBY bildirilmemiþtir. Bu çalýþmanýn amacý bir bisiklet anahtarýyla saldýrý sonrasý gelen 21 yaþýndaki bir erkek hastayý raporlamaktý. Anahtar sol pariyetal bölgeye takýlý kalmýþ ve sol pariyetal kraniyotomiyle çýkartýlmýþtýr. Altta yatan parankimal kontüzyon eksize edilmiþtir. Ameliyat sonrasý ikinci gün hastada motor afazi geliþmiþ ve daha sonraki günlerde ödem çözücü önlemlerle geçmiþti. Birinci aylýk izlemde hasta normal konuþma ve bilincine kavuþmuþtu. Penetran beyin yaralanmalarýnýn hemen tedavi edilmesi önemli olup PBY için her zaman anjiyografi gerekmemektedir.

Penetrating brain injury (PBI) may be caused by low-velocity or high-velocity objects. Several objects are known to cause such injury ranging from knives to rooster pecks. However, an assault with the key of a bike causing PBI has not been reported in the literature. The objective of this study was to report the case of a 21-year-old male patient, who presented after an assault with a bike key. The key was impacted in the left parietal region. Left parietal craniotomy was done and the key was removed. There was an underlying parenchymal contusion, which was excised. On post-operative day two, the patient developed motor aphasia, which subsided in subsequent days with antiedema measures. At the first month follow-up, the patient was having normal speech and consciousness. Prompt treatment of penetrating brain injury is important and angiography is not always necessary for PBI.

Künt travma sonrasý kardiyak rüptür insidansý nadirdir ve tüm künt travma hastalarýnýn %0.3 ile 0.5’inde görülür. Bu travma olay yerinde ölümcül olabilir ve sýk olarak acil servis ortamýnda taný atlanabilir. Kardiyak travma þiddeti maruz kalýnan kuvvettin þiddeti ve mekanizmasýna baðlý olarak deðiþir. Burada hipovolemik þok belirtileri ile acil servise baþvuran, motorlu araç çarpýþmasýna karýþmýþ, 32 yaþýndaki erkek olguyu sunmaktayýz. Hastanýn göðüs travmasýna baðlý acil müdahele gerektiren hemotoraksý olduðu tespit edildi. Hastaya sað atriyal yaralanmayý ortaya çýkaran acil torakotomi yapýldý. Atriyal yaralanma tamiri hastanýn þok durumunundan kurtulmasýna yardýmcý olmuþtur. Hasta 35 gün sonra iyi durumda hastaneden taburcu edilmiþtir.

The incidence of cardiac rupture following blunt trauma is rare, occurring in 0.3%–0.5% of all blunt trauma patients. It can be fatal at the trauma scene, and is frequently missed in the emergency room setting. The severity of a cardiac trauma is based on the mechanism and degree of the force applied. The objective of this study was to report the case of a 32-year-old male patient who was involved in a motor vehicle collision and presented to the emergency room with signs of hypovolemic shock. The patient was found to have severe chest trauma associated with massive hemothorax requiring immediate intervention. The patient had an emergent thoracotomy revealing a right atrial injury. Repair of the atrial injury reversed the state of shock. The patient was discharged after 35 days of hospitalization in good condition.

Safra kesesi (SK) torsiyonu yaþlýlarda seyrek görülen acil bir durumdur. Safra kesesinin kist arter ve kanalý ekseni çevresinde dönmesi nedeniyle oluþur. Bu çalýþma yaþlý bir kadýn hastada multidedektörlü bilgisayarlý tomografi (BT) ile taný konmuþ bir akut SK torsiyonu olgusunu raporlamayý amaçlamýþtýr. Safra kesesi torsiyonunun ameliyat öncesi tanýsýna yardýmcý olmak için kullanýlabilen klinik ve görüntüleme özellikleri BT kriterleri vurgulanarak tartýþýlmýþtýr.

Gallbladder (GB) torsion is a rare surgical emergency seen in the elderly. It occurs due to the rotation of the gallbladder along the axis of the cystic artery and cystic duct. This study aimed to report a case of an acute GB torsion in an elderly female patient diagnosed by multi-detector computed tomography (MDCT). The clinical and imaging features of GB torsion, which can be used to assist in the preoperative diagnosis, were also discussed with emphasis on CT criteria.

Chilaiditi sendromu, ince kalýn baðýrsaklarýn hepatodiafragmatik interpozisyonu durumudur. Nadir görülür ve olgularýn çoðuna tesadüfen taný konur. Sýklýkla semptomsuz olmakla birlikte aralýklarla ortaya çýkan hafif abdominal aðrý, intestinal obstrüksiyon, kabýzlýk, göðüs aðrýsý, nefes darlýðý gibi semptomlarla da ortaya çýkabilir. Karýn aðrýsý, bulantý ve kusma öyküsüyle hastaneye baþvuran 54 yaþýnda erkek hastanýn çekilen akciðer grafisinde dilate kalýn baðýrsak ansýnýn alttan basýsý sonucu sað diyafragmanýn yükselmiþ olduðu gözlendi. Hasta perforasyon ön tanýsýyla acil operasyona alýndý. Chilaiditi’s sendromunun neden olduðu intestinal obstrüksiyon nedeniyle sað hemikolektomi ve ileokolik anastomoz uygulandý. Nadir görülen bir sendrom olmasý ve tipik radyolojik bulgular nedeniyle bu olguyu sunmayý amaçladýk.

Hepatodiaphragmatic interposition of the small or large intestine is known as Chilaiditi syndrome, whichis a rare disease diagnosed incidentally. Chilaiditi syndrome is typically asymptomatic, but it can be associated with symptoms ranging from intermittent, mild abdominal pain to acute intestinal obstruction, constipation, chest pain and breathlessness. A 54-year-old male patient was admitted to the hospital with a history of abdominal pain, nausea and vomiting. Chest X-ray revealed an elevation of the right hemidiaphragma caused by the presence of a dilated colonic loop below. The patient underwent urgent surgery with perforation as preliminary diagnosis. The patient underwent right hemicolectomy and ileocolic anastomosis because of the intestinal obstruction related to Chilaiditi’s Syndrome. Due to the rarity of this syndrome and typical radiological findings, this case was aimed to be presented.