AMAÇ
Deneyimli bir cerrah için bile akut apandisit tanýsý kimi zaman zor olabilir. Tanýdaki gecikme komplikasyon oranýný arttýrmaktadýr. Bu deneysel çalýþmadaki amacýmýz, akut apandisit tanýsýnda belirteç olarak neopterinin uygunluðunun ve öneminin araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM
Otuz beþ adet Yeni Zellanda tipi erkek tavþanda oluþturulmuþ akut apandisit modelinde neopterin düzeyleri ölçüldü. Hayvanlar apendektomi uygulanana kadar geçen zamana göre 5 gruba ayrýldý. (Grup 1: Kontrol, Grup 2: Sham, Grup 3: 12. saat, Grup 4: 24. saat, Grup 5: 48. saat). Her bir gruptan alýnan kan örneklerinde (Grup 3, Grup 4 ve Grup 5’te apendektomi öncesinde) neopterin düzeyleri enzim immunoassey kitinde ölçüldü.
BULGULAR
Akut apandisit tanýsý için optimal eþik deðeri noktasý 34,475 nmol/lt olarak saptandý. Neopterin düzeyi 34,475 nmol/lt üzerinde olduðu zaman akut apandisit olma olasýlýðý 4,667 kat fazla olarak bulundu.
SONUÇ
Bu çalýþma deneysel bir hayvan çalýþmasý olsa da klinik uygulamalar açýsýndan deðerli ipuçlarý vermektedir. Neopterinin akut apandisit tanýsýnda kullanýlabilecek potansiyele sahip bir belirteç olduðunu düþünüyoruz.

BACKGROUND
The diagnosis of acute appendicitis, even for experienced surgeons, can sometimes be complex. A delay in diagnosis increases the complication rate. This experimental study aimed to investigate the suitability and significance of neopterin as a marker for acute appendicitis.
METHODS
The levels of neopterin were measured using an acute appendicitis animal model in 35 New Zealand male rabbits. They were divided into 5 groups as Group 1= control; Group 2= sham; and Groups 3 (12-hour); 4 (24-hour); and 5 (48-hour) (based on the elapsed time period before their appendectomies). The neopterin levels of each group were measured by neopterin enzyme immunoassay kit in blood samples (taken before the appendectomies in Groups 3, 4 and 5).
RESULTS
For the diagnosis of acute appendicitis, the optimal cut-off point was 34.475 nmol/L. The probability of acute appendicitis was found to be 4.667 times higher when the neopterin level was greater than 34.475 nmol/L.
CONCLUSION
This study was an experimental animal study; however, it provides valuable clues useful in clinical assessment. Neopterin seems to have great potential as a new diagnostic marker for the diagnosis of acute appendicitis.

AMAÇ
Bir hayvan modelinde, sürekli epidural anestezi ile kolon anastomozunun gücü arasýndaki iliþki araþtýrýldý.
GEREÇ VE YÖNTEM
Beyaz erkek 14 adet Yeni Zelanda tavþaný çalýþmaya alýndý ve randomize iki grup oluþturuldu. Grup 1’de (n=7) epiduralden sürekli olarak %0,9’luk NaCl infüzyonu (0,4 mlkg-1 bolus ve 0,2 mlkg-1 sa-1 infüzyon) ve Grup 2’de (n=7) epiduralden sürekli olarak %1’lik lidokain infüzyonu (0,4 mlkg-1 bolus ve 0.2 ml kg-1 sa-1 infuzyon) uygulandý. Ýnfüzyonlara, operasyonlarýn baþýnda baþlandý ve cerrahi sonrasý 6. saate kadar sürdürüldü. Bütün deney hayvanlarýna genel anestezi altýnda sað kolon rezeksiyonu ve kolo-kolonik anastomoz uygulandý. Cerrahi sonrasý 4. gün, re-laparotomi yapýlýp in situ olarak anastomoz patlama basýnçlarý ölçüldü. Dikiþ hattýný içine alan 1 cm’lik segment çýkartýlýp, hidroksiprolin ve kollajen düzeyleri ölçüldü.
BULGULAR
Anastomoz patlama basýnçlarý, epidural lidokain grubunda (medyan 248 mmHg - [117-300]) serum fizyolojik grubuna (medyan 109 mmHg - [47-176]) göre anlamlý derecede yüksek bulundu (p=0,006). Doku örneðindeki hidroksiprolin ve kollajen düzeyleri açýsýndan gruplar arasýnda fark yoktu (p>0,05).
SONUÇ
Kolon anastomozunun dayanýklýlýðýnýn epidural lidokain infüzyonu ile artabileceðini düþünüyoruz.

BACKGROUND
The association between the infusion of continuous epidural anesthesia and the anastomotic strength of colonic anastomosis was examined in an animal model.
METHODS
Fourteen white male New Zealand rabbits were included in the study and randomly assigned to two groups. Group 1 (n=7) had continuous epidural 0.9% NaCl infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion) and Group 2 (n=7) had continuous epidural 1% lidocaine infusion (0.4 ml kg-1 bolus and 0.2 ml kg-1 h-1 infusion). Infusions started at the beginning of the operation and were continued for six hours postoperatively. All experimental animals underwent right colon resection and colo-colonic anastomosis under general anesthesia. On the fourth postoperative day, relaparotomy was applied and the bursting pressures of the anastomosis (BPA) were measured in situ. Segments 1-cm long consisting of the complete suture lines were excised, and the levels of hydroxyproline and collagen were measured.
RESULTS
BPAs were statistically higher in the epidural lidocaine group (median: 248 mmHg; min 117 - max 300) than in the saline group (median: 109 mmHg; min 47 - max 176) (p=0.006). There was no difference between the groups in terms of hydroxyproline and collagen levels in the sample tissues (p>0.05).
CONCLUSION
We concluded that the strength of colonic anastomosis may be increased by epidural lidocaine infusion.

AMAÇ
Bu çalýþmada, zon-II fleksör tendon onarýmlarýndan sonra, iki haftalýk süre içerisinde enjekte edilen 3 doz hyaluronik asit (HA) enjeksiyonunun plaseboya (salin) karþý etkinliði araþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmaya Ýkinci parmak izole zon-II fleksör tendon hasarlanmasý olan 22 hasta dahil edildi. Tenorafi öncesi, parmaklar randomize olarak iki gruba ayrýldý; 11 parmakta tenorafi çevresine 3 doz HA enjekte edilirken, ayný þekilde salin enjekte edilen 11 parmak da plasebo grubunu oluþturdu. Birinci doz tenorafi sýrasýnda verildi ve ilave 2 doz 1 hafta ara ile enjekte edildi. Operasyon sonrasý Kleinert rehabilitasyon protokolü uygulandý. Eklem hareket açýklýðý, 3. hafta, 3. ay ve uzun dönemde total aktif ve pasif eklem açýklýðý ölçülerek deðerlendirildi. Fonksiyonel sonuç, Strickland sýnýflandýrmasýna göre belirlendi.
BULGULAR
Üçüncü haftada eklem hareket açýklýðý açýsýndan iki grup arasýnda bir fark tespit edilmedi. Ancak, 3. ay ve uzun dönemde, eklem hareket açýklýðýnda, HA enjekte edilen parmaklarda plasebo grubuna göre anlamlý derecede iyileþme olduðu gözlendi.
SONUÇ
Bu plasebo kontrollü ön çalýþmada, mükerrer HA enjeksiyonlarýnýn, primer tendon onarýmýnda, muhtemelen adezyon azaltýcý etkisine baðlý olarak, klinik sonuçlarý iyileþtirebildiði ileri sürülmektedir.

BACKGROUND
The aim of this study was to investigate the efficacy of three injections of hyaluronic acid (HA) versus placebo (saline) over a two-week period on functional outcomes after zone-II flexor tendon repairs.
METHODS
Twenty-two patients with isolated zone-II flexor tendon injury of the index fingers were included in this study. Before tenorrhaphy, fingers were randomly divided into two groups; 11 were treated with three injections of HA around the tenorrhaphy site and 11 served as a placebo group and were treated with saline in the same way. The first dose was given at the time of tenorrhaphy and two additional doses were given at one-week intervals. A Kleinert rehabilitation protocol was employed postoperatively. Range of motion was assessed with total active and passive movement evaluation systems at 3 weeks, 3 months and long-term. Functional outcome was evaluated using the Strickland classification.
RESULTS
There were no differences between the two groups in terms of range of motion at 3 weeks. However, at 3 months and long-term, a significant improvement was observed in fingers treated with HA compared to placebo.
CONCLUSION
This preliminary placebo-controlled study suggests that repetitive injections of HA can improve clinical outcomes presumably due to the effect on decreasing adhesions in primary tendon repairs.

AMAÇ
Bu araþtýrma, yoðun bakým ünitesinde yatan hastalara yapýlan ziyaretin hastanýn yaþam bulgularý üzerindeki etkisini incelemek amacýyla yapýldý.
GEREÇ VE YÖNTEM
Tanýmlayýcý olarak gerçekleþtirilen çalýþma Ýstanbul ilinde bir üniversite hastanesinin acil cerrahi yoðun bakým ünitesinde gerçekleþtirildi. Araþtýrmanýn örneklemini 24 saatten fazla süre ünitede bulunan, 18 yaþ ve üzeri 43 hasta oluþturdu. Verilerinin toplanmasýnda hastalarýn demografik özellikleri ile ziyaret öncesi, sýrasý ve sonrasýndaki yaþam bulgularýnýn yer aldýðý bilgi ve deðerlendirme formu kullanýldý. Veriler ziyaret öncesi, ziyaret sýrasýnda ve ziyaretten sonra ölçüldü.
BULGULAR
Hastalarýn %39,5’i (n=17) kadýn, %60,5’i (n=26) erkekti. Ziyaret öncesi ateþ deðerleri ortalamasý 36,7±0,81 sonrasý 36,8±,94; nabýz deðeri ortalamasý öncesinde 97,3±26,4, sonrasýnda 98,4±26,1; solunum deðeri ortalamasý 23,76±4,55 sonrasýnda 24,30±4,53; sistolik basýnç deðeri 113,4±25,86, sonrasýnda 120,4±21,15; diyastolik basýnç deðeri 64,81±8, sonrasýnda 67,30±3 bulundu.
SONUÇ
Pilot bir çalýþma niteliðinde yürütülen bu araþtýrmada, yoðun bakým ortamýnda bulunan hastaya yapýlacak ziyaretlerin hastayý etkilediði, ancak bu etkinin yaþam bulgularýnda ciddi bir fizyolojik deðiþime neden olmadýðý sonucuna varýldý.

BACKGROUND
This research was conducted to analyze the impact of visiting patients in the intensive care unit on the vital signs of the patients.
METHODS
This descriptive study was conducted at the emergency surgical intensive care unit of a university hospital in Istanbul. The sample consisted of 43 patients aged 18 and above, who stayed at the unit for more than 24 hours. Data collection included the demographic features of the patients as well as the information and evaluation form including the vital signs of patients before, during and after visits. Data were measured before, during and after visits.
RESULTS
39.5% (n=17) of the patients were female and 60.5% (n=26) were male. Values before and after visits, respectively, were as follows: Mean fever 36.7±0.81 and 36.8±.94; pulse 97.3±26.4 and 98.4±26.1; mean respiration 23.76±4.55 and 24.30±4.53; systolic pressure 113.4±25.86 and 120.4±21.15; and diastolic pressure 64.81±8 and 67.30±3.
CONCLUSION
This study, carried out as a pilot study, found that visiting patients in intensive care units affects the patients; however, this effect does not cause a serious physiological change in the vital signs of the patient.

AMAÇ
Son yýllarda ileri travma yaþam desteði protokollerine göre rutin testlerin gerekliliði tartýþýlmaktadýr. Bu çalýþmanýn amacý, majör travma hastalarýnda rutin testlerin gerekliliði ve tanýsal deðerini analiz etmektir.
GEREÇ VE YÖNTEM
Bu prospektif çalýþmada, Glasgow Koma Skoru 15, Revize Travma Skoru 12 olan ve 15-65 yaþ arasý majör travma ile acil servise baþvuran toplam 103 künt travma hastasý deðerlendirildi.
BULGULAR
Hastalarýn (%30,1 kadýn,%69,9 erkek) yaþ ortalamasý 35±12.97 idi. Tüm hastalarýn %72,8’i araç içi trafik kazasý, %12,6’sý araç dýþý trafik kazasý ve %14,6’sý yüksekten düþme ile baþvurdu. Rutin testlerin hepsi ayrý ayrý deðerlendirildi. Servikal inceleme ile lateral servikal röntgen istemi, pelvik muayene ile tam kan sayýmý ve idrar testi istemi hariç, tam kan sayýmý, yan servikal röntgen ve karýn ultrasonografisi istem nedenleri ile diðer test sonuçlarý ve istem nedenleri karþýlaþtýrýldýðýnda önemli farklýlýklar saptandý.
SONUÇ
Çalýþmamýza göre biyokimyasal testler, ön-arka göðüs grafisi ve ön-arka pelvis grafisi hedefe yönelik testler olarak istenebilir. Hedefe yönelik testlerin istemi ile maliyet ve iþ yükü azalacaktýr.

BACKGROUND
The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients.
METHODS
This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study.
RESULTS
The average age of the patients (30.1% female, 69.9% male) was 35±12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography).
CONCLUSION
According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload.

AMAÇ
Bu çalýþma, acil servise baþvuran tekstil ve giyim sektörü çalýþanlarýnda iþle ilgili yaralanmalarý araþtýrmak için yapýldý.
GEREÇ VE YÖNTEM
Prospektif tasarlanan çalýþmaya iki yýllýk araþtýrma süresince tekstil ve dokuma endüstrisinde çalýþanlarýn iþ kazalarý ile iliþkili baþvurular alýndý. Çalýþma örnekleminde sadece iþ yerinde ve fiilen çalýþma sýrasýnda olan yaralanmalar analiz edildi.
BULGULAR
Toplam 374 hasta çalýþma kriterlerine uygun bulundu. Olgularýn büyük bölümünü kadýnlar (%76,2, n=285), yaþ dilimleri içinde ise 14-24 yaþ arasýndakiler oluþturdu (%44,7, n=167). Olgularýn yaklaþýk üçte ikisi iþ kazasýna baðlý olarak ilk kez hastaneye baþvurduðunu bildirdi (%65,8, n=246). Ýþ kazalarý en sýk 07: 00 ile 09.00 (%27,3) ve 23: 00 ile 01: 00 (%17,9) saatleri arasýnda oluþtu. Hastalar kazalarýn nedenini en sýk olarak dikkatsizlik ve acelecilik olarak bildirdi (sýrasýyla, %40,6 ve %21,4). Hastalarýn yaklaþýk dörtte üçü olay sýrasýnda koruyucu malzeme kullandýðýný bildirdi (%74,3, n=278). Yaralanma tiplerine bakýldýðýnda, kesi/batma/amputasyon/ avulsiyon yaralanmalarý %55,6 (n=208) oranýndaydý. En sýk olarak üst ekstremite yaralanmasý (%75,1 n=281) görüldü.
SONUÇ
Ülkemizde tekstil ve dokuma endüstrisinde çalýþanlarýn iþ kazalarýný bir bütün olarak tanýmlamak için geniþ, toplum tabanlý araþtýrmalara gereksinim vardýr. Hýzla geliþen bu sektörde iþ kazalarýnýn azaltýlmasý için düzenlemeler yapýlmalýdýr.

BACKGROUND
This study was conducted as a survey including work-related injuries (WRI) of workers in the textile and clothing industry admitted to the emergency department (ED).
METHODS
This prospective study included patients with WRI reportedly occurring in the textile and clothing industry over a two-year period. The study sample comprised only the casualties occurring at the workplace and while working de facto.
RESULTS
A total of 374 patients were eligible for the study. More than three-fourths of the study sample were females (76.2%, n=285). A significant proportion of the patients were between 14 and 24 years of age (44.7%, n=167). Approximately two-thirds reported that this was their first admission to a hospital related to WRI (65.8%, n=246). WRIs occurred most frequently between 07: 00-09: 00 (27.3%) and 23: 00-01: 00 (17.9%). “Carelessness” and “rushing” were the most commonly reported causes of WRIs from the patients’ perspective (40.6% and 21.4%, respectively). Three-fourths of the patients reported that they were using protective equipment (74.3%, n=278). With respect to injury types, laceration/puncture/ amputation/avulsion injuries accounted for 55.6% (n=208) of the sample. Trauma to the upper extremities was the main type of injury in 75.1% (n=281) of the cases.
CONCLUSION
Broad population-based studies are needed to define the situation as a whole in WRIs in the textile and clothing industry in the country. Strict measures should be undertaken and revised accordingly to prevent WRIs in these growing sectors.

AMAÇ
Torakoabdominal býçak yaralanmalarý bulunan ve hemodinamik açýdan stabil olan hastalarýn tedavisi halen tartýþmalýdýr. Bu çalýþmada, bu tip hastalardaki tanýsal peritoneal lavaj (TPL) sývýsýndaki eritrosit sayýsýndaki optimal deðer tartýþýldý.
GEREÇ VE YÖNTEM
Hemodinamik yönden stabil ve torakoabdominal býçak yaralanmasý olan 388 hasta çalýþmaya alýndý. Laparotomi yönünden açýk bir endikasyona sahip olmayan olgularda, peritoneal kavite 1000 cc serum fizyolojikle yýkandý ve akýntý sývýsýndaki eritrosit sayýsý analiz edildi. Karýn yaralarýnda >100,000/mm3 ve alt göðüs yaralarýnda >10,000/mm3 seviyesinde eritrosit sayýsý eksploratuvar laparotomi (konvansiyonel yaklaþým) için endikasyonlar olarak kabul edildi. Geriye dönük yapýlan analizde, eritrosit sayýsý için yeni eþik deðerler hesaplandý.
BULGULAR
Konvansiyonel yaklaþýmýn duyarlýlýðý ve özgüllüðü, sýrasýyla %90 ve %84 olmuþtur. Karýn yaralarýnda >15,000/mm3 ve alt göðüs yaralarýnda >25,000/mm3 seviyesindeki eritrosit sayýsý, operasyon gereksinimi olan veya olmayan hastalarýn ayýrt edilmesinde, sýrasýyla %94 ve %96’lýk bir duyarlýlýk ve özgüllük ile en uygun eþik deðeri bulundu.
SONUÇ
Tanýsal peritoneal lavaj sývýsýnda eritrosit sayýsý ile ilgili yeni eþik deðer, torakoabdominal býçak yaralanmalarý bulunan ve hiçbir açýk operasyon endikasyonu bulunmayan TPL hastalarýnýn tedavisine kullanýlabilir.

BACKGROUND
Managing hemodynamically stable patients with thoracoabdominal stab wounds is still under dispute. This study aimed at discussing cut-off points of red blood cell (RBC) count in diagnostic peritoneal lavage (DPL) effluent in these patients.
METHODS
Three hundred and eighty-eight patients with thoracoabdominal stab wounds and hemodynamically stable status were enrolled. In cases without a clear indication of laparotomy, the peritoneal cavity was washed out with 1000 ml of normal saline and the effluent fluid was analyzed for RBC count. RBC counts of >100,000/mm3 in abdominal wounds and of >10,000/mm3 in lower chest wounds were considered as indications for exploratory laparotomy (conventional approach). New cut-off points for RBC count were calculated in backward analysis.
RESULTS
Sensitivity and specificity of the conventional approach were 90% and 84%, respectively. RBC counts >15,000/mm3 in abdominal wounds and >25,000/mm3 in lower chest wounds were the best cut-off points in distinguishing patients with and without need of operation, with a sensitivity and specificity of 94% and 96%, respectively.
CONCLUSION
New cut-off points of RBC count in DPL effluent may promote management of patients with thoracoabdominal stab wounds and no obvious indication for operation.

AMAÇ
Bu çalýþmada, tek veya çok sayýda cerrahi debridman gereken Fournier gangreni (FG) hastalarý karþýlaþtýrýldý, debridman sayýsýný etkileyebilecek faktörler araþtýrýldý.
GEREÇ VE YÖNTEM
Fournier gangreni nedeniyle tedavi edilen 36 hastanýn verileri geriye dönük olarak incelendi. Hastalar uygulanan debridman sayýsýna göre iki gruba ayrýldý (Grup I: tek seans; Grup II: ≥2 seans). Hastalara ait veriler (klinik ve cerrahi veriler, lezyon özellikleri, FG þiddet indeksi, prognoz verileri) gruplar arasýnda karþýlaþtýrýldý.
BULGULAR
Hastalarýn ortalama yaþý 55,5 idi ve hepsi erkekti. Grup I’de 21, Grup II’de 15 hasta incelendi. Grup II’de ortalama debridman sayýsý 2,2 idi. Genel mortalite oraný %11 olarak saptandý (Grup I’de %4,8, Grup II’de %20; p=0,287). Diyabet en sýk karþýlaþýlan komorbidite idi (%44). Hastaneye baþvuruya kadar geçen süre, baþvuru sýrasýnda lezyonun boyutu ve FG þiddet indeksi açýsýndan gruplar arasýnda fark tespit edilmedi. Grup II’de FG þiddet indeksi skorunun tekrarlanan her operasyon öncesinde anlamlý derecede artýþ gösterdiði saptandý (p<0,05).
SONUÇ
Her ne kadar tek veya çok sayýda debridman uygulanan hastalar arasýnda debridman sayýsýný etkileyebilecek anlamlý fark saptanmamýþsa da; FG þiddet indeksi, tekrarlanan her debridmanda arttýðý tespit edildiði için, ilave debridmanlara karar vermede yardýmcý olabilir.

BACKGROUND
We aimed to evaluate the factors potentially affecting the number of surgical debridements in patients with Fournier’s gangrene (FG) who underwent single or multiple operative sessions.
METHODS
We retrospectively reviewed the data of 36 patients with FG. The patients were assigned to one of two groups according to the number of debridements (Group I: single session; Group II: ≥2 sessions). Data of the patients (clinical and surgical data, lesion characteristics, FG severity index, and prognosis) were compared between the groups.
RESULTS
The mean age of the patients was 55.5 years, and all were male. Group I consisted of 21 patients and Group II of 15 patients. The mean number of debridements was 2.2 in Group II. Our overall mortality rate was 11% (Group I: 4.8% vs Group II: 20%; p=0.287). Diabetes was the most common coexistent pathology (44%). Time to admission to the clinic, size of the lesions at admission, and FG Severity Index (FGSI) scores of the groups were similar. In Group II, FGSI scores were found increased before each of the repeated debridement sessions (p<0.05).
CONCLUSION
There was no difference in the clinical data of the patients who required single or multiple debridement sessions; however, FGSI may be useful in deciding repeated debridements, as it was found increased at each repeated session.

AMAÇ
Bu çalýþmanýn amacý, etyolojik mekanizmalarýna baðlý olarak iþ kazalarýna baðlý el yaralanmalarý için alternatif bir sýnýflama sistemi ortaya koymaktýr.
GEREÇ VE YÖNTEM
Ýki el cerrahisi ünitesi cerrahlarýnca, Ocak 2005 ile Aralýk 2007 yýllarý arasýnda ameliyat edilen hastalarýn geriye dönük olarak analizleri yapýldý. Hasta dosyalarý retrospektif incelendi ve yaralanmaya neden olan mekanizmalar incelendi. Benzer yaralanma mekanizmalarý ayný gruplarda sýnýflandýrýldý ve görülme sýklýklarý araþtýrýldý. Yaralanmalarýn sýnýflandýrýlmasýnda hasarlanan dokular temel alýndý. Hastaneye yatýrýlan 4120 el cerrahisi hastasýndan 2188’i (%53,1) iþ kazasý sonucu yaralanan olgular idi. Bunlarýn 2063’ü erkek (%94,3), 125’i kadýndý (%6,7). Ortalama yaþ 28,2 (daðýlým 15-71 yaþ) idi.
BULGULAR
Yaralanmaya neden olan ajanlarýn incelenmesinde 62 ajan belirlendi. Bu ajanlarýn ileri incelemesi ile benzer yaralanmaya neden olan ajanlar “iþ kazalarýna baðlý el yaralanmalarýnýn etyolojik sýnýflandýrmasý”na (ÝKEYES) göre gruplandýrýldý. Bu gruplarý kesici-delici, kesici-ezici, ezici-delici, ezici-sýkýþtýrýcý, ezici-yakýcý, batýcý, avulziyon, elektrik çarpmasý ve kimyasal yaralanmalar ve diðer yanýklar oluþturdu. Etyolojideki en sýk iki mekanizmayý 744 (%34,0) olgu sayýsý ile ezici-sýkýþtýrýcý yaralanmalar ile 514 (%23,5) olgu sayýsý ile kesici-ezici yaralanmalar oluþturmaktaydý.
SONUÇ
ÝKEYES sýnýflamasýnýn literatürde etyolojik faktörlerin sýnýflamasý için ortak bir dil oluþturulabilmekte önemli olduðuna inanmaktayýz.

BACKGROUND
The aim of this study was to construct an alternative classification system for occupational hand injuries based on etiologic mechanisms and to analyze the injury patterns resulting from various mechanisms.
METHODS
A retrospective analysis of patients operated between January 2005 and December 2007 in two hand surgery units staffed by a team of hand surgeons was made. The patient files were retrospectively examined, and mechanisms causing the injuries were analyzed. Similar mechanisms were classified in the same groups, and the mechanism of injury was matched with type of injury often caused by this mechanism. In the classification of injuries, the tissues that were injured were taken as a basis for classification. 4120 upper extremity injuries were seen in the study hospitals, and 2188 (53.1%) of them were occupational injuries. There were 2063 males (94.3%) and 125 females (6.7%). The mean age was 28.2 (range: 15-71) years.
RESULTS
Examination of the agents causing injury yielded 62 agents. Further examination of these agents showed that the mechanism by which they caused injury was similar in some agents, and these agents were placed in the same groups, which constituted the Etiologic Classification of Hand Injuries (ECOHI) classification. These groups of mechanisms were: cutting-penetrating, cutting-crushing, crushing-penetrating, crushing-compressing, crushing-burning, stinging, avulsing, electrical current, and chemical injuries and miscellaneous burns. The two most common mechanisms were crushing-compressing and cutting-crushing types, constituting 744 (34.0%) and 514 (23.5%) of injuries, respectively.
CONCLUSION
We believe that ECOHI is important to form a common language for the classification of etiologic factors.

AMAÇ
Bu çalýþmanýn amacý, hastanemize baþvuran harman dövme makinesine baðlý üst ekstremite yaralanmasý bulunan hastalarý sunmak, en uygun sýnýflandýrmayý belirlemek, tedavi seçeneklerini deðerlendirmek ve korunma yollarýný tartýþmaktýr.
GEREÇ VE YÖNTEM
Harman dövme makinesine baðlý yaralanmasý olan 25 hasta geriye dönük olarak incelendi. Hastalarýn yaþlarý, cinsiyetleri, baþvuru aylarý, hastanede kalma süreleri, yaralanan dokularýn çeþidi ve uygulanan tedaviler açýsýndan analiz edildi.
BULGULAR
Hastalarýn 24’ü erkek 1’i kadýn ve yaþ ortalamalarý 19,4 (daðýlým, 2-51 yaþ) idi. Hastalarýn %60’ý 15 yaþýn altýndaydý. Hastalar en çok Aðustos ayýnda baþvuru yaptýlar.
SONUÇ
Tarým makinelerinin yaralanmaya sebep olan dönen parçalarýnýn korunaklarla saklanmasýnýn, tarým ile uðraþan ailelerin saðlýk çalýþanlarý tarafýndan bilgilendirilmelerinin, çocuklarýn tarým makinelerinin olduðu bölgelere girmelerinin yasaklanmasýnýn, tarým sektörünün geliþtiði bölgelerdeki okullarda çocuklara tarým kazalarý ve önleme yollarý hakkýnda bilgi verilmesinin, yýlýn en sýcak olduðu aylarda tarým çalýþanlarýnýn mesai saatlerinde ayarlamalar yapýlmasýnýn tarým makinelerine baðlý kazalarýn önlenmesinde faydalý olacaðý kanaatindeyiz.

BACKGROUND
The aim of this study was to report the patients who were admitted to our hospital with upper extremity injuries due to threshing machine, to determine the most appropriate classification, to estimate the treatment modalities, and to discuss the prevention methods.
METHODS
Twenty-five patients who had suffered injuries sustained by a threshing machine were retrospectively investigated. The patients were analyzed with respect to age, gender, admission month, hospitalization period, the type of injured tissue, and the treatment modality.
RESULTS
Twenty-four of the patients were male and one was female, and the mean age of the patients was 19.4 (2-51) years; 60% of the patients were under the age of 15. The patients were admitted most commonly in the month of August.
CONCLUSION
We believe that shielding the rotating components of farming machinery that cause injuries, informing and educating farming families (by physicians), forbidding the entrance of children to areas with agricultural machines, providing information to children in schools (in those regions with developing agriculture) about agricultural accidents and their prevention methods, and adjusting the working hours of farming personnel, especially in the hottest months of the year, may be beneficial in preventing accidents due to farming machinery.

AMAÇ
Bu çalýþmada, üzerine televizyon (TV) düþmesi sebebiyle yaralanan çocuklarýn risk faktörleri, yaralanma çeþitleri ve cerrahi giriþimler geriye dönük olarak incelendi.
GEREÇ VE YÖNTEM
Bu çalýþmaya Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi, Travma ve Acil Cerrahi Birimine baþvuran 42 çocuk hasta dahil edildi. Olgularýn tümünde demografik ve yaralanma detaylarý, televizyon tipleri, mobilya türü, yaralanmanýn mekanizmasý, pediatrik travma skoru (PTS), pediatrik Glaskow koma skalasý (PGKS), hastanede kalýþ süresi, yoðun bakým ünitesi deðerlendirmesinin gerekliliði ve tedavi planlarý incelendi.
BULGULAR
Çocuklarýn %65’inden fazlasý 1 ile 3 yaþ arasýnda idi. Yaralanma erkeklerde (%66,7), kýzlara (%33,3) oranla daha fazla idi. Kýrk iki hastanýn 17’sinde (%40,5) sadece kafa travmasý mevcuttu, bunlarýn yaklaþýk olarak yarýsýnda travmatik beyin hasarý görüldü. Altý hastada sadece toraks travmasý (%14,3) ve dört hastada ise (%9,5) sadece ekstremite travmasý saptandý. Ortalama PGKS 7 (3-15) ve ortalama PTS 9 (-6 ve 12) idi. TV düþmesi sonucu beþ çocuk hayatýný kaybetti, bunlarýn hepsi iki yaþ ve altýnda idi ve hepsinde kafa ve toraks travmasý bulunmaktaydý. Bu çocuklarýn baþvuru anýndaki PTS ve PGKS skorlarý daha büyük çocuklara oranla daha düþüktü. TV düþmesi sonucu yaralanmalarýn en sýk nedeni uygun olmayan sabitleyicilerdir. Büfeler ve raflarda bu sorun daha sýktýr (%71,4), en sýk yaralanma mekanizmalarý ise mobilyanýn üzerine düþmesi veya çocuðun mobilyayý kendi üzerine doðru çekmesidir (%19).
SONUÇ
Televizyon düþmeleri ile ilgili yaralanmalar çocuklarda ciddi morbidite ve mortaliteye yol açabilir. Bunlar önlenebilir yaralanmalardýr. Çocuklarýn televizyon etrafýndaki hareketleri kýsýtlanmalý ve çocuklar mutlaka iyi denetlenmelidir.

BACKGROUND
We reviewed retrospectively TV-related injuries to determine the risk factors, type of injuries, and operative intervention(s) required in children injured by falling TVs.
METHODS
This was a retrospective descriptive study conducted on 42 pediatric patients who were admitted to Istanbul University, Istanbul Medical Faculty, Emergency Surgery Department. Case notes included all demographic and injury details, TV and TV-related furniture type, mechanism of injury, Pediatric Trauma Score (PTS), Pediatric Glasgow Coma Scale (PGCS), length of hospital stay, need for intensive care unit assessments, and management plans.
RESULTS
More than 65% of the children were aged 1 to 3 years. The injury rate was higher for boys (66.7%) than girls (33.3%). Of the 42 patients identified, 17 (40.5%) sustained only head injuries, with almost half of these having a definite traumatic brain injury; 6 (14.3%) had only thoracic injury, and 4 (9.5%) had only limb injury. The PGCS ranged from 3 to 15, with a mean of 7. The PTS ranged from -6 to 12, with a mean of 9. Five children (11.9%), all aged 2 years or younger, died in the hospital as a result of the TV-related injury, all sustaining head and thorax injuries, which are reflected in a significantly lower PTS and lower PGCS on admission compared with older children. TV falls on to children often occur because of unstable supports, with dressers and shelves being the most common. The most common mechanism of injury (71.4%) among all age groups was fall/tipping of furniture. Pulling the furniture onto oneself (19%) was the second most frequent mechanism of injury.
CONCLUSION
Injuries related to TV falls can lead to significant morbidity and mortality in children. As they are preventable injuries, restricted activity and improved supervision of children around the TV can potentially lead to fewer incidences.

AMAÇ
Bu çalýþmanýn amacý, perkütan kanüle vida veya dinamik kalça vidasý (DKV) ile tedavi edilen femur boyun kýrýklý hastalarýn kaynama süresi, fonksiyonel sonuçlar ve komplikasyonlar açýsýndan karþýlaþtýrýlmasýdýr.
GEREÇ VE YÖNTEM
Aðustos 1999 ile Ekim 2003 tarihleri arasýnda femur boyun kýrýðý bulunan altmýþ altý hasta perkütan kanüle vida (n=33) veya DKV (n=33) ile tedavi edildi. Fonksiyonel sonuçlar Harris kalça skoru ile deðerlendirildi. Çalýþmada ayrýca kayanama süreleri, kanama miktarý ve komplikasyon oraný ölçüldü.
BULGULAR
Kaynama süreleri ve fonksiyonel sonuçlar açýsýndan iki grup arasýnda anlamlý fark bulunmadý. Avasküler nekroz riski en çok kýrýðýn kayma miktarý ile iliþkili bulundu. Perkütan kanüle vida uygulanan grupta ameliyat süresi ve kanama miktarý anlamlý olarak daha düþük bulundu.
SONUÇ
Kayanama süresi ve fonksiyonel sonuç açýsýndan perkütan kanüle vida ve DKV uygulamarýnýn birbirlerine üstünlüðü bulunmamaktadýr. Avasküler nekroz riski kýrýðýn kayma miktarý ile iliþkilidir. Bununla birlikte ayný kayma miktarý bulunan hastlarda iki tekniðin birbirleri ile karþýlaþtýrýlmasý için prospektif randomize bir çalýþma gereksinimi vardýr.

BACKGROUND
The purpose of this study was to compare the period of union, functional outcomes and complications of patients with femoral neck fracture treated with percutaneous cannulated screws versus dynamic hip screw (DHS).
METHODS
Sixty-six patients with femoral neck fracture were treated with percutaneous cannulated screws (n=33) or with DHS (n=33) between August 1999 and October 2003. Functional outcome was measured using Harris Hip Score, and period of union, amount of bleeding and complications were also recorded.
RESULTS
The period of union and functional outcomes were not different between the two groups. Risk of avascular necrosis (AVN) was associated mainly with the grade of fracture displacement. In the percutaneous cannulated screw group, duration of surgery was shorter and blood loss was less than in the other group.
CONCLUSION
There was no superiority between cannulated screws and DHS according to union times and functional results. Risk of AVN is related to the degree of displacement. However, a prospective randomized study is needed to determine the outcome of each technique for patients suffering similar displacement rates.

AMAÇ
Bu retrospektif çalýþmanýn amacý, apendiküler kitle tespit edilen hastalarda erken apendektominin güvenirliðini ve etkinliðini araþtýrmaktýr.
GEREÇ VE YÖNTEM
Vakýf Gureba Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði’ne Ocak 2004 ile Nisan 2010 tarihleri arasýnda baþvuran 47 hasta apendiküler kitle nedeni ile 24 saat içerisinde ameliyat edildi. Apendiküler kitle tanýsý fiziksel inceleme, karýn ultrasonografisi, bilgisayarlý tomografi ya da ameliyat sýrasýnda konuldu. Yaþ ve cinsiyet, semptomlarýn süresi, baþvuruda fiziksel inceleme bulgularý, ameliyat bulgularý, intraoperatif ve postoperatif komplikasyonlar ile hastanede yatýþ süresi her hasta için analiz edildi.
BULGULAR
Çalýþmaya 25 erkek (%53,2) ve 22 kadýn (%46,8) hasta alýndý. Ortalama yaþ 37,23±15,60 (daðýlým 14-75 yaþ) idi. Semptomlarýn baþlamasý ile ameliyat arasýnda geçen ortalama zaman 4,06±2,50 gündü (daðýlým 1-15 gün). Apendektomi 38 hastada (%80,9) uygulandý. Yirmi dokuz hasta (%61,8) cerrahi sonrasý herhangi bir komplikasyon olmaksýzýn taburcu edildi. Yara yeri enfeksiyonu 13 hastada (%27,7) saptandý.
SONUÇ
Erken apendektomi, apandiküler kitlelerde konservatif tedaviye alternatif güvenli ve etkili bir yöntemdir.

BACKGROUND
The aim of this retrospective study was to evaluate the safety and effectiveness of immediate appendectomy in patients presenting with appendicular mass.
METHODS
Forty-seven patients with appendicular mass were operated within 24 hours after admission to Vakif Gureba Training and Research Hospital, General Surgery Department, from January 2004 to April 2010. The appendiceal mass was diagnosed with physical examination, abdominal ultrasonography, and computed tomography, or during surgical exploration. Age and sex, duration of symptoms, physical examination findings at admission, operation details, intraoperative and postoperative complications, and length of hospital stay were analyzed for each patient.
RESULTS
There were 25 males (53.2%) and 22 females (46.8%), with a mean age of 37.23±15.60 (range: 14-75) years. The mean time from the onset of the symptoms to operation was 4.06±2.50 (range: 1-15) days. A simple appendectomy was performed in 38 (80.9%) patients. Twenty-nine (61.8%) patients were discharged and followed up without any complication after surgery. Wound infection was detected in 13 (27.7%) patients.
CONCLUSION
Immediate appendectomy in appendicular mass is a safe and effective alternative to conservative management.

AMAÇ
Yüzeysel korneal yabancý cisimler acil servise sýk baþvuran olgulardýr. Bu çalýþmanýn amacý, acil servise yabancý cisimlerle oluþan göz travmasýyla baþvuran olgularý tanýmlamak ve göz travmasýnýn önlenmesi ve acil servis yönetim stratejilerini tartýþmaktýr.
GEREÇ VE YÖNTEM
Çalýþma geçmiþ iki yýlýn kayýtlarý incelenerek geriye dönük olarak yapýldý. Demografik bilgiler, yaralanma zamaný, yaralanma tipi (açýk veya kapalý glob yaralanmasý), yabancý cismin ne olduðu, hastane yatýþ ve oftalmoloji konsültasyonu varlýðý, uygulanan tedaviler ve geç dönemde görülen kalýcý hasarlar kaydedildi.
BULGULAR
Toplam 476 hasta çalýþmaya alýndý, hastalarýn %83’ü erkekti, ortalama yaþ 34,16±14,02 idi. Yaralanmalarýn %9,7’si açýk glob yaralanmasý iken, kalanlar yüzeysel yabancý cisim bulunan veya bulunmayan kapalý yaralanmalardý. En sýk görülen yabancý cisimler metal çapaklarý (%37,6) ve toz (%31,1) olarak saptandý. Hastalarýn çoðunda (%72,1) iþ yerinde yaralanma söz konusuydu. Hastalarýn %42,4’ü oftalmoloji ile konsülte edilirken, diðer hastalar acil týp asistan ve uzmanlarý tarafýndan tedavi edildi. Hastalarýn %10’u hastaneye yatýrýldý ve %2,3’ünde uzun dönemde komplikasyon görüldü.
SONUÇ
Göz yabancý cisim travmalarý en çok genç saðlýklý erkeklerin, iþ nedenli yaralanmalarý olarak oluþmaktadýr. Çok sayýda göz travmasý acil servislerde görüldüðü için, acil servis hekimleri yüzeysel korneal yabancý cisimlerin tanýnmasý, tedavisi ve yönetimi konusunda eðitilmelidir.

BACKGROUND
Superficial corneal foreign bodies (SCFB) are common injuries seen in the ED. The aim of this study was to describe the eye injuries caused by FBs and to determine clinical strategies for the prevention and management of ocular trauma.
METHODS
This was a retrospective chart review of the previous two years. Demographic data, timing of the injury, injury type (open- or closed-globe injuries), source of the FB, hospital admission and ophthalmology consultation, treatments, and the long-term complications were recorded for each patient.
RESULTS
There were 476 patients, and 83% were male, with an average age of 34.16±14.02 years. 9.7% of the eyes had an open-globe injury, while the rest were closed-globe injuries with or without SCFB. The most common FBs were metal fragments (37.6%) and dust (31.1%). The majority of the patients (72.1%) sustained work-related injuries. 42.4% of the patients were consulted to ophthalmology, and the remaining were treated by the emergency physicians. Only 10% of the patients required hospitalization, and complications were seen in 2.3% of the patients.
CONCLUSION
Ocular FB involved mainly young healthy males who had sustained work-related injuries. In view of the large number of eye injuries seen in EDs, ED colleagues should train themselves in order to appropriately recognize, treat and refer the SCFB injuries seen in the ED.

Direkt radyografi veya bilgisayarlý tomografide (BT) vertebralarda kýrýk veya çýkýk bulgularý olmaksýzýn görülen omurilik yaralanmalarý SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) olarak adlandýrýlmaktadýr. Bu tür yaralanmalar, omurganýn kendine özgü anatomik ve fonksiyonel özellikleri nedeniyle çocuklarda daha sýk görülür. Bu yazýda, anatomik olarak tam kat kesi ile birlikte ve iki seviyede ayný anda olarak görülen nadir bir SCIWORA olgusunun sunulmasý ve SCIWORA’nýn adli týp açýsýndan öneminin vurgulanmasý amaçlandý.
Üç yaþýnda bir erkek çocuðu otomobil çarpmasý sonrasýnda paraplejik halde acil servise getirýldi, BT’de ve direkt radyografik incelemelerde herhangi bir kemik kýrýðý veya çýkýk olmamakla birlikte manyetik rezonans görüntülemede T3-4 ve T6-7 seviyelerinde omurilikte tama yakýn ve tam kat kesi ile bütünlük kaybý izlendi.
Bugüne kadar literatürde sadece iki adet çift seviyeli SCIWORA olgusu bildirilmiþtir. Ancak bu olgu çift seviyeli SCIWORA’nýn tam kat kesi ile birlikte görüldüðü ilk olgudur. Trafik kazasýnýn adli týp açýsýndan rekonstrüksiyonu ile ilgili olarak bu olgudaki yaralanma mekanizmasý tam anlaþýlamamýþtýr.

Spinal cord injuries without evidence of vertebral fracture or dislocation on plain radiographs and computed tomography are referred to as SCIWORA (Spinal Cord Injury without Radiological Abnormality). This entity is seen more often in children due to the specific anatomical and functional properties of the pediatric spine. The aim of this study was to present a rare case in which SCIWORA occurred at two levels simultaneously with complete anatomic transection and to emphasize the importance of SCIWORA in forensic medicine. A three-year-old boy was admitted to the emergency department with paraplegia after being hit by a car. Computed tomography and plain radiographs failed to reveal any bone fracture or dislocation. However, magnetic resonance imaging showed loss of continuity with near-complete and complete anatomic transection of the spinal cord at the T3-4 and T6-7 levels. According to the literature, only two cases of double-level SCIWORA have been reported previously. However, this is the first case of double-level SCIWORA with complete anatomic transection. The mechanism of injury in the case reported here remains obscure regarding the forensic reconstruction of the event.

Biz burada çift lümenli endotrakeal tüp ile entübasyon sonrasýnda 7 cm’lik trakeal rüptür oluþan 48 yaþýndaki hastayý sunmak istiyoruz. Ringli vasküler greft ile desteklenmiþ plevral yama kullanýlarak yeni bir teknik ile trakea yaralanmasý onarýldý. Bu tekniðin büyük trakea yaralanmasý olan hastalarda kullanýmý trakea stenozunu önleme açýsýndan uygun olabilir.

Here we describe a 48-year-old woman who suffered a 7-cm rupture in the lower trachea after intubation with a double-lumen tube. We repaired the rupture with a new technique using a pleural patch reinforced by a ringed vascular graft. This technique appears to be appropriate for use in patients who have large tracheal ruptures to avoid tracheal stenosis.

Kehr bulgusu ilk olarak Alman cerrah Hans Kehr (1862–1916) tarafýndan tanýmlanmýþtýr. Kehr bulgusu yansýyan aðrýnýn klasik bir örneðidir. Diyafram irritasyonu klavikulanýn üzerindeki bir bölgede aðrý duyusu olarak frenik sinir tarafýndan oluþturulur. Acil servise sol omuz aðrýsý nedeniyle baþvuran ve splenik apse tanýsý konulan 21 yaþýndaki kadýn olguyu sunduk.

Kehr’s sign was originally described by the German surgeon Hans Kehr (1862-1916). It is a classical example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the clavicle. We present a case of a 21-year-old woman admitted to the emergency department with the chief complaint of left shoulder pain related to splenic abscess.

Gastrointestinal sistemin yabancý cisimlerle perforasyonu farklý klinik tablolarla kendini gösterebilir ve operasyon öncesi doðru taný nadiren konulur. Biz hastanemize sað alt karýn aðrýsý ile baþvuran, klinik olarak akut apandisit ve divertikülit öntanýlarý düþünülen, 69 yaþýndaki kadýn hastanýn multidedektör bilgisayarlý tomografi incelemesinde balýk kýlçýðýna baðlý terminal ileum perforasyonu saptadýk. Bu gibi olgularda doðru taný koyabilmek için öncelikle klinik olarak þüphelenmek gerekir.

Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report the case of a 69-year-old woman who experienced severe pain in the right iliac fossa. The presumptive diagnosis was acute purulent appendicitis or diverticulitis. Multidetector computed tomography (MDCT) imaging showed the fish bone perforation of the terminal ileum. A high index of suspicion should always be maintained in order for the correct diagnosis to be made.

Travma olmadan iki taraflý kalça kýrýklarý nadirdir, fakat epileptik nöbetler bu tip kýrýklara neden olabilir. Bu olgu sunumunda, 82 yaþýnda, kemik kalitesi kötü olan ve 20 yýllýk epilepsi hastasý olduðu bilinen bir kadýn olgu sunuldu. Hasta yaklaþýk 20 yýldýr antikonvülzan ilaçlar kullanmaktaydý; bir epilepsi ataðý sýrasýnda her iki kalçasýnda intertrokanterik femur kýrýðý oluþtuðu, fakat tanýnýn 12. gün sonra konulabildiði öðrenildi. Daha erken çekilen bir pelvis ön-arka grafisi erken taný için yardýmcý olabilirdi. Epilepsi hastalarýnda travma olmaksýzýn kýrýklar olabileceði akýlda tutulmalýdýr.

Although spontaneous and simultaneous bilateral hip fractures without trauma are seen rarely, epileptic seizures may lead to these fractures. We present an 82-year-old female patient with poor bone quality and a 20-year history of epilepsy. She had been using anticonvulsant drugs for almost 20 years. Following a convulsive epileptic attack, bilateral intertrochanteric femur fractures occurred (causing bilateral hip pain), which was diagnosed on the 12th day. An earlier pelvic anteroposterior roentgenogram would be helpful for early diagnosis. It should not be forgotten that bone fractures may be observed without trauma in epilepsy patients.

Künt travma sonrasý diyafram yýrtýðý nadir görülür. Bu yazýda, trafik kazasý geçirdikten 3 yýl sonra acil servisimize baþvurup baðýrsak týkanýklýðý nedeniyle laparatomi yapýlan 24 yaþlarýndaki erkek olgu sunuldu. Diyafram yýrtýklarýnýn karýn içi organlarýn fýtýklaþmalarý ya da mekanik intestinal týkanýklýk nedeni olabileceðini, tanýsý konduðunda bu olgularýn zaman geçirmeden ameliyat edilmesi gerektiðini düþünüyoruz.

Rupture of the diaphragm after blunt trauma is uncommon. In this report, a 24-year-old male with intestinal obstruction who underwent laparotomy is presented; he had been involved in a traffic accident three years prior to presentation to our emergency service. We conclude that diaphragma ruptures may cause herniation of abdominal organs and intestinal obstruction, and thus should be repaired when diagnosed.