AMAÇ Bazý çalýþmalarda, trapidilin periferik sinir sisteminde iskemi ve reperfüzyon hasarýndaki koruyucu etkileri gösterilmiþtir. Ancak, periferik sinir hasarý sonrasý trapidilin etkileri deðerlendirilmemiþtir. Çalýþmamýzýn amacý, düþük doz trapidil’in sinir rejenerasyonu üzerindeki etkilerini elektrofizyolojik yöntemle saptamaktýr.
GEREÇ VE YÖNTEM Siyatik sinir, bir “jeweler forceps” ile 20 saniye sýkýþtýrýldý. Trapidil tedavi gruplarýna, sinir hasarý sonrasý tek doz trapidil (8 mg/kg) intraperitoneal olarak enjekte edildi. Sinir hasarýný takiben 2., 7., 15., 30. ve 45. günlerde sadece hasar uygulanan gruptan ve hasar+trapidil grubundan elektrofizyolojik kayýtlar yapýldý.
BULGULAR Sinir hasarýný izleyen ikinci günde, trapidil tedavisi uygulanmayan gruptan kaydedilen EMG kayýtlarýndan elde edilen gastroknemus kasýna ait bileþik motor aksiyon potansiyellerinin, kontrol hayvanlarýndan elde edilene göre daha düþük genlikte olduðu bulundu; keza, ayný sonuç kontrol ve trapidil grubu arasýnda da gözlendi. Her iki gruptan kaydedilen (sadece hasar uygulanan grup ile hasar ve trapidil uygulanan grup) aksiyon potansiyelleri parametreleri, deneyin sonunda (45. günde) kontrol deðerlerine ulaþmadý. Hasar uygulanan ile hasar ve trapidil uygulanan sýçanlardan 2., 7., 15., 30. ve 45. günlerde kaydedilen aksiyon potansiyellerinin genlik, alan ve distal latans parametreleri arasýnda anlamlý farklýlýk bulunmadý. SONUÇ Sinir hasarý uygulanan sýçanlarda, bir düþük doz trapidil uygulanmasýnýn, elektrofizyolojik yöntem kullanýlarak sinir koruyucu bir etkisi olmadýðý sonucuna varýldý.

BACKGROUND Trapidil has been shown to possess the protective effects in the treatment of ischemia and reperfusion injury in the peripheral nervous system. The purpose of this study was to determine the effects of low dose trapidil on peripheral nerve regeneration with electrophysiological method. METHODS The sciatic nerve was compressed for 20 sec by using a jeweler’s forceps. Trapidil treatment groups were administrated a single dose of trapidil (8 mg/kg) intraperitoneally just after the injury. Electrophysiological recordings were performed in crush and crush + trapidil treatment groups on the 2nd, 7th, 15th, 30th and 45th days following the nerve injury. RESULTS EMG recordings on the second day following the crush injury showed low values of compound motor action potentials in the gastrocnemius muscle when compared to normal values obtained in intact animals; also, the values on the second day following the crush injury were significantly different between control and trapidil-treated groups. The action potential values for both groups did not yet reach baseline values at the end of the experiment. There was no difference in the action potential amplitude, area and distal latency values between rats with crush and crush+trapidil on all days. CONCLUSION We could not prove a neuroprotective effect of a single low dose of trapidil in rat crush injury model using electrophysiological method.

AMAÇ Bu çalýþma, bir-üç yaþ grubu çocuðu olan annelere verilen eðitimin, evde güvenlik önlemleri alýnmasý ve kaza görülme sýklýðýna etkisini incelemek amacýyla yarý deneysel olarak yapýldý. GEREÇ VE YÖNTEM Denizli ili Çivril ilçesinde bir-üç yaþ grubunda çocuða sahip olan, iletiþim sorunu olmayan, araþtýrmaya katýlmaya istekli, çalýþmayan, okur yazar olan, 60 anne araþtýrmanýn örneklemini oluþturdu. BULGULAR Verilerin toplanmasýnda “0-6 Yaþ Çocuklarda Annenin Ev Kazalarýna Yönelik Güvenlik Önlemlerini Tanýlama Ölçeði” ve “Ev Kazalarýyla Karþýlaþma Sýklýðý Formu” kullanýldý. Test öncesi ve test sonrasý uygulamalarý ile verilen eðitimin etkinliði deðerlendirildi. Eðitim öncesi ve eðitim sonrasý annelerin tutum puan ortalamalarý ve çocuklarda kaza görülme sýklýðý arasýnda anlamlý bir farklýlýk saptandý. SONUÇ Bire bir ev ziyaretleri ile ev ortamýndaki riskleri ve anne eðitim gereksinimlerini belirleyip bu gereksinimlere göre eðitim ve danýþmanlýk yapýlmasý, çocuk geliþimi hakkýnda ebeveyn eðitimi saðlanmasý önerilebilir.

BACKGROUND This study was conducted with the mothers of 1-3 year old children as a quasi-experimental study for the purpose of examining the effect of home safety education on taking precautions and the incidence of home accidents. METHODS The research sample was composed of 60 mothers of 1-3 year old children who were living in Çivril municipality of Denizli province, had no difficulty in communication, agreed to participate in the research, were not working and could read and write. RESULTS The tools used for data collection were “0-6 Year Old Children’s Mothers’ Knowledge of Safety Precautions for the Prevention of Home Accidents Scale” and “Frequency of Encountering Home Accidents Form”. The effect of education was evaluated with pre-test and post-test utilization. A significant difference was seen in the mothers’ mean conduct score and in the frequency of children’s accidents before and after education. CONCLUSION It is recommended that individual home visits should be made to determine the risks in the home environment and the educational needs of mothers. Education and counseling should be given based on these needs and adult education should be provided on the subject of child development.

AMAÇ Önkol voler yüzde düzgün tendon yaralanmasý olan olgularda erken primer tamir ve pasif hareket sonrasý distal radiusta meydana gelen kemik mineral yoðunluðundaki deðiþimin araþtýrýlmasý. GEREÇ VE YÖNTEM On beþ dominant olmayan el yaralanmasý olan hasta (grup I), 12 dominant el yaralanmasý olan hasta (grup II) ve saðlýklý gönüllülerden oluþan 15 kiþilik kontrol grubu (grup III) çalýþmaya alýndý. Ameliyattan sonra 6. haftada ve 4. ayda elde edilen önkol proksimal, orta ve ultradistal bölgelerin yan-yana kemik mineral içeriðindeki deðiþimler (SSD) istatistiksel yöntemlerle karþýlaþtýrýldý.
BULGULAR Kontrol grubu ile kýyaslandýðýnda, grup II olgularda altýncý haftada radiusun proksimal ve orta bölgelerindeki SSD ölçümleri anlamlý derecede azaldý (p<0,01 ve p<0,001). Bu azalma sýrayla %8,9 ve %8,6 oranýndaydý. Benzer þekilde, kontrol grubu ile kýyaslandýðýnda, grup II olgularda dördüncü ay radiusun proksimal ve orta bölgelerindeki SSD ölçümleri anlamlý derecede azaldý (p<0,001). Bu azalma sýrayla %10,2 ve %7,7 olduðu kaydedildi. Grup I’de 4. aydaki radius orta kýsým SSD ölçümündeki %7,4 azalma hariç tutulursa, kontrol grubuna kýyaslandýðýnda SSD ölçümlerinin anlamlý farklýlýðý yoktu. SONUÇ Önkol voler yüzde düzgün tendon yaralanmasý olan olgularda erken primer tamir ve pasif hareket sonrasý distal radiusta meydana gelen kemik mineral yoðunluðunda anlamlý derecede azalma olabilmektedir.

BACKGROUND We investigated the changes of bone mineral density at distal radius and ulna in patients with volar wrist clean-cut tendon(s) injuries that were treated by early primary repair and passive mobilization. METHODS Fifteen patients with non-dominant hand injury (group I), 12 patients with dominant hand injury (group II) and 15 healthy volunteers serving as the control group (group III) were enrolled into this study. Side to side bone mineral component differences (SSD) of the proximal, middle and ultradistal radius that were obtained at 6th week and 4th month after operation were statistically compared. RESULTS In comparison with the control group, SSD measurements of the middle and proximal subregions of group II at the 6th week were significantly decreased (p<0.01 and p<0.001). The decreases were 8.9 and 8.6% respectively. Similarly, the 4th month SSD measurements of the middle and proximal subregions of group II were also significantly decreased compared to group III (p<0.001). The decreases were 10.2% and 7.7%, respectively. In group I, except a 7.4% decrease at the middle subregion of the radius at 4th month, there was no significant difference in SSD measurements as compared with the control group. CONCLUSION Results of our study indicate that there is a considerable bone loss of distal radius in patients who are surgically treated for acute clean-cut tendon(s) injuries at the volar wrist level.

AMAÇ: Bu çalýþmada Türk Ceza Kanunu’nda tanýmlanan “Yaþamý tehlikeye sokan yaralanma” kavramýnýn deðerlendirilmesinde uluslararasý travma çalýþmalarýnda kullanýlan, GCS (Glasgow Coma Scale), RTS (Revised Trauma Score), ISS (Injury Severity Score), NISS (New Injury Severity Score) ve TRISS (Trauma and Injury Severity Score) skorlama sistemlerinin doðruluðunun karþýlaþtýrýlmasý ve kullanýlabilirliðinin kontrol edilmesi amaçlanmýþtýr.
GEREÇ-YÖNTEM: 2003 yýlýnda, Uludað Üniversitesi Týp Fakültesi Hastanesi Acil Servisi’ne kabul edilen 627 travma hastasýnýn, yaþ, cins, travma tipi, yaralanma tipi ve lokalizasyonu, GCS, RTS, ISS, NISS ve TRISS deðerleri ile yaþamý tehlikeye sokan yaralanma olup olmadýðý incelenmiþtir.
BULGULAR: Olgularýn % 35.2’sinde yaþamý tehlikeye sokan yaralanma saptanmýþtýr. GCS, RTS, ISS, NISS ve TRISS deðerlerinin, yaþamý tehlikeye sokan yaralanma kararý verilen hastalara uygunluðu sýrasýyla, %74.8, %76.9, %88.7, %86.6, %68.6 saptanmýþtýr. En iyi uygunluk cut-off noktasý 14, sensitivite %79.6, spesifite %93.6 ile ISS sisteminde saptanmýþtýr. Resmi olarak yaþamý tehlikeye sokan yaralanma olarak karar verilen izole olarak kafatasýnda lineer kýrýk bulunan tüm olgularda ISS 5, NISS 6 ve GCS (15), RTS (7.8408) ve TRISS (%100) sisteminde en iyi deðerleri olan skorlar saptanmýþtýr.
SONUÇ: GCS, RTS ve TRISS ile karþýlaþtýrýldýðýnda, yaþamý tehlikeye sokan yaralanma kararýnýn verilmesinde ISS ve NISS en uygun travma skorlama sistemleri olarak görülmektedir ve Türk Ceza Kanunu’ndaki yaþamý tehlikeye sokan yaralanma kararýnýn deðerlendirilmesinde kullanýlabilecek, kabul edilebilir skorlar olabilir.

Background. To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the “life threatening injury” concept established by the Turkish Penal Code.
Methods. The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined.
Results. A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best association was determined with ISS in the cut-off point 14 with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408), and TRISS (100%).

AMAÇ Kalp yaralanmalarýndaki klinik bulgularý ve tedavi sonuçlarýný deðerlendirmektir. GEREÇ VE YÖNTEM 1996-2005 tarihleri arasýnda kliniðimizde kalp yaralanmasý nedeniyle cerrahi giriþim uygulanan hastalarýn verileri deðerlendirildi. BULGULAR Tümü delici kesici alet ile yaralanan, 18 hasta (17 erkek, 1 kadýn; ort. yaþ 25,9; daðýlým 17-45) ameliyat edildi. Acil servise getirildiklerinde beþ hasta (%27,8) agonide, yedi hasta (%38,9) derin þokta idi. Diðer altý hastada (%33,3) hipotansiyon (60-90 mmHg) vardý; hastalarýn üçüne (%16,7) ameliyat öncesi perikard tamponadý tanýsý konuldu. Ýki hastaya (%11,1) acil servis torakotomisi yapýldý. Agonideki hastalarda mortalite %80 olup, genel mortalite %44,5 idi. SONUÇ Kalp yaralanmalarý yüksek mortaliteye sahip olup, hastaneye ulaþabilen hastalarýn vital bulgularý ve genel durumlarý prognozu belirler. Bu hastalarda hýzlý deðerlendirme ve gecikmeden yapýlacak cerrahi giriþim mortaliteyi azaltacak en önemli faktörlerdir.

BACKGROUND The aim of this study was to evaluate our clinical findings and results of cardiac injuries. METHODS We reviewed the records of patients who were admitted to our clinic between 1996 and 2005 and operated due to penetrating cardiac injury. RESULTS Eighteen patients (17 male, one female; mean age 25.9; range 17-45 years) (all penetrating stab wounds) with cardiac injuries were operated. The clinical aspects were: agonal status in 5 patients (27.8%), profound shock in 7 patients (38.9%). The remaining 6 patients (33.3%) were in mild shock (hypotension 60-90 mmHg) and 3 of them (16.7%) had a diagnosis of cardiac tamponade preoperatively. Emergency room thoracotomy was made in 2 patients (11.1%). Mortality rate was %80 in agonal patients whereas overall mortality was 44.5%. CONCLUSION Cardiac injuries have high mortality. The mortality rate of the patients, who can arrive to the hospital alive, is c l o s ely related to the vital signs and general condition. The mortality can be reduced by quick evaluation and prompt surgical intervention.

AMAÇ Toraks travmalý hastalarda torasik epidural ve sistemik hasta kontrollü analjezi uygulamalarýnýn yoðun bakým tedavi sürecine etkileri geriye dönük olarak araþtýrýldý.
GEREÇ VE YÖNTEM Çalýþmamýzda 1997 ve 2003 yýllarý arasýnda yoðun bakým ünitesine (YBÜ) alýnan toraks travmasý sonrasý kot kýrýðý oluþan ve yoðun bakým tedavisi uygulanan olgular deðerlendirildi. Üç veya daha çok kot kýrýðý olan, fentanil ile intravenöz hasta kontrollü analjezi veya bupivakain ve fentanil ile torasik epidural analjezi uygulanan 49 olgu çalýþmaya alýndý. BULGULAR Gruplar arasýndaki yaralanma aðýrlýk skorunda fark saptanmadý. APACHE II skor deðerleri (8,1±1,6 ve 9,2±1,7) ve kýrýk kot sayýsý ortalama deðerleri (4±1,1 ve 6,8±2,7) torasik epidural uygulanan gruptaki hastalarda daha yüksekti (p<0,05). Torasik epidural analjezi uygulanan hastalarda tedavi süresince 6. saatten itibaren anlamlý düzeyde düþük aðrý skorlarý gözlendi (p<0,05). Gruplarýn YBÜ’de kalma süresi (15,6±5,9 ve 12,1±4,4 gün) torasik epidural analjezi grubunda daha kýsa olarak saptandý (p<0,05). Gruplar arasýnda mekanik ventilasyon gereksinimi, pulmoner ve kardiyak komplikasyonlar açýsýndan fark saptanmadý. SONUÇ Üçten fazla kot kýrýðý olan toraks travmalý olgularýn yoðun bakým tedavisinde, analjezi amacýyla lokal anestezik ve opioid infüzyonu ile torasik epidural analjezi kullanýmýnýn daha etkili analjezi saðlamasý ve YBÜ yatýþ süresini kýsaltmasý nedeniyle daha uygun olacaðý kanýsýndayýz.

BACKGROUND The results of thoracic epidural and systemic patient controlled analgesia practice were evaluated retrospectively in patients with thoracic trauma.
METHODS Patients who were admitted to the intensive care unit between 1997 and 2003, with a diagnosis of multiple rib fractures related to thoracic trauma were evaluated retrospectively. Data were recorded from 49 patients who met the following criteria; three or more rib fractures, initiation of PCA with I.V. phentanyl or thoracic epidural analgesia with phentanyl and bupivacaine. RESULTS There were no significant differences between the groups concerning injury severity score. APACHE II score (8.1±1.6 and 9.2±1.7) and the number of rib fractures (4±1.1 and 6.8±2.7) were higher in thoracic epidural analgesia group (p<0.05). Pain scores of patients who received thoracic epidural analgesia were significantly lower as from 6th hour during whole therapy (p<0.05). Length of intensive care unit stay (15.6±5.9 and 12.1±4.4 day) was found to be shorter in thoracic epidural analgesia group (p<0.05). There were no differences between the groups regarding mechanical ventilation requirement, pulmonary and cardiac complications. CONCLUSION We suggest that the use of thoracic epidural analgesia with infusion of local anesthetics and opioids are more appropriate as they provide more effective analgesia and shorten length of intensive care unit stay in chest trauma patients with more than three rib fractures who require intensive care.

AMAÇ Bu yazýda çocuk acil ünitemize gelen düþmeye baðlý travma olgularýný deðerlendirmeyi amaçladýk. GEREÇ VE YÖNTEM Çocuk acil ünitemize düþme þikayeti ile gelen 161 olgu (100 erkek [%62,1], 61 kýz [%37,9]) geriye dönük olarak incelendi. Olgular yaþ, cinsiyet, baþvuru þekli, düþme þekli ve yükseklikleri, yaralanma tipi, radyolojik bulgular ve yatýþ oranlarý açýsýndan deðerlendirildi. BULGULAR Baþvuran 161 olgunun yaþ ortalamasý 4,29±3,33 yýl ve düþme yüksekliði ortalamasý ise 135±95 santimetre idi. Sýk görülen düþme nedenleri ev eþyalarý (%35,4), merdiven (%17,4) ve balkon ile pencere (%11,2) idi. Yaralanmalarýn çoðu %84,4 ile kafa, %72,7 ile yumuþak doku ve %37,9 ile ekstremite travmalarý idi. Olgularýn 30’u (%18,6) yatýrýlýrken, 112’si (%69,6) ayaktan tedavi görmüþ ve %11,8’i ise acil servisten kendi isteðiyle ayrýlmýþtý.
SONUÇ Çocukluk çaðýnda düþmeye baðlý yaralanmalar genellikle ev içinde meydana gelirken sýk görülen travma tipi ise kafa travmasýdýr. Çocukluk çaðýnda düþmeye baðlý yaralanmalarý azaltmak için düþme nedenleri hakkýnda ailelerin eðitimi ve önleyici tedbirlerin artýrýlmasý gibi önlemler alýnmalýdýr.

BACKGROUND The aim of this study was to evaluate the fall-related trauma cases who were admitted to our pediatric emergency unit. METHODS We retrospectively evaluated the files of 161 cases (100 males [62.1%], 61 females [37.9%]) who had sustained falls and were admitted to our pediatric emergency unit. Data on the patients’ age, sex, arrival type, type of fall, height fallen, type of injuries, radiological findings and hospitalization rates were investigated. RESULTS Of 161 cases mean age was 4.29±3.33 years and height fallen was 135±95 centimeters. The common types of fall were from furniture (35.4%), stairs (17.4%) and balconies and windows (11.2%). Major injuries included head trauma (84.4%), soft tissue (72.7%) and extremity (37.9%). Thirty cases (18.6%) were hospitalized, while 112 cases (69.6%) were treated as outpatient and 11.8% of them were discharged due to their own demand. CONCLUSION
The majority of fall-related injuries in childhood mostly occurs in private houses and head trauma is the most frequent injury. To decrease the frequency of the fall injuries, strategies should include parents’ education about the mechanism of falls and increase prevention strategies.

AMAÇ Bezoar nedeniyle oluþan ince baðýrsak týkanmalarýnýn tanýsýnda bilgisayarlý tomografi (BT) tekniklerini ve görüntüleme bulgularýmýzý sunmayý amaçladýk.
GEREÇ VE YÖNTEM Bu çalýþmada bezoarlarýn neden olduðu ince baðýrsak týkanmasý bulunan 7 olgunun (3 erkek, 4 kadýn, yaþ aralýðý; 30-93) BT görüntüleri deðerlendirmeye alýndý. BULGULAR Tüm olgularda, bezoarýn BT’de preoperatif tanýnmasýna yardýmcý olan en belirgin özelliði baðýrsak lümeni içinde, içerisinde hava kabarcýklarý bulunan kitle lezyonu gözlemlendi. Ayrýca anastomoz hattý, affarent ve efferent segmentler gibi ameliyat sonrasý deðiþiklikler de BT ile belirlenebildi. SONUÇ Ýnce baðýrsak týkanmasýna yol açan bezoarlara taný koyabilmesi ve detaylý abdominal anatomik bilgi sunmasý nedeniyle BT görüntüleme yararlýdýr.

BACKGROUND We aimed to present our experience on computed tomography (CT) findings of small bowel obstruction due to bezoar impaction. METHODS CT scans of seven patients (3 males, 4 females, age range; 30-93 years) who were diagnosed as small bowel obstruction due to bezoars were reviewed. RESULTS In each patient, an intraluminal mass with a mottled gas pattern on CT enabled specific preoperative diagnosis of bezoars, and postoperative changes such as anastomotic lines and afferent-efferent loops.CONCLUSION CT imaging is useful in making the diagnosis of bezoar associated with small bowel obstruction, and greatly helps assessing the detailed abdominal anatomy.

AMAÇ Cerrahi tedavinin morbidite ve mortalitesinin yüksek olabildiði künt karaciðer travma olgularýnda, ameliyat edilmeksizin izlenen iyi seçilmiþ hastalarda yüksek saðkalým oranlarý bildirilmektedir. Bu yazýda, invazif taný ve/veya tedavi yöntemleri uygulanmadan izlenen 19 olgunun sonuçlarý deðerlendirildi. GEREÇ VE YÖNTEM Yatýrýlarak izlenen ve invaziv taný yöntemleri ya da cerrahi tedavi uygulanmayan 19 künt karaciðer travmalý hasta (9 erkek, 10 kadýn; ort. yaþ 46,6; daðýlým 19-73) deðerlendirildi. Hastalarýn demografik özelliklerinin yanýnda, yaþamsal bulgularý, hemodinamik parametreleri, karaciðer iþlev testleri, transfüzyon gereksinimleri, hastanede kalýþ süreleri ve izlem amaçlý yapýlan radyolojik testler kaydedildi. Karaciðerdeki yaralanmanýn sýnýflanmasýnda, Amerikan Travma Cerrahlarý Birliði’nin Organ Yaralanmasý Skorlama Sistemi kullanýldý.
BULGULAR On dokuz hastada radyolojik olarak kanýtlanmýþ karaciðer yaralanmasý vardý. Dokuz hastada evre I, beþ hastada evre II, iki hastada evre III ve üç hastada evre IV yaralanma vardý. On iki hastaya kan transfüzyonu gerekti. Ortalama yatýþ süresi 7,6 gündü. On dört hastada orta derecede transaminaz artýþý görülürken, beþ hasta biyokimyasal olarak normaldi. Bir hastada büyük bir karýn duvarý hernisi meydana geldi ve travmadan üç ay sonra laparoskopik olarak onarýldý. Hiçbir hastaya konservatif tedavinin baþarýsýzlýðý nedeniyle cerrahi uygulanmadý ve hastalarýn hiçbiri kaybedilmedi.
SONUÇ Künt karaciðer travmasý geçiren hastalarda, hemodinamik dengenin saðlanabilmesi ve sürdürülebilmesi þartýyla, konservatif izlem öncelikli yaklaþým olmalýdýr. Cerrahi giriþim kararý, travmaya eþlik eden karýn içi organ yaralanmasýnýn varlýðýna göre alýnmalýdýr. Karaciðer yaralanma skoru konservatif tedavi kararýnýn alýnmasýnda, hemodinamik denge kadar önemli deðildir.

BACKGROUND Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma’s Organ Injury Scaling System. RESULTS Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Lipomlar ince ve kalýn baðýrsaðýn nadir görülen fakat iyi tanýmlanmýþ tümörleridir. Genellikle submukozadan köken alýrlar ve bazen lümene doðru protrüde olarak týkanma veya intussusepsiyon ile karýn aðrýsýna neden olabilirler ya da hemoraji ile ortaya çýkabilirler. Ýntestinal lipomlar þiddetli semptomlara yol açabilmesi ve intestinal tümörlerde genellikle malinite olasýlýðýný ekarte etmek için doku örneði alýnmasýnýn endike olmasýndan dolayý endoskopik ya da cerrahi olarak çýkarýlmalýdýrlar. Bu yazýda semptomatik intestinal lipomu olan iki olgu taný ve tedavi açýsýndan tekrar gözden geçirilerek sunuldu.

Lipomas are rare but well-recognized tumours of the small and large intestines. They usually arise from the submucosa and may occasionally protrude into the lumen, thus causing abdominal pain resulting from obstruction or intussusception or they may become evident through haemorrhage. Intestinal lipomas should be removed either endoscopically or surgically because they can cause severe symptoms and usually a tissue diagnosis is indicated in intestinal tumours to exclude a malignancy. We describe two cases of symptomatic intestinal lipoma and review some aspects of diagnosis and treatment.

‘Konjenital intraperitoneal herniler’ olarak da bilinen paraduodenal herniler, baðýrsak týkanýklýðýnýn ender görülen nedenlerindendir. Bu herniler baðýrsaðýn rotasyonundaki deðiþimler nedeniyle oluþurlar ve tekrarlayýcý karýn aðrýlarýndan akut baðýrsak týkanýklýðýna kadar deðiþebilen semptomlar oluþtururlar. Bu yazýda mekanik baðýrsak týkanýklýðýna neden olan biri sol, diðeri sað iki paraduodenal herni olgusu sunularak paraduodenal hernilerin klinik özellikleri ve cerrahi tedavilerideðerlendirildi.

Paraduodenal hernias, or so called “congenital intraperitoneal hernias” are rare cause intestinal obstruction. These hernias are caused by variations in intestinal rotation and the patients present with symptoms ranging from intermittent abdominal pain to acute obstruction. We report two cases of obstructive paraduodenal hernias which are at left and right each and review of its clinical features and surgical management.

Ýnce baðýrsak tümörleri ancak hastalar kanama ya da týkanma gibi komplikasyonlarla baþvurduklarýnda tanýnabilmektedir. Ýntestinal lipomlar ince baðýrsaðýn benin neoplazileri arasýnda üçüncü sýklýkta yer alýr ve çoðunlukla laparotomiyle çýkarýlmasýný takiben histopatolojik incelemeyle kesin tanýsý konulur. Subileus ve rektal kanama þikayetiyle baþvuran 76 yaþýndaki erkek hastada, ultrasonografiyle karýnda kitle saptandý. Karýn tomografisinde dansite ölçümü intussusepsiyona yol açmýþ lipom tanýsýný destekliyordu. Ardýndan yapýlan enteroklizis ile jejunumdaki intussusepsiyon redükte edildi. Elektif þartlarda ameliyat edilerek, parsiyel ince baðýrsak rezeksiyonu ile çýkarýlan kitlenin lipom tanýsý histopatolojik olarak da doðrulandý. Kanama ve týkanma ile baþvuran bu hasta, görüntüleme yöntemleri ile preoperatif olarak intestinal lipomun tanýnmýþ olmasý nedeniyle sunuldu.

Small bowel neoplasms are usually diagnosed when patients are referred with complications such as hemorrhage or obstruction. Intestinal lipomas are the third most frequent benign tumors among all intestinal neoplasms and their definite diagnosis is usually obtained after histopathological examination of the resected specimen. A 76 year-old male patient with partial intestinal obstruction and rectal bleeding at admittance was found to have an abdominal mass on ultrasound. The density pattern of the mass at abdominal CT was supporting a jejunal lipoma leading an intussusception. Then an enteroclysis localized and reduced the jejunojejunal intussusception. The diagnosis of lipoma was confirmed with histopathological examination of the mass removed by an elective intestinal resection. This case was reported as the intestinal lipoma leading a jejunojejunal intussusception associated with bleeding, could be diagnosed preoperatively.

Penetran kafa travmalarý, çeþitli çalýþmalarda gösterildiði gibi, %90-100 oranlarýna ulaþan mortalite ve morbidite sonuçlarý nedeniyle beyin ve sinir cerrahisinin en ciddi konularý arasýndadýr. Genellikle kurþun ve þarapnel parçalarý ile olan bu yaralanmalar, her ne kadar modern zamanlarda az görülse de “ok” ile de olabilmektedir. Bu yazýda bir kaza sonucu baþýndan “ok” ile yaralanan, 37 yaþýndaki erkek hastanýn klinik bulgularý, tedavisi ve klinik seyri tartýþýldý.

As demonstrated in various studies, with mortality and morbidity rates reaching 90%-100%, penetrating brain injuries are among the most devastating subjects of neurosurgery. Shell and sharapnell fragments are the most common cause of this type injuries; although rarely reported in “modern times”, transcranial arrow injuries may also be the cause. In this report, a 37 year-old male patient, who was shot by an “arrow” accidentally, was evaluated regarding clinical presentation, treatment and clinical progress.

Otuz dokuz yaþýndaki erkek hasta, sol alt boyun tarafýndaki býçak yaralanmasý ile baþvurdu. Göðüs grafisinde sol hidropnömotoraks mevcuttu. Torasentez yapýldý ve analiz þilöz sývýyý gösterdi. Hasta kapalý göðüs drenajý ve total parenteral beslenme ile konservatif olarak tedavi edildi. Bu klinik olgunun ve literatür taramasýnýn temelinde, torasik duktus yaralanmasý penetran boyun travmalarýnda akýlda tutulmalý ve öncelikli olarak konservatif tedaviye baþvurulmalýdýr.

A 39-year-old man was admitted with a stab wound to left lower neck. Chest X-ray revealed a left hydropneumothorax. Thoracentesis was performed and analysis of the fluid revealed chyle. Patient was treated conservatively by closed chest drainage and total parenteral nutrition. On the basis of this clinical report and review of the literature, it is concluded that thoracic duct injury should be kept in mind in penetrating neck trauma and conservative treatment should be the first line therapy.

Posttravmatik psödoanevrizma ve arteriyovenöz fistül oluþumu nadiren gözlenmektedir. Klinik gidiþ bakýmýndan erken yapýlan cerrahi tedavi tercih edilmektedir. Bu yazýda sol uyluktaki süperfisiyel femoral arter psödoanevrizmasý ve süperfisiyel femoral arter ve ven arasýndaki arteriyovenöz fistül olgusu sunuldu. Ateþli silahla yaralanma sonucunda oluþan bu patolojinin tanýsý için manyetik rezonans görüntüleme ve renkli Doppler ultrasonografi yapýldý. Olguya anevrizmektomi, safen ven interpozisyonu ve venöz tamir uygulandý, ameliyat sonrasý sekizinci gün taburcu edildi.

Posttraumatic pseudoaneurysm and arteriovenous fistula are rarely observed. Because of the imminent clinical course, early operation is usually indicated. In this study, we present a case of pseudoaneurysm in the left superficial femoral artery and arteriovenous fistula between the left superficial femoral artery and vein in the left thigh, as a result of a gunshot injury. Magnetic resonance angiography and color Doppler ultrasound were used for diagnosis. The patient underwent a successful aneurysmectomy, saphenous vein interposition and venous repair and was discharged on the eighth postoperative day.

Cilt altý amfizemi cilt altý dokularda hava veya gazýn bulunmasýyla karakterize anormal bir durumdur. Cilt altý amfizemin en önemli nedenleri kot kýrýðý, akciðer parankim yaralanmasý ve özofagus travmalarýdýr. Bununla birlikte, dental, oral ve nazal cerrahi uygulamalarla, maksillofasiyal travmalara baðlý olarak da geliþebilen bir komplikasyondur. Minör maksillofasiyal travma sonrasý acil servise baþvuran ve maksilla ön duvarýndaki basit bir kýrýk nedeniyle gözlem altýna alýnan hastada, periorbital bölgeden boyuna ve üst mediastene yayýlan cilt altý amfizemi gözlemlendi. Bu sunudaki amacýmýz acil servise baþvuran minör fasiyal travmalý olgularda zaman içinde ciddi komplikasyonlarýn geliþebileceðini, bu komplikasyonlarýn yakýn gözlemle saptanýp, erken giriþimle önlenebileceðini hatýrlatmaktýr.

Subcutaneous emphysema is the inadvertent introduction of air into tissues under the skin covering the chest wall or neck. The common causes of subcutaneous emphysema are rib fracture, parenchymal lung wound and esophageal trauma. Rarely, it occurs after oral and nasal surgery or maxillofacial trauma. We observed subcutaneous emphysema spread out from periorbital region to upper mediastinum in a patient presented to emergency department following minor maxillofacial trauma and admitted due to a simple fracture at his frontal maxillary wall. We present this present case to emphasize early initial management and close observation of minor facial traumas which can prevent further unexpected complications.