AMAÇ
Bu çalýþmada, deneysel kontrolsüz hemorajik þok modelinde agresif sývý resüsitasyonu, düþük volümlü sývý resüsitasyonu ve ýlýmlý hipotansif resüsitasyonun etkinliði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Çalýþmada 44 erkek Guinea pig türü kobay kullanýldý. Deneysel kontrolsüz hemorajik þok modeli uygulandý. Kobaylar normovolemik-normotansif sývý tedavisi alan grup, normovolemik-ýlýmlý hipotansif sývý tedavisi alan grup, düþük volümlü-normotansif sývý tedavisi alan grup, düþük volumlü-ýlýmlý hipotansif sývý tedavisi alan grup, tedavi almayan grup (n=6) ve kontrol grubu (n=6) olmak üzere altý gruba ayrýldý. Ortalama arter basýncý (OAB) 30 mmHg olduðunda resüsitasyona baþlandý. Ilýmlý hipotansif resüsitasyon gruplarýnda OAB 45±5 mmHg olacak þekilde ve agresif resüsitasyon gruplarýnda OAB 60±5mmHg olacak þekilde sývý uygulandý. Düþük volümlü sývý tedavisi alan gruplarda hetastarch 6% (hidroksietil niþasta) ve normovolemik sývý tedavisi alan gruplarda Ringer laktat kullanýldý.
BULGULAR
Ortalama yaþam süresi normovolemik-normotansif grupta 122,75±4,83 dk, normovelemik-ýlýmlý hipotansif grupta 130,87±16,31 dk, düþük volümlü-normotansif grupta 122,12±11,53 dk, düþük volümlü-ýlýmlý hipotansif grupta 152,25±9,10 dk idi. Düþük volümlü ýlýmlý hipotansif grupta yaþam süresi diðer gruplardan istatistiksel olarak anlamlý düzeyde yüksek bulundu.
SONUÇ
Normotansif gruplarda kolloid ve kristalloid etkinliði benzer olmasýna raðmen ýlýmlý hipotansif gruplarda kolloid tedavisi daha etkili bulundu. Sývý tedavisine basýncýn etkisi karþýlaþýtýrýldýðýnda ýlýmlý hipotansif resüsitasyonun, kolloid ve kristalloid kullanýlan gruplarýn tamamýnda daha etkili olduðu bulundu.

BACKGROUND
In this study, we aimed to compare the efficacy of aggressive fluid resuscitation, low-volume fluid resuscitation and permissive hypotensive resuscitation in an experimental uncontrolled hemorrhagic shock model.
METHODS
Forty-four male Guinea pigs were used in the study in an experimental uncontrolled shock model. Guinea pigs were split into six groups including normovolemic-normotensive fluid treatment group, normovolemic-permissive hypotensive fluid treatment group, low-volume normotensive fluid treatment group, low-volume permissive hypotensive fluid treatment group, no treatment (n=6), and sham-operated groups (n=6). Resuscitation was initiated when mean arterial pressure (MAP) reached 30 mmHg. In the permissive hypotensive resuscitation group, fluid treatment continued until MAP reached 45±5 mmHg and in the aggressive fluid groups until MAP reached 60±5 mmHg. Resuscitation fluid was hetastarch 6% (hydroxyethyl starch) in the low-volume fluid groups and Ringer’s lactate in the normovolemic fluid groups.
RESULTS
Mean survival time was 122.75±4.83 min in the normovolemic-normotensive fluid group, 130.87±16.31 min in the normovolemic-permissive hypotensive group, 122.12±11.53 min in the low-volume-normotensive fluid group, and 152.25±9.10 min in the low-volume-permissive hypotensive fluid group. Survival time was found significantly higher in the group in which low-volume-permissive hypotensive fluid treatment was applied than in the other groups.
CONCLUSION
When pressure effect was compared during treatment, permissive-hypotensive resuscitation was found more effective in both groups that received colloid and crystalloid treatment.

AMAÇ
Erken dönemde genel vücut travmalý (GVT) hastalarda, kafa travmasýnýn ve diðer bölge travmalarýnýn koagülasyon üzerine etkisi ve bu hastalarda koagülasyon parametreleri ile Glaskow Koma Skoru (GCS) ve travma þiddet skoru (ISS) iliþkilerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Acil servise GVT ile baþvuran, 50 hasta (9 kadýn, 41 erkek) çalýþmaya alýndý. Hastalarýn GCS, ISS, koagülasyon parametreleri düzeyleri belirlendi. GCS, ISS ile koagülasyon parametreleri arasýnda korelasyon deðerlendirildi. Hastalar; önemli bir travma tespit edilmeyen (A), sadece kafa travmasý olanlar (B), kafa travmasý ve diðer bölge travmasý olanlar (C), kafa travmasý olmayan ancak diðer bölge travmalarý olanlar (D) olarak ayrýldý.
BULGULAR
ISS ile uluslararasý normalize oraný (INR), aktif parsiyel tromboplastin zamaný (aPTT), D-dimer ve fibrin yýkým ürünleri (FDP) düzeyleri arasýnda pozitif, ISS ile antitrombin (AT) ve fibrinojen düzeyleri arasýnda negatif bir iliþki saptandý (p<0,05). C grubuyla diðer gruplardaki INR, D-dimer, fibrinojen, aPTT, AT parametreleri karþýlaþtýrýldýðýnda istatistiksel anlamlýlýk saptandý (p<0,05). Kafa travmasý olan ve olmayan gruplar arasýndaki INR, D-dimer ve fibrinojen parametrelerinde istatistiksel anlamlýlýk saptandý (p<0,05).
SONUÇ
Kafa travmasý olan hastalarda koagülasyon parametrelerinin bozulduðu, ancak kafa travmasýna diðer bölge travmalarý eþlik ettiðinde koagülasyon parametrelerinin daha fazla anormalleþtiði belirlendi.

BACKGROUND
This study aimed at analyzing the effect on coagulation of head trauma and other local traumas in patients exposed to multiple traumas in the early stage, and also the relations of Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) with coagulation parameters in these patients.
METHODS
Fifty consecutive patients (9 women, 41 men) with multiple traumas were included in this study. The GCS, ISS and coagulation parameter levels were measured. Presence of a correlation between GCS and ISS with coagulation parameters was analyzed. Patients exposed to multiple traumas were assessed in four categories as the patients with no significant traumas (A), only head traumas (B), head trauma and other local traumas (C), and no head traumas but other local traumas (D).
RESULTS
A marked relationship was found between ISS and international normalized ratio (INR), activated partial thromboplastin time (aPTT), D-dimer, fibrin degradation product (FDP), antithrombin (AT), and fibrinogen (p<0.05). There was a statistically significant difference between Group C and the other groups in INR, D-dimer, fibrinogen, aPTT, and AT parameters (p<0.05). There was also a statistically significant difference between the groups with and without head trauma in INR, D-dimer and fibrinogen (p<0.05).

CONCLUSION
The coagulation parameters were observed to diverge in patients with head trauma, but in cases with head injuries accompanying other local traumas, more coagulation parameters became abnormal.

AMAÇ
Bir çoklu yaralanma senaryosu kullanarak acil hekimlerinin triyaj karar verme yeterliklerini deðerlendirmek ve acil týp etiðinin temelinde yer alan triyaj eðitimi ihtiyacýný belirlemektir.
GEREÇ VE YÖNTEM
Kocaeli ili hastane ve hastane öncesi acil servislerde çalýþan 110 acil hekimine Simple Triage and Rapid Treatment (START) algoritmasýna göre triyaj uygulayacaklarý 17 olguluk bir çoklu yaralanma senaryosu içeren anket formu daðýtýldý. Kiþisel ve profesyonel özellikler ile triyaj kararlarý arasýndaki farký belirleyebilmek için ki-kare testi kullanýldý.
BULGULAR
Acil hekimlerinin doðru triyaj karar oranlarý, birinci öncelikteki dört yaralý için %83,6 ile %90,0, ikinci öncelikteki yedi yaralý için %26,4 ile %78,2, üçüncü öncelikteki dört yaralý için %70,9 ile %91,8 ve ölü olan iki olgu için %82,7 ile %97,3 arasýnda deðiþmekte idi. Kiþisel ve profesyonel özellikler (yaþ, mesleki deneyim, hastane acil deneyimi ve hastane öncesi acil deneyimi) beþ yaralý için istatistiksel açýdan anlamlý bulundu (p<0,05).
SONUÇ
Çalýþmamýz acil hekimlerinin yaralýlar için yetersiz triyaj kararý verme eðilimde olduðunu göstermiþtir. Bu sonuç ve ikinci öncelikteki yaralýlar için verilen doðru triyaj kararlarýndaki sapma eðitim programlarýnda klinik-etik karar verme yöntemlerinin geliþtirilmesi gerektiðini göstermektedir. Böylece acil hekimlerinin önemli etik ödevlerinden olan adalet ve zarar vermeme ödevlerinin ihlal edilmesi önlenebilecektir.

BACKGROUND
We aimed to examine the accuracy of triage decision-making among emergency physicians, using a multiple casualty scenario. This will assist in determining the necessity of triage training, which is the foundation of emergency medical ethics.
METHODS
A self-administered questionnaire including a multiple casualty scenario requiring each casualty to be prioritized for treatments by Simple Triage and Rapid Treatment (START) was given to 110 emergency physicians working at pre-hospital and hospital emergency services in Kocaeli. The differences between personal/professional characteristics and triage decisions were analyzed using chi-square test.
RESULTS
Accurate triage decision rates of the emergency physicians ranged from 83.6% to 90.0% for four immediate casualties, 26.4% to 78.2% for seven urgent casualties, 70.9% to 91.8% for four delayed casualties, and 82.7% to 97.3% for two dead cases. Personal and professional characteristics were found to be statistically significant in five cases (p<0.05).

CONCLUSION
This study showed that emergency physicians tended to under-triage patients. This result and the discrepancy of the accuracy rates in urgent casualties revealed the necessity for improvement in medical-ethical decision-making in the training programs. This improvement will help in reducing violation of the important duties of justice and of do no harm by the emergency physicians.

AMAÇ
Yýlan zehiri ile zehirlenme hýzlý tedavi gerektiren bir týbbi acil durumdur. Türkiye’deki zehirli yýlan sokmalarý kýsmi doku hasarý ve sistemik semptomlara neden olabilmektedir. Vipera ammodytes türü Türkiye’nin güneydoðusunda en zehirli olanýdýr.
GEREÇ VE YÖNTEM
2003 ve 2005 yýllarý arasýnda acil servisimize baþvuran 79 V. ammodytes yýlan sokmasý olgularýnýn demografik, epidemiyolojik karakterleri, klinik belirti ve bulgularý, laboratuvar bulgularý, tedavileri ve sonuçlarý prospektif olarak incelendi, analiz edildi.
BULGULAR
En yaygýn belirti ve bulgular diþ izleri (%100), aðrý (%100), þiþkinlik (%83,54), ekimoz (%92,40), taþikardi (%24,05), baþ dönmesi ve bayýlma (%14,52), ateþ (%18,98), bölgesel lenf nodu büyümesi (%43,03), bulantý (%70,89), hipotansiyon (%21,52), kusma (%36,71) ve dispne (%3,22) idi. Ana komplikasyonlar tromboflebit, hareket kýsýtlýðý, lokal hemorajik bül oluþumu, cilt kanamasý, rabdomiyoliz, duyu azalmasý, akut böbrek yetersizliði, doku kaybý ile beraber nekrozis, parmak amputasyonu, karpal tunel sendromu ve kompartman sendromu idi.
SONUÇ
Bir V. ammodytes ýsýrýðý acil hastane bakýmý gerektiren ciddi bir durumdur. Olgularýn çoðu konservatif yöntemlerle baþarýlý bir þekilde tedavi edilebilir. Serimizde ölüm meydana gelmemiþtir.

BACKGROUND
Snake venom poisoning is a medical emergency requiring immediate attention. Bites from poisonous Turkish snakes can lead to local tissue damage and systemic symptoms. The Vipera ammodytes species accounts for the majority of envenomation in southeast Turkey.
METHODS
The demographic and epidemiological characteristics, clinical symptoms and signs, laboratory findings, treatment, and outcome of 79 consecutive victims of V. ammodytes poisoning admitted to our hospital from 2003 to 2005 were reviewed and analyzed prospectively.
RESULTS
The most common symptoms and signs included fang marks (100%), pain (100%), swelling (83.5%), ecchymosis (92.4%), tachycardia (24.1%), fainting or dizziness (14.5%), fever (19.0%), enlargement of regional lymph nodes (43.0%), nausea (70.9%), hypotension (21.5%), vomiting (36.7%), and dyspnea (3.2%). The main complications were thrombophlebitis, reduced range of motion, local hemorrhagic blister formation, bleeding from skin, rhabdomyolysis, reduced sensation, acute renal failure, necrosis with tissue loss, digit amputation, carpal tunnel syndrome, and compartment syndrome.
CONCLUSION
A V. ammodytes bite is a potentially serious event that requires immediate hospital care. Nevertheless, the majority of victims can be treated successfully with conservative methods. No deaths occurred in our series.

AMAÇ
Travmatik diyafragma fýtýklarý, künt ve penetran yaralanmalardan sonra sýklýkla oluþmaktadýr. Travmatik diyafragma yýrtýðý tanýsýnda zorluklar, eþlik eden yaralanmalar ve diyafragma yaralanmalarýnýn sessiz doðasý ilk baþvuruda geç taný konmasýnýn en sýk nedenleridir.
GEREÇ VE YÖNTEM
Alzahra Hastanesi’nde Aðustos 2004 ile Haziran 2008 tarihleri arasýnda post-travmatik diyafragma fýtýðý nedeniyle tedavi edilen 34 hastanýn (28 erkek, 6 kadýn; ortalama yaþ 32,3 yýl; daðýlým 1-68) týbbi kayýtlarý, retrospektif olarak incelendi.
BULGULAR
Diyafragma yýrtýðý hastalarýn 22’sinde (%64,7) sol tarafta, 11’inde (%32,4) sað tarafta ve 1’inde ise (%2,9) iki taraflýydý. Künt travma, 22 hastada yaralanma (%64,7) nedeniydi. Ýlk operasyonda taný, 15 hastada (%44,1) ameliyat öncesinde, 13 hastada (%38,2) ameliyat sýrasýnda koyuldu. Taný, 6 hastada (%17,7) ilk operasyonda atlandý. Üç hastada, viseral organ strangülasyonu görüldü. Travma baþlangýcý ile taný arasýndaki en uzun interval, bir olguda yaklaþýk üç yýl oldu. Hastalarýn 22’sinde (%64,7) eþlik eden birden çok sayýda yaralanma gözlendi ve bunlar en yaygýn olarak dalak yaralanmasý (%38,2), ekstremite kýrýklarý, hemotoraks (%29,4) ve karaciðer yaralanmasý (%26,5) þeklindeydi. Dokuz hastada (%26,5) ameliyat sonrasý komplikasyonlar gözlendi. Ýzole künt travmatik rüptür mortalitesi %0 oldu. Hemorajik þok, genç yaþ ve eþlik eden yaralanmalar, mortalite ve morbiditeyi anlamlý þekilde arttýrdý.
SONUÇ
Diyafragmatik fýtýk insidansýnýn nadir olmasý gerçeðine karþýn, toraks ve karýna iliþkin tüm künt ve penetran travmalarda diyafragma fýtýðýndan kuþkulanýlmalýdýr. Geç komplikasyonlarýn çoðunlukla yüksek morbidite ile birlikte olmasý nedeniyle, böyle bir yaralanmanýn varlýðý, tanýsal iþlemler tamamlanmadan önce ekarte edilmelidir.

BACKGROUND
Traumatic diaphragmatic hernias commonly occur after blunt and penetrating trauma. The difficulties in diagnosing traumatic diaphragmatic rupture due to coexisting injuries and the silent nature of the diaphragmatic injuries at the first admission are the most common causes of delayed diagnosis.
METHODS
The medical records of 34 patients (28 male, 6 female; mean age 32.3 years; range 1 to 68) treated for post-traumatic diaphragmatic hernias between August 2004 and June 2008 in Alzahra Hospital were analyzed retrospectively.
RESULTS
Rupture of the diaphragm was left-sided in 22 (64.7%) and right-sided in 11 (32.4%) and bilateral in 1 (2.9%) of the patients. Blunt trauma accounted for the injuries of 22 patients (64.7%). In the first operation, diagnosis was established preoperatively in 15 patients (44.1%) and intraoperatively in 13 (38.2%). The diagnosis was missed in 6 (17.7%) patients in the first operation. Strangulation of the viscera was seen in three patients. The longest interval between the onset of trauma and diagnosis was approximately three years in one case. Multiple associated injuries were observed in 22 patients (64.7%), the most common of which were spleen injury (38.2%), fractures of the extremities and hemothorax (29.4%) and liver injury (26.5%). Postoperative complications were seen in nine patients (26.5%). Mortality of isolated blunt traumatic rupture was 0%. Hemorrhagic shock, young age and associated injuries significantly increased the mortality and morbidity.

CONCLUSION
Despite the fact that the incidence of diaphragmatic hernia is uncommon, it should be suspected in all blunt or penetrating traumas of the thorax and abdomen. Because late complications are usually associated with high morbidity, the presence of such an injury should be excluded before terminating the exploratory procedure.

AMAÇ
Çocuklarda penetran kalp yaralanmalarý dramatik ve ölümcül travmalardýr. Birçok olgu, hastaneye ciddi þokta veya hayatýný kaybetmiþ olarak ulaþýr. Bu çalýþmamýzda penetran kalp yaralanmasý olan çocuk hastalarýmýzla ilgili deneyimimizi aktarmayý amaçladýk.
GEREÇ VE YÖNTEM
Penetran kalp yaralanmalý 17 çocuk hasta geriye dönük olarak incelendi. Hastalarýn demografik karakterleri, yaralanmanýn nedenleri, hastaneye geliþ zamaný, acil servis inceleme bulgularý, kullanýlan taný yöntemleri ve uygulanan cerrahi yöntemlerin sonuçlar üzerine etkisi incelendi.
BULGULAR
Geriye dönük analizleri yapýlan 17 hastanýn erkek-kadýn oraný 16: 1, yaþ aralýðý 3-15 yaþ, ortalama 12,94±3,52 yaþ idi. Tüm hastalarda yaralanma nedeni kesici delici alet yaralanmasý olarak tespit edildi. Ivatury fizyolojik indeks skoru 8.23±0.78 iken ortalama kardiyak yaralanma organ ölçeði skoru 5,00±0,00 olarak bulundu. Bir olgu ile hastane mortalitesi %5,9 olarak tespit edildi.
SONUÇ
Çocuklarda penetran kardiyak yaralanmalarda kanama ve/veya tamponad nedeniyle çok kýsa sürede þok geliþebilir. Erken taný ve acil torakotomi yaralanma sonrasý hastalarýn hayatta kalmasýnda temel faktörlerdir.

BACKGROUND
Penetrating cardiac traumas in children are dramatic and fatal. Many of the patients are admitted to hospital either in a state of shock or they are dead at presentation. In this study, we aimed to present our experience in penetrating cardiac trauma in children.
METHODS
Seventeen pediatric cases of penetrating cardiac trauma were retrospectively evaluated. The effects on the results of the demographic characteristics of patients, etiology of penetrating trauma, time of presentation to the hospital, physical examination findings in the emergency department, diagnostic methods used, and the surgical techniques applied were evaluated.
RESULTS
The male to female ratio of the 17 retrospectively evaluated cases was 16: 1, with an age range of 3-15 years. The patients’ mean age was 12.94±3.52 years. In all patients, the penetrating cardiac trauma was due to incisive/penetrating tools. The mean Ivatury physiologic index score was 8.23±0.78, whereas the mean cardiac injury organ scale score was 5.00±0.00. The hospital mortality rate was 5.9% due to the loss of one patient.
CONCLUSION
Shock may develop in pediatric penetrating cardiac trauma in a short time due to hemorrhage and/or cardiac tamponade. The prime factors for patient survival are early diagnosis and emergency thoracotomy.

AMAÇ
Bu çalýþmada, elektrik çarpmasýyla yaralanan hastalarda voltaj seviyesinin kas harabiyeti üzerine etkisi araþtýrýldý.
GEREÇ VE YÖNTEM
Bu geriye dönük olarak yapýlan çalýþmaya elektrik çarpmasýyla yaralanan 36 hasta alýndý (21 yüksek voltaj ve 15 düþük voltaj). Baþvuruda her bir hastanýn serum kreatin kinaz (CK), aspartat aminotransferaz (AST) ve alanin aminotransferaz (ALT) deðerleri belirlendi.
BULGULAR
Her nekadar biz çalýþmamýzda yüksek voltaja maruz kalan hastalardaki serum CK seviyelerini düþük voltaja maruz kalan hastalardakilerden daha yüksek bulduysak da, bu iki grup arasýndaki fark anlamlý deðildi. Serum AST ve ALT seviyeleri her iki grupta da yüksek idi. Fakat gruplar arasýnda hiçbir anlamlý fark yoktu.
SONUÇ
Ýskelet kas harabiyetinin yüksek ve düþük voltaj elektrik yaralanmasý ile meydana gelebildiði ve bu hastalarda kas harabiyeti derecesinin kas enzimlerinin özellikle CK’nýn, yükselmiþ baþlangýç serum seviyeleri ile uyumlu olabildiði sonucuna varýldý. Bununla birlikte voltaj seviyesinin kas harabiyetinin derecesi ile direkt korelâsyonunun güçlü bir delilinin olup olmadýðýný belirlemek için daha ileri araþtýrmalar gereklidir.

BACKGROUND
In this study, we investigated the effect of voltage levels on muscle damage in patients with electrical injuries.
METHODS
This retrospective study included 36 patients with electrical injury (high voltage, 21; low voltage, 15). Initial serum creatine kinase (CK), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were obtained from each patient on admission.
RESULTS
Although CK levels were observed to be higher in the high-voltage injured patients than in those exposed to a low voltage, the difference was not statistically significant. The serum AST and ALT levels were elevated in both groups, but there was no significant difference between the groups.
CONCLUSION
Skeletal muscle damage can be caused by both high-voltage and low-voltage electrical injury, and in these patients, the degree of muscle damage may be consistent with the elevated initial serum levels of muscle enzymes, especially of CK. However, further researches are necessary to determine if there is strong evidence of a direct correlation between voltage level and the degree of muscle damage.

AMAÇ
Çocuklarda yüz yanýklarý oldukça sýk gözükmektedir. Aðrý çeken hastalarýn yanýk yaralarýný kapatma amacý ile birçok yara kapama örtüleri kullanýlabilir. Bu örtüler aðrýyý azaltma amacý ile lokal anastezikler ile kombine edilebilirler. Lidokain - prilokain krem (%5’lik) (LPC) plastik cerrahlar tarafýndan lokal anatezik olarak deðiþik amaçlarla kullanýlmaktadýr. Bu çalýþmada, yüzü yanan çocuk hastalarda aðrýnýn kesilmesinde topikal LPC etkilerini, LPC pansumanýn kullanýlmadýðý bir kontrol grubuyla da karþýlaþtýrarak araþtýrdýk.
GEREÇ VE YÖNTEM
2003 ile 2006 yýllarý arasýnda acil servis ve plastik cerrahi polikliniðine baþvuran 30 çocuk hasta (ortalama yaþ 11,3; daðýlým 8-15) çalýþmaya dahil edildi. Hastalarýn yanýk alanlarý toplam vücut yüzeyinin yüzde 1’i ile 5’i arasýnda deðiþmekteydi.
BULGULAR
Her iki grupta yanýk sonrasý aðrý kesici ilaç ihtiyacý birinci, ikinci ve üçüncü 8 saatlik sürelerle kaydedildi. Aðrý düzeyi bu zamanda sözel numaralandýrma skalasý kullanýlarak deðerlendirildi. Sonuçta ilk ve ikinci 8 saatlik dönemde LPC kullanmayan grup ile kullanan grup arasýnda anlamlý fark gözlendi. Üçüncü 8 saatlik dönemde ise anlamlý fark gözlenmedi. LPC’nin pansumanda kullanýmý ile yaralanma sonrasý ilk 16 saatte etkinliðinin güçlü olduðu ve daha sonra aðrý kesici ihtiyacýnýn gerektiði ve klinik uygulamada çocuklarýn yüz yanýklarýnda uygulanabileceði sonucuna varýldý.
SONUÇ
LPC ilk 16 saat içinde iyileþtirmede etkili bulunmuþtur. Son 8 saatlik süre içinde etkinliðini kaybettiðinde destek oral aðrý kesici tedavisini öneririz.

BACKGROUND
Facial burns are quite common among children. Many different wound-covers can be used for dressing burn wounds, which is usually painful for the patients. These covers can also be combined with local anesthetic creams. Lidocaine-prilocaine cream 5% (LPC) is commonly used as a topical anesthetic by physicians performing plastic surgery. In the present study, we investigated the effects of topical LPC on pain cessation in pediatric patients with face burn and compared results with a control group in which LPC was not used in the wound dressing.
METHODS
Thirty pediatric patients (average age 11.3, range 8-15) among those who admitted to our emergency service and plastic surgery outpatient clinic between 2003 and 2006 were included in this study. The patient’s burned areas ranged between 1 and 5% percent of their total body surface.
RESULTS
The need for analgesic medicine was recorded in the first, second and third 8-hour periods postburn in both groups, and pain level was evaluated at these time points using a verbal rating scale. There was a significant difference between the two groups with respect to values of the first and second 8-hour periods, while in the third 8-hour period, no significant difference was observed. We conclude that topical local anesthetics administered for 16 hours postburn significantly reduce the duration of pain after injury, which suggests a potential use in clinical practice in the treatment of children with face burn.
CONCLUSION
While LPC was found to have an ameliorating effect in the first 16 hours, we recommend oral analgesic co-therapy support since it loses its efficacy in the last 8-hour period.

AMAÇ
Travmaya baðlý akut subdural kanamalar kafa travma tanýlarý arasýnda en ölümcül olanýdýr.
GEREÇ VE YÖNTEM
Bu çalýþmada 1998 ile 2006 yýllarý arasýnda travma sonrasý akut subdural kanama tanýsý ile ameliyat edilen 113 hasta geriye yönelik olarak incelendi. Baþvuru sýrasýndaki Glasgow Koma Skalasý (GKS) Skoru, hasta yaþý, travma ile ameliyat arasýnda geçen süre ve pupilla reaksiyonundaki anormalliklerin mortalite ve morbidite üzerindeki etkilerini saptamak amacýyla istatistiksel analiz yapýldý.
BULGULAR
Elde edilen sonuçlar güncel literatürle karþýlaþtýrýlarak tartýþýldý. Yüz on üç hastadaki toplam mortalite %56,6 olarak bulundu.
SONUÇ
Baþvuru sýrasýndaki GKS skoru, hasta yaþý, travma ile ameliyat arasýnda geçen süre ve pupilla reaksiyonundaki anormalliklerin prognozun belirlenmesinde önemli olduðu sonucuna varýlmýþtýr.

BACKGROUND
Traumatic acute subdural hematoma is the most lethal of all head injuries.
METHODS
In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity.
RESULTS
Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%.
CONCLUSION
According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient’s age.

AMAÇ
Elektrik yaralanmalarý günümüzde dünya çapýnda artýþ gösteren bir sorundur. Türkiye’de yanýklar göreceli olarak yaralanmalarýn küçük bir kýsmýný oluþtursa da önemli bir halk saðlýðý sorunu olmaya devam etmektedir. Elektrik yaralanmalarý yüksek ya da düþük voltajla temasla ortaya çýkar. Düþük voltaj yaralanmalarý genellikle evde olmaktadýr. Yüksek voltaj yaralanmalarý iþle ilgili bir ortamda kýsa süreli temas sonucunda, ciddi doku hasarýna ve ikincil yaralanmalara sebep olabilir.
GEREÇ VE YÖNTEM
1997-2005 yýllarý arasýnda elektrik yaralanmasý nedeniyle saðlýk kurumumuza baþvuran 55 olgu deðerlendirildi. Elektrik yaralanmasý olarak taný alan 55 kiþinin dosya kayýtlarý araþtýrma verisini oluþturdu. Dijital ortamdaki yanýk kayýtlarý analizlerde kullanýldý.
BULGULAR
Yanýklar farklý yaþ gruplarýnda ve her iki cinste de görülebilmektedir. Olgulardan %89,1’i erkek idi. Yaralanmalarýn 41’inde yüksek 14’ünde düþük voltaj nedeniyle hasarlanmalar oluþmuþtur. Komplikasyonlarýn en yaygýn olduðu grup yüksek voltajýn neden olduðu yaralanmalardýr. Erkeklerin hastanede en uzun kalma süresi (33,69±21,13) gündür. Bu gruptaki hastalarýn çoðu ameliyat edilmiþtir.
SONUÇ
Ýþle ilgili faaliyetler yüksek voltaj yaralanmalarýnýn çoðunluðundan sorumludur. En yaygýn olarak elektrik hatlarý üzerinde çalýþan elektrikçiler bu tip kazalara maruz kalmaktadýr. Bu gruptaki hastalar genç insanlardýr, iþ yaþamlarýnýn da baþlangýcýndadýrlar. Araþtýrmamýz daha iyi toplumsal eðitim, kazalarý önlemeye yönelik güçlü çabalar, elektriðin kullaným ve daðýtýmýnda katý düzenlemeler gerektiðinin altýný çizmektedir.

BACKGROUND
Electrical injuries currently remain a worldwide problem. In Turkey, burns are relatively small in number among injuries overall, but they continue to be a major public health problem. Electrical injuries may occur due to high- or low-voltage contact. Injuries due to low voltage usually occur at home. High-voltage injuries are usually work-related and result from a shorter contact, but may cause serious tissue destruction and secondary injuries.
METHODS
The objective of this study was to review a medical institution’s experience with electrical injuries between 1997–2005. The institution admitted 55 electrical injury cases throughout this period. A computerized burns registry was used for data collection and analysis.
RESULTS
The burn causes differed among age groups and between the sexes, with males constituting 89.1% of the electrical burn patients. Forty-one of the injuries were due to high voltage whereas 14 injuries were due to low voltage. Complications were most common in the high-voltage group. Mean length of stay was longest in this group, at 33.69±21.13 days, and the patients in this group also required the most operations.
CONCLUSION
Work-related activity was responsible for the majority of these high-voltage injuries, with the most common occupations being linemen and electricians. These patients tended to be younger men in the prime of their working lives. Our study underlines the need for stronger efforts aimed at prevention, such as better public education and strict regulations regarding the distribution and use of electricity.

AMAÇ
Çalýþmamýzda iþ kazalarýna baðlý yaralanmalarýn özelliklerini, nedenlerini ve sonuçlarýný tanýmlamayý amaçladýk.
GEREÇ VE YÖNTEM
Ýþ kazalarý sonucunda oluþan yaralanma ile acil servise gelen hastalar geriye yönelik olarak incelendi. Ýþ kazalarýna baðlý yaralanmalarda, cinsiyet, yaralanmanýn oluþ mekanizmasý, yaralanma tipi, yaralanmanýn olduðu yer, yaralanma þiddet skoru ve iþ tipi gibi parametreler deðerlendirildi.
BULGULAR
Her iki acil bölümüne 2006 yýlý boyunca gelen iþ kazasýna baðlý yaralanma sayýsý 1038 idi. Olgularýn yaþ ortalamasý 31,6±9,6 idi. En yaygýn görülen yaralanma mekanizmasý %31,5 ile vücuduna makinaya kaptýrma olarak saptandý. Bunu sýrasýyla %21,5 ile künt cisimle yaralanma, %18,9 ile yüksekten düþme, %17 ile delici kesici aletle yaralanma, %3,9 ile göze yabancý cisim kaçmasý ve diðerleri izledi. Ýzole ekstremite yaralanmasý (%74,2) en çok yaralanan vücut bölgesi idi. Bunu sýrasýyla çoklu vücut yaralanmasý (%8,5), yüz yaralanmalarý (%5,5), baþ-boyun yaralanmalarý (%4,6) izledi. Olgularýn %90’ý acil serviste tedavisi yapýldýktan sonra taburcu edilirken, %7’si deðiþik bölümlere yatýrýldý.
SONUÇ
Ýþ kazalarýna baðlý yaralanmalarýn büyük kýsmý acil servislerde deðerlendirilmektedir. Acil servislerdeki gözlemler, iþ yeri ile iliþkili kazalarýn önlenmesinde ve iþ kazalarýna baðlý yaralanmalarýn özelliklerinin tanýmlanmasýnda yardýmcý olabilir.

BACKGROUND
We aimed to identify the characteristics, causes and rates of injuries associated with occupational accidents.
METHODS
Patients who presented to the Emergency Department due to injuries occurring as a result of occupational accidents were determined retrospectively. In occupational injuries, several parameters were evaluated, such as gender, occurrence mechanism, injury type, injury localization, severity score of the injury, and the type of profession.
RESULTS
The number of occupational injury admissions in the Emergency Departments of our two centers during 2006 was 1038. Mean age of the cases was 31.6±9.6. The most common mechanism of injuries was determined to be caught-in-machinery, at 31.5%, followed by blunt object injury (21.5%), fall from height (18.9%), penetrating-sharp object injury (17%), ocular foreign body (3.9%), and others. Isolated extremity injuries (74.2%) were the most common injury site, followed by multiple bodily injuries (8.5%), facial injuries (5.5%) and head-neck injuries (4.6%). While 90% of cases were discharged after treatment in the Emergency Department, 7% were referred to various departments for hospitalization.
CONCLUSION
In the majority of cases, patients with injuries associated with occupational accidents presented to Emergency Departments. Observations in Emergency Departments may help reveal details of occupational injuries and prevent workplace-related accidents.

AMAÇ
Akut apandisit (AA) cerrahi gerektiren hastalýklar arasýnda en sýk rastlanan patolojilerden biridir. Tipik olgularda tanýsý kolaydýr, atipik olgularda tanýsý son derece zordur. Bu çalýþmada AA ön tanýsý ile izlenen hastalarda ultrasonografi (USG) bulgularý ve lökosit sayýsý incelendi ve AA tanýsýndaki deðerleri belirlenmeye çalýþýldý.
GEREÇ VE YÖNTEM
2006 yýlýnýn ilk 6 ayýnda AA ön tanýsý ile laparatomiye alýnan 85 hastanýn verileri retrospektif olarak incelendi. Histopatolojik taný (akut apandisit) ile lökosit sayýsý ve USG bulgularý karþýlaþtýrýldý; tanýdaki duyarlýlýklar ortaya konulmaya çalýþýldý.
BULGULAR
Hastalarýn yaþ ortalamasý 33,5 yýl ve %44,7’si kadýndý. Hastalarýn %95,3’ünde lökosit sayýsý 10000/mm³ ve üstündeydi. Hastalarýn %74,1’inde (n=63) USG yapýlmýþ ve %58,7’sinde (n=37) AA ile uyumlu rapor edilmiþtir. Histopatolojik olarak 4 hastada (%4,7) AA lehine bulgu yoktur (negatif laparatomi). Histopatolojik tanýya göre lökosit sayýsýnýn (≥10000/ mm³) AA tanýsýný belirlemedeki duyarlýlýðý %98,77 ve seçiciliði %75’dir. USG’nin tanýdaki duyarlýlýðý %61,02 ve seçiciliði %75’dir. ROC eðrisi altýnda kalan alanlar karþýlaþtýrýldýðýnda lökosit sayýsýnýn tanýyý belirlemede daha duyarlý olduðu görülmüþtür.
SONUÇ
Bu çalýþmada USG’nin duyarlýlýðý literatürde bildirilen yüksek duyarlýlýk oranlarýna göre düþük bulunmuþtur. Lökosit sayýsýnýn duyarlýlýðý ise USG’ye göre daha yüksek bulunmuþtur.

BACKGROUND
Acute appendicitis (AA) is one of the most frequent pathologies among surgical illnesses. Diagnosis is easy in typical cases, but difficult in atypical cases. In this study, ultrasonographic (USG) findings and leukocyte counts of patients were examined to determine their values in the diagnosis of AA.
METHODS
Data for 85 patients seen in the first six months of 2006 were examined retrospectively. Histopathological diagnosis together with leukocyte counts and USG findings were compared, and sensitivities in the diagnosis were determined.
RESULTS
The average age of the patients was 33.5, and 44.7% were female. In 95.3% of the patients, leukocyte counts were 10000/mm3 and above. In 74.1% of the patients (63 patients), USG was performed, and 58.7% of the cases (37 patients) were compatible with AA. In four (4.7%) of the patients, AA was not found histopathologically (negative laparotomy). The sensitivity of leukocyte counts (≥10000/mm³) was 98.8% and its selectivity was 75%. The sensitivity of USG was 61.0% and its selectivity was 75%. When the areas under the receiver operating characteristics (ROC) curve were compared, leukocyte counts were more sensitive in determining the diagnosis.
CONCLUSION
In this study, the sensitivity of USG was lower than the high sensitivity ratios reported in the literature. However, the sensitivity of leukocyte counts was significantly higher than that of USG.

AMAÇ
Amyand herni, inguinal herni kesesi içinde normal veya enflame apendiksin bulunduðu nadir bir durumdur. Bu nedenle ameliyat öncesi ayýrýcý tanýsý oldukça zordur. Bu çalýþmada, farklý yaþlardaki çocuk olgularýn özellikleri incelenerek, bu özelliklerden ameliyat öncesi tanýda yararlanýp yararlanýlamayacaðý deðerlendirildi.
GEREÇ VE YÖNTEM
Bu çalýþmada, ameliyat ettiðimiz 4 olgu ile literatürlerdeki 15 Amyand hernili çocuk hastanýn (0-15 yaþ arasý) demografik, ameliyat öncesi, ameliyattaki ve ameliyat sonrasý özellikleri geriye dönük olarak deðerlendirildi. Bu 19 olgu 0-1 yaþ ve 1 yaþ üstü olarak iki gruba ayrýlarak özellikleri karþýlaþtýrýldý.
BULGULAR
Ýki grupta da farklý özellikler saptandý. Ancak, 1 yaþ üstü çocuklarda herni kesesi içinde apandisit varlýðýnda, semptomlarýn görülme sýklýðý ve sýrasý, lökositoz varlýðý, baðýrsak seslerinin durumu gibi ölçütler abdomendeki apandisit (akut apandisit) ile benzerlik göstermekte idi.
SONUÇ
Bir yaþýndan büyük, inkarsere-strangüle herni þüphesi ile acil kliniklere baþvuran Amyand hernili çocuklarda, dikkatli inceleme sonucu ameliyattan önce Amyand herninin tanýsýnýn konmasý mümkün olabilir.

BACKGROUND
Amyand’s hernia is a rare hernia in which a normal or inflamed appendix is found in the inguinal hernia sac. Differential diagnosis of Amyand’s hernia prior to surgery is quite difficult. In this study, in order to develop a preoperative diagnostic approach, cases of pediatric patients at different ages were analyzed and their common properties are discussed herein.
METHODS
In the present study, the findings in pediatric patients (ages 0-15) with Amyand’s hernia reported in the literature together with findings in four cases operated in our center were retrospectively assessed with respect to their demographic, preoperative, peroperative, and postoperative characteristics. These 19 cases in total were divided into two groups as age 0-1 and over age 1, and their characteristics were compared.
RESULTS
The two groups revealed different characteristics. However, in children over age 1, in the presence of appendicitis in the hernia sac, criteria like the frequency and order of symptoms, leukocytosis and bowel sounds showed similarity with abdominal appendicitis (acute appendicitis).
CONCLUSION
In children over age 1 with Amyand’s hernia who are admitted to the emergency clinic with suspected incarcerated and strangulated hernia, it is possible to diagnose Amyand’s hernia after a detailed preoperative examination.

AMAÇ
Çalýþmanýn amacý, bir üçüncü basamak hastane acil servisine baþvuran adli nitelikli çocuk hastalarýn, demografik, epidemiyolojik özelliklerini ve tedavi sonuçlarýný saptamak, ulusal verilerimize katkýda bulunmaktýr.
GEREÇ VE YÖNTEM
Adli nitelikli çocuk hastalarýn dosya bilgileri geriye dönük incelendi. Hastalar travmatik (Grup 1) ve travmatik olmayan (Grup 2) baþvurular olarak iki gruba ayrýldý. Yaþ, cinsiyet, baþvuru sebepleri ve sýklýklarý, lokal ve çoklu travma görülme sýklýðý (Kýsaltýlmýþ Yaralanma Ölçeði temel alýnarak) ve oluþtuðu vücut bölgeleri, yatýþ, taburculuk ve mortalite oranlarý gibi özellikleri kaydedildi. Veriler, tanýmlayýcý yöntemler (frekans, yüzde oran, çeyrekler arasý oran), Kolmogorov-Simirnov ve ki-kare testleri kullanýlarak deðerlendirildi, p deðeri <0,05 olan istatistiksel farklýlýklar anlamlý kabul edildi.
BULGULAR
Çalýþmaya 486 hasta dâhil edildi. Yaþ ortalamasý 8,91±5,08 yýl olarak saptandý (%95 GA). Hastalarýn çoðu erkekti (%66,3). Beþ-dokuz yaþ grubu hasta sayýsý (n=162, %33,3) diðerlerine oranla fazlaydý (Kolmogorov-Simirnov testinde p=0,000). Yaz baþvurularýn en sýk gözlendiði mevsimdi. Grup 1’de 153 (%31,5) hasta saptandý. En sýk baþvuru nedeni kazara ilaç içmeydi (%13,8, n=67). Grup 2’de en sýk baþvuru nedeni trafik kazasýydý (n=158, %32,5).
SONUÇ
Çocukluk çaðýnda motorlu araç ve ev kazalarý önlenebilir saðlýk sorunlarýnýn baþýnda yer almaktadýr. Güvenli bir çevre oluþturulmasý, ebeveyn ve çocuklara sürekli koruyucu saðlýk eðitimi verilmesi ve yasal düzenlemeler yaralanma kontrolünde etkin olacaktýr.

BACKGROUND
This study aimed to determine the demographic and epidemiological characteristics and to investigate the outcomes of pediatric medico-legal cases who admitted to the emergency department. It was also aimed to contribute to the national survey.
METHODS
Medico-legal charts of the pediatric cases were reviewed retrospectively. Patients were allocated into two groups as traumatic (Group 1) and non-traumatic (Group 2). Age, sex, presenting complaint and frequencies, local or multiple trauma frequencies, and localizations (based on the Abbreviated Injury Scale) and also admission, discharge and mortality rates were ascertained. Data were evaluated by descriptive methods, Kolmogorov-Smirnov and chi-square tests. Values of p<0.05 were accepted as significant.
RESULTS
There were a total of 486 eligible patients. The mean age was 8.91±5.08 years (95% confidence interval [CI]). The majority (66.3%) were male. The group aged 5-9 years was larger (33.3%) than the others (in Kolmogorov-Smirnov test, p=0.000). Summer was the most common season for admissions. There were 153 patients in Group 1, and the most common complaint was accidental drug intake (13.8%). In Group 2, the most common reason for admission was motor vehicle accident (32.5%).
CONCLUSION
Motor vehicle and home accidents in childhood are preventable health problems. To ensure a safe environment, continuous health education programs on injury and prevention for parents and children and legal controls will be effective in injury control.

Sað alt kadran aðrýsýyla baþvuran hastada ilk akla gelen tanýlardan biri akut apandisittir. Apendektomi en sýk yapýlan acil cerrahi ameliyattýr. Karýn sol alt kadran aðrýsýnýn çok deðiþik nedenleri olabilir. Situs inversus totalis embriyonik geliþim sýrasýnda meydana gelen bir anomalidir. Bu anomalide karýn ile toraks içi organlar ters yerleþimlidir. Bu olgu sunumunda sol alt kadran aðrýsýyla baþvuran, incelemeler sonrasý situs inversus totalis ile birlikte akut apandisit tanýsý konulan olgu tartýþýldý. Hekimlere yanlýþ taný ve tedavi sonrasý açýlan davalar göz önüne alýnýrsa, acil serviste yapýlan tüm incelemelerin yeterli deðerlendirilmesi ve eldeki radyolojik imkanlardan doðru ve yeterince yararlanýlmasý gerektiði düþüncesindeyiz.

For the patient admitted with right lower quadrant abdominal pain, acute appendicitis is the most frequently considered diagnosis. Appendectomy is the most common of all emergency operations. However, there may be several reasons for left lower quadrant abdominal pain. Situs inversus totalis is an anomaly that occurs during embryonic development when intraabdominal and intrathoracic organs have reverse localization. In this case report, we present a patient who was admitted with left lower quadrant abdominal pain and was diagnosed as situs inversus totalis and acute appendicitis. In view of the legal repercussions for doctors as a result of erroneous diagnosis and treatment, we think that adequate evaluation of the studies in the emergency service is important and that the radiological investigations have to be used appropriately and sufficiently.

Travmatik aortik rüptürü içeren potansiyel olarak önlenebilir bir ölüm olgusunu sunmayý ve mevcut bilgilerle uyumlu istmik aortik rüptürlerinin tedavisine yönelik kritik bir yöntem geliþtirmeyi amaçladýk. Uzmanlardan oluþan multidisipliner bir panelde geriye dönük kayýt incelemesi yapýldý ve Revize Travma Skoru ile Yaralanma Ciddiyet Ölçeði skoru esas alýnarak saðkalým olasýlýðý tahmin edildi. Daha sonra ortaya çýkabilecek olgulara yönelik önemli bir tedavi algoritmasý geliþtirmek için, kalite ve güvenlik incelemesi yapýlýrken, literatür gözden geçirmesi ile uzman konsensüsünden yararlanýlmýþtýr. Motosiklet kazasýnda yaralanan 32 yaþýndaki erkek hasta, þok tablosu içinde bir travma merkezine sevk edildi. Hastada ciddi olarak torasik aortik rüptürden kuþkulanýldý. Eðitim için, geniþlemiþ bir mediastene iliþkin klasik belirtiler, sað trakeal deviasyon ve sað hemotoraks (önemli bir deselerasyon yaralanmasý açýsýndan) travmatik aort rüptürüne yönelik akut bir bakým triadýna dahil edilmiþtir. Bu tür olgularda, aortografi iþleminin yapýlamayacaðý durumlarda, taný doðrulama ve operatif planlamaya yönelik olarak (seri gerektirirse) kontrastlý bilgisayarlý göðüs tomografi taramasý yapýlmasýný öneriyoruz. Ýlk baþvurulan travma merkezinde ameliyat kapasitesi mevcutken hastanýn hemodinamik stabilite gerekçesiyle ikinci bir merkeze transferi katastrofik sonuçlar doðurabilir.

We aimed to present herein the case of a potentially preventable death involving traumatic aortic rupture and to develop a critical pathway for the management of isthmic aortic ruptures consistent with the available resources. A retrospective record review by a multidisciplinary panel of experts was done, and the probability of survival was estimated based on the Revised Trauma Score and Injury Severity Scale score. Literature review and expert consensus were used in a quality and safety analysis to develop a critical care pathway for future cases. A 32-year-old man, injured in a motorcycle accident, was referred to a trauma center in a state of shock. Thoracic aortic rupture was highly suspected. For educational purposes, the classic signs of a widened mediastinum, right tracheal deviation, and left-sided hemothorax (in a context of significant deceleration injury) are incorporated into an acute care triad for traumatic aortic rupture. In such cases, in the absence of poor access to aortography, we suggest (serial - if needed) contrast-enhanced chest computed tomography scanning for diagnosis confirmation and operative planning. Assumption of hemodynamic stability can be catastrophic, and transferring the patient to a second facility may endanger survival, when operative capacity exists at the initial trauma facility.

Femoral herni olgularýnda, femoral artere uygulanan invaziv giriþimler sonucu ince baðýrsak perforasyonu nadir görülen bir komplikasyondur. Pulmoner yetersizlik nedeniyle yogun bakýmda takip edilen 48 yaþýnda kadýn hastada, kan gazý incelenmesi amacýyla femoral artere uygulanan giriþimden sonra þiddetli kusma ve karýn aðrýsý oldu. Hasta akut karýn olarak deðerlendirilerek ameliyata alýndý. Laparotomide ince baðýrsak perforasyonu saptanmasý üzerine segmenter ince baðýrsak rezeksiyonu, uç-uca anastomoz yapýldý. Femoral kanal plak meþ ile kapatýldý. Femoral arter giriþimleri esnasýnda iyatrojenik ince baðýrsak perforasyonunu önlemek için femoral herni olasýlýðý gözönüne alýnarak dikkatli fiziksel inceleme yapýlmalýdýr.

Small bowel perforation is a rare complication of femoral artery access in cases of femoral hernia. A 48-year-old woman was admitted to the intensive care unit due to pulmonary insufficiency. After a routine femoral arterial blood gas analysis, severe abdominal pain and nausea began. She underwent emergency laparotomy due to acute abdomen. Laparotomy revealed small bowel perforation. Segmental resection and end-to-end anastomosis were performed. The femoral canal was closed using plaque mesh. Special attention is needed during femoral artery access to avoid accidental small bowel perforation. As seen in this case, a careful examination should be done in cases of femoral hernia.

Gastric volvulus ile komplike olan post-travmatic diyafragma hernisi olaydan hemen ya da yýllar sonra bulgu verebilir. Travmatik diyafragma hernisinin gastrik volvulusla geç bulgu vermesi nispeten nadir bir durumdur. Burada, bir yýl önce sol alt göðüse aldýðý penetran býçak yaralanmasý sonrasý diyafragmatik herni ve buna baðlý olarak gastrik volvulus geliþen 28 yaþýndaki bir erkek hasta sunuldu. Diyafragmatik herninin primer dikiþle onarýlmasýnýn ardýndan hasta, son iki yýldýr semptomsuz izlenmektedir.

Post-traumatic diaphragmatic hernia complicated by gastric volvulus may manifest immediately or several years after the incident. Delayed presentation of traumatic diaphragmatic hernia with gastric volvulus is relatively unusual. We report a 28-year-old male patient who admitted with gastric volvulus due to traumatic diaphragmatic hernia after sustaining a knife wound to the left lower chest one year before presentation. The patient has been followed without any symptom for two years since the diaphragmatic hernia was repaired by primary suture plication.

Kafa travmasý nedeniyle tedavi edilen hastalarýn %1,5’inde epidural hematom görülür. Bu durum hayatý tehdit edebilir ve acil cerrahi giriþim gerektirir. Bazý olgularda epidural hematomun kendiliðinden emilebildiði görülür. Bu yazýda, kendiliðinden, hýzlý bir þekilde emilen epidural hematom bildirildi ve olasý mekanizmalar tartýþýldý.

Incidence of acute epidural hematoma is estimated as 1.5% of patients treated for head trauma. The condition can be fatal, and urgent surgical evacuation is recommended. Spontaneous resolution may occur in some cases. Herein, rapid spontaneous resolution of an epidural hematoma is reported and possible mechanisms are discussed.

Akut taþsýz kolesistit, tüm kolesistit olgularýnýn yaklaþýk %10’unu oluþturur. Kesin mekanizma tam olarak bilinmemekle birlikte, patogenezde en önemli faktörler safra stazý, sepsis ve iskemidir. Biz bu çalýþmada, Bakey tip 3 aort diseksiyonuna baðlý olarak geliþen safra kesesi iskemisine sekonder oluþmuþ akut taþsýz kolesistit olgusunu sunmayý amaçladýk.

Acute acalculous cholecystitis (AAC), inflammation of the gallbladder without evidence of calculi, comprises approximately 10% of all cases of acute cholecystitis. Although the mechanism of AAC has not yet been sufficiently clarified, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis and ischemia. We present a case of AAC associated with ischemia of the gallbladder caused by aortic dissection Bakey type III.