AMAÇ
Bu çalýþmanýn amacý deðiþik yönlerden gelen künt travmaya karþý göðüs kafesinin parenkim koruyucu potansiyelini deneysel bir hayvan modelinde araþtýrmaktýr.
GEREÇ VE YÖNTEM
Diþi Wistar albino sýçanlar, herbirinde 6 adet olmak üzere kontrol, anterolateral, lateral ve posterolateral travma gruplarý olarak ayrýldý. Deney için özel imal edilen bir platformda kinetik enerjisi 1,96 jul olacak þekilde 500 gr’lýk bir aðýrlýk 40 cm’lik bir yükseklikten sol hemitoraks bölgelerine düþürüldü. Travma öncesi ve travmadan 0, 1 ve 5 dakika sonra solunum sayýsý ile kalp tepe atýmý not edildi. Travmadan 24 saat sonra sol akciðer; yaþ akciðer aðýrlýðý, histoloji ve doku malondialdehid tayini için eksize edildi.
BULGULAR
Tüm travma gruplarýnda, histolojik olarak kontrol grubuna göre ciddi akciðer kontüzyonu oluþtuðu gözlendi. Malondialdehid hem lateral hem de posterolateral travma grubunda artarken kontrol grubuna göre yaþ akciðer aðýrlýðýnýn sadece posterolateral travma grubunda arttýðý saptandý. Histolojik olarak pigmente hücre artýþý ve mononükleer hücre infiltrasyonu posterolateral travma grubunda anlamlý bulundu. Fizyolojik parametrelerde anlamlý bir deðiþiklik saptanmadý.
SONUÇ
Göðüs kafesinin posterolateral bölgesinden alýnan travmalarda akciðer parenkimi daha þiddetli etkilenebilmektedir. Farklý göðüs bölgelerinin ayný künt travma stresine farklý cevaplarýnýn olabileceði ve bu cevaplarýn göðüs kafesinin biyomekanik özelliklerine baðlý olabileceði düþünülmektedir.

BACKGROUND
We aimed to investigate the protective potential of the thoracic cage on the parenchyma in response to blunt trauma from different directions in an animal model.
METHODS
Female Wistar albino rats were divided into control, anterolateral, lateral and posterolateral trauma groups, with six rats in each group. A weight of 500 g was dropped from a height of 40 cm on the left hemithorax to produce an energy of 1.96 joules, using a specially designed platform. Respiratory rates and heart rates were noted before and at 0, 1, and 5 minutes after trauma. Twenty-four hours later, the left lungs were excised for wet lung weight measurement, histological examinations and tissue malondialdehyde determination.
RESULTS
Severe pulmonary contusion was observed in all trauma groups according to histological parameters. Malondialdehyde was increased in both the lateral and posterolateral groups. Wet lung weight was increased only in the posterolateral trauma group when compared to controls. Histologically, macrophages were increased and mononuclear cell infiltration was significant in the posterolateral trauma group. There were no significant changes in physiological parameters in the groups.
CONCLUSION
Lung parenchyma seems to be badly affected after trauma to the posterolateral thoracic wall. Different thoracic regions may respond differently to the same traumatic stress, and this may be related to the biomechanical properties of the thoracic cage.

AMAÇ
Bu prospektif kontrollü deneysel çalýþma, levosimendanýn erken dönem sepsiste transforming growth factor (TGF)-β3 ve Smad1, Smad2 ve Smad3 oluþumuna etkilerini araþtýrmak amacýyla planlandý.
GEREÇ VE YÖNTEM
Yirmi dört sýçan rasgele dört gruba ayrýldý: 1) sham kontrol grubu 2) dobutamin grubu - abdominal hipertansiyon, çekal ligasyon ve delme (ÇLD) tekniði ile peritonit modeli prensibiyle sepsis oluþturuldu, sonra sýçanlar 10 µg.kg-1 dk-1 intravenöz (IV) dobutamin infüzyonu ile tedavi edildi, 3) levosimendan grubu - 2. grupta olduðu gibi sepsis modeli gerçekleþtirildi sonra sýçanlar levosimendan IV bolus 200 µg.kg-1 takiben, 200 µg.kg.-1 dk-1 IV infüzyonu ile tedavi edildi, 4) kontrol grubundakilere tedavi yapýlmadý. Tüm sýçanlar ÇLD’den 8 saat sonra öldürüldü. Aort doku örnekleri immünohistokimyasal olarak boyandý.
BULGULAR
ÇLD hem kontrol, hem de dobutamin gruplarýnda ýlýmlý IL-1 boyanmasýna neden oldu. Tumor necrosis factor (TNF)-α immünreaktivitesi sham ve kontrol grubunda ýlýmlýydý. Sham, kontrol ve dobutamin gruplarýnda TGF-β3 ýlýmlý derecede yüksek bulunurken, bu parametre levosmendan grubunda orta derecede yüksek saptandý. Smad1, Smad2 ve Smad3 levosmendan grubunda orta derecede yükselmiþ olarak saptandý.
SONUÇ
Levosimendanýn hemodinami ve global oksijen taþýnmasýna saðladýðý olumlu etkiler, deneysel ve klinik çalýþmalarda bildirilmiþtir. Levosimendanýn C++ iyon duyarlýlýðý üzerine etkileri yaný sýra, TGF-β3, Smad1, Smad2 ve Smad3 oluþumunu etkileyerek enflamasyonda sitokin salýnýmýna da etkileri olabilir.

BACKGROUND
This prospective, controlled experimental study was planned to investigate the effects of levosimendan on transforming growth factor (TGF)-β3 and Smad1, Smad2 and Smad3 expression in the early stages of sepsis.
METHODS
Twenty-four rats were randomized into four groups: 1) sham-operated controls, 2) dobutamine group - subjected to abdominal hypertension and peritonitis-induced sepsis using cecal ligation and puncture (CLP), then treated with 10 µg.kg-1min-1 intravenous (IV) dobutamine infusion, 3) levosimendan group - as in 2, then treated with levosimendan IV bolus 200 µg.kg-1 followed by 200 µg.kg.-1 min-1 IV infusion, and 4) a control group as in 2, with no treatment. All rats were killed 8 hours after CLP. Aorta tissue samples were analyzed by immunohistochemical staining.
RESULTS
CLP caused mild interleukin (IL)-1 immunostaining in both control and dobutamine groups. Immunoreactivity of tumor necrosis factor (TNF)-α was mild in both sham and control groups. TGF-β3 immunostaining was mildly increased in groups sham, control and dobutamine, whereas it was found moderate in group levosimendan. Smad1, Smad2 and Smad3 were found moderately increased only in group levosimendan.
CONCLUSION
Beneficial effects of levosimendan on hemodynamics and global oxygen transport were reported in experimental and clinical trials. Besides its potency on C++ ion sensitivity, it should influence inflammatory cytokine production by diminishing TGF-β3 and Smad1, Smad2 and Smad3 expression.

AMAÇ
Týbbi biliþim sistemleri arasýndaki iþbirliði, kablosuz iletiþim ve hastane öncesi acil hizmetler, optimum hastane öncesi hasta tedavisi için kaçýnýlmazdýr. Teknolojik yeniliklerin kullanýlmasý, hastanýn yararýna bütün taraflarý koordine eden entegre bir merkezin organizasyonu ile ilgili olarak hastane öncesi ortamda týbbi bakýmý iyileþtirir.
GEREÇ VE YÖNTEM
Güneybatý Yunanistan’da bir kent olan Patras’da, þehir planýný gösteren dijital bir harita üzerinde acil giriþim araçlarýnýn yerleþimini hemen iþaretleyen bir Coðrafi Bilgi Sistemi ile donatýlmýþ bir görev daðýtým merkezi geliþtirilmiþtir. Ek olarak, Ulusal Acil Yardým Merkezi’nin üç ambulansý, trafik ýþýðý bulunan kavþaklarda aracýn trafik önceliðine yönelik bir trafik düzenleme sistemi ile donatýlmýþtýr. Sistem, araç kabininde bulunan hücresel esaslý bir teletýp modülü, bir Küresel Konumlandýrma Sistemi ve bir web kamera sisteminden oluþmuþtur.
BULGULAR
Yukarýda söz edilen sistem, öncelikle kaza bölgesine en yakýn ambulansý seçmek ve daha sonra hastaneye doðru optimum rotayý çizmek ve böylelikle genel transport süresini anlamlý þekilde azaltmak suretiyle, hastane öncesi tedaviye kayda deðer ölçüde katký saðlamýþtýr.
SONUÇ
Projenin, travma hastalarýnýn tedavisiyle ilgilenen acil hastane departmanlarýnýn ileri teknoloji kullanmak suretiyle diðer acil servisler ile koordine edilmesine yönelik hedefi, bu disiplinlerarasý çaba kapsamýnda yerine getirilmiþtir.

BACKGROUND
Cooperation between medical informatics, wireless communication and pre-hospital emergency services is essential for the optimal pre-hospital patient treatment. The use of technological innovations improves medical care in the pre-hospital setting with regard to the organization of an integrated center, which coordinates all parties involved for the patient’s best interest.
METHODS
A dispatch center was developed in the city of Patras, in southwestern Greece, equipped with a Geographic Information System (GIS), which immediately points out the location of emergency vehicles (EVs) on a digital map depicting the city plan. Additionally, three ambulances of the National Center of Immediate Aid (NCIA) were equipped with a decentralized traffic management system for the vehicle’s traffic priority at signaled junctions. The system consisted of a cellular-based (GSM) telemedicine module, a Global Positioning System (GPS) and a web camera system in the vehicle cabin.
RESULTS
The aforementioned system provided considerable assistance to the pre-hospital treatment first by selecting the ambulance closest to the accident’s location and then by pinpointing the optimum route to the hospital, thus significantly reducing the overall transportation time.
CONCLUSION
The project’s objective to coordinate emergency hospital departments involved in the treatment of trauma patients with other emergency services by utilizing high technology was achieved within this interdisciplinary effort.

AMAÇ
Bu çalýþma, Ýran’daki travmatik alt ekstremite vasküler yaralanmalarýnýn özelliklerini belirlemeyi amaçlamýþtýr.
GEREÇ VE YÖNTEM
Alt ekstremite vasküler yaralanmasý bulunan hastalar, Ýran Ulusal Travma Projesinden seçildi. Bu proje, 2000-2004 yýllarý arasýnda sekiz büyük kentte yürütüldü ve 17000’den daha fazla sayýda hastayý içerdi.
BULGULAR
Toplam 92 vasküler alt ekstremite yaralanmasý bulunan 63 olgu (54 erkek) belirlendi. Hastalarýn ortalama yaþý, 25,87±13,37 yýl idi. Künt travma, penetran yaralanmaya göre daha yüksekti (%38’e karþý %62). Olgularýn 36’sýnda (%57), yaralanma nedeni, karayolu trafik kazasý (KTK) idi. Hastalarýn %21’inde (n=24), vasküler yaralanma mesleki travmadan kaynaklanmýþtýr. Ýþçiler (n=23, %20) en çok etkilenen grup olmuþtur. Üç hasta (%5) eþlik eden yaralanmalarýn þiddeti nedeniyle ölmüþtür.
SONUÇ
Bizim bulgularýmýz, KTK’nýn Ýran’daki en sýk alt ekstremite vasküler yaralanma nedeni olduðunu göstermiþtir. Ayný zamanda bizim bulgularýmýz, mesleki yaralanmalarýn da kayda deðer bir prevalansa sahip olduðunu göstermiþtir. Bu yaralanmalarýn sýklýðýný azaltmaya yönelik önleyici stratejilerin oluþturulmasýný önermekteyiz.

BACKGROUND
This study aimed to determine the pattern of traumatic lower extremity vascular injuries in Iran.
METHODS
Patients with vascular injury of the lower extremity were selected from the Iranian National Trauma Project. This project was conducted in eight major cities during 2000-2004 and consisted of more than 17000 patients.
RESULTS
Sixty-three subjects (54 men) with a total of 92 vascular injuries of the lower extremity were identified. Mean age of the patients was 25.87±13.37 years. Blunt trauma was more frequent than penetrating (62% vs. 38%). In 36 cases (57%), road traffic crash (RTC) was the cause of injury. In 21% of the patients (n=24), vascular injury resulted from occupational trauma. Workers (n=23, 20%) were the most frequently affected group. Three patients (5%) died due to severity of the associated injuries.
CONCLUSION
Our results revealed that RTC is the most frequent cause of lower extremity vascular injuries in Iran. Our findings also showed that occupational injuries have considerable prevalence. Establishment of preventive strategies to reduce the frequency of these injuries is recommended.

AMAÇ
Çocuk acil servisimize travma nedeniyle baþvuran hastalarda radyolojik maliyet analizi yapmaktýr.
GEREÇ VE YÖNTEM
Tüm olgularýn yaþ, cinsiyet, travma tipi, istenilen radyolojik görüntüleme sonuçlarý ve bunlarýn maliyetleri, hastalarýn gözlem süreleri ve tedavi sonuçlarý ile hastaneye yatýþ oranlarý geriye dönük olarak incelendi.
BULGULAR
Bu çalýþmada yaþlarý 1-15 yaþ arasýnda deðiþen ve yaþ ortalamasý 5,91±3,82 yýl olan 1231 travma olgusu incelendi. Radyolojik inceleme yapýlan 996 olguya toplam 3382 radyolojik görüntüleme yapýlmýþtý ve bunlardan sadece 300’ünde (8,8%) patolojik bulgu mevcuttu. Ortalama radyolojik görüntülemelerin maliyeti 40,42±34,38 US$ (4,67-139,26 US$) idi. Total radyolojik inceleme maliyeti Glaskow Koma Skalasý ile ters (r= -0,37, p<0,001) ve Travma Þiddet Skoru ile doðru (r= 0,27, p<0,001) orantýlý olarak artýþ gösterirken Pediatrik Travma Skoru ile arasýnda anlamlý bir iliþki yoktu (r= -0,16, p>0,05). Çalýþmaya alýnan olgularýn hastanede kalýþ süresi ise ortalama 8,54±10,91 saat idi.
SONUÇ
Travmalý hastalarda ileri görüntüleme yöntemleri erken tanýda yardýmcý bir unsurdur. Bununla birlikte acil servislerde gereksiz radyolojik incelemelerin ve bu incelemelere ait maliyetlerin azaltýlmasý için periyodik eðitim programlarýnýn uygulanmasý gerekmektedir.

BACKGROUND
The aim of this study was to examine the cost of radiologic imaging in pediatric trauma patients admitted to the pediatric emergency department.
METHODS
All patients were retrospectively evaluated according to age, gender, details of injury, radiological investigations ordered and their results, cost of radiologic imaging, length of stay, outcome of the injury, and hospitalization rates.
RESULTS
The cost of radiologic imaging was retrospectively analyzed in 1231 trauma patients aged between one month and 15 years (mean 5.91±3.82 years). For the 996 patients who had radiological imaging, 3382 images were taken in total. Of these, only 300 (8.8%) were abnormal. The mean (and SD) total cost of radiologic imaging was US$ 40.42 ($34.38) (range $4.67 to $139.26). Total cost correlated inversely with Glasgow Coma Scale (GCS) (r= -0.37, p<0.001), directly with Injury Severity Score (ISS) (r= 0.27, p<0.001) and was not correlated with the Pediatric Trauma Score (PTS) (r= -0.16, p>0.05). The mean (and SD) duration of hospital stays was 8.54 (10.91) hours.
CONCLUSION
Advanced radiological images may help in early diagnosis of trauma cases. However, periodic education programs to prevent unnecessary radiological imaging in emergency departments are also necessary to decrease the cost of these imaging modalities.

AMAÇ
Müslüman ülkelerde her yýl hac ayýnda kurban bayramý kutlanýr ve bu bayramda binlerce hayvan kesilir. Gerek hayvanýn kesimi, gerekse etin iþlenmesi sýrasýnda çok sayýda ve çeþitte yaralanmalar meydana gelmektedir. Çalýþmanýn amacý, hayvan kesimi ile iliþkili yaralanma ile baþvuran hastalarýn, demografik özelliklerini, hayvan kesimi deneyimlerini, yaralanma tiplerini ve hastane tedavi maliyetini saptamaktýr.
GEREÇ VE YÖNTEM
Ankara’da Gazi Üniversitesi Týp Fakültesi ve Ankara Eðitim ve Araþtýrma Hastanesi Acil Servislerinde yapýlan prospektif gözlemsel bir çalýþmadýr. Ýki kurban bayramý süresince acil servise hayvan kesimi ve et iþlenmesi ile iliþkili yaralanma þikayetiyle baþvuran ve çalýþmaya katýlmayý kabul eden 17 yaþ üstü eriþkin 120 hasta alýndý.
BULGULAR
Hastalarýn yaþ ortalamasý 41,85±85 ve 101’i (%84,2) erkekti. Yüz on altý hastanýn (%96,7) hayvan kesimi ve et iþleme için yeterli deneyimi yoktu. Hastalarýn 97’si (%80,8) bayramýn ilk günü baþvurdu. Yaralanmalarýn 99’unun (%82,5) kesici alete baðlý, 21’inin ise (%17,5) düþme, boynuzlanma veya tekmelenme ile gerçekleþtiði görüldü. Tam tendon kesisi, parmak amputasyonu, ekstremite kýrýklarý ve göz travmasý olan 14 (%11,7) hasta ameliyata alýndý. Ortanca 104,76 (67,48-322,12) Türk Lirasý (74,30 [47,86-228,45] USD) hastane tedavi maliyeti saptandý.

SONUÇ
Kurban kesimi için uygun koþullar hazýrlanmalý, profesyonel kiþilerce kesimlerin yapýlmasý saðlanmalý, özellikle kurban bayramýnýn ilk günlerinde acil servisler hem ekip, hem de malzeme yönünden takviye edilmelidir.

BACKGROUND
During the Feast of Sacrifice in Muslim countries, thousands of animals are slaughtered every year. Many injuries occur during the sacrifice. Thus, the aim of this study was to determine the demographic characteristics of patients, their slaughtering experience, types of injury, and related hospital costs.
METHODS
This prospective observational study was conducted in Emergency Departments (EDs) of Gazi University and Ankara Training and Research Hospital. One hundred and twenty adult patients were admitted to EDs with injuries related to the slaughter and processing of meat during two consecutive Feasts of Sacrifice.
RESULTS
The average age of patients was 41.85±13.6, and 101 patients (84.2%) were male. One hundred sixteen patients (96.7%) were not professionals. Ninety-seven patients (80.8%) were admitted to EDs on the first day of the feasts. Ninety-nine injuries (82.5%) were related to cutting tools, and 21 patients (17.5%) were admitted with complaints of either falling or being harmed by animals. Fourteen patients (11.7%) with tendon lacerations, finger amputations, extremity fractures, and eye traumas were taken into surgery. Hospital costs were a median 104.76 [67.48-322.12] Turkish Liras (74.30 [47.86-228.45] USD).
CONCLUSION
Proper conditions for slaughter should be provided and professionals should perform the slaughter and/or processing of the meat. EDs should be supplied both more equipment and physicians, especially on the first days of the feast.

AMAÇ
Kalýn baðýrsak týkanmalarýnýn tedavisinde ameliyat esnasýnda baðýrsak yýkamasý ve kolonoskopisi, seçilmiþ hastalarda, güvenli bir rezeksiyon ve primer anastomoz yapýlmasýna imkân vermektedir. Ancak önceden kullanýlan teknikler uygun olmayan boþaltma yolu ve saçýlma gibi ciddi sakýncalar taþýmaktadýr. Kolonun ameliyat masasýnda bir kamera kýlýfý içerisinden ileriye doðru yýkanmasý, risklerin önlenmesi amacýyla yeni bir teknik olarak tanýmlanmaktadýr.
GEREÇ VE YÖNTEM
2003 ve 2009 yýllarý arasýnda tümöre baðlý kalýn baðýrsak týkanýklýðý nedeniyle acile baþvuran altý hastaya (yaþlarý 58-80, median 73) ameliyat masasýnda baðýrsak temizliði yapýldýktan sonra kalýn baðýrsak rezeksiyonu ve primer anastomoz uygulandý. Kalýn baðýrsak, týkanmanýn proksimalinden kesilip proksimal uç bir naylon kýlýf içine sokuldu. Kýlýf baðýrsaða sýkýca dikildi. Kolonun yýkamasý için bir Foley kateter appendiksten çekuma ilerletildi. Yýkamadan sonra ameliyat sýrasýnda kolonoskopi yapýldý.
BULGULAR
Teknik tüm hastalarda baþarýyla uygulandý. Kalýn baðýrsaðýn yýkanmasý 12-16 dakika sürdü, kolononoskopiler ise 7-20 dakikada tamamlandý. Kalýn baðýrsaðýn yýkanmasý sýrasýnda bulaþ olmadý. Dört hastaya sol hemikolektomi, birine geniþletilmiþ sað hemikolektomi diðerine ise total kolektomi uygulandý. Ameliyat sonrasý dönemde komplikasyon geliþmedi.
SONUÇ
Tanýmlanan ameliyat masasýnda kýlýf içi(ne) yýkama tekniði, týkanmýþ kolonun dýþký yükünün boþaltýlmasýnda çabuk ve güvenlidir. Bulaþ riskini azaltýr ve primer rezeksiyon anastomoz için ameliyatýn süresini kýsaltýr. Bu yöntem ayný zamanda ameliyat sýrasýnda etkin bir kolonoskopiye olanak saðlar.

BACKGROUND
In the management of large bowel obstruction, on-table lavage and intraoperative colonoscopy allow a safe resection and primary anastomosis in selected patients. Previous techniques carry serious disadvantages, in the form of inconvenient drainage route and spillage. A novel technique of in-sleeve on-table colonic lavage using a camera sleeve is described.
METHODS
Six patients (58-80 years old, median 73) who admitted to emergency service between 2003 and 2009 with colonic obstruction due to tumor underwent colonic resection and primary anastomosis after on-table lavage. The colon was divided proximally to the obstruction, and then was introduced into a nylon sleeve and sutured. A Foley catheter was inserted to the cecum for irrigation. After irrigation, intraoperative colonoscopy was accomplished.
RESULTS
The technique was successfully used in all patients. The colonic irrigation took 12-16 minutes and colonoscopy was completed in 7-20 minutes. There was no contamination during the washout of the colon. Four patients underwent left hemicolectomy; extended right hemicolectomy and total colectomy was performed in the remaining two. There were no complications in the postoperative period.
CONCLUSION
The described technique of in-sleeve on-table lavage is safe and quick to washout the fecal load in the obstructed colon. It prevents the contamination risk and shortens the operative period for resection and primary anastomosis. This method also enables an effective intraoperative colonoscopy.

AMAÇ
Bu çalýþmanýn amacý, acil cerrahi sorunlarý ile hastanelerimize baþvuran ince baðýrsak tümörü olan 13 hastanýn klinik sürecini, taný çalýþmalarýný, uygulanan cerrahi iþlemleri ve saðkalýmlarýný irdelemektir.
GEREÇ VE YÖNTEM
1996 ile 2008 tarihleri arasýnda Cumhuriyet Üniversitesi Týp Fakültesi Genel Cerrahi Anabilim Dalý’nda ve Kütahya Devlet Hastanesi Genel Cerrahi Kliniði’nde ince baðýrsak tümörü nedeniyle acil cerrahi giriþim uygulanan 13 hastanýn dosyalarý retrospektif olarak deðerlendirildi.
BULGULAR
Hastalarýn yedisinde ince baðýrsak týkanýklýðý, beþinde perforasyon ve birinde de invajinasyon vardý. Histopatolojik olarak hastalarýn dördünde adenokarsinom, üçünde ince baðýrsak sarkomu, ikisinde Non-Hodgkin Lenfoma, birer hastada karsinoid tümör, ince baðýrsak anjiyoleiomiyomu, Brunner bezi adenomu ve ince baðýrsaðýn enflamatuvar psödotümörü saptandý. R0 rezeksiyon oraný %76 (10/13) iken R2 rezeksiyon üç (%23) hastada uygulanmýþtýr.
SONUÇ
Ýnce baðýrsak tümörleri çok nadir görülür. Bulgularý spesifik deðildir ve taný sürecinde daha ileri taný yöntemlerine gereksinim duyulmaktadýr. Bu tümörlerin biyolojik davranýþ tipi ve geliþim süreçlerine yapýlan giriþimin zamaný ve çeþidi saðkalýmý belirlemektedir.

BACKGROUND
The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy, and prognosis of 13 patients with small bowel tumor admitted for surgical procedures in an emergency setting.
METHODS
From 1996 to 2008, 13 consecutive surgical cases of small bowel tumors were treated at the Cumhuriyet University Faculty of Medicine, Department of General Surgery, and Kütahya State Hospital, Department of General Surgery. Clinical and radiological charts of these patients were reviewed retrospectively from the department database.
RESULTS
Intestinal obstruction (7 cases) and perforation (5 cases) were the most common clinical presentations, followed by intussusception (1 case). Adenocarcinoma was the most frequent histologic type (4 cases), while small bowel sarcoma was seen in three cases and non-Hodgkin lymphoma in two cases. The remaining cases had carcinoid tumor, small bowel angioleiomyoma, Brunner’s gland adenoma, and inflammatory pseudotumor of the small intestine.
CONCLUSION
Small bowel tumors are rare, the symptoms often non-specific, and the accuracy of different diagnostic tests remains to be improved. Timing and type of the intervention to the process and biological behavior of the pathological cells predict the prognosis.

AMAÇ
El metakarp ve falanks kýrýklarýyla ilgili olarak, uygun açýk redüksiyon ve internal fiksasyon, hastalarýn %5’inden daha azýnda gerekli olmaktadýr. Bunun dýþýnda kalanlarda, bu kýrýklarýn kapalý redüksiyondan gerek önce gerek sonra stabil olmalarý nedeniyle, kapalý redüksiyon teknikleri olgularýn çoðunda tatmin edici sonuçlar vermektedir. AO mini-fragman plak ve vidalar doðru seçilmiþ olgularda kullanýldýðýnda eklemlerin erken hareketlenmesine ve böylelikle dýþarý uzanan K-telleri ve hareketsizlik sorunlarýný önleyerek iyi fonksiyonel sonuçlara olanak tanýyan sert fiksasyon saðlayabilir. Ýnternal fiksasyonun avantajlarý, bizi bu tip el yaralanmalarýnýn yaygýn olarak görüldüðü eyaletimizde böyle bir çalýþma yapmaya teþvik etmiþtir.

GEREÇ VE YÖNTEM
Kýrk iki adet stabil olmayan metakarp ve falanks kýrýðý bulunan 40 hasta, AO mini-fragman plak ve vida kullanýlarak, ileriye dönük olarak üç yýllýk sürede açýk redüksiyon ve internal fiksasyon yöntemiyle tedavi edildi.

BULGULAR
Genel olarak sonuçlar Amerikan El Cerrahisi Derneði ölçütlerine göre, olgularýn %78,5’inde iyi, %19’unda orta derece ve %2,5’inde kötü olarak deðerlendirilmiþtir.
SONUÇ
Bu teknik, komþu eklemlerin erken hareketlenmesine olanak saðlamaya yetecek oldukça sert bir fiksasyon saðlamasý ve iyi fonksiyonel bulgular elde etmeye yardým etmesi nedeniyle, stabil olmayan metakarp ve falanks kýrýklarýný tedavi etmeye yönelik uygun bir seçenektir.

BACKGROUND
Accurate open reduction and internal fixation for metacarpal and phalangeal fractures of the hand is required in less than 5% of the patients; otherwise, closed treatment techniques offer satisfactory results in most of these cases as these fractures are stable either before or after closed reduction. AO mini-fragment screws and plates, when used in properly selected cases, can provide rigid fixation, allowing early mobilization of joints and hence good functional results while avoiding problems associated with protruding K-wires and immobilization. The advantages of such internal fixation urged us to undertake such a study in our state where such hand injuries are commonly seen.
METHODS
Forty patients with 42 unstable metacarpal and phalangeal fractures were treated with open reduction and internal fixation using AO mini-fragment screws and plates over a period of three years in a prospective manner.
RESULTS
The overall results were good in 78.5% of cases, fair in 19% of cases and poor in 2.5% of cases, as judged according to the criteria of the American Society for Surgery of the Hand.
CONCLUSION
This technique is a reasonable option for treating unstable metacarpal and phalangeal fractures as it provides a highly rigid fixation, which is sufficient to allow early mobilization of the adjacent joints, thus helping to achieve good functional results.

AMAÇ
Travmalý hastalarda en sýk gözden kaçan yaralanmalardan birisi diyafram yýrtýðýdýr. Tespit edilmesi halinde tedavi için laparatomi veya torakotomi gerekmektedir. Bu çalýþmanýn amacý, ameliyat öncesinde ve ameliyat esnasýnda tespit edilen diyafram yaralanmalý, hastalarýn tanýsal süreçlerini, mortalite ve morbidite oranlarý eþliðinde deðerlendirmektir.
GEREÇ VE YÖNTEM
Kliniðimize yedi yýllýk süre içinde kabul edilen 16 diyafram yaralanmalý hastada cerrahi giriþim, eþlik eden yaralanmalar, hastanede kalýþ süresi, transfüzyon gereksinimi, mortalite ve morbidite oranlarý retrospektif olarak irdelendi.
BULGULAR
Yedi yýlda 16 hasta diyafram yaralanmasý nedeniyle tedavi edildi. Kadýn/erkek oraný 2/14 idi. Hastalarýn 15’i ameliyat edilirken bir hasta konservatif tedavi edildi.
SONUÇ
Diyafram yaralanmalarý son yýllarda giderek artmaktadýr. Yaralanma þiddeti skoru yüksek hastalarda diyafram yaralanmasý olasýlýðý mutlaka düþünülmelidir.

BACKGROUND
Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. We aimed to evaluate the diagnostic process in patients with diaphragmatic injuries (DIs) who were diagnosed with diaphragm rupture during the preoperative or intraoperative course together with morbidity and mortality rates.
METHODS
Sixteen patients with DIs were admitted to our department during the last seven-year period. Surgical procedure, accompanying injuries, duration of hospital stay, transfusion necessity, and morbidity and mortality rates were analyzed retrospectively.
RESULTS
In seven years, 16 patients were treated and followed-up for DI. Female/male ratio was 2/14. Fifteen patients were operated and one was treated conservatively. The mortality rate was 2/16.
CONCLUSION
DIs are being seen with increasing frequency in recent years. In patients with high Injury Severity Score (ISS), probability of DI should be taken into consideration.

AMAÇ
Safra taþý ileusu safra taþý hastalýðýnýn nadir ve genelde yaþlýlarda görülen bir komplikasyonudur. Çalýþmamýzýn amacý safra taþý ileusu tanýsý alan 12 hastayla ilgili deneyimimizi deðerlendirmek ve güncel literatür eþliðinde tartýþmaktýr.
GEREÇ VE YÖNTEM
Kliniðimizde Ocak 1998-2008 yýllarý arasýnda safra taþý ileusu nedeniyle ameliyat edilen 12 olgunun dosyalarý retrospektif olarak incelendi.
BULGULAR
Hastalarýn 9’u (%75) kadýn, 3’ü (%25) erkek olup ortalama yaþ 63,6 idi (daðýlým, 50-80). Semptomlarýn baþlamasýndan hastaneye baþvurmaya kadar geçen süre ortalama 4,1 (daðýlým, 1-15) gün bulundu. Preoperatif taný sadece 5 (%41,6) olguda konuldu. Hastalarýn 9’una (%75) enterolitotomi, 1’ine (%8,3) enterolitotomi + ince baðýrsak rezeksiyonu, 1’ine (%8,3) tek aþamalý cerrahi, 1’ine (%8,3) ise enterolitotomi + jejunal perforasyona primer dikiþ ameliyatý uygulandý. Perioperatif mortalite 2 (%16.6) olguda görüldü.
SONUÇ
Görüntüleme tekniklerindeki ilerlemeye raðmen safra taþý ileusu halen tanýsal bir problemdir ve ameliyat öncesi taný genellikle gecikmektedir. Safra kesesi taþý öyküsü bulunan ve acil servise akut intestinal týkanýklýk bulgularýyla baþvuran özellikle yaþlý ve kadýn hastalarda safra taþý ileusu akýlda tutulmalýdýr.

BACKGROUND
Gallstone ileus is a rare complication of cholelithiasis, mostly in the elderly. The aim of this study was to evaluate our experience with 12 gallstone ileus cases and discuss current opinion as reported in the literature.
METHODS
Data of 12 patients operated between January 1998 and January 2008 with gallstone ileus were retrospectively studied.
RESULTS
There were 12 cases (9 F, 75%; 3 M, 25%) with a mean age of 63.6 (50-80) years. Median duration of symptoms before admission to the hospital was 4.1 (1-15) days. Preoperative diagnosis was made in only five cases (41.6%). Enterolithotomy was done in nine cases (75%). Enterolithotomy and resection of the small intestine - required for decubital necrosis from the gallstone - was performed in one case (8.3%). In one case (8.3%), enterolithotomy was completed in one stage with cholecystectomy and closure of the fistula during acute surgery, and in another case (8.3%), enterolithotomy + primary suturing of the jejunal perforation was performed. There were two (16.6%) perioperative mortalities.
CONCLUSION
Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Gallstone ileus should be suspected in all cases admitted to the emergency service with acute intestinal obstruction with a history of cholelithiasis, especially in the elderly and females.

AMAÇ
Acil cerrahi polikliniðine baþvuran akut mekanik intestinal týkanýklýk saptanan hastalardaki tedavi modaliteleri ve cerrahi iþlemlerin zamanlamasý ele alýndý.
GEREÇ VE YÖNTEM
Bu çalýþmaya, acil polikliniðe baþvuran ve akut mekanik intestinal týkanma tanýsý konan tüm hastalar dâhil edildi. Sývý resüsitasyona raðmen hemodinamik olarak stabil olamayan hastalar ve fiziksel incelemede peritoneal irritasyon saptanan hastalar acil ameliyat edildi. Hastalar, yapýþýklýða baðlý olanlar Grup 1 ve diðer nedenlere baðlý olanlarda Grup 2 olarak iki gruba ayrýldý. Yirmi dört saat sonraki medikal ve cerrahi uygulamalarý gruplar arasýnda deðerlendirildi.
BULGULAR
Grup 1’deki 22 ve Grup 2’deki 53 hastaya cerrahi tedavi uygulandý. Gruplar arasýnda cerrahi uygulananlar arasýnda istatistiksel olarak fark vardý (p<0,05). Hastaneye baþvurduktan sonra ortalama takip süreleri Grup 1 ve Grup 2 için sýrasýyla 128,3±24,85 ve 43,1±15,51 saatti (p=0,0001). Grup 2’deki hastalarýn %76,6’sýna 24 saatteki takipleri sýrasýnda cerrahi giriþim uygulandý. Oysa ki bu oran Grup 1’de %36 idi (p<0,05).
SONUÇ
Bu çalýþmadan edindiðimiz klinik deneyim yapýþýklýk dýþýnda akut mekanik intestinal týkanýklýk tespit edilen hastalarýn medikal tedavisi ve takibi ilk 24 saat içinde yapýlmalýdýr.

BACKGROUND
In this study, we evaluated our treatment modality and timing of surgery in acute mechanical intestinal obstruction (AMIO) patients who were admitted to the emergency room.
METHODS
Only patients with the diagnosis of AMIO were included in this study. Surgery was performed in patients with hemodynamic instability despite fluid resuscitation and peritoneal signs upon physical examination. Patients were divided into two groups. Adhesion cases were assigned to Group 1, while non-adhesion cases were assigned to Group 2. The decision to provide surgical or medical therapy was assessed 24 hours (h) after admission.

RESULTS
Twenty-two patients in Group 1 and 53 patients in Group 2 underwent surgical procedures. The difference between the groups was statistically different (p<0.05). The mean monitoring time after admission to the hospital was 128.3±24.85 h and 43.1±15.51 h in Groups 1 and 2, respectively (p=0.0001). In Group 2, 76.6% of the patients who were monitored for over 24 hours required surgery. In contrast, this rate was only 36% in Group 1 (p<0.05).
CONCLUSION
Our clinical experience shows that medical therapy and monitoring over 24 hours is not a good substitute for surgical treatment of AMIO when the obstruction is not due to an adhesion.

AMAÇ
Bu çalýþma 1 Mayýs 2007 ile 10 Ekim 2008 tarihleri arasýnda Cengiz Gökçek Devlet Hastanesi Yanýk merkezine kabul edilen 411 olgunun retrospektif bir analizini içermektedir.

GEREÇ VE YÖNTEM
Merkeze kabul edilen tüm olgularýn kayýtlarý elektronik veri tabanýndan elde edildi. Cinsiyete göre yanýk oranlarý %37,7 (n=147) kadýn, %64,3 (n=264) erkek idi.
BULGULAR
Toplam vücut yanýk yüzeyi %20-35 arasýnda olan olgularýn hastanede yatýþ süreleri elektrik, alev ve haþlanma yanýklarý için sýrayla 28, 18 ve 12’þer gün idi. %35-50 toplam vücut yüzey alan yanýðý olan olgularýn ise bu süreler elektrik, kimyasal, alev ve haþlanma yanýklarý için sýrayla 44, 33, 31 ve 22’þer gün olarak saptandý. Vücut yüzey alaný %50’den fazla olan yanýklarda ise elektrik ve haþlanma yanýklarý 40 gün ve daha üzerindeki hastane yatýþ sürelerine sahipti. Ölüm oranlarý %5,6 (n=23) idi. Yanýk tedavisi sýrasýnda en az bir epilepsi ataðý ise %1,2 oranýnda görüldü. Altý olguda hemofiltrasyona yanýt veren akut böbrek yetersizliði geliþti. Alev yanýðý olan 8 olguda inhalasyon hasarý varlýðý gözlendi ve bunlardan 4 tanesi mekanik ventilasyona gerek duydu.
SONUÇ
Yanýk hastalarýnýn tedavisi ile uðraþanlarýn bu yoðun mesailerine ek olarak, kendi verilerini tutmalarý ve bunlarý yayýnlamalarýnýn konu ile ilgili ileriki çalýþmalara yol göstereceðine inanmaktayýz.

BACKGROUND
This study is a retrospective analysis of 411 cases admitted to Cengiz Gökcek State Hospital Burn Center from 1 May 2007 to 10 October 2008.
METHODS
Through an electronic database of medical records of the burn center, all patients admitted to the center were traced. With respect to the numbers of burns according to sex, 35.7% (147) of the cases were female and 64.3% (264) were male.
RESULTS
For total burn surface area (TBSA) of 20-35%, the hospital stays for electric, flame and scald burns were 28, 18 and 12 days, respectively. For TBSA of 35-50%, electric burns resulted in a mean stay of 44 days, followed by chemical burns (33 days), flame (31 days), and scald (22 days). For TBSA over 50%, electric and scald burns resulted in hospital stays of ≥40 days. Case fatality was 5.6% (23 patients). 1.2% of the study group experienced at least one episode of epilepsy during treatment. Six cases had acute renal failure that responded to hemofiltration during treatment. Eight cases, which were flame burns, also had inhalation injury, and four of these cases required mechanical ventilation.

CONCLUSION
Members of the burn care team not only carry a heavy workload in the treatment of burn victims, we believe they also have the responsibility of recording and publishing their own data to increase the overall knowledge related with the subject, which will guide future studies.

AMAÇ
Bu çalýþmada, Diyarbakýr Adli Týp Kurumu’nda travma nedeniyle ölü muayenesi ve otopsi yapýlmýþ olgularda önlenebilir ölüm nedenlerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Geriye dönük tanýmlayýcý nitelikte planlanan bu çalýþmada, Diyarbakýr Adli Týp Kurumunda 01.01.2008 - 31.12.2008 tarihleri arasýnda travmaya baðlý ölümlerde tutulan raporlardan demografik veriler, yaralanma tipi, yaralanma nedeni, yaralanma bölgeleri, ölüm nedeni ve ölüm yeri verileri toplandý. Elde edilen verilerden önlenebilir ölüm nedenleri ve bu ölümlerde medikal hatalar analiz edildi. Hatalarýn tanýmlanmasý-gruplandýrýlmasýnda ve önlenebilirlik kriterlerinin geliþtirilmesinde Amerikan Cerrahlar Birliðinin ölçütleri örnek alýndý.
BULGULAR
Deðerlendirmeye alýnan 747 olgudan %4,15’inin (n=31) önlenebilir, %16,20’sinin (n=121) potansiyel önlenebilir ve %79,65’inin (n=595) önlenemez nitelikte olduðuna karar verildi. Olgularýn %49,34’ü (n=75) suboptimal bakým, %41,45’inde (n=63) müdahalenin gecikmesi, %10,53’ünde (n=16) gecikmiþ ya da yanlýþ taný, %10,53’ünde (n=16) týbbi yönetim karar hatasý, %7,23’ünde (n=11) uygunsuz ya da yanlýþ týbbi uygulama ve %3,95’inde (n=6) diðer hatalar gözlendi.
SONUÇ
Sonuçlar, modern travma bakýmý ve travma merkezlerinin olduðu bölgelerde yapýlan çalýþmalarla karþýlaþtýrýldýðýnda önlenebilir ölüm oranlarý yüksek bulundu. Sonuç olarak modern travma sistemi ve travma merkezlerinin oluþturulmasýnýn önlenebilir ölüm oranlarýnýn azaltýlmasýnda önemli olduðu kanaatine varýldý.

BACKGROUND
In this study, we aimed to investigate preventable deaths due to trauma among cases in whom autopsy and postmortem examinations were performed in Diyarbakýr Council of Forensic Medicine.
METHODS
In this study, which was planned as retrospectively descriptive, demographic data, type of injury, cause of injury, locations of injuries, cause of death, and scene of death data were withdrawn through the reports of deaths due to trauma in Diyarbakýr Council of Forensic Medicine between 1 January 2008 and 31 December 2008. Medical errors in these deaths and preventable deaths were analyzed with this data. The criteria of American College of Surgeons Committee on Trauma was used for definition-classification of errors and compose of preventability criteria.
RESULTS
It was concluded that of the 747 cases taken into consideration, 4.15% (n=31) were preventable, 16.20% (n=121) were potentially preventable and 79.65% (n=595) were unpreventable. Suboptimal care in 49.34% (n=75), delay in treatment in 41.45% (n=63), missed diagnosis in 10.53% (n=16), clinical judgment error in 10.53% (n=16), missed medical administration in 7.23% (n=11), and other mistakes in 3.95% (n=6) of the cases were determined.
CONCLUSION
When the results were compared with the studies performed in the areas in which modern trauma care and trauma centers are located, the preventable death ratio was found high. As a result, it has been determined that development of a modern trauma system and trauma centers have significant roles in decreasing preventable death ratios.

AMAÇ
Ýnvajinasyon, proksimal baðýrsak segmentinin distal segment içine teleskopik olarak girmesidir. Çalýþmanýn amacý, invajinasyon olgularýmýzdan hareketle pnömatik redüksiyon deneyimlerimizi paylaþmaktýr.
GEREÇ VE YÖNTEM
Çocuk cerrahisi kliniðinde 1996-2008 tarihleri arasýnda invajinasyon tanýsýyla tedavi edilen 118 hastanýn dosyalarý, yaþ, cinsiyet, baþvuru ayý, bulgular, taný/tedavi yöntemleri, invajinasyon tipi ve sürükleyici noktalar açýsýndan yeniden incelenerek, bulgular tartýþýldý.
BULGULAR
Hastalarýn 76’sý (%64) erkek, 42’si (%36) kadýn, yaþ ortalamalarý 25±34 ay (daðýlým, 3-180 ay) idi. Baþvuruda en sýk yakýnmalar; karýn aðrýsý, huzursuzluk, kusma ve kanlý gaitaydý. Ýnvajinasyonlarýn 109’u ileokolik (%92,3), 7’si (%6) ileoileal, 2’si ise (%1,7) kolokolikti. Elli üç olgu (%45) cerrahi dýþý, geriye kalan olgular cerrahi yöntemle tedavi edildi. Hastalarýn hiçbirisinde mortalite görülmedi. Ameliyat edilen 65 hastadan 13’ünde sürükleyici nokta saptandý. Pnömatik redüksiyonun baþarý oraný %86 idi. Semptomlarýn baþlama süresi ve kanlý gaita pnömatik redüksiyonun baþarýsýný etkilemezken, yaþla baþarý oraný düþmüþtür.
SONUÇ
Ýnvajinasyona erken taný konulmasý durumunda, cerrahi dýþý yöntemlerle rahatlýkla tedavi edilebilen bir patolojidir. Çocuk yaþ grubunda perforasyon ve peritonit bulgularý olmayan tüm olgularda pnömatik redüksiyonun ilk seçenek olarak denenebileceðini düþünüyoruz.

BACKGROUND
Intussusception is defined as telescopic insertion of the terminal ileum in to the colon after the cecum and colon. The aim of this study was to present our experience in pneumatic reduction of intussusception.
METHODS
In our study, 118 intussusception cases treated between 1996 and 2008 were analyzed. Age, gender, admission time, diagnostic/treatment methods, types of intussusception including leading point, and postoperative complications were evaluated.
RESULTS
Of these patients, 76 (64%) were male and 42 (36%) were female. Mean age was 25±34 months (3-180 months). The most common clinical presentations were vomiting, abdominal pain/irritable crying and bloody stools. Intussusceptions were ileocolic in 109 (92.3%) patients, ileoileal in 7 (6%) patients, and colocolic in 2 (1.7%) patients. No mortality was noted. Fifty-three patients (45%) were treated by non-operative reduction whereas the remainder were treated surgically. Among 65 patients operated, 13 leading points were detected. Pneumatic reduction success rate was 86%. Age significantly reduced the pneumatic reduction success rate; however, the duration between the beginning of symptoms and hospital admission and bloody stool were not effective.
CONCLUSION
Intussusception can be treated by non-operative methods when diagnosed early. Our results suggest that pneumatic reduction of intussusception in the pediatric population should be considered as a first choice.

Yakýn mesafeden oluþan pompalý tüfek yaralanmalarý uzuvlarda tedavisi zor yaralara neden olur. Bu yaralanmalarýn sýfýr noktasýndan yapýlmasý uzuvlarda tipik olarak derin fakat geniþ olmayan kaviter yaralar oluþturur. Bunlarýn tedavisinde çoðunlukla doku nakline ihtiyaç vardýr. Bu þekilde yaralanmýþ iki olguda debridman, negatif basýnçlý pansuman ve serbest grasilis kas flebinin kullanýmý sunulmuþtur.

Close-range shotgun injury to the lower extremity is a devastating problem and is a challenge to the surgeon. Point-blank shotgun injuries to the extremities create a typical wound that is deep but not wide. These wounds almost always need to be treated with local or distant tissue transfer. We report two cases of shotgun injury to the lower extremity at point-blank range, which were treated using debridement, vacuum-assisted closure and free gracilis muscle flap transfer.

Endometriozis uterin kavite dýþýndaki fonksiyonel endometrial doku varlýðý olarak tanýmlanýr. En sýk görülen bölge pelvis içindedir. Alýþýlmadýk pelvis dýþý endometriozis bölgeleri olarak mesane, baðýrsak, apendiks, cerrahi skar, fýtýk kesesi, akciðer, böbrek ve ekstremiteler bildirilmiþtir. Skar endometriozis tanýsý sýklýkla zor deðildir ve anamnez ve fiziksel incelemeye dayanýr. Burada rektus abdominis kasý içerisinde abdominal duvarda yerleþmiþ iki olgu sunulmuþtur. Olgular lokal eksizyonla tedavi edilmiþtir.

Endometriosis is defined as the presence of ectopic functional endometrial tissue outside the uterine cavity. The most common locations are within the pelvis. Unusual sites of endometriosis outside the pelvis have been reported, including the bladder, intestine, appendix, surgical scars, hernia sac, lung, kidney, and extremities. The diagnosis of scar endometriosis is usually not difficult and is based on history and physical examination. We report here two cases who developed endometriosis on the abdominal wall in the rectus abdominis muscle and were treated with local excisions.

Bu yazýda, unutulmuþ bir travmadan 8 yýl sonra bulgular gösteren olgu sunuldu. Yapýlan cerrahiyle, önkolda aðaç bir yabancý cisim bulunduðunu belirlendi. On yaþýndaki erkek çocuk, önemsiz bir künt travmadan sonra sol önkolunda oluþan 6 hafta süreli, þiþlikle birlikte olan aðrý ve zaman zaman oluþan kýsa süreli ateþ yakýnmasý ile baþvurdu. Sol önkolun üst üçte birlik kýsmýnýn postero-lateral yüzünde 7 x 3 cm boyutunda, hassas, lokal sýcaklýðý artmýþ ve skar ya da yara olmaksýzýn fluktuasyon veren oval bir þiþlik gözlendi (travma belirtileri). Önkol radyografileriyle kýrýk, periosteal reaksiyon veya diðer kemik lezyonu içermeyen bir yumuþak doku þiþliði belirlendi. Þiþlikten yapýlan aspirasyon, pürülan materyali ortaya koydu (gram boyama negatif). Apse temizlendi, yapýlan kavite incelemesinde granülasyon dokusu içindeki 14 mm uzunluðunda aðaçtan ince bir yabancý cisim bulundu. Retrospektif sorgulamada, ailesi çocuðun 8 yýl önce bir süpürge sapý üzerine düþtükten sonra penetran yaralandýðýný bildirdi.
Ekstremitelerdeki þüpheli bir þiþlik incelenirken bir yabancý cisim varlýðý akýlda tutulmak zorundadýr. Eksiksiz bir öykü ve dikkatli görüntüleme, tanýya yönelik anahtardýr.

We report herein a case in which symptoms appeared eight years after the apparent trauma, which had been forgotten. Surgery yielded a wooden foreign body in the forearm. A 10-year-old boy presented with a six-week history of pain followed by swelling in his left forearm occurring after a trivial blunt trauma, with occasional bouts of fever. There was an oval swelling (7 cm x 3 cm) on the posterolateral aspect of the upper third of the left forearm. Tenderness, increased local temperature and elicitable fluctuation, with no scars or wounds (signs of trauma), were noted. Radiographs of the forearm revealed a soft tissue swelling but no fracture, periosteal reaction or other bony lesion. Aspiration of the swelling yielded purulent material (gram stain negative). The abscess was drained and exploration of the cavity revealed a 14 mm long slender wooden foreign body embedded in granulation tissue. On retrospective enquiry, the family reported that the child had sustained a penetrative injury eight years before after falling on a broomstick. Presence of a foreign body must be kept in mind while investigating a suspicious swelling on the extremities. A thorough history and careful imaging are the keys to diagnosis.

Yabancý cisimlerin yutulmasý, özellikle çocuklar, alkolikler, psikiyatrik hastalar ve yaþlýlar arasýnda çok sýk rastlanan bir sorun olmasýna raðmen yemek çatalýnýn yutulmasý oldukça nadirdir. Yuvarlak uçlu yabancý cisimler genellikle bir soruna neden olmazken sivri uçlu yabancý cisimler erken dönemde çýkarýlmadýklarý takdirde intestinal duvara penetre olup komplikasyona neden olabilirler. Yutulan yabancý cisimlerin çoðunluðu sorunsuz intestinal kanaldan geçerken sadece %1’den daha azý perforasyona neden olur. Bu yazýda, 25 gün önce yutulmuþ yemek çatalýna baðlý geç dönemde ortaya çýkan nadir bir mide çýkým týkanýklýðý olgusu sunuldu.

Ingestion of foreign bodies can be a common problem especially among children, alcoholics, psychiatric patients, and senile patients, but ingestion of a metallic dinner fork is uncommon. Foreign bodies with smooth edges usually do not pose significant problems, but a sharp foreign object that is not retrieved at the earliest may penetrate the wall and cause complications. Ingested foreign bodies usually pass the intestinal tract without problems, and perforation occurs in less than 1%. In this paper, a case of rare gastric outlet obstruction due to a dinner fork, which was ingested 25 days before, is reported.

Bu yazýda, otomobil kazasýnda açýlan hava yastýðý nedeniyle kraniyo-servikal yaralanmayla olay yerinde ölen 4 yaþýndaki bir kýz çocuk (102 cm, 17 kg) sunulmaktadýr. Hastanýn öyküsünde düþük hýzla seyreden otomobilin yerden sadece 15 cm yükseklikteki bir kanalizasyon logar kapaðýna çarpmasýyla sürücü ve yolcu hava yastýðýnýn açýlmasý mevcuttu. Hava yastýðýnýn özellikle önden çarpýþmalarda sürücü ile yolcunun yaralanma ihtimalini ve derecesini belirgin þekilde azalttýðý bilinmektedir. Ancak, ön koltukta oturtulan çocuklarda düþük hýzla olan çarpmalar sonrasý da hava yastýðýnýn açýlmasýyla ölümcül ciddi yaralanmaya sebep olabileceðini gösteren bu türden olgular, sistem tasarýmýnýn ve hava yastýðý açýlmasýndaki eþik deðerin yeniden deðerlendirilmesi gereðini göstermektedir.

This case report describes a four-year-old girl (102 cm, 17 kg) who sustained fatal craniocerebral injuries as a result of an inflating automobile air bag. The car struck the lid of the sewer system, which was 15 cm above the ground level, at a low speed, and both the driver and passenger air bags inflated. Despite the fact that air bag usage has lessened both the possibility and severity of occupant injuries in frontal collisions, case reports of serious injuries and even deaths especially in children due to air bag deployment, particularly during low speed impacts, highlight the need for changes in both system design and possibly the threshold speed of air bag deployment.