AMAÇ
Sinir defektlerinin rekonstrüksiyonunda ven greftlerinin kullanýlmasý ile ilgili çalýþmalarýn artmasý ve bu uygulamanýn klinikte kullanýma girmesiyle birlikte, ven greftinin kollabe olma sorununun ortaya çýktýðý görülmüþtür.
GEREÇ VE YÖNTEM
Çalýþmada 40 adet Spraque-Dawley sýçan kullanýldý. Beþ gruptan, 1. gruba herhangi bir cerrahi giriþim yapýlmadý; 2. grubun siyatik sinirinde oluþturulan defekt onarýlmadan býrakýldý, 3. grupta defekt sinir grefti ile onarýldý, 4. grupta defekt ven grefti ile 5. grupta ise ven grefti ve katater birlikte kullanýlarak onarým yapýldý. Birinci ve ikinci grup kontrol grubu olarak kullanýldý. Fonksiyonel iyileþmeyi, sinir rejenerasyonunu deðerlendirmek amacýyla, 12. haftanýn sonunda, yürüme analizi, elektrofizyolojik ve histomorfometrik analizler yapýldý.
BULGULAR
Defektin ven grefti ve katater ile onarýldýðý grup (grup 5) ile grup 3 ve 4 arasýnda fonksiyonel açýdan fark bulunmazken, sinir iletim hýzý açýsýndan bakýldýðýnda, 5. gruptaki sonuçlar, ven grefti ile onarým yapýlan gruptan (grup 4) daha iyi bulundu. Onarým distalinden ve onarým alanýnýn ortasýndan alýnan siyatik sinir kesitlerindeki akson sayýsýna bakýldýðýnda 3. ve 5. grup arasýnda fark bulunamazken; 4. ve 5. grup arasýndaki fark anlamlýydý.
SONUÇ
Bu çalýþma sonucunda, ven grefti ile onarýlan periferik sinir yaralanmalarýnda görülebilen ven grefti kollapsýnýn ven grefti içine kateter yerleþtirilmesi ile aþýlabileceði ve bu sayede onarýmda sinir grefti kullanma ihtiyacýnýn ortadan kalkabileceði deneysel olarak gösterilmiþtir.

BACKGROUND
Since vein grafts have been used in the repair of nerve defects, studies regarding this procedure have accumulated, and after coming into clinical use, it was noticed that there is a problem of collapse in the vein graft.
METHODS
Forty Sprague-Dawley rats were used, divided into five groups. No surgical intervention was performed in the first group. The defect was created in the sciatic nerve in Group 2 and left unrepaired. In Group 3, the defect was repaired with a nerve graft. In Group 4, the defect was repaired with a vein graft, while in Group 5, the repair was performed using a vein graft with an inserted catheter. In order to evaluate functional recovery and nerve regeneration, walking track analysis, electrophysiologic and histomorphometric analyses were done at the end of the 12th week.
RESULTS
Although there were no functional differences between Groups 5 and 4, comparisons regarding nerve conduction velocity demonstrated that the results obtained in Group 5 were better than those in Group 4. When the number of axons on the distal part of the sciatic nerve and mid-segment of the repaired area was taken into account, no significant difference was found between Groups 3 and 5, whereas there was a significant difference between Groups 4 and 5.
CONCLUSION
In our study, it was experimentally shown that the problem of collapse of a vein graft occurring after its use in the reconstruction of a nerve defect can be overcome by placing a catheter into the vein graft. Consequently, this method may eliminate the need for the use of a nerve graft in selected cases.

AMAÇ
Bu çalýþmada, yanýk yaralarýnda yaygýn olarak kullanýlan çinko oksit ve gümüþ sülfadiazinin tedavi etkileri karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Yeni Zelanda cinsi 20 tavþanda pirinç propla yanýk yarasý oluþturuldu. Tavþanlar rastgele iki gruba ayrýldý. Yanýklar günlük uygulamayla birinci grupta çinko oksitle (Grup O), ikinci grupta (Grup S) gümüþ sülfadiazinle tedavi edildi. Yara iyileþmesi klinik ve histopatolojik olarak takip edildi. Yara ölçümleri yapýldý ve %50 ve %80 reepitelizasyona ulaþtýðý günler belirlendi.
BULGULAR
Ortalama %50 ve %80 reepitelizasyona ulaþma süreleri Grup O’da sýrasýyla 21,4 ve 25,4 gün, Grup S’de 25,8 ve 30,2 gündü (p<0,001). Yara kolonizasyonu ise 1, 2, 3, 4, 5 ve 6. haftalarda ortalama olarak Grup O’da daha düþüktü. Fark 2, 3, 4 ve 6. haftalarda anlamlý idi (p<0,001). Histopatolojik deðerlendirme sonucunda Grup O’da epidermis, dermis ve skar dokusunun kalýnlýklarý sýrasýyla 0,12, 3,80 ve 2,44 mm idi. Grup S’de ise 0,16, 4,76 ve 3,16 mm olarak bulundu (p<0,001).
SONUÇ
Bu deneysel çalýþmada, çinko oksit yanýk tedavisinde epitelizasyon, epidermis maturasyonu ve skar oluþumunda gümüþ sülfadiazinden daha etkili bulunmuþtur.

BACKGROUND
We aimed to compare the effects of topical zinc oxide and topical silver sulfadiazine in the treatment of partial-thickness burn wounds.
METHODS
The study was conducted with 20 New Zealand rabbits, and burn wounds were created by a brass probe. The animals were randomly divided into two groups. The burns were treated with zinc oxide (Group O) or silver sulfadiazine (Group S) with daily application. The wound healing process was followed both clinically and histopathologically. We determined the days at which 50% and 80% re-epithelization was observed.
RESULTS
The mean time for 50% and 80% re-epithelization was 21.4 and 25.4 days in Group O and 25.8 and 30.2 days in Group S, respectively (p<0.001). The mean score for wound colonization was lower in Group O. The difference was statistically significant at weeks 2, 3, 4, and 6 (p<0.001). In the histopathological examination, the thicknesses of the epidermis, dermis and scar tissue were 0.12 mm, 3.80 mm and 244 mm in Group O, and 0.16 mm, 4.76 mm and 3.16 mm in Group S, respectively (p<0.001).
CONCLUSION
In this experimental burn study, zinc oxide was more effective than silver sulfadiazine in terms of epithelization, dermis maturation and scar formation.

AMAÇ
Bu çalýþmada akut apandisit tanýsýnda serum fibrinojen düzeyinin önemi araþtýrýldý.
GEREÇ VE YÖNTEM
Kliniðimize baþvuran 201 hasta çalýþmaya alýndý. Hastalarýn semptomlarý, semptom süreleri, muayene bulgularý, laboratuvar bulgularý ve akut apandisit için Alvarado skorlarý kaydedildi. Kesin taný histopatolojik inceleme ile konuldu. Ameliyat öncesi kan fibrinojen deðerine bakýldý. Tek bir testin ve test kombinasyonlarýnýn duyarlýlýk, özgüllük ve öngörü deðeri farklý seviyelerinde hesaplandý.
BULGULAR
Çalýþma süresinde 201 hasta akut apandisit ön tanýsý ile ameliyat edildi. Histopatolojik inceleme sonrasý 179 (%89) hasta akut apandisit tanýsý aldý. Hastalarýn yaþ ortalamasý 24,8±7,7 (daðýlým 20-57) yýldý, 154 (%76.6) hasta erkek, 47 (23.4%) hasta kadýndý. Akut apandisit tanýsý için kesim deðeri fibrinojen için 245,5 mg/dl, beyaz küre sayýmý için 11.900x109/L ve Alvarado skoru için 7 olarak bulundu.
SONUÇ
Akut apandisit tanýsýnda fibrinojenin serum deðeri yeni bir akut faz reaktamý olarak kullanýlabilir. Üçlü test formülünün kullanýlmasý gözlem veya acil cerrahi kararýný vermede yardýmcý olabileceði düþünülmektedir.

BACKGROUND
The aim of this study was to investigate the importance of serum fibrinogen level in the diagnosis of acute appendicitis.
METHODS
This study was performed on 201 patients who admitted to our clinic. Symptoms, signs, duration of symptoms, and laboratory indicators of appendicitis were recorded, in keeping with the Alvarado score for acute appendicitis. The ultimate diagnosis was based on histopathological results. Serum fibrinogen levels were detected before surgery. The sensitivity, specificity, and predictive values of single test and test combinations were calculated at different cut-off levels.
RESULTS
During the study period, 201 patients underwent surgery for suspected acute appendicitis. Appendicitis was confirmed in 179 (89%) patients. The mean age was 24.8±7.7 (range, 20-57) years, and 154 (76.6%) patients were male and 47 (23.4%) female. The best diagnostic cut-off point for fibrinogen was found at 245.5 mg/dl, for white blood cells (WBC) at 11,900x109/L and for Alvarado score at 7.
CONCLUSION
The use of fibrinogen blood level may be a new diagnostic acute-phase reactant in the diagnosis of acute appendicitis. The formulation of a triple test is recommended as criteria in deciding emergency surgery or observation.

AMAÇ
Bu çalýþmada, acil cerrahi kliniðimizde boðulmuþ abdominal duvar hernisi nedeniyle ameliyat edilen hastalarda morbidite ve mortaliteyle iliþkili risk faktörlerinin insidansý araþtýrýldý.
GEREÇ VE YÖNTEM
Hastalar hem fýtýk türüne göre (inguinal, umblikal, insizyonel, femoral) kendi aralarýnda hem de morbidite ve mortalite üzerine etkili faktörler bakýmýndan; yaþ, cinsiyet, Amerikan Anesteziyoloji Derneði (AAD) skoru, anestezi tipi, eþlik eden hastalýklar, intestinal boðulma ve nekroz varlýðý gibi verilerle deðerlendirildi.
BULGULAR
Ýnguinal herni erkeklerde, umblikal ve femoral herni kadýnlarda sýktý (p<0,001). Femoral hernide boðulma ve nekrozdan dolayý intestinal rezeksiyon diðer fýtýk türlerine göre anlamlý olarak yüksek saptandý (sýrasýyla, p<0,005 ve p<0,001). Morbidite ve mortalite üzerine; ileri yaþ (≥65 yaþ), ek hastalýk, strangülasyon, nekroz, yüksek AAD skoru (III, IV), semptomlarýn baþlama ve hastaneye baþvuru süresinin anlamlý etkisi bulundu. Genel anestezinin de morbidite için risk oluþturduðu görüldü (p<0,05).
SONUÇ
Boðulmuþ abdominal duvar hernileri yüksek morbidite ve mortalite oranýna sahip bir cerrahi problemdir. Bu yüzden herni saptandýðýnda elektif koþullarda ameliyat planlanmalýdýr.

BACKGROUND
The aim of the present study was to investigate morbidity- and mortality-related risk factors in patients undergoing surgery due to incarcerated abdominal wall hernia.
METHODS
The patients were grouped according to the type of hernia (inguinal, umbilical, incisional, femoral), and these groups were evaluated in terms of risk factors affecting morbidity and mortality such as age, gender, American Society of Anesthesiologists (ASA) score, type of anesthesia, concomitant diseases, and the presences of intestinal strangulation and necrosis.
RESULTS
Inguinal hernia was frequent in males, whereas femoral hernia was frequent in females (p<0.001). The rate of intestinal resection due to strangulation and necrosis was found significantly higher among femoral hernias as compared to the other types of hernia (p<0.005 and p<0.001, respectively). Advanced age (≥65 years), concomitant disease, strangulation, necrosis, high ASA score (III-IV), time from the onset of symptoms, and time to hospital admission were found to have significant influences on morbidity and mortality. General anesthesia was found to be a risk factor for morbidity as well (p<0.05).
CONCLUSION
Incarcerated abdominal wall hernias are surgical problems with high morbidity and mortality rates. Therefore, surgery should be planned under elective conditions when hernia is detected.

AMAÇ
Bu çalýþmanýn amacý, morfin ve plasebo gruplarýndaki klinik olarak önemli tanýsal doðruluk ve fizik muayenedeki deðiþiklikleri belirlemektir.
GEREÇ VE YÖNTEM
Hastalar 1: 1 oranýnda kör olarak morfin veya plasebo almak için randomize edildi. Çalýþmanýn birincil takip verisi, morfin ve plasebo gruplarýndaki tanýsal doðruluk ve fiziksel incelemede klinik olarak önemli deðiþiklikler olup olmadýðýný belirlemektir.
BULGULAR
Seksen hasta (39 morfin ve 41 plasebo) çalýþmaya dahil edildi. Klinik olarak önemli tanýsal doðruluk oraný morfin grubunda %80 (31/39), plasebo grubunda %78 (32/41) ve %2’lik bir fark oraný saptandý (güven aralýðý [GA] %95, -7% ile 13%, p=0,9802). Morfin grubundaki hastalarýn tüm fiziksel inceleme bulgularý içinde sadece abdominal rijidite bulgusunda (%15) istatistiksel olarak anlamlý deðiþiklik saptandý, ancak plasebo grubunda herhangi bir deðiþiklik (%0) yoktu. Ýki grup arasýndaki fark anlamlý idi (GA %95, %2.3 ile %30.5, p=0.031).
SONUÇ
Bu çalýþma ile acil serviste opioid analjezi uygulanmasýnýn güvenli olduðu ve akut nonspesifik karýn aðrýsý olan yaþlý hastalarda klinik olarak önemli tanýsal deðiþikliðe neden olmadýðý, fakat hastalarda abdominal rijidite gibi önemli fiziksel inceleme bulgularýný deðiþtirebileceði sonucuna varýlmýþtýr.

BACKGROUND
The objective of this study was to determine the clinically important change in diagnostic accuracy and physical examination in the morphine vs. placebo group.
METHODS
Subjects were randomized in a 1: 1 ratio to receive a single dose intravenous morphine or placebo in a blinded fashion. Primary outcome measure was to determine if there was a clinically important change in diagnostic accuracy and physical examination in the morphine vs. placebo group.
RESULTS
80 subjects (39 were assigned to morphine and 41 to placebo) were included in the final analysis. Clinically important diagnostic accuracy rate was found to be 80% in the morphine group (31/39) and 78% in the placebo group (32/41), with a difference rate of 2% (95% CI -7% to 13%, p=0.9802. There was a statistically significant change in abdominal rigidity finding (15%) in morphine group in all of the abdominal physical examinations findings; however there was no change in placebo group (0%). The difference between two groups was also statistically significant (95% CI 2.3% to 30.5%, p= 0.031).
CONCLUSION
Administration of opioid analgesia is safe and does not seem to impair clinical diagnostic accuracy in elderly patients with acute undifferentiated abdominal pain. Nevermore, opioids may change the physical examination findings such as abdominal rigidity.

AMAÇ
Aþil tendonu yýrtýðý sýk rastlanan bir yaralanmadýr, komplikasyonlarý iþlevini bozabilir. Yýrtýlmýþ tendonun rekonstrüksiyonu için sayýsýz operasyon tanýmlanmýþ olmasýna raðmen bu yöntemler tendonda mikrosirkülasyonu riske atabildiði gibi tendonun iyileþmesini ciddi derecede bozabilir. Yýrtýktan hemen sonra minimal invaziv tenokutanöz teknikle dikiþ atma ve sistemik fonksiyonel egzersiz, komplikasyon riskini büyük ölçüde azaltabilir.
GEREÇ VE YÖNTEM
Haziran 1996 ile Þubat 2009 arasýnda bu yöntemle 21-66 yaþ arasý 88 (54 erkek) hasta tedavi edildi.
BULGULAR
Bir ile 7 yýl arasý izlemden sonra ortalama (Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (American Orthopedic Foot and Ankle Society) ayak bileði ayak arkasý skoru 95 (90-98 arasý) ve ameliyat sonrasý skarýn maksimal uzunluðu 3 cm idi. Bir hasta, cerrahiden 1 yýl sonra bir kazada Aþil tendonunu yeniden yýrtmýþtý. Ancak 10 ay sonra onarýlmýþ tendon hâlâ saðlamdý. Baþka bir hastada uca doðru atýlan gerim dikiþinin delip geçmesine baðlý olarak nervus suralis zedelendi, ameliyat sonrasý his kaybý ve ödeme neden oldu. Bu dikiþ hemen çýkartýldý ve hasta konservatif tedaviyle iyileþti. Aþil tendonu üzerinde uzun süre hareketsiz kalanlarda olduðu gibi düzensiz büyük skarlar yoktu.
SONUÇ
Minimal invaziv perkütanöz dikiþ Aþil tendonunun orijinal uzunluk ve bütünlüðünü saðlayabildiði gibi diðer yöntemlere göre ameliyat sonrasý komplikasyonlarý daha az olan minimal invaziv bir yöntemdir.

BACKGROUND
Achilles tendon rupture is a common injury, and its complications can impair function. Numerous operations have been described for reconstructing the ruptured tendon, but these methods can compromise microcirculation in the tendon and can seriously impair its healing. Suturing with a minimally invasive tenocutaneous technique soon after the rupture and systematic functional exercise can greatly reduce the possibility of complications.
METHODS
Between June 1996 and February 2009, we treated 88 patients (54 males; age range, 21-66 years) with this method.
RESULTS
After follow-up ranging from 1-7 years, the mean American Orthopedic Foot and Ankle Society ankle-hind foot score was 95 (range, 90-98), and the maximum length of postoperative scarring was 3 cm. One patient re-ruptured his Achilles tendon one year after surgery in an accident, but after 10 months, the repaired tendon was still intact. In another patient, the nervus suralis was damaged during surgery by piercing the tension suture at the near end, causing postoperative numbness and swelling. The tension suture was quickly removed, and the patient recovered well with conservative treatment. No large irregular scars, such as those sustained during immobilization, were present over the Achilles tendon.
CONCLUSION
Minimally invasive percutaneous suturing can restore the original length and continuity of the Achilles tendon, is minimally invasive, and has fewer postoperative complications than other methods.

AMAÇ
Bu çalýþmada, kan S100B ve laktat deðerlerinin çocuk ve eriþkin minör kafa travmasý sonrasýnda düzeylerinin belirlenmesi ve bilgisayarlý beyin tomografi (BBT) ile karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Bu çalýþmada, Ankara Eðitim ve Araþtýrma Hastanesi Acil Servisi’ne baþvuran, 100 kafa travmasý hastasý geriye dönük olarak incelendi.
BULGULAR
S100B için kesim noktasý 0-0,15 ve laktat için 0,9-1,5 alýndýðýnda; bireylerin %42’sinde S100B’nin yüksek ve %56’sýnda laktat’ýn yüksek olduðu saptandý. Hastalarýn %12’si 18 yaþ ve altý, %88’i 18 yaþ üstündeydi. Yaþ gruplarý arasýnda S100B ve laktat açýsýndan anlamlý farklýlýk bulunamadý. BBT ile S100B ve laktat düzeyleri iliþkilendirildiðinde istatistiksel olarak anlamlý iliþki saptanmadý.
SONUÇ
Buna göre minör kafa travmalarýnda serum S100B ve laktat yüksekliði belirlenmesi klinik muayene veya BBT kullanýmýnýn yerini alamaz ve minör kafa travmalarýnda S100B ve laktatýn prognoz tahminlerinde güvenilir iþaretleyiciler olmadýðý kanaatindeyiz.

BACKGROUND
In this study, we aimed to set levels of blood S100B and lactate and to determine any correlation with brain computerized tomography in minor head traumas in children and adults.
METHODS
This clinical trial is a prospective study including 100 head trauma patients who applied to Ankara Training and Research Hospital emergency service.
RESULTS
In this study, cut-off ranges of 0.0-0.15 ug/ml and 0.9-1.7 mmol/L for blood S100B and lactate levels, respectively, were used. S100B level was higher than the cut-off range in 42% of patients and lactate level was higher in 56% of patients. No significant differences were determined between age groups. When the relation between S100B and lactate levels with brain CT was evaluated, no statistically significant relation was determined.
CONCLUSION
According to our results, in minor head traumas, the determination of elevated serum S100B and lactate levels cannot take the place of clinical examination and the use of cranial CT. Although the patients in our study group had minor head trauma, we do not consider S100B and lactate to be reliable markers for estimating progression.

AMAÇ
Bu çalýþmamýzda amacýmýz, yýlan sokmalarýna baðlý geliþen kompartman sendromlarýnýn tedavisinde, klasik kompartman sendromu kriterlerinden uzaklaþarak yapýlan erken fasyotominin hem klinik iyileþmeyi hýzlandýrdýðý hem de ilerleyici doku hasarýný azalttýðýný vurgulamaktýr.
GEREÇ VE YÖNTEM
Yýlan ýsýrmasý nedeniyle baþvuran 14 hasta geriye dönük olarak incelendi. Hastalarýn 5’i rutin tedavi ile takip edilerek iyileþtirildi. Tedaviye yanýt vermeyen 6 hastaya ekstremitede artan ödem, aðrý, peteþi-ekimoz, bül formasyonu, ilerleyici deri nekrozu ve gerilemeyen klinik ve laboratuvar bozukluklar nedeniyle ilk 48 saat içerisinde erken fasyotomi yapýldý. Geç dönemde kompartman tanýsý ile kliniðimize sevk edilen 3 hastaya ise baþvurduklarýnda fasyotomi yapýldý. Fasyotomi insizyonlarý 4 ila 6 gün sonra kapatýldý.
BULGULAR
Erken fasyotomi uygulanan 6 hastada ödemin hýzla azaldýðý, ekstremite derisindeki lokal nekrozlarýn ilerlemediði gözlendi. Ayrýca bu hastalarda lokal ýsý artýþý veya ateþ gibi toksik belirtiler hýzla geriledi. Geç fasyotomi yapýlan 3 hastada ise iyileþme hýzý erken cerrahi yapýlanlarla kýyaslandýðýnda oldukça yavaþtý ve kas ve derideki nekrotik ilerleme kýsmen geriledi.
SONUÇ
Fasyotomi yýlan ýsýrýklarýnda özel bir yere sahip olup kompartman sendromu olgularýnda gerekli tüm tedaviler uygulanmalý kliniðin tam olarak oturmasýný veya kompartman basýncýnýn eþik deðere ulaþmasýný beklemeden erken fasyotomi yapýlmalýdýr.

BACKGROUND
The purpose of this study was to emphasize that early fasciotomy performed in the treatment of snakebites in the absence of the classic compartment syndrome criteria accelerates the clinical recovery and reduces the progressive tissue damage.
METHODS
Fourteen patients with snakebite were examined retrospectively. Five of them healed with routine treatments. Six patients who did not respond to the treatment underwent early fasciotomy procedure in 48 hours. All of the patients had edema, pain, ecchymosis, bulla formation, and progressive skin necrosis over the extremity. Fasciotomy was performed in three patients who were referred in the late period with compartment syndrome. Fasciotomy incisions were closed after 4-6 days.
RESULTS
After the early fasciotomy, edema diminished rapidly, the skin became more viable and local necrosis did not progress. Further, the toxic symptoms like local temperature increase and fever also diminished. The healing process in the three patients who underwent late fasciotomy was much slower compared with the early fasciotomy group. In particular, necrosis on the muscle and skin had deteriorated.
CONCLUSION
Fasciotomy has a special place in snakebites. In cases of compartment syndrome, all necessary treatments including early fasciotomy should be performed before the full clinical symptoms develop or the compartment pressure reaches the threshold value.

AMAÇ
Temporal kemik kýrýðý olan hastalarda etyoloji, otolaringolojik semptom ve bulgularýn radyolojik deðerlendirmeleri, tedavi yaklaþýmlarý ve sonuçlar deðerlendirildi.
GEREÇ VE YÖNTEM
Yetmiþ yedi temporal kemik kýrýðý olgusu, yaþ, cinsiyet, kýrýðýn yeri, kýrýðýn etyolojisi ve kanlý otore, timpanik membran perforasyonu, serebrospinal otore, iþitme kaybý, hemotimpanum, fasiyal ve diðer kraniyal sinir paralizilerinin varlýðý ve bilgisayarlý tomografi sonuçlarý yönünden geriye dönük olarak deðerlendirildi.
BULGULAR
Olgularda kýrýklarýn %55’i trafik kazasý sonucu meydana gelmiþti ve çoðunluðu erkekti (%76,6). Otolaringolojik bulgular sýklýk sýrasý ile erken dönem iletim tipi iþitme kaybý (%65,8), kanlý otore (%61,2), hemotimpanum (%58,5), timpanik membran perforasyonu (%25,6), fasiyal sinir paralizisi (%12,3), serebrospinal otore (%8,5) ve sensörinöral iþitme kaybý (%5,4) idi. Kýrýklarýn çoðu petroz (%65,8) ve uzunlamasýna tip (%51,2) idi.
SONUÇ
Bu araþtýrmada 77 temporal kemik kýrýðý hastasýnda sýklýk sýrasý ile otolaringolojik bulgularý ve tedavi yaklaþýmýmýzý literatür bulgularý ile karþýlaþtýrýp tartýþtýk. Temporal kýrýklarda sistematik bir deðerlendirme ve tedavi için bir algoritma oluþturduk.

BACKGROUND
We aimed to evaluate the etiologies, otolaryngological features, radiological findings, management strategies, and outcomes of temporal bone fractures.
METHODS
Seventy-seven temporal bone fracture cases were retrospectively evaluated for age and gender distribution, side of the fracture, etiology of injuries, the presence of blood otorrhea, tympanic membrane perforation, cerebrospinal fluid otorrhea, hearing loss, hemotympanum, and facial or other cranial nerve palsies, and computerized tomography reports.
RESULTS
Nearly 55% of the cases were caused by traffic accidents and were predominantly male (76.6%). Otolaryngological presentations in order to frequency were early conductive hearing loss (65.8%), blood otorrhea (61.2%), hemotympanum (58.5%), tympanic membrane perforation (25.6%), facial nerve paralysis (12.3%), cerebrospinal fluid otorrhea (8.5%), and sensorineural hearing loss (5.4%). Most of the fractures were petrous (65.8%) and longitudinal type (51.2%).
CONCLUSION
In this research, otolaryngological findings in order of frequency and treatment approaches were compared with literature findings and discussed in 77 temporal bone fracture cases. We formed a management algorithm for the systematic evaluation and treatment of temporal fractures.

AMAÇ
Bu yazýda, distal tibia (pilon) kýrýklarýnýn cerrahi tedavi sonuçlarý, radyolojik ve klinik olarak araþtýrýldý.
GEREÇ VE YÖNTEM
2002-2009 tarihleri arasýnda cerrahi olarak tedavi edilen 31 hastanýn (25 erkek, 6 kadýn; ortalama yaþ 46; daðýlým 17-72 yaþ) 32 ayaðý deðerlendirildi. Bu kýrýklarýn 24’üne açýk redüksiyon ve internal fiksasyon, 8’ine eksternal fiksasyon yapýldý. Hastalar ortalama 46 ay takip edildi. Hastalar Teeny-Wiss fonksiyonel ayakbileði skorlamasýna göre deðerlendirildi. Radyolojik olarak kýrýk redüksiyon skorlamasý Ovadia ve Beals kriterlerine göre yapýldý.
BULGULAR
Tip 2 kýrýklarýn 9’unda (%47,4), tip 1 kýrýklarýn 5’inde (%26,3) ve tip 3 kýrýklarýn 5’inde (%26,3) mükemmel sonuç elde edildi. Tip 3 kýrýklarýn 9’unda (%69,2) kötü sonuç elde edilmiþken, tip 1 ve tip 2 kýrýklarýn 2’sinde (%15,4) kötü sonuç elde edildi. Eksternal fiksatör uygulamasý ile karþýlaþtýrýldýðýnda, çok iyi ve iyi sonuçlar anlamlý derecede yüksek sayýda açýk redüksiyon internal fiksasyon uygulamasý ile elde edildi (sýrasýyla, n=3, %15,8 ve n=16, %84,2; p<0.05).
SONUÇ
Pilon kýrýklarýnýn cerrahi tedavisinde, atravmatik yumuþak doku diseksiyonu, eklem yüzünün anatomik redüksiyonu, stabil bir tespit, erken hareket ve hastanýn mobilizasyonu ilkelerine uyulduðunda baþarýlý sonuçlar alýnabilmektedir, ancak bu prensiplere uyulmasýna raðmen tip 3 kýrýklarda travma sonrasý artrit kaçýnýlmazdýr.

BACKGROUND
In this report, the surgical treatment results of distal tibia (pilon) fractures are analyzed radiologically and clinically.
METHODS
Between 2002 and 2009, 32 feet of 31 patients (25 males, 6 females; mean age 46 years; range 17 to 72 years) who were treated surgically for tibial pilon fractures were evaluated. Open reduction and internal fixation were applied to 24 and external fixation to 8 fractures. The patients were evaluated according to the Teeny-Wiss functional ankle score, and overall assessment of reduction was calculated radiographically according to the criteria of Ovadia and Beals.
RESULTS
While excellent results were achieved in 9 (47.4%) type 2, 5 type 1 (26.3%), and 5 (26.3%) type 3 fractures, fair/poor outcomes were obtained in 9 (69.2%) type 3 and in 2 (15.4%) types 1 and 2 fractures each (p<0.015). Compared to the external fixation application, a statistically significantly higher number of excellent and good outcomes were obtained with open reduction internal fixation application (n=3, 15.8% vs n=16, 84.2%, respectively; p<0.05).
CONCLUSION
If the principles of atraumatic soft tissue dissection, anatomic reduction of the joint face, stable fixation, and early mobilization of the patient are complied with in the surgical treatment of pilon fractures, successful results can be achieved. However, in type 3 fractures, even if these principles are complied with, post-traumatic arthritis is inevitable.

AMAÇ
Yanýk travmasý sonrasýnda erken dönemde ortaya çýkan psikiyatrik bozukluklar deðerlendirildi.
GEREÇ VE YÖNTEM
Yanýk travmasýna maruz kalan 1369 hastanýn dosyasý geriye dönük olarak incelendi. Psikiyatrik bozukluk saptanan 45 hasta yaþ, cinsiyet, kronik hastalýk, yanýk öncesindeki psikiyatrik bozukluk, yanýk nedeni, yanýk yüzdesi, yanýk derecesi, ek travma, ameliyat sayýsý, hastanede kalýþ süresi, ekstremite amputasyonu, entübasyon durumu, psikiyatrik semptomlar, travma sonrasý psikiyatrik bozukluk ve mortalite açýsýndan deðerlendirildi.
BULGULAR
Yanýk travmasý sonrasý erken dönemde 45 hastada psikiyatrik bozukluk saptandý. Hastalarýn 7’si (%15,5) kadýn, 38’i (%84,5) erkekti. Ortalama yaþ 32±14,3 yýl, yanýk yüzdesi %40,09±20,69, geçirilmiþ ameliyat sayýsý 2,95±1,75, hastanede kalýþ süresi 51.57±38.62 gün idi. Hastalarýn 12’sinde (%26,6) post travmatik stres bozukluðu (PTSD), 11’inde (%24,4) deliryum, 8’inde (%17,7) anksiyete bozukluðu, 7’sinde (%15,5) depresyon, 1’inde (%2,2) yoksunluk sendromu, 1’inde (%2.2) þizoaffektif bozukluk, 2’sinde (%4,4) PTSD ve depresyon, 2’sinde (%4,4) PTSD ve deliryum ve 1’inde (%2.2) PTSD ve anksiyete bozukluðu görüldü.
SONUÇ
Yanýk multisipliner yaklaþýmla tedavi edilebilen bir travmadýr.

BACKGROUND
We aimed to assess early period psychiatric disorders following burn trauma.
METHODS
The files of 1369 patients who had burn trauma were analyzed retrospectively. Forty-five patients with the diagnosis of psychiatric disorder were assessed based on the variables of age, gender, presence of chronic diseases, psychiatric disorders prior to burn trauma, cause of the burn, burn percentage, degree of burn, additional trauma, number of surgeries, duration of hospitalization, extremity amputation, intubation status, psychiatric symptoms, post-trauma psychiatric disorders, and mortality.
RESULTS
Forty-five patients developed psychiatric disorder in the early period following burn trauma. Of the 45 patients, 7 (15.5%) were female and 38 (84.5%) were male. The mean age was 32±14.3 years, burn percentage was 40.09±20.69%, number of operations was 2.95±1.75, and the total duration of hospitalization was 51.57±38.62 days. Twelve (26.6%) patients had post-traumatic stress disorder (PTSD), 11 (24.4%) had delirium, 8 (17.7%) had anxiety disorder, 7 (15.5%) had depression, 1 (2.2%) had abstinence syndrome, 1 (2.2%) had schizoaffective disorder, 2 (4.4%) had PTSD and depression, 2 (4.4%) had PTSD and delirium, and 1 (2.2%) had PTSD and anxiety disorder.
CONCLUSION
Burn is a trauma that can be treated with a multidisciplinary approach.

AMAÇ
Penetran kardiyak yaralanmalar, ciddi klinik sonuçlarý sebebiyle yüksek mortalite oranýna sahiptir. Bu çalýþmanýn amacý, hastanemizde penetran kardiyak yaralanma nedeniyle cerrahi tedavi uygulanan hastalarýn araþtýrýlmasýdýr.
GEREÇ VE YÖNTEM
Bu yazýda, Þubat 2006 ve Ocak 2011 tarihleri arasýnda hastanemize penetran kalp yaralanmasý þikayeti ile baþvuran 21 hasta (18 erkek, 3 kadýn) geriye dönük olarak incelendi. Hastalar klinik bulgular, tedavi yöntemleri ve sonuçlarý açýsýndan deðerlendirildi.
BULGULAR
Olgularýn 19’u delici kesici alet, 2’si ateþli silah yaralanmasý þeklindeydi. Tüm olgulara acil cerrahi giriþim uygulandý. Kardiyak yaralanma 13 olguda sað ventrikül, 5 olguda sol ventrikül ve 3 olguda sað atriyum yaralanmasýný içeriyordu. Sol atriyum yaralanmasý gözlenmedi. Kardiyak yaralanmalar primer dikiþ yöntemi ile onarýldý. Mortalite 6 olgu ile %28,6 olarak saptandý.
SONUÇ
Penetran kardiyak yaralanmalar genellikle genç yaþ grubunda görülmektedir. Erken transport, uygun resüsitasyon ve acil cerrahi tedavi penetran kalp yaralanmasý olan hastalarýn hayatta kalma oranýný artýracaktýr.

BACKGROUND
Penetrating cardiac injuries carry high mortality rates due to serious clinical outcomes. This study was planned to investigate patients treated surgically in our hospital for penetrating cardiac injury.
METHODS
In this article, we reviewed retrospectively 21 patients (18 male, 3 female) suffering from penetrating heart injuries who admitted to our hospital between February 2006 and January 2011. Patients were evaluated with respect to clinical findings, treatment methods and clinical outcomes.
RESULTS
Among the patients, 19 cases were due to stab injury and 2 cases to gunshot injury. Emergent surgical interventions were performed in all patients. Cardiac injuries involved the right ventricle in 13 patients, left ventricle in 5 patients and right atrium in 3 patients. There was no left atrial injury. Cardiac injuries were repaired by primary suturing method. Mortality was determined in 6 patients (28.6%).
CONCLUSION
Penetrating cardiac injuries are seen generally in young people. Early transport, proper resuscitation and emergent surgery treatment improved survival in patients who sustained penetrating cardiac injuries.

Mekanik ince baðýrsak týkanýklýðýnýn en sýk nedeni önceden yapýlmýþ karýn ameliyatlarýdýr. Buna karþýn, karýn ameliyatý hikayesi olmayan hastalarda taný koyulmasý ve tedavi zordur. Omfalomezenterik kanal fetal geliþim sýrasýnda midgut ile yolk kesesi arasýnda yer alan embriyonik bir yapýdýr. Bazý kiþilerde, varlýðý sebat eder ve özellikle çocukluk yaþlarýnda bazý komplikasyonlara neden olur. Eriþkinlerde ise omfalomesenterik kanalýn sebat etmesine baðlý geliþen baðýrsak týkanýklýðý oldukça nadir rastlanýlan bir durumdur. Bu yazýda, omfalomezenterik kanal açýklýðýnýn devam etmesine baðlý baðýrsak týkanýklýðý geliþmiþ 42 yaþýndaki erkek hasta sunuldu.

Previous abdominal surgery is the most common cause of mechanical small bowel obstruction. However, in patients with no abdominal surgery history, it is difficult to diagnose and treat. Omphalomesenteric duct is a primitive embryonic structure of fetal development between the midgut and yolk sac. In some cases, it may persist and result in several complications, particularly in childhood. In adults, intestinal obstruction due to persistent omphalomesenteric duct is an extremely rare circumstance. We report a 42-year-old male patient presenting with omphalomesenteric duct remnant causing small bowel obstruction.

Baþýn kurþun yaralanmalarý genellikle ölümcüldür ve beyin içinde kalan kurþunun kendiliðinden hareketi nadir bir durumdur. Bu olgu sunumunda, 23 yaþýndaki erkek hastanýn beyninde kendiliðinden hareket eden kurþun sunuldu. Beyin bilgisayarlý tomogafisi (BT) kurþunun sol parietal bölgede derin yerleþimli olduðunu gösterdi. Hastanýn bilinci açýktý ve sað homonium hemianopsi vardý. Kurþun, hayati yapýlara yakýn ve derin yerleþimliydi. Bu yüzden, cerrahi giriþim düþünülmedi. Ýki ay sonra çekilen kontrol BT’sinde kurþunun yerçekimi etkisi ile kaudale ve posteriyora doðru yer deðiþtirdiði görüldü. Beyin içinde kalan kurþunun tedavisi tartýþmalýdýr. Derinde yerleþen kurþunu çýkarmak ek nörolojik hasara neden olabileceði gibi kalan kurþunun hareketi de hayati yapýlarýn zarar görmesine neden olabilir.Sonuç olarak, ek nörolojik defisite neden olmayacak kolay ulaþýlabilir kurþunlarýn çýkarýlmasýný öneriyoruz.

Gunshot injury to the head is usually mortal, and spontaneous migration of a retained bullet is rare. We report the case of a 23-year-old man with a spontaneously migrated bullet within the brain. Cranial computerized tomography (CT) indicated that the bullet was lodged deeply in the left parietal region. The patient was conscious and had right homonymous hemianopsia. The bullet was close to the vital structures and deep-seated; therefore, surgical intervention was not considered. Two months after the injury, repeat CT revealed that the bullet had migrated posteriorly and caudally due to gravitational factors. Management of the retained bullet was controversial. Removal of a deep-seated bullet may cause additional neurological deficit, but migration of a retained bullet may cause damage to vital structures, producing significant neurological damage. We proposed that the bullet in the brain should be removed if it could be reasonably accessed without causing additional neurological damage.

Bu yazýda, sýrtýnda ve üst ekstremitelerinde býçak yaralarýyla gelen 52 yaþýnda bir kadýn olgu sunuldu. Göðüs duvarýnda kalmýþ býçak acil servis bölümünde fark edilmemiþti. Olgu bize, ayrýntýlý hasta öyküsü, tam bir fiziksel inceleme ve düz film çekilmesine raðmen belirgin bir yabancý cismin gözden kaçabildiðini hatýrlatmaktadýr. Çýkartýlmamýþ bir yabancý cisim enfeksiyon riskini arttýrabileceði gibi ilerde iç organ hasarýna neden olabilir. Penetran yara yeterince incelenemediðinde veya travma cerrahý yaralý hastalarda ayrýntýlý inceleme yapamýyorsa hastalarýn bilgisayarlý tomografi taramasýndan geçmesini öneririz. Bilgisayarlý tomografi görüntüleri penetran yaralanmayý, þiddetini ve yabancý bir cisim riskini aydýnlatabilir.

We report a 52-year-old woman presenting with stab wounds on her back and upper extremities. A knife retained in her chest wall was not discovered in the emergency department. This case reminds us that an obvious foreign body can be missed even after obtaining a detailed history, complete physical examination and plain film. Particularly, a retained foreign body increases the risk of infection and may cause further internal organ injury. We suggest that patients undergo computed tomography (CT) scanning whenever a penetrating wound cannot be explored adequately or the trauma surgeons are unable to perform detailed examinations on the injured patients. The CT images could delineate the course and severity of the penetrating injury, and decrease the risk of a retained foreign body.

Otuz yaþýnda bir kadýn hasta çift taraflý ve eþzamanlý olarak her iki kalça ekleminde anterior dislokasyonla baþvurdu. Hasta konservatif yolla tedavi edildi. Ýki yýllýk takip avasküler nekroz belirtileri olmaksýzýn mükemmel sonuçlar alýndýðýný gösterdi. Yaralanmanýn önceden bildirilen olgulardan farklý olan nedeni ve mekanizmasý tartýþýldý.

A case of bilateral simultaneous anterior dislocation of the hip in a 30-year-old female is presented herein. The patient was managed conservatively. Follow-up at two years showed excellent results with no signs of avascular necrosis. The cause and mechanism of injury are discussed, which are different from those of previously reported cases.

Go-kart kazasýna baðlý yaralanma Türkiye’de yeni bir acil cerrahi türüdür. Hastalara göre çok deðiþik þekillerde izlenebilirler. Araçlarýn tasarýmý ve hasta karakteristikleri arasýnda ince ayrýntýlarlar vardýr. Bu yazýda, iki farklý go-kart kazasýnda iki ciddi yaralanma olgusu sunuldu. Bu hastalarda karaciðer laserasyonu ve mezenterik intestinal avulsiyona baðlý þiddetli karýn içi kanama izlendi. Hastalar cerrahi yöntemlerle tedavi edildi, problemsiz olarak taburcu edildiler.

Injury due to go-karting accidents is a new kind of surgical emergency in Turkey and may show variations between patients. There are special details as relate to the design of the vehicles and patient characteristics. We report two seriously injured patients as a result of two different go-kart accidents. Severe intraabdominal hemorrhage due to liver laceration was seen in one patient and mesenteric intestinal avulsion in the other. Both patients were treated surgically and discharged uneventfully.

Bilateral travmatik bazal ganglion kanamasý son derece nadir bir nöropatolojik antitedir. Blastik yaralanmaya baðlý bilateral bazal ganglion kanamasý daha öncesinde hiç tanýmlanmamýþtý. Patlamaya baðlý geliþmiþ bilateral bazal ganglion kanamasý olan bir olgu sunuldu.

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. Bilateral basal ganglia hemorrhage secondary to blast injury has not described before. We report a case with bilateral basal ganglia hemorrhage secondary to explotion.